By Pamela J. Gallagher

The Health Insurance Portability and Accountability Act, more commonly referred to as HIPAA, has been in effect for nearly two decades. In that time, no crisis has challenged the fabric of those regulations like the COVID-19 pandemic.

By Pamela J. Gallagher

Whether in reports from journalists, briefings from government officials, or socially-distanced conversations with next-door neighbors, “unprecedented” seems to be the word on everyone’s lips these days.

By Pamela J. Gallagher

The spread of COVID-19 has turned the U.S. healthcare industry upside down, and healthcare executives and professionals are having to relearn how to care for patients in the midst of a pandemic. The loss of life and peace of mind are sobering. I also believe that the way we deliver care during the coronavirus can provide healthcare leaders with an opportunity to re-imagine how we care for our patients in a post-pandemic world.

By Pamela J. Gallagher

There is reluctance in the healthcare industry to adopt new price transparency technology. Some healthcare providers are ignoring it all together, saying they’ll wait and see if anything comes of it.

But this technology isn’t “coming.” It’s already here. With the technology in place and demands for increased affordability coming from consumers and legislators alike, this technology is just one little tilt from being mainstream—and I believe that it can change the healthcare industry for the better.

By Pamela J. Gallagher

The relationship between physician and patient, has been the foundation of healthcare, built on empathy, honesty, and trust. Will moves toward increased price transparency change this foundational aspect of healthcare?

By Pamela J. Gallagher

The federal government has introduced price transparency policies in hopes that consumers will be able to compare services and receive quality care that won’t break the bank. But not enough has been done to equip consumers to determine the overall value of the care they receive.

By Pamela J. Gallagher

With increased calls for healthcare pricing transparency from consumers and government entities alike, hospitals’ chargemasters are moving from proprietary information to public knowledge.  However, putting chargemasters under the microscope has not led to the clarity that patients are seeking regarding quality care at a price they can afford. 

By Pamela J. Gallagher

A hospital’s charge description master (CDM), or chargemaster, is often referred to as the “heart” of the healthcare revenue cycle. It includes codes for every procedure, material used, medication, and service that a healthcare organization provides its patients. It is the structure that drives the hospital, and is the starting point for billing patients and insurers and complying with public reporting.  A typical health care system chargemaster may contain 15,000 to 25,000 entries, according to Becker’s Hospital Review. 

By Pamela J. Gallagher 

With an unprecedented number of healthcare provider mergers and acquisitions in recent years and new requirements being ushered in with the Affordable Care Act, healthcare professionals are in a constant state of technology systems transition.  Though replacing a legacy system can be necessary and even beneficial to patient care or a hospital’s bottom line, times of transition deeply impact the people these organizations are relying on to provide quality care and keep the healthcare organization running efficiently.

To consider the implementation of a new system a success, you need to do more than make it to launch day on time and under budget.  Your employees—the intended users of the new technology—need to understand the “why” behind the switch and actually use the system as intended with their sanity intact.  In my experience, this can only be accomplished by engaging your people and giving them a voice at every step in the process.

Preparation

Before selecting a new system for your hospital or healthcare organization, it is essential to get the right people at the table to create a roadmap for the transition process. Be sure to involve and gather feedback from:

• Employees who can think critically about workflow efficiencies so you can ensure that you aren’t carrying bad practices forward with the new system.

• People who are highly knowledgeable about the current technology in place and its limitations. They will have invaluable insights into problems that any future systems need to solve.

• Anyone who has a vested interest in the new system. If the new technology is clinical in nature, you need to make sure physicians and nurses have a voice. If it’s a change in back-office technology, human resources professionals or accountants who will use this technology regularly will need to be invited into the conversation.

• Any department who will deal with a heavier-than-normal workload during the parallel running process or launch.

These groups have the expertise and high levels of investment to help your executive team document your current process, find the right technology to replace your legacy system, determine real costs, and set a reasonable timeline.

By Pamela J. Gallagher

The business world seems to be moving in the direction of business process automation, yet in the healthcare industry only about 20% of provider organizations are widely engaging in hospital financial automation, according to a new Black Book CFO survey. 

Automation can result in immediate cost savings, the elimination of duplicated tasks, and improved visibility.  For the healthcare industry in particular, the automation of business processes can result in improved compliance, elimination of errors in workflow processes, enhanced vendor management, and better billing practices, to name a few.

So why are so few hospitals adopting automation for their back-office processes? I believe it’s because they have seen that automation technology doesn’t always save money as it claims.  I have learned that when automation is employed without critical thinking around cost and workflow efficiency, the result is automation that will only produce unwanted outcomes—faster.

Consider the actual cost.

I don’t want to come across as overly negative toward technology—I love technology!  My doctoral studies examined impact of computerization on business administration in healthcare industry.  However, through the course of my research, I learned that despite promises to the contrary, technology doesn’t always save you money.  In many cases, the difference in cost savings between companies that had completely automated their business functions and those that didn’t use automation at all was negligible.

