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Geisinger Lowers Turnover for Healthcare Revenue Cycle Success
Geisinger Health System’s VP of revenue management attributed healthcare revenue cycle excellence to lower staff turnover rates and an engaged workforce.
A MAP Award for High Performance in Revenue Cycle from the Healthcare Financial Management Association (HFMA) indicates that a health system achieved outstanding healthcare revenue cycle performance on metrics such as net days in accounts receivable and cost to collect.
However, the award also signifies healthcare employment improvements for Pennsylvania-based Geisinger Health System, one of four winning integrated delivery systems.
Barbara Tapscott, CHFP, CPAM, Geisinger’s Vice President of Revenue Management, attributed the system’s healthcare revenue cycle performance to staff and physician engagement strategies as well as the system’s collaborative workflows.
“It’s more the cohesiveness of the team that brings Geisinger the good performance,” she recently shared with RevCycleIntelligence.com. “We have a very engaged executive senior executive team here with CFOs and our System CFO. We have great employees and they’re all engaged. Geisinger provides professional development opportunities. We do additional education. We do executive coaching. We have certification for all to promote careers at Geisinger so that we get to retain our talent.”
But establishing an engaged healthcare workforce at the physician-led system of about 30,000 employees, 12 hospital campuses, and two research centers did not happen overnight. Geisinger Health System recently struggled to retain staff like many other healthcare organizations across the country.
Average turnover rates among healthcare employers reached 19.2 percent in 2015, representing a 1.5 percent increase from the previous year, a Compdata survey revealed.
Healthcare organizations also faced greater turnover rates for a wide range of positions. The Missouri Hospital Association found that the roles with the highest turnover rates in 2016 included housekeeper (29.6 percent), registered behavioral health nurse (29.2 percent), unlicensed assistive personnel (25.9 percent), licensed practice nurse (21.8 percent), certified occupational therapy assistant (20.8 percent), and registered staff nurse (17.9 percent).
High turnover rates can put significant financial strain on hospitals and health systems and negatively impact healthcare revenue cycle performance. An NSI Nursing Solutions report stated that the average cost of a turnover for a bedside registered nurse can be up to $58,400, which could result in average losses of $5.2 million to $8.1 million annually.
“It’s difficult when we have high turnover…That does take a lot of time and diminishes results.”
In light of healthcare employment challenges, Geisinger Health System targeted rising turnover rates to achieve excellent healthcare revenue cycle performance. The most recent HFMA recognition represented the system’s success with lowering turnover rates, Tapscott explained.
“One of the key performance indicators where we improved this year was in our turnover rate,” she said. “It’s difficult when we have high turnover and have to engage recruitment to get people onboard. That does take a lot of time and diminishes results.”
The integrated delivery system aimed to boost employee and physician engagement to reduce turnover rates by investing in health IT systems to support employees.
“We have significant investment in technology to manage administrative costs and routine transactions,” she stated. “We want people to be engaged and not necessarily be doing transactions that are routine. We can engage technology for that. These best practices and this focus on providing education and retention strategies for our staff have paid off.”
A major technological investment Geisinger recently made was in Fast Healthcare Interoperability Resources, or FHIR. The health IT innovation is a standard for electronic health information exchange.
Geisinger worked with Cerner Corporation in 2016 to implement FHIR to move beyond the EHR system for workflow improvements. By linking an application to the EHR system, the healthcare data standard resource stopped providers and other staff from going to multiple health IT systems to gather information on the same patient.
In addition to health IT support, a centralized business office also helped the large integrated delivery system improve its workforce engagement across several hospitals and two states.
“We are here to take care of people. That culture permeates through all of our employees regardless of where they sit.”
“Even when I have employees at different hospitals and they’re in different teams, there is centralized management so that we have standardization in our processes,” Tapscott pointed out. “We work very closely with our leadership at the various facilities to make sure that we’re still there to take care of our patients.”
