Fall 2009
Improve Patient Satisfaction Through Segmentation By Tina Eller, Vice President, SearchAmerica Hospitals have turned to new technology to better serve their patient populations by segmenting outstanding receivables. As with any solution, hospitals are asking whether it is helpful or hurtful to the patient’s financial relationship with a healthcare provider. Fortunately, leading hospitals are turning to advanced segmentation strategies to strengthen their community and patient relations, provide an unbiased approach, and improve their bottom line. One of these hospitals is INTEGRIS Health, a large healthcare system in Oklahoma with 14 hospitals. After implementing a patient segmentation strategy in 2004, their organization has virtually eliminated all customer service complaints related to their financial experience. How? They use an automated probability of payment model across all of their hospitals in order to apply the proper collection activities to each patient. Continued on pg. 3
Contents President’s Message………..2 Letter from the Editor……..4 New Members……………..7 Upcoming Events……….....8 Region 8 Executive Article..9 Page 1
President’s Message By Greg Shaw, FHFMA, CPA, MBA Show-Me of Missouri members, We celebrated our 50th anniversary as a chapter this year at our Summer conference in July. We spent time talking about the past from the perspective of four Past Presidents who were in attendance. One common theme from the Past Presidents was challenges that exist in healthcare. I would add two others; change and confusion. During the five decades our chapter has been in existence, there have been many changes in healthcare finance that providers have had to adjust for in order to survive. In the mid 1960s Medicare was created. Along the way CPT, HCPCS, and ICD were developed. When it became too much of a financial drain on the federal government, DRGs, MS-DRGs, OPPS, SNF RUGs, and HH PPS were created to control cost. Commercial payers also got into the act through PPOs and HMOs. The federal government then decided to take more money out of the healthcare system when BBA97 was passed. This was soon followed by BBRA when too much money was being taken away from providers. In addition to the squeeze on reimbursement from Medicare and commercial plans, we’re now faced with HDHP and HSAs for self pay. When healthcare became more political, providers had to rely on AHA, MHA, MGMA and other associations to lobby on their behalf. On the quality front providers are faced with JCAHO, QA, and TQM among other quality initiatives. Furthermore, EMTALA and HIPAA give us more reasons to stay up at night wondering when the OIG will knock on our door. Everything mentioned above is minor compared to the potential overhaul of our healthcare system that is being proposed to take place over the next few years. CIOs are now scrambling to implement an IS that will include CPOE so an EHR can be developed that will meet the definition of “meaningful user.” All of this has CFOs wondering how they can squeeze more out of their AR to pay for an IS and keep AP current. At some point we’re all going to end up in the ICU and have an MRI ordered on our head to see if there’s any matter left in between our ears. HFMA where are you? As anyone who has worked in healthcare for more than three days knows, this is a very challenging field to work in. With all of the changes we’ve been through and will go through in the future, one of the best things we can do is to invest in ourselves to increase our value to our employers. Through conferences, webinars, audio conferences, and other means, HFMA provides a wide array of opportunities to educate ourselves to stay current with all the changes. In addition to education, HFMA also offers certification which demonstrates to others that an individual has a certain competency level in healthcare finance. With all of these resources available, it is relatively easy to invest in yourself. Please contact any Show-Me chapter officer if you have a question or need additional information about what is available to you through HFMA. Sincerely, Greg Shaw Page 2
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Smarter Segmentation Based on Payment Likelihood Predictive modeling is used to segment patients by using data elements to predict future behavior– in this case paying their hospital bills. The use of predictive modeling tools is growing significantly in healthcare, with hospitals using its results to improve their revenue cycle and prevent fraud. In a nutshell, predictive modeling is simply an equation used for scoring and ranking patients, based on payment likelihood. Hospitals using predictive modeling to determine payment likelihood typically leverage three key performance indicators (KPIs): History of behavior Medical data available Age of account (30, 60, 90 days) In addition, most are also leveraging third-party services that offer credit and financial information. By adding these additional attributes to their modeling, hospitals can better derive payment advice specific to their patient population. With the use of predictive modeling, it is possible to examine groups of patients and determine their payment likelihood. These results will allow facilities to segment out patients with high probability of payment and approach them differently than they would a patient with low probability of payment. It All Hinges on Communication A patient’s impression of a healthcare facility is determined by their experiences, both with their clinical treatments and their financial interactions. Both rely on communication. To establish a level of trust, a hospital’s frontline staff must be able to establish the appropriate financial relationship with each patient based on advanced segmentation to effectively and politely communicate their financial responsibility, if any. If not done well at the onset, a patient is quickly frustrated and the relationship is off to a poor start.
