Bama Chatter

Meet Matt James

1.       Tell us a little about your work and education background, where you’re from, hobbies, family and pets?

My name is Matt James and I am originally from Montgomery, Alabama. Every job that I have held have all been in the medical field and I began my career my senior year in high school. While most of my experience is in registration I have also worked in medical records, precertification, scheduling, and really enjoyed being an Inpatient Physical Therapy Tech during college in Mobile.

I graduated from Troy University in 2014 with a Bachelor degree in Business Administration Management. I am planning to begin a Masters in Leadership and Organizational Effectiveness this summer.

In my free time, I enjoy spending time with my family and friends, hunting, playing softball, singing karaoke, working with youth and Alabama Football!! My family includes my mom, my younger sister, my brother-in-law and three wonderful nieces! I have one pet, a yellow lab named Jackie. For the past 14 years I have been a part of Central Alabama Chrysalis which is a three day Christian experience for youth ages 15-19. Chrysalis has been a very big part of my life from going through my original flight when I was 15 years old, to working on many conference room teams, to now serving as the Community Lay Director.

2.       Where is your favorite place to vacation and why?

I love the water but I also really enjoy going to the mountains. My favorite place that I have vacationed is probably between Cozumel and Pigeon Forge. We took a family cruise to Cozumel and it was a blast and I have been to the mountains several times. Both have always been a very relaxing time for me! Anywhere that I am with my family or friends are always a great time!

 

3.       What is your favorite thing about living in your current location?

I currently live in Birmingham, Alabama. I have only resided here for a year but I love Birmingham! I knew early on in life that I wanted to be a part of the medical field and Birmingham has always been where I wanted to grow professionally.

 

4.       What keeps you up at night in relation to current healthcare issues?

If one thing about healthcare keeps me up it would be exactly what I deal with daily, insurance. I think that insurance is misunderstood by a lot of people. In my role, I get to help patients understand the breakdown a little bit more daily and that is rewarding to me. Insurance plays such a huge role in healthcare that I feel like everyone should be more knowledgeable of the topic, regardless of their carrier.

5.       Tell us one thing we don’t know about you that you’re willing to share?

One thing that not very many people know is that I passed up a once in a lifetime trip to Australia while in school because I was afraid to fly! Still to this day I have never flown, however I am looking to plan a trip soon that will involve a plane ride!

CPAR In Picture

 Deborah Holder, Jessica Butler, Catherine Muir, Jacqueline Singleton  Grandview Medical CPAR recipients that earned their CPAR this year in Birmingham.

Deborah Holder, Jessica Butler, Catherine Muir, Jacqueline Singleton

Grandview Medical CPAR recipients that earned their CPAR this year in Birmingham.

 Angela Shelton, CFO at Jack Hughston Memorial Hospital earned her Advanced CPAR in 2016.

Angela Shelton, CFO at Jack Hughston Memorial Hospital earned her Advanced CPAR in 2016.

 Carissa Ramos-Lopez, Chelsea Wiley, Victoria Dozier earned their CPAR at the Phenix City testing site in December

Carissa Ramos-Lopez, Chelsea Wiley, Victoria Dozier earned their CPAR at the Phenix City testing site in December

 Medco ladies that passed the exam in 2016 in Huntsville.  (L to R) Clara White, Beth Murphy, Amanda Lenderman.   

Medco ladies that passed the exam in 2016 in Huntsville.

(L to R) Clara White, Beth Murphy, Amanda Lenderman.

 

Are you certified?

The Alabama Chapter of the Healthcare Financial Management Association is one of two states left offering the CPAR (Certified Patient Account Representative) Program.  The CPAR test is held on number dates at numerous locations throughout the state.  The certification covers a variety of topics but gives an overview of the entire patient experience through the Revenue Cycle.  In the year of 2016, we had 219 participants to test which resulted in 202 new CPAR recipients.  Of these new recipients, we had one to make a perfect score.  Congratulations to Shonda Blevins.  We had 89 recipients to score a 90 or above with two scoring a 99; great job Aria Smith and Thomas Clark.  The Alabama Chapter has a great certification committee that takes pride in coaching and developing the participants to prepare them for the CPAR test.  I would like to thank each team member for their time and support teaching the classes throughout the state:  Birmingham (Gail Harris, Sharon Petty, Matt James), Dothan (Erika Chancey), Huntsville (Deborah Oresteen, Donna Alldredge, Miranda Cottrell), Montgomery (Rhianna Arnold, Jessica Cherry),  and Phenix City (Amanda Norton).

 

The chapter also offers the Advanced Certified Patient Account Representative.  This program provides ongoing educational resources that will allow our representatives to continue their professional knowledge, develop leadership skills, promote career laddering, and provide support to CPAR recipients in all healthcare settings.  After you have obtained the CPAR, you can achieve the ACPAR by attending five Alabama or National HFMA events during the course of a two year period.  Once this has been completed, you can apply for your certificate.  During 2016, we had three recipients of the ACAPR:  Matt James, Angela Shelton, and Annette Fields.

 

The Certified Revenue Cycle Representative (CRCR) is the first of the National HFMA certifications.  This certification will allow one to be better prepared to increase receivables, reduce denials, and work more efficiently; all while earning their organization high patient satisfaction scores.  The program has been redesigned and is available online 24/7 and can be taken from the comfort of your home.  This certification is filled with new, essential information on best-practice approaches for the patient-centric revenue cycle.

