Communication, training, education should lead revenue cycle operations, HFMA policy expert says

Sandra Wolfskill asked the crowd gathered at the Orange County Convention Center in Orlando for this year's HFMA ANI conference what word first came to mind when they thought of patient financial communication; attendees were to submit their answers via their smartphones, with the results displayed live on the hall's two large video screens. One of the words that came up most frequently: "Confusion."

Wolfskill, director of healthcare finance policy for the Healthcare Financial Management Association, had proven her point. A health system's revenue cycle, she said, can't perform optimally if patients don't have a clear understanding of their financial obligations. Communication, staff training and outreach are the best ways to avoid that confusion, she said.

Her opinion was backed up by representatives of high-profile health systems, who convened at the ANI conference on Sunday. Donna Graham, senior director of revenue cycle for the MetroHealth System, was especially enthusiastic about the outreach component, taking the view that the revenue cycle begins even before the actual episode of care, with the hospital taking the lead by going out into the community.

[Also: Geisinger, CHRISTUS, among top award winners for revenue cycle performance at HFMA]

"Outreach for us has always been pre-service," said Graham. "We needed to go beyond, to outreach, before the patient actually became the patient. We're talking about the consumer now."

It's the consumer, after all, who'll ultimately be making the decision about where to receive their care when their health becomes compromised, and it was this realization that inspired MetroHealth to acquire a 38-foot RV -- which Graham often drives herself -- for excursions into the community, looking for people who are uninsured and perhaps don't qualify for Medicaid. The goal is education, and making people feel comfortable with the health system.

"There are consumers out there who need healthcare but don't know how to get access, or feel embarrassed because they don't know how to get that access. It takes that fear factor and that surprise factor away."

Barbara Tapscott, vice president of revenue cycle at Geisinger Health System, said it's important to take the element of surprise away from a patient so they're not overwhelmed when their true financial responsibility starts to kick in.

[Also: 'Slow and steady' philosophy should rule volume to value transition, HFMA ANI expert says]

"Our strategy at Geisinger is caring about the community, caring for our patients, and caring for our employees," said Tapscott. "We want to make sure the patient experience is delivered to our patients in a manner that they expect. It's people caring for other people."

When that becomes a system's approach, it's crucial to make sure staff is properly trained, she said. They become empowered to respond appropriately to patients, and the patients feel more comfortable transitioning through the various phases of care. Even staff members' professional attire is given consideration, because from the patient's perspective it takes away the question of who they're speaking to, and what importance they have in the grand scheme of their care.

"We are now seeing the results of the learning, of what we can do better as an organization," said Tapscott. "Everyone is engaged on the same page as to how our patients want to be treated."

Part of that treatment is making sure the patient understands what they owe, even letting them know upfront if they still owe money from a previous episode. That creates a culture of respect, and in an increasingly consumer-driven industry, failure to show that respect can lead to a health system potentially losing a lifelong customer.

"It's not just about what the hospital is going to do, but it really is becoming patient-centric," said Graham. "We've changed our focus a little bit in our delivery model for community outreach for the earliest possible connection. It's before they even become a patient -- that's when they're a little more open for education. So we concentrated on our employees. … We talk about the quality, and not from the financial aspect. The money will come if the quality is where it should be."

Little things can make a difference in that quality. MetroHealth mails greeting cards to folks on their 65th birthdays to remind them they're now eligible to hop onto Medicare. Patient financial information brochures are freely distributed, potentially quashing any vagaries surrounding payment.

Yet there are challenges to implementing this kind of approach. Patti Consolver, director of patient access at Texas Health Services, said long-standing procedures and customs at a system's disparate hospitals can be an impediment.

"We're so large, and hospitals that have been around for a long time have employees who have been around for a long time," said Consolver. "It's easy to say we'll do everything the way it's always been done."

Last month, Consolver's health system started a 10-year strategic agenda to have its hospitals come together and and adopt the same processes, and ensure every hospital addresses patients in the same way. It also centralized its financial information so consumers can receive all of the pertinent information in a single phone call.

"Part of communication means communicating with these clinical folks to make sure they understand why these types of conversations need to take place," said Consolver. "If you're a multiple-hospital system, make sure everyone's doing the same thing. Put policies in place and formalize things."

"You will be amazed at all the things you could potentially do … to make a difference in patients' lives," said Graham.

Twitter: @JELagasse