Blog, Revenue Cycle, The Hospital Finance Podcast®

Engaging Physicians in the Revenue Cycle [PODCAST]

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The Hospital Finance Podcast

In this episode, we are joined by Dr. Tinu Tadese, Vice President of Clinical Informatics and Chief Medical Informatics Officer at Lake Health, to discuss strategies for engaging physicians in the revenue cycle.  

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Highlights of this episode include:

  • Background on Dr. Tadese’s transformation from a physician to a Chief Medical Informatics Officer.
  • How physicians can get involved in supporting revenue growth for their healthcare organization.
  • How did working with Lake Health physicians help increase revenue capture in their emergency department?
  • Advice for hospital revenue cycle executives about how to engage their physicians.
  • And more…

Mike Passanante: Hi, this is Mike Passanante and welcome back to the award-winning Hospital Finance Podcast®. Getting physicians more involved in the revenue cycle at hospitals can be challenging, but their understanding and appreciation for how the revenue cycle operates and their role in it is critical for driving optimal reimbursement. To share strategies for how to engage physicians, I’m joined today by Dr. Tinu Tadese. Dr. Tadese serves as the Vice President of Clinical Informatics and Chief Medical Informatics Officer at Lake Health in Concord, Ohio. In her role as CMIO, Dr. Tadese advances strategies to use data from both the electronic medical record and other data sources to enhance patient experience and safety, support quality and process improvement initiatives while optimizing Lake Health’s payer reimbursement in fee-for-service and value-based contracts. She is certified by the Healthcare Financial Management Association and is a fellow of the American College of Healthcare Executives. Doctor Tadese, welcome to the show.

Dr. Tadese: Thank you so much, Mike. I’m excited to be here.

Mike: Well, we’re excited to have you because this is a unique perspective as you’re a physician yourself and deeply involved in the revenue cycle at your hospital. I think you’ll bring some very interesting perspectives to the audience. So why don’t you start off by telling us a little bit about yourself?

Dr. Tadese: So just like you introduced, I’m a physician. I was trained in pediatrics and practiced that for a few years, and then for a little bit, I was at home raising a family. And when I was ready to get back into the workforce, I decided to check out informatics. I got certified in informatics and then joined the Cerner Corporation, and I was an executive there for a few years, working with other healthcare leaders in the United States, helping them to stand up their electronic medical records and so on. And I also got into revenue cycle, and I became lead physician for revenue cycle at Cerner. Two years ago, I joined the Lake Health system in Ohio. And since then, I’ve been the chief medical informatics officer. I guess, my main passion is being able to connect the dots between clinical practice, IT, and revenue. That’s what really gets me excited in the morning.

Mike: Well, that’s great. And what did get you interested in the revenue cycle specifically?

Dr. Tadese: I guess, I’m the odd physician. When I traveled to United States in my previous role, I started to realize how difficult it was for physicians to be able to translate their services to just the reimbursement. We’re so strong on taking care of our patients and making sure they’re safe while they’re in the hospital or within our care. But we’re even strong about population health, making sure people stay healthy and not even need the hospital. But I started to realize that there was a lack. There was a gap between those services been rendered and offered most of the time in an excellent way and the reimbursement coming into the health system or to the clinics and so on. So I dove further into that, and I realized that it wasn’t so hard a subject really, and I thought, “Well, if a physician can go to medical school, they certainly can understand the bedrock of revenue or reimbursement to the health system.” So I decided that I would devote myself to not just patient safety but also making sure we’re reimbursed appropriately for our services. And so I dug in, and that’s what I’ve been doing for the last few years.

Mike: Reimbursement is so absolutely critical, particularly these days when there is such a contraction in reimbursement for hospitals specifically. So great thoughts there. How has your role as the CMIO given you a seat at the table in revenue cycle at your organization?

Dr. Tadese: If one thinks about the role of the CMIO or the chief medical information officer, there are a few things we need to remember. Most likely, that role means that you have done clinical practice one way or the other, maybe as a physician or a nurse practitioner. I am a physician. And I’ve done clinical practice for several years. So I understood the science of taking care of the patient. But also, I got into informatics, which really is the intersection between clinical practice and IT. So we have to make sure we have documentation right. We have to design the systems right. But then, those same systems that we design also are the bedrock for capturing the kind of quality of care we’re delivering to our patients. And then, in this case, it’s also where you pull the data necessary to send to the payers for reimbursement. So I sit at that intersection of maybe four main areas in healthcare, clinical practice, revenue cycle quality, and informatics, and so that gives me a seat at the table. I could speak to just about any of those aspects of healthcare. And then, it helped me to get into the meetings, make sure I was able to represent my colleagues, but also make sure that I was able to transmit back what we were missing. And of course, I was able to get into the analytics of it, discover missing charges, and help optimize quality outcomes. So having this skill set just put me right where I need it to be in revenue cycle especially.

Mike: Dr. Tadese, what practical ways do you see physicians getting involved in helping shore up the revenue of a healthcare organization?

