Posted on June 19, 2013
The 2008 recession was part of the impetus for launching a formal enterprise risk management (ERM) process at Cleveland Clinic. But the real catalyst came in the form of a high-level sponsor: the chair of the board’s audit committee. Cleveland Clinic’s CFO was also very engaged. “Without high-level support, there would not have been as much oomph behind this,” said Clinic’s Charles Kolodkin, JD, executive director, enterprise risk and insurance at a Tuesday ANI session.
From the beginning, Cleveland Clinic wanted to ensure that its ERM approach would be sustainable. “When you speak about ERM, many people worry about the value you get out of it, said Angela Hoon, principal, KPMG, who co-presented with Kolodkin. “How do you keep it sustainable so that it’s not just, ‘Do a risk assessment, check the box, and we’re done’?”
To create a long-term, ongoing approach to risk management, Kolodkin and his colleagues went through six steps.
Establish a structure. A governance committee was established with representatives from operations, accounting, risk management, legal, internal audit, and continuous improvement, as well as two physicians. The governance committee then created work teams to “do the heavy lifting,” or conduct detailed assessments on specific risks, said Kolodkin. Each of these work teams had an executive sponsor who served as a sounding board for the team.
“We did not create a new department, Kolodkin said. “Instead, we tried to use our existing resources.” Instead of adding FTEs, Kolodkin borrowed some FTEs (e.g., financial analysts) as needed.
Identify top risks. After interviewing high-level leaders across Cleveland Clinic about potential threats to the organization’s reputation and livelihood, a consultant came up with a list of 300 plausible risks. The governance committee then narrowed this list down to seven high-priority risks:
Conduct detailed risk analyses. A work team was assigned to each of the seven high-priority risks. The teams conducted a “deep dive” analysis of each risk, which involved identifying sub-risks, conducting various types of analyses on these sub-risks, and predicting the impact and likelihood of each sub-risk.
Determine how to mitigate and respond to risks. The work teams also outlined ways to mitigate each of the sub-risks. In some cases, this simply involved documenting what was already being done.
Continually monitor and report. Regular reports to Cleveland Clinic’s leadership team and board audit committee helped ensure the teams followed through on plans to address the various risks.
Embed risk management in business. The initial detailed risk assessment process was completed in 2012. Cleveland Clinic plans to repeat this detailed process (minus the executive interviews) every few years.
In addition, the health system is working to make risk assessment part of every leader’s job. One step is asking all service line and physician group leaders to identify major risks as a part of their quarterly business reviews, Kolodkin said.
Posted on June 19, 2013
As many as 70 percent of healthcare finance professionals who attended ANI: The HFMA National Institute would describe themselves as introverts, according to an informal poll taken Wednesday at ANI.
How can healthcare finance professionals who feel uncomfortable in group situations or with public speaking break out of their shells and find success in highly visible positions? Susan Cain, author of Quiet: The Power of Introverts in a World that Can’t Stop Talking, and HFMA President and CEO Joe Fifer, who are both self-professed introverts, offered these strategies.
Find time to yourself to reflect each day, particularly before making a big decision. “Sometimes, it’s difficult to find your quiet time [as an introverted leader]. I love my quiet time,” Fifer said. Giving yourself space to consider a decision before sharing it with the group is a sign of self-awareness and strength for introverts, Cain said.
Pay attention to the physiological changes that you experience in high-profile situations. “Really pay attention to what your body does when you’re not feeling confident and also when you’re feeling relaxed,” Cain said.
If public speaking makes you anxious, expose yourself to public speaking opportunities bit by bit. “If you expose yourself to the thing that you fear in small, manageable doses, eventually, the horror of it starts to go away,” Cain said. For Fifer, “Preparation is everything,” he said. “To have a thorough knowledge of the material takes that feeling [of anxiety] away.”
Find a friend who will accompany you on clinical rounds. For example, in his former position at Spectrum Health in Grand Rapids, Mich., “I could never feel comfortable going into a nursing unit by myself. I felt like a fish out of water,” Fifer said. Instead, he would ask the health system’s chief nursing officer to accompany him.
Posted on June 19, 2013
Conway Medical Center in Conway, S.C., faced a number of emergency department (ED) billing challenges related to contract payment rate challenges, credentialing, delayed or lost payments, payers bundling or rejecting part of the professional services claim (such as EKG interpretation), and more.
Accounts receivable (A/R) increased, both from difficulties with payer contracts and with claim line adjudication. The medical center also had trouble identifying outstanding balances between the facility and physicians/other professionals, which made the status of A/R unclear. In some instances, bills were mailed six to seven months after patient discharge due to payer disputes over professional CPT codes, causing a public relations issue for the medical center. Just as bad, physicians lost trust in the numbers the medical center shared with them.
