One revenue cycle VP shared three tips she uses in her organization.
HealthLeaders previously spoke with Lynn Ansley, HealthLeaders Exchange member and vice president of revenue cycle management for Moffitt Cancer Center in Tampa, Florida about the importance of succession planning.
During the recent Revenue Cycle Exchange, executives noted the importance of succession planning, yet many expressed that their organization’s didn’t have time for it. Here are three tips Ansley suggests to aid leaders in their succession planning efforts.
It’s never too soon to identify talent
“I’m always looking for talent because I know that there’s nothing more important than good people and good people will not stay if you don’t invest in their growth as well.”
Communication
“I have sat down and talked to people and found out that they don’t want to be leaders anymore, or someone that isn’t in a leadership role to gauge their interest. Do you want to manage people or manage projects? People change over the course of their career and it’s all about how fast or slow you want to accelerate.”
Understanding who employees are outside of work
“I’m an executive that also has three young children. I’ve never really felt the need to hit the breaks in my career because of my family, but not everyone is the same in that regard. And so, I was always very open and honest about my career aspirations with my boss because she asked.
Organizations are considering new measures to protect patient information.
In the aftermath of the Change Healthcare ransomware attack, affected providers are doing their best to resume normal operations and looking for proactive measures to protect them in the future.
The attack was a major disruptor to the revenue cycles of providers throughout the country, leaving them unable to submit claims or process payments. The gravity of the disruption emphasizes the importance of having a business continuity plan in place.
“We’re in the business of treating patients, so a lot of the time, if you don’t have people that are focused on this type of stuff and know its importance, it gets thrown by the wayside,” Joi Lee, manager of cyber governance, risk, and compliance for Moffitt Cancer Center, previously told HealthLeaders.
She noted that healthcare is behind other industries when it comes to making cybersecurity a priority. According to Lee, many companies either don’t have a business continuity plan, don’t have an updated plan, haven’t tested it, or haven’t communicated it to the necessary individuals.
The increasing frequency of cyberattacks has made cybersecurity a priority for organizations, particularly as it relates to revenue cycle management solutions. In some organizations, information technology specialists are included in the decision-making process for finding and implementing RCM solutions.
“There is a newer wave of IT leaders that grew up from the operational side of business and weren’t just tech people,” Bill Arneson, director of business operational transformation at Moffitt, previously told HealthLeaders.
“I think those are the people that you need, someone that can speak business and IT, to bridge those gaps,” he said. “Those are the people getting stuff done.”
Organizations can be proactive in protecting their data by ensuring their tech infrastructure is secure and appropriate controls in place prior to implementing a new solution or integrating a new platform. Additionally, organizations should inquire about antivirus and data protection controls in conversations with potential vendors and RCM partners.
The average tenure of employees on the VPs team is 10 years.
Succession planning was revealed to be a common issue among revenue cycle executives during the recent HealthLeaders’ Revenue Cycle Exchange. The leaders agreed on its importance, yet many stated their organizations didn’t have the time to allocate towards it.
However, at Moffitt Cancer Center in Tampa, Florida, Lynn Ansley, Healthleaders Exchange member and vice president of revenue cycle management, has made succession planning an integral part of the employee experience for her team and has seen great outcomes because of it.
Where to Start
Simply creating an organizational chart is a step in the right direction.
“When you look up an [organization’s leadership] chart, no matter where you’re sitting in that org chart, you want to know there’s a path for you to go,” Ansley told HealthLeaders. “Whether it’s up or even laterally across the organization.”
Succession planning then begins with an informational interview, where the employee is able to learn more about the role or department they’re interested in, qualifications, and discuss what they need to do to meet those qualifications.
During this stage, in particular, Ansley looks for potential leaders and will give them stretch assignments, which is a task where they have the chance to display their skills and capabilities as a leader.
They’ll be included in the organizational wide programs Moffitt’s development team puts together where they learn more about the organization and how different roles intersect with each other. Employees will also meet with their leader each quarter for professional development meetings to check their progress.
“When you look down in any area of my front, middle, and back-end shared services, there’s a pipeline of who’s up next for that leadership role,” Ansley said.
Different ladders within the organization require a particular HFMA certification, which, upon receiving the certification, makes them qualified to advance in the organization and increases their marketability should they ever decide to pursue other opportunities at a different organization.
Pictured: Lynn Ansley attends the 2024 Revenue Cycle Exchange.
Looking Forward
In addition to training opportunities, employees are encouraged to think about how and where they want to grow in the organization, especially now that the practice is growing.
“What I encourage our team members to do a lot is not just focus on the next six months, but look out a little bit further,” Ansley said.
“If the role that you think you want isn’t available today, we’re going to be multiplying the number of opportunities in the short term and into the next 10 years.”
The average tenure of members on Ansley’s team and leaders she reports to is 10 years. Because of this, she stated, the organization has a wealth of internal knowledge on their operations and processes, which contributes to a greater culture of continuous learning and improvement.
“We have a lot of, I call it ‘musical chairs’ in rev cycle, because it means that our team members are growing throughout all of the areas,” Ansley said.