Instead, organizations must equip their staff with systems to rapidly identify the appropriate collection strategy for each patient, at that specific point in time. If they qualify for financial assistance, patients should be told their options and enrolled immediately, whenever possible. For the remaining patients, registrars should provide payment options, if needed, and/or remind the patient of their financial responsibility. Communication doesn’t stop after the patient leaves the hospital. Hospitals know that a billing statement can either strengthen or weaken their satisfaction with your facility. One of the largest complaints from patients is the vague or cryptic information on their billing statements. And, the harder it is for them to understand, the less likely they are to pay it in a timely fashion. Billing statements offer today’s hospitals an opportunity to demonstrate their commitment to patient satisfaction. With informative statements based on the patient’s appropriate collections strategy, patients will respond more quickly and favorably. Hospitals today need to improve how they communicate not only with their patients, but also the community they serve. Thus, INTEGRIS and other health care organizations are curing potential media misperceptions by reaching out to educate and build awareness within their service area. For example, local consumers are saving significant dollars on healthcare annually through the hospital’s charity care programs. This generosity is widely unknown by the general public. It is to everyone’s advantage to make this fact known in the community. Continued on pg. 5 Page 3
Letter from the Editor As our cover article suggests, we are all concerned about patient satisfaction within our organizations. Patients are what makes our businesses successful. At my organization, we measure many types of satisfaction including employees, physicians, volunteers and vendors. In our HFMA chapter, we strive to satisfy our members by providing educational and network opportunities. On page 8, there is information about an upcoming educational opportunity pertaining to the impending RAC audits. Page 9 contains an article written by Mary Lonon, a Show-Me of Missouri chapter member, where she interviews our Region 8 executive, Carol Friesen. Carol provides advice on how to become involved with our chapter to increase your satisfaction with your HFMA membership. Please contact any member of the Show-Me of Missouri chapter board if there are ways that we can help increase satisfaction with the educational and networking opportunities within the chapter. We are always looking for ways to go above and beyond. Regards, Deana Thomas
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Best Practices in Segmentation: A Case Study At INTEGRIS Health, they have achieved a reputation for excellence in their communication of financial responsibilities with patients. Using predictive modeling to segment their patient population since 2004, INTEGRIS now applies the proper collections activities to each patient account. “We wanted our patients to have a positive experience with INTEGRIS’ administrative and financial operations, as well as our clinical side,” stated Brent Grimes, Corporate Director of Patient Financial Services at INTEGRIS. “Today our segmentation strategy is consistent across all facilities and patients, providing an unbiased approach to our patient relations. Using a probability of payment segmentation strategy, our staff can have straightforward and sensitive discussions with our patients, resulting in a better outcome for all. Since implementing our segmentation strategy, our patients are happier and less stressed as they understand their financial responsibility, but most importantly we have a mutually agreed upon plan to eliminate surprises.” INTEGRIS is focused on communicating its financial assistance offering and related screenings as part of its admissions process. Due to the nation’s economic recession, more patient populations need hospitals’ charity care and/or other financial assistance programs to help cover the gap between billed charges and what their insurance plan pays. Thus, INTEGRIS is communicating its financial assistance options to patients much earlier than before. On the frontend, INTEGRIS uses a predictive modeling solution to segment each patient as they enter their facilities based on their probability of payment. They are quickly able to identify qualified charity care accounts, offer payment options to those who need them, and ultimately make all patients aware of their financial responsibility at the onset of their relationship. After a patient leaves their facilities, INTEGRIS uses predictive modeling on the backend to determine the best strategy for collections, e.g., the number of phone calls, letter series, when an account should be Continued on pg. 9 Page 5