Conway worked with an ED revenue cycle specialist to:
Collections increased by 41 percent, or $9 million, and patient and physician satisfaction improved. During an early riser session Wednesday at ANI: The HFMA National Institute, presenters offered the following lessons learned that could help other organizations facing similar challenges:
Posted on June 19, 2013
HFMA awarded its highest chapter honor—the Robert M. Shelton Award, which recognizes five continuous years of excellence—to both the Florida Chapter and the Maryland Chapter during HFMA’s annual chapter awards ceremony Tuesday evening at ANI: The HFMA National Institute in Orlando, Fla.
The Robert M. Shelton Award recognizes chapters that have stepped up through the years with sustained, strong volunteer leadership.
“Judging the Shelton is always tough, but this year the results were so close that the judges selected two chapters for the award for only the third time since the award’s inauguration in 1980,” HFMA Chair Steve Rose said.
Rose presented the awards to Florida Chapter past presidents Mimi Taylor, Joanne Aquilina, David Sierra, Karen Fry, and Dwight Tillman along with the past presidents of the Maryland Chapter, Michael Zito, Jennifer Maher, Eric Melchior, George Bayless, and Joseph Sirugasano.
In 2012-13 alone, the chapter achieved a Hottum Award for Educational Performance Improvement, a Gold Award for Education, a silver Award for Membership Growth and Retention, a Gold Award for Certification, and two Yerger Awards, one for Education and one for Improvement.
The Florida Chapter has demonstrated consistent success over the past five years by earning three silver and two bronze awards for education, three gold and one bronze award for membership growth and retention, gold, silver, and bronze awards for certification, three Hottum awards for educational performance improvement, and 18 Yerger awards.
The Maryland Chapter, which has 728 members, also has been a top performer. In FY13 alone, the chapter achieved a bronze award for education, a gold award for membership growth and retention, and two Yerger awards, one for education and another for membership recruitment and retention.
Over the past five years, the Maryland Chapter has demonstrated consistent success by earning a silver and a bronze award for education, two gold and two bronze awards for membership growth and retention, a gold and two bronze awards for certification, four Hottum awards for educational performance improvement, and 10 Yerger awards.
Posted on June 19, 2013
They could not have imagined that five minutes before the session was scheduled to start, there would be so many attendees—primarily women, but also a few men—that staff would need to find extra chairs to accommodate them all.
“There are so many things that are unique to us [as women leaders] that we just need to talk about it,” HFMA Board member Kim Griffin-Hunter, a partner with Deloitte who has been a member of HFMA for 25 years, told those in attendance.
A panel of HFMA Board members—Griffin-Hunter; Carol Friesen, president and CEO, Crete Area Medical Center, Crete, Neb., and vice president, health system services, Bryan Health; Kari Cornicelli, vice president and CFO, Sharp Grossmont Hospital, La Mesa, Calif.; Rebecca Speight, CFO, Lake Pointe Health Network, Rockwall, Texas; and Melinda Hancock, senor vice president and CFO, Bon Secours Virginia—offered their thoughts on managing their work as healthcare finance executives with their roles as wives, mothers, and daughters. Some also talked about the ways their faith had influenced the paths they have taken as finance executives.
The conversations were often deeply personal, and their forthright discussions of challenges they faced in becoming finance leaders and in their roles as executives resonated with the women in attendance, with discussions ranging from the sacrifices they had made to become leaders to female bullying in the workplace to their efforts to balance work and family.
There were several tips they offered to HFMA members considering taking on similar roles in healthcare finance.
Seek out mentors in the workplace and within HFMA. “I’ve always had strong female mentors and strong female leaders. I have to say that has been key to my success,” Cornicelli said.
Maintain an appointment calendar that reminds you of both work and personal responsibilities. For example, Speight’s schedule includes not only dates and times of important meetings and due dates, but also her 4-year-old daughter’s activities, so that she can keep track of responsibilities for work and home at the same time. She also takes steps to integrate her home life with her work life by sharing stories about her daughter with staff members and letting team members know that between the hours of 6-9 p.m., her focus is on her family. “We are one person. We are not ‘Work Becky’ and ‘Home Becky,’” she said, as several attendees and the panelists nodded in agreement.
Concentrate on being an engaged listener when staff and family need to talk. For example, Cornicelli, who describes herself as “the quintessential multi-tasker,” said she often used to talk with family or team members while completing other activities. “I’ve had to practice being more present,” she said.
Be cognizant of the ways in which your attitude or approach affect those who work for you. “Understand that how you react has an impact on your team,” Hancock said.
Ignore the judgments or negative energy that can sometimes be directed toward women leaders as they navigate their work lives and personal lives. “Who are those six or 12 people in your life who really matter? Concentrate on what those people think,” Friesen said.