Members-only revenue-cycle club
HFMA-led group sets measures to gauge efficiency
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.