Nearterm wins HAAPC awards again!!!!

It was another awesome year for Nearterm. While our greatest reward always is client satisfaction, we certainly were excited to be recipients of the following professional recognition at the recent HAAPC banquet:

FIRST PLACE Contract/temporary award in the technical professional division
(Team of Randy Bingham, Lori Francis, Shelley Muhs and Gayle Tapps)

$250,000+ Contract/temporary in the technical professional division
(Gayle Tapps and Randy Bingham)

Congratulations to all!

Service Management in Hospitals – “The Moment of Truth”

Healthcare Providers are in a more competitive environment than ever before. Patients are making self-directed decisions and they are well informed about their options. There are many websites and other sources patients can access to get information ranging from clinical outcome measurement to peer experience accounts by other consumers.

Interestingly, their decisions are increasingly centered on level of service defined using criteria like wait time, staff attitude, question resolution and patient friendly billing/charge explanation (a diversion from clinical criteria). The impact of this shift in today’s market is magnified when one considers what we have learned about consumer behavior in other industries and how it may now apply to healthcare. For example, TARP conducted research cited in the book “Service America” by Albrecht and Zemke that revealed in part the following summarized findings:

• Unhappy customers who had a problem with a service organization will tell 9-10 people and 13% of customers who had a problem will tell >20 people.


• You will never hear from 60% of unhappy customers.


• Complainers are more likely than non-complainers to do business with companies that upset them.


• Of customers that do complain, 54-70% will do business with you again if the complaint is resolved and a staggering 95% will do business again if the complaint is resolved immediately or quickly.


• Customers who complained and had the complaint resolved satisfactorily will tell an average of 5 people.


• For every complaint received, 26 other customers have problems, 6 of which are considered "serious".

Powerful stuff!

In your organization you have probably heard management directives like “service is everybody’s job”. But how do you know how you are doing if the percentage of unhappy patients who complain is relatively low? You may have patient surveys conducted routinely and those often provide useful feedback and trend analysis driven by the questions constructed jointly by your marketing team and an external resource. But what about all of the patients who did not participate or were systematically excluded in those conventional methodologies? Remember, every unhappy customer is likely to tell 9-10 others about the bad experience they had but they are not likely to tell you!

Here is another methodology we believe every provider organization should embrace as part of a service management strategy – the "Moment of Truth Audit”. A “Moment of Truth” can be defined as any encounter a patient or prospective patient has with your organization in which they can form an impression about your organization. The Moment of Truth Audit approach involves:

1. Discovery; an initiative designed to determine and define what Moments of Truth exist in your business. You might be surprised by how people form their opinions.


2. Assessment; empirical and scientific evaluation of each Moment of Truth Outcome.


3. Empowerment; a plan designed to empower the orgnization to manage service based on Moment of Truth Outcomes.

As one of our clients so aptly put it, “GET YOUR MOTO WORKIN!” (MOTO=Moment Of Truth Outcomes).

We are especially interested in your feedback related to this topic. For example:

What are you doing in your organization to improve customer service?
How do you measure service performance?
Do you have stories you are willing to share that might help other facilities?
Are you generally interested in improving patient service?
Would you consider using a professional services firm to help you improve financial service perception?

Please respond to this blog or just call us if you would like to contribute with peer comments about service management.

Jim Matthews; Principal, Nearterm Corporation

Let’s get acquainted at the HFMA Region 9 Conference next week!

If you are coming to New Orleans next week for the HFMA Region 9 Conference, please come to the exhibit area and meet me at area #19. We are always eager to meet new friends and colleagues.

If you are not coming to the conference, we will come to you! Check out the Nearterm website or just give me a call at 281-646-1330.

Jim Matthews

“Will We Pay These Guys More Than We Collect?”

Nearterm has an Interim Management contract serving one of our more complex multi-facility clients as Interim Revenue Cycle Director. One issue identified during initial analysis was a 7 figure backlog consisting of delinquent accounts with a reasonable probability of collection if worked properly. In this case it was determined that a lot of on-site research would be required. That determination led our client to consider the option of bringing in Interim AR Specialists (Billing and Collection Experts) to work in the business office rather than outsourcing the AR to a remote collection service.

When the Revenue Cycle Team presented this option to the CEO in the form of a recommendation, the very astute and entrepreneurial CEO asked a question that I thought was so simple it was brilliant:

“WILL WE PAY THESE GUYS MORE THAN WE COLLECT?”

I am a student of simplicity, among other things. My background in management consulting, organization development and revenue cycle strategy has required me to help hospitals transform seemingly overwhelming challenges into bite-sized action plans that are in a word “simple” enough to be actionable. So, when a client recently asked this question of one of our senior professional staff, I thought it was worth presentation.

Obviously there are a lot of surrounding considerations that would be answered before a decision could be made but if you can get to “yes” on this one, it certainly means you have mitigated the risk!

In many situations, it is advantageous to outsource to a remote service provider. We often recommend it and frequently help with vendor selection. However, in cases where extraordinary repeated interaction with case management, clinical, health information management, financial, IT and/or other disciplines is necessary at the account level, many vendors lose interest or minimize work protocols. In those cases onsite AR Specialists are a great option.

