Perioperative care in critical access hospitals: Holly’s Impact on Revenue Recovery

Critical access hospitals face significant financial challenges, with tight budgets and limited resources making every penny crucial. Holly, a former perioperative nurse who now specializes in hospital finance, is making a tangible difference. She helps these hospitals recover missed charges, significantly improving their financial health. For instance, Holly once assisted a hospital in recovering $2.9 million, a substantial amount for a critical access facility, ensuring they continue to receive this income for services provided in the future.

From Perioperative Nurse to Financial Specialist

Holly initially thrived in the high-stakes environment of surgery, anticipating the needs of doctors during operations. However, after years in the role, her career took a turn towards hospital financial management. Holly’s transition was driven by her observations of hospitals closing and her desire to prevent such outcomes.

Challenges in Financial Management

In her financial role, Holly noticed that critical access hospitals often lack the time to ensure they are properly reimbursed. Systems intended to secure accurate reimbursements, like points systems, frequently fail to reflect the complexity of care provided, particularly for older patients with more significant health issues. This results in these hospitals being under-reimbursed, further straining their financial capabilities.

Addressing Reimbursement Inequities

Holly uses the example of two knee replacement patients to highlight the disparities in care and subsequent reimbursement. One patient, a young woman injured in a car accident, contrasts sharply with an older woman with osteoporosis and arthritis. Although the procedure is the same, the care required and associated costs are different, yet this is often overlooked in billing, leading to lower reimbursements.

Systematic Solutions and Ongoing Impact

By meticulously reviewing patient files and updating billing systems, Holly ensures that care variations are accounted for in the billing process. Her work not only recovers lost revenue but also eases the burden on the revenue cycle teams at these hospitals. Holly’s efforts are crucial in keeping critical access hospitals operational and focused on serving their communities, reflecting her ongoing commitment to enhancing patient care through financial stability.

Photo by SJ Objio on Unsplash