7 healthcare leaders share advice for improving revenue cycle performance

As patients take on more responsibility for their healthcare costs, decisions about where to receive care are frequently made based on out-of-pocket fees and their satisfaction with the provider.

This shift from payer reimbursement to patient reimbursement has major implications for revenue cycle management, forcing hospitals and health systems to abandon traditional processes for the adoption of patient-centric practices.

Here, healthcare leaders share their advice for improving revenue cycle performance. The leaders work with organizations that received either the Healthcare Financial Management Association's 2016 MAP award for high performance in revenue cycle, or HFMA's 2016 MAP Certificate of Recognition in Revenue Cycle Achievement.

Note: Responses have been lightly edited for length and clarity.

Brad Arthur. Director of the business office for St. Elizabeth Healthcare (Edgewood, Ky.).
You have to have access to good data and analytics. Build your key performance indicators that align, support and cascade with all areas of the revenue cycle including access, pre-access, clinical documentation improvement, health information management and the business office. Review data that supports your key performance indicators every single day of the year. There should never be surprises to your financial leaders in an effectively ran business office.

Also, hire the right people and create a culture that aligns with your organization's strategic plans and goals. It's not always about financial metrics, it can be about culture. For example, net revenue is important to most financial leaders but do you review your cost to collect to determine the overall effectiveness of your revenue cycle?  Is it more effective and efficient to insource a particular part of the revenue cycle and does the culture support that? Will your leaders support adding full-time equivalents that in the end will drive down outsourcing costs? At St. Elizabeth Healthcare we have created a culture where ideas are supported by data and analytics but most importantly by effective leaders.

Drew von Eschenbach. Vice President of Revenue Cycle for CHRISTUS Trinity Mother Frances Health System (Tyler, Texas).
It all begins with creating a purpose, and our purpose/mission within our revenue cycle is "to support the delivery of care in order to better serve our patients and our community." This is shared with all revenue cycle staff so they understand the importance of what we do and why we do it. 

We also have created an environment of transparent accountability. This transparency begins at the macro level of our revenue cycle tracking and monitoring the trends of 20+ key performance indicators. These indicators cascade down to the micro level with each of our revenue cycle departments, teams and staff so that all employees know how their work and efforts are impacting our performance. Teams meet in daily huddles to review prior day performance and goal set for [the] current day. 

Additionally, we couple our cascading metrics with an operational workflow that demands production and efficiency in what we do. This is evident in solid work queue management and throughput to ensure we avoid bottlenecks or inefficiencies.

Laura Holt. Director of Revenue Cycle Management for St. Luke's Hospital (Chesterfield, Mo.).
Healthcare providers should examine the entire lifecycle and not overlook the simple steps at the beginning. Recently, St. Luke's smart use of technology has propelled performance forward. We carefully select appropriate forms of technology to support our revenue cycle and make sure we use it to its fullest potential.

At the core is having an engaged, productive staff and forming great relationships with other departments in the hospital. Cross collaboration is vital, and providers should create a culture of teamwork among all areas. Focusing on the patient experience and helping patients understand how to access the healthcare services they need and how to manage healthcare costs also positively impacts the revenue cycle. 

Each of these pieces is great individually, but the trick is getting them all to work together. That's when you get outstanding performance in your revenue cycle management.

Rick Lyman. Vice President of Shared Revenue Cycle Organization for Advocate Health Care (Downers Grove, Ill.).
A little over two years ago Advocate Health Care started on a journey to centralize its revenue cycle operations. A key component of this effort was to never forget that the shared revenue cycle organization was there to serve the hospital. That attitude and strong leadership from [Barrington, Ill.-based] Advocate Good Shepherd Hospital enabled the hospital to be recognized by HFMA for revenue cycle excellence.

Jon Neikirk. Assistant Vice President of Revenue Cycle for Froedtert & the Medical College of Wisconsin (Milwaukee).
My advice would be to focus on the patient experience, and make it the driving force behind projects you take on. Price transparency is our biggest one lately. The healthcare industry needs to move this topic to the front of conversations with patients. Let them know what to expect in a way that's meaningful to them. We recently started giving patients out-of-pocket cost estimates. I also would recommend keeping an eye on self-service technology — apps that let patients self-schedule and do other things. It's the way things are going in the future.

Kathleen Stapleton, CFO of Baptist Easley (S.C.) Hospital.
At Baptist Easley Hospital we focus on teamwork among the various components of our revenue cycle so that we can provide an improved patient experience. What is best for our patients focuses on getting the right insurance, right estimates, right point of service collections and working closely with our hospital-owned physician practices to improve access and information flow. We have a goal of a "high reliability" revenue cycle to match Baptist Easley's high reliability safety culture on the clinical side.

William F. Wyman. Vice President of Revenue Services for Lowell (Mass.) General Hospital.
Continuous improvement through cycles of learning and improving has been characteristic of our ability to achieve top metrics. We take a focused review of our metrics on a daily, weekly, and monthly basis. Using those metrics we identify annually about three metrics that, if improved, could have the most positive impact to our organization. The initiative chosen must align to an overall hospital strategy goal for the year. If it aligns to a strategy objective, a revenue cycle leader will lead a multidisciplinary group to drill into the areas of opportunity for improvement related to that metric. This team will use cycles of learning and improving to achieve success over a multi-month process. The progress is reported monthly to our Revenue Cycle Excellence Team. Once we achieve top decile or better performance as compared to our national benchmark we select another metric and charter another team. Our success has been achieved by focusing on metrics, continuously learning and improving, and the use of multidisciplinary teams.


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