The following is a profile of just one of the thousands of revenue cycle leaders at healthcare providers across the U.S. I'd like to thank Peter Troia for generously offering his time to provide his insights. If you are a revenue cycle professional at a healthcare organization and would like to participate in a profile like this, please contact me. I would love to hear from you.
What's your name, organization & position?
Peter Troia, Collections Manager, Aurora Health Care
How’d you land in your role at Aurora Health Care?
When I left the banking business and joined Aurora Health Care (a system now comprised of 15 hospitals and over 150 clinics), it was in the midst of some growing pains. At the time Aurora utilized two systems; one for medical billing, and one for physician billing. We were in the process of migrating to one Medical Health Record and billing platform: EPIC. I came to Aurora with significant collections experience, but zero healthcare experience. I really have to thank my boss, Julie Kallies, for taking a chance on me.
We had an in-house collections shop but the staff were being utilized for handling overflow customer service calls and were not trained in the art of collections. We had a lot of work to do in re-training staff on the new systems and how to better serve the patient by collecting balances to avoid collection activity. Luckily, my team came with tremendous healthcare experience, and everyone was supportive and receptive to change.
Was there something obvious about the revenue cycle you felt you could improve?
Having come from the financial services industry, I brought some elements of that collections culture to Aurora, but adapting the approaches to the healthcare environment. In financial collections, we take a top-down approach to negotiations. And we aren’t asking “yes” or “no” questions. We have a probing conversation so that we can determine the best payment option for the individual. So what I brought to the organization was an agency collections strategy, and a philosophy around collections that you don’t often see in a healthcare setting. I believe that you can be respectful and friendly, preservative of a positive patient experience, but still run collections as a top-down effort that steers toward a resolution.
My staff helped me adapt my approach to respect the nuances of healthcare. In retrospect, it was crucial to our success that we collaborated to find a middle ground that was in line with the Aurora brand. To build “our idea” as a healthcare collections team has been far more rewarding than building “my idea.” As a leader, it’s what I enjoy most about what I do.
Has your approach to collections worked as well as you expected?
Yes, absolutely. We’ve seen double-digit increases in our collections in each of the years that I’ve been with Aurora Health Care (since 2013). I attribute that to pairing a positive patient experience with a sense of urgency about paying your bill. Two things need to land with healthcare consumers: urgency and options. A typical healthcare collection method is geared toward avoiding patient complaints. But by pairing urgency and options you can prevent complaints and still steer toward a resolution. If you’re not pushing to resolve the situation, that’s not a collections effort.
What’s your special sauce?
There is actually a methodology to educating consumers, listening actively to them, and then partnering with them. Of course, you want them paying the largest amount possible in the shortest amount of time, but foremost, you want to establish a relationship. I don’t mind making an adjustment in our repayment guidelines for a consumer until they gain their footing. We can bend, but we can’t break and just accept “I’ll call you when I have some money.”
Do you think the newer approaches to patient finance (offering low- or no-interest extended payment plans) will help soothe the raging self-pay crisis?
I get concerned about all the outsourcing to external patient finance vendors I see in the business. I think you maintain better control if you can manage that internally. It’s another way to collect on the balance but it’s also another vendor to partner with and to manage. You’re trusting them with your brand so the partnering aspect is crucial.
What about technology? Do you see it as a friend to healthcare collections?
From where I sit, I can tell you that our agencies are certainly getting more data elements on patient behavior from us. And that helps. Our in-house team attempts to collect for a period of time while the patient is receiving monthly statements. This enables us to have those crucial conversations and answer any questions they might have on their bills. For the patients we aren’t able to make contact or obtain payment we have an agency strategy of both first and second placements. The more data I can send my partnering agencies, the better job they can do recovering those balances.
Another way I think technology will change our business is that I expect a lot more of these online chat portals, social media outreach and other non-traditional means of collections to take off. It already exists in a lot of industries, but we’ve taken a conservative approach so far while allowing other industries to test these waters and inevitably the lawsuits that come with this type of change. These suits will surely be followed by a backlash of regulations that could prevent us from even using these great tools to their full potential. It will be interesting to see this play out.
Speaking of avoiding the ire of regulators and lawsuits, how are you monitoring your agencies on compliance issues?
We’re the largest healthcare system in the state of Wisconsin, so naturally, many agencies want to engage with us. They’re not all a good fit, because we’re extremely hands on. We take very seriously our continued responsibility on these accounts. We consider our first- and second-placement agencies our partners, and we work very hard to make sure they are well supported and understand how we want those accounts handled.
We have a contract in place and a document of work standards explaining how we expect our accounts to be worked. We also do agency audits every year with each agency. One of the audits is on site, and it’s intense. It’s everything from evaluating security cameras, access points, server room, employee background checks, financials and more---at all sites. We also have quality assurance specialists who monitor all of our agencies monthly by reviewing calls and performing monthly call calibrations. Together we partner with our agencies in training and coaching for best practices and results.
Don’t get me wrong; we don’t just make demands; this is definitely a partnership. We work with our agencies’ leadership teams to develop a training and collections strategy that mirrors what we’re doing internally. It’s a pretty unique approach. One of our trainers is out of the office right now, doing side-by-side coaching with an agency. She’s been there three days. We make a big investment in time and focus on extending our brand experience through our agency partners. This can take the form of role plays, call scripting, and other coaching methodologies. This is really a different approach to healthcare collections, and I’m proud of what we’ve added to Aurora’s collection efforts.
Can you boil down some solid gold advice for other healthcare rev cycle pros?
Two big things:
- Have clear work standards for your vendors. We’re going to see increasing regulations in healthcare collections, The antidote, in my opinion, is to form real partnerships and protect providers’ brands by ensuring accounts are worked thoroughly and given the attention they deserve.
What does this mean? I think it means you have to have clear work standards to share with your agency vendors. And this isn’t just a document you create and your vendor files away. This has to be a practical, living document of expectations and checkpoints. They should be working like every day is audit day. Be diligent, thorough and above and beyond what the regulators expect.
- Look for backbone. Frivolous lawsuits are a real thing. Make sure you work with vendors who know how to handle unfounded complaints. Ask them about their litigation and settlement approach. You want to know their philosophy and how these types of complaints are handled but also how they prevent them from happening. You want to know this is an arena they are familiar with and can handle without a history of rolling over on unfounded claims.
If you could thank just one person in the industry, who would it be?
Joe Antonacci, who has been a mentor and a trusted friend to me since some of my first outbound dials as a rookie collector.
Is there a TV show or movie that you can't live without?
The Rocky Balboa movies. “It’s not how hard you hit, it’s about how hard you can get hit and keep moving forward.”
What do you think needs to change most urgently in the revenue cycle field?
Healthcare debt is the most complicated debt to understand and explain to the everyday patient who receives the bill. Any significant strides towards making this easier to understand would be a big boon for all involved.