Moving to a Health System

 History – Hospital Centralized Scheduling, January 2013 ◦ Scheduling ◦ Appointment Reminders ◦ Insurance Verification ◦ Authorization / Referral Management ◦ Patient Estimation ◦ Up-front Cash Collections ◦ Medical Necessity Denial Resolution 2

Hospital – Service For: ◦ Anticoagulation ◦ Cardio Pulmonary Testing ◦ Cardio Pulmonary Rehabilitation ◦ Diabetic Teaching ◦ EEG ◦ Endoscopy ◦ Infusion (Authorization) ◦ Inpatient (Authorization) ◦ Labor & Delivery Testing ◦ Medical Observation (Authorization) ◦ Nutritional Counseling ◦ Occupational Therapy ◦ Pain Clinic ◦ Physical Therapy ◦ Psychiatric Day Treatment ◦ Radiology ◦ Same Day Surgery ◦ Sleep Study ◦ Speech Therapy ◦ Spine Clinic ◦ Wound Care Clinic 3

 Hospital – FTE Structure ◦ Manager ◦ Supervisor ◦ Physician Liaison ◦ Call Center  Representative III, 3 fte  Representative II, 3.9 fte  Representative I, 5.7 ◦ Grand Total

ADD – NEW PHYSICIAN SCHEDULING 5

 New - Physician Scheduling ◦ Employed Physicians ◦ Primary Care Offices  Three Offices  10 Providers ◦ Specialty Office, Physical Medicine & Pain Management  One Office  4 Providers 6

PREPARATION 7

 Phone volumes – No ACD (Automatic Call Distributor) 8

 Visit Data SUMMARY BY PHYSICIAN - FISCAL YEAR 2014 PHYSICIANFY 14 VISITAVG % CANCAVG CANC VISITAVG % NO SHOWAVG NO SHOW VISITTotal Estimated Volumes 12 min *Encounter **25 Specialty Encounter PHY 14,62010%4625%231 5, PHY %448% PHY 34,6318%46317%787 5, PHY 43,62420%36211%399 4, PHY 54,46012%44611%491 5, PHY 66433%648% PHY 73,3848%3385%169 3, PHY 84552%462% PHY %8426%219 1, PHY 102,96644%29710%297 3, **PHY 113,55614%4984%142 4, **PHY 124,10216%6593%123 4, **PHY 134,64017%78916%742 6, TOTALS38,3622,6072,68843,

 Payer Mix 10

 Denial / Rejection Percentages  Billing Rejections for Insurance = 69% of Claims Billed  Incorrect PCP MCO’s  Lack of Referral for Specialty  Inactive Insurance  Incorrect Subscriber  Lack of Authorization Specialty 11

 Site Visits / Information Gathering  Physician Specific Templates  Physician Preferences  Triaging Preferences  To Medical Assistant, LPN, Physician?  Role of Office Assistants  How would this change?  Upfront Collection Process  Sliding Fee Schedule / Financial Assistance  Policy & Procedures  Cancellation / No Show  Patient Discharge from Practice 12

 Use of Different / Additional Technology  Scheduler Instructions  Defining scheduling templates  Increment variances by Physician  Defining event usage  Established vs. Follow-up  Duration variances by Physician  Quality checks  270/271 Vendor Partner  Integration 270/271  Batching vs. Real-Time 13

Define Scope 14

Centralized Center StaffOffice Staff Scope ▫ Incoming Calls / Scheduling ▫ Triaging  Prescription Refills  Test Results  Referral Requests ▫ Use of Medical Assistance  Triage Medical / Clinical Questions ▫ Appointment Reminder Results ▫ Insurance Verification ▫ Notification of Patient Liability ▫ Office Referral / Authorization Completion ▫ Procedure Visit Authorizations ▫ Special Needs Identification  Scope ◦ Same Day Follow-up Visits ◦ Physician Call-Out Patient Notification ◦ Triage Completion ◦ Guarantee “BAT” Phone Availability ◦ Walk-Ins  Scheduled  Insurance & Authorization Completion if Needed ◦ Collection of Patient Liability ◦ Coordination of Special Needs 15

 Reporting Structure 16

 Combined Services – FTE Structure ◦ Management Same  Manager  Supervisor  Physician Liaison ◦ Call Center – 4.5 Added  Added Representative III,.9  Added Representative I, 2.7  Added Medical Assistant,.9 ◦ All Combined, Grand Total,

REFERENCE MATERIAL  TRAIN, TRAIN, TRAIN  Training Glossary  Welcome Letter  Department Mission Statement  Department Structure  Service Outline  Employee Specific Training Calendar  Call Center Structure  Clinical Templates  Clinical Preferences  Clinical Indicators  New Technology  Insurance Verification  Upfront Collection  Sliding Scale / Financial Assistance  Authorization / Referral  Business Office Triaging  Patient Accommodations 18

LET’S GO! 19

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 Responsibility Alignment ◦ Defined Core Groups / Responsibility  Scheduling  Hospital & Physician Combined  Use of Reference / Preference Material  Call Center Enhancement  Call Tree  Additional Agents  Overfill Agents  Automated Appointment Reminders 22

 Responsibility Alignment ◦ Defined Core Groups / Responsibility  Insurance Verification  Separate Hospital Real-Time Eligibility  Separate Physician Real-Time & Batch Eligibility  Use of Web-Sites  Authorization  Separate Hospital Authorization Rules  Separate Physician Referral / Authorization Rules 23

 Some Challenges Found  Insurance Information Incorrect ◦ “Starting Over”  Not Every Process Communicated  Physician’s Changed Their Minds on Templates & Preferences  Lack of Scheduler Instructions ◦ Specialty Preferences Came from Reference Material  Changes on Templates & Preferences Daily  Caller ID – Phone Queues 24