 

The Certified Healthcare Financial Professional (CHFP) has been updated by National HFMA to provide the broad range of business and financial skills essential for succeeding in today’s high-value healthcare environment.  The new CHFP is geared toward financial professionals, clinical and nonclinical leaders, and payers; all those whose jobs require a deep understanding of the new financial realities in health care.  The CHFP program includes two modules and both modules must be successfully completed to earn the CHFP.  If you are an active member of the Alabama Chapter of HFMA, we will reimburse you the cost of the certification upon successful completion.

 

The ultimate certification that all our members should be setting to include on their resume is the Fellow of the Healthcare Financial Management Association (FHFMA).  As recognized industry leaders, HFMA Fellows act as ambassadors to the profession by raising the standard of practice through consistent participation in professional development activities and service to the healthcare finance industry.

 

 

If you have questions about any of these certifications, please feel free to contact me by phone or email.

 

If not, let the certifications begin…..

 

Wanda

 

Wanda A. James

System Director, PFS-Hughston

Certification Chair, AL HFMA

334.732.3952

wjames@jhmhospital.com

 

 

Maintain Accurate Medical Records

Maintain Accurate Medical Records

A medical record is crucial to the defensibility of a case; occasionally it can be the biggest hurdle. The primary purpose of a medical record is to provide a complete and accurate description of the patient’s medical history. This includes medical conditions, diagnoses, the care and treatment you provide, and results of such treatments. A well-documented medical record reflects all clinically relevant aspects of the patient’s health and serves as an effective communication vehicle.

The medical record also has a critical secondary function: it is the most important piece of evidence in the successful defense of a medical professional liability claim. On average, a medical malpractice lawsuit takes five years to resolve.[1] Most physicians cannot recall specific patient encounters from several years ago—so it is important to have accurate, thorough, and timely documentation of all your patient encounters.

Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

Good medical record documentation includes, but is not limited to, the following elements:

1.      Legible – If your handwriting is not legible, consider dictating your notes.

2.      Timely – Most electronic medical record systems document the date and time of all entries. If you still use paper records, note the date and time of each entry, with an accompanying signature or initial. It is best to chart patient encounters either contemporaneously or shortly after the visit for more accurate and thorough documentation.

3.      Accurate – Ensure your documentation accurately reflects what occurred during a patient encounter.

4.      Chronological – Documentation is more easily understood when it is sequential by date and logical in process. The SOAP (subjective, objective, assessment, plan) format, or something similar, is suggested when documenting patient encounters. A logical, clear thought process is compelling evidence to present to a jury. 

5.      Thorough – The old adage “if it’s not documented, it didn’t happen” still applies today. It is challenging to show something happened if there is no documentation to support that assertion.

6.      Specific and objective – Make documentation as specific as possible (e.g. using actual measurements rather than descriptors such as “small” or “large” in size).

Additions, corrections, or addendums may be pertinent in certain situations, but altering a medical record is strongly discouraged. It will destroy your credibility in the eyes of a jury and cast doubt on the legitimacy of the entire chart. Alterations include modifying accurate information for fraudulent or self-serving reasons. 

To properly correct a written chart, strike a single line through incorrect information, leaving it readable. Then make the correction or addition as needed. Be sure to authenticate the change with a time and date, along with your initials or signature. In the event of litigation, be prepared to be questioned about any changes made to the patient’s chart—especially if they occurred after the incident in question or suit was filed.

Follow the same authentication principles in electronic records; consider using a “strikethrough” function rather than deleting information. Making any corrections or additions to a medical record after a claim or lawsuit has been filed—or after receiving notice a claim or lawsuit may be filed—is strongly discouraged. These actions will likely be viewed as self-serving and could severely undermine your defense.

 

 

[1] Suszek A., “How long will it take to settle your medical malpractice case?” <http://www.alllaw.com/articles/nolo/medical-malpractice/how-long-settle.html>, accessed on October 31, 2016.

The True Cost of Non-Compliance

With the constant emergence of new standards and regulations across all areas of health care, hospital and health system leaders are working hard to ensure that they have effective compliance programs in place. Compliance is an active process that entails staying abreast of regulations, maintaining relevant policies and procedures, implementing continuous training and professional development, and dealing with discipline and breaches when necessary. The process is arduous, but the consequences for noncompliance are exponentially worse.

According to a 2014 survey, about one-third of healthcare providers estimate their total annual budget for compliance to be $1 million to 5 million.a Thirty-eight percent state that their compliance budget has increased in the past year, and 52 percent state that it has stayed the same. The cost of compliance makes a compelling argument for investment in a strong program. Across industries, a compliance program costs about $222 per employee, versus the $820 per employee for non-compliance.b Two factors are responsible for the high costs in the latter case: poor patient outcomes and litigation.

Costs of Poor Patient Outcomes

A 2010 study examined the costs of Methicillin-resistant Staphylococcus aureus (MRSA) infections among patients who acquired the infection as a result of a nurse’s lack of compliance with a hand hygiene policy.c The study found that a 200-bed hospital incurs $1,779,283 annually in MRSA-infection-related expenses, directly attributable to hand hygiene noncompliance. A 1 percent increase in hand hygiene compliance resulted in annual savings of $39,650 for the hospital.

