The Centers for Medicare and Medicaid Services (CMS) this month released its annual hospital Inpatient Prospective Payment System (IPPS) and Long Term Acute Care Hospital (LTCH) proposed rule for 2017. The elements of the LTCH rule outline the continued focus on transforming our reimbursement system. With the health care industry moving from volume- to value-based care, the importance of revenue cycle organizations to transform and improve is greater than ever. To effort these improvements, we must address core knowledge, skills and capabilities that are transferable across the organization.
For an organization to be successful in the new reimbursement landscape, they must have good leadership. John Kotter’s book, “Leading Change,” provides a good roadmap, using an eight-step process to guide the transformation of an organization. One of the early goals is “building a guiding coalition” to help define the issues and solutions, as well as add organizational credibility. The step “proper organization and membership” helps facilitate communication across departments and identify the impact of changes before they happen. By focusing on cross collaboration, an open environment provides a forum to regularly discuss issues and opportunities that cut across departmental barriers.
Today, improving revenue cycle efficiency requires identification of best practice workflows adapted to an organization’s specific structure, patient population and technology. While the identification of workflow changes relies on strong cross-organizational leadership, the execution relies on a foundation of integrated, adaptable technology. The technology enables connecting workflows across clinical and administrative functions.
A second essential part is leveraging technology to automate business process. Many years ago, this automation was confined to processes within the business office. For example, recognizing the efficiency in automating remittance posting allowed shifting staff from the tedious work of data entry to a focus on fighting claims denials, or more proactively preventing those denials. Today, the automation is more complex, such as identifying and reacting to the specific results inside an eligibility transaction and taking action, or proactively identifying possible “no show” appointments and sending out reminders.
It's important to think of integration from more than just an information technology perspective, but also focus on selecting the right areas to strategically connect. The complexities of the business require a more highly specialized staff. For some, this may simply mean optimizing the performance of current outsourcing of collection agencies. For others, this is strategically targeting specific areas of the revenue cycle.
A good set of metrics and reliable measurement tools help identify areas for improvement. Targeting a set of key performance indicators (KPIs) guides the selection and monitoring of improvement efforts. The issue with some of these metrics is they may be impacted by a variety of factors. In my past experience as a patient financial services director for a medical center, I recall being recognized for a significant improvement in cash flow over the course of a year. While I appreciated the recognition, the fact that patient volumes had increased in record numbers might have had something to do with it. While KPIs may offer an area to investigate, more refined performance indicators help target specific areas: How many new patients are we seeing in our primary care practice? How is the point of service cash collection by department or even registrar trending?
The efforts to refine and improve our revenue cycle has expanded to encompass workflows that cross through the entire organization. Having regular discussions with leaders across the organization about key issues can identify opportunities that may lead to automation, workflow redesign or improving the quality of service delivery. In the past, we were challenged with adapting to changing payment models and regulations. Today, we’re challenged to think differently about how the revenue cycle becomes part of the clinical process and across the continuum of care.
Join Cerner at HFMA’s 2016 National Institute, June 26-29 in Las Vegas (booth 221), and experience how your organization can create healthier stories for your communities and your bottom line.