Successfully Consolidating Your Business Office - Hayes Management
WHITE PAPERSuccessfully Consolidating Your Business Office:3 Key Areas to Focus Onwww.hayesmanagement.com
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERTable of ContentsIntroduction11. Situational AssessmentGovernanceFinancial reviewPeopleProcessTechnology233445Patient Impact52. Change ManagementStaff EducationPatient EducationProvider EducationChange Control667773. ROI Analysis - Justify the ExpenseTechnologyWorkflow and StaffingRevenue Growth8899Short Term Investment vs. Long Term ROI10Summary11About Hayes11www.hayesmanagement.com
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERIntroductionThe drumbeat for more cost-effective healthcare delivery is constantand growing. While Washington wrangles with the conundrum that is along-term plan for the U. S. healthcare system, organizations must operatein a “right now” environment of reduced revenue and shrinking margins.The shift to value-based care and alternative payments is adding additionalstress to the financial well-being of health systems, physicians and otherprovider groups.The Healthcare Financial Management Association (HFMA) points outthat the “transition from volume to value and a corresponding move topopulation health management will require sophisticated managementexpertise and significant capital investments.”1 The rollout of MACRAadds new requirements and regulations to physician practices.Increasingly, hospitals and physicians are realizing that they can’t meet theseregulatory and financial demands alone and need to partner with othersto maximize resources. Such thinking has resulted in “merger mania” in thehealthcare industry.Since 2010, there have been over 500 mergers and acquisitions involvingalmost 1300 hospitals.2 The percentage of physicians in groups of nine orfewer dropped from 40.1 to 35.3 in 2015 while the proportion of doctorsin groups of 100 or more increased from 29.6 to 35.1 percent.3As more health systems merge, consolidate and diversify, many arelooking to combine disparate hospital and physician billing offices intoone single billing office. Even those organizations that are not actively inM&A mode are looking for ways to improve margins by lowering overheadcosts through streamlined revenue cycle operations. These efforts ofteninvolve consolidating business office functions such as patient statements,customer service and systems integration. They may be trying to get on asingle technology platform or to streamline like functions and minimizeduplication of effort around registration, insurance assignment andverification on the physician and hospital sides of the organization.Consolidation - whether external or internal - means merging of centralbusiness office operations specifically and the entire revenue cycle ingeneral. Combining tasks, workflows and technology to create economiesof scale can result in much needed cost savings.www.hayesmanagement.com1
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPEROrganizational leaders often agree on the potential benefits of consolidation, but many fear disrupting established operations could make thingsworse and may result in lost revenue or diminished employee morale.There are also concerns surrounding the breaking down of organizationalsilos that could result in loss of positions or jobs. More frequently, theyjust aren’t sure where and how to start the process.Here are three things to think about if an M&A is forcing a consolidationor if you are simply looking to combine revenue cycle operations forbetter efficiency.1. Situational AssessmentExecuting mergers or centralizing your business offices to achieve maximumvalue can be challenging.You need to begin with an honest evaluation ofwhy you are considering merging or consolidating. There could be severalreasons: To grow larger to hedge out the competition and gain an edge in acompetitive environment Obtain negotiating leverage with payers and vendors Streamline operations and reduce costs Improve productivity and efficiency Increase patient satisfaction through single threaded patient engagement Allow more rapid access to a wider range of consolidated financialinformation and operating detailAccording to a recent HFMA report, the value of consolidation involves twokey questions: will there be benefits to the merging entities and will thosebenefits ultimately be passed on to consumers in the form of higher qualitycare, lower costs or both.4Once you establish the basic value proposition of your consolidationproject, you can proceed to assessing your current situation. Before you candetermine where you might be able to combine functions and streamlineoperations, you need to understand the inherent differences betweenthe organizations or divisions you plan to consolidate. This requiresconducting a comprehensive organizational assessment of your people,process and technology to establish your current situation and providea baseline from which to proceed with the project.www.hayesmanagement.com2
