As the healthcare industry consolidates, hospitals and health systems have been increasingly acquiring physician practices and medical groups. While these acquisitions are anticipated to increase referrals and better position organizations to improve clinical quality, they are placing a strain on revenue cycle operations in the short term.
With this in mind, HBI gathered physician revenue cycle leaders at its Fall 2017 Revenue Cycle Academy Member Retreat to discuss their strategies for breaking down barriers to integration in roundtable format:
- Cathy Boelke, System Vice President, Physician Revenue Organization, SSM Health
- Chris Mattingly, Acting Director of Revenue Cycle for Physician Network, Premier Health
- Todd Craghead, Vice President of Revenue Cycle, Intermountain Healthcare
- Julie Carpenter, System Vice President of Revenue Cycle, Baptist Health
- Harpreet Cheema, Vice President of Payer Strategy and Product Development, Trinity Health
The following is excerpted from the white paper “Trends in Physician Revenue Cycle Integration” that reviews the key points shared by roundtable participants.
What are some hesitancies physicians at your organizations have about revenue cycle integration and consolidation?
Chris Mattingly (Premier): They have strong relationships with their front-line staff and patients, so that is a large element. They state that their staff know their patients—so for example, if a patient calls in and is having an emergency, the staff know who they are and what’s going on and can get them in sooner rather than later. That connection to the existing patient is a big factor.
Cathy Boelke (SSM): Physicians operate in an environment that is based on making quick, independent decisions. That’s a different framework than revenue cycle and can result in physicians having performance expectations that are not realistic. Helping them become educated about the time and effort it takes to do revenue cycle work is key.
Todd Craghead (Intermountain): The top of the list at Intermountain is the model of compensation for providers. Various compensation models have been retained as Intermountain has acquired physician practices and groups. Given that these models may differ, inconsistencies are created which need to be standardized. It should come as no surprise making any changes that deal with compensation can be disruptive.
What strategies have you implemented to improve physician buy-in for integration/consolidation efforts?
Harpreet Cheema (Trinity Health): What we have found to be really effective with the physicians is finding those formal and informal leaders to influence the staff. Your chief medical officer will tell you who the informal leader is. Also, when we talk to physician groups about their performance, we recognize who those informal leaders are. They have a voice, and they want to make sure that decisions are made collaboratively and meet the needs of their peers which they represent at the table.
How are various barriers and solutions manifesting on the front end, especially with respect to registration sites?
Todd Craghead (Intermountain): We are continuing to try to create a more seamless experience between the medical group and the acute side, eliminating redundant work like in registration. When there is consistent governance of these areas, it makes it easier to apply standard operating procedures in order to eliminate variation. Failure on the front end tends to create two to three times as much effort on the back end to resolve. Without the functional responsibility it can be difficult to enforce developed standards.
Julie Carpenter (Baptist Health): From my perspective, those front-line physician office staff don’t have to report to me, but we do want to help them. We want to help how they impact us on the CBO or hospital side, and so, I would ideally like to have a little team of people that can go sit with them and teach them what they are not understanding in the system, and how to mitigate the downstream impact of denials, incorrect registrations, all of those things. I just want to be an asset to them.
Chris Mattingly (Premier): That was a point I’ve made as well. I’m not accountable for them, but they do affect my world, so I’m going to invest time and effort into helping them know what they need to know. We’ve taken our registration training class, which was a full eight-hour session, and chopped that up into 45 pieces—each one revolving around a piece of or functionality in Epic. That way, I can measure who is making mistakes in that functionality and deliver targeted education.
Todd Craghead (Intermountain): Reporting will really help you align and implement changes in the standards. We can highlight areas where, say point-of-service collections are nowhere near what the developed standard benchmarks are, but if you have a lack of visibility or you are not consistently demonstrating that metric, folks have no reason to adopt the standard.
Cathy Boelke (SSM): I do not feel scheduling, registration, and/or check-in should be combined (as they are at SSM). To me, registration requires a different skill set than scheduling and/or check-in. It seems unreasonable to expect so much of our front desk staff—to schedule, register, collect copayments, obtain forms, etc. My preference is to centralize and preregister patients so that by the time the patient arrives, everything is taken care of and teed up for the check-in staff. That frees them up to focus on the patient.
HBI gathers insights from top healthcare leaders like these, and reports on the best practices organizations are using to navigate the transition from volume- to value-based care. Click here to check out our white paper “Trends in Physician Revenue Cycle Integration.“ Not a member? Learn how to join the HBI community by filling out the form below!