If you have experience with decisions related to this topic that would be helpful to your colleagues, please share. Nearterm is a repository for revenue cycle case study and we would welcome your input.

Hospital Access Professionals Wear A Lot Of Hats–How About “Loan Officer”?

Most hospitals understand how important admitting and registration professionals are in terms of public image and customer service. They are often the first encounter a patient has with a hospital and therefore represent the first opportunity for a patient and/or loved one to form an opinion about the facility. The intake process and even communication prior to arrival can make patients feel comfortable, confident and trusting in what can otherwise be a very intimidating provider system. That is important in today’s competitive healthcare environment where increasingly patients make choices.

Admitting representatives also have another critical role – Hospital Loan Officer. Just think, they categorically extend more unsecured credit than you see in any other industry. Every time a patient is admitted or treated as an outpatient without paying in advance 100% of the charges in cash, credit is extended. The only collateral is an insurance card, Medicare/Medicaid card, verified coverage or maybe a promissory note – no collateral. It is billions of dollars each year in unsecured credit.

Sometimes non-resource patients apply for charity care. This requires an extensive application process involving proof of income, ability to pay, proof of residency and other components. Sounds like a credit application to me. It is typically initiated and often completed with the guidance of an access representative.

Suffice to say that the role of access professionals in the healthcare delivery system is extremely important! They are the first impression and they have everything to do with getting paid. If that is the case, one might speculate about the recruiting practices, on-boarding, pay scale, training, schedule and many other items used to ensure that these functions are conducted effectively. The expectation would be that these positions would be highly trained and well compensated. If that is not the case, the organization may have a difficult time competing. Let’s face it, it is has been traditionally difficult for hospitals to maintain an access team that “wows” the public but still minds the purse strings. Those folks are hard to find and keep.

My thought here is not so much to talk about what we are doing now – you probably already know that about your organization. I offer the idea that hospitals should consider recruiting admitting personnel with banking or credit screening experience. The characteristics banks, lenders and screening companies are after include:

- Detail orientation and thoroughness

- Professional appearance

- Articulate, good interpersonal communication skills

- Computer savvy

- Comfortable asking for personal information and money

- Sensitivity in face to face encounters

- Ability to say “no” when necessary

- Knowledge about basic financial practices and ability to apply specific policy

- Commitment to confidentiality

- Tolerance to work with a diverse public

- Willingness to initiate problem escalation

I submit that hospitals might be well served to weigh these characteristics and non-hospital experience that requires these characteristics more heavily than healthcare experience when hiring entry level admitting staff. This practice expands the labor pool beyond those with healthcare background and ensures that fundamental qualities are present among the candidates. It is much easier to train a new hire in the nuances of hospital policy and procedure than to teach them the things listed above.

At Nearterm, our Patient Access Consultants have introduced and implemented this kind of thinking successfully in many provider organizations. This process typically starts with assessment of the access system and advances to a conceptual design, work plan and implementation. We also advocate other hiring practices that are “outside the box” both for our clients and internally. Related innovations we have facilitated are remote verification, pre-admission and financial counseling.

Our Healthcare Search Professionals work with clients daily as we partner to re-invent hiring guidelines designed to attract the kind of talent they need. We are always available to discuss patient access, admitting and registration issues with hospital revenue cycle managers.

Revenue Cycle Manager or Revenue Cycle Leader – Which are you?

First allow me to clear the air a bit; neither is “better” than the other and we need both to meet the revenue cycle challenges ahead. Also, volumes have been written on this topic so this is not an effort to present a treatise on leadership or management. It is just a summary of recent thoughts on the subject.

I just heard an interesting definition of “leader”;

“A leader is one who has willing followers”

This seemed so oversimplified that I almost dismissed it but then realized that many who consider themselves leaders look behind them to find no willing followers. There may be employees, customers, colleagues or others who do what is asked of them but that alone constitutes a “management relationship”, not necessarily leadership. Obviously, you cannot be a leader without willing followers.

People are willing followers because they believe in a leader who has vision and value prioritization. Most people when asked to list their 10 most important values will create about the same list. It is how the list is prioritized and applied that often separates leaders from managers.

Vision and value prioritization occurs every day in the hospital environment. A CFO is required to make a decision that weighs patient care against budget constraints. The VP of Revenue Cycle considers how aggressive to be with collection practices that can influence both the bottom line as well as service perception in the community. There are many other examples. Leaders make these decisions effortlessly in a way that attracts followers.

An obvious question arises, “How do leaders do that and can others learn to do it?” I submit that all leadership skills except one can be learned and that is TALENT. It is talent, combined with a litany of learned competencies that allows leaders to be leaders. If you do not have talent, people will not follow. You cannot learn to be talented.

Here is what I think is important in this context. Leaders give direction, but it is managers who know how to get there. Regardless of your place in the organization, never underestimate the importance of both. It is a symbiotic relationship wherein neither role brings value without the other.

iPad2 WINNERS!

Congratulations to Nancy Brock, CFO of Christus St. Catherine in TX (pictured above with Jim Matthews, Principal of Nearterm Corporation) and Steven Bender, CFO of Wuesthoff Health System in FL winners of our iPad2's! Thanks everyone for visiting our booth at the HFMA ANI! See you all again next year!