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERCOMPREHENSIVE ORGANIZATIONAL ASSESSMENTPEOPLEPROCESSTECHNOLOGYGovernanceThere can be many pitfalls during a consolidation project so it isimportant to put a strong governance structure in place. A key part ofthis effort involves identifying a visionary with deep revenue cycleknowledge within the organization who can lead the charge. This personshould spearhead the assessment of cultural issues in the billing offices,identify potential leaders who can facilitate the transition and gauge theorganizational willingnessto change.The governance team must have the solid support of senior managementand include cross-functional representatives from all critical businessfunctions – legal, finance, compliance, clinical, business office, technology,facilities, human resources and public relations/marketing. Every aspect ofthe business will be affected in a consolidation project so it is best to havea broad governance team early on. This will ensure decisions are madekeeping the interests of the entire organization in mind.Without a single source of direction, the effort can often veer off courseand cause disruption without achieving the goals you have set. Stronggovernance is crucial to help vet decisions involving changes to systems,personnel and workflow. Establish a vetting process that is efficient so asnot to cause significant delays to the decision-making process.Financial reviewThe assessment should begin with a comprehensive review of the financialstate of the organization.You will need to conduct a complete analysisof your financial statements including the P&L, balance sheet and cash flowstatement. Examine all purchased services, capital expenditures andany other outlays that can be targeted for cost reduction. Review andunderstand the revenue cycle KPI’s to identify under performing groupsor departments. Complete an ROI analysis of gained efficiencies, costwww.hayesmanagement.com3
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERreduction and cash acceleration that can be realized through consolidation.This ROI analysis should be the foundation of your internal “selling”of change throughout the organization and with impacted groups. Furtherin this document, the process for performing an ROI analysis is outlined.PeoplePeople can be an organization’s most important asset, so assessingpersonnel is a critical component of the overall assessment. Start byreviewing your organizational chart, open positions, staffing details, payrollschedules, compensation policies, and benefit summaries. Perform a paygrade analysis and look for areas to implement normalization of jobdescriptions and positions and potential elimination of redundant positions.Review productivity reports to assess the strength of your staff to help inmaking staffing decisions.You should also review quality results and outcomes. Many organizationsdon’t fully track the quality of individual work performance but whenconsidering consolidation of staff, this analysis is crucial when trying toidentify your “star players.”You will also need to assess the skill levels of your management personnel. Consolidation requires sophisticated management techniques to meetthe demands of right sizing the organization so you want to be sure yourmanagement team has the necessary skill set. The management personnelare your ongoing “change agents” pre and post consolidation, so they needto have buy-in and ownership of the consolidation efforts.ProcessPart of the assessment is reviewing the policies, processes and workflow ofthe merging entities and if different, uncovering the underlying reasons.The key is determining which, if any, represent best practices. These canbecome part of the foundation of the consolidated organization. Reviewthe reporting metrics, productivity measures and quality monitoring in everydepartment.Your plan should include a timeline for internal and externalchanges as well as a communications matrix for sharing information withstaff and patients before, during and after implementationGuard against a “this is the way we’ve always done it” attitude.Consolidation presents a perfect opportunity to introduce fresh, newworkflows that eliminate redundancies that may have crept into existingprocesses. A representative for all the merging groups should participatein the review and development of any new processes, procedures orworkflows. Each group and department will inevitably feel “their way iswww.hayesmangement.com4
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERthe best way.” Having representation from the staff/function level is criticalto making the final decisions on best practices and getting “buy-in” foreffective implementation of consolidated workflows.Consolidation provides an optimum time to look at performance metrics,level set expectations, establish measurements and set goals.TechnologyMerging technologies is often one of the most challenging aspects of aconsolidation effort. Each site will likely have chosen a vendor for anynumber of reasons – feature set, lower costs or more responsive customersupport. Analyze each technology stack to determine which is “best inbreed” and most effectively meets the needs of the consolidated operation.Establish which of your service lines are strong and which may requirepartnering with a system that will add synergy and excel in services thatyour current group does not.The final decision as to which system you choose can come down to cost.You may opt for a new, integrated solution or to continue with one of thecurrent systems. If you choose an existing system, you need to guard againstthe appearance that the team from that entity is in charge and that theirworkflows are to be adopted.Moving to one system provides the best opportunity to reduce cost andresource time. Supporting and maintaining multiple systems will reduce theROI of the project. One system that provides consistent workflows acrossall entities enables a true “apples to apples” comparison across all divisionsand locations. This can be problematic for some organizations that havedifferent billing systems and requirements for the physician and hospitalsides.Any systems decisions will involve a review of current vendor contractsto determine the approach to take to consolidate or replace third partyvendors that handle bad debt or clearinghouses.You will also need toassess the impact of system change to payer contracting.Patient ImpactRising consumerism is bringing much needed transparency to thehealthcare market so successful consolidations must include ways in whichthe combined organization can pass the benefits of consolidation on tothe consumer.www.hayesmanagement.com5
