Monday, January 24, 2011

How do healthcare financial management professionals influence employee focus?

We all want to contribute to the success of our respective organizations. A mentor of mine once imparted to me a simple management tenet that helped me over the years to do just that. He said, “Employees determine what is important based on how you spend your time”. Because my mentor was a brilliant healthcare leader and a great human being, I took this seriously and felt compelled to interpret his subtle advice. Here is what he really told me:

  • When people embrace importance, they act accordingly. In the workplace, when employees recognize that what they do is important and/or that their work will result in something important to their organization, they get engaged. This translates to creativity, harmony, efficiency, ownership and stability.
  • When people are asked to participate in tasks and activities that are not perceived as important, the result is very different, particularly in light of the generational diversity in the workplace today. If you want to test that, ask a GEN Y employee to do something without some explanation of purpose and why it is important. Or for baby boomers, a great example was the scene in the old movie “Cool Hand Luke” where a prisoner was repeatedly asked to dig a hole then fill it back in again to “break” him. It was not important and so the prisoner continued efforts to escape until his death, certainly not the behavior the warden was after.
  • The key question then, is how do employees determine what is important? It is less based on things like what a manager writes in a memo, what the manager says or posts on the wall. It is how the manager spends his/her time. Here are a couple examples:
  1. In patient financial services, account documentation is an important part of the work process. In our revenue cycle consulting practice, we review work samples as part of our discovery process. That means looking at accounts. When we find absent or poor documentation and ask the business office manager about it, we find that they do not routinely look at a sufficient sample of accounts to have made the observation on their own. Employees no longer think it’s important so either discontinue writing up account history or do a hap-hazard job. Spend more time randomly reviewing account stratifications and discussing findings with employees. It becomes important and documentation improves.
  2. Most hospital controllers and hospital chief financial officers would concur that maintaining logs is an important function. At the beginning of the fiscal year, they tell the accounting staff it is important and back it up with a memo or email. Fast forward as other priorities emerge over the course of the year. The CFO spends time working on the bond issue or the new building project and deploys the accounting staff accordingly. The accounting staff perceives those issues must be important and does a great job supporting those initiatives. Now it is time to do the cost report, the logs are summoned and we learn they have not been maintained since the second quarter. Nobody asked to see them or otherwise spent time on the logs all year.
  • The idea is to consider how you spend your time in the context of how your presence influences what people think is important. We can’t be everywhere and certainly there is nothing wrong with job descriptions, emails, memos, verbal direction and other communications. Just bear in mind that at the top of the communication hierarchy is “how you spend your time”.

In overview, you might want to reflect on how you have invested your time and presence over the recent month. Another effective way to assess what employees think is important is to ask them casually and privately, then listen carefully to what they say (not a survey that gives them a lot of time to construe what you want to hear in lieu of what they really think). Perhaps the result would represent an opportunity for you to rethink or fine-tune your management practices as I did.

Friday, January 7, 2011

Why you should consider using a search firm?

Over recent years, approximately two thirds of those hired in healthcare management positions were acquired through a search firm. Most hiring authorities and HR professionals are therefore acquainted with the significant differences among these firms and the various levels of service they provide. That said, there are a number of reasons healthcare provider organizations use search firms and the following is a brief summary you might find useful in confirming the value of such services:
  • Search professionals help you access “hidden candidates”. These are candidates who are very happy in the current employment scenario. They typically do not have the time or interest to look at ads and they would not answer them if they did. They are not looking for jobs. Often, these are highly desirable candidates for obvious reasons. Through research and other techniques, competent recruiters identify and build relationships with hidden candidates on your behalf.
  • Search professionals help you avert “sight seers”, people interviewing without serious interest or compatibility. This saves you considerable time, money and aggravation.
  • Search professionals help you by bringing “confidence” in the probability that a candidate you are working with would accept the position if offered. Issues like compensation, relocation, family/personal matters and others are addressed by the firm before you advance too much time and energy in the process of considering the candidate.
  • Search professionals uphold the highest standards of “confidentiality” in all they do. That allows them to conduct search activities inside your organization as well as individuals you have targeted outside of your organization but were reluctant to pursue directly for various reasons.
  • Search professionals are experts in “on-boarding” and can assist you with this process. On-boarding is a critical element of a successful transition of the newly hired candidate into your organization. It is well documented that organizations that have adopted an active on-boarding process experience fewer failed hiring attempts.
The above is only a summary. If you would like to discuss this topic further or you have comments, please feel free to contact us.

Monday, December 20, 2010

Considerations when hiring Revenue Cycle Consultants and/or Interim Managers

Almost all provider organizations engage Revenue Cycle Consultants or Interim Revenue Cycle Managers from time to time. A lot has been published through HFMA about vendor selection criteria and vendor management. Most professional organizations offer a resource guide that lists options.

That said, here are two practical things to consider when hiring these resources:
  1. Far too often when organizations hire external resources that will be deployed to their patient financial services, finance or health information management departments, they consider only the person OR the company supplying the resource. In order to better leverage your investment; be certain that you are hiring quality resources supported by an offering company with deep expertise in revenue cycle management operations.

