Developing Connections in Collections: Building Your Team with C.A.R.E.

When we think about methods for boosting practice revenue, it is generally in terms of increasing collections or reducing costs. But there are so many more factors that could be affecting your revenue cycle success. One key factor is the quality of your team.

An engaged and committed workforce leads to engaged and satisfied patients.

Developing a culture of success and hiring employees who will nurture and maintain that culture are critical to your organization’s success. John McNeil, Chief Culture Officer for Cancer Treatment Centers of America, said, “Clinical excellence is absolutely necessary at every step, you don’t get extra credit for having what you must have—it’s an expectation and it’s not enough. Too often in healthcare there is a sense that’s all that matters.”(1) Delivering an exceptional patient experience should not only be the mission of all healthcare professionals—it is now also a requirement for reimbursement.

An engaged and committed workforce leads to engaged and satisfied patients. Creating a team that will be accountable for those experiences from preregistration all the way through final payment will ensure that you maintain your patient base, help you to develop a reputation that will bring new patients to your practice, and ensure that your practice gets paid. So how can you ensure that you have the right culture and team in place? Build it with C.A.R.E.: character, attitude, respect, and enthusiasm.

Character

Character and values are foundational to success and do not ever change. Character is the first requirement in the model because it is the most critical one. If someone does not have the right character to uphold your practice’s mission and vision, he or she is not right for your organization, regardless of experience or skill level. How can we expect our team to treat our patients with respect if our team is not made up of individuals with high character?

Hiring

Understaffing and a shortage of qualified applicants is an issue that is plaguing healthcare, and it can be tempting to hire someone with previous work experience or the right skill set simply to fill a seat. However, if the person you hire does not have a passion for what he does, and is not committed to upholding your culture of success, his work will be overshadowed by the negative effect he has on everyone else on his team.

We do not often talk about passion in the context of patient collections, but passion is critical to the success of your patient account representatives. You cannot expect everyone on the team to be passionate about collecting money, but they should be passionate about something related to what they are doing, whether that is the patients they help, the teammates they work with, the leadership they work for, or upholding your culture. This holds true for everyone within the organization, including leadership.

If your employees have no passion for the work that they do, they cannot be successful.

Figure out what you are passionate about, enough to outwork everyone else in the world, because 90% of success in life is a direct result of how much effort you are willing to put forth. The trick is you have to be honest with yourself about what you are passionate about.

If your employees have no passion for the work that they do, they cannot be successful. After passion, your criteria for hiring should include evidence of longevity. Look for cues of a job hopper. If an applicant has not stayed with a position for more than a year or two throughout the course of her career, she likely will not stay much longer with your practice. Alternatively, a person who has established a consistent work history will likely be much more committed to your organization. Think about the aspect of your job that is most important to you. Is it the work you do? The money you make? Now imagine that if you lost your position you could never get another job that would provide it for you. Chances are you would be much more committed and passionate about the work that you do.

Once you have established that an applicant has the right character to uphold your practice’s vision, and is committed to doing so, then you should consider her skill set and relevant job experience. It may seem counterintuitive for this to be so far down the list, but skills can be taught; passion cannot.

A practical tip for ensuring you have found the right candidate is to bring her back for a second interview with another member of your leadership team. Do not discuss the applicant with the second interviewer prior to the second interview, and compare notes afterward. Generally you will learn something new that could be critical about the applicant the second time around.

Firing

While hiring the right employees is critical to developing an engaged team, firing the wrong ones can be just as important. Firing an employee is never pleasant, and leadership can sometimes believe that firing a member of the team will adversely affect everyone else. In reality, more likely than not the rest of the team will be wondering what is taking so long. Get rid of the bad apples—the good ones will thank you for it.

Employee engagement studies have shown that on average 30% of employees within an organization are committed and energized, and 18% are disengaged.(2) What are you doing within your practice to improve or remove the bottom 18% of your workforce? Standard practice is to spend the majority of our time on the bottom 18%. As a result, your superstars feel ignored. Be sure to put energy toward retaining your top 30%, but focus primarily on the middle 52%. Committing time to this middle group will help you to coach them up or coach them out. Once you have control of the majority of your team, your culture will take care of the rest, and the disengaged employees will probably leave on their own.

Attitude

The second requirement in the C.A.R.E. model is attitude. Attitude is all about what we choose. Having the right attitude requires sacrifice and a choice to rise above our circumstances. Having employees with the right attitude is important because their actions will always reflect their attitude. In fact, in one study, only 9% of surveyed consumers stated they would leave an existing business to go to a competitor, and 14% said they would leave as a result of product or service dissatisfaction. However, an overwhelming 67% of people said they would leave due to the attitude or indifference of just one employee.(3)

The patient’s perspective is often very different from that of your staff.

