Considerations Of Consulting Outside Of The Country

Occasionally Expeditive gets requests from hospitals outside of the United States for interim consultants who can do a variety of revenue cycle projects. We’ll then put out feelers for these positions, knowing that there will be some takers, and also knowing that there will be some people who will cringe at the idea of going to certain places.

Traveling as an independent consultant is always a dicey proposition. It can be a lot of fun, being in a new place and getting to know the area over the course of being in a new location. At the same time, it can add an interesting layer of stress when one has to consider things such as how to pack, for how long, and how to make sure bills can still be paid.

This is definitely important when one is considering leaving the country to work. Heading to a place like India or Dubai will not only be a culture shock for many people, but you don’t go to places like that and expect to fly back home every two weeks. You might have to be ready to make a commitment to stay in a location anywhere from 3 to 6 months at a time; that’s pretty much like moving to a new city. Or you might head to a place like Mexico, which has some pretty strict work standards for non-citizens that you might at times feel chafing.

We have to be honest; this is one of those times when symbiosis between client and the consultant might not be totally achievable. For clients, they can be assured that a staffing company will send them someone that’s competent. For the consultant, guarantees aren’t as solid. The only guarantee is that the consultant will get paid.

Because it’s rare for entities outside the country to fly representatives of interim staffing companies to their locations to take a look around, the status of the location can’t easily be verified. In some countries, the mores as it applies to both race and sex are much different than in the United States; telling someone what they are and having them be experienced are two different things. There’s also the language barrier that has to be overcome. And finally, probably the biggest skill will have more to do with learning how to be an effective communicator and negotiator than even the skill set.

Still, some consultants have a great time in other countries. It’s not an easy decision to make and shouldn’t be taken lightly. If it’s something you’re considering to make yourself available for, so some research on the area to see if you believe you could deal with it. Because if you accept it, you’ll be there for a long time.


Think Of Staffing Like Joint Commission Does

Every hospital in the country has heard of the Joint Commissions on Accreditation of Healthcare Organizations (JCAHO), even if they don’t use them for reviewing their hospital standards. JCAHO is known to be tough, with a great emphasis on regulations and rules for every area of consideration a hospital has to address, even down to things such as putting stoppers in doors (they don’t like that).

Something many people might not know is that JCAHO also has thoughts on proper staffing levels at hospitals, including interim staffing standards. Though not specific to the revenue cycle, it’s interesting to see some of what they believe:

* At least once a year, an organization must provide its Board of Directors with written reports on: (i) all system or process failures; (ii) the number and types of sentinel events; (iii) whether the patient/resident and their families were informed of the event; (iv) all proactive and responsive actions taken to improve staffing safety; and (v) all results of analyses related to the adequacy of staffing.

* When an organization identifies undesirable patterns, trends, or variation in its performance related to the safety or quality of care, it includes the adequacy of staffing in its analysis of possible causes.

* When analysis reveals a problem with the adequacy of staffing, an organization’s leaders responsible for patient/resident safety are informed of the results of this analysis and action is taken to resolve the identified problems.

* At least once a year, an organization’s leaders responsible for the patient/resident safety program review a written report of the results of any analysis related to the adequacy of staffing and any actions taken to resolve identified problems.

Overall, it’s a great outline to use when thinking about staffing levels at your hospital in all departments. As it pertains to the revenue cycle, verifying that there’s enough staff to handle all outstanding claims is critical to the success of the billing department. Making sure that there’s someone who understands how a charge master works and why it’s critical to the success of a hospital’s financial standing is important. Making sure things such as denials, secondary billing, and even proper collection efforts are taken care of might mean taking a look at staffing and determining that interim staff is needed to help address these issues.

Sometimes, you just might need an interim consultant to come in and take a critical look at your organization, especially if those already in leadership positions are too close or too entrenched to give the effort a fair appraisal. Often the claim is that it costs too much money to bring in interim staff, no matter what level they’re at. The reality is that the money you spend just might be the different in ending the year above or below budget, based on what interim staffing can do for you.

Benefits Of Interim Leadership

A blog for a company called Compass Clinical Consulting recently had an article titled Investing in Interim Hospital Leaders: Reaping the Benefits. It mainly talked about some of the benefits hospitals can receive by bringing in interim leadership when needed. It talked about how things such as morale, recruitment, and fixing major problems can be addressed when bringing in a qualified consultant.

Frankly, there’s nothing to disagree with in the article. We have heard of many success stories from clients talking about many of the interim leaders we’ve placed in some hospitals. Many hospitals have had great financial turnarounds when compared to where they were before our consultants were placed. One hospital actually showed more than a 100% increase in revenue and almost 40% increase in cash collections via the efforts of interim leadership we placed.

We have been happy with the quality of the consultants that have worked with us, and our clients have also. Of course, no one is perfect, because you just never know how a consultant will work with certain elements in some hospitals. Often there are situations where our consultant might not have a chance to break through the hierarchy. That’s not just us, as many independent consultants will tell you that management’s reasons for bringing them in weren’t really clear once they arrived on the scene.

However, when clients, interim staffing companies, and consulting leaders achieve a symbiotic relationship, good things happen more often than not. If clients are willing to allow consultants to do what they came to do and accept many of their suggestions, they’ll often find that things will end up working pretty well on the back end. They’ll be able to reap the benefits and skills of someone who usually has a background of previous success.

That part, weeding out the skilled, is the staffing agency’s job, and it’s what they gear themselves to be. Their reputation is on the line, and they won’t risk having it ruined by placing the wrong person. In the end, they also want to reap the benefits of skilled interim leaders as well.

