1. Value Analysis Harnesses Internal Resources for Process Change June 2006 SAVE Government Conference

2. Value Analysis (VA) is not… Simply consultants providing input… Simply consultants providing input…

3. Function-Based Work Flowchart Function-Based Work Flowchart

4. VA Revenue Enhancement Study VA Revenue Enhancement Study n Pre-Study Orientation Sessions Kick-off and Hospital Tour (1-day)Kick-off and Hospital Tour (1-day) Current Work Flowcharts Discussed (2 days)Current Work Flowcharts Discussed (2 days) n Pre-Study Review of Revenue Data n 5-day Value Analysis Workshop Functions and Areas of Opportunity IdentifiedFunctions and Areas of Opportunity Identified Creative PhaseCreative Phase Evaluation/Analysis PhaseEvaluation/Analysis Phase Development PhaseDevelopment Phase Presentation PhasePresentation Phase n Post-Workshop Implementation Meeting

5. Value Analysis Participants Value Analysis Participants n VA Facilitators n Hospital Executive Management (part time) n Hospital Departmental Staff Patient AccountsPatient Accounts Registration from Major DepartmentsRegistration from Major Departments AdmittingAdmitting Utilization ManagementUtilization Management Health Information ManagementHealth Information Management FinanceFinance Information ServicesInformation Services PhysiciansPhysicians n Consultants (typically 3) Healthcare RevenueHealthcare Revenue Managed Care RevenueManaged Care Revenue IT SystemsIT Systems

6. Parameters for a Successful Value Analysis Study Parameters for a Successful Value Analysis Study n Commitment from Executive Management Requires 8 days of participation by key staff membersRequires 8 days of participation by key staff members Must agree to implement acceptable ideasMust agree to implement acceptable ideas n Open Discussion Vow of Confidentiality Among ParticipantsVow of Confidentiality Among Participants n Listen to Staff Ensure Clear Understanding of Current ProcessesEnsure Clear Understanding of Current Processes Encourage Team to Suggest Alternative ApproachesEncourage Team to Suggest Alternative Approaches Clarify if Resources are Preventing Revenue CaptureClarify if Resources are Preventing Revenue Capture  Staff  Printers, Computers, Paper  Software Applications  Reliability of Current Technology n Judgment Withheld Until Appropriate Time n Assign Person to Coordinate Implementation, Track Progress and Record Results

7. Recommendations Covered Recommendations Covered Utilization Management Utilization Management Maximize Reimbursements Maximize Reimbursements Capture Unbilled Revenue Capture Unbilled Revenue Improve Patient Information Improve Patient Information Denials Management Denials Management Enhance Systems Enhance Systems Upgrade Coding Capability Upgrade Coding Capability

8. Utilization Management Utilization Management Key Proposals and Impacts Extend Clinic Hours($3.5m) Extend Clinic Hours($3.5m) Create Charge Capture Czar ($8.0m) Create Charge Capture Czar ($8.0m) Perform Ancillary Tests on Weekends ($5.9m) Perform Ancillary Tests on Weekends ($5.9m) Hire Surgical Coordinator ($4.5m) Hire Surgical Coordinator ($4.5m) Modify Ambulatory SurgeryTesting and Registration/Scheduling ($10.7m) Modify Ambulatory SurgeryTesting and Registration/Scheduling ($10.7m) Add Staff Selectively ($6.4m) Add Staff Selectively ($6.4m)

9. Utilization Management (cont.) Utilization Management (cont.) Redesign Clinic Scheduling ($5.3m) Redesign Clinic Scheduling ($5.3m) Expand Services in Pediatrics, OB, Rehab($11.2m) Expand Services in Pediatrics, OB, Rehab($11.2m) Modify Provider Contracts ($41.1m) Modify Provider Contracts ($41.1m) Develop Revenue Scorecard ($7.0m) Develop Revenue Scorecard ($7.0m) Improve Community Outreach ($2.1m) Improve Community Outreach ($2.1m) Establish Redirect Office ($1.9m) Establish Redirect Office ($1.9m)

10. Maximize Reimbursements Key Proposals and Impacts Revise Approach to Self Pay Accounts ($2.3m) Revise Approach to Self Pay Accounts ($2.3m) Clear Up Unbilled Backlog($8.0m) Clear Up Unbilled Backlog($8.0m) Bill for all Physician Services ($2.4m) Bill for all Physician Services ($2.4m) Periodically Re-bill Medicaid ($5.0m) Periodically Re-bill Medicaid ($5.0m) Add Staff Selectively to AR, ED, Admissions, BH, Medicaid Enrollment ($15.1m) Add Staff Selectively to AR, ED, Admissions, BH, Medicaid Enrollment ($15.1m)

11. Capture Unbilled Revenue Key Proposals and Impacts Bill for Nursing Visits, Blood, Drugs, Devices ($2.3m) Bill for Nursing Visits, Blood, Drugs, Devices ($2.3m) Enroll all Pediatric Patients in Insurance Plans ($2.0m) Enroll all Pediatric Patients in Insurance Plans ($2.0m)

12. Improve Patient Information Challenges n Patients Do Not Want to Share Their Patient Information n Patients Give False Addresses n Patients Have Grown Accustomed to Receiving Free Care

13. Improve Patient Information Key Proposals and Impacts n Train all Registration Staff to gather Patient Financial Information with Documentation ($2.5m) n Train Clinicians to Fully Document Medical Record ($.9m) n Establish Field Units to Gather Documents ($6.3m) n Improve Mail Handling ($2.4m)

14. Denials Management Key Proposals and Impacts Create Denials Management Task Force ($20.2m) Create Denials Management Task Force ($20.2m) Address Social Admissions Issues ($9.8m) Address Social Admissions Issues ($9.8m) Educate Clinicians re Denials ($2.5m) Educate Clinicians re Denials ($2.5m) Add Staff to Work Denials ($9.2m) Add Staff to Work Denials ($9.2m) Focus on One-Day Stays/Close Clinic Visits/Reconcile ED and Admit Dates ($4.5m) Focus on One-Day Stays/Close Clinic Visits/Reconcile ED and Admit Dates ($4.5m)

15. Enhance Systems Key Proposals and Impacts Enhance Capture of Full Medical Documentation ($3.0m) Enhance Capture of Full Medical Documentation ($3.0m) Implement Claim Scrubber ($6.8m) Implement Claim Scrubber ($6.8m) Update MD lists, Codes, Provider Data Tables ($2.7m) Update MD lists, Codes, Provider Data Tables ($2.7m) Link EMR and Patient Accounting Systems ($4.0m) Link EMR and Patient Accounting Systems ($4.0m) Bar Code ED Charts/Put Online($4.5m) Bar Code ED Charts/Put Online($4.5m)

16. Upgrade Coding Capability Key Proposals and Impacts Add Coding Validators($3.1m) Add Coding Validators($3.1m) Add, Train and Credential Coders/Upgrade Titles and Pay ($5.3m) Add, Train and Credential Coders/Upgrade Titles and Pay ($5.3m)

17. Value Analysis Results(6 Workshops)

18. What Makes VA Different? What Makes VA Different? n Team-Based Approach n Utilize Hospital Staff as Members of Team n Supplement Team with Consultants n Changes are Recommended by Credible Front-Line Staff and are not Imposed from Outside n Function-Based Analysis of Current Processes n Limited Involvement of Executive Management n Sessions are Away from Normal Work Environs

19. Key Benefits of Value Analysis Key Benefits of Value Analysis n Revenue Improvement n Team Building Among Staff n Staff Discussions of Current Processes Identify Most Issues/Opportunities/Ideas n Consultants Provide Experience from Similar Hospitals n Team Becomes Change Agents n Change Implementation More Likely as Staff Buy-in During Study n Morale Improves