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERConsolidation opportunities that can improve patient satisfaction and keepsthe patient at the center of planning and implementation include combiningregistration and billing activities. This enables centralized customer serviceand single statements which simplifies the patient experience. For example,instead of multiple staff contacting the patient for payment there is onepoint of contact in the form of a financial counselor for the entireorganization.You can also streamline patient access and engagement whenit comes to financial counseling and other interactions.The goal is to create a “single-threaded” patient engagement model thatcentralizes all the touchpoints between the patient and the organization.This includes financial counselling, communication, billing, and collections.2. Change ManagementChange is uncomfortable for many people and organizations andconsolidation certainly represents significant change. According to a 2013Towers Watson study, only 25 percent of change management initiativesare successful over the long term.5 To beat those odds and manage changeeffectively you need a structured change management process.Consider implementing change management coaching sessions for themanagement team. Many managers in the healthcare industry lack formaltraining in this area but having skills they can leverage is crucial when anorganization is undergoing a significant transition like a consolidationinitiative.The key to effective change is education and communication. Clearlycommunicate timeline and milestones and report progress on a regularbasis. Successful consolidation efforts educate all stakeholders on what toexpect and when to expect it and how the desired end state will benefitthem. Defining expectations will help reduce anxiety. Change management,properly implemented and aligned with technology and strategic initiatives,leads to spending reduction.Staff EducationYour staff will feel the biggest impact of change related to consolidation soit is critical to involve them as much as possible. Extensive training will berequired anytime there is a new system, revised organization structure orupdated policies and procedures. The lack of a significant level of trainingcan lead to confusion and chaos. In the uncertainty, staff might improviseand create their own policies and procedures on the fly which will likely bedifferent from the ones you have put in place. Productivity and efficiency willwww.hayesmanagement.com6
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERsuffer as a result. Set expectations as to when productivity will return tonormal or what the new norm will be after the transition.As staffs from the different entities merge, you must avoid the “we do it thisway” mentality. Involving the staff as an intricate part of the transition willhelp avoid these pitfalls.Patient EducationSuccessful consolidations educate the consumer on what is happening andthe impact it will have on them. Highlighting potential benefits they willenjoy – reduced costs, improved quality of care, streamlined patientengagement and interaction – will help dispel anxiety.Consider using consumer focus groups to assess what your patient basefeels is lacking or what services need improvement. This has been a highlysuccessful tactic in other business markets although it has rarely been usedin the healthcare industry. Obtaining the “voice of the customer” is alwaysan effective way to keep the interests of the patient at the forefront.It’s important to carefully explain the coming changes especially involvingservices being offered, look and feel of bills and statements and customerservice support. If this is a merging of organizations in separate geographies,patients will want to know if their local contacts will be changing and if so,where they should go for help. Stress that you are trying to streamline yourorganization and process and make it less arduous for patients to contactyou.Provider EducationIt’s also important to inform your providers of the changes to come andhow it applies to them. They feel responsible for the integrity of therevenue cycle so when you talk about streamlining there is a high levelof concern that they may lose some control. Managing physicianexpectations to mitigate anxiety is a critical part of change managementand if not handled properly, can derail the project.Change ControlThere will be many decisions regarding changes that need to be madeduring the consolidation process. It’s important to put a process in placeto ensure that each change is discussed, reviewed and signed off by thegovernance group before it is implemented.There will always be some resistance and fear regarding the changes to bemade so it’s critical to anticipate potential issues and problems that mightwww.hayesmanagement.com7