Are You Certifiable? Become a Certified Healthcare Financial Professional (CHFP) Enhance your career potential by becoming a Certified Healthcare Financial Professional (CHFP). HFMA's certification program provides you an opportunity to earn this designation when you meet the following requirements: • Be an HFMA member for a total of two years and be an current active member • Have two years of professional experience in the healthcare finance industry • Successfully complete the HFMA Core certification exam and one of the specialty exams - Accounting and Finance, Patient Financial Services, Financial Management of Physician Practices, or Managed Care • Obtain a reference from an elected HFMA chapter office and your CEO or supervisor All active members are eligible to take the certification exams. Once you meet the requirements for becoming a CHFP, submit a CHFP application to HFMA National within 24 months of successfully completing the first exam, with a one-time fee. You will then receive a certificate through your chapter that you can proudly display and will be entitled to used the CHFP designation after your name. For more information about the HFMA certification program or resources available locally, please contact Janice Janssen at
[email protected] or 573-882-8010.
Searching For a New Job? Look at the Show-Me of Missouri Job Bank at www.hfmashowme.org for details.
Revenue Cycle Manager Clinton MO The Show-Me of Missouri chapter offers a job bank in which employers can advertise their open positions. To place a Job Bank Listing or for more information Contact: Deana Thomas Lake Regional Health System 54 Hospital Drive Osage Beach MO 65065
[email protected]
Kyle Lee Financial Resource Group, LLC 6048 Black Oak Springfield MO 65804
[email protected]
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Welcome New Show Me of Missouri Chapter Members! Ann Perry Chief Finance Officer Pike County Memorial Hospital Candice Richerson Chief Financial Officer Family Health Center Susan Taube Director St John’s Hospital Elsie Brannan Manager, Patient Accounts Ashley Esther Financial Analyst St John’s Medical Group
Special Thanks to Our 2009-2010 Sponsors Gold
Silver
Bronze
BKD, LLP
Berlin-Wheeler Inc
Accounts Management Services
CACi
Human Arc
Accounts Resolution Corporation
LarsonAllen
MedTranDirect
Consumer Collection Management
Missouri Medical Collections
MSCB Inc
H & R Accounts, Inc Lilley and Associates Inc Perot Systems The Outsource Group
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UPCOMING EVENTS
Presented by Region 8 greater st. louis chapter . heart of america chapter . iowa chapter . minnesota chapter . nebraska chapter . north dakota chapter . show me of missouri chapter . south dakota chapter . sunflower (kansas) chapter
RAC ATTACK –Revenue Cycle Impacts of RAC ++Tools to Conduct an Internal Risk Assessment. November 10, 2009 Audio Webcast Time 12:00PM – 1:30PM CST Program Fee: $ 30.00 per site (unlimited participants!!!) Please register online at http://www.hfma.org/site/eMeetReg/Main/MtgInfo.cfm?MtgCode=09REG82 If you have any questions, please call Esteban Ponce at (816)932-5450 or email
[email protected]
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tagged as bad debt or presumptive charity, etc. By communicating with each patient in a unique manner based on the financial responsibly established at registration, a patient’s dignity is maintained as well as INTEGRIS’ bottom line. Automation Delivers Consistent, Unbiased Results Smarter segmentation is achieved only by automating the process, making it consistent and unbiased. With an automated system, the guesswork is removed and staff must follow a predetermined process that applies to all patients in a particular segment, regardless of age, race, education, etc. In conclusion, all segmentation is not equal. Exclusively relying on credit histories isn’t likely to yield the financial, community, and patient satisfaction results that healthcare networks are looking to achieve. Understanding a patient’s payment likelihood can, just ask INTEGRIS Health.