To ensure that your team has the right attitude, you may need to help them change their mindset about collecting money from patients. The patient’s perspective is often very different from that of your staff. From your perspective you understand that stricter regulations, new data security requirements, changing reimbursement models, understaffing, and exploding operating costs, coupled with increasing bad debt, means that some costs may have to be offset by the patient. All the patient sees is that he or she is paying more for the same service. Patients often do not consider the value of the services being rendered, or what it costs to have the best doctors, top-of-the-line equipment, and up-to-date facilities.

Encourage your staff members to leave “their place” and visit the patient’s. John Maxwell has shared the 101% Principle: find the 1% you agree on and give it 100% of your effort.(4) Train your staff to acknowledge that the patient has a valid viewpoint, and to try to see the situation from his perspective. There could be various reasons why the patient is not paying their bill, and usually it is not because he does not want to. The inability to pay a bill often comes with feelings of shame and guilt. It is more likely that the patient or his family members are dealing with an unexpected situation in his life. Additionally, patients are navigating new and inferior insurance coverage, higher deductibles, and higher premiums in addition to the rising cost of care.

If your staff has the right attitude and is willing to make the effort to bridge the perspective gap, the result will be a better experience for the patient, and often more revenue collected.

Respect

The third element is respect. At the heart of respect is caring, and you are in the business of providing care. Without respect on the part of each member of your team, not only for your patients but also for the rest of the staff, you cannot provide quality care.

The leadership within your practice is just as responsible for maintaining respect in the organization as the rest of the staff. Leaders should treat their employees as the “internal customer.” Your team members are the ones who must perpetuate your culture, and sell it to your patients, so you need to make the same commitment to them as you do your patients. Have enough respect for your team to love them and to discipline them.

It may seem inappropriate to talk about love in the context of business, but treat “love” as a verb. Show your teammates and staff that you care. Be willing to be yourself around them, and get to know them on a personal level. Ask about their family, not just business. If you love and respect them, you will develop a group of people who are willing to run through walls for you.

You must also respect your employees enough to discipline them. Allowing actions or behavior that is counterproductive to your culture will only harm everyone else. Hold people accountable for their results, and provide frequent feedback about their performance. An employee should never hear anything in his or her annual review for the first time. Respecting your team means loving them enough to tell them what they need to hear to get better, and to benefit your culture, not necessarily what they want to hear.

Enthusiasm

The final element of the C.A.R.E. model is enthusiasm. Enthusiasm equals effort. Involve your staff in the planning of the work that affects them. By asking for their opinions and suggestions on how to improve processes and procedures within your practice, and implementing those suggestions, you will create a culture of accountability.

The key to maintaining that enthusiasm is to reward it. The C.A.R.E. model is about valuing character, attitude, respect, and enthusiasm over skills, so it follows that you should reward those attributes in your team members, as well as the effort they put forth for you, in addition to results. One major driver of employee satisfaction is the feeling of accomplishment when a task is completed, so celebrate the wins. It can also be beneficial to tell war stories. You can’t win all the time, so when you don’t, commiserate, share past experiences, and find ways to learn and grow with your team.

Return on Investment

Developing a culture of success takes time and a lot of hard work. It has to start from the top and requires persistence and dedication until everyone in the organization embraces your new vision. Building your team with C.A.R.E. will lead to employee satisfaction, which comes with obvious emotional and psychological benefits to leaders, employees, and patients. However, there are also significant economic impacts directly related to employee engagement.

Engaged employees are more productive. They are committed to their employer, satisfied with their work and are willing to give extra effort to help your organization achieve its goals. Dedication on the part of your patient accounting staff means more revenue for your practice. A well-developed team will also lower human resource costs as a result of lower turnover and reduced absenteeism, and can help with recruitment. Your pool of qualified applicants will grow when you create an environment that people really want to work in.

Finally, and perhaps most importantly in terms of bottom line, the right team will result in patient retention. It is the little extra touches that differentiate you from other practices. Your services will always be rivaled by your competitors, but what cannot be rivaled is a great culture. As consumerism takes over in healthcare and patients are shopping more for care, the patient experience is the differentiator, and that experience is determined by your team.

References

1. McNeil J. Creating World-Class Excellence. Presented at New Jersey MGMA PMC2016. June 2, 2016.

2. Adkins A. Employee engagement in U.S. stagnant in 2015. Gallup. January 13, 2016. www.gallup.com/poll/188144/employee-engagement-stagnant-2015.aspx .

3. Quitona J. Motivating Employees. Presented at New Jersey MGMA PMC2016. June 2, 2016.

4. Maxwell J. Everyone Communicates Few Connect. Nashville, TN: Thomas Nelson, Inc., 2010.