March 6, 2018
The devil is in the details, and that is doubly true when it comes to the Community Health Center (CHC) revenue cycle. This complex process is incredibly involved, ever-changing, and to keep cash flow steady you must constantly ‘stay on top of things.’ But from an executive perspective what does that really mean? We decided to find out just how involved CFOs are in the day-to-day revenue cycle / billing functions and how that ultimately affects the success of their center.
How CHC CFOs Spend Their Time
We interviewed a series of community health center CFOs and asked them to complete a brief survey indicating how they spend their work week. The patterns we noticed were rather surprising. We found that CFOs at prospering CHCs actually spend far less time (50% less) working on revenue cycle management/ billing. These same CFOs also noted that they spent about 1.25 days per week thinking and working on strategic initiatives (growth channels, grant opportunities, talent acquisition, etc.) Spending more time focusing on future plans, these CFOs felt they were better able to position their centers for long-term success.
Frankly, thinking about the big picture can be overwhelming, and it feels good to check off many small items on our lists so we can have a sense of accomplishment. However, it seems that breaking that pattern may be the path to prosperity. So how do you do it, remove yourself from the details, and focus more on the big picture? Our research shows that there were commonalities among all of the successful CFOs; they were able to select the right staff for the job, delegate the day-to-day activities to them, define how they would measure success, and then have the assigned staff report on the decided measures regularly.
Successful Delegation Is Key
Successful delegation begins with the selection of competent staff. You need to be involved in the hiring process and understand what skills your team should possess. We at PMG have seen more and more centers creating the position of ‘Revenue Cycle Manager.’ This differs from a billing manager in that they extend beyond the billing department, serving as a hub between all parts of the revenue cycle (the front desk, providers, PM system vendors, credentialing/enrollment, executive team, etc.) The Revenue Cycle Manager serves as the point of contact with the CFO and reports out regularly on both challenges and successes.
There is, of course, the problem of finding, training and retaining these capable employees to delegate to. With budgets getting tighter and tighter, attracting and retaining qualified staff is becoming more and more of a challenge for CHCs. If the talent you need is out of your price range, you may want to outsource the entire department (and no it doesn’t have to be with PMG, each vendor has different pros and cons to consider) Just like hiring internal staff, know what skills you are looking for. Be sure to do your homework and check references but don’t close the book on these options because you want to retain control. Many CHCs are opting to co-source their revenue cycle, keeping high-performing staff in positions such as Revenue Cycle Manager, while working with an outside vendor for billing, denials management, etc. The most important thing is that you trust those whom you are delegating to.
Once you have a reliable team in place, you can begin to plot your path. Work with your team to determine your long-term goals and with reasonable measures of success. These can be selected to fit your center’s needs. Perhaps your team should focus on lowering days in AR, or maybe the focus should be on increasing your blended encounter rate. Once goals are in place, ask your team to develop an action plan of smaller steps that will bring you to your long-term goals. The plan should also include methods for measuring that allow you to determine how things are going at any given time quickly. These may be qualitative or quantitative, but you need to have a defined measure your success or how will you know when you’ve reached your goal?
Keep a Focus on the Metrics
Keep a focus on the metrics put in place during the planning phase. These should allow you to manage the processes without having to delve too deeply into the details. Require those to whom you have delegated to report back to you on a regular basis. When you notice that indicators fall below expected norms, ask for an explanation and any proposed solutions. Use this information to revise your action plan accordingly.
Throughout our research, we found that effective CFOs vary widely in their character, strengths, weaknesses, values, and work methods. What they all have in common is that they have a sincere wish to help the FQHC and those it serves. Some are lucky enough to be born effective; others are still a work in progress. But the numbers show that those who are able to delegate their revenue cycle effectively find more time to focus on this big picture and ultimately position their CHC for success.