Summer 2022

Letter from the board chair

COVID remains. Monkeypox is the latest ailment. The WHO [World Health Organization] cannot agree on a new name for Monkeypox that does not offend someone. I can’t make this up. Despite these many other work, economic, and social issues, it’s time for us to DITCH OUR DESK!

Strive for Operational Excellence & Impact Your Revenue Everyday is a one-day event which will take place on Thursday, September 15, 2022, at the Conference Center at Central Penn College, in Summerdale, PA. This is a great opportunity for us to reconnect with one another, as well as learn from the experts on topics that affect us and our practice.

Get inspired to achieve operational excellence. Impact your staff and the overall performance of your practice in new and practical ways. Improve your day-to-day operations, motivate your team, and further your career! The finalized agenda of topics and speakers will be released the week of August 8th. Watch your email for complete details. If you’re certified, you can earn up to six [6] CEUs.

In a previous issue, I mentioned that I came to rely on the support of family, friends, co-workers, and my peers on the Pennsylvania MGMA Board of Directors. We shared our respective experiences to realize that we are not in this alone. Take the time on Thursday, September 15 to treat yourself and your managers to a day with the PA MGMA. You will be glad you did!

Shelley Rine, CPC, COPC
Board Chair
Pennsylvania MGMA

Choosing and Onboarding an RCM Partner for your Practice

By: Jordan Shelton-Greene

A recent study found that a majority of healthcare CFOs are planning to switch from in-house Revenue Cycle Management (RCM) operations to outsourcing their services ( Outsourcing your RCM comes with many benefits to your facility or practice, including increased revenue collections, cost reduction, expert service management, and increased resource management time.

Once you’ve made the decision to outsource, what’s next? What plans and adjustments will you need to make? Who do you pick for the job? This short guide will help you navigate some of the factors and processes that go into transitioning to outsourced RCM.

1. Determining Needs
The first step in transitioning to outsourced RCM is to decide which services your medical group needs. Many RCM companies offer a wide range of services, like insurance eligibility and verification, medical coding and billing, insurance follow-up and denial management, and patient collections. Your medical group should assess what areas of your in-house RCM need assistance and determine which services your group might profit from most.

2. Setting Targets
Setting the targets you want for your medical group is a fundamental part of beginning any project; transitioning to outsourced RCM is no different.

You’ll need to make sure that your targets align with whatever services your medical group needs and they achieve the goals and objectives of your organization. Most RCM companies can help you determine problem areas and give you example targets/goals by running a few simple reports with your medical group.

3. Finding a Good Partner
You don’t want to pick just any Revenue Cycle Management vendor. You’ll want to search for a vendor that is right for you! This starts by publishing a Request for Information (RFI) for vendors and suppliers to send you responses/information.

A few of the main attributes you will want to consider when choosing an RCM partner are:  

  • Does the vendor align with your goals?
  • Verify the vendor has data security (HITRUST credential, PCI compliant, HIPPA compliant).
  • Are you asking the right questions about the services you’re interested in outsourcing?  
  • How much relevant, similar experience does the vendor have performing these services?
  • Who are their references? Make sure you check with them.

There are many RCM companies available to you. Choose one that not only fits your needs but is reputable and staffed with well-credentialed professionals.

What to expect during the Transition Process:
Once you have assessed your needs and chosen a vendor you believe will meet them, it’s time for the transition process to begin.

There are many different variations to this process and all of them look a little different. As an example, GetixHealth, an experienced RCM vendor for over 15,000 providers, uses the below process for onboarding and integrating with new clients who have not outsourced previously:  

 Steps Description and Tasks
1. Execute an Agreement The agreement between you and the RCM vendor with the terms of the project execution. You’ll need to establish project goals and milestones as well as productivity/performance standards into the agreement.
 2. Project Implementation The largest and most intricate part of the transition process:
Multiple kick-off meetings are held (both internal and external) to determine several factors, including who’s on the team, the location(s), availability, and expertise needed. Vendors should help review the scope and expectations of the project, including setting up meetings with IT and Operations to form working apparatuses. They should also complete Testing and Validation processes for automation (where the vendor makes sure all the data you have given matches the data being loaded into automation systems).
 3. Milestone Review Before going live (or starting services), the vendor should set up a meeting to go over the milestones set in the Execution of Agreement. During this meeting, everything should be verified before the final Go Live date.
 4. Going Live Your medical group is ready to Go Live (start using outsourced vendor) for the contracted revenue cycle management services! 