    You are importing expertise and human capital to your organization and those values are not found in the company logo, rather they are delivered through the people serving you. Therefore, it is important to interview the specific people who will be working with you. Is the chemistry good? Do they have the technical background required? Have their achievements with other clients been commensurate with expectations you have in your organization? This interview process allows you to access what you are buying without the influence of a logo, business development person or other external factors.

    It is then a value added if you select a professional services company with the capacity to leverage the people selected. Once you have interviewed the consultant or interim director, pursue how the offering vendor achieves synergy by supporting the engagement with a brain trust, technical depth, management practices and other props. At Nearterm, we have (a) a quality assurance program called Q-100, (b) Principals with successful background leading provider organizations and (c) a mechanism for our field professionals to access our collective resources and expertise on a real time basis when engaged in development and/or problem solving endeavors. As a result our clients have the benefit of professionally managed resources with access to a cache of experience, eliminating the “trial and error” approach.

  2. We always have to consider cost. I submit that in most cases, when provider organizations identify sustained operating deficits, performance problems, extended vacancies in key positions and backlogs, the real cost is in NOT getting help from an external resource.

    If these items could have been addressed internally, they would have already been resolved. Losses can be measured in terms of cost of cash and also balance sheet losses. Often the extra set of eyes and new ideas represented by an interim CFO or interim Business Office Director are just the change catalyst needed to improve performance. An Interim Controller can assist finance with accelerating close schedules and new formatting so that management reports are more timely and useful. Regardless of the issue, always think about the cost of inaction in terms of financial performance and even career development.

Thursday, December 9, 2010

Billing backlog, collection backlog, posting backlog – what is the right option?

There is no “cookie cutter” solution because the factors contributing to processing backlogs vary. Here are just a few:
  • System conversion
  • Limited labor pool
  • Space constraints
  • Volume increase
  • Training deficits
  • Ineffective work flow design
  • Change in payor requirement
  • IT problems

The first step is to understand the root cause of the backlog and establish (a) an acceptable timeframe for resolving the backlog and (b) a mechanism to prevent recurrence. The result is almost always a determination that part of the game plan should include additional resources. That is when the question of options becomes critical. Conventional options have summarily included:

  • Hire more staff and accept the time required to train them to the point where they are effective
  • Outsource to a vendor with a remote processing venue
  • Bring in skilled temps (interim collector, interim biller)
  • Some combination of the above
There is another viable option not mentioned above that is very effective – REMOTE AR SPECIALIST. This would be a highly skilled, experienced collector, biller or insurance follow-up person(s) that would work from home with access to the provider system. Typically, this resource would initially work at the provider site for a short time getting familiar with the systems, people, policies and other critical orientations. Work standards would be established and the AR SPECIALIST would then work from home, saving travel cost and eliminating the need for work space at the facility. This very contemporary approach is available through Nearterm Corporation and has worked very well for many provider organizations.

Thursday, October 7, 2010


Most people have conventional wisdom that drives their belief about healthcare funding sources. Here is a trend analysis I recently reviewed in the September/October 2010 “Healthcare Executive” publication that tells you where the money really comes from and illustrates how things are changing;

You can visit to review other interesting facts about our industry trends. Obviously, Medicare is increasing as a funding source and Private Pay is decreasing on a percentage basis. This shift demands that we continuously evaluate operating practices and use of technology. Our Revenue Cycle Strategists and others on our consulting team are working with provider organizations every day to assist with best practice implementation and process innovation designed to stay ahead of the curve. If you have identified solutions you would like to share or if you would like to talk with us about how to deal with the changes ahead, please give us a call.

Friday, September 24, 2010


If you are a healthcare financial professional or want to become one, you are probably familiar with HFMA. It is the best source of educational, networking and career development opportunity available to us. We are all aware of the economic pressure around us but this is not the time to neglect the very resource that can position us to meet the challenges we face. So get involved with your local chapter. The HFMA website is very comprehensive and offers a good explanation of what is available to you both through your local chapter and also national. Here is a link to the website:
Hope to see you at the next meeting!

Monday, September 13, 2010


Have you heard the saying “the cobbler’s son has no shoes”? As healthcare professionals, we are expert at caring for emergent patients and educating the public about wellness and safety. But sometimes we neglect our own wellbeing in lieu of our commitment to the welfare of others. Here’s an easy thing you, your family and friends can do to ensure that in the event of an emergency, your caregivers have a chance to deliver the best care possible. In your cell phone and computer contacts, set up a contact called ICE. Emergency, hospital and other officials are trained to look at your contacts for an “ICE” contact in emergency situations. Here is a link with more details about “ICE”;

By doing this, emergency teams can immediately obtain critical information from you about the patient (history, meds, allergies etc.) and also let you know where the patient is being taken for treatment. You might consider passing this along to school, church, sports and other groups you associate with.