After its recent electronic health record (EHR) transition, a hypothetical health system found itself struggling to implement computerized physician order entry (CPOE) across its 10 hospitals and 3,400 employed, contracted, and community-based physicians. Older physicians were frustrated with the technology while other physicians were unhappy with what they perceived to be an extra administrative burden for medication orders. The productivity of physicians (and the nurses who were supporting them) was trending poorly, and the patient experience was suffering due to delays in service.
To address these challenges, the CEO asked leaders to uncover what was delaying the adoption of CPOE by rounding on direct reports. During rounding, leaders touch base with employees who report to them for five to 10 minutes—typically on a monthly basis—to learn the following:
At first, the leaders were skeptical that rounding could help increase the number of physicians using CPOE. They had been rounding on direct reports for some time and physician engagement had not yet improved. But after the leaders refined their approach to rounding, they were pleasantly surprised.
The goals of rounding are to strengthen relationships, create approachability, assess process improvement opportunities, and demonstrate appreciation. As this health system learned, rounding can also be used to help an organization identify and resolve barriers to organizationwide goals, such as CPOE adoption. Here are four ways this health system adapted rounding to meets its needs.
Target questions around specific organizationwide priorities. Many leaders at this health system had been rounding on direct reports for four years. They were bored with the standard rounding questions, and staff weren’t responding with much actionable information. Because CPOE was a high organizational priority, leaders decided to make CPOE the focus of their rounding questions for a period of time, which ended up energizing the process.
For example, instead of asking, “What’s working well today?” they asked, “What’s working well with the CPOE implementation?” With this line of questioning, leaders learned that changes made to the standard order sets streamlined the process for ordering labs. In the past, physicians had to sort through many similar codes, so errors required patient blood re-draws, which was a huge dissatisfier.
Rather than asking, “Who can I reward and recognize?” They asked, “Who’s done a nice job with CPOE this week?” When the CFO rounded on the director of IT in this way, the director responded, “Dr. Menendez really went the extra mile to resolve some of the CPOE challenges we’ve been having with the hospitalists.”
Also, leaders learned that when staff didn’t have a response to a rounding question, they needed to be more specific and set an expectation for an appropriate response next time.
For example, when one employee said she couldn’t think of anyone to recognize, her leader said, “Sarah, I understand no one comes to mind, but let me rephrase the question: It doesn’t have to be a big deal, just something simple that made you smile or made your day go better. If you still can’t think of anyone right now, please think about who you can mention next time I round.”
Follow up on findings. When the CNO rounded on her nursing directors and asked about CPOE, she learned that the pharmacy was struggling to fill orders on time because it was spending so much time problem-solving orders that were entered incorrectly by physicians. However, the CNO did not act on this information in a timely manner. So physicians continued to be frustrated with delayed pharmacy orders and complicated order sets.
Once the CNO was coached on how to document her findings using a rounding log, she could then bring objective results to the CPOE team for action. The CPOE team members met with the pharmacy and the therapeutic team to review and simplify some of the standard order sets to make the order entry easier for physicians.
Next, the CNO posted a stoplight report—a close-the-loop document—to keep everyone posted on progress towards resolution of each type of CPOE order entry challenge as recorded on the rounding logs. Issues that had been addressed were highlighted in green, those that were pending were highlighted in yellow, and recommendations that were not adopted after review were highlighted in red.
Maintain a consistent schedule. Leaders discovered that rounding wasn’t occurring consistently. When they drilled down to find out why, some directors and managers said they just couldn’t find the time. Even when rounding opportunities were scheduled, they were frequently bumped because of last-minute meeting changes and other emergencies.
Sometimes rounding became a lengthy, unstructured hallway conversation focused on putting out a fire instead of on proactive strategies for improvement. As a result, the organization was experiencing pockets of high physician engagement where leaders were rounding consistently and low engagement where rounding was sporadic.
To resolve this, they decided to incorporate rounding into every one-on-one monthly supervisory meeting. The CEO modeled the new approach with his direct reports; he added five- to 10- minute rounding sessions as a standing agenda item at the opening of these meetings. When he learned about process design issues with CPOE, he asked the CIO to track these as a priority item with the vendor.
Find a time that works for staff. Some leaders had difficulty rounding on frontline staff who were constantly moving between patient rooms or various locations throughout the health system. Instead of chasing down staff, leaders set an expectation by saying, “I need to round on you next week, so please page me when you have five minutes to accomplish this.” They also capitalized on spontaneous moments when staff arrived with a concern or question to complete the round.
For example, one director of case management was approached by a frustrated case manager who couldn’t complete a durable medical equipment referral for a patient because of a malfunctioning computer. The director responded by saying, “That’s really important. I want you to have the tools and equipment you need to do your job, so let me get that fixed. And while you’re here, do you have five minutes I can round on you to find out about other processes or systems we need to address?”
Using these four tactics to improve the quality and quantity of rounding across the organization helped the health system improve CPOE compliance significantly among its physicians over a three-month period. Leaders also began to experience the rewards of consistently high physician engagement as measured by their physician and patient satisfaction surveys and more proactive partnership in problem solving with hospital leaders organizationwide.
Lyn Ketelsen, RN, is senior coach leader and national speaker for Studer Group, Gulf Breeze, Fla., and a member of HFMA’s McMahon Illini Chapter.
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.