Making Revenue Cycle Outsourcing an Organization Wide Responsibility Michael S. Browning Chief Financial Officer Madison County Hospital Jeffrey Ellerbrock Consultant (formerly with The Outsource Group) Bryana J. McGill Senior Vice President of Operations The Outsource Group, a Parallon Company
Agenda Introductions & Background Decision to Outsource Aligning Incentives Results Keys to Success Keys to Ongoing Success Tools and Resources 2
Madison County Hospital Who We Are County of Madison, Ohio - Agricultural community - 42,000 residents Madison County Hospital Not-for-profit general acute care hospital 76 licensed beds 1,500 annual admissions 15,000 annual ED visits 230 FTEs 3
Events Leading Up to the Decision to Outsource The Great Recession of 2008 Banking System Collapse of 2008 Market pressures Hospital turnover in key PFS positions Limit on access to resources Limit on access to expertise 4
Stakeholders Concerns & Points of Resistance to Outsourcing Turf issues Displacing employees Community perception Too expensive High exit costs High re-entry costs No looking back 5
Aligning Contract Incentives with Performance Expectations Responsible for active AR including self-pay Base fee at 10% less than current cost to collect Bonus for achieving AR Days goals Bonus for achieving Gross Bad Debt Placement goals Bonus for achieving both AR Days and Gross Bad Debt Placement goals 6
Our Results: Days Cash on Hand 7
Our Results: AR Days 8
Our Results: Uncompensated Care 9
Our Results: Point of Service Collections 35.0% 30.0% 25.0% 27.4% 30.3% 25.6% 20.0% 15.0% 10.0% 13.1% 14.2% 5.0% 0.0% 2.3% 2008 2009 2010 2011 2012 2013 POS as % Total Patient Payments 10
Keys to Our Success: Hospital Leadership Commitment Commit to partnership Agree on expectations Lead by example Expend resources where appropriate Participate in decision-making Adopt vendor recommendations Hold vendor accountable Independent analyses and quality assurance 11
Keys to Our Success: Implementation Due Diligence Conduct a full assessment: Due Diligence = Prevention Prepare a comprehensive implementation plan: Clear benchmarks Clear assignments Clear timelines with major milestones Make plan a priority Make all necessary resources available 12
Keys to Our Success: Operations Model Onsite Engagement Director Overall project management Hospital-Vendor liaison Root cause champion Staffing and Point of Solution Technical expertise Onshore versus Offshore 13
Keys to Our Success: Recruit the Right Onsite Engagement Director Characteristics Promotion & career progression Optimizing complex revenue cycle management Building & sustaining a culture of continuous improvement, analytics, & urgency Ability to motivate & align parties towards a shared vision Driving & improving KPI metrics Recruiting & developing exceptional teams 14
Keys to Our Success: Engage Revenue Cycle Committee/Leaders Develop & facilitate effective working relationships among team members Create a culture of accountability Create a culture of continuous learning & education Establish targeted KPIs Solicit feedback Provide assistance & guidance Celebrate WINS 15
Keys to Our Success: Foster a Culture of Urgency and Analytics Set clear expectations Engage through education & coaching Provide the tools Solicit feedback Communicate KPI data to every level Coach everyone to think like analysts!!! 16
Performance Metrics Patient Access - Pre-Registration Rate - Insurance Verification - Authorization Denials - Point of Service Cash Medicaid Eligibility - Conversion Rate of Uninsured
Performance Metrics Revenue Integrity -Discharged Not Final Billed -Credit Balances Billing -Discharged Not Sent to Payer -Clean Claim Rate -Denial Write Offs as a %of Net Revenue -Net Days in Accounts Receivable
Keys to Our Success: Assess, Plan, & Stay the Course Identify gaps using an assessment tool Agree on priorities & develop action plans Drive change together Examples: DNFB/billing requests Balance after posting Follow-up reporting POS collections Reconcile early-out AR between systems 19
Keys to Our Success: Reward Desired Behaviors & Celebrate Successes Show team members how what they do fits into achieving success Solicit & act on feedback from team members Create a culture of reward & recognition Examples: POS process in the ED Monetary incentives for POS 20
Keys to Ongoing Success Ensure a culture of continuous improvement Review KPIs daily Always have list of initiatives & expect regular updates Participate in onboarding when management and staff changes occur Involve all parties when major systems or process changes occur Ensure robust policy & process documentation 21
Questions/Discussion 22
Tools and Resources HFMA Magazine September 2013 http://www.hfma.org/content.aspx?id=19175 An Outside Approach to Revenue Cycle Improvement An HFMA Education Report Publication Date: Sunday, April 01, 2012 http://www.hfma.org/content.aspx?id=1333 HFMA MAP Keys http://www.hfma.org/content.aspx?id=13116 23
Contact Information Michael S. Browning Email: mbrowing@mch-ohio.org Phone: 740-845-7015 Jeffrey Ellerbrock Email: jeffellerbrock@yahoo.com Phone: 614-477-2158 Bryana J. McGill Email: bmcgill@togarm.com Phone: 314-692-6539 24