For those on the finance side of healthcare, it can be difficult to feel the impact of their work as it directly relates to bettering patients’ health outcomes. It’s just the way it is—finance, supply chain, and revenue cycle teams don’t sit wall-to-wall with patients. For these departments, connecting their missions to a successful medical operation is hard if they haven’t built a strategy that puts patients at the heart.
That is, unless you’re on Jon Wright’s team. The associate vice president of revenue cycle improvement at Atrium Health Wake Forest Baptist constantly reminds his teams “that while we don’t attend to patients’ health directly, our efforts are critical to the health system’s core mission. We improve patients’ financial health. The revenue we collect covers the costs of life-saving treatments. Most importantly, the health system imports optimized revenue back into our academic and research programs.”
Wright has spent six and a half years advancing through three different positions, standing up teams and tightening efficiencies. The health system’s cash yield has improved 155 basis points since 2018. “One basis point means another million dollars in revenue,” he explains. “I’m proud of my team for contributing to such significant change.” In the last three years, there’s been a 16 percent decrease in denial write-offs as a percentage of net patient service revenue and a 20 percent decrease in uncompensated care as a percentage of gross charges.
Crises Generate Innovation
“Embedding unique performance improvement skills within the revenue cycle enables us to consistently identify and realize improvement opportunities,” Wright explains. For the 2019-2020 financial year—a year defined by the COVID-19 pandemic—Wright’s team hit 108 percent of its performance improvement initiatives’ targets. More impressively, in the 2020-2021 financial year, they hit 159 percent of those targets.
In February 2021, the American Hospital Association (AHA) published a report forecasting hospital revenues would be down between $53B and $122B due to the “lingering effects of COVID-19.” At the time of writing, “lingering” is a hopeful word.
“AHA anticipates hospitals not going negative will still see an average of 10 to 80 percent margin reduction,” Wright says. “Having this revenue improvement program in place created natural forward momentum for our organization, which was especially helpful with unexpected strong headwinds from COVID.”
There are so many moving parts to the innovation occurring during these revenue cycle improvements that each probably merit their own investigation. But for Wright, it all comes down to a team that he is not shy to be bragging about. “There has been a big increase in revenue cycle consulting in the last decade, and so often that means bringing in consultants to find opportunities for improvements,” Wright says. “A firm will come in from twelve to eighteen months, and then they’ll move on to the next thing.”
Wright’s model is different. They’ve embedded driven professionals with improvement-oriented skills into the revenue cycle who might otherwise be working as consultants but who crave more of a connection to the patients they’re serving. “I would stack my team against the best consultants in the country,” Wright says. “These people work to understand our staff and our patients, and they’re right here alongside them every single day.”
“Having this revenue improvement program in place created natural forward momentum for our organization, which was especially helpful with unexpected strong headwinds from COVID.”
That team was able to stand up a vendor management office (VMO) in the middle of the pandemic. “The reality is that health systems across the country have expanded their vendor partners in response to growing complexities of revenue cycle. Multiple vendors can be difficult to manage,” says Wright.
Upon establishing the VMO, the team found 57 percent of the vendors in its portfolio weren’t hitting performance targets. One fiscal year later, that number has been cut to 25 percent. “We’ve holding our vendors accountable just as we do ourselves internally,” Wright says. Wright noted the vendor portfolio’s cost to collect also improved in the same period.
As Wright continues to embrace, stand up, and mature nontraditional revenue cycle practices, he’s invested in other ancillary support services, like the VMO, to further the mission. He spent his first couple of years in leadership maturing Wake Forest Baptist’s analytics abilities.
“Analytics is a means to an end, so I don’t want anyone to think we’re doing analytics just for the fun of it,” Wright says, laughing. “As we continue to mature our analytics, we lay the foundation for advancements in other areas. For example, as we are beginning to explore predictive analytics, we’re able to put the right account at the right time in staff’s hands.” In a time when more is expected for less, Wright says it’s more important than ever to prioritize work for staff in an order that will benefit the most people while creating less work.
Data Accelerates Progress
Visibility into payer patterns is also paramount, Wright notes. The newly expanded analytical abilities of Wright’s team provide insight into individual payers, comparing each peer group on specific performance indicators.
“Understanding individual payer performance is invaluable,” he says. “Modeling parameters such as payer adjudication patterns, payment velocity, and denial appeals highlights where cash velocity and yield improvement opportunities exist.”
Wright and the revenue cycle team are also incorporating recent advancements in data analytics to stand up new quality performance tools, incorporating a new quality program with existing education program to make education continual.
“For the first time, we can share with a registrar the front-end denials their actions resulted in,” Wright says. “Who doesn’t like feedback on how they are performing well and where they can improve? We’re able to look at new quality issues as they arise and address them with quarterly education to frontline staff.”
With the recent roll out of the quality program to hundreds of registration team members, the team is already seeing a decrease in registration-related denials and an increase in point-of-service collections.
But Wright has only gotten started. For a man who graduated from Wake Forest and claims that he “bleeds black and gold,” he’s done his alma mater proud. But he’s insistent that his team, leaders, and the mission of the healthcare system are the ones responsible for his success.
In fact, he says he’ll stack his teams up against yours any day. Any takers?