As the demand for long-term care has increased amid changes in the billing and reimbursement landscape, health service providers have needed to navigate a host of new challenges across the managed care and commercial insurance space. And for providers in the postacute space, says Chris Bahrke, the key to managing those challenges is to look at where they’ve already occurred within the industry.
“We’re seeing a very unique progression from the acute space to the postacute space, where the same processes that have been occurring in that sector are now migrating to the postacute sector,” explains the vice president of revenue cycle at the Brentwood, Tennessee-based provider Diversicare Healthcare Services. “There is a need to now implement the revenue cycle from the acute space and apply it to the postacute care sector.”
When Bahrke first joined the organization in 2011, that was what he set out to do. Bahrke is no stranger to navigating periods of intense change—having worked for eight years as a manager at Arthur Andersen starting in the mid-1990s, where he implemented large-scale enterprise planning systems for various clients. He was forced to rethink his own career goals after the company was indicted amid the Enron collapse in 2002. This landed him in Nashville, where he worked for several years consulting with various healthcare organizations, which led him into designing and implementing payer compliance-based systems in the acute care space.
Working amid the changes taking place there is what led him to the postacute space, where he recognized there would be a need for his skill set. “I knew there would be a need at Diversicare to create new processes to drive scalability and create cost efficiencies because of reimbursement pressure; the introduction and growth of commercial insurance products; as well as the challenges that all healthcare providers face around payment reform,” Bahrke explains.
He adds that traditional postacute reimbursement methods had previously been very simple—they were per diem and all-inclusive, and most of the payers were government-based. But as commercial insurers have entered the postacute space, reimbursement and denial management have become more complex, with with a shift away from per diem-based reimbursements. And amid that complexity, demand was rising—particularly at Diversicare, which was looking to double their size when Bahrke arrived at the company. To do that, Bahrke needed to find scalable ways to ensure that goal could be achieved.
His biggest initiative for the company was designing and developing a central billing office. “What that did was to enable us to acquire new centers without having to add resources on a one-to-one basis,” Bahrke says. The company would soon see the benefits of this project.
During an acquisition of a portfolio of twenty-two centers—nearly a 50 percent increase to their existing portfolio—Bahrke set out to find vet software vendors that would help them to streamline the process. After settling on PointClickCare, he worked to make sure that they were aligned on a methodology going forward. “I’m a big believer that we need to fit the process with the software,” Bahrke says.
Working under a tight timeline, with forty-five days to implement the first eleven new centers and then another thirty-day timeline to implement the remaining centers, Bahrke and his team worked with PointClickCare to implement a solution for a new billing platform. Once that was up and running, he worked closely with the PointClickCare to adapt it further to their needs, particularly around the month-end close process, and has moved on to transitioning their other centers on to that the PointClickCare platform.
“A renewed focus for PointClickCare is to ensure our customers’ business processes and systems are tuned to deliver the most value, says Russ DePriest, PointClickCare’s senior vice president and general manager for skilled nursing. “We measure these efforts against days sales outstanding, and early returns are very encouraging.”
Throughout that process, Bahrke continued to work on enhancing the central billing office, making sure that the team members stationed there had the solutions they needed. And to do that, he focused on having collaborative discussions with his team, making sure that everyone felt involved in decision-making and was able to offer feedback. “I strive to not make decisions in a vacuum. I’m a big believer that if you make your team part of the solution, they will want to make a difference for that solution and the path to the solution will be accelerated,” Bahrke says. “That was a big part of our success.”
“I strive to not make decisions in a vacuum. I’m a big believer that if you make your team part of the solution, they will want to make a difference for that solution and the path to the solution will be accelerated.”
As other challenges require alternative new solutions, he continues to drive those collaborative discussions, both with his team members and with payers. “We’re learning to make sure that we’re clearly delineating with our commercial payers how we define a care level, and to clearly define exclusions and carve outs to make sure that our contract rates are in line with market expectations,” Bahrke says.
He adds that insurers are learning more now about the postacute sector because they’re less familiar with it, leading to some confusion in contracts. He’s continued to implement changes using new technology, working with different vendors to develop payer compliance software that helps Diversicare identify services provided to patients, as well as designing and creating new reporting services. And as the company continues to expand and add other new centers, he’s comfortable that they now have the infrastructure to support that long-term growth.
“Just getting us to a point where we can utilize technology and change processes to drive efficiency has been one of the biggest things we’ve done,” Bahrke says. And, knowing that he has team members who are part of that process and are comfortable coming to him with their opinions and feedback will be critical to that growth as well, he says. “If they want it to succeed, it’s going to succeed,” Bahrke says. “I have a great team who supports me, and I can’t do it without them.”
PointClickCare Technologies Inc. is helping more than fifteen thousand long-term and postacute care providers meet the challenges of senior care by enabling them to achieve the business results that matter—enriching the lives of their residents and patients, improving financial and operational health, and mitigating risk. PointClickCare’s cloud-based software platform is advancing senior care by enabling a person-centered approach to care, connecting healthcare providers across the care continuum with easy to use, regulatory-compliant solutions for improved resident outcomes, enhanced financial performance, and staff optimization. For more information on PointClickCare’s ONC certified software solutions, please visit www.pointclickcare.com; Phone: 800-277-5889; Email: [email protected]