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transcript
TFC Survey 2012The Pulse of the Nation
Debbie MastStanford Hospital and Clinics,
Database Administrator and Financial Manager
Amy Hackney, MBAManager, Transplant Reimbursement
Tulane Transplant Institute
TFCA WorkshopSeptember 18-20th, 2013
TFC Survey 2012
• 1st Survey – 1997• 2nd – 2002• 3rd – 2007
• Who participated in the survey? Transplant Administrators Transplant Financial Coordinators – Solid
Organ and BMT
2012 Survey Focus
• Program volumes• FTE’s• Educational requirements• Reporting Structure• Salaries• Job duties and responsibilities• Certification
How was the survey conducted?
• E-mail via TFCA and Administrators List serves with link to survey
• SurveyMonkey.com• Secure and confidential• Professional online survey• Results collected and compiled
Reminder notices were sent out encouraging everyone to complete along with passing along to other team members who might not be on the list serves.
Response Rate by Survey Year• 133 of 274 (49%) of transplant centers
responded to 1998 survey
• 130 of 257 (51%) of transplant centers responded to 2002 survey
• 147 of 261 (56%) of transplant centers responded to 2007 survey
• 158 of 250 (63%) of transplant centers responded to 2012 survey67 Administrators and 175 TFC’s responded to the
survey
UNOS Regional Map
Administrator Responses by Region
1 2 3 4 5 6 7 8 9 10 11
4
12
5
13
7
2 24
3
10
5
14
34
28 3032
9
23
20
15
21
24
Centers Responding Centers in Region
Types of Transplants Performed
Heart Lung Liver Kidney Pancreas Intestine Bone Marrow
52.2%
34.3%
62.7%
94.0%
67.2%
9.0%
25.4%
% of Centers Performing each Type of Transplant n=67
Organ Type
% o
f C
ente
rs
Number of Referrals per Calendar Year
Heart Lung Liver Kidney Pancreas Intestine Bone Marrow
5,56011%
4,3238%
10,78021%
28,95456%
8362%
1200%
7912%
Number of Referrals per Calendar Year per Program
Organ Type
# R
efe
rrals
How Many Transplants per Year?
Heart Lung Liver Kidney Pancreas Intestine Bone Mar-row
# Organs 23 32.68 55.54 99.88 12.46 2.07 62.5
Center Responses 35 25 39 64 39 14 16
Average Number of Transplants per Calendar Year by Program.N
o o
f T
ran
spla
nts
Let’s Take Another Look…
Heart Lung Liver Kidney Pan-creas
Intes-tine
Bone Marrow
# Or-gans
805 817 2166 6392 486 29 1000
% to-tal Or-gans
0.0688328345446772
0.0698589140658401
0.18520735356
9902
0.54655835827
2766
0.0415562206070971
0.00247969217614365
0.0855066267635742
Number of transplants per calendar year by program.
To
tal O
rga
ns,
% o
f T
ota
l
Are the Transplant Financial Coordinators Dedicated to the Transplant Program?
94.0%
6.0%
Yes
No
Of the 4 centers responding NO; 3 Region 10 and 1 Region 3
Who handles the responsibilities of the TFC if there is no primary TFC dedicated?
Social Worker 3%
Billing/Collections Representative 1.5%
Other (shared position) 1.5%
How Many Transplant Financial Coordinators (FTE’s) are Assigned by Program
Heart Lung Liver Kidney Pancreas Intestine Bone Marrow
0.48 0.64
1.16
1.99
0.23 0.35
0.8
FTE Assigned per Organ Program
Organ Type
Avera
ge %
FTE a
llocate
d
One Liver Program and One Kidney program had > 5 FTE’s per Organ
Program Examples of FTE per Referrals/Transplants
1 2 3 4
287
150
112
4863
3346
15
# of Referrals and Transplants per FTE - Liver
Referrals Transplants
Who is the TFC Employed by?
Hospital/Medical Center – 63, 94%
Physicians Group – 1, 1.5%
Patient Financial group (Billing/PFS) – 2, 3%
Outside Contracted Agency - 1, 1.5%
Who does the TFC Report to?