Costs of Litigation

In 2014, New York-Presbyterian Hospital and Columbia University paid a combined $4.8 million to the Office of Civil Rights (OCR) to settle a 2010 HIPAA violation. The breach occurred when a physician tried to deactivate a personal computer that was connected to the hospitals’ shared network. The protected health information (PHI) of 6,800 patients, including vital signs, medications, and lab test results, was compromised. The OCR’s investigation found that neither hospital had conducted an adequate risk assessment or documented a risk management plan for their IT systems that access PHI. Neither did NewYork-Presbyterian Hospital have appropriate policies and procedures in place for authorizing access to its database. The hospitals paid the settlement, and both agreed to a corrective action plan.

In addition to the financial costs of noncompliance, there are intangible costs as well. A lack of compliance can lead to a loss of accreditation, resulting in a detrimental impact on the hospital’s reputation. If a provider has had a breach of PHI of more than 500 residents of a state, media outlets must be notified, further damaging a hospital’s reputation and potentially bringing about a loss of trust among patients, staff, and the wider community. Recent research found that 65 percent of patients would consider changing providers after a HIPAA data breach.d

A well-organized approach to managing compliance is the most critical component to mitigating risk exposure. Over the past five years, both the industry and most leading analysts have deemed effective compliance programs and strategies such as policy management to be the nucleus of a sound governance, risk, and compliance strategy.

Implementing an electronic, cloud-based policy management program is one proactive method to invest in compliance. Such a system can aid a hospital each step of the way, from writing policies and procedures that reflect current standards and regulations, to training and disciplining employees, and managing breaches. There are, unfortunately, no shortcuts to executing an effective compliance program. It requires continuous monitoring, evaluation, and improvement. But in today’s healthcare environment, an investment in compliance pays off in spades.

Saud Juman is the President and CEO of PolicyMedical in Richmond Hill, Ontario, Canada.

Mitigating Risk—Five Key Areas of Focus

Healthcare liability insurers cannot tell physicians or midlevel providers how to better practice medicine or avoid surgical mistakes—but can offer guidance that can help you mitigate risk. Here are five key areas to focus on that can help protect your practice.

Use Technology with Caution

Healthcare looks very different than it did 25 years ago. Physicians are using tablets, smartphones, interactive apps, and other electronic means to provide efficient healthcare to patients.

According to several sources, between 75 and 85 percent of physicians use a smartphone or tablet for professional purposes.[1] Uses include email, research, EMR entry, x-ray review, telehealth, and more. While electronic devices have many benefits, their use presents new risks.

Chief among these risk exposures is the increased possibility of a HIPAA violation. While a HIPAA violation is not the same as a malpractice claim, it can still negatively impact you and your practice, staff, and patients.

HIPAA concerns arise in several areas of electronic device use. Losing a device may allow an individual access to protected health information (PHI) stored on the device. If the device is not properly encrypted or secured, an individual may access PHI through apps, email, or hacking into a system using the device’s connectivity.

Another risk arising from mobile electronic devices involves app usage. There are approximately 26,000 healthcare apps available, and 7,400 of those apps are marketed to physicians.[2] Somewhat surprisingly, the FDA has only approved 10 healthcare apps as of July 26, 2016.[3]

One physician wrote about a blood pressure app he was using that gave inaccurate readings. When he contacted the app’s developer, he was told the app was in the “beta-testing stage” and intended for “entertainment purposes only.” Despite this information, the developer was selling the app to end-users—without any disclaimers or mention of its test status.[4]

Healthcare providers need to be vigilant when deciding whether to use certain apps. Research the app’s usage and do preliminary testing to ensure its accuracy. Use the app, then verify the results with traditional testing until the physician is satisfied the app’s results are accurate. Another suggestion is to contact the app’s developer and request testing/clinical trial results on its accuracy.

Use of smartphones, tablets, laptops, etc., in healthcare becomes more main stream every day. Be sure you are proactive in mitigating the accompanying risks. You may need to contact an IT security specialist to help ensure you are managing potential risks as effectively as possible.

Track and Follow up on Your Tests

Missed or delayed diagnosis is one of the most often litigated allegations in medical malpractice.[5] These claims often result from tracking and follow-up procedure failures.

Lab testing is one of three key areas (the others are referrals to specialists and missed/canceled appointments) where tracking and follow-up are vitally important. A retrospective study researched the frequency of patients not being informed of test results, concluding there was a 7.1 percent failure rate.[6] Tracking and follow-up procedural safeguards can be implemented and have a large impact on potential liability claims.

A reliable test tracking and follow-up system ensures the following steps occur:

1.      The test is performed.

2.      The results are reported to the practice.

3.      The results are made available to the ordering physician for review and sign-off.

4.      The results are communicated to the patient.

5.      The results are properly filed in the patient’s chart.

6.      The results are acted upon when necessary.

Here are some suggestions for improving your process:

·         Route all test results to the ordering physician for review. Procedures to ensure the ordering physician receives each and every test result can help lessen the risk of a result “falling through the cracks.” Something as simple as a log book or email notification can help facilitate physician review.

·         Ask the ordering physician to review and sign off on each ordered test result. Physicians order lab tests for specific reasons; physicians are encouraged to sign or initial each test result following review.

