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.
On February 10-12, Physicians, Payers, and Providers will discover strategies for implementing value-based payment arrangements with both private and public sector payers.
Stay up-to-date in a rapidly changing industry in New Orleans (Mar. 7-9) or Chicago/Rosemont (Apr. 20-22). Register early and save.
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 2/29, save $150.
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 Lauren Phillips
Given the high cost and complexity of electronic health record (EHR) implementation, it is not surprising that small and rural hospitals continue to lag behind: Only 13.9 percent of small hospitals and 12.9 percent of rural hospitals were in a position to qualify for Stage 1 meaningful use incentives at the end of 2011, according to a May 2012 Health Affairs study.a In comparison, 29.7 percent of large hospitals and 20.3 percent of urban hospitals qualified.
Subscribe to Strategic Financial Planning
In fact, this EHR gap grew from 2010 to 2011: Small and rural hospitals that had some form of EHR jumped about 10 percent in that time, compared with 17.3 percent and 12.1 percent growth for large and urban hospitals, respectively. Yet, says Tracey Mayberry, partner, CSC Healthcare Group, most organizations understand that, even if they can’t move fast enough to meet the deadlines for meaningful use incentive payments, they must act in time to avoid the penalties for noncompliance that go into effect in 2015. To do otherwise “is really almost an admission that you’re done as a hospital.” The problem, of course, is resources?or rather, the lack of them. “Hospitals in the rural market find it difficult to make the significant investment in EHRs due to constraints in available financing, competing priorities for limited capital dollars, and thin operating margins,” says HFMA’s Todd Nelson, technical director for senior financial executives/accounting. While bank loans and other traditional financing options may be an option for some well-positioned small/rural facilities, others may find better luck with philanthropy and nontraditional financing approaches, such as the ones highlighted in this article.
Small and rural hospitals have a number of government-sponsored funding options to explore, says Aaron Fischbach, public health analyst, Federal Office of Rural Health Policy. Community Facility Direct and Guaranteed Loan Program. Under the auspices of the U.S. Department of Agriculture’s (USDA’s) Rural Development offices, the Community Facility program covers health IT and is intended to foster compliance with meaningful use in not-for-profit and public hospitals and clinics in communities of less than 10,000 people. The Community Facility program has little grant money, says Fischbach. However, hospitals can use anticipated meaningful use incentive funds as collateral to borrow funds from the Community Facility program. The terms on these loans give hospitals enough time to implement an EHR, attest to meaningful use, and then use the incentive payments to repay at least a major portion of the loan. Clinics need to take a more circuitous route. Unlike hospitals, clinics do not qualify for direct EHR incentive payments; instead, the Centers for Medicare and Medicaid Services (CMS) program pays their clinicians, who typically reassign the payments to the clinic under their employment agreements. USDA and Small Business Administration loans. To the extent that for-profit hospitals can prove that job retention and/or creation is involved, they can apply for loans or loan guarantees to cover IT improvements from the USDA Rural Development’s Business & Industry Program or from the Small Business Administration’s capital loan programs. USDA Rural Development also sponsors three other programs where hospitals can look for funding assistance with telecommunications software, hardware, and connectivity:
HUD block grants. Hospitals in counties or cities that are Entitlement Communities and, thus, eligible for monies under The U.S. Department of Housing and Urban Development (HUD) Community Development Block Grant Program, may qualify for funds for equipment designed to provide improved community facilities and services?including hardware to improve health services. CAH-specific programs. Critical access hospitals (CAHs) and other hospitals with fewer than 49 beds can apply to their states for funds to help with activities related to quality improvement and the effective use of IT, which are available from the Health Resources and Administration’s Small Hospital Improvement Program (SHIP) and Medicare Rural Hospital Flexibility Grant (Flex) Program. Fischbach explains that these programs grant money to the states for assistance to hospitals to provide, for example, technical or training help?rather than funds to purchase hardware or software. Rural Health Care Program. One program that Fischbach says is “very under-subscribed” is the Rural Health Care Program, run by the Universal Service Administrative Company under the oversight of the FCC. “Every monthly bill for phone service includes a universal service fee. Those fees are used to subsidize the costs of telecommunications for public and not-for-profit healthcare providers in rural areas, which may pay four or five times as much as their nearby metro counterparts for the same services. The subsidies can be significant?and there is a lot of money that isn’t being spent right now.”
