Take leading role in contract process
Upfront access participation is key
By Jack Duffy, FHFMA
Corporate Director
Patient Financial Services
ScrippsHealth, San Diego
How many times have we as access managers been called by the business office regarding our failure to make the third "patient admitted" call, only to find out that the contract was changed six months ago?
This all-too-frequent occurrence is symptomatic of the lack of partnership between those who negotiate contracts and those who have to comply with an ever-changing contract environment.
For the most part, health care organizations sign contracts whose terms and conditions were prepared by the insurance company. These documents are written for the protection of the insurance company and often are full of restrictions that have a financial penalty.
There are several steps every access department should take to ensure the organization gets the best value for its contracts. They include:
1. Volunteer.
Be an active part of the contract committee. Go to the meetings and let your colleagues know what works and what doesn’t work.
2. Measure, measure, measure.
Keep track of failed accounts and report to the contract committee each month. Most patient accounts systems establish a coded transaction for things like "administrative write-off" or "adjustment." Learn those codes and how they relate to access. There’s often a very direct correlation between the complexity of the contract and the error rate.
3. Network.
Use your professional contacts to determine what works in contract construction. Discuss items in general terms and do not disclose prices. Report particularly onerous terms to your senior management and to the local or state health care councils.
4. Just say no!
If you believe a contract term is so difficult and complex that your department will often fail to comply, just say no. Lay out your objections in a logical way and make your case. A contract usually has dozens of terms that can be negotiated. Leave the ones that cannot be fulfilled at the table.
5. Training.
The key to a successful patient financial services function is training. The most important moment in an account’s history is the point of service. Take the time to thoroughly train on every new contract. Each year, retrain the staff on the most common contracts and on any contract that has a significant error rate.
6. Timing.
This is another critical factor. As referenced at the beginning of this article, it is of little value to learn of a new contract six months late. Make it a departmental service standard that all contracts are reviewed by access before they are signed. It is relatively easy to change a poor term prior to signing, but try to find someone willing to reopen a contract after months of negotiations. The consequences of missing a review date could be years of frustration because of a poorly constructed contract.
7. Reference material.
There are times when we must believe that a photographic memory is required for access management. Look for innovative ways to share contract terms with the staff. At ScrippsHealth, we are in the process of scanning 75,000 pages of contracts into the Intranet. This will allow six-second access to any page in our contracts. We also have created a CD-ROM for all contract summary pages. This allows items like co-pays and contact numbers to be only a mouse move away.
A few words about empowerment: As I work with access managers across the country, I often hear legitimate complaints about not having a voice in how policies and procedures are developed. While there is positive news in some organizations, the lack of participation is still too com - mon. Meet with your chief financial officer and administrator frequently to offer your assistance in contract construction. Come prepared to show the financial advantages of well-thought-out contracts. Keep your commitment to measurement. After a few successful rounds, you will find yourself a trusted member of the contract team.
(Jack Duffy serves as consulting editor for Hospital Access Management.)
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