·         Notify your patients. Several practices notify patients only when there is an abnormal result. Some practices choose to send a letter for normal results and call the patient for abnormal results. Others call patients with all results. In today’s technology-driven world, an email may be appropriate for normal results, or an email directing patients to a portal where results can be reviewed. Patient notification of all test results is advised—however your practice chooses to do so.

Ensuring all tests ordered by your physicians are handled a consistent manner will help avoid tracking and follow-up errors.

Set and Review Policies and Procedures

A policy and procedure manual is an important tool for defining practice operations. In well-run practices, there is one set of rules every staff member understands and follows. The alternative is risky—procedures that vary from physician to physician or between staff members make it easy for errors or omissions to occur.

Develop a comprehensive manual of specific policies and procedures that explains how tasks are performed in your office, and make it readily available to all staff. It’s important for staff to review and initial that they have read and are aware of these policies and procedures.

The following is a list of suggested topics to address in your policies and procedures manual:

1.      Clinical Protocols/Patient Care

2.      Patient Relations and Confidentiality

3.      Health Information Management (Medical Records)

4.      Laboratory (Test Tracking and Follow-up)

5.      Radiology

6.      Appointment Scheduling

7.      Patient Tracking and Follow-up

8.      Infection Control

9.      Human Resources

10.  Practice Operations

11.  Special Procedures

12.  Safety

You may need to add or subtract certain topics to best address the specific areas of your practice. Maintain Accurate Medical Records

A medical record is crucial to the defensibility of a case; occasionally it can be the biggest hurdle. The primary purpose of a medical record is to provide a complete and accurate description of the patient’s medical history. This includes medical conditions, diagnoses, the care and treatment you provide, and results of such treatments. A well-documented medical record reflects all clinically relevant aspects of the patient’s health and serves as an effective communication vehicle.

The medical record also has a critical secondary function: it is the most important piece of evidence in the successful defense of a medical professional liability claim. On average, a medical malpractice lawsuit takes five years to resolve.[7] Most physicians cannot recall specific patient encounters from several years ago—so it is important to have accurate, thorough, and timely documentation of all your patient encounters.

Good medical record documentation may help prevent a lawsuit. Your defense team may be able to disprove a patient’s assertions if the physician has thoroughly and accurately documented the patient encounter.

Good medical record documentation includes, but is not limited to, the following elements:

1.      Legible – If your handwriting is not legible, consider dictating your notes.

2.      Timely – Most electronic medical record systems document the date and time of all entries. If you still use paper records, note the date and time of each entry, with an accompanying signature or initial. It is best to chart patient encounters either contemporaneously or shortly after the visit for more accurate and thorough documentation.

3.      Accurate – Ensure your documentation accurately reflects what occurred during a patient encounter.

4.      Chronological – Documentation is more easily understood when it is sequential by date and logical in process. The SOAP (subjective, objective, assessment, plan) format, or something similar, is suggested when documenting patient encounters. A logical, clear thought process is compelling evidence to present to a jury. 

5.      Thorough – The old adage “if it’s not documented, it didn’t happen” still applies today. It is challenging to show something happened if there is no documentation to support that assertion.

6.      Specific and objective – Make documentation as specific as possible (e.g. using actual measurements rather than descriptors such as “small” or “large” in size).

Additions, corrections, or addendums may be pertinent in certain situations, but altering a medical record is strongly discouraged. It will destroy your credibility in the eyes of a jury and cast doubt on the legitimacy of the entire chart. Alterations include modifying accurate information for fraudulent or self-serving reasons. 

To properly correct a written chart, strike a single line through incorrect information, leaving it readable. Then make the correction or addition as needed. Be sure to authenticate the change with a time and date, along with your initials or signature. In the event of litigation, be prepared to be questioned about any changes made to the patient’s chart—especially if they occurred after the incident in question or suit was filed.

Follow the same authentication principles in electronic records; consider using a “strikethrough” function rather than deleting information. Making any corrections or additions to a medical record after a claim or lawsuit has been filed—or after receiving notice a claim or lawsuit may be filed—is strongly discouraged. These actions will likely be viewed as self-serving and could severely undermine your defense.

Keep Your Team Trained and Informed

Office staff is a critical component of a medical practice. Patients often have more interaction with staff than physicians. Properly trained and educated staff can be strong protection against a professional liability claim. Consider the following risk tips for office staff issues:

·         Prepare written job descriptions for all staff. Review each staff member’s job description at his or her annual performance evaluation to determine whether the description accurately reflects the individual’s responsibilities and capabilities.

·         Ensure each staff member works within the boundaries of state laws regarding appropriate job functions.

·         Provide clear instructions to your staff on the amount and type of advice they may relay to patients and limitations on such advice.

·         Establish a formal orientation period for new employees. Include a review of administrative practices, emergency medical procedures, and clinical skills and responsibilities.

·         Establish procedures to ensure professional staff are credentialed.

·         Educate all employees on patient confidentiality and have them sign a confidentiality agreement annually.

·         Document employee training, including clinical competency, credentialing, performance evaluations, and annual reviews in employees’ personnel files.

·         Conduct regular staff meetings with designated agendas.

·         Provide frequent feedback (both positive and negative) to staff.

·         Ensure tasks are delegated to staff with the appropriate education, training, and experience to perform the task.

While the risk of a medical malpractice claim can never be eliminated, the information provided herein will help you reduce your practice’s risk of a claim. If you have a specific question regarding your practice, please contact an attorney.

