Spontaneous Combustion: Making and sustaining change in Patient Access

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Presentation transcript:

Spontaneous Combustion: Making and sustaining change in Patient Access Debi Stolic, Director of Patient Access, Bethesda Memorial Hospital Anne Habib, OputmInsight

Bethesda Health System Continuous Improvement Culture Overview Introduction Bethesda Health System Continuous Improvement Culture Case Study – Up Front Cash Collections Sustainable Change Transform the organization and foster a culture of continuous improvement Eliminate non-value added activities (waste) within processes Reduce cycle time and touch time; increase communication and data driven decision making Understand the value of integrating people, technology and operational processes and resources Combine strategic thinking with tactical application of principles and change management. Control and improve business processes through disciplined, predictable and repeatable solutions. 1- Describe how the Gold Standard methodology provides a foundation for disciplined problem solving. It is the means to success in making, promoting, and accomplishing sustainable improvements. The methodology ties together operational tasks and technological improvements. 2 -Discuss how upfront cash collections in Patient Access improves hospital viability. 3 - Evaluate and understand baseline metrics representing impacts on cash collections due to price estimates, verification of insurance and payment collection in Patient Access 4 -Understand the need for moving collection activity to the front end of the streamlined process in order to increase the opportunity to collect cash. This alleviates follow up activities in the business office 5 - Removes the duplication of effort and Bottlenecks throughout the process in order to collect cash. Reducing administrative back end costs. 6 -Understand the advantage of point of service collection not making calls, sending out bills, incurring contingency collection fees Introduction: Overview of Cash Collection activity in Patient Access (inpatient and outpatient) - Current State and Future State, Gap analysis and problem solving techniques (Obj 1 WhY ' What was the purpose of putting in Price Estimator. The goals and objectives, What we hoped to accomplish by doing this. How - the merging of the people, process, technology components The Result - baseline measures, improvements, current and future states, value added activities and observations The monitoring and control process - the QA follow up to ensure sustainability Questions and Discussion The Gold Standard successfully provides a simplified process structure that when practically applied, transforms organizational performance. Some of the key elements of this approach: Empower associates to create change rather than providing them with solutions and telling them how to execute changes. Foster a culture of continuous Eliminate non-value added activities (waste) within core processes

Bethesda Healthcare System Bethesda Memorial Hospital is located in Palm Beach County, Florida. We have 401 beds, 525 physicians and 2,300 employees. Bethesda West Hospital opens in early 2013 with 80 beds; the design facilitates growth to a 400 bed hospital in future years. Bethesda Memorial Hospital opened its doors in 1959 with 70 beds, a medical staff of 32 physicians, 65 employees and, as a not-for-profit hospital, a mission to serve the community. Current Situation Today Bethesda has 401-beds and 525 physicians in more than 40 areas of specialty, and a hospital staff of more than 2,300 employees. Bethesda Healthcare System is building an all-new, 80-bed hospital to serve the communities of western Boynton Beach. Construction for the new Bethesda West Hospital began in May 2010 and will be completed in early 2013. Bethesda West Hospital has been designed so that it can grow to become a 400-bed hospital in future years. Together with Bethesda Memorial Hospital and Bethesda Health City, we look forward to bringing Bethesda West Hospital into our family of healthcare services to better serve our western communities.

Bethesda Memorial Hospital

Patient Access at BMH Pt. Access Central Scheduling – 16.5 FTE’s Registration – 38.8 FTE’s 5 Patient Access Points of Entry Our Numbers 20,578 Admissions 60,001 ED Visits 175,558 Outpatient visits 141,195 Tests scheduled Systems QuadraMed Enterprise Scheduling Siemens Patient Management (Invision) Estimator Pro

BMH Payer Mix Our payer mix

Continuous Improvement Culture Overview Need to Improve Operations Tired of IN & OUT Consulting Projects Methodology/Structure for Independence Identify and List Opportunities Define Resolutions Prioritization Criteria Implement Solutions Feedback Loop Next Project Founded in 1959, Bethesda Healthcare System is a nonprofit health care organization serving the medical needs of Florida’s South Palm Beach County, with a mission to provide quality health services in a caring manner. Bethesda wanted a partner that would help decrease those costs, particularly related to the revenue cycle. Bethesda had already worked with Optum through its analytics, technology, services, and consulting company, OptumInsight™ (previously known as Ingenix). Bethesda used several of its revenue cycle management and other products, and had been extremely impressed with the company’s industry-leading technology and world class process improvement expertise.