“At the base of what we do is our mission. We are here to take care of people. That culture permeates through all of our employees regardless of where they sit,” she added.
With an engaged healthcare workforce, Geisinger realized healthcare revenue cycle performance improvements.
“We keep extreme focus on the cycle itself, such as how long does it take for us to gather the right information for billing once a patient has received care and then making sure that we have an environment that is free of billing errors,” she said.
“Once we have that, we can point to the metric that everyone loves, which is how much of your accounts receivable is older than let’s say 60 days or 90 days,” she continued. “If it’s that old it wasn’t collected quickly. We look at making improvements in those areas. We always look at using lean techniques. What’s my root cause? How can I fix it?”
An example of how Geisinger’s healthcare workforce demonstrates cohesiveness from patient access members to clinical teams and the patient starts with the pre-service unit.
“They are the first stop for engaging a clinical team to ensure that what the clinical team has ordered is verified according to insurance coverage,” Tapscott remarked. “If the insurance requires an authorization or it requires a referral, all those administrative transactions are handled before the patient arrives. There’s a lot of coordination with the clinical team to make sure that our clinicians and our patients and then the administrative part are all on the same page.”
The coordinated workflows for pre-service units and clinical teams also earned the integrated delivery system recognition from HFMA MAP for its patient financial responsibilityinitiatives, she added. HFMA awards hospitals, health systems, and physician practices the High Performance in Revenue Cycle award partly based on the organization’s use of best practices for patient financial communications.
“At the same time, we use the tools available to us before a service is rendered,” she said. “We provide financial estimates to our patients. We’ve verified their insurance.”
With a patient financial responsibility workflow in place, Geisinger staff notify patients of the portion their insurance is expected to pay and the estimated out-of-pocket expenses they can anticipate owing.
“Then, we go into the discussion as to what options are there for our patients, from paying in full to making monthly payments,” she stated. “We offer interest-free installment payments to our patients. For those patients that don’t qualify, we have a very generous financial assistance policy.”
“All of that is done in conjunction with communicating with our clinicians and with our patients,” she continued. “We want the patient experience when that patient arrives for care to be totally 100 percent focused on clinical care.”
To evaluate patient experience, the integrated delivery system implemented the ProvenExperience program. Under the program, patients provide feedback on a mobile application and if the patient experience was positive, system leaders recognize providers and staff involved in the experience, increasing employee engagement.
“Your definition of value and my definition of value is probably not the same.”
However, if the patient reports a negative experience, he can request a refund.
“Simply, they didn’t feel that the encounter was as valuable as it should have been,” Tapscott elaborated. “That ProvenExperience program has been in place now for the better part of two years. It’s been very successful. People would think that it would cost any company a lot of money. In actuality, it has not.”
“We have learned a lot about what we could do differently for our patients,” she continued. “Your definition of value and my definition of value is probably not the same. Again, it’s treating people with kindness at a time when they may be overwhelmed by an unexpected event or a bad diagnosis or just the uncertainty of medical care.”
As in other areas within the integrated delivery system, the ProvenExperience team charged with improving patient experience draws on experts from a range of departments to ensure cohesiveness and engagement from all aspects of the patient experience. The team consists of physicians, nurses, and administrative staff.
While Geisinger’s recent HFMA MAP award shows how system leaders effectively reduced days in accounts receivable and implemented patient financial communication best practices, it also speaks to the system’s dedicated workforce.
“It’s all about hiring the right people with the right skills,” Tapscott stated. “At the end of the day, it’s people with the right training that are helping us look for the root cause of a problem so that we can then engage to find a solution.”
Which health-care plans the Senate is voting on (and who to watch) – The Devils in the Details
Senate Republicans opened debate on their health-care bill on Tuesday, but the devil’s in the details.
The Senate is considering a series of amendments to the House’s health-care bill. But don’t let the name fool you; many of these amendments would actually replace the entire House bill with an alternative plan. If the amended bill does pass, it will either be reconciled with the House bill in a conference committee or return to the House for an up-or-down vote.
