No matter the role, every facet of the healthcare industry demands the ability to collaborate and to creatively problem-solve. As the financial side of the industry has become more complex, the need for teamwork has become a major part of the revenue cycle. Across three decades in healthcare, Richelle Fleischer has seen that evolution firsthand. As president of Texas Children’s Physician Group and senior vice president of revenue cycle for Texas Children’s Hospital, Fleischer strives to ensure that families are given the most convenient access to care.
After graduating with a degree in commerce from the University of Virginia, Fleischer began her career in public accounting. She performed audits in a variety of industries, including higher education, nonprofit, and manufacturing. After consulting and working frequently within the healthcare field, Fleischer decided to dedicate her career to the industry. To best prepare for this transition, she added a master’s degree in healthcare finance from Johns Hopkins, and took a financial leadership position at Mayo Clinic in Rochester, Minnesota. There she focused on developing strong financial reporting acumen and building a cohesive team.
Those traits then fueled her progress to an executive director position at a Virginia-based health system. “Initially, I only had responsibility for patient accounting and patient access for one hospital,” she says. “After I streamlined processes and improved outcomes of those two departments, I asked the CFO, ‘What next?’”
Fleischer has always been eager to find new ways to improve both herself and the ways her institution could provide care. She took on streamlining medical records, building a central scheduling team, and converting transcription to a pay-per-line compensation model.
Eventually, she was managing end-to-end revenue cycle for five hospitals and 350 employed physicians. “I enjoyed taking on additional responsibilities and volunteered for the next opportunity,” Fleischer says. “By the end of my tenure in Virginia, I had responsibility for both hospital and professional revenue cycle for the organization. I was also asked to be the operational finance partner of hospital administration for its 570-bed hospital. It was a great learning experience simultaneously managing three diverse roles.”
When Fleischer’s husband decided to take a physician leadership role in Houston, a recruiter reached out to her to discuss a position at Texas Children’s Hospital as a revenue cycle executive. Fleischer jumped at the opportunity. “I was excited by what Texas Children’s was accomplishing and wanted to be a part of that,” she says. “I was energized by the potential to improve the health system’s financial results to support the mission of caring for children.”
Soon after accepting the role, Fleischer was appointed by the CEO to colead a new organizational initiative to improve access to care. “He stressed that timelier scheduling of patients into subspecialty clinics was the number one problem,” she says.
Fleischer partnered with Dr. Larry Hollier, surgeon-in-chief, to address the issue measuring “third-next-available appointment” time frames. Third Next Available Appointment (TNAA) is the average length of days from when a patient requests an appointment and the third available appointment. A TNAA under fourteen days is considered the gold standard when measuring ease of access to care by national hospital rankings. Fleischer and Hollier found that only 66 percent of Texas Children’s subspecialties were meeting the fourteen-day benchmark.
“The team began opening the door to access by utilizing the existing EHR software for online scheduling, vacant appointment flipping, optimizing physician schedules, and other automated features,” Fleischer explains. “We already owned these technologies, but they hadn’t been effectively implemented operationally.”
For example, the organization began to use electronic wait lists for cancellations, which provided a dual benefit: doctors’ time is utilized more efficiently and patients get access to treatment earlier. “We were able to add fifty-three thousand appointments in a year by leveraging the existing technology,” she says. After just one year, the patient-access initiative now has 83 percent of all subspecialties meeting the fourteen-day TNAA threshold. Texas Children’s has successfully increased completed appointments by more than 9 percent without increasing the number of providers.
Texas Children’s provides world-class quaternary care to children in every state and around the world. As millennial parents and their children continue make up more of the patient population, living up to the technological expectations of the families has become another major focus of the organization. The demand for self-service tools such as online payment portals is increasing exponentially. “We’re just beginning to scratch the surface there, with options such as online scheduling and online payment plans,” Fleischer says. “The healthcare industry is only now catching up to how millennial parents conduct business everywhere else. Texas Children’s has already made major strides in closing the gap with 70 percent of our subspecialties clinics available through online scheduling.”
Based on her financial successes within revenue cycle and her ability to collaborate with clinicians, Fleischer was recently appointed the president of the Texas Children’s Physician Group. “I have already enjoyed partnering with the Texas Children’s physicians, and I am excited to work more closely with the physician leadership,” she says. “It tugs on your heartstrings to know that our work helps children grow up to be healthy adults, to lead productive lives, and perhaps inspire them to pursue a career in healthcare.”
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