TFC Survey 2012 -

TFC Survey 2012 The Pulse of the Nation Debbie Mast Stanford Hospital and Clinics, Database Administrator and Financial Manager Amy Hackney, MBA Manager, Transplant Reimbursement Tulane Transplant Institute TFCA Workshop September 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 FTEs 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 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 survey 67 Administrators and 175 TFCs responded to the survey UNOS Regional Map Administrator Responses by Region 34 28 32 30

24 23 21 20 15 14 13 12 7 4 1 10 9 5 2 3

4 4 5 2 2 6 7 Centers Responding 8 5 3 9 Centers in Region

10 11 Types of Transplants Performed % of Centers Performing each Type of Transplant n=67 % of Centers 94.0% 67.2% 62.7% 52.2% 34.3% 25.4% 9.0% Heart Lung Liver

Kidney Organ Type Pancreas Intestine Bone Marrow Number of Referrals per Calendar Year Number of Referrals per Calendar Year per Program # Referrals 28,954 10,780 5,560 4,323 836 Heart Lung

Liver Kidney Organ Type Pancreas 120 791 Intestine Bone Marrow No of Transplants How Many Transplants per Year? Heart Average Number of Transplants per Calendar Year by Program. Lung Liver Kidney

Pancreas Intestine Bone Marrow T o ta l O rg a n s, % o f T o ta l Lets Take Another Look Number of transplants per calendar year by program. Are the Transplant Financial Coordinators Dedicated to the Transplant Program? 6.00% No Yes 94.00% 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% Average % FTE allocated How Many Transplant Financial Coordinators (FTEs) are Assigned by Program FTE Assigned per Organ Program One Liver Program and One Kidney program had > 5 FTEs per Organ 1.99 1.16 0.8 0.64 0.48 0.23 Heart

Lung Liver Kidney Organ Type Pancreas 0.35 Intestine Bone Marrow # of Referrals and Transplants per FTE - Liver 287 150 112 63 46 48

33 15 1 2 3 Referrals 4 Transplants Program Examples of FTE per 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 Percent 57.8% Other: BA Business; SW for

combined role; BA preferred; dont know 23.4% 7.8% 9.4% 1.6% Education Required Out of 64 respondents: 37 HS/GED; 5 AS/AA; 15 BS/BA; 1 Masters; 6 Other Experience Required 1.60% 4.70% 46.85% 46.85% 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 19.98% 33.35% Billing Healthcare Transplant Insurance 38.54% 8.13% Salary Range 21.4% 17.9% 16.1% 14.3% 12.5% 10.7%

3.6% 1.8% 1.8% 0.0% d un 9 9 9 9 0 9 9 9 9 9 99 00 99 99 99 99 99 99 99

99 , , , , , , , , , , 9 8 1 4 4 9 4 9 4 4 -2 -2 -2 -3 -3

-4 -4 -6 -7 $1 5 8 2 0 5 0 5 0 5 1 2 2 3 3 4 4 5 6 er Salary

In comparison to 2007 survey: Salaries above 35k in 2007 encompassed 59.5% of TFCs In 2012, 64.5% of TFCs salaries are above 35k Salary Range by Region Salary Range by Region 14 13 12 2 N u m b e r o f T F C 's 11 10 1 9 3 8

4 2 7 4 6 2 2 5 5 3 4 4 8 4 4

3 3 10 9 9 2 5 7 10 8 4 1 0 1

10 1 4 5 11 10 11 10 5 6 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 79.2% % 11.3% 7.5% # 1.9% 0.0% 1-5 days 6-10 days Days on-call 11-15 days 0.0%

16-25 days 26 days or more N/A 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 Its Our Turn What Did the TFCs have to say... # of TFC's Responding TFC Responses by Region 23 17 14 17

17 14 13 11 9 6 1 2 3 4 5 6 Region 5 7

8 9 10 11 What Programs are the TFCs Assigned to? Intestine Bone Marrow Pancreas 9.23% Heart Lung 7.98% 12.72% 18.20%

2.99% 18.45% 30.42% Liver Kidney Kidney = 122; Liver = 74; Lung = 32; Heart = 51; Pancreas = 73; Intestine = 12; Bone Marrow = 37 N u m b e r o f T F C s R e s p o n d in g Experience 120 119 113 100 80 74 60

65-70% of TFCs had more than 7 years of Healthcare related AND Insurance related experience. 53% had up to 2 years of Transplant related experience 40 20 19 15 4-7 years 17 6 0 7+ years

37 26 22 3 7 10 2 6 Insurance related 2-4 years 19 1-2 years 11 4 Healthcare related

Transplant related Type of Experience 7-11 months 0-6 months Primary Method of Training 60.0% 50.9% 50.0% 39.1% 40.0% Percentage 30.0% 17.8% 20.0% 7.7% 10.0% 0.6%

1.2% 0.6% 0.0% S e up r so i rv w lo l Fe C r oo

or t na di . al .. nt ng u i a m t n an ul ai se / r s m t

ss g on b a n C o cl ni -j i e d a e th tr d n d en O ea tt R

A Training Method O er h t 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? 7+ years 67 Years in Current Position 4-7 years 44 2-4 years 31 1-2 years 17 7-11 months 7 0-6 months

9 0 10 20 30 40 Number of Responses 50 60 70 Educational Level Other (please spec... 6 Masters De...

