Virginia hospital system The secrets to success: switching ... · PDF fileVirginia hospital system The secrets to success: ... RHS paid the exam fee the first time for each staff member

In thIs Issue

p. 4 What’s your incentive?Read how one organization offers incentives for good work. Also, see one facility’s incentives program on p. 5.

p. 6 Medicare occupational mix adjustmentFind out whether it’s serving its original purpose.

p. 8 Be through with poor throughputRead some best practices to relieve gridlock.

p. 11 Just catching upLearn how the University of North Carolina Health Care System is monitoring progress and reporting the results from its PFS process redesign.

It was only four years ago when Teresa Bassett became

the patient access director at Riverside Health System (RHS)

in Newport News, VA, and immediately recognized a few

disturbing trends. Bassett’s top objective was to reduce ac

counts receivable (A/R) by working with her registration

staff. However, the staff members weren’t yet performing

timeofservice (TOS) collections efforts, and when she

learned that the business office was touching 85% of every

thing that came out of registration, she knew that there

couldn’t be a quick fix. “It wasn’t just bad. It was way bad,”

said Bassett, who spoke during the NAHAM Annual Con

ference in May.

However, the business office now steps in only 24%

of the time, and these instances are rarely due to a reg

istration error. “It’s nice to know that we’re finally not

Case study

Virginia hospital system tackles A/R through registration quality

causing patient accounting additional work,” Bassett said.

The secrets to success: switching from manual to elec

tronic audits; studying quality reports; conducting frequent,

onthespot, informal training; launching a dedicated col

lections initiative, and receiving staff support.

up-front collections

RHS is a fourhospital system located in southeastern

Virginia. In 2004, RHS was in the same boat as most facil

ities. It wasn’t doing much to ensure TOS accuracy and

it had yet to look into incentives (e.g., bonuses and pay

scales) to motivate staff members to be more aggressive.

“Administration

was timid about

starting to collect

money,” Bassett

said. “We hadn’t done it before, and we’d have to teach

staff how to do it efficiently.” RHS started from scratch,

purchasing credit card machines and developing protocols

to indicate when TOS was due and when it wasn’t.

Although there was a learning curve, staff members got

it down and now excel at the process. “Now we have very

clear policies, and we’re on target to collect $3 million this

year,” she said.

RHS is aggressive in its collections efforts, but its registrars

always have their eyes on customer service. The organization

offers a 20% discount to patients who pay their copay and/

or deductible at the TOS. “It works wonderfully,” Bassett said.

Some patients naturally say they’ll pay later when a reg

istrar asks for the upfront money. “But when we tell them

about the discount, they’re usually happy to pay,” she said.

“We do it across the board for every patient.”

staff participation

RHS is fortunate to have maintained much of its reg

istration staff for years. But when candidates interview,

> continued on p. 2

August 2007 Vol. 4, No. 8

“ It wasn’t just bad. It

was way bad.”

—Teresa Bassett

Patient Access AdvisorPage �

© 2007 HCPro, Inc.

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August �007

Registration quality < continued from p. 1

Bassett insists that they be comfortable with collecting

money. “It’s one of the most important aspects of the

job,” she said.

However, Bassett prefers applicants who don’t have

registration experience. “I prefer not to hire people with

old, ingrained philosophies from another facility,” she

said. “I’ve had much better luck hiring people without

experience.”

Bassett tracks the collections effort through the Mede

Finance Compass program. “That’s where we develop

most of our reports,” she said.

The missed TOS tracking reports indicate whether a

patient who did not pay anything before TOS has paid off

the balance of his or her bill within 30 days. “In that case,

it’s a loss for [the] TOS [initiative]. That means the patient

probably would’ve paid something at TOS. It’s a good thing

for the company, but a loss for [registration],” Bassett said.

Registration quality

When Bassett joined RHS, the organization was still

conducting manual audits. One senior staff member per

formed about 20 audits per month for each registrar. But

the results weren’t compelling enough to initiate change.

“The staff didn’t buy into it, because it was such a small

sample,” Bassett said. “Because she may have performed

all of the audits for someone in one day, the registrar

could always say she wasn’t feeling good or that she just

had a bad day.” Bassett went shopping for affordable

technology and eventually implemented the AHIQA.com

system in December 2005.

“We saw an immediate improvement,” said Bassett.

