Browse by Topic
Learn more about the healthcare finance industry's leading professional association. Find out why our members rely on HFMA as their go-to source for insight and information.
Members have many options for helping them advance their careers. Conferences, seminars, eLearning, certification, and more -- our education and events will keep you motivated.
Focus on the essentials. Develop strategies that deliver results. Redefine the boundaries of your success. Find out what’s driving innovation at ANI. Register by 5/6, save $100.
Earn the credentials that distinguish you as a leader in the healthcare industry. CHFP. CRCR. FHFMA. CSBI. CSPPM. CSMC. CSAF. Get certified today. Learn more.
Learn about timely healthcare industry topics and earn CPEs with HFMA live and on-demand webinars. View the latest schedule.
Our newsletters offer targeted articles with
technical how-to details and thought-provoking insights from healthcare finance
leaders and industry experts.
Get the perspectives of leading healthcare finance professionals on today's hottest issues.
Information about leading vendors helps your buying decisions.
Forum members can network during live webinars or access a library of past webinars on topics such as ICD-10 implementation, CMS audits, bundled payment, charity care, KPIs, and more.
An ever-expanding collection of spreadsheets, policies, job descriptions, checklists, and more that you can adopt and adapt.
Forum members can submit vexing questions to a panel of experts using our Ask the Expert service.
Your source for employment solutions.
Find new employment opportunities or
reach out to qualified candidates.
Distinguish yourself as a leader among your peers and advance your career by earning certification in our healthcare finance programs.
Get an objective third-party evaluation of products and services used in the healthcare finance workplace.
MAP App is a web-based application that helps organizations improve revenue cycle performance based on industry-standard metrics called MAP Keys.
Find suppliers and products in this comprehensive vendor directory for healthcare finance professionals.
Guidance for understanding and communicating about the price of health care.
Transformation toward value-based healthcare is reshaping the delivery of care, patient expectations, and payment structures.
Improve your revenue cycle performance through standard metrics, peer comparison, and successful practices.
By Lola Butcher
Will a $151 to $1,199 incentive motivate a Medicare patient to choose one hospital over another for a cardiac or orthopedic procedure? It hasn't seemed to make a difference in Hillcrest Medical Center's experience.
The Tulsa, Okla., organization was one of five hospitals and health systems chosen to participate in the Centers for Medicare & Medicaid Services' (CMS's) Acute Care Episode (ACE) demonstration, which piloted a bundled-payment approach. As part of the demonstration, Hillcrest's Medicare fee-for-service patients were eligible for financial incentives for certain cardiac and orthopedic procedures (see the exhibit below).
Hillcrest saw its overall surgery volume increase by more than 25 percent during the three-year initiative. However, the financial incentive does not seem to have been a key driver. To recruit patients to the program, Hillcrest launched a multifaceted communication program that emphasized the high-quality care Hillcrest provides and the cash incentive patients would receive for choosing Hillcrest for specific orthopedic or cardiac care. However, the hospital's research shows that most patients did not consider the incentive in their decisions to go to Hillcrest. In fact, many patients found the financial incentives confusing.
"Patients said the incentive was a nice benefit, but it really was not the market driver that we thought it was going to be," says Nancy Harrison, Ardent's ACE project director. "The incentives didn't influence patient choice."
Through its efforts, Hillcrest leaders gained perspective on what works-and what does not-in communicating to patients about bundled payment.
In May 2009, Hillcrest, which is owned by Ardent Health Services, became the first hospital to launch the ACE program. The program had five specific goals:
Unlike some other ACE sites, Hillcrest participated in both the orthopedic and cardiac components of the program. The orthopedic component includes nine diagnostic-related groups (DRGs) primarily related to hip and knee replacement procedures. The cardiac component includes 28 DRGs that fall into five subcategories:
During the three-year period, Hillcrest served about 3,100 patients through the ACE program. Of those, about two-thirds were cardiac patients; the rest underwent orthopedic procedures. The demonstration worked out very well for all parties: CMS saved money; Medicare patients who participated in the program received checks totaling about $1 million; and Hillcrest saw its overall surgery volumes increase between 25 percent and 40 percent, depending on the procedure.
"Those are very good numbers that we are pleased with," Harrison says.
It is not clear whether Hillcrest's participation in the ACE demonstration is responsible for the medical center's big growth in surgeries. "It's difficult to link these volumes to ACE," Harrison says. "At the same time we significantly improved collaboration with our surgeons through the ACE program, we also made capital investments, expanded programs, and recruited physicians."