Here are some of the most significant amendments we expect to come up:
‘Skinny repeal’ could be the Senate’s health-care bill of last resort
As the Senate prepared Tuesday to take a first-step vote on ill-defined Republican plans to go after the Affordable Care Act, a new phrase entered the lexicon of the debate: “skinny repeal.”
In substance, this plan would repeal just three parts of the ACA, according to several sources familiar with the approach. It would eliminate the requirement that most Americans carry health insurance as well as the requirement that employers with at least 50 full-time employees offer coverage to their workers. Both are central elements of the 2010 health-care law and its least popular aspects with the public.
The “skinny” plan also would rescind the tax on medical devices, one of several taxes the ACA created to help pay for other elements of the law.
A close variant of this surfaced two years ago in the House, as part of the GOP’s strategy back then to lower federal deficits. Congressional budget analysts estimated at the time that 15 million fewer Americans would have insurance coverage “most years” as a result.
For Republicans now in the Senate, the purpose is as much tactics as policy: A slimmed-down repeal plan would essentially be a placeholder bill. The idea would likely surface on the Senate floor as an amendment later this week if the chamber has been unable to pass a fuller demolition of the law. It would buy the Senate’s GOP leaders more time because any bill they successfully push through their chamber would lead to a conference committee with the House, which this spring passed its own anti-ACA legislation.
Negotiations between lawmakers of the two chambers could then continue past Congress’s August recess, preserving the ability of Senate Majority Leader Mitch McConnell (R-Ky.) and other GOP leaders to continue searching for a health-policy formulation that could garner the support of enough members of their caucus.
Key ACA Insurer Urges Gov’t to Keep Customer Subsidies
One of the biggest insurers in the Affordable Care Act’s marketplaces is warning the federal government that it must preserve cost-sharing payments for low-income customers to avoid hurting millions of people.
Centene Corp. said Tuesday that a better-than-expected performance in those individual insurance markets prompted it to beat Wall Street expectations in the second quarter and raise its forecast for 2017.
But Chairman and CEO Michael Neidorff, like other insurance executives, is worried about the fate of cost-sharing reduction payments that ease expenses like deductibles for people with low incomes. Money for those payments has made it into Congressional bills that aim to dismantle the Obama-era law, but the fate of that legislation is uncertain.
Republicans have challenged those payments in court, and President Donald Trump has offered no guarantees that they will continue beyond this month.
Neidorff said those payments and some other government support will be crucial to stabilize the exchanges, which have been marred by dwindling choices and soaring prices.
“Any intentional act to stop these … payments does not advance the debate on how to fix our health care delivery system,” he said. “It only hurts the millions of Americans who currently have affordable health care insurance in the marketplace.
“The leadership in Washington bears the responsibility to ensure that is not happening.”
Centene covers more than 1 million people through the law’s state-based health insurance exchanges, which let people shop for coverage and then buy a plan with help from an income-based tax credit. While big national carriers like UnitedHealth and Aetna have retreated from this market, Centene has switched to growth mode.
The St. Louis-based insurer plans to expand next year into exchanges in Nevada, Kansas and Missouri, with growth in its home state filling a void in 25 counties that had no exchange choices for shoppers.
Analysts have said Centene does well on the exchanges because it sticks with customers it knows. The insurer specializes in managing the state and federally funded Medicaid program for the poor. On the exchanges, it markets to low-income customers in areas where it has a Medicaid presence.
“They came at the exchanges from a core Medicaid business and built (care) networks around largely the same providers,” said Jefferies analyst David Windley.
People with low incomes are eligible for large tax credits that help keep their premiums affordable and shield them from big tax hikes. That makes it more likely they keep up with their insurance payments and renew their coverage.
Neidorff didn’t spell out on Tuesday what his company would do if the cost-sharing reduction payments end. But other insurers have said premiums will soar in many markets.
