Central Oklahoma Family Medical Center (COFMC) is a federally qualified health center (FQHC) in south-central Oklahoma, with two locations, in the towns of Konawa and Ada, located about 90 minutes southeast of Oklahoma City, near the Texas state line.
Like the leaders of other FQHCs, the three physicians, five mid-level practitioners, three licensed clinical social workers, and all the other members of the 75-member staff at COFMC, are deeply committed to their 6,000-some patients and to the two isolated rural communities in which they deliver care. That said, the economics of FQHC operations, with increasingly straitened finances and manifold regulatory requirements, are as challenging as ever.
It is in that context that Central Oklahoma Family Medical Center’s leaders turned to the Richardson, Texas-based Aprima Medical Software as a partner in the area of revenue cycle management (RCM), in February 2017. Since that time, the organization has outsourced its RCM functions to Aprima.
Late last year, Memory Coker, L.P.N., COFMC’s chief administrative officer, and Charlie Vest, its chief financial officer, spoke with Healthcare Informatics Editor-in-Chief Mark Hagland, regarding the policy, payment, and RCM challenges facing their organization, and their work to put the FQHC on a firm financial footing. Below are excerpts from that interview.
Can you share with me some of the core challenges and opportunities facing your organization, in the revenue cycle management arena?
Charlie Vest: The challenge is the unknown. Seventy percent of our federal grant could be cut by the end of the year. That grant came from the ACA [Affordable Care Act]; the funding is set to expire—it’s the same one that was set to expire Sep. 30, with CHIP [the Children’s Health Insurance Program]. HRSA [the federal Health Resources & Services Administration], our governing agency, had money until January. Thus far, the funding has not been reinstated; so if Congress doesn’t come up with something by January, the total $5.1 billion allocated to everyone, will be cut by 70 percent. Our grant makes up about 20-25 percent of our budget.
So you’re potentially facing a 13-15-percent cut to your budget?
Yes, that’s correct.
So what are the key things you need to do, as an FQHC, in terms of revenue cycle management, in order to keep your organization operating effectively?
It’s all about timing. It all has to be quick. I can’t have bills set out for months. If we can get a clean claim out and get paid in 14 days, that’s very important. The providers have to finish their notes in a timely way so that we can get a claim out quickly. So we switched from NextGen to Aprima EHR [electronic health record] in November 2014. We had Synergy Billing. And in February, we switched to Aprima Billing. And that’s been very helpful for us; they know their own EHR; they’ve been able to streamline our process, to get the claims out the door and to lower our days in AR. You’re right, I don’t have excess cash sitting in the bank for a rainy-day fund. We have to pay our bills.
Can you share what your days in accounts receivable were then, and what they are now?
So in April 2017, they were 40 days. Now, they are 30.
Yes. Since Aprima has taken over, we’ve had a ten-day drop in our AR. And that correlates to our monthly working capital. We went from 1.014 month’s [reserves] in working capital in April to 1.5. So we’re starting to get cash in the bank, to plan for expansion, etc. We’re getting some cash on hand, finally, instead of having a bad month and figuring we’re toast.
Every clinician has to play their part to document quickly and well, in order for all of this to work, correct?
Yes, that’s right. We’d like their notes to be done by the end of the next day. We really don’t have much of a problem with that. Aprima RCM has done an audit of our charts, to let Memory educate the providers.
Memory Coker: The audit actually went very well. Our finance department did an audit of one provider so far, that looked at their documentation versus their E&M coding, and found the documentation was in very good support of that coding. As Charlie said, we usually do require that their notes be done within 24 hours after a visit, but 98 percent of the time, all the providers have their notes complete and ready for billing by the end of the day of service. That’s a testament to their efficient use of the EHR.
Memory Coker, L.P.N.
The EHR is user-friendly?
It is user-friendly, yes. And we had reviewed a lot of workflows and analysis as we were implementing and training for Aprima, and we did not have to change any of that workflow; it was easily customized to what the providers were doing; and that helped a lot.
If you had all the money in the world, what would you ideally like to do? And what can you do realistically?