After Transitioning
An outsourced RCM partner won’t just leave you in the dark after transitioning and going live. They should guide and advise on reporting and trends, best practices, and how to further innovate and enhance what is being done today.

Results commonly seen after transitioning are:

  • Increased positive patient experience and satisfaction scores
  • RCM Partner reports on a regular basis (daily, weekly, monthly, or quarterly)
  • Regular Business Intelligence (data translation) Meetings
  • Continued Client Services support to validate processes and functions as designed

With time, your medical group should see reduced expenses, better and more fluid processing, and an easier time with revenue cycle management. Remember you are in a partnership, so don’t hesitate to ask questions and make requests as they arise.

About the Author

Jordan Shelton-Greene
Getix Health

Jordan Shelton-Greene is a healthcare revenue cycle writer who collaborates with specialists across healthcare systems, hospitals, and physician practices to create educational and informational publications for the healthcare community. Considering his Bachelor of Science in Communications from Southwestern Adventist University, his experience working for revenue cycle management leaders, and his drive for creating interesting and helpful content, Jordan has established himself as a go-to resource in the healthcare revenue cycle realm. 

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Workplace Violence: How Prevalent Is It?

By: Brian Courtney, RPLU, AAI

Workplace violence (WPV) is a rapidly-growing public health problem for millions of Americans. WPV is any act or threat of physical violence, harassment, intimidation, or other threatening disruptive behavior that occurs at the work site. It ranges from threats and verbal abuse, to physical assaults and even homicide. It can affect and involve employees, clients, customers and visitors.

It's become essential to understand types of WPV, identify warning signs, profile potential active shooters, how to respond if in an active shooting situation, and the steps for post-incident analysis. These potentially real-life situations demand awareness, knowledge and diligent response management.

Remember: no workplace is immune to workplace violence! In fact, healthcare, service providers and education personnel are more prone to violence. Overall, each year: 2M American employees report being victims of workplace violence; 30,000 women report sexual assaults in the workplace; WPV results in $130B lost; One in seven people do not feel safe in their workplace; 60M Americans have been bullied at their workplace; 23% of employees say they have been bullied via email

    Risk factors for potential WPV:

    • Exchanging money with the public
    • Working with volatile, unstable people.
    • Working alone or in isolated areas may also contribute to the potential for violence
    • Providing services and care
    • Working where alcohol is served may also impact the likelihood of violence.
    • Working late at night or in areas with high crime rates

    Incident prevention:
    If you work with high-risk clients or those that are prone to violence, have a plan in place and take extra precaution when those individuals are on-site.

    Always report any verbal or physical harassment or threats, assaults or other violence, and any behavior that causes you to feel unsafe.

    • A few warning signs of violent behavior:
    • Rapidly changing attitude and behavior patterns; behavior changes that disrupt the work environment
    • Signs of stress are more elevated than normal
    • Excessive absences or lateness, tardiness
    • Changes in work habits: lack of performance, inability to concentrate
    • A history and/or current fascination with weapons or violence
    • Increased use of drugs or alcohol
    • Inability to take responsibility for their actions; making inappropriate statements; overreacting to criticism
    • Social isolation

    It's important to keep in mind that these warning signs don't always lead to violence; they could also be just normal changes in mood. However, it's the drastic personality changes, or changes in situation, that may bring out violent tendencies. It's advised to use your best judgment before reporting issues to a supervisor.

    Nonverbal cues of potential violence:

    A few things to pay attention to are: personal space violations, loud talking or yelling, abusive language, changes in tone, profuse sweating, and any glaring, scowling or sneering.