Some Immediate Benefits Found  Patient Satisfaction  Physician Satisfaction  Intake Process Refined  Ease of Collecting Copayments  Triaging Simplicity  Insurance Verification Enhancement  Efficiency Use in both Technology Solutions  Cross Trained Staff  Reduction in Bill Holds (monitoring DNFB, Discharged Not Final Billed) 25

KEY PERFORMANCE METRICS (KPI) / MONITORING SERVICES PROVIDED 26

Call Center Volume Changes  Hospital Only – July 2014 ◦ Incoming  2,630 ◦ Outgoing  5,302 ◦ Grand Total  7,932  Hospital & Physician Combined – January 2015 ◦ Incoming  4,691  46% More Volume ◦ Outgoing  7,388  29% More Volume ◦ Grand Total  12,079  35% More Volume 27

Call Center Changes  Hospital Only – July 2014 ◦ Maximum Time To Answer  3 minutes ◦ % Answered > 1 Minute  93% ◦ % Long Abandon  2%  Hospital & Physician Combined – January 2015 ◦ Maximum Time To Answer  3 minutes ◦ % Answered > 1 Minute  87% ◦ % of Long Abandon  3% 28

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 No Show BY RENDERING CLINICIAN Row LabelsCount of Rendering% PHY 110% PHY 210% PHY 3322% PHY 4403% PHY 5373% PCP C36728% PHY 6736% PHY 7383% PHY % PCP A41131% PHY % PHY 10534% Grand Total

 No Show – Payer 31

 No Show – By Referring 32 SELF REFERRED121592% OTHER1088%

CULTURE CHANGES 33

 Scheduling – PCP A BASED ON APPOINTMENT TIME PHYSICIAN AMON-THURSFRIDAYWEEK TOTAL Encounters DURATION Minutes MINUTES PER WEEK HOURS DEDICATED WEEKLY Office New Sick Visit Flex Time Physician Out Of Office MINUTES PER ENCOUNTER WEEK TOTAL Encounters 144 HRS DEDICATED WEEKLY AVERAGE CHARGE, $ WEEKLY REVENUE, $11, WEEK TOTAL Encounters LESS Phys Out & Flex 96 HOURS DEDICATED WEEKLY LESS Phys Out & Flex

Scheduling – PCP A Preferences ▫ Children are a priority for scheduling ▫ Cannot prescribe contraception ▫ Physicals should not be back to back ▫ Patients can be placed in open slots available, i.e.  Sick patient in follow-up / established slot ▫ 30 Minute Duration  New / Established New to Provider  Physicals  Hospital / ER Follow-up ▫ 15 Minute Duration  Follow-up / Established  Sick 35

 Scheduling – PCP C BASED ON APPOINTMENT TIME PHYSICIAN BMONDA Y TUE-WED- THURS FRIDAYWEEK TOTAL Encounters DURATION Minutes MINUTES PER WEEK HOURS DEDICATED WEEKLY Office New Sick Physicals Flex Time Administrative Time MINUTES PER ENCOUNTER AVERAGE CHARGE, $ WEEKLY REVENUE, $12, WEEK TOTAL Encounters 141 HRS DEDICATED WEEKLY WEEK TOTAL Encounters LESS Admin Time & Flex Time 107 WEEK TOTAL Encounters LESS Admin Time & Flex Time

Scheduling – PCP C ▫ Well Visits & Physicals  Monday Max 4 Per Day  Tuesday – Thursday Max 3 Per Day  Friday Max 1 Per Day  Can Only Be Booked in Aqua Space ▫ Hospital / ER Follow-up  2 Max Per Day ▫ Physicals  Can Only Be Booked in Lavender Space ▫ Sick Visits  Can Only Be Booked in Yellow Space  Sick Visit Restrictions or Patient Turned Away ▫ Appointment Space Can Only Be Used as Color Defined ▫ 30 Minute Duration  New / Established New to Provider  Physicals  Hospital / ER Follow-up ▫ 15 Minute Duration  Follow-up / Established  Sick 37

 Several Recommendations to Increase Visits:  Double book high no-show patients  Double book MA/MCO patients  Double book % of follow-up base on No-Show Rate  Decrease event durations  Decrease flex time & administrative time  After hour & weekend access for patients  Increased automated appointment reminders  Script of No Show policy at the point of scheduling  Discharge Non-compliant patients  Increase hours available to see patients  Reduce scheduling restrictions by event (appointment type)  Increase availability of accepting new patients  New patients are scheduled far in advance which provides an opportunity to find another physician and therefore No Show 38

 PCP A 39

FORWARD THINKING 40

 Continued Consolidation  Efficiency  Do not have to hire more staff every time you consolidate  Physician recruitment  Discharge clinic  Aligning Patient Care  Securing PCP’s for Patients  Securing Specialist’s for Patients  Keeping Patients out of the Emergency Room  Leveraging Hospital Case Managers  No show policy Compliance  Patient Portal  Patient Self Scheduling  Interactive Voice Response  Financial Counseling Alignment 41

Some ROI (Return on Investment) ▫ Reduction in Office Assistant Staffing ▫ Increase Revenue / Visits ▫ Reduction No Shows / Cancellations ▫ Reduction Billing Rejections ▫ Reduction of Denials ▫ Medical Necessity Awareness ▫ Enhanced Patient Portal ▫ Efficiency to reduce encounters to 15 minutes 42

Affordable Care Act Hospital Perspective 43

Affordable Care Act Primary Care Perspective 44

Barbara Patterson, CRCE I Revenue Cycle Project Manager Calvert Memorial Hospital