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERarise because of a change. Thoroughly examining the impact of every changeon the various elements of the organization is the best way to avoid makinga difficult situation even worse. The key is finding the right balance – when adecision needs to be vetted by the governance group and when it should befast-tracked.3. ROI Analysis- Justify the expenseIn most cases, the main reason for a merger or business office consolidationis cost reduction. There are also benefits involving better care outcomesand improved patient engagement, but the justification most often comesfrom improving the organization’s bottom line.There is no question that consolidations can provide significant savings –up to 40 percent in some cases - but there are short term expendituresneeded to realize the long-term gains.You must be able to clearly outlinethe ultimate return on investment to justify these costs.The opportunity for long term cost savings lies in three main areas:technology, staffing and performance improvements. Although theseinitiatives will require some incremental costs in the near term, you shouldexpect substantial returns in terms of improved analytical capabilities, bettercustomer service and ongoing savings in future yearsTechnologyThe main savings opportunities in the technology area revolve around thesimplification of your technology stack and reducing expenses related tothird party vendors. Start with an inventory and assessment focused on thereview and validation of existing applications and interfaces documentingpotential cost avoidance opportunities.Many organizations have silos of the providers and hospital groups. Evaluatethe various technologies in use and their level of optimization to determine“best in breed” for the core practice management system and EMR. This isthe first step toward streamlining with one integrated platform.You shouldrecognize that if you are under utilizing the technology you have, you maybe able to elevate to “best in breed” simply by optimizing your existingsystem. This strategy can be extremely cost effective in a consolidationproject.Also conduct a review of your third-party vendors handling electroniceligibility, claims, and clearinghouses. If you are paying multiple vendors withsimilar capabilities you can consolidate to simplify your stack and gain betterwww.hayesmanagement.com8
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERpurchasing power by increasing volume and utilization of fewer vendors.This will also reduce licensing fees and staff support costs. With fewersystems, you will likely need fewer system tech experts, analysts anddedicated trainers to maintain and support them.Workflow and StaffingSimplifying the technology stack and minimizing support, training, upgradesand general help desk personnel can be a primary source of staff savings.Other opportunities for staff cost reduction can result from gainingefficiencies from enhanced or new system functionality and automation.Another area for potential cost savings comes from centralizinglike-functions and getting everyone on the same platform. For example,if you have hospital and professional services on two different systemsand can consolidate them on one you can merge your call center customerservice. With a single statement, there is no reason to have separate callcenters.Simplifying and consolidating your operations opens a host of opportunitiesfor right-sizing staff. Look to centralize back end functions like A/Rmanagement, statement production and lockbox payment posting as wellas front end tasks such as financial counseling, patient registration andinsurance coverage verification.Reducing the number of sites where these functions are being handled alsoallows you to decrease the overhead management required to overseethem. These “hidden” costs of managing disparate workflows, staff andtechnology can all be considered areas to target for cost reduction.It can be helpful to go beyond what you think are the normal cost savingsof consolidation because there are other areas that may provide savingsopportunities.You can also research staffing level metrics collected fromvarious industry benchmarks that can help you target possible staffsavings goals.Revenue GrowthThe benefits of consolidation do not lie strictly with cost cutting.Consolidating systems and workflows streamlines your internal operationswhich can translate to a more positive experience for the patient. In acompetitive environment where healthcare organizations are fighting toretain and gain patients, the increased efficiency that attracts morecustomers can mean higher top line revenue.www.hayesmanagement.com9
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPEROrganizations where hospital and provider services are handled byseparate business office can find themselves competing against each otherfor the patient dollar. When a patient comes in, both sides are trying tocollect from them. If you are in that situation, you can benefit from goingto a single, consolidated statement where both sides are collaborating asa single enterprise on collections. This makes it less confusing for thepatient, increases collectability across the board and enhances thepatient experience.Optimized or new system functionality and integration with EMR mayincrease your ability to effectively capture charges and services, leadingto increased revenue and enhanced revenue integrity.Short Term Investment vs. Long Term ROIWhile consolidation provides long term benefits, you should be preparedfor the short-term costs of the investments you will be required to make.Be prepared to pay for up-front costs such as back filling positions andbringing on additional, temporary staff to get things off the ground. Set asidereserves to account for an initial impact on A/R and cash flow.Some short term tactical actions like changing vendors for statementproduction or insurance verification can be done quickly and, dependingon the contracts in place, could reflect savings in a month or two.Altering things that may be ingrained across the enterprise suchtransitioning to a new practice management or EMR system or centralizingstaff will take significantly longer. These core changes need to be vetted,budgeted and ultimately financed over time. Initiatives like co-facilitation ofstaff and reengineering workflows requires up front expenditures and timeto accomplish.Set realistic timelines and milestones to determine when you will breakeven and when you will begin seeing reduced costs or additional savingsfrom your consolidation. Typically, you should realize a positive ROI in yearthree. This is especially the case when you are making PM or EMR systemtransitions or relocation changes.In our experience facilitating multiple consolidations we have been able todemonstrate a 20 to 40 percent savings for our clients. The level of savingsdepends on the extent of the project. If you are making minor adjustmentsto vendor contracts, your savings will be less than if you are completelytransitioning to an integrated PM system or implementing a major workflowconsolidation.www.hayesmanagement.com10
