In rethinking revenue cycle, there's no time to wait

Intermountain's CFO Albert Zimmerli speaks at HIMSS15
By Henry Powderly
08:02 PM

Intermountain Healthcare CFO Albert Zimmerli cut to the chase: hospitals have a lousy track record with revenue cycles and that means there’s a huge opportunity to get it right.

According to Zimmerli, the problem comes down to how well organizations and providers answer these questions for patients: How much does this cost? And how do I find financing?

“In most businesses, they demand answers to those questions,” Zimmerli said during a keynote at the Healthcare Finance Revenue Cycle Solutions Summit held Sunday at HIMSS15. “It’s really unacceptable that in something as valuable as healthcare, that is so important to our families, we can’t.”

Zimmerli said Intermountain, which operates 22 hospitals and 200 clinics and has 2,670 licensed beds, launched a host of initiatives designed to revamp and improve its communication and revenue cycle processes. Intermountain, for instance, sets a goal of a 48-hour turnaround on financial aid applications for patients.

The organization also makes sure to balance patients’ financial needs with Intermountain’s fiscal responsibilities, Zimmerli said. To do that, the organization staffs about 1,800 people who work on some part of the revenue cycle process, Zimmerli said. Intermountain also supports four regional offices focused on billing and account follow-up and six call centers supporting pre-registration and scheduling.

All of this has helped Intermountain cut its bad debt – which Zimmerli called a failure of the system – and successfully shift patients who truly qualify for charity care to that designation. For those who can afford to pay, however, that extra communication about financing is making a difference.

“Everyone should pay something, no matter how small,” Zimmerli said. “It gives patients a sense of self-worth, and they usually follow through on protocols for the rest of their care.”

As vice president of finance at Florida Hospital, Jeff Hurst, who also spoke at the summit, agreed that clear communication with patients is key.

“The conversation does not always have to be about collection,” he said. “It has to be about resolutions.”

Hurst said Florida Hospital has turned to several vendors to help focus on improving accuracy and timeliness of estimates, automation and audit reconciliation. That meant having Cerner manage the bulk of its revenue cycle processes.

Hurst also targeted hospital chargemasters as focusing on maximizing hospital revenue over price transparency. Florida Hospital’s charges are currently 22 percent net-to-gross, which means the system essentially charges five times more than it is reimbursed. The goal is to get that closer to 50 to 100 percent net-to-gross, he said.

“I want us to hold patients’ hands and help them navigate through the complexities and intricacies of the healthcare system just like a physician holds their hands and helps them navigate the clinical intricacies of the system,” Hurst said.

Building value is also a high priority for Intermountain, Zimmerli said, which means investing in innovation and picking the vendors that are going to improve the process for both the organization and the patient.

“What really is the value we bring to patients?” he said.