Leerink analyst Ana Gupte said in recent note that she expects more insurers to leave the markets if the future of payments isn’t clarified by September, and that could include Centene reducing its presence. But both she and Neidorff think the funding ultimately will be preserved.
Neidorff said that he thinks congressional leaders won’t have the appetite to leave the “most vulnerable populations” without coverage.
“I am personally, and I think corporately we are, convinced that when all the dust settles there will be subsidies in some form,” he said.
Senator McCain Delivers a Key Health Care Vote, Scolding Message
The maverick stood with his party on Tuesday, casting a crucial vote in the Republican drive to repeal “Obamacare.” But then, like an angry prophet, Sen. John McCain condemned the tribal politics besetting the nation.
Confronting an aggressive brain cancer, the 80-year-old Arizonan served notice he would not vote for the GOP legislation as it stands now. McCain’s impassioned speech held the rapt attention of his colleagues in the Senate chamber.
“Stop listening to the bombastic loudmouths on the radio, television and the internet,” he intoned. “To hell with them! They don’t want anything done for the public good. Our incapacity is their livelihood.”
A few minutes earlier, McCain dramatically entered the chamber for the pivotal vote, his first since surgery and his cancer diagnosis in Arizona. Unified for once, Republicans and Democrats applauded and whooped for the six-term lawmaker. “Aye,” he said, thumbs up with both hands, for the GOP vote to move ahead on debate.
After he voted, McCain stood at his seat and accepted hugs and handshakes from senators in both parties, drawing laughter from the spectators’ gallery when he and Vermont Sen. Bernie Sanders exchanged an awkward embrace.
McCain then spoke his mind. His face was pale, cheek bruised, a red scar and stitches above his left eye where doctors had removed a blood clot. But his voice was strong. He offered a bit of self-deprecation, saying he was “looking a little worse for wear.”
He bemoaned the lack of legislative accomplishments in the current Congress and the GOP’s secretive process in working on repealing Obamacare. He issued a plea for Democrats and Republicans to work together.
Obama and the Democrats shouldn’t have pushed the Affordable Care Act through on party-line votes when they controlled Washington back in 2010, McCain said, “and we shouldn’t do the same with ours. Why don’t we try the old way of legislating in the Senate?”
That would involve committee hearings and testimony from experts and interested parties, an incremental process that could take months.
He blasted the path taken by Republican leaders “coming up with a proposal behind closed doors in consultation with the administration, then springing it on skeptical members, trying to convince them that it was better than nothing.
“I don’t think that’s going to work in the end, and it probably shouldn’t,” he said.
Debates in the Senate have become “more partisan, more tribal, more of the time than at any time I can remember,” he lamented.
With President Donald Trump threatening electoral retribution for Republicans who don’t toe the line, McCain urged senators to stand up for their own constitutional status.
“Whether or not we are of the same party, we are not the president’s subordinates,” he said. “We are his equal!”
People with health care problems had speculated on social media how McCain would vote, and his decision disappointed many. Addressing concerns that tens of millions will lose coverage if the Republican bill becomes law, McCain said the process is far from over.
“I voted for the motion to proceed to allow debate to continue,” he said. “I will not vote for this bill as it is today. It’s a shell of a bill right now.”
Arizona is one of 31 states that expanded Medicaid under President Barack Obama’s health care law, and Republican Gov. Doug Ducey is worried about tens of thousands losing their health insurance. That has to be addressed, said McCain.
The Arizona senator has emerged as one of Trump’s most outspoken GOP critics. During the presidential campaign Trump had mocked McCain for his capture by the Vietnamese.
The speech Tuesday received a standing ovation.
“He’s tough as a boot,” said Republican Sen. John Kennedy of Louisiana. “Many people understandably would be curled up in bed in the fetal position.”
McCain’s return was reminiscent of a similar scenario involving McCain’s good friend, the late Democratic Sen. Ted Kennedy of Massachusetts, who returned to the Senate in July 2008 while battling brain cancer to vote on Medicare legislation, his dramatic entry in the chamber eliciting cheers and applause. Kennedy died in August 2009. (The current Sen. Kennedy is no relation.)
