staffing

Nearly one year ago, the attention of the healthcare community shifted very quickly to preventing and responding to a new threat called the coronavirus. Hospitals, physician practices, and community health centers faced a challenge like never seen before. Although we’ve learned a great deal in the past twelve months, many of us are just now able to take a deep breath and assess what’s next. We’ve tabled key initiatives, furloughed staff, shifted our priorities, and struggled to keep up with key regulatory changes.

If you’ve had to defer revenue cycle maintenance or eliminate previously budgeted engagements and initiatives, we recommend taking another look at these four areas that can provide meaningful value to your organization – even as you continue to manage ongoing uncertainty and challenges.

1. Address staffing challenges

Has your organization experienced difficulty related to staff recruitment, retention, and engagement during this pandemic?  We regularly hear from clients that staffing challenges during this past year have been very difficult to manage. For many organizations, the patient volumes have returned, but the internal resources required to complete the work is insufficient, untrained, or working remotely, often times less effective and productive. If necessary, align internal processes with what your team does best, and identify partners to help execute the broader strategy. Break the cycle of hire, train, lose employee, advertise position, and repeat.

Additionally, it doesn’t always make sense to promote your best performers. Often times, good “doers” aren’t always effective managers. Be careful not to elevate personnel beyond their level of competence. Understand which skills your local market can provide and which ones make sense to outsource.

2. Improve patient and employee engagement

It is more important now than ever to have meaningful engagement with your patients and internal team members.  So many of our personal relationships have been negatively impacted during the past year.  Take this opportunity to fully engage with your stakeholders and customers to ensure potential improvement opportunities don’t go unnoticed.  For patients, the use of kiosks, portals, telecommunication, and text can help with access to care and staying in touch with your patients.  Consistency within all patient-facing processes is critical.

For internal staff, don’t let telecommuting and alternative work arrangements hinder your ability to receive valuable feedback on what’s working and what can be improved.  Implementing an idea accelerator or automated innovation process can reignite your workforce to be aware of process improvements, cost reductions, and other potential opportunities.  Give them the power to identify and communicate feedback directly to leadership who can implement and impact change quickly and effectively.  Team members appreciate when their voices are heard and good ideas are implemented.

3. Seek out the marginal improvements

When assessing the revenue cycle for improvement opportunities, it doesn’t always require a full-blown overhaul. Review the “margins” for areas of opportunity that are going unrealized. A few recent examples we’ve taken notice of:

• Are charts consistently taking too long to code or is there an increase in volume at the end of each month? Are A/R “hold” buckets continuing to grow with no real improvement? Is A/R aged greater than 90 days too high? Review these processes to determine potential ways to flatten the workload or accelerate and bring forward certain tasks so as to minimize huge swings in volumes and backlogs. Engage external help as needed – don’t let cash collections suffer in the near term.
• Are action items being tasked to departments that don’t know how to address and finalize the request? “We’re too busy to keep up,” we often hear. Provide training, hold them accountable and publish the “backlogs”. If its’ important, it should be tracked.
• Are large dollar priority accounts receiving proactive aggressive follow-up? Remember that 80% of your A/R can typically be managed through just 20% of your account volume. Align your staff accordingly.
• Introduce exception-based processing. Reduce the inventory of work to be done to those outliers that need more scrutiny or review. Spend time on high priority activities and less on the financially immaterial.
• Establish goals that your people can rally around. Many times, goals for cash collections or days in A/R are set by leadership, but not fully understood or tracked at the staff level. Give them ownership and provide transparency into achieving and sustaining progress. Incremental department-specific goals can also be introduced to make them more meaningful to smaller groups or departments.

4. Assess enterprise risks

The last year has presented numerous challenges for healthcare providers to overcome. We’ve been exposed in areas never imagined. No need to elaborate here as we’ve been living it daily. When the timing is appropriate though, take a step back and look at your organization’s risk profile beyond just the revenue cycle. If you’ve done so, develop a testing and monitoring plan to make sure identified risks are addressed and mitigated to the extent possible. Conversely, if your organization has not conducted a risk assessment, consider executing one. Information technology vulnerabilities, HIPAA security measures, cash controls, accounting processes, revenue integrity, compliance oversight, and so many other areas can present organizational risks that need to be identified quickly and managed aggressively. Risks and challenges are never-ending and persistent – so too should be your assessment and prevention plan.

As we continue to deliver healthcare amidst an ongoing pandemic, take a moment to refocus on the fundamentals of your organization. If the core is strong, it’s easier to maintain confidence in a sea of change. If stability is lacking or processes in need of review, seek guidance. No judgment during a pandemic. Each organization is different and requires unique attention and planning.

Adam Shewmaker, FHFMA
Healthcare Consulting Director
ashewmaker@ddafhealthcare.com • 502.566.1054