So much so that RHS upgraded realtime audits in August

2006 at just a small additional cost.

Bassett built more than 300 edits into the program.

Based on those edits, informational boxes pop up at the

sample time-of-service collections report

Source: AHIQA, Miami Lakes, FL. Reprinted with permission.

Patient Access Advisor Page �

© 2007 HCPro, Inc.


August �007

end of each registration to indicate incomplete or incor

rect information for the registrar to fix while the patient

is still in the registration area.

For example, the program networks with the U.S.

Post Office to verify addresses. “It doesn’t verify that it’s

the right address,” said Bassett. “But it verifies that it is a

valid address, and that is extremely useful.”

Bassett had realized that many of the registration

errors stemmed from Medicare policy numbers, which

have nine digits and an alpha character.

“The registrars were invariably leaving off that alpha

character,” she said. “Now it doesn’t happen at all

anymore.”

See “Sample employee error report” below for an

example of a registrar’s detailed field errors report. This

report helps Bassett identify where each registrar needs

additional training.

“We can run the reports whenever we want, so we’re

always on top of things,” she said.

Additional benefits

The AHIQA program also allows Bassett to moni

tor patient wait times. As part of the “lobby” function,

registrars check patients in and administer an electronic

signin sheet, and managers can track the movement of

patients.

“Managers used to have to walk around to monitor

patient volume in each registration area. Now they can sit

in their office and watch it on their computer screen. It’s

allowed us to immediately adjust staffing levels in the vari

ous registration areas based on the patient volume. At the

same time, it is allowing the managers to spend their time

more appropriately,” said Bennett.

“Do we need to call extra help in? Is our inpatient

area swamped and our outpatient area slow? If so,

can we move people around to help out the inpatient

area? We really take advantage of this at all of our

acutecare facilities and outpatient diagnostic centers,”

she added. n

sample employee error report

Source: AHIQA, Miami Lakes, FL. Reprinted with permission.


© 2007 HCPro, Inc.


August �007

teresa Bassett, the patient access director at Riverside

Health System (RHS) in Newport News, VA, knew that the

best way to make the organization’s aggressive time-of-ser-

vice (TOS) collections and registration quality initiatives fly

was to get staff members excited about them.

So in October 2005, well before many of its peers thought

to develop and implement an organized rewards program,

RHS began challenging staff members to perform their regis-

tration duties more efficiently by giving them an incentive to

be great at their jobs.

The results have been tremendous—RHS has seen in-

creased TOS collections, fewer registration mistakes, and

little staff turnover.

Certifications

First, Bassett set out to educate staff members about

their importance to the financial well-being of the organiza-

tion. All too often, registration staff members receive too

much of the criticism and not enough of the praise, she says.

“I wanted our staff to understand how important they are.

If they don’t do the job well, we won’t get paid timely or pos-

sibly at all,” Bassett says. “I wanted to build their confidence

and show that they are not just a registrar.”

To further this goal, RHS began offering $500 bonuses for

patient access staff members who passed the certified patient

access associate exam.

RHS paid the exam fee the first time for each staff member

who took the exam. Eighty percent of the system’s patient

access staff members took the exam, and 75% passed.

“Staff morale was dramatically increased,” Bassett says.

Random gratitude

RHS has worked diligently to create an environment in

which hard work is always noticed—and often rewarded.

“We have a manager’s toolbox filled with movie

passes, gift cards for our cafeteria, Starbucks gift certificates,

and other gifts we can use to reward staff that go above

and beyond,” says Bassett. “We want to continue encourag-

ing staff to work hard, and this is a great way to

do so.”

Incentive plans: Give a little, get a lot back

Incentives program

RHS also has a quarterly incentives program for up-front

collections and registration accuracy. (See “Sample patient

access incentives program” on p. 5 to see a copy of the

policy.)

For up-front

collections, a

staff member

will receive a

$100 bonus for

collecting 70%

or more of all of

the TOS money due to the registrars for that quarter. If the

staff member collects between more than 65%–69.9% of all

the TOS money due to them for that quarter, he or she will

receive a $50 bonus.

For registration accuracy, a staff member will receive

a $100 bonus if he or she has an accuracy rate of 96% or

higher for the quarter. The staff member will receive a $50

bonus for an accuracy rate of 91%–95.9%.