McCain himself campaigned heavily on the “Obamacare” repeal issue last year as he won re-election to a sixth and almost certainly final Senate term. But he has not been a booster of the GOP health bill.
His best friend in the Senate, Lindsey Graham of South Carolina, said he’s been impatient to get back to work.
“Is it surprising that he would get out of a hospital bed and go to work? No,” Graham said. “It’s surprising he’s been in the hospital this long.”
Obamacare’s History Littered With Near-Death Experiences
Few laws have defied as many existential threats as the Affordable Care Act. In seven years, it has been to the brink of elimination nearly a dozen times, only to rally back from seemingly impossible odds. Efforts to kill it have come from Congress (including one in 2015 that made it all the way to President Barack Obama’s desk before being vetoed), the White House and the courts. So far, the law continues.
As the Senate continues its latest effort to remake the law, here is a timeline of the ACA’s “near-death” experiences, which occurred before the bill passed, during its implementation and after benefits began to flow.
Tough road ahead for McConnell on ObamaCare
Republicans on Tuesday cleared a crucial hurdle to begin the Senate healthcare debate, but now face the danger of a circular firing squad if they are unable to unify around a single proposal.
The successful procedural vote sets up 20 hours of floor debate and votes on a virtually unlimited number of amendments, known as a vote-a-rama.
Many of these amendments will fail, and some will pit centrists in the GOP conference against conservatives, a division that has made it exceedingly difficult for Republicans to move forward on ObamaCare repeal.
At press time, votes were expected Tuesday night on an amendment to repeal ObamaCare in two years, and one to repeal and replace ObamaCare with a substitute that Senate Republicans have been working on behind closed doors for months.
Both of those amendments are widely expected to fail, but GOP leaders think it will help them to determine how much support exists for both measures.
That information could be used to craft another compromise before the underlying healthcare bill comes up for a final vote.
Another possibility that seemed to have growing momentum on Tuesday is a so-called “skinny” ObamaCare repeal bill that would only eliminate the healthcare law’s insurance mandates on individuals and businesses and an unpopular tax on medical devices.
If that legislation can pass the Senate, it could be brought to a conference negotiation with the House, when lawmakers from both chambers would try to reconcile their differing products.
Yet it is far from clear that even the “skinny” measure could win support.
Sen. Susan Collins (R-Maine), long a holdout from her party in the healthcare debate, expressed skepticism about the approach on Tuesday. Sen. John McCain (R-Ariz.) predicted in a dramatic floor speech after his return to the Senate following a brain cancer diagnosis that the entire effort was likely to fail, and that Republicans should start over with an open process and committee hearings.
Democrats plan to make the process as painful as possible for Republicans by dragging out proceedings. No Democrats backed the measure to begin debate, and they withheld their “no” votes until the end to highlight the contrast to the GOP.
On Tuesday evening, Democrats forced the Senate clerk to read the entire first proposed amendment to the bill, which was expected to take a couple of hours.
“The aim of our amendment strategy is to defeat the various versions of repeal they proposed and to make it as hard as possible to get to 50,” said a senior Democratic aide.
Republicans control 52 seats, meaning they can survive only two defections with Democrats unified and Vice President Pence breaking a tie.
Several moderates, including Collins and Sens. Shelley Moore Capito(W.Va.) and Lisa Murkowski (Alaska), say they will not support a repeal measure that leaves the question of replacement unanswered.
Republicans are likely to face a rollicking debate over as many as 100 different healthcare proposals.
GOP leaders describe the “skinny” option as a fallback proposal.
“Who knows what the final bill will look like. I’d be happy to have a comprehensive bill that 50-plus senators agree to, but if we can’t, then the idea would be to come up with a core of pieces that 50 of us agree on,” Senate Majority Whip John Cornyn (R-Texas) told reporters.
Even Republican leaders admitted they don’t fully know what to expect.
