HFMA: Revenue Cycle, Reimbursements Share the Spotlight

Executives attending the Healthcare Financial Management Association's annual ANI conference know that maximizing revenue cycle efficiencies and forming new reimbursement relationships with payers may well be the keys to success in the decades ahead.

It's not hard to tell which issues are top-of-mind for the executives attending the Healthcare Financial Management Association's annual ANI conference at the Orange County Convention Center in Orlando June 16–19.

Looking at the conference brochure, I see the expected smattering of breakout sessions centered on data analytics tools, physician alignment, supply chain, ICD-10, healthcare reform, and capital spending. But the star attractions at this forum are the sessions revolving around two topics: revenue cycle and reimbursements.

It's understandable. As the healthcare industry prepares to shift from the traditional fee-for-service to a value-based payment model, there is high anxiety among many finance leaders who are worried about how to help their organizations remain prosperous in the new world order. Maximizing revenue cycle efficiencies and forming new reimbursement relationships with payers may well be the keys to success in the decades ahead.

Craig Richmond, interim CFO at MetroHealth, a 731-bed system based in Cleveland, is slated to present Tuesday one of the many breakout sessions focused on the revenue cycle "How a Pre-Service Center at MetroHealth System Improved Satisfaction, Efficiency, and Revenue."

A few months ago I spoke with Richmond about his organization's pre-service center, which launched in Q4 2012. The idea is to move much of the collection work that is typically done on the back end to the front of the revenue cycle process. The pre-service center's 12 full-time employees verify insurance information, get pre-authorizations from payers, determine the patients' out-of-pocket cost before a procedure is performed, and try to collect payment up front.

"The reason I am so passionate about the pre-service center is [because] it is part of the front end of the revenue cycle. The focus has always been on the back end. If we can get it right on the front, it mitigates any surprises on the back. If you can minimize the rework, you are able to reduce costs," he told me at the time, adding that the upfront collections have also been a financial boon.

"[If you] secure payment on the front end, you are reducing your cost to collect, and you are reducing your bad debt exposure… High-performing revenue cycle departments have shifted from back-end to front-end processes."

His excitement about the pre-service center was evident during that conversation, and I would bet good money that his presentation will represent the kind of progressive thinking providers need to embrace.

Also scheduled to speak on Tuesday is Charles Kolodkin, executive director, enterprise risk and insurance at the Cleveland Clinic. He will speak at a session called, "Cleveland Clinic and Enterprise Risk Management: From Compliance to a Strategic Tool."

In early 2010, the Cleveland Clinic set up an enterprise risk management steering committee and work groups to focus on specific problems and strategize solutions. Kolodkin will share the lessons learned.

"[My] objective is to give more information to healthcare organizations about enterprise risk management and share some of our experiences at the Cleveland Clinic as part of the presentation. Some organizations may have thought about it and may be at different stages of the process, and we are trying to give them a pragmatic approach as far as how to initiate it."

Healthcare providers need a solid EMR program now more than ever as they prepare for an onslaught of newly-insured patients—and their inevitable impact on reimbursements and the revenue cycle—thanks to the Patient Protection and Affordable Care Act, Kolodkin recently told me.

"It's different than a risk like giving the wrong medication to a patient, but you still have to have a strategy for dealing with it. You may have greater utilization from people that you wouldn't have had before. Importantly, Medicaid reimbursement will be less than commercial payers. Those are risks, so how are you going to address them? What are you going to do to mitigate them? You may decide to use more allied health providers like nurse practitioners and physician assistants or you may introduce wellness programs for things like diabetes and other diseases so you can keep this population from becoming inpatients."

Kolodkin and his co-presenter Angela Hoon, partner at audit, tax, and advisory firm KPMG, will discuss these and other risk factors currently affecting healthcare providers and put them in the context of building a high-level ERM strategy, according to Kolodkin.

"One of the things we will emphasize repeatedly is that a lot of the time people think ERM in healthcare is about patient safety, exposure, liabilities, and how to make hospitals safer for patients. That's true, but it's not what an ERM looks like at the big picture level where you are trying to make it a governance tool."

Other promising-looking keynote speeches and breakout sessions spotlighting reimbursements and the revenue cycle include:

• Don Berwick, MD, founding CEO

Institute for Healthcare Improvement
Transitioning to Value: Barriers, Solutions, and Opportunities

• Gregory Whitlock, director of revenue cycle

King's Daughter's Medical Center
How to Use Data Analytics to Drive Sustainable Change in the Revenue Cycle Process

• Sam Civello, vice president

Texas Health Physicians Group
Engaging Physicians in Revenue Cycle Management to Support Growth at Texas Health Physicians Group

• Diane Watkins, vice president, revenue cycle
• Paul Knudtson, director, patient access

St. Luke's Health System
How St Luke's Health System Enhanced Its Revenue Cycle Process to Improve Total Payment Collections and Service Quality

• Mari Anne Ehler, associate director, patient financial services

University of Iowa Hospitals and Clinics
Using Payer Contract Management to Improve Reimbursements

• Deborah Larkin-Carney, vice president of quality

Barnabas Health System
Operationalizing Value-Based Purchasing: Barnabas Health System's Journey to Maximize Performance and Payments