By Pamela J. Gallagher

When an executive leaves unexpectedly or a major personnel changes occur in your organization, the void is felt at all levels of the organization.  Rather than rushing to return to a feeling of equilibrium, I believe one of the best ways to make the right permanent hire and position your organization for long-term success and stability is to first hire an interim manager. 

Interim managers do more than just “hold down the fort” until a permanent hire can be made.  Interims bring their expertise, perspectives, adaptability, leadership and motivation skills, and entrepreneurial mindset to the challenges your organization is facing.  An interim executive comes in with an analytical mind and unbiased view to help your organization achieve sustainable results in a short amount of time, allowing you the time to iron out persistent organizational issues and assess your organization’s needs so you are better positioned to make hiring decisions with purpose and wisdom.

Gain fresh perspectives and re-focus on your mission.

Getting the objective outsider view that an interim can provide is important for the long-term health of your organization, especially if your organization tends to promote from within. Often, when a management position becomes vacant unexpectedly, organizations will rush to promote a promising lower-level manager, even if he or she still hasn’t fully developed the skills to be successful in the vacant position. Hiring an interim manager into this position for a short time before you hire internally allows your organization to work out process issues, for example, while bringing the potential internal hire up to speed. The interim can bridge that gap, setting up the internal hire and your organization for success.

Times of transition provide the opportunity to consider who you are as an organization and whether processes currently in place promote the organization’s mission and values. A lack of crisis doesn’t mean everything is running smoothly. When growth slows, mission creep sinks in, goals go unreached, or when urgent issues distract your organization’s leadership from mission-centered issues, an experienced interim’s perspective could be just the breath of fresh air your organization needs to refocus on its unique identity.

By Pamela J. Gallagher

Among the dilemmas facing healthcare executives, the decision to hire more in-house staff or outsource non-core functions of an organization is becoming increasingly common and complex. In the healthcare industry, business process outsourcing (BPO) can allow hospitals to increase their focus on what they do best: caring for patients and serving them well.

BPO includes benefits like lowering costs, increasing efficiencies, increasing focus on core business functions, and partnership with trusted experts in a wide variety of front- and back-office functions. But outsourcing has a cost that is more than just financial. Working with a BPO company requires releasing control, and if the relationship doesn’t work out, it can be hard to recover, both for your organization and your people.

Is business process outsourcing (BPO) right for my organization?

How do you know if it makes sense to outsource a function of your hospital or healthcare company?  Start by weighing the costs and benefits to determine if outsourcing makes more sense financially than hiring or training an in-house employee. Ask yourself questions like:

• What specific process or function does my organization need performed? Where is this function lacking in efficiency or cost effectiveness?

• Does my organization currently have the skill set needed to perform this function internally? Locally?

• What is our budget for this function, process, or service? What can we afford?

• How often and for how long do we need this function performed?

If it has been determined that it is financially viable and necessary to your company running efficiently to outsource a service or process, here are some things to consider as your company explores outsourcing options.

How to think critically when solving healthcare operations issues

By Pamela J. Gallagher 

Within the next five years, technology could be performing as much as 30% of tasks commonly performed by people in today’s workplace, according to Supply Chain 24/7.

People tend to react to statistics like this in one of two ways. Some throw their full confidence behind the inevitability of technology, believing it to be the solution to nearly every financial or operational issue.  Others view these numbers through the lens of a “doomsday-er,” prophesying that technology will upend business-as-usual—for the worse.

Whether 30% of people-powered tasks will be fueled by technology a few years from now, I can’t say. But here’s what I do know: The future of the workplace and of the healthcare industry will look different than it does today. We just have to make sure it’s going to be better.  With the costs of technological solutions playing a role in the skyrocketing cost of healthcare, hospital executives must think critically when considering tech solutions to operational issues.

How can you tell if a tech solution is 1. necessary, and 2. worth the time and money to implement?

By Pamela J. Gallagher

For some hospitals, the close of the fiscal year comes with a sense of dread—it’s time to run the gauntlet of another audit.

Though audit requirements vary based on whether a hospital is public or private, for-profit or nonprofit, audits are an inescapable reality for every hospital. The audit process can feel like an irritation, yet another project to add to an already full plate, but audits also bring an opportunity to develop stronger accountability and transparency within the organization.

Preparing for an audit can be daunting, but it doesn’t have to spell disaster for your organization.  There are steps healthcare executives can take today to allow a smooth audit process down the road.

Always be prepared.

The best way for your hospital to prepare for an audit is to always be audit-ready.  Of course, this is easier said than done, especially if financial credibility and accountability haven’t been made a priority across all levels of the organization. It’s only when you haven’t been keeping up with your finances that an audit is a potential issue for your organization.