 

 

 

[1] “Mobile Officially a Staple in the Doctor’s Office,” March 26, 2015, <http://www.emarketer.com/Article/Mobile-Officially-Staple-Doctors-Office/1012271>, accessed on October 11, 2016.
“Professional usage of smartphones by doctors in 2015,” October 27, 2015, <http://www.kantarmedia.com/us/thinking-and-resources/blog/professional-usage-of-smartphones-by-doctors-in-2015>, accessed on January 30, 2017.

[2] Sher, D, MD, “The big problem with mobile health apps,” March 4, 2015, <http://www.medscape.com/viewarticle/840335>, accessed on October 13, 2016.

[3] “Mobile medicine resources: FDA approved apps,” July 26, 2016, <http://beckerguides.wustl.edu/c.php?g=299564&p=2000997> , accessed on October 13, 2016.

[4] Sher, D, MD, op. cit.

[5]PIAA Closed Claims Comparative: A comprehensive analysis of medical professional liability data reported to the PIAA Data Sharing Project,” 2015 Edition.

[6] Casalino, L.P., et al., “Frequency of Failure to Inform Patients of Clinically Significant Outpatient Test Results.”  Archives of Internal Medicine 169 (2009): 1123-9.

[7] Suszek A., “How long will it take to settle your medical malpractice case?” <http://www.alllaw.com/articles/nolo/medical-malpractice/how-long-settle.html>, accessed on October 31, 2016.

Using Analytics to Improve Patient Revenue

Carrie Romandine, VP of Solutions and Services, Apex Revenue Technologies

Patients are now responsible for hundreds of billions of dollars formerly paid to healthcare providers by institutional payers. Struggling to collect, many providers are applying analytical tools to improve the average yield from each patient statement while maintaining positive patient relationships.

In this article, we'll discuss six foundational metrics to track. By carefully monitoring these variables, healthcare providers can conduct controlled experiments to optimize results. But first, what are the preconditions for making this type of patient revenue cycle analytics successful?

To the extent possible, integrating systems and processes is an important preliminary step toward streamlining access to the financial performance data you need to measure results. In our experience, providers will not only experience significant initial improvements in financial results by integrating their patient revenue cycle tools, they will also establish the data framework they need for a clear view of which strategies are having the most positive impact on revenue and cost performance.

These preliminary steps often involve the electronic health records (EHR) system, patient billing platforms, online payment systems, patient portals, and financial communication tools used by patient-access personnel and call center staff. These early results can serve – in an encouraging way – to bring further institutional focus on meeting patient revenue challenges by analyzing revenue cycle data as a means to improve results.

For example, one large Southeastern health system experienced a $77 million reduction in cash collected from patients from one year to the next, together with an increase in bad debt and charity care from 29 percent of net patient revenues to 38 percent. These figures represented a severe decline in the health system's ability to collect cash from patients. The provider's revenue cycle team worked to streamline systems while adding flexibility. By integrating the way their billing and payment tools worked together, they were able to increase collection yield and lower billing-related costs.

Specifically, in the first six months after implementation, this Southeastern health system experienced a 10 percent improvement in collection yield, due to both e-payment increases and improved statement performance, which equated to an annualized increase of $1.3 million. They also saw a 10 percent decrease in statement costs, due to an overall decrease in the number of paper statements sent and the average number of cycles in which collection is required.

Once this kind of foundation is in place to provide visibility into the impact billing communications has on payment results, patient revenue cycle analytics becomes most useful. A flexible communication platform is also key, allowing a provider to use the messages within the various billing channels to get the right message to the right patients at the right time. Providers can apply “flexible logic” in the production of statements, eStatements, payment portals, etc., so that patient-relevant messages about payment plans, other payment options, and online payment portals are most likely to have an impact. In addition to taking into account the age of the patient's balance, the healthcare provider can optimize statements based on factors such as: balance due amount, payment plan status, prompt pay offerings, ZIP code, and other demographic information.

As a specific example, the statement message area could be dedicated to alerting the recipient to the availability of payment plans on statements with relatively high balances due. For lower balances, that message area could instead emphasize the availability of an online payment portal.

Analytics reveals the results of this type of fine-tuning. The revenue cycle team can review dashboard reports, identify challenges and opportunities, and continually optimize messaging, segmentation, channel communication strategies, and process changes based on results.

When implementing segmented messages and other patient-specific approaches, it's essential to measure the “before” and the “after.” The key to continued progress is to analyze key variables that drive success, which brings us to the six recommended foundational metrics:

1. Cash collected
What's pivotal to patient cash success is measuring cash collections from different angles. Patient cash aging buckets and collection aging buckets will highlight trends and successes in patient billing practices, and patterns in overall cash collected. This provides insight into areas of challenge and opportunity in patient billing and collections versus normal business cycles.
Establishing overall patient financial success in terms of the dollars collected, and dollars collected as a percentage of total dollars billed, is integral. The former may be impacted based on changes in patient volumes, payer mix, and the average value of services provided, and should be benchmarked as such.

