Could you describe Conemaugh Health System?
We are a three-hospital health system, based in Johnstown, Pa., which is in the mountains about 90 miles east of Pittsburgh. Our largest hospital, Memorial Medical Center, has about 550 beds. It’s a level 1 trauma center, with a NICU and a lot of subspecialty units in the hospital, as well as a residency and teaching program. We also operate two very small rural hospitals, including Meyersdale Medical Center, a critical access hospital. Meyersdale is especially interesting because they serve a large Amish population. The Amish will not apply for insurance, even medical assistance, because they do not believe in governmental programs. They are completely self-pay. But regardless, they are the first patients to pay their bills. If something happens to an individual within the Amish community, they rally around one another to offer financial support. Bad debt is not an issue with Amish patients. In fact, they like to come in person to pay their bills.
The Conemaugh business office is in Johnstown, but do you have revenue cycle staff at the other facilities?
Yes. Our revenue cycle team is separated into two divisions – hospital and physician. That’s because we have two distinct billing systems. Our entire finance team in Johnstown is located away from the medical campus. However, we do have patient registration staff onsite at the facilities. They are part of the revenue cycle team. We also have a pre-service department in Johnstown, which schedules healthcare services through a call center. There are over 200 revenue cycle staff across all our facilities, including the physician division. That includes centralized coding as well.
How do you manage revenue cycle across the enterprise?
We have a revenue cycle steering committee, which is a multi-disciplinary group that meets every other month. Almost all the system vice presidents, including the clinical leadership, are on that committee. The clinical leaders are included because they oversee employees that perform charge entry or documentation. We used to have separate meetings at the smaller hospitals – we called them Revenue Cycle SWAT teams. I would take my leadership team to those meetings – including my director of patient accounting, the director of registration, for example – and bring in the registration staff and financial counselors for discussions about challenges they faced.
How is healthcare reform going to affect the way your revenue cycle department functions?
We’re dedicating a lot more resources to the front end of the process, to registration. When I look at the bolt-on technology that we have, or that we want to get, a lot of it is at the front end. We’re also looking at what we need to do in regard to educating our front-end staff and our patients. Soon we’re going to get more patients with insurance who have never had it before, and they’ll have to be introduced to the concept of premiums, co-insurance and deductibles. I think we’ll have to serve as a community resource to help educate patients. We do have financial counselors on our staff, but we’re probably going to need more.
Does this mean that the bad debt issue will be reduced significantly?
We saw bad debt rise a bit in 2008, when the economy took a big hit. People were afraid to pay their healthcare bills, even though they had the money, because they weren’t certain what would happen with the economic situation. But we haven’t seen a bad debt increase. Since 2008 we’ve ramped up our point-of-service collections program, and we’ve seen a big increase in those numbers. Every place the patient touches the revenue cycle, they’re being asked about payment. One of the big keys is changing the culture, educating the patient and getting registration staff to be comfortable asking for payment.
How do you change the culture in revenue cycle?
This year we added an incentive program for registration staff and all others who were expected to collect at the point-of-service. That helps a great deal. We tried different things, like group incentives, but individual financial incentives really make a difference. We also recognize staff for their achievements. We’ve found that staff really responded to public recognition from their leaders.
What is the biggest challenge that your team faces in the coming year?
We want to mature our electronic medical record and upgrade our systems, which will require the staff to catch up with the technology. That’s certainly going to be a challenge, but I think there is opportunity as well.