conventus: maintaining healthcare practice profitability without sacrificing patient care

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TheFuture is Now:

Maintainingpractice profitabilitywithout sacrificing

patient care

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The Landscape

Increasing Legislative & Regulatory Requirements

Reimbursement Uncertainties

New Payment Models

New Delivery Models

Physician Alignments

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Welcome to The New Healthcare Paradigm

Maximize Patient Care Time

+

Minimize EVERYTHING ELSE

=

Better Quality Care

+Decreased Risk

+Better Reimbursement

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Get ready for Value-Based Purchasing

In 2016, CMS will apply Value-Based Payment formulas for Medicare fees All physician practices with 10+ eligible professionals Payments based on national quality of care and cost

of care benchmarks

Quality/Cost Low Cost Average Cost High Cost

High Quality +2.0x* +1.0x* +0.0%

Medium Quality +1.0x* +0.0% +1.0%

Low Quality +0.0% =1.0% -2.0%

*Eligible for an additional +1.0x if reporting clinical data for quality measures and average beneficiary risk score is in the top 25% of allbeneficiary risk scores.

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Reinventing your Practice

Risks

Operational

Clinical

Regulatory & Technology

MPL & Legal

Financial

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Operational Risks

Question: What is the most valuable asset in your practice?

Answer:The Provider's Time!

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The Value of a Practice Minute

Schedule

$1.49

Check-In

$1.30

Room-In$1.62

Patient Visit$7.50

In-Office

Follow-Up

$1.62

Check-Out

$1.30

Post-Visit

Follow-Up

$1.75

Billing$1.74

Total=$18.32Source: Mary S. Applegate, MD, FACP, FAAP, Clinical Asst. Professor of Medicine, The Ohio State University College of Medicine

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Workflow Analysis

-An established process describing:

A series of tasks (activities) How they are accomplished (steps) By whom (people) In what sequence (order) At what priority

that accomplishes a defined step(s) in an activity

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Workflow Analysis

What's In It for My Practice? Health Insurance Exchanges Value Based Purchasing v. Fee

For Service Patient Engagement Streamlining Practice Based on DATA New Technology Works for Practice

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Workflow Analysis

What we've learned from CARE Certification Program on-site sessions: Management Attitude: “Everything is fine” Time Constraints Call Volume & Triage Duplicative Efforts Lack of Coordination between Front & Back Office Lack of Teamwork Patient Non-Compliance Physician Attitude:

“We don't have time for customer service.” “We tried that & it doesn't work.”

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Workflow Analysis

How To Do a Workflow Analysis1. Select a Process – Start Small!2. Involve Staff! Collaborate!3. Identify Current Activities/Steps – List or

Graphic4. Identify Issues/Bottlenecks

Data!

5. Identify Improved Activities/Steps – List or Graphic

6. Test (PDSA) Data!

7. Modify & Train

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Workflow Analysis

Processes To Analyze Patient Flow Through Office (through-put)

1. Scheduling/Appointments

2. Reception

3. Waiting

4. Rooming

5. Clinical Exam

6. Check Out

7. Follow Up/Care Coordination

Revenue Cycle Management/Billing/Claims Referrals Diagnostic Testing

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Workflow Analysis Example

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Continuous Workflow Improvement

Do Study

Act

Plan

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Workflow Analysis

Resources: Capko, Judy, Secrets of the Best-Run

Practices, Greenbranch Publishing Cohen, Frank, Lean Six Sigma for the

Medical Practice – Improving Profitability by Improving Processes, Greenbranch Publishing

Institute for Healthcare Improvement, PDSA Worksheet, http://www.ihi.org/resources/pages/tools/plandostudyactworksheet.aspx

Woodcock, Elizabeth, Mastering Patient Flow Using Lean Thinking to Improve Your Practice Operations, MGMA

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The Results

Increased reimbursements

Improved quality of care

Higher patient & staff satisfaction

Lower risk of malpractice

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For Details

For a personal presentation, contactSusan Lieberman, MBA

Vice President, Risk ManagementConventus Inter-Insurance Exchange

877-444-0484, x466slieberman@nipgroup.com

www.conventusnj.com