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Hospital finance teams grow amid reimbursement challenges

For many hospitals and healthcare centers, the CFO, the controller, and the reimbursement manager – form the new ‘trinity’ of finance leadership.

David Weldon, Contributor

For many hospitals and healthcare centers, the CFO, the controller, and the reimbursement manager - form the new 'trinity' of finance leadership.For many hospitals and healthcare centers, the CFO, the controller, and the reimbursement manager - form the new 'trinity' of finance leadership.

Ask the typical hospital CFO who their most important number two is, and odds are they will say the controller. But with all the changes around healthcare reimbursement models, some managers say the role of reimbursement manager is rapidly catching up.

For many hospitals and healthcare centers, that means these three roles – the CFO, the controller, and the reimbursement manager – form the new 'trinity' of finance leadership.

At Griffin Hospital in Derby, Connecticut, Vice President of Finance Mark O'Neill said
reimbursements will demand the most of his attention over the next two or three years.

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"Today it is sort of on an after-care basis, but I think that we're quickly moving to reimbursement up-front. That participation will be at the forefront for us," said O'Neill.

O'Neill said he spends a lot of time reimbursement managers and controllers on a daily basis, and they share a lot of the same skills and qualities.

"They have a lot of experience in healthcare finance. They are very detailed-oriented. They're tremendous at follow-up," O'Neill said. Both also share an appreciation for the top issues that the medical and administrative staffs are facing.

This last point is critical, since O'Neill and company are spending more time with their peers in other areas of the hospital. The new reimbursement models are "something that we're all learning together," O'Neill said.

While O'Neill currently has several members on staff that each handle a variety of specific functions, or defined areas of the hospital and its ancillary organizations, the focus on new reimbursement models will probably mean new hiring in the next year or two.

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For O'Neill, new hires would need a good solid background in accounting and also some exposure to healthcare reimbursement. And though there are plenty of applicants, O'Neill expects to have a challenging time finding candidates with both strong traditional finance skills and experience in the new areas he requires.

Connecticut Children's Hospital in Hartford, a 187-bed medical center integrated with a specialty physician practice, is seeing the same trend.

According to Chief Financial Officer Patrick Garvey, the hospital has 26 areas of specialty, and treats over 300,000 patients annually.

"If you think about a true finance department like an accounting operation we're probably on the smaller size," Garvey said. "When you start to encompass the revenue cycle and some of the other aspects of finance we get a bit bigger, clearly. My accounting operation is about 10-12 people, with the budgeting side and accounts payable, payroll, as well as general accountants and management staff."

Garvey counts three of his reports as the most critical to his department's success.

"My corporate controller is my right hand person who is really keeping an eye on the cash," Garvey said. "Obviously cash is king, and we're not the type of institution that has a massive war chest. We are constantly looking at cash management and vendor relations as well."

"The other key two for me are my contracting director -- who is responsible for negotiating all the key points to all of our contracts and help our institution evolve into a more modern type of institution. The last person is my budget director, who is huge at keeping us on task."

Garvey said his department has remained fairly flat in the past two years, though skill demands have changed a bit. As to recent hires, "We had to go out and do some work around clinical documentation improvement, so we definitely expanded that aspect of our operation," Garvey said.

"Also, in general we've looked at more of a revenue integrity type of role so now have a manager of revenue integrity who helps us to ensure that our charges are appropriate; that we are capturing everything correctly; and that we are maintaining the integrity of our revenue and maximizing it to the best of our ability."

As with Griffin Hospital, reimbursement models are changing for Connecticut Children's Hospital.

Right now between 52 to 57 percent of the hospital's billings are through Medicaid, due to the nature of its patient population. But come January 1, 2016, the state will be making changes to reimbursements based heavily on Medicare.

"Medicaid is generally available to children, so even if the parents don't meet the criteria the kids probably do," Garvey explained. "That is where as a niche hospital we have the most impact, as do most children's hospitals that are standalone.

"But we don't have a big Medicare business, so we don't necessarily have the Medicare billing skills that we're going to need," Garvey explained. "Changes at the state level do require that we keep a constant eye on, 'Do we have the right mix of people?' 'Do we have enough people?'  I don't expect headcount to go up much but I do expect news skillsets to be developed."

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