Practice Management News

Empowering the Frontline to Improve Hospital Revenue Cycle

Visual management boards helped Williamson Medical Center improve hospital revenue cycle performance, including its clean claim rate and customer service.

Hospital revenue cycle

Source: Thinkstock

By Jacqueline LaPointe

- There is always room for improvement in the hospital revenue cycle, according to Rodney Adams, a revenue cycle leader with over 15 years of experience and the current associate administrator of finance at Williamson Medical Center, a 185-bed hospital in Franklin, Tennessee.

“Almost every hospital that I see has an opportunity to improve clean claim rates. They have an opportunity to improve point-of-service collections. They have opportunities to reduce rework, improve efficiencies within the revenue cycle and really throughout the entire financial side of the organization,” he recently told RevCycleIntelligence.com.

That goes for Williamson Medical Center and is the reason why the hospital implemented visual management boards in every revenue cycle management department, he explained.

Hospitals are currently facing a tough financial situation. According to a 2018 analysis from healthcare consulting firm Navigant, two-thirds of health systems saw operating income fall between the 2015 fiscal year and the 2017 fiscal year. For 22 of those health systems, the reduction totaled more than $100 million each.

Rodney Adams, associate administrator of finance, Williamson Medical Center, discusses how visual management boards improved hospital revenue cycle performance.
Rodney Adams, associate administrator of finance, Williamson Medical Center Source: Williamson Medical Center

Falling reimbursement rates, value-based care models, healthcare consumerism, and other trends are putting pressure on the hospital revenue cycle. Improving overall financial performance is key to navigating tighter margins, earning value-based reimbursement, and meeting patient demands in the face of rising out-of-pocket costs. And every revenue cycle department whether it be patient access or business office has a role to play in improving financial performance.

READ MORE: Key Ways to Start A Hospital Revenue Cycle Turnaround Process

But traditional revenue cycle silos and the general structure of the revenue cycle can keep staff from understanding their roles and ultimately from playing as a team, which is vital to improving the bottom line.

At Williamson Medical Center, visual management boards are overcoming these challenges.

The boards installed in every revenue cycle management department display daily and monthly metrics to give staff insight into their performance on relevant key performance indicators. Armed with the information, the departments are able to play the game of hospital financial improvement, Adams explained.

“We are asking our managers and supervisors to coach a game, so they need to know what the scores are to monitor the performance of their team and make adjustments during the month that will allow us to meet our goals and win the ultimate game at the end of the month,” he said.

The monthly metrics, which Adams compares to the Sunday paper’s box scores, are essential to understanding the department’s role in hospital financial improvement, while the daily metrics, or scoreboard, provide key real-time feedback. With the information, departments can not only improve on yesterday’s performance, but also their long-term success.

READ MORE: Tracking Key Hospital Revenue Cycle Metrics to Up Profitability

“We can adjust our course and actions in a way that allows us to win the next inning or the next quarter, however you want to phrase that,” Adams explained. “So, today we should be better than we were yesterday, and it's about continuous improvement.”

Implementing visual management boards

There is some strategy behind setting up the visual management boards, Adams emphasized in the interview.

First of all, the metrics displayed on the boards should differ by department, while still supporting the hospital’s mission, he explained.

“Anything that goes on the visual management board should support the goals of the department and the department goal should support the organization's strategic plan,” he elaborated. “That way there is alignment all the way from strategic planning to frontline staff, and that helps us easily articulate how these frontline staff members and what they do on a daily basis matters and supports the overall organization.”

For example, visual management boards in patient access track quality, specifically the quality of data being collected at registration.

READ MORE: Revenue Cycle Steering Committee Improves Financial Health

“Without quality data, we have all kinds of problems down the line,” Adams said. “So, level one of the visual management board is the target. Our target is 95 percent initial accuracy rate, and we measure initial accuracy, not final, because I don’t want to know how good we are after we’ve had to work the account two or three times. I want to know how good we are and how good our staff was performing after the initial conversation with the patient.”

The next level of the visual management board is displaying performance. Using AccuReg’s Quality Assurance tool, Adams pulls the monthly data and updates the board. If the data shows that 95 percent or more of registrations went through error-free, then a green checkmark appears on the board. If the department does not meet its goal, then a red X goes on the board and stays there for the entire month.

But what gets measured, gets managed, Adams highlighted. For instance, patient access has improved the number of patients moving through registration in ten minutes or less, which was another one of their board’s metrics. The hospital went from the 80 percent range to about 96 percent, Adams reported.

Adams has also observed performance improvement in other revenue cycle management departments, and together, those improvements have increased the hospital’s clean claim rate, which started in the mid-70 to low-80 percent range and rose to the low to mid-90s.

“What I've found throughout my career is that one solution or one problem-solving exercise will move the needle, but it is the combined effort of a vision that says, ‘I want us to get to 95,’ that creates results across the organization,” he said.

While the visual management boards are moving the needle across the organization, Adams warned that each department’s board should not display more than three metrics at a time.

“If you're asking people to focus on improving more than three metrics at a time, you'll struggle to be successful,” he said. “Managers, leaders, and staff can't focus on eight different priorities. So, we pick metrics that are strategically important, and that ties back to strategic planning. We also pick metrics that we can measure and monitor without taking hours to pull the data.”

Overall, the visual management boards have changed the hospital’s revenue cycle culture, Adams stated. Staff are now engaged with the hospital’s financial performance and they are motivated to improve their department’s metrics for overall success.

“As soon as I walk in an area, I get, ‘We missed our goal yesterday, but we're doing this, this, and this today and we're going to be there,’” he stated. “It's really refreshing because you start to realize that the staff can help solve as many or more problems than our leaders and managers can just because of the power of numbers. And my goal is that we create an army of problem-solvers and people who are focused on improving.”

Implementing the visual management boards may be a challenge at first, but the hardships are worth the rewards according to the revenue cycle leader.

“It's something new and determining which metrics you want to measure and how you're going to get data for those metrics is challenging. All of those are the hardest things, but once you get it up and running, it becomes fun and it becomes transformational,” he concluded.