“I’m not sure that there’s any more valuable of a team member that has sat in multiple seats on the bus and got to see the view from all of those different angles to see how the cycle really impacts one another.”
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Ochsner Health has seen improvements in patient experience since expanding its digital presence.
Since expanding the health system’s digital presence, Ochsner Health has seen improvements in patient communications and collections.
“There’s so much patients can utilize, from scheduling visits, to interfacing and coordinating with their healthcare team,” Eduardo Benitez, Ochsner director of physician payments, told HealthLeaders. “Being able to request their prescription refills, pay their bill, and even being able to do a telehealth visit.”
For other organizations looking to expand their digital offerings, Benitez identified two essential elements: desire for innovation and listening to patients.
“It takes patience, time, expertise—and really with that, keeping security at the forefront of the project,” he explained. “Assuring that security is [prioritized], I think, is most essential a lot of the time.”
He added ensuring security concerns are addressed from the initial stages of exploring digital expansion and protections are put in place is important to the security of the organization as a whole going forward.
Benitez stated that listening to patients and meeting them where they are can help guide a systems approach to digital expansion.
Currently, the system estimates its patient portal utilization to be between 35-45%, with some variation according to location. For example, New Orleans has the highest utilization for the patient portal of all the regions the system serves, while patients in areas like Lafayette prefer to manage their care by phone.
According to Benitez, the system’s new pay by phone option has captured several thousand calls since launching in January.
“Us putting mechanisms into the platforms that our patients are choosing yields [higher] utilization and a better experience for our patients,” he said.
The fiscal year 2025 IPPS proposed rule calls for a 2.6% increase to Medicare payments for hospital inpatient care. This payment update reflects a hospital market basket increase of 3.0%, and would increase hospital payments by $2.9 billion.
However, some hospital groups are saying it’s not enough.
The cost of care has steadily increased since the COVID-19 pandemic, with systems and providers alike calling for higher rates. The prices of drugs and medical equipment continue to rise due to inflation, and the ongoing labor crisis continues to strain system’s finances causing disatisfaction with the 2.6% increase.
Similar concerns were brought up in August, when CMS finalized the FY 2024 payment increase.
“The AHA is deeply concerned with CMS’ woefully inadequate inpatient and long-term care hospital payment updates,” Ashley Thompson, AHA senior vice president for public policy analysis and development, said in a statement. “The agency continues to finalize rate increases that are not commensurate with the near decades-high inflation and increased costs for labor, equipment, drugs and supplies that hospitals across the country are experiencing.”
With these persisting economic challenges, it’s clear that executives can no longer rely on rate increases to level out their financial margins.
Patients are able to access their health information and make payments with ease through the system's patient portal.
From allowing patients to communicate with their providers, to viewing test results and making payments at their convenience, patient portals make up a significant portion of the patient experience.
Over the last decade, Ochsner Health began efforts to expand the system’s digital front door strategy. The system had been sharing billing statements and other information with patients through MyOchsner, its patient portal, but the onset of the COVID-19 pandemic in 2019 expediated these efforts as social distancing impacted patients’ access to care.
According to Eduardo Benitez, director of physician payments at Ochsner, the pandemic forced them to revisit healthcare and the way they coordinate with patients.
“There’s so much patients can utilize, from scheduling visits, to interfacing and coordinating with their healthcare team,” Benitez told HealthLeaders, referring to the capabilities of MyOchsner. “Being able to request their prescription refills, pay their bill, and even being able to do a telehealth visit.
Patients also appreciate having their medical information readily available to them, said Pam Barker, patient accounts supervisor at Ochsner. She added that a team manages the portal which is integrated with the system’s electronic health records platform, and there are smaller teams that oversee specific areas.
Benitez estimates the system’s portal utilization to be between 35-45%, with different factors coming into play, like the patient’s location and the department they want to interact with.
“With patient accounts and customer service, we can get upward of 6,000 easy requests per month just through the digital platform,” he explained. “The usage of it for [prescription refills] or maybe scheduling visits is probably a higher utilization.”
Looking at patient location, utilization varies regionally with some patient populations. According to Barker, New Orleans has the largest utilization for MyOchsner, while patients in areas like Lafayette prefer the system’s new pay by phone option. Since its implementation in January, the system has captured several thousand calls, Benitez said.
The growth of the system’s digital presence has increased the importance of protecting patient information.
“There’s quite a few back-stream methods in place, whether it be in [our EHR platform], within the portal, or even within our site to monitor for any suspicious activity,” Benitez said.
For example, in the event that a patient loses their portal password, they must verify their identity before they’re able to reset it. Similar identity verification efforts are used for employees.
“Any employee that is accessing a patient’s account has to add a notation to it on what [they] were in the account for,” Barker said.
Some federal agencies have voiced their concerns about medical payment products potentially taking advantage of patients.
With patients covering more of their health costs, health systems have begun efforts to make their billing and payment processes as easy as possible, from accepting cash-sharing applications as a payment method, to payment and financing options where the balance can be paid off over a period time with little interest added, if any.
Despite the flexibility that financing and payment plans offer, concerns have been raised about their rise in prevalence and systems potentially taking advantage of patients.
