A health system created a training program for revenue cycle leaders, resulting in improved performance.
Developing Talent in the Revenue Cycle
Training programs for current and future revenue cycle leaders have resulted in improved performance and satisfaction.
The Revenue Cycle Division at New Orleans-based Ochsner Health System works to cultivate a highly engaged culture that values career progression through effective personal and leadership development. In 2013, the revenue cycle training department was charged with developing a program to further develop the leadership team and provide a pathway for future leaders. The training department had been focused on systems training while implementing a new electronic health record and billing system over two years, leaving little time to develop leadership training. The department responded by creating dedicated revenue cycle training and education programs to drive engagement, develop talent, and improve performance. After implementing these programs, Ochsner saw significant improvements, including a 93 percent increase in engagement scores for the division; a 4 percent reduction in voluntary turnover; and double-digit reductions in accounts receivable (A/R) days, aged A/R, and administrative write-offs.
Training for Managers and Directors
The leadership of the revenue cycle training team was tasked with addressing the development needs of the management team to focus on specific deficiencies in areas such as executive presence, budgeting, financial acumen and strategy. These deficiencies were identified through a survey and leadership workshop provided to revenue cycle management where the team worked to identify weaknesses of the leadership team from the supervisor level and above. The revenue cycle leadership identified three trainers to assist in the development of the courses that would be co-created with directors in the revenue cycle to ensure the materials were relevant and would address the deficiencies. The team would then develop a course that managers and directors would be expected to complete within 18 months, and that then would be offered on an annual basis to accommodate any new leaders that joined the division. The initial cohort was a group of directors and managers selected by the senior revenue cycle leadership team, and the goal was set that all managers and above would complete the course within the next two years.
Participants in the training are required to complete two tracks: instructor-led classroom learning and self-paced learning. The classroom training, which takes four days to complete, is conducted by system leaders who have background applicable to the coursework. Class sizes are limited to 20 people to promote collaboration as the courses cover a wide range of topics from cost-cutting opportunities to techniques to drive engagement. Students review real-world situations and best-practice research that they can apply immediately in their jobs. The final piece of the course is a group project and report to senior leadership, and upon successful completion of those steps, the student receives a Revenue Cycle Leadership Academy (RCLA) certification.
About four months were required to conceptualize and design the RCLA program and develop the materials.
Training for Supervisors
After successful implementation of the program, the training team identified an opportunity to provide training for supervisors to develop their skills, as well. All supervisors had been required to go through a week-long, system-led training, but it became clear through questions from supervisors and specific learning opportunities that training wasn’t meeting the needs discussed around leadership, technical, and strategic skills.
Following the same development strategy used for the RCLA program, the team developed a supervisor program to address items such as presentation skills, business behavior, managing across peers, and technical skills, including KPIs and dashboards. Just as senior leaders are charged with creating and delivering each course in the RCLA program, directors are tasked with doing so for the supervisor training.
The 40 hours of classroom work are delivered over a period of three months. Students in this training report out to senior leaders to demonstrate the skills they have developed in the presentation skills class. Students are asked what they found most valuable in the coursework and how they plan to apply the learnings in improving their day-to-day leadership performance. Ochsner was able to move all supervisors through the RCSP in two years, and the courses are now offered to high performers and those who have shown interest in leadership roles.
Attendees have given the two programs high marks, but the true success of the training lies in increased competencies. To ensure the training is effective, Ochsner captures student scores on tests administered before and after the coursework to evaluate the knowledge gained.
Consistently, students who have completed the RCSP exhibit significant improvements in scores on these before-and-after tests, with the highest percentage increases coming from courses on leadership traits” (39 percent), time management and delegation” (30 percent), and KPIs and dashboards (28 percent). Managers and directors in the RCLA program have shown high percentage increases in test scores in the areas of financial acumen (60 percent), budgeting operating rhythm (58 percent) and essentials of project management (35 percent increase).
These programs have been beneficial in preparing new leaders to think strategically, establish a vision for their teams, become better motivators, respond rapidly to change, and take decisive action. The programs also have made Ochsner leaders more well-rounded as they facilitate courses and personalize the material. The faculty members have been able to use these courses as stretch assignments that have strengthened their own professional networks, allowing them to share knowledge and gain a sense of personal satisfaction by contributing to someone's growth and development.
To address training needs comprehensively, the training team seeks information from multiple sources across the division. The team solicits leadership feedback in formal learning sessions as well as in annual calibration sessions, during which the RCLA program and the RCSP are assessed and fine-tuned as necessary. The team uses offline meetings with staff, monthly rounding with individuals, and check-ins with new hires at 30, 60, and 90 days to see if training needs are met and determine how to improve the programs. Ochsner’s HR team works with the training and education team and provides feedback from exit interviews, complaints, and other areas. The training team reviews gaps in the health system’s succession planning and identifies training needs to mitigate those gaps, while also conducting ongoing best practice research.
Through this collaborative and studied process of identifying training opportunities, Ochsner is constantly improving its offerings for developing talent. In 2017, for example, the team created a new class “Journey Through the Revenue Cycle,” that allows all employees within the revenue cycle division to understand the revenue cycle process and the teams that play a vital role in all administrative and clinical functions contributing to the capture, management, and collection of patient service revenue. The class, which is taught by a select group of leaders that includes managers and directors, allows employees to understand each team from a career development perspective. This comprehensive view allows team members to better understand the experience and qualifications needed to further their career. A complementary shadowing program was established to enhance employees’ individual development plans by helping them spend a day with their chosen department to take a deeper dive into its processes, metrics, and core responsibilities. Employees then take the knowledge that they gained from this experience back to their leaders to help identify development opportunities in their career path and, in some cases, apply process improvement initiatives to the procedures in their current department.
Since implementing these training programs in 2013, Ochsner has improved all revenue cycle key performance indicators (KPIs)—including consolidated accounts receivable (A/R) days—year-over-year to the point of meeting or exceeding national benchmarks. The health system has reduced A/R over 90 days by 11.7 percentage points, reduced cost per claim by 26 percent, and reduced cost to collect by 27 percent. Bad debt was reduced by $15 million in 2017 relative to baseline, and both clean claim rate and discharged not final bill were improved through collaboration with operations.
The revenue cycle department was recognized as Department of the Year by Ochsner in 2017, and it is consistently recognized as a top-performing division in the region, its accomplishments have provided an example for other departments within Ochsner seeking guidance when developing engagement initiatives. From an engagement standpoint, 95 percent of the department’s leaders are above the Gallup healthcare benchmark of 33 percent actively engaged.
Ochsner’s revenue cycle leadership programs continue to help the health system improve operational effectiveness while fostering interpersonal growth, expanding networks, and maximizing staff potential. The curriculum development process of these programs and the support of division faculty members together have enabled the training department to successfully maintain its standard systems training, while supporting system growth and facilitating the leadership programs without the need for additional FTEs.
The programs have had a positive impact on the employee engagement metrics, such as turnover and overall engagement scores, as well as on system KPIs, such as consolidated A/R days and administrative write-offs. The program benefits have been supplemented by process improvement projects that strategically focus on areas such as cost effectiveness, waste reduction, and cash collection. Although developing and maintaining these programs has been a major undertaking, the benefits have been shown to far outweigh the costs and efforts involved.
Wendy Burns is vice president of revenue cycle and HIM solutions, Ochsner Health System, New Orleans.
Tina Abbey is healthcare finance project director, revenue cycle PMO and training & education, Ochsner Health System, New Orleans.