Healthcare execs, do you know what’s in your chargemaster?

A hospital’s charge description master (CDM), or chargemaster, is often referred to as the “heart” of the healthcare revenue cycle. It includes codes for every procedure, material used, medication, and service that a healthcare organization provides its patients. It is the structure that drives the hospital, and is the starting point for billing patients and insurers and complying with public reporting. A typical health care system chargemaster may contain 15,000 to 25,000 entries, according to Becker’s Hospital Review.

Neglecting your chargemaster can lead to inaccurate billing, regulatory risks, claim issues with payers, and low patient satisfaction scores, all of which affect your healthcare organization’s revenue. Your hospital can’t afford to overlook this essential piece of its operations. Ongoing evaluation of your chargemaster with an eye toward increased calls for pricing transparency in the healthcare industry is the key to maintaining a chargemaster that will serve your organization, as well as its payers and patients.

Ongoing maintenance

With so many diverse components in a chargemaster, it can be extremely difficult to set up correctly. Failing to update any of the components can result in negative outcomes for your healthcare organization. Often, when hospitals add new items to their chargemaster, they simply copy existing charges. However, this can be problematic because the new charges may not have the same requirements (e.g. CPT codes, modifiers, revenue code, or pricing) as the item being copied. Care should be taken to make sure the new charges are set up correctly.

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Identifying your next career move

I recently had the honor of co-presenting with Mike McBride, Regional President and COO of Ascension St. John, at the American College of Healthcare Executives - Southeast Texas Chapter’s conference in Houston. Our session, “Identify Your Next Career Move,” took the attendees through what makes up a successful career transition -- from self-branding to job interview preparation and all the steps in between.

Key takeaways from our presentation:

Access your mindset

Are you a glass-half-full type of person? Are you in a dark place in your current workplace? Building confidence is a key ingredient to success. To enter a transition without the highest level of confidence is a formula for failure. You must rebuild confidence before you start.

Unpack your baggage

At a certain point in our lives we all acquire baggage. That's a given. It's what you do with that baggage that matters most. Have you shoved it to the back of your closet to deal with later, or is it neatly unpacked and sorted and processed? If it is the former, then you have work to do. You will not make headway in a job search until you have dealt with your baggage.

Speak to your achievements

How are you at speaking to your abilities and achievements? If you cringe at the thought or don't know where to start, you have some work to do before you are ready to make your next career move. Never assume that the person interviewing you will read between the lines just because you have it as a bullet on your resume -- you must verbalize it.

Know your value

What is your superpower? Determine what differentiates you from other people who may be competing for the same job. If you are having trouble determining what makes you different, form an informal advisory board made up of close friends and colleagues. These are the people you can not only trust to tell you what your strengths are, but also areas where you can improve.

Develop your criteria

Create a list -- in priority order -- of factors that matter to you as you seek a new opportunity. Culture and mission should always rank somewhere on the list, but should also include personal factors that are specific to your work/life situation. Use this list as a guide when you determine if an opportunity is right for you.

Identify and research target organizations

Develop a list of companies and organizations that you have a strong interest in. Why are you interested in each of these companies? Be specific, and if they don’t align with your criteria list, then revise. If they do, research them thoroughly. Start connecting with individuals who work at this company on LinkedIn and developing genuine relationships within these organizations.

Build and work your network

Research shows that you will find your next opportunity through someone you know. A good, quality network takes work. You must be intentional and consistent in your outreach efforts to nurture and grow your network. Set aside time each week to focus on cultivating relationships within your industry.

Polish and build your professional brand

You are how others perceive you to be. Your brand includes everything from your resume to what shows up when your name is searched for online. While some perceptions can be outside the realm of your control, many are controllable. You can create the professional image you want to portray. Areas include your:

  • Resume
  • Verbal self-introduction (Answers “Tell me a little bit about yourself.”)
  • LinkedIn profile
  • Google search results (Are they positive/negative/neutral?)

Own the interview

Once you have an interview scheduled -- investigate, practice and prepare. Research those interviewing you. Reach out to network connections that may have inside knowledge of the culture of the organization or might provide you with a connecting point that could prove invaluable once in the interview. Practice your talking points out loud or with a trusted friend. Be prepared to explain an awkward exit from a previous position or extended career gaps on your resume.