• Supervisor - Financial Coordinators 7.6%• Manager - Financial Coordinators 19.7%• Admissions Manager/Director 4.5%• Transplant Administrator 50%• Contracting Manager/Director 3%• Patient Accounts Manager/Director 9.1%• Other (includes: Medical Director; Program
Manager; Operations Manager; Business Manager; Supervisor of Operations) 19.7%
Minimum Education Requirements
HS/GED57.8%
AS/AA7.8%
BS/BA23.4%
Masters1.6%
Other9.4%
Education Required
Perc
ent
Out of 64 respondents: 37 HS/GED; 5 AS/AA; 15 BS/BA; 1 Masters; 6 Other
Other: BA Business; SW for combined role;BA preferred; don’t know
Experience Required
0-2 years47%
2-5 years47%
5-8 years5%
8 or more years1%
In comparison to 2007 survey:0-2 years 31% increased by 16%2-5 years 57% decreased by 10%5-8 years 12% decreased by 7%8 or more years 0% increased by 1%
Area of Experience Required
83.9%
72.6% 43.5%
17.7%
Insurance
Healthcare Billing
Transplant
Salary Range
unde
r $18
,000
18-2
1,99
9
22-2
4,99
9
25-2
9,99
9
30-3
4,99
9
35-3
9,99
9
40-4
4,99
9
45-4
9,99
9
50-6
4,99
9
65-7
4,99
9
0.0%1.8% 1.8%
10.7%
21.4%
17.9%
14.3%
12.5%
16.1%
3.6%
In comparison to 2007 survey:Salaries above 35k in 2007 encompassed 59.5% of TFC’sIn 2012, 64.5% of TFC’s salaries are above 35k
Salary
Salary Range by Region
1111
10
10
10
1010
99
8
8
7
6
5
5
5
5
4
4
4
44
4
4
3
3
3
2
2
22
1
1
1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Nu
mb
er
of
TF
C's
Salary Range by Region
On what Position is salary Based?Similar positions within the hospital 80.3%
Specifically on TFC position 19.7%
Additional Compensation includes:
Overtime 60.9%
Compensatory Time 14.1%
Education and Travel expenses 71.9%
Call Pay 9.4%
Annual Bonus 17.2%
On-call Days
1-5 days 6-10 days 11-15 days 16-25 days 26 days or more
N/A
0.0%
11.3%
1.9% 0.0%
7.5%
79.2%
# Days on-call
%
Would your Center be willing to Pay for TFC Certification?
66.2% - YES
7.7% - NO
16.9% - Maybe
9.2% - Not Sure
How do our Administrators feel?
The TFC role is a requirement of the OPTN for transplant center membership. Education and certification will only help to emphasize the need for development of these positions within the transplant program.
We can't really have enough resources or expertise in this area.
I believe the certification of TFC's is very important to the organization and its credibility.
A certification program would allow us (administrators) to lobby for higher pay and stand along titles as we could establish the field better than we currently can
How do our administrators feel?
TFCs are one of the most under valued team members on the Transplant team. Somewhat due to lack of professional development opportunities. Please let us know how to better help develop this profession.
TFC is an excellent organization
This is a specialized position and very demanding. We would welcome certification to justify appropriate compensation for the role.
It would be awesome if you can provide certification for our team members. It will help internally to further differentiate them from the rest of the hospital employees as specialty trained
Now It’s Our TurnWhat Did the TFC’s have to say...
TFC Responses by Region
1 2 3 4 5 6 7 8 9 10 11
14
17
13
17
23
65
17
11
9
14
Region
# o
f TFC
's R
espondin
g
What Programs are the TFC’s Assigned to?
12.72%7.98%
18.45%
30.42%
18.20%
2.99%9.23%
Kidney
Pancreas
Intestine Heart Lung
Liver
Bone Marrow
Kidney = 122; Liver = 74; Lung = 32; Heart = 51; Pancreas = 73; Intestine = 12; Bone Marrow = 37
Experience
Insurance relatedHealthcare re-
lated Transplant re-lated
0
20
40
60
80
100
120113
119
371926
22
15
7196
1011
3
2 4
17
6
74
7+ years
4-7 years
2-4 years
1-2 years
7-11 months
0-6 months
Type of Experience
Nu
mb
er
of
TF
C’s
Re
sp
on
din
g
65-70% of TFC’s had more than7 years of Healthcare related AND Insur-ance related experi-ence.53% had up to 2 years of Transplant related experience
Primary Method of Training
Super
viso
r
Fello
w C
oord
inat
or
Consu
ltant
Atten
ded
clas
s/se
min
ar
Read
trai
ning
man
ual
On-
the-
job
trai
ning
Oth
er0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
7.7%
39.1%
0.6% 1.2% 0.6%
50.9%
17.8%
Training Method
Perc
enta
ge
Training (other)
• None provided• Prior experience• TFCA Forums• Supervisors• Training manual• “On my own”• “I had no help, I learned as I worked”• “I winged it”• Self trained
How Long at your Current Position?
0-6 months
7-11 months
1-2 years
2-4 years
4-7 years
7+ years
010
2030
4050
6070
9
7
17
31
44
67
Number of Responses
Years
in C
urr
ent
Posit
ion
Educational Level
High School Graduate/GED
0-2 Years of College
Associate Degree
2-4 Years of College
Bachelors Degree
Some Graduate Coursework
Masters Degree
Other (please specify)
05
1015
2025
3035
4045
15, 8.6%43, 24.7%
21, 12.1%
21, 12.1%43, 24.7%
12, 6.9%
13, 7.5%
6, 3.4%
Number of Responses
Professional Certifications or Licensures
4.4%
2.6%
2.6%
27.2%
Other
MSW
LCSW
RN
Other: Certified Professional Coder; Certified Pharmacy Tech; Certified Revenue Cycle Rep; AAHA; EMT Basic; LPN; Certified Patient Account Tech; CRCA; CMA; RHIA; LICSW;
Full-Time TFC?
91.9%
8.1%No
Yes
Total of 172 responses
158 are full-time14 are not
Do You Have More Than One Role?
97 respondents reported they have a dual role in their program
7 (7.2%) spend 0 - 10% of time as a TFC2 (2.1%) spend 10 - 20% of time as a TFC2 (2.1%) spend 20 - 30% of time as a TFC3 (3.1%) spend 30 - 40% of time as a TFC4 (4.1%) spend 40 - 50% of time as a TFC3 (3.1%) spend 50 - 60% of time as a TFC6 (6.2%) spend 60 - 70% of time as a TFC7 (7.2%) spend 70 - 80% of time as a TFC8 (8.2%) spend 80 - 90% of time as a TFC56 (57.7%) spend 90 - 100% of time as a TFC
> 82%
Hours Worked
The average responding TFC works 42 hours per week
Median hours = 40
Coverage Availability During TFC Absence
76.0%
24.0%
No42 TFC’s
Yes133 TFC’s
Who is Covering?
Fello
w T
FC
Socia
l Wor
ker
RN Coo
rdin
ator
Direct
or/A
dmin
istr
ator
Super
viso
r
Reim
burs
emen
t Spe
cial
ist
Hospi
tal B
illin
g M
anag
er
Prior TF
C
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%89.1%
3.6% 0.7% 0.7% 3.6% 0.7% 0.7% 0.7%
TFC’s noted that coverage is typically only for URGENT issues that arise in their absence
TF
C J
ob R
espo
nsib
ilitie
s Attend patient selection 87.2%
Obtain insurance precerts for transplant admissions 87.2%
Verify RX benefits 77.3%
Maintain database for financial screenings 73.8%
Obtain insurance precerts for pre/post transplant services 73.8%
Research and explore alternate funding sources 71.5%
Obtain referrals for pre/post transplant outpatient services 64.5%
Coordinate contractual arrangements 55.8%
Monitor federal/commercial industry reimbursement changes 52.3%
Follow inpatient admissions (admitting office function) 51.2%
Mor
e R
espo
nsib
ilitie
sAssist patients in completing Medicaid applications 43.0%
Verify RX benefits and obtain auths 37.8%
Assist patients in completing Medicare applications 34.3%
Prepare monthly financial reports 32.6%
Register patients (outpatient registration function) 29.1%
Assist patients in applying for manufacturer grants for RX 29.1%
Obtain RX auths 22.7%
Make payment arrangements for patient liabilities 22.1%
Additional duties noted as: Monitor clinic and inpatient accounts for charge capture and coding; Assist with Medicare D applications; RFI’s; VAD authorizations; Re-pricing claims; Policy and procedure development; clinical trial approvals
Average Time Spent on Tasks
Prescription verification/authorizations
Verifying insurance coverage for trans-plantation
Obtaining transplant approval and other ongoing communications with insurers
Informing patient/family of insurance bene-fits for transplant; advising of other funding
options
Billing and collecting on transplant accounts
Handling patients' billing questions/billing problem resolution for transplant-related
claims
Outpatient registration
Inpatient account handling: follow admit, notify case manager, update benefits
4.93
9.16
9.04
7.84
3.50
5.00
3.08
5.66
Average Percent of Time Spent
% of TFC’s Responding to Completion of Tasks
Inpatient account handling: follow admit, notify case manager, update benefits 93.7%
Outpatient registration 90.3%
Handling patients' billing questions/billing problem resolution for transplant-related claims 94.9%
Billing and collecting on transplant accounts 90.9%
Informing patient/family of insurance benefits for transplant; advising of other funding options 98.3%
Obtaining transplant approval and other ongoing communications with insurers 97.1%
Verifying insurance coverage for transplantation 97.7%
Prescription verification/authorizations 93.7%
Patient Educational Classes71.2% of respondents advised their programs offer/they participate in education classes to their patients
One on
One Counseling76.7%
Group Teaching39.5%
Indi-vidual Teaching17.8%
Group and Indi-
vidual Teaching40.3%
TFC Provides Coverage for:
Pre and Transplant only
24.7%
Pre and Post75.3%
Several TFC’s responded that they also follow non-transplants patients; others are available for post but only in urgent cases or if there is a problem; social worker and nurse follow post but they assist if needed
TFC Provides Services for:
Medical Center,27.1%
Medical Center and Physician group
72.9%
Although many TFC’s work on behalf of the hospital, they are still responsible for ensur-ing services for both the facility and professional services.
