Transforming Patient Access from a Cost Center to a Revenue Center
For far too long the front-end revenue cycle has been treated as a cost center. Trends are bucking that axiom as improvements in technology, trade industry support and interdepartmental collaboration are allowing Patient Access leaders to stake their rightful claim in Revenue Cycle Management (RCM). A major driving force for change is a focus on the patient’s experience – an organizational motivation to treat the patient’s clinical and financial need. In fact, sixteen presentations at the 2015 HFMA ANI had some element of the patient experience included.
In April of this year, the HIMSS Revenue Cycle Improvement Task Force published a white paper stating that “RCM, as it exists today, is ill-equipped to handle the market forces impacting healthcare.” The paper cites that “Rapid growth in consumer payments, reduced payer reimbursement rates, an ever changing regulatory environment, and shifting consumer expectations have all contributed to the challenges facing RCM.” The Task Force, comprised of over 60 individuals from providers, payers, consultants, vendors and healthcare associations has envisioned a future of unprecedented interoperability by which a central healthcare data hub will help facilitate a consumer-friendly experience.
While this future business model is being worked out, healthcare is adopting internal changes through a wide variety of disparate technology options (see sidebar) which has forced many Access and Revenue Cycle leaders into the role of project manager and QA analyst. These leaders are subjected to having to manage implementation and maintenance, mentor staff who toggle through multiple applications collecting as much data and money as possible from the patients all while “focused” on ensuring the patient has a positive experience.
Industry groups such as HFMA and NAHAM (National Association of Healthcare Access Management) have published metrics with the MAP Keys SM and AccessKeys ® 2.0 designed to help organizations track performance using objective, consistent calculations. There are 5 Map Keys SM dedicated to Access measuring Pre-Registration Rate, Insurance Verification Rate, Service Authorization Rate, POS Cash Collection Rate and Conversion Rate of Uninsured Patient to Payer Source. NAHAM’s 22 AccessKeys® measure the effectiveness of front-end revenue cycle across 6 Patient Access domains: Collections, Conversions, Patient Experience, Process Failures, Productivity and Quality.
These same organizations, along with AAHAM (American Association of Healthcare Administrative Management) additionally offer a variety of certifications aimed at ensuring staff at the supervisor through executive levels are exceptionally knowledgeable in areas of Revenue Cycle Management.
The utilization of proper procedures, the application of appropriate technologies in a well-educated organization that measures their successes appears to be the recipe for success in the current RCM environment. From this cauldron of change management Access leaders are able to reposition their departments into revenue centers.
The PFS Committee held two sessions that tie into the theme of this article. Revenue Integrity Day was held on February 11th 2016 at the LaGuardia Marriott and Patient Experience Day was held on April 12, 2016 at the Viana Hotel and Spa with a cocktail hour afterward. Expert speakers and experienced panelists provided their insight into these timely topics.
Lastly and on a lighter note- one of our chapter hospitals, Montefiore, was highlighted in the Delta Sky magazine this month. The tag line of the article caught my eye, Making Hospitals Fun, by Kevin Featherly – “A comfortable, creative hospital environment isn’t just nice to have – for the youngest patients, it can be key to healing, inside and out.” Focus on the child’s experience is showing positive clinical outcomes and it is hard to disagree with Meghan D. Kelly, Director of the Phoebe H. Stein Child Life Program and the CDM Group Creative Arts Therapy Program at Children’s Hospital at Montefiore Medical Center- “This approach makes all the difference in the world. We are going to see a trend toward more of it in the future.”
Metro NY HFHA PFS Committee Co-Chair
Mid-York AAHAM Chapter President
Salucro Regional Vice President
Source material and further reading
HIMSS Revenue Cycle Improvement Task Force: http://www.himss.org/library/health-business-solutions/rethinking-revenue-cycle-management
HFMA MAP Keys SM: https://www.hfma.org/MAP/MapKeys/
HFMA Certifications: http://www.hfma.org/Content.aspx?id=508
NAHAM AccessKeys®: http://www.naham.org/?page=AccessKeys
NAHAM Certifications: http://www.naham.org/?page=Certification
AAHAM Certifications: http://www.aaham.org/Certification.aspx