One of the frustrating issues our team often comes across when we help hospital partners transition from being with a management company to owning and controlling their own program, is the lack of correct billing, coding, and collection processes we find. More frustrating than finding these issues is often times the battle we need to engage in to get the hospital to correct the issues.
Allow me to explain; when a wound care management company works with a hospital, the contract they provide almost always, (and correctly) identifies the hospital as the sole responsible party in regards to billing, coding, and collections. Having said that, the management company is there for a reason and teaching the hospital team how to correctly bill, code, and collect at least 25% to 30% of their charges is one of the main reasons a hospital pays the company in the first place. No wound center management company has the right to ignore the financial viability of the hospital, no matter how small or large it is.
To do this right includes certain registration processes, coding plans, fast turnarounds, and careful attention to write-offs. The issue almost always comes in when the wound center team starts meeting with other department managers and directors to put these processes in place. Common comments include: "Our other outpatient service (usually physical therapy) doesn't do it that way", "That seems like a lot more work", "We have always done it this way", "Our system won't allow it", and my all time favorite: "You may be right, but I don't get paid enough to fight this battle."
The last comment best explains why often times other management companies yield to the concerns and complaints. Changing these processes often involves the time, dedication, confidence, and backbone to fight the battle. You have to be willing to tell the hospital "NO", a tough thing to do when you can let them do it their way and your company gets paid whether they collect what they should or not.
The bottom line however is that no matter how exceptional the healing rates of a program are, or how incredible a wound team is, if the wound center cannot support itself financially, especially in light of the dramatic reimbursement changes we are expecting to see in Medicare over the next few years, it will not stay open. If a program closes, the largest travesty is that a center that helps prevent amputations, re-admissions, and long lengths of stay will be lost to that community. The WCA vision is that ultimately comprehensive wound centers will exist within almost every hospital in the US, and with strong management of both clinical outcomes and financial viability, that could be come a reality sooner than later.
To accomplish this we have to first learn to say no:
No, easier is not always better. No, just because it is done by other centers in your hospital chain does not make it right. No, wound care is not JUST like physical therapy. No, we are not going to allow a serious mistake to be made if it is within our power to stop it. No, we won't wear togas to a hospital event again. (Thats a whole other blogpost!)
This willingness to fight for the right way to do things is inherent in how WCA works, and I hope is a quality more hospital administration teams look for in a partner. With hospitals now looking for an alternative to a monolithic wound center management company and a way to retain more revenue and control, I feel more hospital CEO's and CFO's will be willing to hear a few no's to get to one yes; "Yes, we have increased your revenue while healing patients quickly."