Ask anyone and you will hear a “worst case scenario” of outsourcing. Whether its you speaking to some guy at a call center who says his name is Bob… and clearly his name is NOT Bob… Or you know someone who lost their job due to corporate consolidation of “back office processes…” Or you just heard that another CHC’s cash flow all but dried up after some firm came in promising the moon and failed to deliver.
I’d be lying if I said we were never part of these nightmares. I can think of two really challenging cases in which we legally compelled a newly signed CHC to stay with PMG despite their “cold feet” after signing the contract and sending the deposit. While we have had some limited success in these instances… inasmuch as we were able to rapidly and sustainably improve a new CHC’s cash-flow to the point that they became almost immediately convinced that outsourcing was THE right decision, we also have had situations where neither the CHC nor PMG wanted the relationship to continue. There are numerous and understandable reasons…
- Residual and resentful CHC billing staff sabotage relations from the inside out
- Not all C-suite staff are really fully on board with the decision
- A newly hired C-level person, hired post outsourcing decision, makes it his/her mission to displace the new outsourcing partner
Just like any personal relationship, you cannot force someone to be engaged or involved when one of the parties wants out. If you do and are surprised when eventually the thing blows up, well… that’s just not too bright. (Yes, I am saying at times I am not too bright). However, there are steps you can take, whether outsourcing or not, which will dramatically improve your chance of success around the CHC Revenue Cycle.
First and foremost, be honest about why you as a CHC are in business… to provide access to high-quality, affordable healthcare for all those who seek it. Some CHC leaders and their boards have said they are in the business of being a local economic engine primarily to provide employment opportunity. While that is certainly noble, we can unfortunately share some very real stories where CHCs have allowed this goal, and their hubris around fixing billing problems with “some training and consulting” result in their CHC going completely out of business. Fast. Not much of an economic engine if you can’t even keep the doors open.
Second, be able to be pragmatic about what you do and don’t do well. Good to Great author Jim Collin teaches a solid lesson around the “Stockdale Paradox” in which he emphasizes the need to be committed and focused on a goal but with an ability to pragmatically see the reality that exists around you. If your reality is that your billing team will never be able to move from even mediocre to good, never mind good to great… well, what’s the point of keeping it in-house?
Third, even an exceptional Revenue Cycle Management (RCM) partner… and I would humbly offer that is how PMG is viewed by 99% of our clients… cannot be successful unless the Triangle of (Mis)Communication is addressed. I won’t belabor the topic as my business partner and friend, Robert Skeffington, wrote in the last year or so a solid paper on this topic. However, frequent, honest, and meaningful dialogue between Billing (corner one), Front Desk/Operations (corner two), and Providers (corner three) is essential for the RCM eco-system to function at optimal capacity. PMG still has RCM clients who have NEVER allowed us to train or meet with their doctors to discuss how to optimally capture billable services. Data clearly demonstrates that PMG training, never mind PMG actually taking the entirety of the RCM helm, results in a CHC seeing 10% to 15% in increased payments. We have CFOs who routinely “no-show” with our operations team at regularly scheduled monthly conference calls without so much as a phone call to cancel. We are presenting benchmarking data of their CHC vs. PMG’s other CHC clients as well as comparative analytics against millions of other CHC encounters. This is powerful stuff yet they choose to operate in the dark about their CHCs RCM position. And these guys are responsible for the financial viability of their CHC. How do you ignore a top-line (gross revenue) item like billing and call yourself a fiscal fiduciary?!?
Remember, if dialogue is absent between these three corners, cash-flow is always well below maximum potential.
So while billing horror stories exist and will continue, there are ways to mitigate your CHC from playing a leading role in yet another one. When considering partnering with a RCM firm, do it with an open mind. When you make the leap, follow the lead of Alexander the Great and “burn the boats” so your CHC may move boldly ahead maintaining an honest assessment of your present status vs. future end-game. Finally, maximize the Triangle of Communication… not one of those “corners” works in a vacuum and while an RCM partner can maximize their corner, without the other two interacting regularly and openly… optimal performance (i.e., maximum sustained cash flow) will remain elusive.