While sometimes it takes seeing a certain job posting to spark your desire for a career change, it’s far more effective to begin working on the areas above well in advance of that moment. That way, when the right opportunity does come along, you are ready to start that journey.

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Leading with calm urgency in times of crisis

Whether coming from outside your organization or internally within your own hospital or health system, crisis situations have a lasting mark on the healthcare organizations they impact—and the CEOs who run them. Disasters—and how executives respond to them—can cost them their jobs and, more significantly, the public’s trust in their organization.

The fact is, you can have the best health system in the nation, and one crisis can eliminate years of goodwill and good work. Clear, decisive, prompt communication from a healthcare organization’s CEO is the key to navigating disasters while maintaining trust.

As a leader, you must bring calm urgency to communications with:

  1. Your employees,
  2. Other organizations and stakeholders in the community,
  3. And the general public

Employees

When a crisis occurs, many executives focus primarily on their message to the general public, trying to provide accurate, up-to-date info, stay ahead of public opinion, and set the tone for communication about the incident. While this is certainly important, it is also essential to provide care and attention to your employees.

In times of crisis, a lack of stability impacts the workplace culture. Employees at every level of the organization will feel the effects of this. As an executive, it is your responsibility to ensure your hospital’s greatest asset—its people—receive accurate and timely communications regarding the crisis your organization is facing. Make your confidence in your staff clear, and actively seek out ways to be a source of stability.

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Building Trust to Succeed

When it comes to building a strong leadership team, choosing top talent isn’t the only priority; building a culture of trust is also essential to growth and success. According to a recent PwC survey of more than 1,400 CEOs worldwide, more than half of organizational leaders believe a lack of trust is a serious threat to the success of their teams and their business. However, if you are aware of the importance of trust, and actively working to make it part of your workplace culture, you can use it as an asset to your organizational function, rather than a liability.

Environments where trust is a key component encourage innovation, increase the pace of decision making, and often team members outpace their competition. The Workplace Therapist Brandon Smith insists, “Trust enables teams to not just take risks but also to move more quickly. There’s little second-guessing in high trust environments because team members assume there’s positive intent.”

It’s hard for teams to move forward effectively if they don’t trust each another. Instead of innovating, they are second-guessing each other, unnecessarily reworking tasks, or relying on one or two key team members to get the work done. I have found that when you have trust, things move much more efficiently. You have the ability to take the risk because your team feels comfortable and supported.

Trust is key, and risk, innovation, growth, and expansion can only happen when you have a solid foundation of trust to build upon.

To maximize your organizational potential and lead in your sector and community, you have to create a climate of trust and transparency.

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Community Vitality: The importance of access to high-quality healthcare and K-12 education

The question of why some communities and companies grow and prosper, while others shrink or even cease to exist, has intrigued me for decades. Theories exist with no single one applicable to every situation. Two variables stand out to me as “must-haves” to ensure community vitality.

  1. Access to high-quality healthcare, and
  2. Access to high-quality K-12 education

As a registered nurse I have focused on the delivery of and access to high quality healthcare for the last 28 years. Having cared for patients at critical times in their lives, I have consistently seen how reliable access to affordable, preventive and restorative healthcare services is critical to community health, especially for vulnerable or indigent populations.

My focus on quality and access in healthcare for all populations broadened during my tenure working with large geographies and populations as an experienced healthcare CEO and as a member of numerous boards of directors.

The ability to recruit, develop and retain human talent is essential to the success of any company, and healthcare is no exception. My experience suggests that since 2011, it has become harder to recruit and retain human talent based on each region’s overall access and quality of K-12 education.

In my rural area of Virginia, from a healthcare perspective, recruiting nationally and internationally was challenging for all types of careers, from entry-level professionals, through senior leadership positions. I attributed the recruiting issues to fierce competition over a finite talent pool, but exit interviews and feedback from existing employees and prospective employees indicated that a significant concern was the quality of K-12 education in my area.

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A CARE PLAN for Burnout Prevention

Too much of a good thing can sometimes be a problem; there is a risk that caring too much can result in burnout. Even a profession that is literally and figuratively built on it, as is healthcare, there is not immunity to an overdose of caring.

You might be thinking: “What healthcare leader would ever tell a member of their team to care less?” Self-reflect and visualize your peers and the people you are leading. Do any of these characteristics seem familiar?