Those parameters may need to change soon as RHS

registrars have gone from 65% accuracy to 98.7% during

the past few years. “We originally had the top goal at 85%

accurate, so I guess we’ll probably have to raise the bar

again,” Bassett says.

An easy sell

Don’t anticipate much pushback from administration,

Bassett says. “We collect probably 20-fold the amount that

we’re paying out,” she says. “Plus you can’t really put a dol-

lar amount on what the accuracy does on bills dropping

clean and no one needing to touch them.”

But Bassett insists that you need a legitimate registration

audit system to pull it off. “My feeling is providers are wast-

ing their time doing manual audits,” she says.

Just as important as the financial gains, Bassett says, is

that registration staff members are happier with their jobs

now. “They’re talking to us more, coming forward with sug-

gestions,” she says. “They just feel proud of their work. And

that’s very important.”

“ We originally had the top

goal at 85% accurate, so I

guess we’ll probably have

to raise the bar again.”

—Teresa Bassett

Patient Access Advisor Page 5

© 2007 HCPro, Inc.


August �007

FormThis Month’s

➤ Download this entire form in the Patient Access Advisor section of www.accessresourcecenter.com.

sample patient access incentives programOverview1. An incentive system is a method of wage administration designed to pay employees in proportion to the hours that they work and the goals

that they achieve. A “positive incentive program” is an incentive system in which employees receive set bonus amounts for achieving goals.

The bonus amounts will be in proportion to the actual hours that the employees worked during the quarter.

2. The program is designed to increase productivity and provide employees an opportunity to earn incentive payments. It is also designed to

assist in the recruitment/retention of quality personnel.

3. The maximum incentive award will not exceed $200 per employee, per quarter. Employees will receive the net dollar amount of the incentive

that they have earned.

4. Time-of-service (TOS) goals are set up as departmental goals; if the department as a whole meets or exceeds a goal, all eligible employees will

receive the incentive. If the department does not meet the goal, no one will receive the incentive. It is understood that patient payments that

are collected within 30 days of date of service would have been paid at the TOS had the registrar attempted collection. The goal is to increase

the amount collected at the TOS and decrease the amount collected within the first 30 days. Months for this goal will run one month behind

to allow the full 30-day payment period to occur for the last month of the actual quarter.

5. Registration accuracy goals are set up as individual goals. Individuals who achieve either the 5% or 10% goal will receive the incentive.

Individuals who do not achieve either the 5% or 10% goal will not receive this incentive.

eligibility requirements

Award percentages are based on the percentage of total hours worked out of the total possible during the incentive period. Worked hours are

based on 480 hours in a quarter, less six days time off, for a total possible of 432. Worked hours will be translated into a percentage and used for

award calculation. An employee’s total worked hours must be greater than 50% of the total hours possible for him or her to be eligible for the

incentive award.

Payment

Award calculations are completed by the 15th of the month following the end of the quarter.

Administrative pointsManagement reserves the right to adjust the incentive plan goals and/or criteria at any time for the following and subsequent quarters.

Fraudulent activity to meet the incentive will result in disciplinary action up to and including immediate termination.

Source: Riverside Health System, Newport News, VA. Reprinted with permission.

Goal Improvement Maximum level ($100) Minimum level ($50)

Customer service

Registration accuracy

Individual goal

Increase in registration

accuracy based on AHIQA

audit system

96% registration accuracy for quarter 91% registration accuracy for quarter

FinancialTOS collection

Departmental goal

Decrease in missed TOS

collection opportunities70% collected 65% collected


© 2007 HCPro, Inc.


August �007

Medicare occupational mix adjustment: healthcare experts question whether it serves its original purposeby Tina Ford and Scott Besler

Congress enacted the Medicare occupational mix adjust

ment (MOMA) in federal fiscal year (FFY) 2005 as part of

the Benefits Improvement and Protection Act of 2000.

The MOMA is one component of the Medicare wage

index reimbursement methodology, which the federal

government uses as a mechanism to recognize the differ

ent wages hospitals in different geographic areas pay.

The general concept of MOMA is to control the effect

of a hospital’s employment choices on the wage index.

Currently, the MOMA methodology basically works this

way: If a labor market area’s nursing average hourly wage

is higher than the national average, a negative MOMA

applies and reduces the overall wage index factor for that

labor market area.

The reverse is true if a labor market area’s nursing

average hourly wage is lower than the national average;

the labor market experiences a positive MOMA, which

increases the labor market area’s wage index.