2. Statement billing costs
Perhaps the most clear and simple indicator of payment performance is volume-based reduction in your statement print costs. Lackluster eStatement adoption and ePayment performance falls short in off-setting more costly printed communications. And slow payment performance among any or all patient segments drives added print costs incurred through multiple print cycles. 
It's important to understand the number of statements sent and the average number of billing cycles required to collect at both a macro level and by patient segment. Improvement tactics include patient segmentation, targeted messaging to drive patients to pay earlier, and use of alternative financial communication methods (i.e., patient access staff and text notifications) as part of the billing cycle.

3. eStatement performance
eStatements are important to billing and payment performance for two reasons:

·         Adoption of eStatements reduces your billing costs and overall cost to collect. 

·         Patients who opt in for eStatements tend to pay faster through integrated ePayment portals because of the convenience.

Therefore, key metrics to track include total enrollments, total electronic statements sent, and electronic statements sent as a percentage of total statements. Despite the convenience, adoption won't happen by chance. A multi-touch effort to drive eStatement adoption through one-to-one interactions and messaging on bills and portals is required.

4. Payment performance by channel
Research shows that patients tend to pay faster when they have access to payment options that are appropriate and convenient for them. Yet, not any one channel is right for all patients, so segmentation is a clear factor in this analysis. Patient access staff, printed bills, eServices, mobile devices, and telecommunication channels, such as call center agents and IVR technologies, are all tools in the tool belt that provide different value at different times for different segments.

So what to use and when? By understanding which channels are performing for which patient segments, you can better tailor messaging and present preferred options more appropriately to increase yield and drive down costs. Factors include speed to payment by channel, the percentage of overall payments by channel, and the amount collected as a percentage of total dollars billed by channel.

5. Revenue Performance
As you balance the use of paper versus electronic services appropriately, and target your financial messaging and channels of communication to the right patient segments, you'll begin to see costs go down and the speed to collect increase. The financial rewards are significant! Yet, the greater opportunity comes when you begin to move beyond cost-cutting measures and collection speed, and into overall revenue improvements.

Metrics to track include collection yield, percentage write-offs to bad debt, and percentage write-offs to charity care. Although these are likely metrics you track today, the goal is to watch them with a keen understanding of what strategies you are applying to drive improvements so you can see what's working and further refine your patient financial engagement tactics.

6. Other Billing-Related Costs
As your integrated patient billing and payment strategy pays off in increased revenue, the benefit will be a reduction in the fees paid for in some of the less cost-efficient back-end tactics used for collections, such as collection agency fees and customer service calls. Collection agency fees can be analyzed by patient segment. Customer service calls should be measured on the average fee per billed statement.

In conclusion, healthcare providers can achieve relatively fast improvements in meeting patient revenue cycle challenges by implementing a modern, integrated approach. From there, a combination of organizational focus and careful measurement of key variables brings further progress. The familiar adage, “You can't manage what you can't measure” applies well in the context of the patient revenue cycle. By focusing on key metrics, providers can achieve sustained progress in improving financial outcomes while also connecting with patients in ways that strengthen the patient-provider relationship and improve patient satisfaction.

Ms. Romandine leads Apex’s implementation and partner integration efforts, as well as customer support and product strategy. Apex is a patient revenue cycle solutions company that helps healthcare organizations Fit the Payment to the Patient™ to improve financial results and the patient experience. Contact her at cromandine@apexrevtech.com or visit www.apexrevtech.com.

Region V Update

Renee’s Region 5 Update

Happy New Year!  It’s hard to believe that the HFMA 2016-2017 chapter year is half over. Yet we still have a lot of important work to do including our big regional event – The Dixie Institute with a theme of #ThriveAtRegion5.  This year’s institute is hosted by the Georgia chapter in Savannah from March 21st - 24th, 2017.  For more information please visit the website www.hfmadixie.org.  I look forward to seeing many of you there.   

In November I attended the Regional Executive Counsel meeting in Chicago to represent Region 5.  The primary focus of this meeting was to evaluate the Chapter Balance Score Card (CBSC) and the metrics assigned thereto as well as chapter awards.  The CBSC is designed to assists chapters with goal setting and performance tracking of key chapter activities.

I’m excited to announce the following changes to the 2017-2018 CBSC:

·         The CBSC will no longer include elements for Certification, Membership Satisfaction, Board Composition, Days Cash on Hand, and DCMS On time Reporting.  However these elements will be reported to chapter leaders to ensure stability of chapter operations. 

·         The Membership metric has been significantly changed to measure two factors:

o   1.) Member Retention and

o   2.) Growth of new members from the target market segment of physicians, physician groups and health plans.

·         Technology has been added to the Innovation category by requiring chapters to implement the Group Ahead App.  HFMA National has contracted with Group Ahead to provide a mobile app for all chapters.  The app will include calendar of events, posting communications to members and messaging. 

CBSC elements that remain the same for 2017-2018 include Education, Innovation, and Networking.  The Regional Executive Council feels that these changes reflect the voice of the chapter leaders, and focuses on the HFMA strategic goals.  I am confident that the Region 5 chapters will succeed at meeting these goals. 

The Council also approved the recommendations of the Chapters 2.0 Task Force on The Role of Regional Executive.  The Task Force redefined the Role, Qualifications/Competencies and Responsibilities of the Regional Executive as well as the Selection Process.  The selection process will result in the Regional Executive Elect-Elect to be identified earlier in the chapter year thereby allowing additional mentoring time for the Regional Executives.  Additionally, the selection process will be standardized through an application and interview process for all regions.   