When the demonstration ended April 30, Hillcrest sought-and received-approval from CMS to continue the orthopedic component of the program. Both Hillcrest and Medicare beneficiaries will continue to share the financial savings that Hillcrest creates for the Medicare program. The hospital did not seek to extend the cardiac component. Because Hillcrest employs its cardiac surgeons, the desired integration with cardiology already exists, Harrison says.
When planning the ACE program, Hillcrest identified several key communication messages to get across to patients:
Initially, Hillcrest used a wide range of marketing and advertising strategies, including print, radio, and TV advertisements; billboards; direct mail pieces to patients; posters; and brochures placed in physician offices and in display cases throughout the hospital. The hospital also marketed the ACE program at patient seminars. Registration staff, financial counselors, and case managers were trained to talk with patients about the program. "We basically tried all avenues to educate the patient," Harrison says.
Access sample communication pieces from Hillcrest
Hillcrest's ACE liaison, who received all calls from patients inquiring about the program, collected information to help analyze the communication efforts. "Whenever patients called to ask about the program, we asked them first where they heard about it," says Harrison. "We also worked with our patient satisfaction surveyor to add some questions, such as 'How did you hear about the program?' and 'When did you hear about the program?'"
The hospital found that most cardiac and orthopedic patients did not choose Hillcrest because of the ACE opportunity. "Even in our recent survey results, most of them learned about the ACE program when they presented at the hospital for the procedure," says Harrison.
That said, some of Hillcrest's communication efforts have proved more worthwhile than others.
Symptom-based seminars. Hillcrest offers education seminars to patients who are suffering specific symptoms, such as hip or knee pain. These programs are led by a physician who describes various treatment options, such as physical therapy, pharmacological options, and joint replacement surgery for orthopedic patients or stents for certain cardiac diagnoses.
During the seminars, a Hillcrest patient liaison is on hand to educate participants about the benefits of the ACE program. The hospital uses direct-mail marketing to inform Medicare beneficiaries about the seminars.
Physician referral. Hillcrest places ACE brochures in physicians' offices, and some physicians mention the program to patients, says Harrison. However, the program is only available to Medicare fee-for-service patients. Because physicians often do not know if a patient has Medicare fee-for-service or Medicare Advantage, they generally steer clear of discussing the ACE demonstration. "We are careful not to mislead a patient when he or she may not be able to participate in the program," she says.
Print advertisements. "We found our most successful advertising was through some type of print, whether it was published in magazines or newspapers," Harrison says.
Television, radio, and billboard ads. None of these worked well enough to justify the expense. After experimenting with those media in 2009, Hillcrest discontinued their use.
Based on patient feedback, Hillcrest reworked its marketing approach-and cut its advertising budget considerably. In the first year, the hospital spent $312,107, which included launch costs, such as printing brochures that have been used in subsequent years. The marketing budget dropped to $250,313 in year two.
Although Hillcrest has not found that the financial incentive influenced patient decision making, the bonus program did generate some extra work for the hospital staff. The incentive checks are issued by CMS, but Hillcrest's ACE patient liaison fields calls when patients are wondering why they have not yet received the checks-or, in many cases, when they can expect to receive their checks.
During the registration process, all patients in the ACE program sign forms acknowledging that they have been informed about their participation in the bundled payment initiative and that they will be issued an incentive check. The checks typically arrive three to six months after the procedure is performed. Harrison says many patients or their family members call Hillcrest to verify that it is a valid check that they can cash.
"It's a confusing concept for the patients to fully grasp," she says. "They had a surgery, there are savings tied to it, and CMS is now going to mail them back checks for the savings that CMS actually earned. That's not normal."
Lola Butcher is a freelance writer and editor based in Missouri.
Interviewed for this article:
Nancy Harrison is director of the Acute Care Episode project/financial operations, Ardent Health Services, Nashville, Tenn. (firstname.lastname@example.org).
Publication Date: Tuesday, July 17, 2012
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 print, email, online, and mobile opportunities provide you maximum reach and impact. We will work with you to build a plan that meets your needs. Contact a sales rep.
HFMA offers online, email, and print opportunities to help you recruit the most talented healthcare finance professionals. Place your classified ads today.
Drive down costs while improving quality in a reform environment.
Stay informed about new directions in healthcare finance. Share tools and strategies for improving performance. Be an active participant in your profession. Together, we’ll reshape the business and practice of healthcare. Join us.
Copyright 2016, Healthcare Financial Management Association.
Join HFMA today and enjoy: