Using MAP Keys (KPIs) to Measure Enterprise System Implementation Success “Back to Basics” (B07) Mary Lee DeCoster, HFMA KPI Task Force Chair Vice President Revenue Cycle, Maricopa Integrated Health System

Agenda What is Maricopa Integrated Health System? Who isn’t starting, in the middle of, or just finished implementing an Electronic Health Record system? How did that turnout? How could we tell? Cash Collections AR Days Aging

Maricopa Integrated Health System 522 Licensed Beds Arizona Burn Center Level 1 Trauma Adults & Pediatrics 11 FQHC-LA Primary Care clinics 47 medical subspecialty clinics Urgent Care Attendant Care Maricopa Health Plan

Maricopa Integrated Health System Largest teaching hospital in Maricopa County 17,500 admissions/year 61,000 Emergency Department visits/year 3,900 FTEs, 465 physician providers

Maricopa Integrated Health System FY12 Capital Budget - $44.5M FY12 Operations Budget – Net Income $20M Payer Mix –AHCCCS (Medicaid) 49% –Commercial Insurance 9.8% –Medicare 10.2% –Self Pay 27.3% –Other 3.7% 5

MIHS Revenue Cycle Access Management Eligibility Customer Service HIM Managed Care Contracts Revenue Management Business Office

Where is MIHS today? Post Go Live implementation of enterprise integrated system: EHR and Revenue Cycle applications Changes in AHCCCS eligibility and reimbursement New CFO CEO resigning Cash roller-coaster AR Days roller-coaster

Transition from Old to New Legacy System – 16 years Pro Fees billed off hospital system No collector tools Home-grown data-mart Limited & Predictable

New System Fully integrated enterprise system - including Hospital and Professional Billing - KLAS #1 rating -Dashboards -On line work-queues -Retire RevMart

Some surprises The fabulous new revenue cycle system does not have it all Additional functionality needed in peripheral tools -E-claims -Contract management -BI/Analytic tools

Post Go Live Assessment MANY Issues >340 issues Cash <70% of budget Reporting challenges Incomplete workflows Training, Training, Training

Where to Start? Regular meetings Shared responsibility Group Norms External Support

Group Norms 1.No Finger Pointing 2.Accountability 3.Participate 4.Contribute 5.Timely Updates 6.Partner/Share

Time Value Purely Tactical Approach – Value is gained in the short term, however the long term value levels off as issues continue Targeted Strategic Approach – By addressing the root causes associated with the system modifications greater value can be achieved Strategic versus Tactical Approach? MIHS is actively working through issues with quick results, but over time without mitigating the root causes there will be diminishing returns. EHR Value v Time Targeting the root cause will ultimately provide a more sustainable return on investment for the EHR purchase

MIHS Measures Back to Basics Cash to Goal A/R Days Anything preventing success

MIHS Goals Cash – 105% Patient Net Revenue A/R Days – 55

Measuring Self to Self The Daily Report Weekly Graph Package Monthly Financials

What did we Find? MIHS Revenue Cycle KPIs Pre Go Live GO LIVEPost Go Live MetricJanFebMarAprMayJune Cash118%154%70%74%95%115% POS Cash8.9%6.7%29.0%22.9%10.1%8.0% AR Days Aging>9012.1%11.1%6.8%9.6%6.8%13.6% Aging> %20.8%17.9%15.0%11.8%11.4% Denials12.2%16.1%17.1%15.1%9.6%6.6% Credit Bal Days DNFB Late Chgs17.4%15.0%5.5%4.3%3.7%4.1%

Impact to Cash Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Cash110.4%153%74%70%91.2%115%

Measuring MIHS to Others Like Us MAP App Peer Group includes: Net Patient Revenue > $500k Self Pay >10%

Impact AR Days Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune AR Days

Net Days in A/R

Impact on Aging Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Aging>9012.1%11.1%6.8%9.6%6.8%13.6% Aging> %20.8%17.9%15.0%11.8%11.4% 33.4%31.9%24.7%24.6%18.6%25.0%

Aged A/R (Billed A/R)

Impact on Denials Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Denials12.2%16.1%17.1%15.1%9.6%6.6%

Initial Denial Rate – Zero Pay

Impact on DNFB Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Days DNFB

Days in Total DNFB

Impact on Late Charges Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Late Chgs17.4%15.0%5.5%4.3%3.7%4.1%

% Late Charges

Impact on Credit Balances Pre Go LiveGO LIVEPost Go Live MetricJanFebMarAprMayJune Credit Bal

Net Days Revenue in Credit Balance

What we Saw CASH A/R Days Aging Credit balances

Credit Balance Exercise If this was your indicator - What is the Goal for CB? What tools would you use? Where would you look? Work together to define: your approach to find and resolve

Exercise Debrief How many started with Cash Posting?

Mystery Solved

Revenue Cycle Benchmarking: 8 Tips that Get Results 1.Use Industry-Standard Metrics 2.Ensure calculations needed to apply the metrics are clearly defined 3.Cover the entire scope of the revenue cycle 4.Draw on a significant number of hospitals to establish your peer group

Revenue Cycle Benchmarking: 8 Tips that Get Results 5.Identify valid peer groups 6.Ensure that all benchmarking data are routinely scrubbed and audited 7.Use timely comparative performance data 8.Identify and calculate the ROI on specific improvement opportunities

Open and Transparent The Daily Report Daily dashboards Weekly Graph Package Weekly Revenue meetings Weekly Revenue Cycle Issues meetings Monthly MAP App Keys performance Monthly Financials posted on website

Questions? Thank you for your participation Mary Lee DeCoster