Staff Education
On-site seminars
Off-site seminars
Self-guided manuals
TFCA Resource Guide
TFCA List serv
Medicare Manuals
Webinars
UNOS Conference
Co-Workers
Internet
None offered
Funding for Off-Site Seminars/Conferences
Yes No Unsure0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
68.5%
21.4%
10.1%
10.1% of respondents advised they are not allowed to go to conferences or there is no funding available
Guidelines for Seminars/Conferences
35.4%
54.2%
10.4%
Two or more/year
One conference/year
Specific dollar amount/year
32 respondents were either unaware of guidelines for conferences or had to pay out of pocket with limited or no reimbursement
UNOS Regional Meetings Attendance
Attend all1-2 times per
year Attended at least once Never
attended Not sure what they are
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
10.6% 2
1.2%
2313.3%
14282.1%
52.9%
14 respondents advised they would never be able to attend and that their facilities do not think it is important for the TFC
UNOS Transplant Management Forum Attendance
Attend each year Attended at
least once Never attendedNot sure what
they are
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
21.2%
3017.4%
13578.5%
52.9%
UNOS Transplant Management Forum
Do you anticipate attending this coming year?
6% Yes
20.2% Possibly
73.8% Unlikely
What Educational Opportunities would you like UNOS to Provide?
Regional Administrative/Financial Forums (similar to Regional Clini-
cal Forum)
Financial Coordinator Hand-book/Reference Manual
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
63.5%
93.5%
Networking
At least monthlyFew times per year
Yearly or less frequently Not at all
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
47
27.5%
67
39.2%
26
15.2%
31
18.1%
In comparison to 2007 survey:
Monthly networking has grown from 5% to 27.5% Several times a year has dropped from 46% to 39.2% Annually has grown from 7% to 15.2% Not at all has dropped from 27% to 18.1%
Where Did these Contacts Come From?
UNOS Regional Meetings 3.7%
UNOS Annual Management Forum 13.2%
Consortium or other multi-center affiliation 8.8%
TFCA Annual Workshop 10.3%
TFCA List serv 95.6%
Other 7.4%
Social Workers
Transplant Programs in area
Co-workers
TFCA Member?
Yes
75.6%
No
24.4%
TFCA Workshop/Business Meeting Attendance
Attend each year Attended at
least once Never attended
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
21.1%
53.8%
25.1%
Member of TFC List serv
83.7%
8.1%
NO
YES
What Are You Thinking?• I would very much like to attend the annual workshop and any
seminars available. I would like to educate myself further in order to serve my Team and patients in the greatest capacity possible. I am also interested in becoming TFC certified, when the exam becomes available.
• I believe our program would be better served if the financial coordinators were offered continued education.
• I love my job and would like Administration & Management to recognized that our jobs are unique. We do not do the same job as Registration Reps or other financial coordinators.
• TFCA was very helpful to me.• TFCA Forum is very helpful and is awesome to meet other
fellow TFC's. Wish our center could afford the trip in the budget.• Would like to have access to financial coordinators reference
book that addresses common problems that face this unique position. Not all hospitals permit attendance to conferences and my hospital does not reimburse membership dues.
