Mem­bers-only rev­enue-cy­cle club

HFMA-led group sets mea­sures to gauge ef­fi­ciency

Modern Healthcare - - Front Page -

One ma­jor health­care fi­nance pro­fes­sional as­so­ci­a­tion has launched an am­bi­tious ef­fort to de­fine, col­lect and com­pare mea­sures of how ef­fi­ciently hos­pi­tals bill and col­lect from pa­tients, in­sur­ers and govern­ment pro­grams.

Since Jan­uary, the Health­care Fi­nan­cial Man­age­ment As­so­ci­a­tion has de­vel­oped and re­leased 19 mea­sures of rev­enue-cy­cle per­for­mance that health­care ex­ec­u­tives say were de­signed as long-awaited uni­form mea­sures to al­low hos­pi­tals to com­pare per­for­mance.

“We’re al­ways com­pet­i­tive and want to do bet­ter than we do to­day,” says Keith Eg­gert, vice pres­i­dent of rev­enue man­age­ment at Or­lando (Fla.) Health and one of the ex­ec­u­tives who helped draft the stan­dards. “I think it’s ex­cit­ing for the rev­enue com­po­nent to have a cred­i­ble plat­form to com­pare our­selves. We didn’t have that pre­vi­ously.”

Ac­cord­ing to the Westch­ester, Ill.-based HFMA, more mea­sures are un­der devel­op­ment, and last July, the as­so­ci­a­tion an­nounced plans for its own on­line prod­uct that re­lies on the newly cre­ated mea­sures to al­low hos­pi­tals to re­port and com­pare per­for­mance. The prod­uct is ex­pected to be re­leased by year-end.

Suzanne Lestina, HFMA di­rec­tor of rev­enue cy­cle MAP—an acro­nym for mea­sure, ap­ply, per­form—says the as­so­ci­a­tion con­ducted mar­ket re­search and opted to cre­ate a sub­scrip­tion-based prod­uct, dubbed MAP App, to give hos­pi­tals and health sys­tems ac­cess to mea­sures from a source that does not sell an­cil­lary prod­ucts or ser­vices.

But the ef­fort is not en­tirely free of ven­dor in­flu­ence. Four com­pa­nies, Conifer Health So­lu­tions, the rev­enue-cy­cle man­age­ment sub­sidiary of Tenet Health­care Corp.; two group pur­chas­ing and con­sult­ing com­pa­nies, MedAs­sets, based in Al­pharetta, Ga., and Premier, Char­lotte, N.C.; and re­cently, health­care soft­ware de­vel­oper Data­base So­lu­tions, Mo­bile, Ala., spon­sor the meet­ings of health­care ex­ec­u­tives who drafted the HFMA mea­sures. Spon­sor rep­re­sen­ta­tives par­tic­i­pated, but did not vote, dur­ing task force meet­ings, Lestina says. Spon­sor back­ing cov­ers ex­penses for the meet­ings, such as air­fares.

Ex­ec­u­tives who over­see hos­pi­tal billing say the in­dus­try has made do for years with prod­ucts or sur­veys that fail to col­lect com­pa­ra­ble data that would al­low rev­enue-cy­cle ex­ec­u­tives to mea­sure per­for­mance against oth­ers.

“There were just a lot of ques­tions,” says Diane Watkins, vice pres­i­dent of rev­enue cy­cle for St. Luke’s Health Sys­tem, an 11-hos­pi­tal sys­tem based in Kansas City, Mo., also an ex­ec­u­tive who con­trib­uted to devel­op­ment of the mea­sures. “It was very pro­pri­etary. You never quite knew what you were get­ting.” To date, 22 hos­pi­tals and health sys­tems, in­clud­ing the Mayo Clinic, Chris­tus Health and Sut­ter Health, have par­tic­i­pated in the task forces.

Ac­cord­ing to Mary Lee DeCoster, vice pres­i­dent of rev­enue cy­cle for Mari­copa In­te­grated Health Sys­tem in Phoenix, “all of us ques­tioned the in­tegrity” of com­monly used, but poorly con­structed sur­vey data that did not clearly de­fine data to re­port for any given mea­sure. Re­sults re­sem­bled a pot­pourri, she says.