Therefore, the MOMA tries to adjust for hospital man

agement decisions rather than account for the geographic

difference in the cost of labor. With that said, one would

expect that a healthcare facility in New York City would

receive a higher Medicare wage index factor than one in

Mississippi.

This would be a result of the higher average hourly

wage in New York City. However, you’d be surprised

to discover that hospitals in New York City actually

receive positive MOMAs, whereas many other hospitals

located in rural areas receive negative MOMAs. To be

exact, onethird of rural hospitals currently receive a

negative MOMA.

MOMA is meant to benefit rural hospitals

To make sense of this, it is necessary to determine

which hospitals are supposed to benefit from MOMA.

Historically, rural healthcare associations have claimed

that there is an inequity in current wage index calcula

tions due to hospital employment choices.

Therefore, Congress enacted, and CMS implemented,

the MOMA to benefit rural hospitals. CMS has made

revisions to the MOMA methodology since its inception

in October 2004, and the same result has occurred each

Decreases in wage index

Code Name FFY 2008 Code Name FFY 2007

05 California -0.0246 05 California -0.025206 Colorado -0.0225 53 Wyoming -0.024743 South Dakota -0.0171 06 Colorado -0.023447 Vermont -0.0146 43 South Dakota -0.018221 Maryland -0.0093 47 Vermont -0.012213 Idaho -0.0078 13 Idaho -0.010250 Washington -0.0068 16 Iowa -0.006616 Iowa -0.0062 50 Washington -0.005728 Nebraska -0.0055 20 Maine -0.005053 Wyoming -0.0047 21 Maryland -0.004520 Maine -0.0040 28 Nebraska -0.004139 Pennsylvania -0.0019 23 Michigan -0.003427 Montana -0.0017 38 Oregon -0.003023 Michigan -0.0017 39 Pennsylvania -0.0019

Source: Besler Consulting, Princeton, NJ. Reprinted with permission.


© 2007 HCPro, Inc.


August �007

time—up to onethird of rural core based statistical areas

(CBSA) are affected negatively. (See “Negative MOMA in

rural areas” below for a list of rural areas that witnessed a

negative MOMA.)

As you can see from “Decreases in wage index”

on p. 6 many of the rural areas adversely affected in

FFY 2007 are adversely affected in the projected data

for FFY 2008. This is not much of a coincidence, as

CMS will also use the data from 2007 in 2008 (albeit

one additional quarter). The data are from the same cal

endar year (2006).

CMs rolls out full implementation of MOMA

But that is not the only change in the MOMA

methodology. The MOMA methodology applied begin

ning in FFY 2007 contained several changes from the

previous version that was in effect for FFY 2005 and

FFY 2006.

The most notable change was the full implementa

tion of the MOMA. The initial methodology (used in

FFY 2005 and FFY 2006) was implemented at only 10%

of CBSAs (the current methodology is implemented at

100%). In FFY 2006, 34 of the 47 rural CBSAs witnessed

a reduction of their wage index value as a result of the

MOMA. But as you can see in “Decreases in wage index”

on p. 6, the decreases to the wage index in FFY 2006

were not as severe as those in FFY 2007 and FFY 2008,

as shown previously.

MOMA’s success is still unclear

Is MOMA serving its purpose? It appears that CMS

may have answered that question in FFY 2005, when

it was obligated by statute to implement MOMA but

only did so at 10%. CMS kept MOMA at 10% until

a courtimposed mandate to implement at 100% in

FFY 2007.

Although CMS has the authority to revise the MOMA’s

methodology, it does not have the authority to imple

ment it at less than 100%. The answer to the question

of whether MOMA is serving its purpose lies with its

creators in Congress, as it will take a statutory change

to either eliminate or reduce the effect of MOMA.

