Once upon I time, I was working on my Ph.D. and eagerly working three to four jobs at a time – as a clinician with psychiatric and brain injury patients across multiple settings. In those days, I loved patient care, but I avoided “the suits” (aka, hospital administration) at all costs. I had a naïve and dichotomous belief that if I cared about hospital finance, I was doing a disservice to my patients. Ironically, over time, I became a hospital CEO and became acutely aware of how all the departments, roles, responsibilities and functions fit together like a puzzle, all to support the overall goal of patient care. Then, I went further to the dark side by developing and enhancing revenue cycle workflow and processes across many behavioral health units within medical hospitals across a score of states.
I have learned that without a comprehensive revenue cycle plan and execution to support behavioral health operations, it is exceptionally difficult to support growth initiatives, clinical programming, staffing plans, and expense management actions (especially when times get tough). Revenue Cycle processes are often not viewed as cool, but they are cool because they help set up hospitals for the clinical and financial win/win scenarios: It’s good for the hospital and good for the patients. Processes such as insurance verification, enrollment/coverage maximization, upfront collections, utilization review, denials management, and billing functions all help the hospital obtain revenue for services the interdisciplinary teams have worked so hard to provide. By identifying the correct insurance coverage and helping patients maximize their coverage options, that helps connect patients to a larger network post discharge, and hopefully, keep them healthy and in recovery in the community. Without such coverage, the clinical continuum of care shrinks and options are sparse.
Beyond the bricks and mortar of the hospital, I have learned how other key functions relate to successful hospital operations. Relationships in the community, business development, strategic planning, regulatory preparedness, supporting the needs of families, and meaningful managed care contracts and relationships are imperative. And, over the decades, I have also developed a keen appreciation and respect for architectural design, as it relates to successful operations. To truly incorporate all the clinical, financial, operational and strategic needs of the organization into one coherent plan, design, and environment, completes the puzzle – and I still love patient care.