One way small hospitals can obtain IT resources is by joining networks and consortia that take advantage of discounted pricing and economies of scale. Mayberry has seen a number of community hospitals leverage strategic partnerships?either by affiliating or by joining large, mature independent delivery networks?to gain access to solutions, products, and talent they might not otherwise be able to afford. “Smaller organizations with non-overlapping geographies can form collaboratives to work on IT initiatives, especially if they have a common vendor. For example, they might start a shared service organization, essentially combining their IT operations,” he says. Fischbach cites another advantage of affiliation. “Small, independent hospitals tend to be the last priority for vendors that can make more money working with a big health system like Mayo or Kaiser Permanente. So if the small hospitals can group together, they can not only save on hardware purchases but they can also probably get the attention of a vendor sooner.” To encourage collaboration among rural providers, HHS allocated $12 million in 2011 for grants to networks of rural healthcare organizations in support of IT adoption and and meaningful use. The money must be used for purchasing technology, installing broadband networks, and training staff. In 2011, when 25-bed Jersey Shore Hospital in north central Pennsylvania decided to team up with 21-bed Fulton County Medical Center in McConnelsburg, 2.5 hours away, the two CAHs didn’t even know about the availability of these HHS grants. They were just looking for a means to share IT resources needed to achieve meaningful use, including joint installation of an EHR that would otherwise have cost each organization an estimated $2.3 million, according to Carey Plummer, Jersey Shore’s CEO. Thanks to the Pennsylvania Mountains Healthcare Alliance, a 19-hospital collaborative to which both belong, they found each other, a partnership that has saved each some $300,000 on EHR implementation?and provided grant money, too. Both hospitals expect to attest to stage 1 meaningful use criteria by Sep. 1, 2013. (For more details, see the case study "Two CAHs Team Up to Achieve Meaningful Use" in this newsletter.)
Not all small and rural healthcare organizations are struggling to find IT dollars and meet meaningful use deadlines; some of them were close to the finish line when the American Recovery and Reinvestment Act was enacted. Winona Health Services, a Minnesota system consisting of one 99-bed hospital, a nursing home, an assisted living community, and 45 employed physicians, started its EHR journey more than 10 years ago and was ready to attest in November 2011, says CFO and treasurer Michael M. Allen, FHFMA, CPA. “We really just needed to go the last mile. There were a few small pieces of functionality to put in place, and there was still work to do with the medical staff to bring a few operational processes in line with meaningful use criteria.” Central to Winona’s success, according to Allen, is something he recommends that every small hospital pursue: a close, strategic, integrated relationship with its EHR provider. “As a small, independent system that wanted to accomplish big things, we knew we’d get lost in the shuffle with any vendor if the relationship was simply based on a transaction. The EHR is so critical to the goals of the organization and of the community. You need to feel comfortable with your partner, and be able to work together over the long haul.” Despite due diligence, Allen cautions that hospitals are not going to fully understand what they’re getting from a vendor at proposal time; it’s just too complex. “Increasingly, however, EHR systems are going to cost about the same and have about the same functionality. If you have a strong, give-and-take relationship, the cost and other issues will fall into line.” What does a give-and-take relationship look like from the provider side? Feedback plays a prominent role. Allen himself sits on the vendor’s client care council with 35 or 40 other hospitals and systems. “We get together at least twice a year and at other times on the phone, and work on improvements and solutions to problems in the delivery or use of software or the billing for software?whatever it might be. It’s rewarding from my perspective because I’ve got colleagues from all these other places in the room, and we learn from each other.” Likewise, Winona physicians sit on the vendor’s physician council, which focuses on how physicians use the software to improve patient care and workflows, and how changes could enhance and accelerate those improvements. “We also open ourselves up for site visits by other small hospitals that want to see how the system is working,” says Allen. “The vendor organizes the visits, but it still takes a day of our time every time.” In return, Allen explains, the vendor helps Winona mature its software. “Maybe they need a beta partner for some new software, which is exciting and interesting but also very time intensive. So, typically, they will end up giving us that functionality or discounting it significantly.” Sometimes there are gray areas in the agreement, things the provider and vendor don’t see eye to eye on. Because Winona has been generous in working with the vendor, “they’re going to be more flexible and understanding,” says Allen. “If all you do is take, at some point the relationship is just not going to be there when you need it most,” he continues. “You need to make investments of money and effort both. Structure the contract in a way that you can manage financially, then roll up your sleeves and put in the time.”