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERYour ROI calculation should include conservative, moderate, and aggressiveprojections depending on the number of actions you ultimately execute. Inthe end, you are likely to land somewhere among those three.SummaryThese three major planning areas are relevant whether you are involved ina major merger of separate entities or consolidating business offices withina single organization.You need to determine how much time, money, effortand energy you are willing to devote up front to make your consolidationproject successful.It’s important to remember that a consolidation effort isn’t over once youflip the switch.You still need to keep your finger on the pulse to track theresults of the actions you are taking and to confirm that you are realizingthe projected savings. Establish milestones and monitor them on a regularbasis. Only then will you know if you are achieving the goals you have setand realizing the hoped-for value.Taking on a consolidation project can seem daunting. Engaging with anexperienced partner who has been through it before and understandsthe potential pitfalls can make the initiative much more manageable.Your partner can help you develop an action plan with timelines, milestonesand checklists that breaks down the tasks to make the project morecontrollable.About HayesHayes Management Consulting is a leading, national healthcare consultingfirm and software developer that partners with healthcare organizations tostreamline operations, improve revenue and enhance technology to drivesuccess in an evolving healthcare landscape. To learn how Hayes can helpyou with your revenue cycle needs, call 617-559-0404 anagement.com11
Successfully Consolidating Your Business Office:3 Key Areas to Focus OnWHITE PAPERSources12345Health Care 2020: Consolidation, HFMA report, Fall 2016Health Care 2020: Consolidation, HFMA report, Fall 2016Consolidation of US Physician Practices Continues to Surge, byNicola M. Parry, DVM, Medscape, September 7, 2016Health Care 2020: Consolidation, HFMA report, Fall 2016New Study Explores Why Change Management Fails – And How to(Perhaps) Succeed, by Victor Lipman, Forbes, September 4, 2013.1320 Centre StreetNewton Center, MA hayesmanagement.com12
or if you are simply looking to combine revenue cycle operations for better efficiency. 1. Situational Assessment Executing mergers or centralizing your business offices to achieve maximum value can be challenging. You need to begin with an honest evaluation of why you are considering merging or consolidating. There could be several reasons:
Coping Successfully with Pain Neville Shone Coping Successfully with Panic Attacks Shirley Trickett Coping Successfully with Prostate Cancer Dr Tom Smith Coping Successfully with Shyness Margaret Oakes, Professor Robert Bor and Dr Carina Eriksen Coping Successfully with Ulcerative Colitis Peter Cartwright Coping Successfully with Varicose Veins
1 Reg Office: Cmd Line Reg Office: Cmd Line 2 Reg Office: Desktop v1 Reg Office: Desktop v1 3 Reg Office: Desktop v2 Reg Office: Web v1 4 Reg Office: Web v1 Reg Office: Web v2 5 Reg Office: Web v2 Reg Office: Desktop v2. Client-Side Web Programming: CSS . - book.py, database.py
accounting office. 4. The DoD accounting centers identify elimination amounts required for the eliminations column of the consolidating DoD stand-alone entity financial statements (e.g., Army General Funds) and supporting schedules (e.g., Active Army Consolidating Statements). Using the DDRS-AFS trial balance data base with trading partner
Why Oracle for Linux on System z Value Statement – The best TCO characteristics can be obtained from consolidating many servers with low CPU utilization and taking advantage of the virtualization capabilities of z/VM. – However, Linux scales well in an LPAR and may resolve other issues or problems such as availability.
viii Consolidating Microsoft SQL Server on the IBM System x3950 M2 Simon Champion is an IT Specialist in UKISA ITDelivery based in the United Kingdom. He has over 19 years of IT experience. He has worked at IBM for 5 years and his areas of expertise include Window
Standard Test Method for Passing Ability of Self-Consolidating Concrete by J-Ring . 1. Scope . 1.1 This test method covers determination of the passing ability of self-consolidating concrete by using the J-Ring in combination with a slump cone mold. The test method is limited to concrete with maximum size of aggregate of 1 in (25 mm). 1.2 The .
and 3) segregation and bleeding of the drilled shaft concrete (1). Self-consolidating concrete (SCC) is not routinely used for drilled shaft construction in North America; however, due to its flowability and resistance to segregation, the use of SCC was evaluated in this project as a viable material to improve in-place shaft quality. ACI 237 (2 .
AGMA American Gear Manufacturers Association AIA American Institute of Architects. AISI American Iron and Steel Institute ANSI American National Standards Institute, Inc. AREA American Railway Engineering Association ASCE American Society of Civil Engineers ASME American Society of Mechanical Engineers ASTM American Society for Testing and .
