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Define, Design, and Communicate: Optimizing Revenue Cycle Performance Monitoring

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You’ve seen this image across multiple Marvel and DC comics and movies—the heroes stand on rooftops, vigilantly gazing across the city. The citizens—and the villains—know that at a moment’s notice, upon hearing a siren or scream, the hero will jump into action. This is akin to the Hawthorne effect, where people change their behavior when they know someone is watching. It’s similar to your organization monitoring the performance of its departments and individuals. Superheroes are the comic world’s version of performance monitoring.

Getting Started

Within all high-functioning organizations, leaders need to monitor performance to drive strategic priorities, and the revenue cycle is no different. Consistent performance monitoring is key to reaching financial goals, holding stakeholders accountable, and understanding performance relative to historical market figures. Building these priorities and ensuring that they will be used to create meaningful change depends on driving transformation through better data management.

How should performance be monitored in order to be effective? There are three things to do.

  • Define the key performance indicators (KPIs) to monitor.
  • Design effective monitoring tools.
  • Communicate performance across relevant business units.

1. Define the KPIs to monitor.

There are a variety of KPIs that can be used to evaluate the health of any revenue cycle operation. These measurements can provide insight across service lines into many business functions and can be organized based on the following categories:

  • Financial: Measurements that relate to the income statement and budgetary performance against goal
  • Operational: Indicators that provide insight into process-based performance
  • Leading: Input-oriented measurements that review preprocess and preservice delivery performance
  • Lagging: Outcome-oriented measurements that track postprocess and postservice performance

Your organization must determine which KPIs are most important and who will be responsible for tracking and monitoring them, with accountability for metrics clearly assigned across all levels of management. This can be accomplished by implementing a standard KPI package and grouping from the lowest management level (e.g., supervisor level) all the way up to the executive level. Table 1 below provides a sample summary of measures by organizational role.

When your organization has clearly defined the KPIs to track and how frequently they should be reviewed, you can hold all revenue cycle teams accountable. Stakeholders at every level of the organization should be able to meaningfully engage according to a specific cadence, allowing enough time to effect change without too narrow a window that changes can’t be made in response to underperformance. For example, individual staff productivity should be measured at least weekly to ensure short-term goals are being met and long-term ones are progressing positively.

2. Design effective monitoring tools.

Once each leadership group has a defined set of KPIs, designing effective monitoring tools that present information in a meaningful way for operational stakeholders at each level is the essential next step. Throughout the design process, it is important to keep the communication methods and forum in mind or risk developing a monitoring tool that does not meet the needs of its end users and renders the data useless.

Common monitoring tools include graphs and statistics published via performance dashboards and reports specifically pushed to end users for interpretation. Out-of-the-box reports can be found within an organization’s Health Information System; however, many metrics are not readily available in a client’s host system. Thus, pulling meaningful data and reporting may require the implementation of bolt-on reporting tools or working within an existing business intelligence framework to customize reports based on specific inputs, metric calculation, and user security.

For each monitoring tool developed, the level of detail presented should be driven by the size and makeup of the group it is shared with and the forum in which it will be presented. As the group size increases, the data should rise to a higher level to ensure it can be quickly explained and understood. Similarly, when forum diversity increases, the data set presented should expand to include data points and conclusions that are relevant for all group members and can be understood by those at a variety of experience levels.

3. Communicate performance across relevant business units.

Once KPIs are defined and meaningful monitoring tools developed, leadership at each level should dedicate time to reviewing the appropriate KPI reports, as individuals and with their teams, to ensure that the strategies developed to improve performance yield successful and sustainable outcomes. The practice of review begins as a learned behavior, modeled and coached by leadership, where planning, implementing, and evaluating become routine tasks used to refine strategies and effort allocation. This behavior should ultimately evolve into a formal expectation, with managers and directors dividing their time between daily staff management and strategic action plan development.

The review and publication of KPI data is critical to ensuring organizational transparency and accountability. Data should be accessible to both functional teams (e.g., denials follow-up team) as well as across business units (e.g., denials management groups, such as patient access, ambulatory operations, and payer relations). Forums such as staff huddles are appropriate venues to translate larger department goals into individual staff assignments and standards for personal monitoring. For supervisors and managers, internal team scrums or focused cross-functional group meetings offer great ways to engage and connect with staff. Managers and directors should be involved in business unit–level forums. For example, a leader can participate in a revenue integrity group tasked with reviewing performance statistics to compare against benchmarks and subsequently guide operational improvement efforts. These meetings should be governed by defined agendas with clearly identified roles and responsibilities for each participant and a static reporting or metric list driving the meeting’s focus.

Turning the Mirror on Your Organization

How do you rate the success of your current performance monitoring? To gauge your efforts, ask the following questions about your organization:

1. Have we defined the most important organizational measures for success?

2. Do we have the right tools in place to accurately and efficiently report on those measures?

3. Do we use those tools on a regular basis?

4. Is there an existing governance and communication structure to facilitate change management when performance improvement opportunities are identified?

5. Are measures moving in the right direction over time?

If you are questioning your organization’s ability to successfully monitor its operational performance improvement efforts, it may be time to ask for help.

Need Help?

Find out how ECG can help you monitor and optimize your revenue cycle performance.

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