Once a hospital has an EHR in place that will allow it to qualify for meaningful use incentives, how can the hospital be sure it is getting maximum value from that system? The trick, says Jim D’Itri, partner, CSC Healthcare Group, is to not stop there. “In a small way, meaningful use is pushing the effective application of automation to make the hospital more efficient, but it doesn’t go far enough in terms of safety and quality. The hospital has to engrain the meaningful use values into its culture, into its normal workflows. For example, meaningful use requires 30 percent of medical orders to be done through computerized provider order entry. But it makes no sense to stop at 30 percent.” Meaningful use, like the EHR, is part of a much bigger agenda, says D’Itri. “In the end, it’s about harmonizing investments to foster accountability, assuming responsibility for the health of a population, and managing consumption wisely.”
a DesRoches, CM, et al, “Small, Nonteaching, and Rural Hospitals Continue to Be Slow in Adopting Electronic Health Record Systems,” Health Affairs, April 2012, vol. 31, no. 7.
Lauren Phillips is president, Phillips Medical Writers, Ltd., Bellingham, Wash., and a frequent contributor to Strategic Financial Planning (email@example.com). Interviewed for this article (in order of appearance):
Tracey Mayberry is partner, CSC Healthcare Group, Powell, Ohio (firstname.lastname@example.org).
Todd Nelson, technical director for senior financial executives/accounting, HFMA, Westchester, Ill. (email@example.com).
Aaron Fischbach is public health analyst, Federal Office of Rural Health Policy, Rockville, Md.
Carey Plummer is CEO, Jersey Shore Hospital, Jersey Shore, Pa (firstname.lastname@example.org).
Michael M. Allen, FHFMA, CPA, is CFO and treasurer, Winona Health Services, Winona, Minn., and a member of HFMA’s Minnesota Chapter (email@example.com).
Jim D’Itri, partner, CSC Healthcare Group, Pittsburgh (firstname.lastname@example.org).
A good place to turn is the 70+ Regional Extension Centers, funded by the Office of the National Coordinator, which offer technical assistance, guidance, and information on best practices to support and accelerate providers’ efforts to achieve meaningful use. This includes on-site technical assistance to “priority primary care providers” that have not yet adopted an electronic health record (EHR) or that have certified EHR technology but need help meeting meaningful use criteria.
Find the extension center that serves your region at www.regionalextensioncenters.com.
Many critical access hospitals (CAHs) breathed a sigh of relief in July when the Centers for Medicare & Medicaid Services (CMS) changed its policy to allow CAH’s meaningful use incentive payments to include the cost of capital leases for certified electronic health record (EHR) technology. Previously, while a CAH could include lease costs on its cost report, only reasonable costs to which purchase depreciation would apply were allowable for incentive payments. But in July, CMS decided that a capital lease is essentially the same as a virtual purchase agreement and meets the intent of the statute and regulation to qualify the leased asset as a purchased asset. The cost must be based on the fair market value of the asset at the date the lease was initiated. For more information about this reversal, visit www.cms.gov/EHRIncentivePrograms.
Publication Date: Wednesday, August 22, 2012
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
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.
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.
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.
Emad Rizk, MD, president and CEO of Accretive Health, discusses the uncertainty facing hospitals and the transitions affecting revenue cycle management.
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.
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.
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.
Steve Scibetta, senior director of channel sales for Ontario Systems' healthcare product line, shares insights into effectively managing receivables.
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.
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.
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.
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.
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
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.
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.
Greg Burgess, Founder and Chief Product Officer at Burgess Group shares insights and opportunities for payment integrity in the rapidly changing healthcare IT landscape.
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.
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.
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.
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: