1. Penn State Hershey Medical Center

2. Penn State Hershey Medical Center Outpatient Pre Arrival Services l Presenters n Mary Stephens, Manager, Inpatient Access – Previously a Coordinator in Outpatient Pre Arrival Services (6 yrs) n Linda Cranston, Manager, of Out Patient Pre Arrival Service n LeAnn Stringer, Manager, Eclipsys Application

3. Penn State Hershey Medical Center l 500 bed Tertiary Care Academic Medical Center l Adult and Children’s Hospital l Level 1 Trauma Accreditation (adult/pediatric) l Penn State Cancer Institute l 588 Faculty Physicians

4. Annual Clinical Activity n Inpatient admissions – 27, 615 n OR Cases u Inpatient – 10,125 u Outpatient – 6,564 n Emergency Room visits – 47,163 n Outpatient Visits u Booked - 1,412,255 u Actual - 779,520

5. HMC Systems l Eclipsys AM/PFM l Eclipsys Registration data interfaces to 20 systems Other Systems used at HMC n Cadence (Scheduling) n Cerner Clinicals n GE Centricity (Radiology) n Mysis (Laboratory) n Pyxis n Seimens (Signature-Professional Billing)

6. Redesign of Front End Processes l Multi-Disciplinary Team Approach n Patient Financial Services (PFS) n Nursing n Physicians n Inpatient Access n Health Information Services n Information Technology n Representatives from various outpatient clinics

7. HMC Identified Financial Opportunities l Reduce Accounts Receivable n Hospital & Physician AR l Reduce write offs (revenue deductions) l Decrease check in time for outpatients

8. Team Recommendation l Form the Outpatient Pre Arrival Services (OPAS) Department (2001) l OPAS Goal n Obtain accurate patient and insurance information prior to the outpatient visit to ensure full reimbursement of services n Facilitate gathering and verification of sensitive information to ensure HIPAA compliance and increase patient satisfaction

9. OPAS Department Goals l Decrease facility accounts receivable days from 86 to 45-55 l Decrease professional account receivable days from 81 to 51-57 l Decrease facility write offs from 3.2% to 1.3-1.7% l Decrease professional write offs from 2.8% to 1.3-1.6% l Decrease average check in time from approximately 6 minutes to less than 1minute

10. OPAS Staffing l Initial Pilot (3 month period in 2001) n 4 new FTEs n 2 clinics (Dermatology and OB/GYN) l Currently n 70 FTE’s (existing and new staff) n 43 clinics

11. Pre-Arrival Processes Process Improvement Goal Decision Pre-Registration/ Registration How often should patient demographic information be updated/validated Suggested 60-90 days Pre-Clinic% of scheduled patients pre-registered prior to date of service 100% Insurance Verification How often should insurance be verified (this will vary by payer and all services) Each encounter/visit (100%)

12. Pre-Arrival Processes Process Improvement Goal Decision Referrals% of referrals obtained prior to service 100% Authorization/ Certification % of scheduled patients authorized prior to service 95% Authorization/ Certification Walk Ins pre-registered patients that have authorization/pre- certification verified within 24 hrs of arrival 100%

13. System Enhancements l Scheduled appointments 28 days out (Cadence Report) l Eclipsys pre-clinic visit creation l Eclipsys Worklists by service and location l Identify & refer S/pay accounts to Financial Counselor

14. Self Pay Process l Price estimate of service is obtained l Review patient’s account for payment history l Credit report l Patient is contacted n Provide estimated cost of service n 75% of estimate is requested n MA process is discussed n Financial Risk process u Physician makes the decision (based on medical necessity) whether appointment is canceled or postponed

15. Improved Outcomes in Clinics l Decreased denials due to 100% verification of insurance and ability to obtain referrals and authorizations prior to the clinic visit l Reduced check in/check out time for patients l Increased point of service cash collection n approximately $750,000 monthly

16. Financial Improvement Outcomes l Facility accounts receivable days reduced from 86 to 45 l Professional accounts receivable days reduced from 81 to 45.2 l Facility write offs reduced from 3.2 % to less than 0.5 % of revenue l Professional write offs reduced from 2.8% to less than 0.5 % of revenue

17. Conclusion l Questions