Congress did pass the Tax Relief and Health Care Act

of 2006, which contains a statute for the Medicare Pay

ment Advisory Commission to study alternatives to the

current Medicare wage index methodology and issue a

report. n

Editor’s note: Ford is a senior manager and Besler is a man-

ager at Besler Consulting in Princeton, NJ.

negative MOMA in rural areas

RuralRural core based

statistical areas

10%

Implementation

Code Name FFY 2006*

12 Hawaii -0.003845 Texas -0.003244 Tennessee -0.003019 Louisiana -0.002904 Arkansas -0.002837 Oklahoma -0.002542 South Carolina -0.002411 Georgia -0.001913 Idaho -0.001901 Alabama -0.001951 West Virginia -0.001810 Florida -0.001826 Missouri -0.001825 Mississippi -0.001533 New York -0.001518 Kentucky -0.001549 Virginia -0.001435 North Dakota -0.001103 Arizona -0.001046 Utah -0.001014 Illinois -0.000834 No. Carolina -0.000732 New Mexico -0.000729 Nevada -0.000617 Kansas -0.000621 Maryland -0.000623 Michigan -0.000450 Washington -0.000315 Indiana -0.000308 Delaware -0.000316 Iowa -0.000328 Nebraska -0.000324 Minnesota -0.000236 Ohio -0.0001

* Previous methodology that CMs revised as a result of

the Bellevue v. Leavitt case.

Source: Besler Consulting, Princeton, NJ. Reprinted with permission.

Patient Access AdvisorPage 8

© 2007 HCPro, Inc.


August �007

Patient throughput: Determine the severity of your problem and identify realistic solutions for your facility

Poor patient throughput is common in hospitals nation

wide—both large and small, rural and urban. EDs are

overcrowded, beds are scarce, space is limited, and quality

of care and customer service ratings are down significantly.

According to a study from The Lewin Group, there

were nearly 5.3 billion ED visits in 2004. In 1991, there

were only about 85 million visits. During this same time

period, the number of EDs dramatically decreased.

“This has created a significant problem causing capac

ity issues,” said Susan Werthem, RN, consulting man

ager for revenue management at IMA Consulting in

Chadds Ford, PA, who spoke during the NAHAM Annual

Conference in May. “The increased aged population, unin

sured, and boarded patients only compound the situation.”

Overcrowding directly results in diversion. It also frus

trates referring physicians, hospital staff members, and

patients and their families, Werthem said. To a patient

access professional, this is old news. However, there are

new bestpractice approaches, such as admissions units,

that can help you relieve this gridlock.

Determine whether you measure up

The first step is to measure key performance indica

tors (KPI) to determine the severity of the problem within

your organization. Werthem suggested that you take a

long, hard look at the following areas:

➤ The hours that your facility is on diversion.

Examine diversion by hour of day and day of week. Per

haps your facility is on diversion more often at a certain

time of day. “See if you can find a trend,” Werthem said.

Then calculate the ramifications of that trend.

Not only is it important to compile this information

to fuel any process change, The Joint Commission also

requires you to track patient throughput data (Joint Com

mission standard LD3.15.10). “You need to demonstrate

that you’re reviewing the data and discussing it on a regu

lar basis, resulting in quality improvement,” said Werthem.

The financial impact of diversion is not just from

the loss of ED patients. The loss of revenue is also seen

through the potential loss of ED admissions and market

share. “Determine the average ED revenue generated,”

Werthem said. “Then multiply that times the potential

number of lost ED patients due to diversion to determine

the financial impact.”

You can also calculate the same for potential ED

admissions, she added.

➤ Admissions. Measure ED and direct admissions by

time of day and day of week. “You’re looking for trends that

might suggest patients are waiting and beds aren’t available

because the discharges aren’t out on time,” Werthem said.

If that’s the case, Werthem said, work to communicate the

discharge time expectation to patients and the physicians

right from the start. “If people understand this, they are

more likely to follow through,” Werthem said.

➤ Average length of stay (LOS) for general acute

care. You’ll want to know whether patients of a particu

lar physician have a longer LOS than other physicians’

patients. If you know that, you can target particular prob

lems with staff members.

➤ Noon occupancy. Compare your noon census

with your midnight census. “That might help identify a

discharge problem,” Werthem said. Perhaps one end of

the throughput cycle is lagging.

➤ Wait times for inpatient beds. This tracks the

performance of patient access and illustrates how many

patients you are boarding. “Ask yourself if you’re utiliz

ing precious inpatient beds for lower reimbursement out

patient services,” said Werthem.

➤ Wait times from registration to ED bed. It’s

important to see whether patient access is part of the

problem or the solution. “Frequently the registration is

viewed as the bottleneck,” Werthem said. “Obtain the

data to identify registration opportunities for improve

ment or to dispel the myth.”

Patient Access Advisor Page �

© 2007 HCPro, Inc.


