Clinical-financial alignment driving changes in hospital revenue cycle, expert says

Image of Florida Hospital from Florida Hospital.

Jeff Hurst is senior vice president of finance at Florida Hospital, a 2,247-bed, multi-site acute-care organization and a member of the 44-hospital Adventist Health System. Hurst is the senior executive responsible for the health system’s enterprise-wide revenue cycle, and he directs all financial and clinical revenue cycle functions, including patient access, patient financial services, revenue integrity, care management, clinical documentation, medical records, coding and transcription.

Hurst spoke with Healthcare Finance editorial director Richard Pizzi about managing the revenue cycle in an age of increasing consumerism and the need for increased patient engagement and education.

Healthcare Finance: Florida Hospital has made a concerted effort to align and integrate financial and clinical operations, for the optimization of both. Is this something that will happen industry-wide?

Jeff Hurst: The overall trend is toward alignment. The larger health systems are ahead of the curve, but the entire industry is heading that way. It’s been approximately three and a half years since the initiation of our planning conversations about this kind of alignment. Now, alignment efforts extend across the entire continuum, in both the ambulatory and acute spaces.

[Also: What CFOs think about revenue cycle]

Healthcare Finance: You are spearheading multiple initiatives around consumer outreach, and trying to build a more consumer-friendly revenue cycle process. What are the practical aspects of that strategy?

Jeff Hurst: About two years ago we designed a strategic road map, and one of the priorities was patient advocacy. Historically, the healthcare industry has done a good job advocating for patients in a clinical setting, and helping the patient understand what to expect during treatment. But the financial side of the healthcare industry has not kept pace with the clinical side.

Our job from a revenue cycle standpoint is to help the patient navigate the financial intricacies of the healthcare system. That means we need to be much more proactive in education and outreach. We must be sensitive to the individual needs of each patient, and offer payment options that are tailored to specific patients, as opposed to a one-size fits all approach. Because healthcare financing can be so complex, we must try to simplify as much as possible, to make it easier for patients to understand everything.

[Also: How consumerism is changing revenue cycle]

It’s important to note that the clinical focus on the patient experience has been – and should be – very influential for us in finance. Revenue cycle must learn to focus on continuous improvement of the patient experience. The patient experience has to extend beyond the clinical to the finance side of the business.

Healthcare Finance: How important is price transparency to your revenue cycle initiatives?

Jeff Hurst: We have two major initiatives around price transparency. We’re trying to create more parity between what we charge and what we get paid, so the net to gross is closer to 100 percent. We also want to streamline our chargemaster, specifically to reduce the number of line items for which we charge. Hospitals really do need to simplify their chargemaster. The second initiative around transparency is patient out-of-pocket spending. Florida Hospital has a price estimate phone line that allows patients to get an estimate on their out-of-pocket responsibility, based on the patient’s unique circumstance. Last fall we launched an online application for a out-of-pocket responsibility estimate. We’ve also restructured our patient estimate letter, which explains the methodology by which we calculate an OOP estimate. We’ve tried to use the estimate letter as an education and awareness tool for patients, in some cases to explain the basics of how healthcare financing works. This includes definitions of key terms, and details about a patient’s own healthcare benefit plan.

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Healthcare Finance: There is a lot of industry conversation around the trend of increased patient self-pay responsibility. What are you seeing in Florida?

Jeff Hurst: The average self-pay responsibility for Florida Hospital patients increased almost 17 percent from 2010 to 2013. Our average patient responsibility in 2010 was about $1,500 and our average patient responsibility in 2013 was approximately $1,750. Of that $250 increase, we collected about $50, or 20 percent. The remaining 80 percent was equally distributed between financial assistance and bad debt.

In response, we determined that we had to do better at triaging the patient from a financial standpoint. We needed to know what was happening socioeconomically, and to tailor payment options to a patient’s socioeconomic status. One of the first things we did was stop using the word “collection” and replaced it with “resolution.” Our focus going forward is to have a conversation with a patient about their unique circumstances and to create a custom resolution that is best for the patient.

Twitter: @HFNeditor