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Lessons for Hospitals in a Tight Economy

Dom Nicastro, for HealthLeaders Media, June 9, 2009

Dunn Memorial Hospital did not send its front-end staff on a lavish junket during the National Association of Healthcare Access Management's Patient Access Week back in April. No trips to Las Vegas for NAHAM's annual show late last month.

In this economy, hospitals like Dunn Memorial in Bedford, IN, are lucky to make trips to sister sites, much less national shows across the country.

So what did its patient access staff do for Access Week? They painted.

The waiting room and their own office needed a makeover, so they did the work. The hospital and its fundraising foundation supplied the paint, and the staff supplied the labor.

What a fitting metaphor for how hospitals and their front-end staffs cope today in a recession.

The days of endless outsourcing and frugal spending on the best software systems seem to be gone for now. Facilities are finding ways to stay in the black inside their own walls.

In short, hospitals are doing the painting themselves today.

"Since Patient Access has a new supervisor, she was limited on funds and also wanted to create a ‘team project' to help build her team around her and each other," says Stephanie Smithson, CHAM, Patient Accounts director at Dunn Memorial. "She asked for ideas of team projects, and this is one she received back. Our hospital has redone all of our main hospital rooms this way. Employees design and submit for approval, then are responsible for picking a team to help complete rooms."

Dunn Memorial did its own "painting" in many other ways as hard times fell:

  • Shift changes. To save on staffing expenses, Dunn restructured shifts to provide "minimal" coverage on lighter days versus covering at its own comfort level. "We did this on days we had less volume historically," Smithson says.

  • New in-house tools. Dunn's I.T. department has developed new tools instead of seeking outside vendors for better reporting and workflow.

  • Less travel expenses. Travel and education expense allowances have been reduced and in some cases eliminated. Employees are encouraged to participate in sharing the cost of educational conferences or travel. Managers at every level are being reminded to staff to level appropriate and eliminate overtime except for "extreme need."

  • Free education. Dunn's Revenue Cycle team actively searches for new free education from all sources, including NAHAM, Passport, Medicare, Medicaid, and its own FI.

  • Contract negotiations. "We are looking at all contracts for vendors to see if prices can be renegotiated or a different product at a lower price can be found or a different product with more functionality at the same price," Smithson says.

  • Cash management. Dunn works on automating its payments, payment posting and scanning all in one solution and database.

  • Patient accounts management. Dunn now uses Electronic Funds Transfers in Patient Accounts for all available payers and seeks ways to streamline its work, including new worklist tools and Excel database spreadsheets. It has denial management and contract management tools to track and trend in a timely manner. It is developing in-house education and testing for Patient Accounts and Cash Management.

"All that being said, we are actually posting a positive cash flow for the first quarter of 2009 through a combination of all of these items plus an increase in revenue," Smithson says. "We are seeing a trend of increased payer mix on the commercial side in our inpatient stays. We believe this is due to people waiting longer to seek care and by then their illness has become more serious. We are seeing a downward trend in our physician offices and our walk-in clinic, while our ED visits continue to go up."

Editor's note: This is the second in a four-part series of stories on HealthLeaders Media talking to revenue cycle managers about coping in a tough economy.


Dom Nicastro is a contributing writer. He edits the Medical Records Briefings newsletter and manages the HIPAA Update Blog.

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