Why A Specialist? Critical Access Hospitals

Sometimes people want to know why a specialist might be needed when a general consultant can usually do so many things, often quite well. Let’s take a look at the needs of a critical access hospital as an example.

Critical access hospitals are small. They’re located in rural areas, at least 35 miles from other hospitals, or 15 miles from another hospital in mountainous terrain or areas with only secondary roads. In other words, they’re pretty remote. For Medicare purposes, they’re paid based on costs, which means in many instances they’ll get paid more than their other counterparts because their needs are unique.

This usually means that more impetus should be given to things such as how charges are captured, how they’re priced, and ultimately how they’re billed out. Charge capture is important because CAH’s must be vigilant in making sure that they’ve captured every potential billable item and procedure that they’re allowed to charge for. Pricing is important because hospitals not only need to make sure they’re not under-charging based on Medicare reimbursement, but not pricing themselves so far out of range that they would trigger an audit. And billing is important because many services have relationship issues, which means that other charges, supplies, or pharmaceuticals are either supposed to be billed along with the main charge, or are a component of that main charge and thus aren’t allowed to be billed.

Not all patient account directors know these types of things because they didn’t have to know it in their background. Some hospitals have a charge master person who handles that sort of thing. Most hospitals leave all charging issues up to others who have set those rates, never going back to see whether the rates are in line with Medicare or other insurance company reimbursements. CAH’s need interim staff that truly is more of a jack of all trades, who understands both charges and billing at the same time, to truly be effective.

Going through an agency such as Expeditive helps to verify that a client’s time isn’t being wasted by looking at people who don’t have a background that shows they have skills in many different areas. Trying to hire the right person sometimes can take a long time in rural areas, so hiring an interim consultant with those skills already present makes a lot of sense.

Articles On Expeditive

We’re not only an interim staffing company, although that’s the main concentration of our business. We also offer revenue cycle consulting services through Expeditive and our main stock holder.

Because of that, we’d like to introduce you to our articles page. At the present time we have six articles, with more coming, and they address issues regarding both staffing and accounts receivables issues. Here are the titles and brief synopsis of those articles; you can visit the main article page to read any of them.

When Might You Need an A/R Swat Team – our recommendations for helping health care entities decide if they need to bring in professionals to help them out.

Five Ways To “EMPOWER” Your Patient Accounting Personnel” – our recommendations for ways to help your current staff work better independently.

Accelerating Cash: Using an Action Plan – our recommendation for how to increase your cash collection process.

Hiring Top-Quality Revenue Cycle Staff – our recommendations on how to evaluate talent that you want to bring into your facility as full time staff. You can also use these criteria in evaluating interim needs.

Improving Your Revenue Cycle IT Infrastructure – our recommendations for what your financial needs are if you’re looking into changing your computer patient accounting systems.

Challenges When Outsourcing Your Business Office – our thoughts on what you might want to consider if you’re thinking about outsourcing your accounts receivables.

We hope you stop by to take a look at what we have to offer in our articles.

Staffing Issues To Consider

There was an article on a blog called Office Arrow titled Cost Effective Staffing Strategies that we found intriguing. It went in a totally different direction than our last post titled Can You Go It Alone, as it addressed taking a look at how your current full time staff is performing as it pertains to issues like absenteeism, overtime, and general work performance.

Those are definitely important internal issues for all companies to review because it could be indicative of a breakdown of work practices throughout a business. In an odd way, some of those issues could lead you to determine that you could use the services of a staffing agency when applied to your medical financial offices because they might highlight why you would want to consider getting outside help.

For instance, let’s take a look at overtime. If you’re paying your staff a lot in overtime hours and they’re still not catching up, it might indicate that you need more people on the job. One of the problems with just hiring a new person is that you have to go through a long training process and that could mean your departments will fall behind even further. Bringing in someone with experience already helps you catch up while also taking time to train a permanent employee.

The same type of thing could relate to dealing with high numbers of absenteeism. At a certain point you as the employer are going to have to do something about it, but you still can’t afford to fall too far behind. You could determine to outsource some of your work, or you could bring in an interim person or persons to help you catch up while training the new person. You could also bring in interim people while you evaluate things to determine if there are other changes needed.

Interim staffing companies can offer many business solutions that help companies buy themselves some time while making sure they don’t fall too far behind on the important daily operations that help them sustain themselves.

Can You Go It Alone?

Something that we are proud of at Expeditive is our white paper, titled Can You Go It Alone? This isn’t necessarily an advertisement for our staffing company as much as a recommendation for health care entities that are having difficulties with their revenue cycle operations and ways to review how they might get out of those difficulties. We’re not going to print the entire white paper here, as we’d love for you to download it and absorb what we have to say, but we will give you some highlights here to whet your appetite.

First, facilities must determine what their issues are when the believe their financials are performing poorly. Is it the billing department? Is it medical records? Could the problem be charge capture? Could there be an issue with how the budget was put together? Maybe there’s a logjam at registration which results in poor information capture. It could be many things, and they might take time to review.

Second, what do you want to do when you’ve figured things out? Can you handle it all with the people you have, or do you need some kind of outside assistance? Do you want to outsource things, or bring someone in to work on your issues? Do you need some leaders, or some independent workers? Do you need training of some sort?

Third, what would be success to you? Sure, you might want it all, but can you afford it all? Do you want quick results or are you willing to take the time to get it right?

And fourth, where can you go to get this help? For that one, click on the first link in this post and see if we might be able to offer you what you need.