Diligence in front-end processes is critical - Executive Insights - interview with Cheryl A. Harmon - Interview

Healthcare Financial Management, Dec, 2002

An Interview with Cheryl A. Harmon

Cheryl Harmon's position reflects her organization's emphasis on an expanded role for the CFO. Harmon was hired recently to sen'e as CFO of Provena Covenant Medical Center (PCMC) in Urbana, Illinois. Her mission as CFO is to help develop strategies to ensure that Provena Covenant maintains its financial stability. Harmon appreciates Provena Covenant's creative approaches to challenges faced by many healthcare organizations, such as workforce shortages.

HFM: What is unique about your job?

Harmon: At Provena Covenant, my role involves an emphasis on financial strategy and revenue management, since the accounting function is a service shared by two hospitals in the Provena Health System. I am accountable for the financial reporting at Covenant, but have less involvement in the day-to-day operations of accounting. I joined the organization three months ago. Provena Covenant was emphatic that its CFO needed to provide a consistent finance perspective, focusing on strategies to help the organization remain a financially viable entity I take that focus very seriously.

HFM: What steps have you taken to retain individuals in key positions, such as patient financial services and nursing?

Harmon: We have been fortunate that our turnover rate in patient financial services positions is fairly low We are concerned about the nursing shortage and have developed incentives to encourage our nurses to stay with us. Shift differentials that encourage permanent evening and night positions rather than having nurses rotating on those shifts are in place. Our CEO, Diane Friedman, has developed a pilot program in which nurses are allowed to have the summer off while their salary is pro-rated throughout the entire year. The results of this experiment will be studied as part of a research project. Several of our nurses currently are taking advantage of this program. Other nurses have expressed an interest in taking the winter months off. This may create an opportunity to balance the two programs. Our nurses seem satisfied with the program, and we hope they see it as an incentive to stay with Provena Covenant.

The research related to this project will determine the impact of this kind of scheduling on staffing and nurse satisfaction. When we see those results, we'll determine whether to make this program permanent.

HFM: What is the biggest challenge facing Provena Covenant?

Harmon: As with any hospital today our biggest challenge is remaining profitable and financially viable so that we can continue to respond to the healthcare needs of our community So we are always looking at ways to keep our expenses in check, explore new sources of revenue, and continually evaluate existing services for improvements.

We are working to grow key quality-driven service lines. For example, Cardiac Surgery Associates, a group of physicians affiliated with Loyola University Medical Center in suburban Chicago, now practices at PCMC in Urbana. Our women's center will be designed to provide a multitude of quality-oriented services in one location for ease of access. Our cancer center continues to employ the latest technology to provide quality patient care aimed at improved patient outcomes.

Of course, diligence in understanding and managing costs is clearly in the forefront. We are currently implementing tools, primarily software, that will enhance management of controllable expenses on a real-time basis.

We also want to make sure that we receive the revenue to which we are entitled for the services we provide. We're focused on improving our charge-capture and coding processes on the front end. Being diligent in these areas reduces the chances of missed revenue. We're also examining coding quality. This is not only critical from the perspective of appropriate payment, but also will ensure the integrity of our databases as we work to improve clinical resource management.

Finally, we are beginning an improvement project centered around our admission process, including point-of-service collections. Currently, our ability to collect copayments is limited, and we are investigating setting up processes so that we can more consistently obtain copayments at the time of service. Of course, processes that we adopt must be in compliance with EMTALA.

In addition, we want to address staff training--not only how we do admissions, but also whether the staff has received appropriate training to make the collections. In addition, we're examining our decentralized admitting organization. We're looking at improving portions of the process to ensure the integrity of the data we're collecting, while continuing to make admissions easier for the patient. We have high hopes for these process improvements.

HFM: Accurate coding has a lot to do with the skill and experience of coders. How do you encourage your coders to attain a high skill level?

Harmon: Provena Covenant has established an internal advanced coder status for those individuals who receive certification or other related credentials through a recognized association, or who have many years of experience in the coding field. This status demonstrates that the coders have stayed abreast of changes in their profession. Coders who achieve this status are placed in a higher pay range.