Rev­enue-cy­cle ex­ec­u­tives also were un­able to com­pare against hos­pi­tals of sim­i­lar size or own­er­ship, an im­por­tant con­sid­er­a­tion for a safety net sys­tem such as Mari­copa, which may see some re­sults vary from for-prof­its or hos­pi­tals in more-af­flu­ent com­mu­ni­ties, DeCoster says.

The HFMA’s ef­fort to set stan­dard billing and col­lec­tion mea­sures emerged last year as a re­sult of its decade-old “pa­tient-friendly billing” project, Lestina says. The pa­tient­friendly billing project was launched as crit­ics took aim at hos­pi­tals’ pric­ing and billing prac­tices for unin­sured pa­tients.

The trade group in­vited rev­enue-cy­cle ex­ec­u­tives from providers and spon­sors to cre­ate a task force, which pri­or­i­tized and se­lected eight ini­tial mea­sures to de­fine. The HFMA’s three na­tional ad­vi­sory coun­cils and its di­rec­tors vet­ted the mea­sures prior to ap­proval by the trade group’s board and their re­lease in Jan­uary, Lestina says. A sec­ond tem­po­rary task force was formed, and an­other 11 mea­sures quickly fol­lowed in July.

Ex­ec­u­tives say spon­sor rep­re­sen­ta­tives shared their ex­per­tise, but did not in­flu­ence the out­come. Lestina says spon­sors must sub­mit bi­ogra­phies for task force rep­re­sen­ta­tives, who must have rev­enue-cy­cle ex­pe­ri­ence.

DeCoster says spon­sors “have taken a very back-seat role” and do not dis­cuss prod­ucts. Glenda Owen, vice pres­i­dent of fi­nance for the Se­ton Fam­ily of Hos­pi­tals, an Austin, Tex­as­based sub­sidiary of As­cen­sion Health, an­other ex­ec­u­tive who par­tic­i­pated in the mea­sure devel­op­ment, says all the par­tic­i­pants brought a va­ri­ety of per­spec­tives. Spon­sor rep­re­sen­ta­tives had valu­able ex­pe­ri­ence work­ing with mul­ti­ple providers. “There are no wallflow­ers in that room,” she says.

With more mea­sures to de­fine—and po­ten­tial changes un­der health re­form for those mea­sures al­ready es­tab­lished—the trade group was prompted to con­vert its tem­po­rary task force into a per­ma­nent HFMA coun­cil.

Ground rules for the coun­cil, es­tab­lished in Septem­ber, set its in­vi­ta­tion-only mem­ber­ship at 15 rev­enue-cy­cle se­nior ex­ec­u­tives, at least four of whom must be chief fi­nan­cial of­fi­cers. Mem­bers will serve two years and have drafted the next six mea­sures for vet­ting.

Roughly 130 hos­pi­tals sub­mit­ted the fi­nal round of data in Septem­ber to pi­lot the 19 es­tab­lished mea­sures, Lestina says. Once launched, sub­scrip­tions to the HFMA on­line rev­enue-cy­cle ser­vice are ex­pected to fund its op­er­a­tions, she says.

Eg­gert says early re­sults from pi­lot data sub­mit­ted by Or­lando Health has prompted a closer look at pay­ment col­lec­tion from pa­tients cov­ered by PPOs. “There is cred­i­bil­ity in the com­par­i­son,” he says.

Con­sul­tant and ven­dor ac­cess to the rev­enue-cy­cle ser­vice has not yet been de­cided, but the HFMA hopes to en­cour­age de­vel­op­ers to adopt its stan­dard mea­sures to al­low hos­pi­tals to more eas­ily com­pile per­for­mance data, Lestina says. The on­line tool also will of­fer fo­rums and net­work­ing to al­low ex­ec­u­tives to share what works and what doesn’t.

HFMA’s “MAP App” will of­fer a snap­shot of billing and col­lec­tions bench­mark data.

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