  • Constantly worries about what people think
  • Always feels obligated to fix things
  • Has a hard time letting things go
  • Starts the day with a list of worries
  • Ends the day with a list of worries
  • Stresses about staff turnover
  • Stresses about staff happiness

I’m sure you can identify with some of these tendencies personally or amongst your team. The answer is not to stop caring about patients, staffing, getting through your “to do” list, or about being liked; the answer is to care just the right amount! Think of care as sugar; in the words of Mary Poppins it takes “Just a spoonful of sugar…!”

Care enough to progress toward your goals, being visible and open, maintaining control while knowing when to let go, and earning respect. Care about being liked, but do not rest your self-worth on it. Sound advice you might say, but easier said than done. Try this CARE PLAN:

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Podcast: Getting Your Hospital to Act Like a Startup

Recently I had the privilege to be a guest on the podcast, “Getting Your Hospital to Act Like a Startup.” My part begins in minute 28, but please enjoy the entire episode.

Summary:

The innovative path is the key to the future of successful healthcare. Innovation and technology are the indispensable components for tomorrow's care; unfortunately, health systems and hospitals often allow the here and now focus to take precedence over the future. The internal daily demands can force a loss of perspective and a diminished capacity for a cultural attitude of innovation. The future positioning of the healthcare organization is always where the CEO and leadership team must be viewing today's decisions for organizational viability and long-term success.

Designing and living a successful innovative culture is possible. The adoption of the "start-up" culture should be the drive of every CEO and leadership team. In this podcast I share my experience in working within health systems and discuss adopting the necessary characteristics to successfully acquire the adventure, joy, focus and discipline of a startup culture. In addition, the obstacles start-ups face when working with health systems is also explored.

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Does your hospital know what happens when your bill goes to collections?

This article published recently in the The Atlantic points out that unexpected, large hospital bills can happen to anyone. This caregiver was hounded by collectors, one even inviting them to connect on LinkedIn! As healthcare administrators, we have a good understanding of our average reimbursement and collection rates, as a percentage of the gross, billed charges. But do we really know what happens when the uncollected charges are turned over to collection agencies? Are we aware when and if they are then turned over or “sold” to other debt buyers? To me, poor treatment by collection agencies and debt buyers is still a reflection on the health system where the patient received their care. Can health systems and doctors afford this type of reputational risk?

I turned to a colleague, a revenue cycle professional and expert - the best I’ve ever worked with in the business. They provided a more balanced perspective:

There are two sides to this dilemma depending whether you are a patient or provider. From the patient perspective, medical debt is increasing and in too many cases crippling, often leading to financial ruin, depression and shattered lives. Statistics show the percent of total bankruptcy, because of medical debt, at over 50% and employers shifting costs through deductibles, now on average over $1,300 and growing, according to the Kaiser Foundation. On top of that, healthcare spending as a percent of GDP is approaching 20%; an unsustainable trajectory. Bottom line, patients and families are harmed by unaffordable medical debt and there is no solution in sight.

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The Wedding Toast: Lessons in Leadership from Love

Recently, I had the opportunity to share the joy and intense emotions of giving away my daughter in marriage. At this extraordinary event, I had the fatherly privilege of making the welcome toast. Reflecting on these thoughts in the days that have passed, I realize that these principles and practices that guide us toward happy and healthier relationships are key traits that great leaders exhibit. Please indulge me in the following excerpt from that toast I gave at the wedding of my daughter Francesca to her husband Matthew.

One of the privileges of being the Dad of a little girl is that she sits on your lap and you have little talks from time to time. One I remember in particular is when her mother was out shopping, because that’s what she did when Daddy and daughter spent time together, Francesca looks me in the eyes and says: “Daddy when I grow up I want to marry you” ….. I had to politely explain to her that Mommy wouldn’t like that too much! She then went on to say: “How will I ever find the right person to marry?” I said: “Honey, when you fall in love and if that person treats you as well as I do, then he’s the one.” Matthew you’ve passed that test.

So I can’t leave without a little advice for Francesca and Matthew…..You are starting your life together, what’s the most important thing? The most important thing is LOVE….that’s a great word but there are a lot of things that go into it. For my colleagues in medicine, you know we have to make acronyms out of everything to help us remember….

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Are tech solutions the only solution?

How to think critically when solving healthcare operations issues

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue. Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better. With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

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Direct Support Works! Care Navigators Improve Outcomes Save $$$

There aren’t too many experiences more overwhelming than being sick and trying to deal with the U.S. health care system. All of us have personal stories of disconnected providers and lousy communication. “It’s like nobody talks to anybody around here!”