A new study from researchers at the University of Southern California revealed that while many hospitals promote different medical payment products (MPPs), of the 20% random sample of hospitals used for the study, fewer than one in 10 promote them to patients. The sample included nongovernment, short-term general, and surgical hospitals.
Non-profit institutions with high rates of uncompensated care costs were found to be more likely to promote interest-bearing payment plans, while interest-free payment plans were more commonly offered by 87% of facilities in the study.
While the use of MPPs doesn’t appear to be overtly predatory, that doesn’t mean systems should be nonchalant about their utilization.
Last summer, the Consumer Financial Protection Bureau, alongside CMS, HHS, and Department of the Treasury, issued a request for information regarding “medical credit card, loans, and other financial products used to pay for health care.”
Price transparency and estimates have assisted in increasing transparency for patients regarding what they’re paying for, as well as ensuring billing statements are simplified in a way that patients can understand.
“Healthcare billing continues to be a complex process especially since you have the provider, patient, and payer all involved,” Chris Johnson, vice president of revenue cycle at Atrium Health, previously told HealthLeaders.
“Quite frankly, when some patients see an insurer’s use of CPT and ICD-10-CM codes, it can be like a foreign language, and it can cause real confusion.”
The first quarter of 2024 brought more attention to Medicare Advantage and its rapid growth.
From financial incentives being given to brokers enroll consumers in the program, to CMS taking a closer look at the ways payers use AI and algorithms in their processes, there’s much to consider and critique when it comes to Medicare Advantage.
Now, with the Center for Medicare and Medicaid Services’ finalizing pay rate increase, payers are concerned about protecting their profits.
Here are four HealthLeaders articles from Q1 to get you caught up on all things Medicare Advantage.
While popular among consumers, the Medicare Advantage program is straining itself. The program is catching up to traditional Medicare enrollment numbers, costing the government around 6% more per member.
Aggressive broker marketing, where brokers are given financial incentives to enroll individuals into MA plans, is also contributing to the program’s overpopulation.
Health systems have begun pushing back against payers regarding Medicare Advantage for a number of reasons including low reimbursement rates and substantial amounts of denials. As a result, some organizations have terminated these contracts because they can’t afford to maintain them if things don’t change.
“There is rarely one final straw, but rather, a cumulation of events that negatively impact the fiscal viability of the relationship,” Britt Berrett, managing director and teaching professor at Brigham Young University and former HCA CEO, told HealthLeaders.
Much like health systems, payers have begun implementing AI solutions into their operations. CMS warned payers that any AI solutions and algorithms they use must adhere to internal benefits requirements and nondiscrimination rules.
“We are concerned that algorithms and many new artificial intelligence technologies can exacerbate discrimination and bias,” CMS stated a memo. “MA organizations should, prior to implementing an algorithm or software tool, ensure that the tool is not perpetuating or exacerbating existing bias, or introducing new biases.”
Last month, the consulting firm McKinsey & Company pinpointed five notable trends surrounding Medicare Advantage, including the growing aging population, expanding special needs plans, and increasing regulation around third-party marketing and broker organizations. MA plans aren’t as profitable as they’ve been in the past and payers are looking to protect their profits.
Payers will have to work harder to protect their profits.
CMS finalized the proposed rule for a 3.7% payment rate increase to Medicare Advantage (MA) plans, raising concerns for insurers over the implications.
The rate increase, as well as a 0.16% decrease for MA benchmark payments, will go into effect January 1, 2025.
When the changes were announced at the beginning of the year, payers expressed concern over the rate increase and its potential to affect their profits. One argument is that CMS didn’t consider the high utilization of MA plans and the way it impacts payers’ spending.
In a letter to CMS last month, AHIP (formerly known as America’s Health Insurance Plans) expressed their member’s concerns about the estimated growth rate—at the time 2.44%—and how it contrasted with the findings of survey they conducted which reflected a 7% growth rate.
Similarly, a Berkeley Research Group analysis suggests that the growth factor is closer to 4-6%.
“It is important to note that the Medicare Advantage and Part D programs are already undergoing a number of significant regulatory and legislative changes,” AHIP president and CEO, Mike Tuffin, said in a statement on the rate announcement. “Moreover, the cost of caring for Medicare Advantage beneficiaries is steadily rising.”
Despite complaints from payers, the impact of the rate increase to their profits may not be as bad as they’re thinking. In its initial proposal announced in January, CMS stated that federal payments to Medicare Advantage plans are estimated to increase by 16 billion from 2024 to 2025.
Post acute providers, like skilled nursing facilities, also made their voices heard after the rule’s finalization. In a statement Katie Smith Sloan, president and CEO of LeadingAge, an association of nonprofit, mission-driven aging service providers, acknowledged that CMS pays more for Medicare coverage provided to beneficiaries through MA plans than fee-for-service Medicare.
However, these plans pay providers in skilled nursing facilities and home health agencies less than if a member had received care in Medicare FFS.
“Overpayments to plans also siphon off funds faster from the Medicare Trust Fund, leading to earlier insolvency concerns,” Sloan said.
Pictured: Lynn Ansley attends the 2024 Revenue Cycle Exchange.