13 Some Graduate Course... 12 Bachelors De... 43 2-4 Years of Col... 21 Associate De... 21 0-2 Years of Col... High School Graduate... 43 15 0 5

10 15 20 Number of Responses 25 30 35 40 45 Professional Certifications or Licensures LCSW Other 11.96% 7.07%

RN 7.07% MSW 73.91% 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? No Total of 172 responses 8.10% 158 are full-time 14 are not 91.90% Yes

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 TFC 2 (2.1%) spend 10 - 20% of time as a TFC 2 (2.1%) spend 20 - 30% of time as a TFC 3 (3.1%) spend 30 - 40% of time as a TFC 4 (4.1%) spend 40 - 50% of time as a TFC 3 (3.1%) spend 50 - 60% of time as a TFC 6 (6.2%) spend 60 - 70% of time as a TFC > 82% 7 (7.2%) spend 70 - 80% of time as a TFC 8 (8.2%) spend 80 - 90% of time as a TFC 56 (57.7%) spend 90 - 100% of time as a TFC Hours Worked The average responding TFC works 42 hours per week Median hours = 40 Coverage Availability During TFC Absence No 42 TFCs

24.00% 76.00% Yes 133 TFCs Who is Covering? 90.0% 89.1% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 3.6% 0.7% 3.6%

0.7% 0.7% 0.7% 0.7% 0.0% w lo l Fe C TF S ia oc lW

ke r o r N R C r oo to a n di ir D r r to

c e dm A / t is n i r or t a S e up m ei R

or s i rv se r bu m t en S t is l a ci e p a it

p os H ng i l il lB M er g a an P or ri TF C

TFCs noted that coverage is typically only for URGENT issues that arise in their absence TFC Job Responsibilities Attend patient selection 87.2% Obtain insurance precerts for transplant admissions Verify RX benefits 87.2% 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% More Responsibilities Assist patients in completing Medicaid applications Verify RX benefits and obtain auths 43.0% 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; RFIs; VAD authorizations; Re-pricing claims; Policy and procedure development; clinical trial approvals Average Time Spent on Tasks

Inpatient account handling: follow admit, notify case manager, update benefits Outpatient registration 5.66 3.08 Handling patients' billing questions/billing problem resolution for transplant-related claims Billing and collecting on transplant accounts 5.00 3.50 Informing patient/family of insurance benefits for transplant; advising of other funding options 7.84 Obtaining transplant approval and other ongoing communications with insurers 9.04 Verifying insurance coverage for transplantation 9.16

Prescription verification/authorizations 4.93 Average Percent of Time Spent % of TFCs 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 transplantrelated 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 Classes 71.2% of respondents advised their programs offer/they participate in education classes to their patients 23.12% 44.00% 10.21% 22.66% TFC Provides Coverage for: 24.70% 75.30% Several TFCs 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: 27.10% 72.90% Although many TFCs work on behalf of the hospital, they are still responsible for ensuring 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 10.1% of respondents advised they are not allowed to go to conferences or there is no funding available 80.0%

70.0% 68.5% 60.0% 50.0% 40.0% 30.0% 21.4% 20.0% 10.1% 10.0% 0.0% Yes No Unsure Guidelines for Seminars/Conferences Two or more/year 10.40% Specific dollar amount/year

35.40% One conference/year 54.20% 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 90.0% 80.0% 82.1% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 0.6%

13.3% 1.2% 2.9% 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 80.0% 78.5% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 17.4% 10.0% 1.2% 0.0% 2.9%

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? 100.0% 93.5% 90.0% 80.0% 70.0% 63.5% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0%

0.0% Regional Administrative/Financial Forums (similarFinancial to Regional Coordinator Clinical Forum) Handbook/Reference Manual Networking 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 39.2% 27.5% 10.0% 15.2% 5.0% 18.1%

0.0% y hl . t .. n In comparison to 2007 o survey: er m p st esto 27.5% a Monthly networking has grown from 5% e m l ti 46% to 39.2% t Several times

A a year has dropped from w Annually has grown from 7% to 15.2% Fe Not at all has dropped from 27% to 18.1% Y ea y rl or s le s f . .. e

r ot N at l al 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?

75.60% 24.40% TFCA Workshop/Business Meeting Attendance 60.0% 53.8% 50.0% 40.0% 30.0% 20.0% 21.1% 25.1% 10.0% 0.0% Attend each year Attended at least once Never attended Member of TFC List serv

8.82% NO YES 91.18% 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 Recommendations Review 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 TFCs 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 youve lost your passion, find a way to get it back. Talk to your fellow TFCs, put yourself in the footsteps of a patient and you will get that passion back. Youre taking care of your patients and their families

You can only do that if you take care of yourself! You can only do that if you take care of yourself!

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