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The Revenue Cycle and Clinical Excellence

model of a brain made with push pins

Educate to connect the dots for your team.

By Julianne Brandt, PT, MBA

Revenue cycle management is arguably one of the most outsourced functions in today’s private practice industry.

And no wonder! Balancing big-picture goals with precision while incorporating all of the mysterious payer rules and processes is a task for the experts. Even if our revenue cycle functions are kept in house, we often miss the opportunity to bridge the gaps between posting a payment and clinical excellence. But what if we saw it differently? If we are playing the long game and are truly invested in the success of our business, knitting together the revenue cycle world and the clinical outcomes world unlocks the door to success. The decision to walk through that door is entirely yours, and it starts with trusting the culture of your organization to lead you one step at a time. Do you value clinical excellence? Financial success? The patient experience? The education of your team? Buy-in from the entire staff?

If your answer is yes to any or all of these, it’s time to prioritize the synergy between your clinical and revenue cycle people and processes.

ENGAGED STAFF MATTERS

It’s not enough to simply educate your therapists on accurate billing, coding, and documentation. Nor is it enough to train your support staff and billing team on proper procedures and efficient processes. Adhering to compliance rules and regulations is paramount, but also the bare minimum if your goal is more than satisfying a transaction. Your therapists and entire team can contribute more significantly if they understand why and how payment for services is a critical piece of the value chain and business success. You may be convinced that connecting these dots is important, but can we convince our clinical teams to care about the whys and hows of the financial underpinning of our industry?

Of course we can. Let’s start by debunking some myths:

MYTH #1: YOUR THERAPISTS SHOULD NOT BE CONCERNED ABOUT THE BUSINESS SIDE OF THE BUSINESS; THEY SHOULD FOCUS ON PATIENTS

Protecting your clinical staff from information that drives their compensation, pays their benefits, and provides a safe work environment prevents them from understanding how the work they do every day is directly connected to the things they receive. Appreciation for the link between their daily efforts, clinic operations and their compensation is vital. Without transparency, employees are left to their own devices on how revenue is generated, where it goes, how much things cost, and how things are paid for. Don’t allow them to make assumptions—educate!

The growth and progress of our profession relies on our ability to openly discuss and advocate for the recognition and elevation of our value within the health care environment and our communities. It is the “boots on the ground” therapists whose advocacy has the most effect on insurers and legislators who are setting the reimbursement rules of engagement. Those on the front line see first-hand how cuts, edits, and varying payer rules affect their patients’ experiences, and those stories are powerful ammunition. Although it takes a lot of effort and can be overwhelming, share the details of payment changes with your staff. Demonstrating our value starts with them.

MYTH #2: NO ONE BUT YOU NEEDS TO KNOW HOW THE BOOKS WORK

No need to give everyone an accounting lesson; however, it is imperative to educate your staff that running a profitable business is necessary to provide them with support, resources, and opportunities. You know that your ability to reinvest in the business and your employees is crucial to employee engagement, recruitment, retention, and motivating staff. Now they know and are empowered by the fact that their efforts contribute to all the things that matter to them and the people on their team.

MYTH #3: YOU ALONE CARRY THE BURDEN TO KEEP YOUR BUSINESS SUCCESSFUL

It’s true that no one will ever care as much about your business as you do. However, an engaged and motivated team will want to share the burden with you because they share your purpose. Cultivate an environment where an ownership mentality is encouraged and rewarded and those who can help you achieve your goals will give you their 100%.

MYTH #4: THE INFORMATION IS TOO COMPLEX FOR EVERYONE TO UNDERSTAND

Medical billing, payer contracts, payer behaviors, and payment changes can be complicated, tricky, inconsistent, and confusing. However, believing in your employees’ ability to understand and make sense of it all cultivates a mindset of patience, problem solving, discipline, trust, and learning. The more they understand, the better chance they will solve problems upstream so that reimbursement process is smooth, sans hiccups, delays, unpredictability, and extra work.

