Some hospitals are discovering that investing in a revenue integrity team can yield tenfold gains.
Gary Borgstede has spent 15 years of his career at the seven-hospital Ochsner Health System in New Orleans—most of them as a jack-of-all-trades, responsible not only for the revenue cycle at the seven-hospital system and its 600-physician group practice, but most recently for operations at Ochsner's 20,000-member division of health and fitness centers and its 142-room hotel, as well. Now he's losing half his job—the revenue cycle portion—to a specialist. But don't worry for Borgstede. After rolling all revenue cycle responsibilities into one master—a vice president of revenue integrity—he's gladly moving on within Ochsner as system vice president of operations.
Borgstede's revenue cycle challenge over the past 18 months has been significant. Ochsner has been at the forefront of a recent trend in hospital systems to develop vice president of revenue integrity positions, holders of which are in charge of the delicate balance between accurately charging for services and maximizing payment for care provided.
Many healthcare systems that are good at providing care can be pretty bad at making sure they're being paid for the entirety of that care. Many financial shortcomings can ensue from the far-flung operations of individual hospitals within the system. Some of that misalignment results from years of legacy systems in acquired hospitals whose chargemasters can't be aligned immediately. Some of it can be traced to poor coding, poor documentation, or both, as well as inappropriate tracking of pay-for-performance measures. Much of the siloing in revenue generation at hospitals has happened organically because of the complicated nature of bringing in revenue in such a highly regulated environment. Developing a czar of revenue integrity for the system is the new way to combat those silos.
The revenue cycle integrity team that Borgstede has developed is reserved for someone else to run.
"We've really established the team and department of revenue integrity over the past year, and we've had some challenges staffing that team with good leadership to shape the vision and implement the strategies," he says. Ochsner's revenue integrity team is made up of a group of nurse auditors, a team of internal consultants for chargemaster management and maintenance, and a revenue cycle analytics team. "All of those teams had been in various parts of our organization and, in many cases, very weakly resourced and focused," Borgstede says. "By bringing it all together under one director of corporate revenue integrity, we've taken our best leaders and asked them to assume these roles."
Ochsner's leadership team has also dictated that these teams are empowered to work together to achieve the larger goal, which encompasses not only making sure the hospital is appropriately being paid for services rendered, but also that quality of care reporting is accurate and timely.