In 2009, Connecticut's New Milford Hospital was facing significant operating losses and questions about its future viability as a stand-alone hospital. "The organization was losing patient volume, which affected the organization's ability to expand its clinical offerings, access capital, and recruit physicians," says Richard J. Henley, FACHE, FHFMA, president & CEO, Healthcare Strategic Solutions, LLC. "The board knew it was likely that the hospital would need to consolidate with another healthcare provider."
Brought in as interim CEO, Henley transitioned the 85-bed New Milford Hospital through a merger with Danbury Hospital, a larger teaching hospital about 15 miles away. The deal between the two not-for-profits was successfully completed in a year's time, and the two hospitals have since expanded and also consolidated a number of services.
Despite the speed of the transaction, the merger was anything but routine in the town of New Milford, which has a population of about 30,000. Employees had worked their entire careers at the hospital, and many had parents or siblings who had worked there, says Henley. Residents worried that they would lose community medical services, and many of the medical staff practiced only at New Milford, and felt like their livelihoods might be threatened by the merger.
"It was clear from the start that we needed to approach this with a strong sense of openness and transparency," says Henley. "The most important way of dealing with monumental change-whether mergers, employee benefit conversions, or other changes-is to have frequent, timely, and transparent communications."
How did you go about communicating the merger to employees, physicians, and other stakeholders?
Henley: It was clear that we needed a multipronged communication effort that included all of the hospital's constituencies: employees, physicians, the board, union leaders, community members, donors, major suppliers, and the media. If you communicate to one group and not another, then people start talking in the cafeteria and parking lot-and that's how falsehoods start multiplying.
For staff, we held town meetings at every juncture of our financial turnaround plan. Every employee was invited, and after I gave a presentation that summed up our progress, I opened up the floor for questions. Employees would often get up and say, "I heard such and such," which gave me the opportunity to clarify issues, address concerns, and dispel rumors.
To communicate to physicians, we spent a lot of time attending medical staff meetings and meetings of major clinical departments. At the end of the agenda, I would give an update on the financial turnaround and the merger discussions. It's very important to keep physicians informed because medical staff can often make or break a merger.
Knowing this, we added a very well-respected physician to the board committee that was negotiating the merger between the two hospitals. The physician was not then a regular board member, but he was very well regarded by his medical staff colleagues, his patients, and members of the community. By sitting on the board committee, he was able to provide regular reports to other physicians, build support, and dispel rumors.
How were you able to prove to stakeholders that you were sincere in your message?
Henley: Here's a mistake that many healthcare organizations make after merger negotiations commence. Typically, leaders put everything on hold. For example, there are no clinical advancements or new equipment purchases. The physicians and employees see that leaders are not trying to advance or develop the organization, which can really destroy morale. More important, if the merger ends up not taking place, the organization is now one year behind.
As the veteran of numerous mergers, I took the opposite approach. We did everything possible to strengthen the New Milford Hospital during the year leading up to the merger. For example, we acquired major capital equipment, including a brand new MRI and a high-speed, low-dose CT scanner, as well as a new linear accelerator for our cancer center. These investments showed the community that, even if we do merge, no one is going to close us down. I was honest with community members. I told them that some services would likely be relocated or consolidated. But I also stressed that the goal was to use the footprint of their community hospital-the buildings, the staff, the equipment-to continue to offer needed services.
In addition, by continuing to invest to become clinically stronger, we showed our medical staff, nurses, and other clinicians that we're making a strong commitment to improving services for our patients and staff. This helped minimize the defection of physicians, employees, managers, donors, and others.
What if a leader is not a good communicator by nature?
Henley: Some leaders are good at one-on-one communication, but freeze up in front of large groups. In those cases, it's better to ask another leader on the executive team to handle group presentations than to not do them at all. Each presenter needs to come across as credible, open, and transparent for the message to have true value and meaning.
What communication mediums did you find effective?
Henley: To work through and accept change of this magnitude, people need to see your message, hear it, and touch it in a variety of mediums. This communication is not a letter that you write to a group of people. You need a multipronged strategy and approach.
We worked with our marketing people to develop a well-rounded communications plan. In addition to all the various meetings I mentioned earlier, we had a monthly column about the merger in the employee newsletter. Employees could also submit questions (anonymously, if they wanted) via our intranet site. We also posted news about the merger on the hospital's website for everyone in the community. So maintaining an online presence also proved helpful.
However, when communicating major changes, you have to be very visible-you need to get out and about on the departments and units, make presentations in front of groups, and talk one-on-one to major donors, physician leaders, community leaders, etc.
What can healthcare leaders do to prepare before they have to deliver major news to a particular group?