Chapters may only have one member serve at a time in one of the three roles (Regional Executive, Regional Executive Elect, and Regional Executive Elect-Elect) to ensure equitable distribution across the chapters.  Regional 5 will begin the selection process for the 2019-2020 Regional Executive in February by seeking nominations of Past Presidents.  Currently the three roles for 2016-2017 are filled by:

Renee Jordan – Regional Executive (Florida Chapter)

Ray High – Regional Executive Elect (South Carolina Chapter)

Karen Newton – Regional Executive Elect-Elect (Georgia Chapter)

We look forward to speaking to those Chapter Past Presidents interested in the role of Regional Executive.  If you have any questions please feel free to reach out to one of us. 

I hope that 2017 is a wonderful year for all! 

Renee Jordan

2016-2017 Regional Executive

 

 

 

 

CFO Spotlight - Nina Dusang

 

1.       Tell us a little about your background, where you were born, raised, education, family, hobbies, favorite sports team and pets?

I was born and raised in the Greater New Orleans area.  I attended college at Louisiana Tech University where I majored in Accounting.  After graduation I went back to New Orleans to work for KPMG as an auditor and CPA.  I was introduced to healthcare during my time as an auditor.  I cannot say I had a special calling to healthcare.  No one in my family had been a clinician, nor did I know anyone that was in the industry.  However, I enjoyed learning the ins and outs of the business aspect of healthcare as it was ever-changing, which appealed to my need for a challenge.  I left public accounting to join the healthcare industry in the hospital setting and have never looked back.

My career has provided many opportunities.   Personally, I have had the chance to travel and live in a variety of areas in the Southeastern United States, experience different towns and their cultures.  Professionally, I was given the chance to be on the operations side of the business for 6 years, including serving as the Vice President of Operations for an acute-care Hospital.

I have been married for 23 years and have 2 girls, ages 13 and 8.  We are also home to a dog, two cats, a gecko and various other animals and insects at any given time. My girls keep me moving constantly, but when I do have time for myself, I enjoy exercising (yoga, CrossFit, roller skating…), reading fiction, and shooting sporting clays and handguns.

2.       Where is your favorite place to vacation and why?

My family and I love to go to South Louisiana to catch blue crabs (my favorite seafood of all time) as well as fish for trout, redfish and flounder.  My husband and I both grew up in South Louisiana where we spent many days on the bayous catching and eating seafood.  Being able to share these memories with our children has been a joy.

3.       What is your favorite thing about living in your current location?

The energy of the town (Roll Tide) and the variety of activities Tuscaloosa has to offer.

4.       What keeps you up at night in relation to current healthcare issues?

We are at a defining moment in the evolution of the business of healthcare.  The uncertainty of where the industry is going and where it will end up creates unique challenges every day.  The historical identity of the hospital is at question.  The hospital was previously tasked with the treatment and healing of patients who had an acute episode of illness.  Today that paradigm is shifting and the expectation is that the hospital will be the epicenter of the patient’s well-being.  The hospital’s role will be to provide an on-going presence in the patient’s life in the form of coaching, treatment, and wellness.  How we will be able to morph into this new role and still be able to be financially viable for our community is what “keeps me up at night”.  Our clinical model is being forced to change at an unprecedented pace, one at which our financial model is not keeping up with.  The disconnect in the evolution of these models creates challenges beyond those typical to our industry.  If we have any hope of navigating the rocky waters ahead, it is imperative to ensure finance is not siloed but serves as a partner with our clinicians.

5.       Tell us one thing we don’t know about you that you’re willing to share?

A friend and I owned and operated a tanning salon for over 6 years.

6.       What is the one piece of advice you would give to someone who is aspiring on becoming a CFO for a Healthcare provider facility?

You cannot just know the numbers!  What separates a great accountant from a CFO is the ability to effectively communicate information to a variety of audiences:  Board members, Executives, Staff, Physicians and the Community at large.   Someone asked me once what I actually did and after thinking about it my reply was that I spend my time being a communicator and advisor.  Don’t get me wrong, I think I could still make a journal entry if I had to but that ability is not what is integral to my job.

 

President's Message

I’m always amazed at how quickly the years come and go and here we are with another one in the books. As we embark on this particular new year, we are faced with a lot of unknowns and challenges with the recent changing of guards.

There’s a constant flow of daily healthcare news speculating risks, concerns, and debates on what is best for American healthcare.  The new self-pay debt, consumerism, Retailization, bundled payments, quality, MACRA, population health, and the list goes on.  Changes in healthcare is nothing new to us.  In fact, the one thing that seems constant in our world is change.  That’s not a bad thing.  Change gets us out of our comfort zone and provides us with an opportunity to make a difference, to be creative and improve not only care outcomes, but financial outcomes as well.

With the commitment of repealing and replacing the Affordable Care Act, it will be important for us to be creative and think outside of the box.  As the new president and congress appear to be moving quickly on this initiative, we must all be diligent in our research and staying informed to these rapid changes. 

The Alabama Chapter of HFMA is committed to helping you stay informed through a number of upcoming events.  There are 5 One Day education events north, south, central, east, and west in the state and there will be webinars specific to the expected risks and the future of healthcare.  It is our goal to provide you with the quality education and the topics you need.  If there is something specific that you would like more information on, please let us know. 