    Active Shooters: how to respond using Run, Hide, Fight

    An active shooter is an individual or group of individuals engaged in killing or attempting to kill people in a confined, populated area. In most cases, active shooters use firearms with no pattern or method to their victim selection. These situations are usually over within 10-15 minutes which is before law enforcement can arrive. Following Run, Hide, Fight can help save yours and your colleagues' lives.

    Run: Have an escape route and plan in mind, leave your belongings behind, and keep your hands visible.

    Hide: Hide in an area out of the active shooter's view, block your hiding place's entry, and lock the doors.

    Fight: As a last resort, and only when your life is in imminent danger, attempt to incapacitate the active shooter through physical aggression (ie: throw items at the shooter).

    Information to provide law enforcement or 911 Operator:

    • The number of shooters and their location
    • The shooter's physical description
    • Number and type of weapons held
    • Number of potential victims at the location

    Once authorities have arrived at the scene, remember to remain calm and follow instructions; keep hands visible and raised, and fingers spread open, avoid quick movements, pointing, screaming, or yelling, and do not stop to ask officers for help or direction.

    Post-Incident Analysis

    If an incident of WPV occurs, learn from it.

    • Were there warning signs that may have been missed?
    • How did the individual enter the facility? Were they granted unauthorized access?
    • Were authorities alerted promptly, and were customers and employees kept safe in the interim?
    • Did employees follow the emergency action plan? Did the plan work, as intended, to keep everyone safe?
    • What can be done, moving forward, to better discourage violence in our workplace?

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    About the Author

    Brian Courtney, RPLU, AAI
    VP, Safegard Group, Inc.

    Brian began his career at the height of a difficult insurance market.  Working with a large regional insurance broker, Brian served various industries in procuring insurance coverage for tough-to-place risk    

    Prior to joining The Safegard Group, Brian joined a large national insurance brokerage firm where he gained considerable experience in risk management serving the needs of large middle-market companies in industries such as Healthcare, Manufacturing & Distribution, Construction and Not-for-Profit.
    Brian Courtney joined The Safegard Group, Inc. in April 2005 and currently serves as Vice President for the company.  He is primarily responsible for the direction of risk management services for his clientele.  

    Brian is a dynamic and engaging speaker that is unafraid to speak on difficult subject matters that impact any organization’s total cost of risk.  His interactive approach makes it easier for the audience to learn the subject matter and to gain key takeaways to improve their business.


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    The 2022 Health Care Power 100

    By: Hilary Danailova

    As the worrying numbers on COVID-19 infections and hospitalizations demonstrate more succinctly than words can, the third year of the pandemic has meant that the spotlight continues to shine on Pennsylvania’s health care industry, from its leaders to the frontline workers who put it all on an increasingly fraught line daily. COVID’s prolonged onslaught has made it even more difficult to marshal resources and attention to tackle preexisting crises like the opioid epidemic, families and children at risk, and senior care, to name just a few.

    The people populating this year’s Health Care Power 100 list are earning their reputation as the Meds part of the state’s enviable Eds and Meds sobriquet by confronting all of the aforementioned challenges while also preparing the state, their institutions and the public for a better, more health-secure future. This list, written by Hilary Danailova, recognizes the public officials, health care executives, innovators, academics, advocates and activists – and their roles in taking care of us.

    1. Leslie C. Davis, President and CEO, UPMC

    After a successful run heading UPMC’s Health Services Division – which encompasses 40 hospitals and dozens of ancillary facilities – Leslie C. Davis became CEO of UPMC last year. She oversees the largest non-governmental employer in Pennsylvania – 92,000 employees – as well as the largest medical insurer in western Pennsylvania, with more than 4.1 million members. With Davis at the helm, UPMC launched Pennsylvania’s first tele-emergency department and partnered with the Pennsylvania Department of Health on opioid overdose prevention training.

