By Suzanne Lestina

To help their organizations thrive, revenue cycle leaders at MAP Award-winning organizations are using five strategies to exceed performance targets and improve patient satisfaction.

Providers are being challenged with payment changes and cuts, increases in uncompensated care, and the implementation of ICD-10 and other federally unfunded mandates. This has resulted in hospital budget cuts and cost reductions. Revenue cycle leaders will continually be challenged to do more with less.

It is clear that thriving in today's healthcare environment requires strong leadership. I have seen this firsthand among HFMA's 2011 MAP Award winners, all of which have achieved the designation of "high performance in revenue cycle." Getting to that level requires revenue cycle leaders who are not just good but great. These leaders have the necessary desire and skills to continually move their organizations to higher levels of performance.

Patient-friendly revenue cycle approaches are key to improving overall performance. While each of the 12 2011 MAP Award winners had to meet financial goals, they were also challenged to improve patient satisfaction and the patient experience. MAP Award winners had to achieve a score of 75 percent or higher for "would definitely recommend" in the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.

Traits of a Great Revenue Cycle Leader

While revenue cycle leaders are unique and leadership styles vary, there are five traits that I believe move these leaders from "good to great," to borrow a term from Jim Collins.

They measure improvement. Although high-performing revenue cycle leaders' metrics score in the top quartile, they are never satisfied. They refer to their performance as good and then immediately talk about what they can do to move the metrics even higher. For example, when it comes to point-of-service cash collections, I've never heard a great revenue cycle leader say, "I'm happy where we're at." Instead, I hear things like, "We've done a good job, but we can do even better."

They compare performance. At a recent HFMA event, a revenue cycle leader shared one of his organization's performance metrics. He thought his organization's net days in accounts receivable was right around the top performers in the industry. But when I asked him, "Compared to what and whom?" the revenue cycle leader wasn't exactly sure. A good leader compares his organization's performance to other industry organizations and confirms they are doing a good job.

What elevates a revenue cycle leader from good to great is their desire to figure out where their organization's performance on metrics stands in the industry and how they compare with their organization's peers, as well as how to move those scores to a higher level.

They identify solutions-with an emphasis on patient-friendly practices. High-performing revenue cycle leaders conduct in-depth analyses of their current performance, leverage peer comparison data to set meaningful goals, and set realistic targets to move their performance scores  from good to great.

In identifying potential solutions, they consider how patients will be affected and aim to implement patient-friendly practices. For example, one award-winning organization implemented an online bill payment program to increase collections. However, by streamlining the collections process, the program eliminated personal contact with patients. Because not all patients are comfortable sharing their credit card information online, the organization allowed patients to opt out of the online payment program and instead talk to a patient financial services representative to finalize bill payment.

Another award-winning organization was able to improve its scheduling process by grouping all pre-encounter services-including schedulers, preregistration and verification staff, financial counseling, and pre-arrival nursing-together to address patient needs.

A third organization was able to develop an "out-of-pocket" calculator for their registrars to produce accurate information on copays, deductibles, and coinsurance for patients.

They share best practices with peers. Great revenue cycle leaders are always looking for ways to implement best practices. They do this by asking questions, challenging status quo, engaging in conversations with their peers, and bringing that information back to their organizations to determine if there are other, better ways of improving performance.

At the 2011 MAP Event this past October in Miami, MAP Award winners shared revenue cycle best practices with their peers. There were many instances of "a-ha" moments, as stated to me by one attendee: "Suzanne, education was great. I came back with a couple of novel ideas, and that always thrills me. I'm more excited than ever about the MAP initiative and what it's doing for the revenue cycle. I met a lot of people who were inspired-just as I was-to rise to the top when, in the past, being average was OK. After the panel discussion, I had a couple of good conversations with folks about just how to make it happen, too."

They engage staff in improving patient satisfaction and financial outcomes. High-performing revenue cycle leaders invest in their human resources. Great leaders understand that their staff are one of their most valuable assets to ensuring that financial and patient satisfaction outcomes are not only achieved but sustained.

MAP Award winners have implemented several ways to track staff interaction with patients to improve patient satisfaction. For example, at one organization, patients who talk to a staff member-at the front end and at the back end of the revenue cycle-are asked to rate how their call was handled. The staff member records the patient's response on a scale of 1 to 5 (5 being the highest), and any score below 3 is used for additional training to improve the patient experience.

The Bar Is Set High

High-performing revenue cycle leaders take a disciplined approach to process improvement and patient satisfaction. This includes encouraging innovative ideas, engaging staff, implementing innovative patient-friendly processes, comparing performance to their peers, measuring their success, and striving to push the bar to the highest level of revenue cycle performance possible.

The many challenges facing revenue cycle leaders today-and on the horizon-can be overwhelming to a good leader, but a great leader is ready to take them on.

Suzanne Lestina is director of revenue cycle MAP, HFMA (

Learn more about HFMA's MAP initiative.


Publication Date: Friday, November 18, 2011