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In July, when Anthony M. Bruno, MPA, MEd, assumed the position of director of patient access and business operations at Presbyterian Medical Center in Philadelphia, he was facing more than the usual transition to a new job.
Bruno has been charged with creating a brand-new department at the hospital, which is part of the University of Pennsylvania Health System, and making it an integral part of a major systemwide revenue management initiative.
His mission, Bruno explains, involves "taking departments that have been decentralized and putting together a centralized operation of the business activities." The new arrangement, he adds, will allow not only a focused, consistent training of staff, but also the opportunity for cross-training in different areas.
Previously central registration, financial counseling and cashier services reported to the patient accounts department, emergency department (ED) registration reported to ED administration, and admissions reported to the chief medical officer, Bruno says. Now all those areas are consolidated under patient access and business operations.
As he handles the nuts and bolts of creating a department where one did not exist before — including allocating office space, setting up files and revising policies and procedures — Bruno is also involved in evaluating the scope and responsibility of the different areas he oversees.
Then, he says, "we will make the determination of what is needed to carry out the health system’s Code Green Workplan." That project — begun in 1999 — is designed to "improve our management of the entity revenue cycle and increase the health system’s profitability," Bruno adds. In the past couple of years, he explains, the system has undergone a positive turnaround after experiencing a serious budget shortfall in 1999.
"We are now writing the fiscal year 2002 work plan," Bruno says, with an eye on continuing to reduce registration errors, billing rejections, and denials in an effort to decrease days in accounts receivable and ultimately improve the bottom line.
"On the front end, we’re talking about expanding collaborative work efforts between registration, medical records, utilization management, and patient accounts," he notes. "All of these departments directly impact our ability to manage rejections, denials and the revenue cycle."
Meanwhile, Bruno says, he has been interviewing people for several positions that are being created for the new department, including manager for quality assurance and training, manager of the admissions center, and a manager to oversee central registration and registration services in ancillary departments.
"Right now, I am building a management team for the new department," he explains. "We really need a strong teamwork approach to aggressively manage our responsibilities in the revenue cycle. In today’s health care environment, every patient registration and account is important. You have to be extremely accurate and thorough and take all opportunities to appropriately bill a patient’s insurance and, if there is none, determine if the patient is eligible for assistance."
The new department also will work very closely with clinical resource management and social work, Bruno says, to ensure that admissions meet the appropriate clinical admission criteria. "We are just beginning to re-engineer our preadmission and transfer processes."
[Editor’s note: Hospital Access Management will give periodic updates in future issues on the establishment of the patient access and business operations department at Presbyterian Medical Center of the University of Pennsylvania Health System. Anthony Bruno may be reached at (215) 662-9297 or by e-mail at email@example.com.]