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Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
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Problem: Create accurate tool for predicting and monitoring chapter performance.
Solution: Created education hours spreadsheet that breaks down education attendance hours by local live programs/webinars, Regional and national events.
Strategy: The New Hampshire-Vermont Chapter knew that the best way to stay on track for success is to set reasonable expectations and closely monitor performance. They use the PPT and DCMS reports along with the Membership Satisfaction Survey, suggestions from our CAT consultant, and their Strategic Plan to create a spreadsheet to accurately budget for education and to track their success throughout the year.
It all starts with the initial planning. Historically, the chapter began its planning in May, but last year they in March. “We called a meeting for a preplanning kickoff, explained the committee mission, purpose, importance to chapter, and ways to get involved with education” says Sandra Pinette, president-elect of the New Hampshire-Vermont Chapter. The entire chapter was invited and it was held during their Annual Meeting.
“It’s great if people can have that opportunity for input at an annual meeting or event,” says Pinette. “It’s a good place to recruit and a great way to get people excited about the committee and ways to involve both experienced and new volunteers.”
“We told the participants, “These are the areas where the chapter has opportunities to better serve our members and deliver on our mission,” says Pinette. The chapter offered opportunities to be involved in the committee and in the chapter.
At the official planning meeting conducted after LTC in May, the chapter invited those who attended previously along with the entire chapter. They asked participants to review the reports and evaluations and identify: Where did we hit it out of the park? Where do the numbers say we are going?
To develop the chapter’s education plan, they started with the premise: We have to provide X number of hours, how will we meet that?
“We understood that in order to meet our goal and deliver meaningful, timely education to our members we had to ‘think outside the box,’ ” says Pinette. “Budgets are limited so we needed various ways to deliver education to our members that give them much needed information and value.”
They started with the historical data from the PPT, the CBSC, and DCMS and broke it out into local events, regional events, and national events.
For the local events, both live onsite and webinars they looked at the last two to three years to get averages for the actual hours and attendance, but they also looked at topics and location. “We saw that webinar attendance was going up, and some typical topics were falling off. We looked at location, too, along with the demographics of our membership. Did the numbers indicate that the location was good?
Next, they looked at Regional events like the Region 1 Conference and figured averages over the last three years. Finally, they looked at the average number of hours they earned from national events.
These averages—combined with member feedback from their Membership Satisfaction Surveys that identified what was working for members and what was not—were the basis for their future forecasts.
Another benefit of the projection spreadsheet is budgeting, both for the financial aspects and for the education hours aspect. The chapter can use it for financial statements to track revenue and expenses. But it also helps with forecasting.
“We repeat some programs for a few years in a row,” says Pinette. “Cost report and Reimbursement are both popular. I’ve been able to look at final budget and education numbers and say that, on average, we get X members at X dollars, and X non-members at X dollars, and determine what the expenses were. We take an average of each element, round down for revenue and round up for expenses. That gives us conservative estimates when we do our education budget.”
In doing all this forecasting Pinette worked closely with her co-chair. “I ran everything by him and each program coordinator to get their feedback. I said—this is my estimate, how do you feel about that-does this make sense?”
“I wasn’t the one who completely came up with how to review the hours,” says Pinette. “I knew I had to figure out a forecasting method, so I talked to past presidents and got some recommendations and created the spreadsheet template.”
“It’s all about going back to your mentors and your resources,” she says. It’s important to engage both experienced and new stakeholders to work together.
To keep the process on track, the leadership has regular check in calls with the committee. If something doesn’t look like it’s going where they want or if someone’s having problems, they get together and provide help.
At least every month (sometimes more, depending on the number of events) Pinette and the committee review the DCMS and PPT reports. “We look at our spreadsheet to see where we are with actual numbers and our forecasted numbers, what worked, and what didn’t. The spreadsheet helps track what topics are really hot, and identify what we want to do for next year.
For example, the chapter’s Member Satisfaction Survey identified that one of the topics members wanted education on was ACOs; the problem is that in a 2-state chapter, location is always an issue. “We asked: How do we deliver at the right time, in the right place,” says Pinette. “Should we do half-day or full-day?” Each had some appeal.
In the end, they decided to do it at midway point, in a location that was a little remote, but they felt that topic would carry it. Ninety-three people registered and despite a snowstorm, 70 actually showed up. In the end, New Hampshire-Vermont went over its budget for attendee hours for the event by 40.
Right topic, right time, right location.
“The data helps us quantify and measure,” says Pinette.
In this business profile, Amy Gross, senior vice president of Key Government Finance, discusses the benefits of private placement transactions to support large-scale financing projects.
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
In this business profile, Doug Polasky, executive vice president at Xtend Healthcare, explains the importance of having sound workflow processes in a consolidated business office to ensure optimal performance and reduce costs.
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
A leader from McKesson discusses how healthcare reform is forcing hospitals and health systems to take a different approach to capacity management and patient flow.
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Jim Bohnsack, vice president, solution & corporate development for Conifer Health Solutions, explains how the company helps healthcare providers leverage data to deliver better outcomes while optimizing reimbursement for all payment arrangements.
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Elena White, vice president of risk, quality, and network solutions for Optum, discusses how healthcare providers can leverage data and technology as they enable risk in their organization.
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Somnia President and CEO Marc Koch, MD, MBA, explains how hospitals can drive transformative change in the perioperative experience for outstanding clinical and financial outcomes.
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
PMMC President Roger L. Shaul discusses the effects of healthcare reform on revenue cycle management and how PMMC's products help clients adapt to a changing financial environment.
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
HFMA’s Buyer’s Resource Guide is a comprehensive vendor directory that helps healthcare finance professionals find products and services.
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HFMA's MAP App is a web-based application that helps organizations track results, compare data with peers, and improve revenue cycle performance. Schedule a demo.
Access all the tools and resources you need to develop your personal skills. Organized into distinct career levels, this tool creates a career plan specific to your career goals.
Copyright 2016, Healthcare Financial Management Association.
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