As a health leader it is always embarrassing to listen to the stories of friends and family who were left on their own. My response was to put in place clinically trained care navigators whose job was to stand with the patient and help them in every way (even if that help meant sending the patient to another health provider). Many other health providers have taken similar steps. But this idea really needs to be as universal as the coverage we want everyone to have.

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Meet the Mother of Strategy: Hope

A mentor of mine is often quoted: "Hope is not a strategy!"

Indeed, there is a world of difference between hoping things will improve and implementing a well thought out plan. However, nothing can ever change or improve unless we can imagine it as such. Once it is imagined, there must be some belief or "hope" that this vision can be realized. Now that's where strategy comes in, making the vision a reality.

As leaders, we must start by inspiring hope, not by asking for the action plan. When your team believes they can make a difference, they will. It is very obvious in healthcare: patients would never come to us without the hope that we can make them better. Hope is not just for our patients, it is for every member of our team.

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Working Naked

The human body is the most brilliant machine ever created and the quintessential work of art. The headline above is not referring to your creativity and accomplishments in your clothing optional private abode; it is taking literary license from 19th century Danish author, Hans Christian Andersen.

Reflect on the fairy tale, The Emperor’s New Clothes. The Emperor (leader) was a vain man, concerned more with appearances, accolades, and maintaining his current position than the harsh realities that others faced. His subjects were afraid to express their honest opinions to him, fearing they might be deemed unfit for their position or even stupid. The climax of this tale occurs when he is fooled by some weavers into wearing a “spectacular new suit” that, in fact, doesn’t exist at all. The Emperor is allowed to parade through the town naked. Finally, a mere child blurts out in honesty that the Emperor is wearing nothing at all.

Leaders at all levels of an organization run the risk of being caught naked at work, but this risk increases as one ascends the ranks. People see pleasing their boss as important, essential to keeping their jobs. Most leaders would proclaim they are wise enough to detect blatant deception, but it is often more subtle than that. Very often what happens is filtering; direct reports present the info that makes them look good and their boss is expecting. This filtering of information is equivalent to a slight degree of course variation which becomes obvious 100 miles or more into the journey.

What would Mr. Andersen say to leaders today?

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The Path to Better U.S. Health Care must have room for ‘All of US’

In recent weeks Democratic candidates seeking the party’s nomination have given their preferences about how to reform U.S. health care. My experience in over 30 years of community hospital leadership led me to agree with the comments of John Delaney that Medicare-For-All would be a financial disaster for the vast majority of American hospitals. Very few U.S. hospitals have costs at or below Medicare payments.

Yet I don’t agree with Congressman Delaney’s statement that we shouldn’t touch the private health coverage market that covers 100 million Americans because those people will want to keep their coverage. I think there are a great number of Americans in the private coverage spectrum who have been saddled with enormous up-front deductibles and large co-payments and ever-narrowing health provider options who are ready to talk.

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Turning your wiz bang digital solution into reality through effective implementation

In this episode on helping digital startups sell their solutions, I want to focus on the issue of implementation. It is certainly important to have a wiz bang digital solution. Equally important is how to implement the solution and manage the changes it causes. All startups should understand the concerns the hospital C-suite has around the implementation process. Specifically, the startup must be prepared to answer the following:

  1. Is the company going to take responsibility for all the administrative hurdles including the IT security approval? Customers want assurance that the company is going to answer all inquiries and assist with completing documentation. Additionally, customers will want the company to track the progress of all approvals and follow up as necessary.
  2. Does the company have previous experience with change management? Although the hospital may have a performance improvement team skilled in change management, it is important for the company to have people who also understand this complex process in order to work collaboratively.

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Clearing Healthcare Hurdles and Building a Client Base

In my last blog post I discussed the challenges digital health startups face when trying to sell to hospitals and health systems. In this post I suggest some ways to overcome the hurdles and succeed in building a client base.

Startups need to be realistic about where they are in their product life cycle. As I mentioned previously, hospitals are risk adverse with tight budgets. These organizations want proof that your solution is actually going to have the impact you claim. Early on it is beneficial to look at smaller organizations for “proof of concept.” Ambulatory settings, such as ambulatory surgery center or multi-specialty clinics are often good places to alpha and beta test a new solution. These organizations are often nimbler, and as a result, more receptive to innovation. Smaller healthcare settings may present easier access to administrators and clinicians who can help get your solution implemented. Additionally, the information security requirements may be easier to address in smaller settings.