Dr. Tadese: That’s a great question. So typically, after working with revenue cycle, I guess, specialists, I’ll call them – all the way from the chief financial officer, VP of Rev Cycle, and then the foot soldiers who really make this work – I started to see a trend. Most of the time, the revenue cycle discussions would exclude physicians in particular. It would stay in the jurisdiction, I would call it, of just the revenue cycle practitioners. It would stay between when we would receive a patient or schedule a patient for services in a healthcare organization all the way to billing and then receiving reimbursement. And somewhere in that cycle, you would find just a little reference to physicians doing what they need to do. But actually, the physicians work– and of course, nurses if we were talking of our nurses is a foundation of what the revenue cycle practitioners could actually build to cares or even to patients. So if you think about it, a physician has to see the patient but then document what they found maybe while taking care of the patient. They have to talk about what the patient said. So we call that taking a history. And then we have to describe the signs we see in that patient. And then we have to make a judgment as to, “Okay, this is what we think the patient has.” So we diagnose the patient. All of these little aspects of our documentation transmit back into the quote that would eventually be reimbursed. Now, what I found out is many physicians do not understand just that connection. So if we want to bring our physicians into this conversation, we have to help them understand how that clinical encounter with a patient translates into documentation, and then into a quote that would eventually play into what we’re reimbursed. So the role the physician plays is to document appropriately. That’s one. And then, of course, to understand what really makes the bedrock of the reimbursement. I’ll leave it at that. We might be able to get into it further.

Mike: Well, and you have a very specific example from a project that you worked on in your emergency department there at Lake Health. How did working with physicians help increase revenue capture in the ED in that specific example?

Dr. Tadese: One of the things I found out is, at least in our hospital, in all our hospitals and emergency departments, most of our admissions – I’ll say up to 70 percent of our admissions, if not up to 80 – come through the emergency department. So when a patient shows up to our hospital, most of the time they come to the emergency room. Emergency room, physicians will take care of those patients. And then if appropriate, they would be admitted. So 80% or slightly less than that of our hospital admissions are really from our patients that show up in the ER. So it dawned on me that we needed to look at what was happening in our ER. Again, our ER physicians provide excellent care, but it does not necessarily mean that every aspect of that care is reimbursed. A lot of time, a lot of urgent assessments, and a lot of tests are done when the patients are there. So I decided I’m just going to dig in and look at what we’re doing there. And I found out that we had several, several opportunities to capture a lot of the charges that was being generated from those services we were rendering. So I found out that in some specific instances, we had also millions of dollars of charges we were not capturing. So I pulled together a team, and I said, “Okay, let’s find out what’s really going on here.” And I guess the main thing I found out, just the summary of it, was that physicians did not understand two things. They understood the care of the patient. Patient would recover or would be admitted, but they did not understand two things. One, the documentation. And the ED was lacking most of the time. And if we pull back and think of the emergency department, it is a very fast-paced environment and the focus is emergent care. I have to triage this patient and give care immediately. No one is really thinking about, “Did I put down this particular symptom though I put down the sign. And from the patient, well, the less of that you capture, the less you can charge or bill. So what we did was we settled down and mapped out the specific areas that we were losing all of this reimbursement. We found out, for example, that many of our physicians will order verbally in the urgency of the moment or order an EKG. And the nurse would go ahead and get that done, and it will be documented. But in the emergency room, if you do not actually place the electronic order or paper order, whichever order it is, it will never be reimbursed. So many times, we found out that our physicians were verbally telling the caregivers what to do, but we’re not writing it down or tracking it in the patient’s record. And so when we would submit this to our peers, we would not be reimbursed. The other thing we found out was that our nurses would do those tasks. Patients will get better, but they were too much in the moment and never reconciled, “Okay, I did this test. Did I ever check if there was an order written, order given?” And so that, we started to lose a lot of the documentation of whether we needed a particular order, a particular test. We’ll find that it’s done on every test. Every study we do, of course, cost a lot of money, which ended up not being reimbursed. So we pulled all of this together. We educated our physicians, and we were able to recoup quite a lot of our loss charges.

Mike: That’s a great case study, great story there. Dr. Tadese, say overall, what advice would you give to a CFO or hospital revenue cycle executive about how to engage their physicians?

Dr. Tadese: Well, the first thing that I would say to them – and I haven’t sat on many of these committees over the years – is to maybe give a little credit to the physician. I think many revenue cycle leaders think that physicians will probably not grasp the basics of revenue cycle. They would not understand how the various aspects of revenue cycle work. But I dare say that if they were able to go through a medical school, I’m sure they’re smart enough to understand these basic principles. And so what I will say is find a way of educating your physicians. Like in our health system, we’re committed now to not just educating our physicians in the revenue cycle principles. We actually put in together a program for new hires, our new physicians that are hired to make sure that they’re adequately trained for the little traps that we found over the years where we lose a lot of charges and money.

And also, it might be helpful to work with the chief medical officer to create maybe in-service training once a year, just kind of remind them of those principles and help them remember how their services translate into reimbursement, little things like that. And since I interact with other CMIOs around the country and CMOs, chief medical officers around the country, I’m starting to find out that a little by little, these things that happen, education, education, education. And get your chief medical informatics officer involved if you do have one. I know not all health systems have that, but those who do, get them. Give them a seat at the table, and they’ll be able to help you translate this documentation. They’ll join you in documentation improvement projects, and then they’ll be able to pull their colleagues in. That would be my counsel to them.

Mike: Very sage advice. Dr. Tadese if someone wanted to find out more about you, where can they go?

Dr. Tadese: Well, of course, you can reach out to me at Lake Health. Lake Health is an organization in this part of Cleveland in Ohio. And also, I do have a consulting company called Zoe Consults. And if you reach out to me at info@zoeconsults.com, you’d be able to reach me. I do consult also in training physicians in helping them get into revenue cycle and do in-service training as well for other physicians in other health systems.

Mike: Dr. Tadese, thank you so much for coming by the podcast today and helping us all understand some strategies for engaging physicians around the revenue cycle.

Dr. Tadese: Thank you so much for having me, Mike.


The Hospital Finance Podcast

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