At the annual Healthcare Financial Management Association National Institute conference, healthcare leaders are responding to a long list of pain points by linking information systems to financial performance and revenue cycle processes to patient experience.
Fittingly for Florida in June, healthcare finance executives are feeling the heat.
With commercial insurance carriers and Medicare squeezing payment rates in the ongoing drive to reward providers for value rather than volume in the delivery of medical services, healthcare finance executives are scrambling to identify their weaknesses and retool their organizations for value-based care.
The stakes for the bottom line are high, according to one of the featured speakers during Monday's kickoff of the annual Healthcare Financial Management Association National Institute conference in Orlando, FL, which has more than 5,000 registered participants.
Yvonne Chase, section head for patient access and business solutions at Mayo Clinic Arizona in Phoenix, said data collected at Mayo Clinic indicates that 93% of patients who are satisfied with the health system's billing practices are also satisfied with their clinical experience. But only 63% of patients are satisfied with their clinical experience when the billing experience is negative.
"If the patient does not have a good experience, we know they will go elsewhere," Chase said.
One of Monday's morning workshops focused on using health information management (HIM) as a transformative agent at health systems and hospitals. During a quick round of introductions and "pain point" sharing on the shift to value-based care, the audience of about four dozen healthcare finance professionals unleashed a copious number of concerns and initiatives designed to address them:
- Clinical documentation improvement (CDI)
- Computer-assisted coding
- Improving the patient experience
- Establishing revenue cycle best practices
- Converting paper-based record systems to electronic health records
- Managing queries from coders to physicians
- Managing coding query responses from physicians
- Integrating physician electronic health records with revenue cycle systems
- Speeding up cash flow
- Providing timely data to frontline healthcare finance and clinical staff
The importance of information systems to financial performance
One of the HIM workshop speakers, George Semko, administrative director of revenue cycle at Fishersville, VA-based Augusta Health, said HIM is a critical component of any effort to optimize revenue cycle operations at health systems and hospitals. "First, you have patients coming in the door, and you help craft that experience. Then at the end, you're getting the bills collected. The golden nugget in the middle is HIM," he said.
CDI is a key element of optimizing the revenue cycle function on several fronts, Semko said, noting the importance of "opening up lines of communication between the clinicians and the revenue cycle administrators." Accurate clinical documentation has a significant financial impact on healthcare providers, playing a fundamental role in the claims reconciliation process and cash flow levels.
Bottom line: If clinical documentation is done poorly, health systems and hospitals do not get paid on a timely basis, or not at all.
At Augusta Health, Semko said senior nurses have performed well in CDI roles working with physicians because there is "earned respect by both parties." August Health monitors several key performance indicators to boost the quality of clinical documentation, including the physician responsiveness rate to coder queries, physician-by-physician query responsive rate comparisons, coding accuracy, and average per query financial benefit. "We're never going to have 100% agreement around queries, but at least we have people responding to them."
Augusta Health has been able to achieve a 95% rate of physician responsiveness to coder queries, against an industry benchmark rate of about 85%, Semko said.
Another presenter at the HIM workshop, Sandy Wood, director of revenue cycle at Naples, FL-based NCH Healthcare System, said designing and implementing a new approach to revenue cycle operations has improved the health system's financial performance.
Mainly due to increased pressure from competitors, NCH's market share fell from 80% to 69% from 2010 to 2013, which prompted the health system to revamp revenue cycle administration, Wood said. In addition to CDI efforts, NCH financial administrators concentrated on leveraging HIM capabilities to "get information out to our folks," she said.
An electronic dashboard was established to circulate key clinical and financial metrics to all NCH department heads, including daily inpatient census, daily emergency room visits, and daily cash collection. NCH also started monitoring about a dozen revenue cycle metrics, including bad debt as percentage of gross revenue, cash collection, cost to collect, billing net days in accounts receivable, and final claims denial rate.
The financial turnaround has been dramatic, she said. In 2010, NCH was on track to lose $6 million. In the first quarter of 2014, the health system posted a 6% margin for revenue over costs.
Wood said NCH investment in HIM has impacted revenue cycle in several ways, including improved electronic medical record development and oversight, more effective claims denial management, better electronic records training for physicians, and replacement of paper processes with digitization. "All the documentation in our system is electronic," Wood said.
Linking revenue cycle processes to patient experience
Mayo Clinic has been investing time, energy, and money to improve the health system's patient experience performance, which has been both more complicated and gainful than many executives in the organization had anticipated, Chase said. "We want to talk about a partnership with patients. I want them to know that their finances are also my concern."
The entire revenue cycle lifespan presents opportunities to boost patient experience. "Pre-services communication sets the tone for the entire encounter," she said of Mayo Clinic outreach efforts before a patient arrives for services, which includes collecting the correct information, scheduling patients appropriately with the right doctor, and ensuring that services are covered and reimbursed at the highest possible level for patients. "We need to give the patient at least a 'guesstimation' of how much it's going to cost out of pocket."
While patients are receiving medical services, it is the healthcare provider's responsibility to work proactively and manage patient expectations, Chase said. "Gone are the days when we could say, 'It's their insurance and they should know their benefits.’ Patients want to be knowledgeable about the cost of service. They want to know whether they have coverage. … They don't want to be surprised. They want to be educated patients. They're thirsting for it."
Mayo Clinic has generated significant bang from the bucks that the health system has invested in several initiatives to improve patient experience, such as recording most phone calls to make sure patients are getting the information they need to understand the financing of their care. "Recording calls allows for root-cause analysis," Chase said.
The patient experience gains at Mayo Clinic are measurable, she said, noting that pre-service communications with patients has helped increase point-of-service collections 12%. And streamlining of the health system's referral process has cut appointment wait times by about one third. "We were at six days, and now we're down to four," Chase said.
To thrive in straitened circumstances, she said, healthcare providers need to learn from each other, share their success stories, and brace for the hard work of organizational change. "We can't get enough new tools."
Christopher Cheney is the CMO editor at HealthLeaders.