Department demonstrates big financial impact
Staff training isn't skimped on
Does your hospital include specific questions related to patient access when measuring patient satisfaction? If not, consider changing this so the revenue cycle is addressed, recommends Frank Danza, vice president of revenue cycle management at North Shore-Long Island Jewish Health System. "The revenue cycle plays an important function in patient satisfaction. I believe that patient satisfaction scores should be referenced as they relate to patient access," says Danza.
"Using some of the standard forms that are out there, you don't necessarily have questions that are specific to your patient access department," says Danza. "So you can either amend them, adjust them or create your own."
Danza argues that the revenue cycle holds the first point of contact, which is patient access, and the last point of contact, which is the collection on the bill.
"So if revenue cycle is not putting its best foot forward, we are starting the patient off with a bad attitude, or we are leaving them with a bad taste in their mouth at the end," says Danza. "I believe that patient satisfaction at both the front end and the back end is important."
Data show financial impact
Danza's department collects data on registration accuracy, insurance verification, and the number of authorizations secured. "We measure all of these on a daily basis, and every single one of those translates into financial benefits to the organization," says Danza. "As we ramped up our insurance verification rates, our authorization secured rates, and accuracy rates, we watched our bad debts come down."
By maintaining increased accuracy rates, "there is a financial impact in that every day," says Danza. "You have the ability to maintain your bad debts at the level that you set your target at."
Danza says that the department measures its bad debts as a percentage of gross charges. "If your facility is running at 3% of gross charges and I implement certain front-end functions and through that I've demonstrated that I can bring my bad debt down to 1.5%, then next year these processes give me the ability to maintain my bad debt at 1.5%," says Danza. "I'm not adding more, but I'm sustaining a low level of bad debt."
The department publishes a set of metrics around its denials and uncollectable accounts, including its historical performance and goals for the coming year. "Unless we have specific initiatives around our bad debt, we would make our goal equal to what it was last year," says Danza. Those data are tracked and reported to senior leadership.
"So if I was down to 1.5% last year and I run 1.5% this year, even though the report shows I'm not contributing more, what I'm contributing is another year that I'm not at 3%, I'm at 1.5%," says Danza. "You have to instill that mentality, and constantly report how you are doing in those categories."
Become more efficient
When it comes to budget cuts and "doing more with less," Danza says that there is no department in the hospital that has been overlooked. Each department is making sure that it is operating as efficiently as possible, and patient access is no exception.
"The approach we are taking, in all departments, not just our revenue cycle, is how can we be more efficient, and how can we do more with less not how can we slash and burn a department or stop doing things that we currently do," he says.
To date, the access department has not been targeted for staff reductions. "The places we are looking to become more efficient are things like electronic posting of cash," says Danza. "Where we can eliminate the effort of manually posting cash, we can re-deploy those resources to more effective activities."
The department is establishing direct electronic links with its payers. "Since we already have technology that directly links to our payers so we can submit our claims to them, it doesn't require additional software or hardware to get it done," says Danza. "What it does require is work effort to test those transactions, to make sure they are working before we go live on it."
This requires an investment from the department, not of hardware or software, but of time and energy to make sure the transactions work correctly.
The department doesn't have any particular system or technology it is looking to implement right now, but it is looking to consolidate its platforms. "We are still not on one billing platform for the entire health system," Danza explains. "We have a couple of hospitals that we need to migrate onto our system of choice. Those are in the pipeline we have one going on right now and one scheduled over the next couple of years."
Danza says that while the department is certainly watching how it spends its capital very closely, the recession hasn't had a direct impact on any planned investments in technology.
"We have always had to demonstrate a return on investment [ROI]," says Danza. "When we implemented some of our patient access processes and tools, and have done other things to reorganize our business office and add collection and follow-up tools, we have always brought ROI into those decisions." Typically, ROI is related to reduction in A/R or claims denials.
If a patient access department cuts training and staff education, Danza says instead of doing more with less, "you end up doing less with more and shortcutting the organization."
Danza says that most of his training cost involves the "shadowing" done by new hires during on-the-job training. "If I bring a new patient access rep on, I'm not getting full use of that person until they've been shadowed for two to five weeks. But we don't shortcut that. Because if you do that, you really can debilitate yourself in not too much time."
Danza says that he considers these "training efforts," as opposed to "training costs." It's important, he says, to "have the discipline to continue our relationship between the revenue cycle and our managed care department, and effectively inservice our staff. If you allow yourself to have open positions or vacancies, you cut yourself thin on your ability to do that."
Routine meetings are held between the hospital's managed care department and revenue cycle directors. Unit meetings are held on a weekly basis, with varied agendas. "It might be problems we are having with an increase in denials, or an inservice on what changes are coming down and how we're going to deal with them," says Danza. "If there is additional training that needs to happen, we make sure we do that."
[For more information, contact:
Frank Danza, Vice President, Revenue Cycle Management, North Shore-Long Island Jewish Health System. E-mail: [email protected].]
Does your hospital include specific questions related to patient access when measuring patient satisfaction?You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content