Financially, Sonoma Valley Hospital continues to be challenged, as all district hospitals are, but current re-focusing efforts are proving successful.
The hospital is reporting good news from many quarters. SVH building plans are on course with the selection of a design-build team. Physician recruitment process is moving forward with three new primary care physicians, a new general surgeon, and, coming soon, a new orthopedic surgeon specializing in total joint replacement. New technical upgrades are in place and soon, MRI services will be increased to full time.
One key to the recent successes is a person who reports, at financial and board meetings, in a quiet, unassuming manner, what amount to amazing results.
Marni Richards, director of revenue management, has been on board for less than a year, and is not only saving this hospital money by increasing efficiency, but recouping “written off” revenues. While helping to keep the hospital financially stable, she makes the financial aspect of patients’ experience more friendly, comfortable and efficient.
“We want our patients to concentrate on getting better,” says Richards. “We don’t want them to worry about the bills they’re going to get later. So we do everything we can to put their minds at ease.”
For Richards, the first step is education. “The healthcare industry has become so complicated and so difficult, even for those of us in the business, that it’s our obligation to make sure our patients understand every step of the process,” she believes. “Not only about the clinical care they’re receiving, but about the financial aspect — to help them understand what their responsibility may or may not be, and what steps they may or may not have to take.”
Richards put financial counselor Charlene Ganza in the admitting office to help patients deal with financial and insurance issues. “She’s doing a great job,” says Richards. Ganza will work with the patients to help them apply for MediCal or, if they’re denied, for the SVH financial assistance program.
“We have a number of people on our staff who are bilingual,” says Richards. “So when necessary, we’ll supply an interpreter.”
Insurance reimbursement procedure is a mind-bendingly complex field in which simply assigning a slightly wrong code can make the difference between reimbursement or denial. Richards is working with patients and their physicians so that the diagnosis and treatment and their codes all satisfy Medicare’s requirements.
Workmen’s Compensation is another area where she’s uncovered “write-offs” that could potentially be reimbursed and potentially, she says, could be in the six figures. She’s expecting the results of that analysis soon.
Richards is like an obsessive detective, imbued with the “every penny counts” ethic, going about with her magnifying glass, examining records, launching department audits, finding instances of treatments that have been provided but have been, for one reason or another, written off or rejected for payment by Medicare. Her corrections and efficiency measures are adding up to real money, and real excitement.
“When I came on board, 90 percent of our payments were hand-keyed,” she recalls. “Now we are automatically posting about 75 percent. So now the hours that were spent keying can be spent going after denials, and those small dollars that do add up.”
Revenue management is a very big concept in the industry now, and with the results she’s bringing, it’s clear why. “Health care is getting so incredibly complicated that one of the keys to success is to effectively manage the entire revenue cycle and bring the components together so that everyone’s working together,” says Richards. “It’s crucial that the clinical side and the business side are joined in efforts, and managers needs to view each department as kind of a small business.”
She says she’s gotten great cooperation from the departments and, with all the detective work, and uncovering piles of claimable revenue big and small, she’s very pleased with results so far.
“I’m having the time of my life,” Richards says. “It’s not very often that you can embark on an endeavor like this and see instant results. To be able to have an impact right away is very gratifying.”