Just as healthcare continues to change, so does your HFMA Chapter.  We put a lot of effort into making sure you are getting value and continue to THRIVE in 2017.  We appreciate your feedback and your participation.  Attend a meeting, meet and learn from your peers, join a committee, write a newsletter article, get certified, renew your membership, invite someone new to join.  Get creative and think outside the box this year and find ways to make a difference. 

I look forward to seeing you at one of our events and working together to make a difference for our Chapter.

 

Warmest Regards,

Karen

CFO Spotlight - Nesha Donaldson, Cullman RMC

Nesha Donaldson, CFO Cullman RMC

1.       Tell us a little about your family and pets?

My husband Mike and I have been married for 34 years.  We have a son and a daughter.  Our son is a Grain Buyer and trades on the commodities market and our daughter is a Pharmacist.  We also have two red-headed granddaughters who are only 6 weeks apart in age.  Many people mistake them for twins instead of cousins. 

We live “in the country” and have been in the same house for almost 30 years.  The area we live is surrounded by family.  Over the years, we have had almost every possible kind of pet or livestock, including cows, horses, sheep, goats and even miniature donkeys.  We now have 2 dogs, a cat, a horse, 23 hens and 2 roosters.  My granddaughters love the animals and love being outside.

2.       What is your favorite place to vacation and why?

My favorite place to vacation is Destin, Florida.  We have been going to Destin since we married, and we love the area.  The beach is the one place where I can truly relax.  Destin has beautiful white sand, emerald green water and the sound of the waves is soothing for my soul.

3.       What is your favorite thing about living in Cullman, AL?

I was born in Cullman, and have lived here most of my life.  Cullman is a wonderful place to live and raise children with good healthcare, good education systems and good quality of life.  We have always been active in our church and the local school system, and I couldn’t imagine living anywhere else. 

We are very thankful that our children chose to raise their children where they grew up, around family and friends.  They live near us, on the “family compound,” and we get to share in their daily lives.  We also provide free babysitting service.

4.       What keeps you up at night?

With the constant changes in healthcare, it is always a struggle to keep up with the new requirements and regulations.  The last few years at Cullman Regional Medical Center have seen some very dramatic financial improvement, and I worry about sustainability. 

5.       Tell us one thing we don’t know about you that you’re willing to share?

My husband and I, along with our two children, and our son-in-law, graduated from Auburn University.  Even though we love Auburn, we are Alabama fans.  We were raised Alabama fans, and just never converted.  My husband’s middle name is Bryant!  Most people assume that we are huge Auburn fans, so I usually just keep that to myself.  My secret is now out.

Save the Date - Annual Moves to Birmingham

The Annual Institute will be held June 1 and 2, 2017 at The Club in Birmingham, Alabama. The move was to encourage participation from a more accessible and centrally located venue. Save the date now for our two-day Annual Institute. Speaker proposals and sponsorship being accepted now. Contact Beth Witten at blueturtlebeth@gmail.com for more details.

Region V Update

 Renee Jordan, Region V

Renee Jordan, Region V

Happy Fall Y’All.  I’m filled with renewed inspiration having just completed the HFMA Fall President’s Meeting in Memphis Tennessee.  Each year the Presidents and President-Elects from every chapter come together for strategic discussions, and to network with their peers.  As Regional Executive it was my responsibility to organize the regional meeting and plan networking events.  Of course that meant a trip to Graceland!!  What a great experience. 

The Fall President’s Meeting kicked off on Sunday with updates from HFMA National.  We received an update on the Chapters 2.0 projects and we learned about the HFMA Strategic Direction discussed at this year’s board retreat:

Our Challenge:  How can HFMA lead healthcare stakeholder to meet the challenges of today while creating a sustainable healthcare industry?

Our Audience:  Healthcare Finance Professionals 3-circle CFO’s, Health Insurance Professionals, Physician Leaders, Vendor/Business Partners

·         Easy Access to Relevant Information

·         Collaborate to Define & Influence Change

·         Helping “Audience” Successfully Navigate Complexity & Pace of Change to Support FinancialSustainability

·         Invest in Acquiring, Developing, and Retaining Talent

On Monday and Tuesday we broke out into our regions where we had an opportunity to discuss many National, Regional, and Chapter topics.  HFMA Secretary/Treasurer, Kevin Brennen, joined us for conversation regarding membership and HFMA Strategies.  Region 5 provided Kevin with feedback from the Chapter Leadership and Chapter Member prospective.  Additionally, our Region was fortunate to have HFMA staff member, Lorraine Schnelle, present during our meeting.  Lorraine was a wonderful person to bounce ideas off and she took copious notes to bring back to HFMA to share our prospective.   

The unanimous consensus was that the meeting was very informative and productive.  Additionally, the group enjoyed the networking events which allowed them to build relationships with their peers thereby strengthening the Region as a whole. 

In November I will attend the Regional Executive Counsel meeting in Chicago to represent Region 5.  The primary focus of this meeting is to evaluate the Chapter Balance Score Card (CBSC) and the metrics assigned thereto as well as chapter awards.  The CBSC is designed to assists chapters with goal setting and performance tracking of key chapter activities.  At the FPM the Presidents and President-Elects of Region 5 shared their ideas for possible changes to the CBSC.  I look forward to bringing these recommendations to the REC meeting and to effect some meaningful modifications to the CBSC.   

I wish everyone a peaceful and healthy holiday season!