What Are You Thinking?• I truly love what I do. I would like to be viewed as a professional
and have it known at my facility that what I do is very different from any other "regular" financial coordinator. I play a vital role in the transplant arena and would like the administration and management to acknowledge this. In the last two years we have been "stripped" of our transplant financial coordinator title and are now referred to as revenue cycle 3 senior representatives. There are many others outside the transplant arena that have this title. We are also part of the financial team and are not officially part of the transplant team. On paper we look exactly the same but as transplant financial coordinators we do so much more!!!! I would like my title to be reinstated and to also be a formal part of the transplant team.
• I am a TFC member and I love it very much. The conferences are always educational and informative.
• Would like to have access to financial coordinators reference book that addresses common problems that face this unique position.
• Not all hospitals permit attendance to conferences and my hospital does not reimburse membership dues.
What Are You Thinking?• Happy to see another survey to update TFC info!• I still need more info on the List Serv. I know that I am on it but
have not used it. Not sure how it all works.• Our challenge has been in getting reclassified. Our
reclassification has been shot down 3 times. We will try again and hopefully the organization will recognize our worth.
• I feel it is imperative that we establish or take more seriously the need for a certification process, and a credential if we are to be regarded as true professionals, and establish our importance in the transplant network/process. How can we collectively move toward this goal? What is an appropriate timeline?
• The roll of a financial coordinator is a very detailed position and it requires a lot of responsibility. I love the job position but the pay sucks. It's too much work and responsibility to not be compensated for it. What makes the job interesting is the fast pace and multi-tasking. Money(Pay) is its only downfall.
What Are You Thinking?• Attended my first TFC Conference in Memphis. It was wonderful
and I learned a lot. Met some nice people and was able to network and get ideas.
• I hope to see a TFC Certification soon.• Although I have not personally posted a question on the list
serv, I look through the questions and answers. This serves as a great learning tool for me. I also enjoyed the TFCA Workshop this year, meeting my fellow TFC's and gaining new ideas from the group. Keep up the good work.
• The information obtained thru the list serv is wonderful. There is so much knowledge out there !
• TFCA is very helpful and the manual is an excellent source of reference .
• TFCA HAS BEEN SO MUCH HELP TO ME I WISH I HAD THIS ORGANIZATON 20 YRS AGO KEEP UP THE GREAT WORK
• I have learned many things from the List serv. It has been a great source of information for me.
What Are You Thinking?• TFCA is a very helpful organization. Thanks for all of the
information. Keep it coming..• I would like for all TFC's to have the opportunity to attend the
TFC Workshop. Great opportunity to learn and network with fellow TFC's. All centers should be required to send TFC's to conferences.
• I firmly believe that your organization is valuable to the successful improvement of our transplant department however this opinion is not shared with ______ University Administrators
• As I'm sure everyone else is, I'm interested in salaries of other TFC's in my region. I am the only TFC at my center and I have no comparison salary information to back myself up indicating my salary should be higher. I don't feel hospital administration understands my role and therefore always classify it at a lower grade salary range. I have been a TFC for almost 7 years and have fought every year to get more money, but with no back up it is always pushed aside.
What Are You Thinking?• Have asked List serv question, never received response.• I think for most financial coordinators we are probably under
paid. Maybe with this survey, it will give us something to take our Director to resolve this matter.
• The TFCA community is the most useful tool out there. The List serv is poorly managed where rules about what you can post are changed all of the time without a unanimous vote.
• I am still pretty new to this position/field, and when I began I had extremely limited training both with the outgoing TFC and with any other type of training. I am very interested in any and all types of ongoing training that I can learn about through the TFCA.
• I think the Transplant Financial Coordinators group is great. We can ask each other questions that you can't fine the answers to anywhere else.
2012 Survey RecommendationsReview the survey results with your
administrator, program advocates and HR
Advocate for salary commensurate to your position
Request educational materials and access to meetings
Advocate for additional staffing based not only on transplant volumes but all the pre and post workload
Remind the team that your position is a UNOS required position and you should be recognized as such
What can TFCA do for YOU?
Gain momentum on the certification process
Complete List serv By-Laws for continuity
Continue to provide networking and training opportunities
A TFC’s work is never done and can sometimes be overwhelming. Our passion for what we do keeps us coming back for more.
Keep the passion as it truly makes a world of difference to your patients, your team, and yourself.
If you ever feel like you’ve lost your passion, find a way to get it back. Talk to your fellow TFC’s, put yourself in the footsteps of a patient and you will get that passion back.
You can only do that if you take care of yourself!
You’re taking care of your patients and their families…
You can only do that if you take care of yourself!