July, 2016:

Interim Management-An Opportunity for Improved Management Transition

In today’s dynamic Healthcare market, sudden leadership transitions are becoming increasingly frequent. Organizations that are not prepared or positioned for these leadership vacancies are forced to consider going outside of the organization for interim management support.  These positions can be in the executive office, the business office and other key operational positions of the organization.


Frequently these openings are created due to a resignation with short notice, a key leader needing to retire or take a leave of absence due to illness and in other cases the organization or system is restructuring. Occasionally, organizations find themselves in a position that they are unable to find a replacement due to regional challenges of recruiting and the difficulty of finding and matching skills needed to fill the position.  Depending on the position vacated it can take over 90 days to complete the posting, recruiting and interview process and then additional time for the selected replacement to resign from their current position and possibly relocate.


At this point, the organization is facing the challenges of keeping up with key projects, making strategic decisions and maintaining day-to-day operations. There are several options for filling the vacancy.


  1. Quickly promote from within
  2. Fast track the recruiting process – (if possible)
  3. Retain interim management.


It is not uncommon for organizations that fast track the recruitment and interview process to promote or hire someone that does not have the total skill set needed to manage the position. This often leads to revisiting the same challenges with the recruitment process within a short period of time.


For organizations considering retaining an interim leader for their management team, it is critical that expectations and needs are well defined with a good understanding of key challenges, projects and any significant ongoing issues facing the organization. Documenting these issues will benefit the interim candidate as well as the organization in its efforts to retain the appropriate person for the interim role and also provide a better understanding of the skills they are recruiting for.  The interim leader will need to be brought up to speed regarding current operational issues along with some of the medical groups historical decision-making.  Depending on the length of time the interim leader will be in the position the organizations should have established goals and objectives to ensure key initiatives remain on schedule and proper leadership is maintained.


According to the Interim Management Association, “Interim Management is the rapid provision of senior executives to manage change or transition”.

In simpler terms, an interim manager is a highly experienced and specialized executive whom you can employ in your organization for a short period of time to solve a specific business problem. They are a master project manager and will not only act as a consultant and give you advice, but also solve problems for you.


Below is a short checklist to review as you consider retaining an interim leader.


  • Identify any significant projects – underway or to be started
  • Will the candidate have any interaction with Board or senior leadership?
  • Define authority to make and initiate change if necessary
  • Identify key leaders for communication and updates
  • Is the candidate there to maintain or to implement and design change (opportunity)
  • Consider asking for an assessment from the interim leader – fresh set of eyes
  • Define the mentor/transition role for full time hire
  • Review the job description
  • Establish a key contact for on boarding the interim manager including
  • Human Resources,
  • Introduction to Board, physician leadership, system leaders, and areas of responsibility
  • Facility Access – keys and ID
  • Computer access and training
  • Site visits to meet staff and providers
  • Management team introductions
  • Define how invoices will be submitted for time and expenses
  • Address extension process if needed as soon as possible
  • Short-term agreement– 60/90 days or greater
  • Be realistic in how long it will take to permanently fill the position – national or regional or local search
  • Transition plan for interim leader to permanent hire


An interim executive provides an excellent opportunity to have a fresh set of eyes observing the daily operations and providing feedback on potential areas for improvement while keeping the department/practice functioning. It also provides the organization with the ability to recruit and place the best possible candidate for a vacant leadership position.



Empowering Health IT Leadership


Clinical Operations Insight into Revenue Cycle Revitalizations

Lisa Monteleone

Lisa Monteleone

On the surface revenue cycle revitalization initiatives for physician practice groups, hospitals and health care organizations appear to only require the involvement of patient access, patient financial services, information systems and the various functions of the health information management department. Often times it’s the areas where clinical operations overlap, areas that perpetuate patient care and cultivate patient trust, that are overlooked and are not considered part of any transformation effort.  As a result, process improvement teams that fail to include members with clinical operations insight could potentially produce a prolonged or unsuccessful revitalization initiative.

