Unit/department managers at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, N.Y., used to spend an inordinate amount of time dealing with scheduling and staffing issues. This is a common and frustrating problem for hospital managers. In fact, staffing tasks—such as developing schedules, struggling with paper processes like paid time off (PTO), tracking licensure and credentialing details, complying with union regulations, or trying to recruit staff to fill open shifts—can occupy 50 percent or more of a manager’s time, according to anecdotal reports.In 2010, the 381-bed CVPH moved to a centralized approach to staffing and scheduling for nursing and other departments, such as pharmacy and respiratory therapy. It also replaced manual and, at times, paper-based processes with automated scheduling solutions. A time study of inpatient nursing units revealed a return of 7 hours of work per manager for every pay period. Managers have been able to redirect their time from scheduling activities to patient care and staff mentoring.
One challenge many healthcare organizations struggle with is a silo approach to labor management, which usually involves a director or manager controlling the unit’s scheduling, deployment, and administrative duties. At first glance, allowing managers to administer those functions may seem like a good idea because they are familiar with the work performed and the skills of staff members on each shift. However, in the end, managers find themselves spending too much time planning and handling day-of-shift chaos that results from last-minute call-ins or scheduling errors. In addition, the silo approach to labor management can result in overstaffed units sending staff home while similar units run short on staff and need to use overtime or bring in more expensive, last-minute sources of external staffing. The end result is excessive overtime and the use of temporary employees because the system is unable to effectively coordinate resources.By centralizing resource management, deployment, and alignment strategies at the enterprise level, organizations can leverage economies of scale and use real-time coordination of staffing to use on-hand resources effectively. This concept is not reserved solely for large, multi-site organizations. Economies of scale increase the larger the organization is, but stand-alone organizations, like CVPH, have seen tremendous benefits from the coordination of resources, the consistent and fair application of policies, and efficient deployment of contingency staff. CVPH’s resource management center is a 24/7 operation that balances schedules, ensures staff are scheduled to their FTE, proactively identifies upcoming gaps in the schedule, and handles administrative duties previously carried out on the unit. The resource management center works directly with the clinical decision makers (typically the house supervisors), providing them with the most up-to-date understanding of the entire staffing picture.
Many of CVPH’s staffing efficiencies are the result of the hospital’s scheduling software. CVPH’s staff resources can be viewed in real-time across the organization so managers can make quick and accurate decisions without having to consult different systems, spreadsheets, or scheduling data. For example, the following illustration shows the impact of staffing decisions in both dollars and hours.
The scheduling software allows CVPH staff members to submit scheduling and time-off requests electronically. Once a staff member submits a request, a manager is sent a notification that automatically shows the impact the request will have on staffing. As soon as the request is approved, the schedule is updated as shown in the following illustration.
Notifications are sent to staff members. In addition, the changes are transmitted to CVPH’s time-and-attendance system, eliminating the need for double entry of information and diminishing the likelihood of data entry errors. CVPH also made sure that its scheduling software would integrate with existing systems, such as the organization’s time-and-attendance software and systems that track:
Ensuring integration with other systems in the organization eliminates the need for paper-based workarounds.
An open shift management protocol should be configurable to allow for an almost limitless number of rules and protocols, such as those governing:
For example, CVPH required customization of its open shift management to accommodate its business and union rules. At CVPH, once a cyclic schedule is copied and pushed forward for future shifts its staff members are able to self-schedule and use the automated system to fill holes in the schedule and meet their FTE requirements. Following this, the system uses a seniority-based, equitable process of filling the remaining shifts.
The success CVPH has experienced is a direct result of its effort to transform its culture, as well as adopt new processes and technologies. The path to transformational change, like CVPH experienced, is a succession of small steps, with three major components:
Change is difficult for any organization, and it is impossible for organizations that do not want to change and don’t see the value. This need for change is what must be communicated effectively. CVPH was successful in its transition to an enterprise staffing model because its leadership and staff alike understood that their previous approach to managing labor resources was not effective, resulted in too many errors, and was not sustainable given the changes that the healthcare industry was and is facing.CVPH’s enterprise model for automated staffing delivered enormous returns both in dollars and in managers’ time. The staffing software created a framework for repeatable outcomes that are in line with CVPH’s goals and provide managers with the time to focus on their responsibilities to their patients and staff.
Jackie Larson is senior vice president of client services, Avantas, Omaha, Neb. (JLarson@eavantas.com).Rhonda Kowalowski is supervisor, patient services, Champlain Valley Physicians Hospital, Plattsburgh, N.Y. (RKowalowski@cvph.org).
The Claro Group: Partnering for Performance Improvement
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Ontario Systems: Maximizing Self Pay Collections
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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.
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.
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.
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.
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.
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.
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.
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
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Streamlining the Patient Billing Process
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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
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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
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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
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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
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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
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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.
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Building a Clinically-Integrated Network
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Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
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This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.