Henley: You want to know your facts. I always ask myself, "What is this group's likely issues and concerns?" These should not be canned speeches. You need to tailor your message to the audience. For example, if you are meeting with members of the obstetrics department, put yourself in their shoes. As you think about the audience's perspective on the issues discussed, always be guided by, "What is the impact on them?"
What if someone asks you a question that you aren't prepared to answer?
Henley: Be careful not to get defensive. Be factual. If you don't know the answer, don't speculate. Say something like, "That has not yet been discussed, but I will certainly share the information with you as it becomes available."
Also it's important to always be honest and forthright. If someone says, "I was told by so and so that the IT departments would be consolidated and relocated off site …" If that has been decided and is true, and you had just denied it, then you would lose all credibility.
In some cases, you may not be able to share certain information with employees, the press, or others. But you can still be honest. For instance, you might say something like, "Those discussions are being held at the committee level, and I'm not at liberty to discuss that at this time." Or you might say, "Here's what I can share with you at this juncture. Other specifics are at a confidential juncture, and I can't discuss them yet but will do so as soon as we can share them with you."
What do leaders sometimes do wrong when delivering difficult news?
Henley: Some leaders downplay the situation and say something like, "Nothing will likely change. It will be business as usual." But in the case of something as monumental as a merger, everyone knows that is not true. I've seen leaders use this sugarcoated approach as their communications style. But these leaders will, ultimately, lose trust and respect amongst their stakeholders.
One phrase resonates in my mind: It takes a long time to build trust, but it is very easy to lose. You can spend a lot of time communicating with physicians, employees, the board, the community, and the media. But if they feel that you are not honest and transparent, then all that goodwill you are trying to foster will be for naught.
Richard J. Henley, FACHE, FHFMA, is president & CEO, Healthcare Strategic Solutions, LLC, Easton, Conn., and former senior executive in a variety of healthcare settings (RJH@HealthcareStrategicSolutions.com).
Access related article: How Meta-Leaders Mirror Influence
ClearBalance: Boosting Patient Payment through Consumer-Friendly Loan Programs
In this Business Profile, Bruce Haupt, president and CEO of ClearBalance, discusses how a patient loan program can increase patient collections, reduce bad debt, and speed cash flow.
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
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.
Deloitte Consulting LLP: Employing Innovative Solutions to Optimize Revenue Cycle Performance
In this Business Profile, Jerry Bruno, principal with Deloitte Consulting LLP, discusses the importance of choosing revenue cycle solutions that help an organization meet the challenges of a quickly evolving healthcare environment.
10 Ways to Reduce Patient Statement Volume (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.
Grant Thornton LLP: Maintaining and Improving Collections During an EMR Implementation
In this business profile, Lane Jackson, a partner in the Grant Thornton LLP Health Care Advisory Services practice, with extensive experience in overseeing system implementations and revenue cycle reorganizations, discusses best practices for elevating revenue cycle performance during an EMR implementation. Grant Thornton LLP is a sponsor of the Large System Controllers Council Affinity Group.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
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.
KeyBank: Offering Expertise in Tax-Exempt Financing to Give Health Systems Flexible Options for Growth
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.
The Future of Online Patient Billing Portals
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.
Xtend Healthcare: Enabling Efficient Business Office Workflow
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.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
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.
SSI: Bringing Patient Access to the Next Level
In this business profile, sponsored by SSI, Jay Colfer, vice president of sales and marketing, shares how patient access solutions are reversing the trend toward increased bad debt resulting from the rise in high-deductible consumer health plans.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
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.
Deloitte: Helping Organizations Elevate the Healthcare Consumer Experience
In this business profile of Deloitte Consulting, Matthew Hitch and David Betts explore the potential benefits of elevating the customer experience and outline strategies to change service delivery.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
TriMedx: Elevating and Streamlining Clinical Engineering
TriMedx helps health systems control costs and uncover savings opportunities by optimizing the clinical engineering function.
Clarity Drives Collections
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.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
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.
Revenue Cycle Payment Clarity
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.
Streamlining the Patient Billing Process
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.
Wallace Thomson Hospital Automates to Maximize Limited Resources
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.
7 Steps for Building and Funding Sustainability Projects
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Key Capital Considerations for Mergers and Acquisitions
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.
Trend Watch: Providers adapt as value-based care moves from hype to reality
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 case study
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.
Reforming with a New 50-Bed Acute Care Facility
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.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
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.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
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.
Providers Focus Too Much On Revenue Cycle Management
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.
Lucille Packard Children’s Hospital Stanford Case Study
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.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
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.
ZOLL and Emergency Mobile Health Care Case Study
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.
Maximizing Medicare Reimbursements White Paper
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.
Denials Deconstructed: Getting Your Claims Paid
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.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.