The PFX Voice

Christine Hanson-Ehlinger
Christine Hanson-Ehlinger

Day one of Avadyne Health’s 2017 Market Roundtable concluded with a Fireside Chat — a focused panel discussion that allows for cooperative thought and vigorous discussion on related revenue cycle topics.

Focused on how to implement a Combined Billing Office (CBO) strategy effectively, the chat presented an opportunity for panelists to share their experience navigating the process of integrating physician and hospital revenue cycles, building supportive cultures, understanding administrator needs and ultimately nurturing an approach to the revenue cycle process that centers the Patient Financial Experience.


Journey to an Aligned Combined Business Office Strategy

This Fireside Chat was based on a series of survey questions answered by all attendees before the event. Discussion opened with introductions of this year’s panel members:

  • Barbara Tapscott, VP, Revenue Cycle Operations, Geisinger Health System
  • Tracy Berry, VP, Revenue Cycle Management, BJC Healthcare
  • Shaun Magill, COO, Avadyne Health

Each question was presented individually, opening up in-depth discussions from multiple perspectives. Attendees came from revenue cycle environments in various stages of development of their CBO strategy, facing challenges that ranged from disparate EHR systems and registration processes to physician reluctance.

The panel discussion prompted detailed and thorough questions from attendees who were excited at this unique opportunity to gain sophisticated perspective on revenue cycle processes that differed from their home environments.  Most importantly, each segment of the discussion naturally circled back to the patient financial experience, indicating a tangible shift away from a transactional approach to revenue cycle and toward one that centers on patients.


Discussion Themes

While the discussion covered a wide range of topics, panel members repeatedly circled back around to a few, central themes:

  • Culture and its importance in gaining organization-wide support for business office changes
  • The Human Experience and how it must be considered at all levels, from patients to employees
  • Working with administrators to build an aligned CBO

These themes garnered continual agreement and curiosity from attendees, clearly emerging as the elemental building blocks of a healthy and fully-aligned CBO strategy.


Survey Discussion

Survey results were presented by Suzanne Lestina of Avadyne Health as she facilitated further candid discussions.


Question 1: In terms of the standardization and consolidation process across the hospital and physician practice arena, where are you and how do you break down cultural barriers if the goal is to integrate? 

This question generated the most detailed discussion. With Geisinger being at the mature stage of its CBO alignment, Barbara Tapscott explained the process of working with hospital CFOs in making fundamental revenue cycle changes.

In their case, clinic billing was given precedence over hospital, leaving CFOs in a difficult position.  To mitigate the increased risk taken on by the hospital, greater attention was placed on managing bad debt and working with patients to resolve accounts (via a multitude of payment options including payment plans and non-interest bearing loans.)

Lestina guided the conversation toward the complications of University hospitals. Brenda Sauer of New York Presbyterian Hospital highlighted the challenges she’s managed around combining multiple registration processes including radiology, physicians, clinics and hospital registration. Tracy Berry shared her challenges at BJC Healthcare regarding the navigation of physician and technical components and BJC’s particular situation of registering across two systems.

Cost containment was also addressed in the survey, with Berry targeting the importance of focusing on “doing the right thing” and taking advantage of scale where it matters most (i.e. cash posting and pre-service/pre-arrival.) Berry made a point of stating that she didn’t minimize the importance of cost containment but added, “I’m thinking more about yield than cost containment.”


Question 2: What metrics do you prioritize?

For mature organizations: How did you know you were successful?

For organizations in the process of building: How will you know you’re successful?

 The metrics discussion kicked off with Tapscott sharing a high-level perspective on Geisinger’s approach and walking the audience down to their more granular metrics.

She explained that their system focuses on percentage of cash over net patient revenue and net days in AR, with more detailed metrics measuring the FTE component and the resources used to accomplish goals. Most importantly, she stressed the importance of continued and gradual improvement. “It’s all iterative. Ultimately improvements that you make at the transactional level reflect at the net days and cash as percentage of net patient service revenue,” Tapscott said.


April York of Novant Health shared a slightly different perspective, explaining that their metrics depend heavily on baseline and reason for measurement. She related her organization’s efforts to measure softer components, such as patient satisfaction and loyalty using metrics. These metrics include reduction in calls, front-end education and rates of front-end patient cash collection that result from their ongoing efforts in patient-facing areas.

Dan Trustem, VP Revenue Cycle, Essentia Health rounded out the conversation with their vision for directed services and goals to reduce AR. Focusing on this metric has led to a “cascade effect” into other departments (including patient access and coding) who have their own targets.


Question 3: How did you align goals and integrate the revenue cycle in developing your implementation? (in terms of teams)

This segment of the discussion focused heavily on change management.

At Geisinger, relationship-building was the solution to addressing goal alignment. Their clinic side was comfortable with shared services while physicians who were used to having their own coders, billers and schedulers were less enthusiastic about the change. To improve understanding, Tapscott reached out to have conversations with physicians about the value their shared services model provided. Building support from employees was encouraged through the use of an incentive plan. Ultimately, “Culture is the biggest hurdle to overcome,” according to Tapscott.

To address the same challenge, BJC uses a point value approach that had definitive impact on  their pay grade system. Berry relayed that a challenge they worked to overcome was helping HR transition from market comparisons. Rebecca Haymaker, Director, Registration & Technical Services for UW Health carefully pointed out that compensation for some positions needs special reconsideration, using cash posting as an example and stressing that perhaps it could benefit from higher prioritization considering the importance of their responsibilities to cash collections. 


How do you address patient perception of the changes?

This discussion of addressing patient perception focused on proactive outreach to patients.

At Geisinger, this translated to the expansion of the role of financial counselors to help them better inform patients. While at Carolinas HealthCare system, statements were re-designed and presented at a 5th-grade reading level. Ultimately it was agreed that there is huge opportunity in focusing on the softer side of the revenue cycle and connecting it with existing systems and approaches.

Avadyne Health’s Market Roundtable brings together healthcare industry leaders to share in open discussions around the Patient Financial Experience through discussion with other revenue cycle C-suite peers from around the country.

The 2-day event focuses on emerging trends, sharing new thoughts and facilitating conversations around the Patient Financial Experience. Attendee collaboration builds insight into opportunities and barriers within the revenue cycle and uncovers new and impactful ways of improving the present and designing the future of the Patient Financial Experience.

Topics: Billing and Collections, Revenue Cycle Management, Market Roundtable