Jane Gray brings nearly 30 years of hospital financial experience to her role as vice president of revenue cycle at Albany, Ga.-based Phoebe Putney Health System.
A certified public accountant and a Six Sigma Black Belt, Ms. Gray began her healthcare career at Macon, Ga.-based Navicent Health, where she served as director of internal audit and corporate compliance officer.
She moved to the revenue cycle in 2000 as Navicent's assistant vice president of revenue cycle.
At Phoebe Putney, which she joined in 2015, Ms. Gray oversees the patient contact center, patient access, health information management, revenue management, the physician central business office, and patient financial services, among other functions.
She also serves on the Healthcare Financial Management Association's national task force on revenue cycle metrics.
Becker's Hospital Review recently caught up with Ms. Gray to discuss her daily mantra, how her organization is addressing revenue cycle challenges and the advice she would pass along to other hospital revenue cycle leaders.
Editor's note: Responses were lightly edited for length and clarity.
Question: What is one thing that piqued your interest in becoming a revenue cycle leader?
Jane Gray: The challenge in the revenue cycle is trying to stay a step ahead of the payer tactics that are barriers to providers collecting their contracted reimbursement. It feels like an ongoing battle — really trying to overcome these challenges — but leveraging technology and working with your people to pull it all together to create a smooth and efficient process, to me, is rewarding.
I have a financial background, but I love revenue cycle operations so much that I can't ever really see myself doing traditional financial work. There is always something new, always new challenges, and I think it will be that way as long as our current reimbursement structure is in place. It's a constant struggle to keep up with the regulations and the changes in payer policies and get everybody rowing in the same direction. Working with great people is a fun part of it, too. Really being able to work with a team and achieve a goal is rewarding.
Q: What is the daily mantra that informs your leadership decisions?
JG: I have to agree with [former President] Ronald Reagan: "Trust, but verify." If it's worth doing, it's worth inspecting — taking action to ensure the strategies we set forth are being followed in accordance with plan. Also, verifying that your leaders are tracking their performance metrics, have what they need and are keeping those lines of communication open so when a barrier arises, we can address it quickly, is important. You have to stay on top of it, really doing a deep dive into what's going on in the workflow. I'm sensitive to making sure we try to make data-driven decisions. If you give me data and give me something to research, we can dig our heels into that and look for true opportunity and real trends we can work on.
Q: How do you approach revenue cycle challenges in today's healthcare environment?
JG: The challenges are different from year to year. It seems like, more recently, we've had challenges more of a regulatory nature, and very specific care policy issues that have arisen. When your payers are operating at the edge of your contracts, implementing additional rules with a significant impact on your reimbursement, it gets extremely granular at the payer level. The clinicians are not used to modeling care based on specific payer coverage restrictions.
We now try to work denials on a weekly basis, which I think has been extremely beneficial, because you can react faster and troubleshoot issues more timely. We originally reviewed denials quarterly, and that really didn't cut it, and then monthly, but we still weren't able to get good traction. Now that we're on top of denials on a weekly basis, we are able to identify the very specific payer denials and provide feedback to the clinicians, which has helped raise their awareness and engagement. This process keeps us all looking at how we need to change to provide more proactive and timely information to our clinical partners.
Q: Phoebe Putney has 4,500 physicians, nurses, professional staff and volunteers, and serves a 41-county region. How does the system's size affect revenue cycle operations?
JG: In 2016, we consolidated revenue cycle functions under the system umbrella. It's been very advantageous for the hospitals to learn from each other to be able to leverage more specialty resources that might not be available to a smaller hospital. We've been able to provide staffing coverage by sharing resources across the system on the patient access side. We've really tried to work together as a system to collaborate on policy and process. I think it's helped make everybody more efficient. Even collapsing some of the stand-alone units to having a comprehensive patient contact center that can take a patient from any county and put them in their location of choice, at the system level, also serves our patients well. Moving forward, we still have opportunity for greater consolidation within the revenue cycle, and we're continuing to take a look at that as we continue to further enhance automation of our manual processes.
Q: If you could offer other hospital revenue cycle leaders a piece of advice, what would it be?
JG: I'm big on weekly review of metrics. We've gotten into a rhythm where we review operational performance every week, whether we need it or not. Our entire management team gets together for a couple hours to review performance against preset targets for each major function of each area — it holds people accountable. Having to explain their data among a group of their peers drives managers to understand what is going on in their areas and stay on top of the important metrics. After three weeks of negative trending, they have to come back with a performance improvement plan. In the past, we took a more traditional stance and looked at our financial numbers after month end. But in the revenue cycle, once the month is gone it's too late. Let's look at it on a weekly basis so if we need to pivot and make an adjustment, we can do that and still have a strong month.
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