Who is our HFMA Region 8 Executive? By Mary Lonon Carol Friesen is a busy mother of two energetic boys ages 13 and 6, community and church volunteer, avid reader, and occasional gardener. She is also the CEO and President of Crete Area Medical Center in Crete Nebraska. For most this would be a full plate, but Carol still finds the time to be the HFMA Region 8 Executive leader. When asked how she started her career in the healthcare industry, Carol simply replied, “untraditionally”. She was working in the private sector offering operational consulting services for a small rural hospital. She found herself employed by the hospital, 2 years in a Human Resources role, and another two as the Chief Financial Officer (CFO). She then moved to another hospital and served as CFO for 8 years. She is currently serving as the President and CEO for Crete Area Medical Center, and has been in this position for the past two years.
How did she get started in HFMA? I explained to Carol, that I have been an HFMA member going on 4 years. My membership started out as a way to receive information and discounts on educational events. I explained that with the writing of this article, I was completing my first active role as a HFMA member. I asked Carol, “How did you get started?” Carol began her membership in HFMA by regularly attending meetings to increase her knowledge about the healthcare industry. Carol’s chapter needed a membership / newsletter chair – she seized the opportunity. At the time this was the only “non-leadership” position that was allowed to attend the annual HFMA Leadership Training Conference (LTC). It just so happened that the LTC that year was being held in beautiful Puerto Rico! Attending the LTC was such a wonderful experience that Carol was hooked, and she has been actively involved in HFMA ever since. She stated that it is neat to look back… She started out learning, now that the “roles have reversed” she is able to give back by leading. Continued on pg. 10
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Region 8 Goals When Carol spoke about the goals for Region 8 she was very excited. At the end of September she attended the Fall President’s meeting. She was excited about the enthusiasm of the leaders to provide cost efficient resources to members. She explained that each chapter in Region 8 will host a webinar as a way to provide cost efficient education. The chapter President’s also discussed the need for stronger collaboration between the chapters. Carol explained that the goal of creating stronger collaboration will allow chapters to share resources creating an “unparalleled potential for change,” and will allow chapters to “leverage best practices” related to industry regulation and compliance. To ensure that we are working efficiently to achieve these goals we have to realize that being a healthcare professional is a “lifelong commitment to learning” says Carol. We have to continually stay abreast of industry changes. Carol mentioned that in addition to HFMA’s HFM Magazine, we have other resources we can utilize such as the American Hospital Association (AHA) and the American College of Healthcare Executives (ACHE). Carol offered a tip for sifting through all the information: “I SKIM” is a task she learned from a friend and colleague and include the following steps: • •
•
When you receive a periodical skim through the table of contents to find articles that are of interest to you. Tear the articles out, put them in a folder, and take them home to read at night. Or, you can read them while waiting for your kid’s games to start, etc. If there is someone in your organization that would benefit from the information, pass it on.
Carol offered an example that tie in the reasons why collaboration and continued education is important for healthcare professionals. Recently, Carol was out to dinner with our President Greg Shaw at the Fall Presidents meeting. Greg was talking about his hospital, and how they are not big enough to be a PPS, and are too big to be a Critical Access. Carol had read in one of her “articles” about a 7 year Med Pac demonstration program that had been going on for hospital’s similar to Greg’s. More importantly, she had read that the program was going to be extended. She was able to retrieve the article and send to Greg for his review.
P arting Words Carol offered these parting words… • “The reward of involvement is 5 times greater than the work in volunteering.” • “Encourage members to volunteer. • “Remember to use your gifts and strengths to help the chapter, whether big or small.” Page 10
HFMA Show Me of Missouri Chapter President Greg L. Shaw, FHFMA, CPA, MBA
President-Elect Jennifer L. Ogden, FHFMA
Vice President Kory Stout
Secretary Janet C. Taylor, CHFP, CPA
Treasurer Deana Thomas, MHA
Board of Directors Mary Bonge Rita Dew Susan Duncan Lorrie Haden Shelly Hunter, FHFMA, MBA Kyle Lee Matt Levsen, FHFMA, CPA
