For two decades I've worked with hospitals and their revenue cycle issues as an independent consultant. Before that I worked as an employee in hospitals, physician billing companies and a FQHC. I've been in health care almost 40 years (man, I'm old!).

Yeah, that's me!

The people I talk to (or try to talk with) at the C-suite level most often are CFOs, also known as chief financial officers, vice presidents of finance, or a host of other titles. These are the folks responsible for the overall financial success of a hospital, and they've got a lot on their plate.

I'm sure they won't mind me saying that sometimes there are things they don't know; it's not their fault. There are so many responsibilities they need to leave with other people because they're not trained in everything. After all, how many CFOs have ever reviewed a medical bill, coded a medical record, registered a patient, purchased equipment... you get the picture?

Since I'm a consultant and always trying to be helpful, I've put together a short list of advice, 5 items in all, that I believe can help CFOs overall. Although this is being written specifically for hospital CFOs, a lot of this advice works for other businesses and industry as well, even if some of the terminology might differ. Let's begin:

1. There's nothing special about your computer system

Cerner, Meditech, HBOC, Epic... on and on... you know what the difference is? The names... that's it. The sales person is going to come in and tell you all kinds of fancy things their system can do, but in actuality they're all pretty much the same.

I point this out because when I was an employee and as a consultant, I get the question "Are you familiar with ____ system". Although it's helpful if the person you're talking to has experience with a particular system, their experience with the job and duties you're hoping to hire them for is drastically more important. It's always more about processes than anything else.

As someone who walked into two jobs as an employee where the hospital had just purchased new computer software and left the employees untrained (also had a 3rd system thrust upon me), had both of those facilities decide to change to another new computer system, and consulted at two other hospitals that had just installed new systems, I can tell you that it's more important to hire someone who knows how to ask the proper questions, learn what they need to know about the software, educate the manufacturers on how charge capture and billing actually works (which I'll admit shocked me) and help to get things working properly in all areas, especially when it pertains to finances.

2. Hire people based more on leadership skills and personality.

Anyone you're hiring for a director position, interim or permanent, obviously has some technical skills, although they may vary. What most people are lacking are good to great leadership skills. If they're lacking that, then their personality is probably not up to par with what you need.

Even if people aren't technically great, if they have great leadership skills their departments will probably shine better than if they have a great technical person with lousy leadership skills. Years ago, 60 Minutes highlighted an automobile plant that had a major turnaround in production. What the plant did was hire someone to lead the plant who was a clinical psychologist. She knew nothing about cars, but knew a lot about people. Within months she changed the culture of the plant, people felt good about their jobs, and the plant thrived. Over time she also learned what she needed to know so she could make better decisions.

This doesn't mean technical skill isn't important. There are lots of people who have pretty good skills that can help hospitals improve. But it takes being able to work with others to really make things jump forward and brings everyone together, working towards common goals.

3. Don't make department directors responsible for their revenue without training them.

I'm not against making department directors responsible for their revenue. As a matter of fact, I think every hospital should make sure those directors know what's going on with their departments as it pertains to finances.

Unfortunately, what I see most often is that maybe one or two directors have figured things out, and can competently tell you what's going on. Most of the time, directors are left to their own devices to figure it out. Sorry, but that rarely works.

Directors of these departments need some training, and probably not from you. They might or might not be able to get some of it from someone already in an accounts receivables position; do you have a full time charge master person? If not, they might need someone from the outside to consult with from time to time, maybe even someone to come sit down with them a couple of times to explain how to use revenue reports, know what the CPT codes actually mean, and see if what they're doing is what's showing up on both reports and bills. Oh yeah; verifying that their charges also have prices related to them helps a lot.

4. Pay for training whenever you can.

Nurses need training to keep their licenses. The same with technicians, doctors, medical billing personnel... maybe even you if you're a member of a group like HFMA and have a certification that requires so many CEUs a year.

Did you know there are groups for people throughout revenue cycle? There are groups for admissions, billing, collections, purchasing, IT and coding. Many of these groups offer certifications. They often have training classes that might be monthly, quarterly or semi-monthly. Many of them are local chapters of national organizations.

There are also groups for pretty much every department in your facility. Allowing employees to go outside the facility for training is always the best decision. What people learn when they're always doing the same is how to always do things the same, even when they need to change.

Even if you don't need people to be certified (which really isn't needed across the board), you need them to be as educated as possible, and not only at the director level. Only so much can be learned from a manual or a newsletter. Allowing people time to go to seminars or join trade groups within their realm, even if you can't afford it and they're willing to spend their own money, benefits your facility way more in the long run than it will them.

5. Question the numbers but don't blame the messenger.

I know this one well. I tell a CFO that the reason their numbers don't look right is that I've traced it back to an incorrect general ledger number. I tell a CFO that based on the statistics, their days in unbilled receivables are overly high, something they hadn't been tracking. They want to rant at me when I wasn't responsible for either event. If that sometimes happens to me, an independent consultant, you know it happens to employees as well.

It's always better to know what's going on than not, because you can't fix what you don't know about. However, if people know that your reaction is going to be something they don't want to deal with, they're going to keep silent. Later, when the problem has gotten so big that it's going to take a long time or a lot of money to fix, you won't know who knew something that could have been rectified much earlier because the employee didn't want to deal with you.

Find ways to ask questions without sounding accusatory. Be someone employees are willing to come to when something's not working properly. Don't make a big deal out things, even if they are a big deal; try to work with the person who brought a situation to you, or with whomever has overall authority over the issue, to find resolutions. If you need outside help, get it; no one knows everything all the time.

Those are the tips; how do feel about them?