August �007

➤ Average discharge time. It’s ideal for your dis

charge time to average close to 11 a.m. to keep with a

healthy discharge flow. “You need to set that expectation,

or else it won’t work,” said Werthem.

the effect on your bottom line

Poor throughput affects many people and, ultimately,

its greatest effect is on your patients and the organiza

tion’s finances. The following are several other sources

of lost revenue Werthem associated with throughput

problems:

➤ Cancelled surgeries and other procedures

➤ Outpatients occupying inpatient beds for less or no

reimbursement

➤ A discharged patient occupying a bed while waiting

for tests, a meal, or a ride home

➤ Diminished DRG profitability due to prolonged LOS

➤ Loss of market share

Werthem noted two longterm solutions. You can either

add more beds and staff members at increased costs, or you

can manage patient throughput to increase revenues and

open more of your existing beds. Before you consider pro

posing expansion to your administration, ask yourself:

➤ What kind of beds do I need?

➤ Can I find the nursing and technical staff we’ll need?

➤ Will I have consistent use of new beds, or will I be able

to use them only during crisis periods?

A more realistic approach is to manage throughput,

process to process, said Werthem. For starters, decrease

LOS through the following practices:

➤ Monitoring LOS by physician and DRG

➤ Enforcing discharge hours

➤ Discharging patients timely in the computer

➤ Ensuring timely turnaround from ancillary departments

Before you do anything, Werthem said your organi

zation should schedule crossdepartmental meetings to

discuss the capacity management from everyone’s view

point. These are hospitalwide problems. Make sure to

involve the following people and department representa

tives in the discussion:

➤ CEO

➤ CFO

➤ Chief operating officer

➤ Vice president of nursing

➤ ED nursing manager

➤ Medical director

➤ Patient access director

➤ PFS director

➤ Case management director

➤ Ancillary department directors

➤ Bed czar

➤ Bed board manager

➤ Nurse manager of discharge and LOS

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August �007

Patient throughput < continued from p. 9

Admissions units

A 2002 Government Accountability Office survey

revealed that 90% of boarded patients in the ED waited

more than two hours for an inpatient bed. The Hospital

Advisory Board estimates that it takes eight hours to admit a

patient. Ideally, you should complete the admissions process

in two hours. “An admissions unit allows you to complete

paperwork, initiate medications, and ensure xrays are start

ed, all in that twohour window,” Werthem said.

Assigning the admissions functions to one unit allows

staff members to perform the admission quicker. The

familiarity with these tasks speeds up the process, just as

the sameday surgery staff is able to prepare a patient for

surgery quickly. “The work an admissions unit can per

form could potentially knock a half day off the [LOS] for

an individual patient,” she said.

Consider opening an admission and discharge center,

a selfcontained unit that provides initial clinical care

to patients for whom an admission order has already

been written. Location is additionally important, said

Werthem. Ideally, you should locate the unit near the

ED and the registration department. Your staff compli

ment for a 12bed unit may include about 9.5 fulltime

employees, including nurses, a nurse unit manager, a

bed czar, clinical technicians, and a unit secretary.

“If I bring my grandmother in, I can talk to admitting

while the IV is started,” she said. “Admitting has access

to the patient to finalize questions with my grandmoth

er. Additionally, financial issues can be discussed and

required signatures obtained prior to transfer to the floor.

Everyone is accessible there.”

Werthem recommends that you do not treat obstet

rics and psychiatric patients at the admission center.

The unit could also serve as a comfortable area in which

discharged patients can wait for transportation home,

get their prescriptions filled, and schedule followup

appointments.

“However, a facility may not be in the financial posi

tion to build an admissions unit,” she said. “When that is

the case, we have seen facilities create admissions nurses,

who go to the unit to admit the patient.”

An admissions unit is only one part of the solution.

Daily capacity management meetings, physician involve

ment, and strong leadership are also essential.

“Whatever solutions are put into place, you must be

proactive. Once you stop, people begin to return to their

old ways, as many do not like change,” said Werthem.

“Keep your eye on the ball.” n

Once you’ve determined that your facility has capacity management concerns, IMA Consulting recommends taking the fol-

lowing steps:

➤ Measure key patient-flow statistics and make them available to the executive leadership group

➤ Develop an administratively directed, high-level, physician-involved work group to address capacity problems

➤ Perform a financial impact study to determine revenue opportunities through improved capacity management

➤ Identify a high-level administrative leader with the ability to cross over department lines of authority to oversee daily patient

throughput

➤ Report capacity management progress objectively/statistically to the executive leadership group at least once per month.

