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!