As a startup in healthcare you must understand the economics of the US healthcare system.

There are two key questions you need to answer as you build your business model.

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Lessons from Global Health Development: Insights from Four Change Models

This is Part 3B of this three-part series.

Part 3A briefly reviewed four change methods. This Part 3B compares them to elicit insights.

Motivational Interviewing, Kotter’s 8-Step Model, Baldrige Communities of Excellence, and SEED-SCALE, reviewed in Part 3A, were selected to reflect and reveal the wisdom of a range of disciplines, applications at different levels (individual, organizational, community and population) and purposes to aid change practitioners in the thinking and doing of their craft. How can comparing these models elicit deeper insights to affect sustainable change sooner and better?

Some Questions for Cross-Benefit

Organizational leaders are inclined to plan and motivated to implement. How can leaders apply the individual-based MI change process, especially its relentless focus on the “why,” to better empower others to engage in large-scale challenges?

Organizational leaders and MI counselors are tempted to pursue short-term results over long-term empowerment and are challenged to sustain progress. How can they employ the iterative, escalating scaling process and longer-term, biologic view of SEED-SCALE to advance in a manner that harnesses the human energy of self-direction and local ownership? Read Full Article.

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Joy in Leaders = Joy in Work

Focusing on joy, especially in work, is gaining momentum. It has my attention! It is clear to me that the mindset and habits are exactly what great leaders have and do and what developing leaders should concentrate on.

It is very tempting for any leader, especially those in healthcare, to focus on what’s wrong, what needs to be fixed. It’s time to view the situation through a different lens…we need to focus on the meaning and purpose of our work. This is a distinct advantage for those of us in healthcare, our mission is making peoples lives better. Joy is not in things, it is in US. IHI describes pride in workmanship as a fundamental right; having the connection to meaning and purpose promotes such pride and is the basis of joy.

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Lessons from Global Health Development: Harnessing Methods of Change

This is Part 3A of this three-part series.

Read part 2.

This Part 3A briefly reviews four change methods and Part 3B will compare them

“I have no idea how to change anyone. But I carry around a long list of people in case I ever figure out how.” - Anonymous

Eliminate four billion dollars of waste from a large healthcare system next year. Increase the CMS TPS (Total Performance Score) for a hospital from the national average of 38.1 to 60 in two years. Reduce maternal, child and infant mortality in Nigeria by 50% in three years. These are large-scale improvement goals – at healthcare system, hospital and population health levels, respectively.

Improvement at the community, organization and individual levels are all connected: improvement requires change and all change is personal. An organization is a group of people with a common purpose; and a community is a group of people with the potential for acting together (Taylor). While communities and organizations are made up of individuals, how they evolve and change is not merely an additive process of how each individual changes. Societies and organizations are complex adapting systems and their advancement matures through their disciplined movement.

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Lessons from Global Health Development: Sustainable Change Contrarian

Part 1 of a three-part series

“We cannot solve our problems with the same level of thinking that created them.” ― Albert Einstein

In the U.S., some refer to healthcare system change as an oxymoron. It is complicated. It is hard. And while progress has been made, we have a long way to go.

But if such change in healthcare is challenging in the richest nation, then imagine it in low resource countries. In many sub-Saharan African countries, healthcare must compete with investment in other more impactful determinants of health such as education, food security, and sanitation that, if present, are weakly established. Layer in different governments, languages/dialects, and cultures; include frontier rural locations, tribal influences and religious differences and the challenge to improve health and healthcare in countries such as Tanzania, Madagascar, and Nigeria can feel truly overwhelming.

Historically, the traditional approach to both change in U.S. healthcare and global development has been to identify needs and direct resources, typically money, at the perceived needs. This pattern has resulted in little success and in many cases, regression, harm and/or increased costs. In global development, despite over a trillion dollars channeled to low resource countries in the past two decades, little progress – and often regress – has resulted (Taylor, Empowerment On An Unstable Planet). In U.S. healthcare, it has created and perpetuated a medical industrial system that is three times as expensive as other countries for almost median outcomes. The lesson? Funds are zero sum limited; human energy is not. And the only real empowerment is self-empowerment.

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