STRATEGIES FOR SUCCESS

Now that you have a strategy, let’s talk tactics:

  • Sit down with your team and share. Start small, with what they know and value—their paychecks, the support staff, their benefits, safety, current and useful equipment, and supplies. Apprise them of the hidden costs required to run any business—liability insurance, rent, repairs, and maintenance. They don’t need every detail, but should be enlightened as to what it takes to keep your doors open. This background will be valuable when you explain the whys behind the decisions you make for the practice.
  • Bring it all back to what is important—the patient, the employees. Serving a community requires resources, and profitability avails your practice of more resources.
  • Connect financial success with employees’ career goals. Strong financial viability allows you to invest in your staff’s professional development, which will pay back in dividends in employee loyalty and new revenue-producing specialties and programs.
  • Walk them through the revenue cycle. What is the lag from date of service to receipt of payment? What facilitates this process? What types of events or behaviors can delay or prevent payment?
  • Emphasize the criticality of accurate coding. Focus on the value of their services and the importance of getting paid correctly for the level of care they are providing. Systematically perform audits comparing documentation of services and coding and share results with staff, educating along the way.
  • Remind your team your business is your product, your clinical outcomes. Are they discharging patients when they are just “good enough” or are they seeing each patient through to their maximum performance and beyond? Help them connect the dots between the highest patient outcomes and the financial success of the business.
  • Be strategic in your intention to disseminate information. Dedicate a section of every staff meeting agenda to address new payment changes and consider sharing revenue cycle metrics including:

    1. First-pass payment or clean claims percentage
    2. % of dollars in each accounts receivable basket
    3. Day Sales Outstanding (DSO)

    Remember to paint a picture and tell a story to accompany metrics, starting with the whats, whys, and hows. Numbers alone can be received differently; supplementing context will foster engagement from your team.

  • Take advantage of APTA resources. APTA constantly sends out payment updates at the national, state, and section level. Encourage your clinical staff to be members. Better yet, pay for their membership as it will pay you back in cutting-edge information and advocacy!
  • Again, the culture sets the stage. Encourage curiosity and questions. Be genuine and transparent. Share your vision so Your employees understand your motivation and let them know what is in it for them. Set goals that align with the culture you are cultivating AND the financial success of the business.

Finally, keep your eye out for those who emerge as financially savvy. Those who demonstrate an affinity for data and numbers and are drawn to business side of care delivery can help others connect the dots to the patient experience. Who are your “change agents”—those who are catalysts for change because they naturally inspire and influence others? Change agents ask tough questions, are knowledgeable, and lead.1 Often, we think these characteristics are related to years of experience. However, this assumption may cause us to miss some real talent. As millennials hit the workforce in the 2000s, we noticed that there was a big shift from doing work with your head down to asking “why” at every turn. What started off as a disruptive attitude from this generation of employees quickly became recognized as a critical challenge to answer “why.” What an eyeopener it was to discover that when we answered “why,” engagement ensued and leaders and change agents emerged. These employees asked why because they wanted to learn, and that opportunity to expand their knowledge has empowered them to collectively bring our business to new heights.

A culture where every employee feels like they are 1) connected to the core purpose of the business, 2) a part of the business team, and therefore 3) contributing to and benefiting from the financial success, results in invested employees who feel valued and a profitable business. These employees will bring the finest version of themselves to work each day and in turn, produce maximal patient outcomes. Connect the dots—take the best care of your employees and your patients and the dollars will follow! 

References:

1Curous G. 5 Characteristics of a Change Agent. https://georgecouros.ca/blog/archives/3615. Accessed May
27, 2021.


Julianne Brandt

Julianne Brandt, PT, MBA, is a PPS member and COO of Spooner Physical Therapy in Scottsdale, Arizona. She can be reached at j.brandt@spoonerpt.com.