Myriam L. Torres, vice president of revenue cycle at Miami-based Jackson Health System, knows the importance of data in deciding whether to implement processes for improvement.
She said delving into the right data can validate or invalidate a proposed revenue cycle process change and inform future decisions.
Ms. Torres began her career at Jackson Health System in 2012 as CFO of Jackson South Community Hospital in Miami, after serving as corporate controller at Miami Jewish Health Systems. She became Jackson Health System's vice president of revenue cycle in 2014.
Here, she shares one of her biggest challenges as a revenue cycle leader, how her organization addresses those challenges and her advice for other hospital revenue cycle leaders.
Note: Responses were lightly edited for length and clarity.
Question: What is the biggest challenge you're facing as a hospital revenue cycle leader?
Myriam Torres: Increasing denials from payers, denials that are coming in nontraditionally. There's the traditional denial that you have no payment. But then there are what we call silent denials, which are diagnosis-related group downgrades or account audits that happen. In Florida, managed care plans have 30 months to come back and review payments, so they use that time period to conduct audits on medical necessity and level of care, review payments and do takebacks. It becomes very challenging to track these takebacks from all these payers.
Q: How is your organization addressing this challenge?
MT: We're approaching denials in a multidisciplinary way. We don't work our denials ourselves. We use agencies. They have staff here working alongside with us, [and] we have committees by facility. And we review denied account examples and try to get everybody's input to identify patterns and try to put processes in place to at least resolve what we're identifying at the time. What we find is once we fix something, we start seeing denials in a different category. It's the never-ending story because regardless of what we fix, something new comes up. We are currently working on developing ANNOVA [a tech solution] to assist us in predicting and preventing denials.
Q: What is one thing you would do to improve the patient financial experience?
MT: [At Jackson], patients can go online and pay their bill, but they cannot pull an itemized bill or a complete statement to review. I think that [being able to pull an itemized bill or complete statement online] would offer more satisfaction to the person who's wanting to review the balance instead of the traditional mailers that everybody gets. There's a lot of returned mail because individuals move or there are incorrect addresses, (most people do not change their email address as often as their home address). If patients were able to go online and look at the detail of their bill alongside the insurance explanation of benefits, I think that would be a big satisfier for our patients.
Q: What is one leadership habit you've developed that has led to improved revenue cycle performance?
MT: We try to approach challenges and projects we work on with a team approach. We have a great partnership with IT, and we involve different areas within our revenue cycle division. For example, we recently rolled out CPMT, a new collection tool, and we involved staff from health information management, which traditionally would not be involved with something to do with collections. So, we try exposing our leaders to other areas within revenue cycle, and also [with] a fresh set of eyes, they come up with some new ideas. Sometimes they're good and sometimes they're not good. But it's not the same individuals that are always looking at the same problem. We expose different departments to our challenges. I think that has made us successful. We've done a lot of automation, and I think it's been primarily because of the partnership with IT and involving different individuals who look at our projects in a different way and bring new ideas.
Q: What is your advice for other hospital revenue cycle leaders?
MT: You need to dig into your data to understand your current status. To set an action plan for the future, you need to understand exactly where you are and know where you want to go. I think sometimes people make decisions because they go by a hunch, but they cannot validate it with numbers. We don't put any processes in place unless we have validated that, in fact, there is a need for improvement. We use an internal database, RC-AIM, to assist us with analysis.
Continuously work on automation and improving workflows so it's continuous performance improvement. Because the truth is every day we have to achieve more with less.
We have focused the last five years on our existing [vendor] contracts, only trying to have tools that we absolutely need, only contracting for services we absolutely need, and negotiating the best price for it. We've been able to reduce our cost to collect] by 2.5 percent without having to impact staff.
Lastly, invest in the leaders. The revenue cycle area is becoming smaller. Twenty years ago, every hospital had a business office. Today it’s either centralized or outsourced. Every time you have to replace a leader it becomes challenging. Invest in the individuals you have today to develop the leaders of the future and encourage them to develop their staff so they can also grow with the organization.
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