➤ Engage a facilitator to assist the organization with overall implementation guidance

Source: IMA Consulting, Chadds Ford, PA. Reprinted with permission.

Capacity management steps to success



© 2007 HCPro, Inc.


August �007

Follow-up

unChCs monitors initiative progress, reports resultsEditor’s note: PAA just completed a four-part series that

examined the significant patient financial process changes

that the University of North Carolina Health Care System

(UNCHCS) in Chapel Hill, NC, has made during the past year.

In this month’s series follow-up, PAA illustrates UNCHCS’

patient-focused collections efforts and progress monitoring and

reporting.

Over the past year, officials at UNCHCS thoroughly

examined every financial process. They considered cus

tomer service, financial viability, and staff burden, and

they drew up realistic changes that would keep each of

the system’s priority interests in mind.

In many cases, they tore down the process structure

and put up new walls from scratch.

When they completed their entire process redesign,

all that was left was a strategy to monitor progress and

report results, says Karen McCall, UNCHCS’ vice presi

dent of public affairs and marketing.

“It was important for us as a system to [track our

performance],” she says.

Instituting audits for charity applications

Officials made wholescale changes to the manner

in which the system screened patients for eligibility,

assisted patients in the process, and alerted patients

of the charity care program.

But the changes were no good if UNCHCS couldn’t

determine whether the new program worked.

UNCHCS designed and instituted an audit process

for all charity care applications and began tracking

the number of patients UNCHCS approved for finan

cial assistance every quarter.

Almost immediately, UNCHCS recorded a 20% in

crease in the number of applications patients filled out.

“It was a definite and noticeable increase for us,” says

McCall. “It told us the process was working.”

Assessing the availability of bilingual Medicaid

assistance counselors

To further the system’s efforts to reach out to the com

munity’s bilingual population, UNCHCS is working with

nine communitybased practices and their bilingual coun

selors to ensure that Spanishspeaking families have the

same access to financial counseling as Englishspeaking

families.

This is another

process that has

seen tremendous

results.

“Our Medicaid

applications are

now way up,”

McCall says. “We

haven’t gotten our Medicaid approvals up much, but our

applications are definitely up. And that’s a definite win

for the system.”

UNCHCS has also begun to use mystery shoppers to

test access to financial assistance.

Letting five principles shape the change

UNCHCS is monitoring progress but also emphasizing

to staff members the following key principles that evolved

from the process redesigns:

➤ Exhaust all third-party options to cover the

cost of care. At the end of fiscal year 2006, UNCHCS

had a staggering $290 million bottled up in accounts

“ We haven’t gotten our

Medicaid approvals

up much, but our

applications are definitely

up. And that’s a definite

win for the system .”

—Karen McCall

Contact Senior Managing Editor Corey Goodman

Telephone 781/��-187�, ext. �7�7

E-mail [email protected]

Questions? Comments? Ideas?

> continued on p. 12

Patient Access AdvisorPage 1�

© 2007 HCPro, Inc.


August �007

unChCs initiative < continued from p. 11

receivable. Now, prompt payments are the order of

the day.

“Our charity care program is only available when all

other options are exhausted. We had to clarify that,”

McCall says. “Things weren’t consistent in our system.

So much of this process was just being diligent to get

consistency throughout the system.”

➤ Ensure access to financial counselors. In 2006,

UNCHCS expanded eligibility requirements for its charity

care program. However, at the time, it didn’t bulk up its

staff to accommodate the additional business.

“Without sufficient staff, we really weren’t able to

keep our promise,” says McCall. So UNCHCS added five

financial counselors to the staff. The organization also

uses roving financial counselors, who bounce around

from clinic to clinic, going wherever there is a need.

Clerical staff members order a roving financial coun

selor through a program on UNCHCS’ Web site.

➤ Ensure that billing is accurate and easy to

read. This is probably the biggest challenge for UNCHCS.

“I think we’ll keep working on this the rest of our

lives,” McCall says. “Hospital and physician billing is so

complex that this will always be a challenge.”

UNCHCS relies on customer focus groups to shape

new ideas to simplify the bills. “People are still looking

for a MasterCard bill, and it’s just not that easy,” says

McCall. “I think the industry as a whole still has a long

way to go.”