    Read the full list of PA's Health Care Power 100

    2. David Holmberg, President and CEO, Highmark

    As president and chief executive officer of Pittsburgh-based Highmark, David Holmberg oversees a $21 billion nonprofit health organization with 37,000 employees, a growing regional hospital network, and one of America’s largest Blue Cross Blue Shield insurers. Holmberg, who joined Highmark in 2007 and became president in 2014, led the organization’s 2016 lawsuit against the federal government in defense of Affordable Care Act funding promises. Under Holmberg’s leadership, Highmark has posted record revenues and revived Allegheny Health Network from near-bankruptcy

    Read the full list of PA's Health Care Power 100

    3. Steven Collis, Chair, President and CEO, AmerisourceBergen Corporation

    Steven Collis leads AmerisourceBergen Corporation, a global health care outfit that is currently ranked No. 10 on the Fortune 500. During his 11-year tenure, AmerisourceBergen has seen its annual revenue jump more than 80% and its number of employees rise to 21,000 people in 50 countries. Collis managed the firm’s 2013 partnership with Walgreens Boots Alliance, as well as the 2015 acquisition of MWI Veterinary Supply, both of which diversified AmerisourceBergen’s market. 

    Read the full list of PA's Health Care Power 100


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    Study Evaluates How to Eliminate Telemedicine's Virtual Waiting Room

    Text Message Indicates when Doctor Is In
    By: Jackie Carr |UC San Diego Health

    Your virtual visit with your doctor is at 1:00 p.m. It’s now 1:20 p.m. and your physician has not yet logged in. Do you call the clinic? Hang up and log back in? Groan in frustration?

    Being stuck in a virtual waiting room and staring at a blank computer or device screen is a huge dissatisfier among telemedicine patients. To respect patients’ time, and provide the optimal experience, UC San Diego Health conducted a 10-week quality improvement study to evaluate how text messaging a link to a patient when their doctor is ready provides a way to connect patients and doctors most efficiently, without relying on the virtual waiting room.

    Results of the study published in the May 27 online issue of Quality Management in Health Care

    “Borrowing from the airline and restaurant industries, we tested whether we could contact patients via text to log into their appointment when their doctor is ready. The goal of the feasibility study was to determine if this flexibility lead to improved perception of waiting time and an enhanced experience, while assessing for time saving for both patients and providers,” said Brett C. Meyer, MD, neurologist, co-director of the UC San Diego Heath Stroke Center, and clinical director of telehealth at UC San Diego Health.

    “We stepped back and asked, ‘Do we need a virtual waiting room at all? Can we let patients know when their provider is available instead of making them wait online?’” said Emily S. Perrinez, RN, MSN, MPH, study co-author and director of telehealth operations at UC San Diego Health. “The reality is that wait times and lack of timely communication both correlate with patient experience. Real-time text notification that the provider is ready improved patient satisfaction and this experience is the kind of feedback we love to see.”

    Twenty-two patients at a stroke clinic participated in the two-and-a-half month study. Patients chose to either receive a text, which included a visit link when their provider was ready for their visit or the standard telehealth routine of logging in at a scheduled time and waiting in front of a camera in a virtual waiting room.

    Results showed that zero patients were seen late, while fifty-five percent of the patients were seen early. On average, there was a 55-minute time savings in clinic operations due to patients being seen early. Study metrics also included demographics, visit rates, and satisfaction surveys.

    “Providers are extremely interested in making clinic visits better and easier for our patients — especially in the event we are running late,” said Meyer. “Our old patient-communication strategy was complicated by the fact that the device that we would call to inform of a delay was often the same device they were actively using for their video visit.”

    During the pandemic, UC San Diego Health saw a 1000-fold increase in the rate of telemedicine visits. The current volume of telemedicine encounters remains high, with more than 550,000 ambulatory telehealth visits seen at UC San Diego Health since the start of the pandemic, for all types of medical and surgical care needs.

    “Overall, the text method makes life so much easier for patients. As long as a patient has a smartphone handy, they can go about their day rather than waiting for the provider to join the video visit,” said Meyer. “For the provider, it definitely increases flexibility and may even increase throughput. Additionally, texting decreases the anxiety of a provider who may be running late. Knowing that we are not keeping a patient waiting is, in my mind, the most important thing. We respect that patients have obligations and their time is precious as well, and we don't want to keep them waiting.”

    UC San Diego Health is expanding the “telemedicine untethered” option into various high-volume primary and surgical care clinics in summer 2022.

    The text-to-video technology was provided by Doximity, Inc.

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