“There will be a lot of different amendments offered by different members trying to craft the bill. It’s really entirely impossible to predict, in a reconciliation debate, exactly what amendments will be offered or what amendments will succeed. It’s wide open,” Senate Majority Leader Mitch McConnell (R-Ky.) told reporters.
Cornyn predicted that as many as 100 different healthcare proposals could receive votes.
“Under the budget process, everybody is entitled to get a vote on an amendment if they want one. So it’s impossible to predict the sequence,” he said. “We’re going to be doing a lot of voting this week. I hope you all have eaten your Cheerios.”
Democratic Sen. Chris Murphy (Conn.) told reporters that he alone has prepared more than 100 amendments for floor consideration.
The Budget Committee will vet the various amendments to make sure they comply with Senate rules.
The advantage of passing healthcare legislation under special budgetary rules is that GOP leaders can pass it with a simple majority, instead of 60 votes as is usually required for controversial legislation in the Senate.
But legislative provisions must pass a six-part test known as the Byrd Rule. The most stringent requirement is that the budgetary impact of the proposals must be more than incidental compared to the policy impact.
In other words, policymaking that does not have a significant impact on spending, revenues or the deficit is not allowed.
‘Skinny Repeal’ of ACA Likely to Leave Everyone Wanting More
https://www.thefiscaltimes.com/2017/07/25/Skinny-Repeal-ACA-Likely-Make-Everyone-Wanting-More
The Senate’s Republican leadership has added yet another option to the complicated menu of Affordable Care Act repeal and replacement measures that may be considered as alternatives to the House-passed American Health Care Act.
Faced with the very real possibility that they will be unable to pass any of the current versions of their own health care legislation, which ranges from a standalone repeal of the ACA to a complicated restructuring of the law, Senate leadership is now considering the possibility of a measure being referred to as a “skinny repeal” of the ACA.
This represents a sort of fall-back position if the GOP is unable to muster the votes for any of the larger repeal and replace bills. The skinny repeal bill would eliminate the employer and individual mandates, which impose penalties on some businesses that don’t offer their employees insurance and on individuals not otherwise covered who do not buy themselves insurance. It would also repeal the controversial tax on medical devices.
The skinny repeal would fall far short of the goal of complete elimination of the ACA, but it would give Republicans the ability to claim at least a small victory. However, according to the Committee for a Responsible Federal Budget, it would also result in at least 15 million fewer Americans with insurance within a year, and 20 percent increases in health insurance premiums, while saving the federal government a relatively modest $225 billion over 10 years.
The skinny repeal would likely set up Senate Republicans for brutal criticism from both sides of the aisle.
It would also be viewed by large segments of the Republican voter base as a placeholder at best, or a betrayal at worst. By leaving in place many of the ACA’s mandates on health insurance providers and its taxes, the skinny repeal would leave many GOP voters clamoring for further action against Obamacare.
On the left, critics would point out that the elimination of the coverage mandates will inject huge and perhaps fatal uncertainty into the individual insurance market, potentially causing many more people to lose insurance, either because of insurers withdrawing from the system, or premiums becoming unaffordable.
First GOP health care bill fails, with many more votes to come
https://www.axios.com/first-gop-health-care-bill-fails-with-many-more-votes-to-come-2465490343.html
The version of the bill, the Better Care Reconciliation Act, that the Senate voted down tonight included an agreement by Sens. Ted Cruz and Rob Portman that added $100 billion to help low-income people transitioning off of Medicaid, as well as Cruz’s proposal to let insurers sell health plans that don’t meet ACA requirements as long as they also sell plans that do.
Since neither of these were scored by the Congressional Budget Office, the BCRA amendment needed 60 votes to pass, meaning it was doomed from the start as Democrats were never going to support it.
Republicans who voted against the bill: Mike Lee, Susan Collins, Bob Corker, Lindsey Graham, Rand Paul, Dean Heller, Jerry Moran, Lisa Murkowski, Tom Cotton.
