Accounting and Financial Reporting

How an Iowa hospital earned 2 MAP Awards for excellence in revenue cycle performance

September 25, 2019 3:51 pm

By aligning its practices with HFMA’s MAP Keys, Henry County Health Center improved performance and received recognition.

When Karoleen Hammel accepted the director of revenue cycle position at Henry County Health Center (HCHC), CFO David Muhs presented a challenge: Align the hospital’s revenue cycle with HFMA’s MAP Keys and Patient Financial Communications Program and win a MAP Award.

Two years later, the critical access hospital in Mount Pleasant, Iowa, has earned two MAP Awards and more important, made noticeable strides toward financial transparency.

“The HFMA MAP Award is more than just achieving the best metrics for an organization,” says Todd Nelson, HFMA’s director of partnerships and chief partnership executive. “It encompasses the need to balance patient financial communications, transparency and patient satisfaction with the strongest revenue cycle metrics.”

To make those strides, HCHC took three key steps.

1. Assess performance using MAP metrics

Identifying the areas where the hospital was performing poorly helped Hammel and her team create a plan for success. One early goal was improving point-of-service collection by collecting copays in the emergency department (ED) starting in November 2017.

“A lot of our revenue came from the ED. Most insurance companies have an ED copay listed, so I thought that would be a good start to increasing the point-of-service payments,” Hammel explains.

The first week, HCHC collected more than $2,000 in copayments, a number that continues to increase and resulted in the hospital’s highest-ever point-of-service collections in both February and March of 2018.

2. Formulate a long-term plan

At Henry County, price transparency efforts worked hand in hand with centralized scheduling. The hospital began by targeting elective procedures such as radiology services or sleep studies. A financial counselor would contact patients
who had made appointments for such services and provide information about their share of the cost. Some patients would cancel because the
cost was prohibitive, and others would make arrangements to pay, but overall, people were happy to have the information that allowed them to make an informed decision about their care, Hammel says.

Training new hires to have a complete understanding of the revenue cycle is essential, even when their jobs don’t touch the full process, she says.

“Schedulers, communication staff and patient access staff start their training with our central patient access members,” says Hammel. This gives them a great base to understand the financial software and how all visits start in the system. If the registration portion isn’t correct from the beginning, this can have an impact all along the revenue cycle as well as patient care.”

Training can take anywhere from two to six weeks depending on the person’s role in the organization. In addition, patient-access staff in both main registration and ED registration are encouraged to complete HFMA’s Patient Financial Communications Training Program.

At HCHC, the proof of success came when a secret shopper from the Iowa Hospital Association called to ask for a self-pay estimate for an MRI. The financial counselor asked whether the procedure would be performed with or without contrast and, when the caller said he wasn’t sure, provided estimates for both as well as an explanation that the radiologist would charge an additional, separate fee. She also offered the patient a 15% discount for prepayment, as is the practice at HCHC. At the end of the call, the patient identified himself as a secret shopper and said they were the first hospital that could answer his questions.

“He said, ‘You are the only one who could give me an estimate,’” Hammel said. He said some hospitals could give a range, but not an exact amount, while others weren’t sure where to transfer his call or just didn’t call back at all. “It kind of blew us away. It was pretty cool.”

3. Communicate and educate

Successful initiatives require buy-in from leadership and staff as well as an information campaign to educate patients when there is a change to a routine. For example, when Henry County began collecting copays in the ED, Hammel took several steps to ensure all stakeholders knew and understood the plan long before attempting to collect copays in the ED. The hospital’s board of trustees wrote ED copayments into its overall financial policy, and the ED director and key physicians were informed of the plan so the collection process could be carefully planned to comply with the Emergency Medical Treatment & Labor Act, which requires hospital EDs to screen and stabilize all patients regardless of ability to pay. Finally, patients were informed via the hospital’s Facebook page, website and local media.

But patient education goes beyond awareness, Hammel says. Providing cost estimates with full explanations of what a patient’s health plan will cover can help the patient make an informed decision. To ensure patients still receive the care they need, the financial counselor routinely communicates with physicians when patients say they can’t afford an elective procedure or service. If the physician insists the procedure or service is necessary, the financial counselor will work with the physician and patient to either amend the care plan or work out a payment plan.

As Henry County looks toward the future, Hammel is hopeful that the hospital’s performance will continue to improve. As the hospital works through its second year of centralized scheduling, Hammel’s goal is to have more services scheduled and provide a greater opportunity to communicate financial estimates to patients prior to their service.

Nelson encourages other hospitals to follow in Henry County’s footsteps. “The HFMA Patient Financial Communications Best Practices provide the basis for performance and taking the next step toward becoming an HFMA Patient Financial Best Practices Adopter like Henry County Health Center shows an organization’s commitment to the patients it serves,” he says.


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