You are the CEO, Cast Your Vision

You, the CEO of a hospital or health system, have a responsibility to your board to deliver on growth objectives, produce profitable outcomes, and furthermore, be the shining beacon of care in the community or communities in which you serve. It is under your authority that hundreds, if not thousands of employees, play a vital role in executing a vision that you lead.

Do your employees know what that vision is? More importantly, do you?

Of course, you have goals. Goals quantify and define the steps you must take. They are the signposts that let you know when you are moving in the right direction. They are measurable and answer questions like when? And how much? Too often leaders set goals without first answering, “For what purpose?” or “Why?” We all have goals, but not all of us have a vision.

A vision answers the question of WHY. Vision gives something direction and is your desired future. It’s the powerful reason of why you want to accomplish something: your overarching purpose. It tells where YOU see the organization going and what YOU see it looking like; goals define how you plan on getting there. As the CEO, you have the highest view of the organization and you watch all moving parts move in what is hopefully the same direction to accomplish the goals set by their leaders. No pressure, right?

This article is not about new information. It will not give you a silver bullet or roadmap to defining a winning vision. Rather, it will remind you of basic blocking and tackling and perhaps remind you that each vertical or silo functions underneath you, feeding and building off another. The partners and vendors you select must also understand your ‘why’ and vision. Moreover, I hope this article encourages you to have a greater influence on the partners and vendors you select and align yourself with to reach your goals and furthermore, achieve your overarching vision.

Goal: Grow Top Line Revenue

Perhaps the most important goal of all; not an easy subject to tackle. Let’s start by asking: Where does revenue come from? Simple, right? Patients and payers. So how do you grow top line revenue?

1. Increase Patient Volume

Building a recognizable brand and strong reputation of patient service and satisfaction via marketing. Focus on underserved needs in your community, such as the cardiac lab for example, or maybe NICU. Many hospitals call them “Conversions”, members of the community that become patients. When you have a conversion, it is not so different from any other service provider or even one of your vendors having a sale. You have a new customer. Now SERVE them and serve them well.

2. Better Contracts With More Payers That Add Steerage To Your Facility

There are so many changes in payment schedules and methodologies today. What is yours going to be? Where are you going to draw the line? What does your vision state as the best way to contact with payers and why?

Goal: Grow Net Revenue

I won’t go any further into the explanation of Net Revenue other than to state an over simplification of the obvious for the purpose of the article and conversation.

NR = Gross Revenue – Expenses.

We are not going to focus on the impact of your purchasing department on this number, or your payroll and benefits package. Rather, we are going to focus on driving the most revenue with the lowest cost and highest likelihood to repeat.

Does your vision state what you will be to your patients and community? We will be the best XYZ in the region. Do you brag about your wait times? Do you track your patient satisfaction scores? More importantly, do you realize and teach how important these scores are?

After your contracting department has signed a new contract with a payer, you should start to see steerage from this payer. At that point, you have only so much money you can make. You are giving the payer a 30 – 70% discount on charges. Then that payer is likely paying only a certain percentage of those charges, and the patient is responsible for 10 – 30%, depending on the benefits. This process is your Revenue Cycle Process, basically determining your cost of sale.

Generally, this department and function is run by your CFO and executed by the Revenue Cycle Department. But do you have your fingerprints on it? What are you expecting out of this process?

Too many times the Revenue Cycle is seen as a very linear process…

Patient gets sick > schedules appointment > registers > sees the doctor and is treated > gets billed > payer gets billed > patient goes into collections > facility writes off certain dollars … End Scene.

I would challenge you as the CEO to cast a vision that this is NOT linear at all, but rather, part of a great circle of growth for the facility. And in the middle… the patient.

Picture if you will, a patient receives an order from a physician to treat a patient with a particular type of surgery. The patient visit is scheduled. The facility has engaged a partner or set of partners who have agreed to work together towards the vision of the CEO with key metrics to support net revenue growth. Now the patient is pre-registered. This means ‘Called-in-Advance’ and given information up-front with regard to time of the procedure, where they should park, when they should arrive, HOW MUCH the procedure will cost them out of pocket, and even gone so far as to arrange payment from the patient in advance.

NOTE: This just impacted your Net Revenue because that patient dollar is only worth a dollar prior to the procedure.

ADDITIONAL NOTE: The patient portion was made available via your payment estimator that is tied directly into your contract management tool, ensuring

1. accuracy
2. the contracts have been modeled to give predictable revenue from both payer and patient.

The patient arrives and places their thumb print down for self-registration. They are taken back within a minute and this is tracked on your patient arrival tracker.

NOTE: A KPI tied to patient satisfaction

The actual registration process is clean because you have employed a partner who verifies the quality of each registration and supplies on-going and customized training to your employees and staff, making them better as they learn more on the job!

NOTE: A reduction in expenses supplied by the right partner ensures lower cost to collect or, in this case, the cost of sale. This is the single most important part of the process as it starts the patient estimation process and gives you the best possible claim data from the front-end.

As the patient goes through their clinical procedure, they are not burdened with financial discussions, rather, they are allowed to heal, and be with their families. Post discharge, rather than receive invoices or collection letters they receive statements that their ACH payment for their hospital charges has been processed.

NOTE: These two items work in concert to increase POS payments, and reduce the cost of sale by keeping these accounts away from collection agencies.

The patient is discharged. Best case scenario, with an excellent prognosis. Surveys go out and the facility receives high marks across the board. Forty percent of your Press Ganey scores come from Patient Access. That is, all of the pieces leading up to treatment. Patients want to deal with costs up front. They want to be reassured. This is part of providing excellent customer service and patient experience.

NOTE: A recent study showed that there is a direct correlation between Patient Satisfaction and Net Revenue. Meaning serve your patients better and your Net Revenues increase. Why?

Because the more you do up-front, the more likely you are to have gotten everything correct the first-time (avoiding the dreaded headache of a DENIAL!). The more work you do, and the more accurate your registrar is up-front, means less stress to the patient, the less you have to pay on the back-end in the form of rework, and best of all, leads you to the easiest part…

Filing the claim, the single most commoditized transaction in healthcare. Filling the claim is THE most standardized transaction. When you have problems with your clearinghouse, often times it is truly not the fault of the clearinghouse. In fact, it’s proven that ninety percent of your denials were caused up-front. So, who you choose as your clearinghouse is almost irrelevant.

The work you do to WIN the business of your customer and patient, and the work you do to SERVE them, is the single most pressing concern, and furthermore, answers the question of WHY. This will help define your overarching VISION in which you are leading your team to achieve.

In conclusion:

  • Tie your revenue cycle process to your contract management system to ensure that your contracts are good for the facility.
  • Partner with a vendor that can maximize your patient and payer dollar while increasing patient satisfaction score.
  • Set the tone for what you want to be for your community.
  • Align yourself with vendors who have a passion for partnership and transformation of your facility, its reputation, and its position amongst peers.
  • Look for partners that do not solve one problem, but take a holistic approach to adding value to the entire organization.

You are the CEO. Set the vision, define your goals, and place your people in position. Execute, report to the board, and lead your team to the vision you’ve set to WIN!