Areas where clinical and revenue cycle operations overlap are relatively easy to identify. These are areas where care is being delivered, reviewed and monitored with underlying processes that ensure continued patient access and ongoing effective revenue cycle outcomes.  Pre-admission testing (PAT) operations for clinical testing, non-invasive studies and surgical procedures require clinical personnel, (registered nurses, advanced practice nurses, and physicians) as well as revenue cycle activities (registration, scheduling, coding and financial counseling).  Exclusion of either side of this tightly integrated unit could lead to poor patient outcomes, decreased patient satisfaction, operational inefficiencies and suspension of the revenue cycle before it truly gets underway.

Care and utilization management teams as well as revenue integrity teams are examples of where the gap has been bridged between clinical and financial areas. These teams are composed of professionals with both clinical and financial backgrounds.  Their knowledge and expertise are leveraged to ensure optimal clinical documentation, discharge planning with the intent for re-admission reduction, and optimal reimbursement for the care and services delivered.   They have the ability to review clinical components and translate the information into financial outcomes. These three teams can prevent denials and are positioned to report on status issues as they occur and can positively affect the ability to improve processes that lead to greater revenue capture. Telephone nurse triage, pre-test screening, transfer center operations, and complex case management are also areas where there is overlap and a need for clinician and non-clinical alike to understand the impact they have on the revenue cycle.

These overlap areas require staff to have a broad understanding of the “business” of healthcare as well as a clear understanding of the care being delivered. Medical assistants, emergency medical technicians, registered nurses, advanced practice nurses, physicians’ assistants and physicians need to understand their impact on the revenue cycle.  The same can be said of the revenue cycle team with regard to clinical operations and its impact on the care delivery model.  The interdependencies of these two seemingly polar groups cannot be overlooked when undertaking a revenue cycle revitalization initiative, large or small.

When formulating the ideal revenue cycle revitalization project team, include team members with clinical operations expertise as they ensure there is effective translation between the care being delivered and the financial transaction being conducted, directly impacting the bottom line. Clinical operations team members add value by understanding the challenges and barriers when attempting to obtain accurate information in the clinical care delivery environment.    Process improvement teams that include members with clinical operations insight produce successful and long-lasting revenue cycle improvement initiatives.

Improving Patient Access: What’s Your 3rd Next Available Appointment?

In continuing the quest to ensure that my colleagues are seeking ways to improve patients access to care; I thought a discussion regarding the 3rd Next Available Appointment would be beneficial.  The 3rd Next Available Appointment metric is often misunderstood, and as a result, not utilized. I would venture to say, if this metric is not one of your top three Patient Access Key Performance Indicators (KPI’s), you need to make it so.  Some might say, “why not measure the calendar days between the day a patient makes a new patient appointment with a physician and the next available appointment? What makes the 3rd available appointment a better indicator of access to care?”

The 3rd Next Available Appointment is preferable to the next available appointment because it is a better reflection of slot availability within your scheduling system.  Given that patients cancel appointments at the last minute, reporting the first available appointment may give a physician practice manager a false sense of timely access.  For example, you are the manager of a busy orthopedic practice.  You are measuring the next available appointment time by physician in an effort to provide patients with a new patient appointment in under three days.  Despite the fact that you confirmed your appointments for the day, a new patient calls to cancel her visit for this afternoon.  Moments later, another patient calls to cancel his new patient appointment for tomorrow with the same orthopedic surgeon.

If you were to report on this surgeon’s Next Available Appointment, and you ran this report from your scheduling system right now, your next available appointment for Dr. Smith would be this afternoon. As a manager, I would assume this means Dr. Smith’s new patient availability is under the three day threshold and my patients are receiving timely access to care.

Now let’s run the third next available appointment for Dr. Smith. In doing so, you find that the 3rd next available appointment for a new patient is 19 days.  The two cancellations received today, while providing an open slot for another new patient to fill, is not a true reflection of Dr. Smiths’ patient availability and as such, intervention should be initiated.

Most scheduling systems include this report as part of their standard package. If you have access to it, run it for every physician in your practice.  Run it often and act on any adverse results.  You’ll find a significant increase in patient satisfaction as well as a positive boost in revenue will be your reward.

MIR_3944-Johanna Epstein