Pre-Visit Information Ancillary Departments Obtain/Review/Update Identify Issues - SIPOC Suppliers Inputs Process Outputs Customers Physicians Insurance Info Customer contacts Central Scheduling Appointments Patients Payer Charge Codes Directions Families Scheduler answers phone using Symposium phone system Patient Test Scripts Transportation Insurance Subscriber Associates Demographic Data Searches for Patient in QuadraMed Scheduling Follow Up Calls Physicians/Nurses Other Facilities Appointments Pre-Visit Information Ancillary Departments Obtain/Review/Update Patient’s demographics Insurance Carriers Other Facilities Schedules appointment Case Mangers Performs Pre-registration If possible

Define Opportunities

Document Process

Prioritize Projects Benefit Strategic or Tactical Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategic or Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections ED Mobile Computing OutPatient Through Put List Prioritized Projects One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects. All 3 techniques require baseline measures, improvement and control plans. The data drives the prioritization and type of project. Baseline Measures Improvement & Standardization Control Plan Measure , Analyze, Improve, Control Continuous Improvement

Document Projects Benefit Strategic or Tactical Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategic or Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections ED Mobile Computing OutPatient Through Put List Prioritized Projects One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects. All 3 techniques require baseline measures, improvement and control plans. The data drives the prioritization and type of project. Baseline Measures Improvement & Standardization Control Plan Measure , Analyze, Improve, Control Continuous Improvement

Implement Project Benefit Strategic or Tactical Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategic or Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections ED Mobile Computing OutPatient Through Put List Prioritized Projects One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects. All 3 techniques require baseline measures, improvement and control plans. The data drives the prioritization and type of project. Baseline Measures Improvement & Standardization Control Plan Measure , Analyze, Improve, Control Continuous Improvement

Feedback Loop Feedback M E T R I C S HIM PFS Pt. Access Sch Auth Reg Pre-Reg iVerify Auth Reg Trspt Code ROI CE Bill Collect Pay Post SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 Feedback M E T R I C S

Case Study – Up Front Cash Collections Prioritization Improved Cash Collections – High Priority Both strategic and tactical Lean Project Baseline Measurement – to determine results Analysis - to ensure Improvement & Standardization Implementation Plan – to ensure success Control/Monitoring Plan – for sustainability

Importance of Up Front Collections If patient leaves without making a payment; chances of collection go down to 40%. Improved patient satisfaction when financial responsibility is known. Receiving a large bill months after service can cause many patients to think negatively about their experience. Without POS, the hospital is basically financing a service interest free for 60 days. As collection costs increase, cash flow to pay salaries and medical equipment may not be sufficient.

Outpatient/Admitting Baseline Measure Central Scheduling Zero Outpatient/Admitting $6,139 Surgery Center $29,386 Heart Institute $4,001

Implementing Technology Price Estimator Have realistic expectations of the technology Understand the pros and cons of the technology and work with the pros Keep your eye on the goal Communicate with your vendor and have regularly scheduled meeting/conference calls to work through issues quickly

Technology, Process, & Collections Training Technology, Process, & Collections Technology Basic training on Estimator Challenges – understanding terminology Process Inserting Estimates and Collection into the pathway Clearly documented process comparing current and future states Collection Scripts Developed statements that are said to patients in a consistent manner including how to handle responses from the patient Speaking with confidence, use of empathy, identifying excuses vs. the need for true financial assistance.

Good Old Competition & Recognition Motivating the Team Bonus Plans Movie Tickets Pizza Parties Lunch Passes Good Old Competition & Recognition Poster boards in departments Target goals

Tracking Collections

Out Patient Results

Central Scheduling Results

Ambulatory Surgery Results

Bethesda Heart Results

Sustainable Change What will make the improvements stick? Regular monitoring and early intervention avoids discrepancies, reprocessing, and waste On going monitoring and audits of the improved process Regular review of KPI reports to ensure compliance Regular consistent communication with staff about what’s working and what isn’t Continuous improvement Stress the importance of adherence to the standards and the essential need to continuously improve Bring a close to the Milestone 3 presentation by identifying the critical steps necessary for sustained success and continued growth. Discuss regular monitoring by client staff and biweekly/monthly visits from Ingenix process SMEs to support their efforts. What will make the improvements stick? In improvement projects, make sure the root cause of the problem has been resolved for the long-term Put metrics in place to notify management if the problem begins to occur again

Thank You!