➤ Ensure that patients understand their obliga-

tion to pay. One ongoing challenge is the fact that hos

pitalbased clinics have an opportunity to charge a facility

fee in addition to the physician charge.

This is because Medicare and Medicaid recognize that

large institutions have additional costs, because they

provide a level of testing to which a normal physician

office doesn’t have access. However, educating patients

as to why they’re receiving two bills isn’t easy. “We’ve

really given a great deal of effort to make sure the patient

doesn’t find this out as a surprise,” McCall says. “We send

letters to them ahead of time, and we include a notice on

the appointment slips to alert them to this.”

The notices also serve as a valuable tool in the cus

tomerfriendly collections efforts. “Patients are more than

willing to pay; they just don’t want to deal with our bill

ing system,” says McCall.

➤ Assist patients with payment plans. UNCHCS

has enlisted the assistance of its collection agencies to

offer nointerest loans.

“It just makes more sense to do what it takes to get

our principle paid back,” says McCall. “Before, we could

only allow patients to pay us over 36 months. Now, if

they need longer, we can make arrangements.” n

editorial Advisory Board Patient Access Advisor

Group Publisher: Lauren McLeod

Executive Editor: Lori Levans

Senior Managing Editor: Corey Goodman, [email protected],

781/6391872, Ext. 3737

Rose t. Dunn, RhIA, CPA, FAChe, FhFMA Chief operating officer, First Class Solutions, Inc., St. Louis, MO

Donna K. GilleyDirector of revenue cycle and regulatory compliance, LBMC Healthcare Group, Brentwood, TN

Amy harttVice president, VHA Southwest, Plano, TX

Diane Jepsky Healthcare consultant, Seattle, WA

steven OrvisSenior consultant, Sinaiko Healthcare Consulting, Los Angeles, CA

Joyce sourbeck, Ms, RnAssistant vice president for patient financial services, Washington Hospital Center, Washington, DC

David s. szabo Nutter, McClennen & Fish, LLP, Boston, MA

sandra J. Wolfskill, FhFMA President, Wolfskill & Associates, Inc., Chardon, OH

Joe Zebrowitz, MDExecutive vice president/senior medical director, Executive Health Resources, Newtown Square, PA

Patient Access Advisor (ISSN 1933-3307) is published monthly by HCPro, Inc., 200 Hoods Lane, Marblehead, MA 01945. Subscription rate: $399/year; back issues are available at $25 each. • Postmaster: Send address changes to Patient Access Advisor, P.O. Box 1168, Marblehead, MA 01945. • Copyright 2007 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978/750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781/639-1872 or fax 781/639-2982. For new subscriptions, renewals, change of address, back issues. billing questions, or permission to reproduce any part of PAA, call customer service at 800/650-6787, fax 800/639-8511, or e-mail: [email protected]. • Visit our Web site at www.hcpro.com. • Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the Marketing Department at the address above. • Opinions expressed are not necessarily those of PAA. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions.

Patient Access Advisor is one of the resources from the Patient Access Resource Center from HCPro, Inc. For information, call 800/650-6787 or go to www.accessresourcecenter.com.

Potential point-of-service calculation tool

A supplement to Patient Access Advisor August 2007

Training ToolTraining ToolAn electronic tool is needed to ensure accuracy when identifying patient payment responsibilities. This tool

should provide information in a variety of ways: individual test charges, case rates for outpatient services, and

inpatient average charges based on DRGs. A further enhancement is to incorporate your organization’s payer

contracts so that payer discounts are accurately applied to the gross charges

Point of service access location (list all within

organization)

Scheduled, unscheduled,

or both?

Administrative vice president

(name)

Current POS

collections? (Y/N)

If yes, annual amount

Annual opportunity (from opportunities

sheet)

Target implementation

date

Day hospital (OP services) Both Y

General hospital IP Both N $0

Surgery center Scheduled Y

ED Unscheduled N $0

Rehabilitation services Scheduled N $0

Sample data only—replace with

hospital-specific data

Source: Wolfskill & Associates, Chardon, OH. www.wolfskill.com. Reprinted with permission.

Editor’s note: This tool was adapted from Upfront Collections Toolkit: 50 Essential Tools for a Winning Program,

published by HCPro, Inc. Visit www.hcmarketplace.com for more information or to order.


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