Ideally, says David Witt, CFO of CHRISTUS St John Hospital, billing errors should be resolved at the bedside, long before financial people get involved. But it is hard for clinical people to think in financial terms. This is because in just about every hospital, there is culture gap between clinical and financial departments, he says.
That's where Christine Longmore comes in. Ms. Longmore holds an unusual position at this 160-bed hospital in Nassau Bay, Texas, near Houston. She acts as a kind of billing troubleshooter, ranging through the clinical departments to look for defective processes and then fixing them.
Mind the gap
Some hospitals have financial staff doing such work, but Ms. Longmore, a former cardiology department manager, is firmly rooted in the clinical world, and that makes all the difference, Mr. Witt says.
"Christine can bridge the gap," he says. "She talks to clinical people in their own language."
From their perch in medical records, billing staff can only have a degree of control over the billing process, Mr. Witt says. When billing snafus arise, it's difficult for them to know how they were caused back at the bedside. This problem leads to a troubling paradox: Only a clinical person can know what went wrong, but only a billing person knows how fix it.
In the ideal hospital, all clinical personnel would know how to fix their billing problems — just as, ideally, all drivers would know how to fix their own car. But in the real world, Mr. Witt says, it's not going to happen. "I don't want the clinical people to spend a lot of time figuring out a billing issue," he says. "They should be doing their clinical work. Christine can spend three to four hours on one thing."
Creating a new role
Ms. Longmore started her unusual job three years ago, when the IT department asked clinicians to help customize a new IT system. It was one of the few times both cultures had gotten together. Clinical staff in scrubs faced billing staff in suits at a post-implementation meeting. "I had so many questions," she recalls. "I didn’t know if this was the right venue, but I decided to begin asking."
Ms. Longmore loved studying math in school and has some background in bookkeeping, but she approaches financial matters definitely from a clinician's point of view. "What clinical departments do not need is one more spreadsheet from one more financial person," she says. "What they do need is someone who speaks their language and can explain financial and IT problems. These things tend to make clinical staff's eyes glaze over."
The culture gap between clinical and financial staff even involves competing sets of codes in the computer system, she says. To describe the same service, clinical staff use a mnemonic that is completely different from the 10-digit billing code the financial office uses.
Clinical staff enter information into the computer every day, but few of them understand how it is being used, Ms. Longmore says. She strives to explain things in ways that open up up their world. "When someone asks me a question, I want to give an explanation that will last forever," she says. "I don’t want to be fixing the same thing every day."
How she works
Ms. Longmore's workday starts with a review of financial reports, looking for potential billing snags. She looks for large numbers of accounts or an account with a high-dollar value in areas such as case management, admitting, medical records or the medical staffing office. "If I see high dollars in one column, I look for a trend that suggests a process is broken," she says.
Then she begins investigating. "I have to go on site," she says. "E-mails and phone calls won't work. I go to the department, stand there and watch what is going on."
Ms. Longmore can cite a number of cases she solved with a little gumshoeing.
- Medication charges from the labor and delivery department were consistently late. It turned out these medications were charged from manual charge slips that were not being sent to the pharmacy department every day. Many of the slips were coming in after a final bill had been sent out for the account, creating late charges that required the account to be rebilled.
- The medical records department was not getting a steady flow of patient orders from the hospital's sports medicine clinics. It turned out the clinics, scattered across many sites, were sending the orders weekly by courier. The medical records department was getting hundreds of pieces of paperwork all at once. To fix this, staff at the clinics were instructed to scan the bills into the billing system on site so that they could be immediately accessible to medical records coders.
- Ms. Longmore solved one particular case only after weeks of regular visits to the OR. OR staff were unable to quickly access drugs from a Pyxis medication-access unit. The unit should have automatically opened once staff started typing in the patient's name, but they had to type in the whole patient identification manually before it would open. "I had to learn the process to figure out what was going wrong," Ms. Longmore recalls. It turned out pre-admitted surgery patients were being sent directly to the OR for prep. They were bypassing the admitting department, where their account would have been added to the computer system that fed into the Pyxis unit.
Showing ROI
It was initially difficult to justify Ms. Longmore's job because it does not directly produce revenue. To establish an ROI, the hospital had to look at the big picture in financial reports. Since she started, there have been reductions in accounts on hold and dollars on hold.
"All I can say is that my numbers are low," Mr. Witt says. "We don’t have a lot of bills being held up. We are saving money and reducing frustrations within the facility."