revenue impact with big bang implementation presented by: jack hueter & novi vinod

Revenue Impact with Big Bang Implementation

Presented by: Jack Hueter & Novi Vinod

Agenda for today

▪ Introductions▪ LVHN organization and timeline▪ Steps taken throughout implementation▪ End results▪ Lessons learned

• 5 Campuses• 1 children’s Hospital• 140+ Physician practices• 17 Community Clinics• 12 Health Centers• 10 ExpressCARE locations• 80 Testing and Imaging Locations• 13,100 Employees• 1,340 Phsycians• 582 Advanced Practice Clinicians• 3,700 Registered Nurses• 60,585 Admissions• 208,700 ED Visits• 1,161 Acute Care Beds

Scope at LVHN▪ Ambulatory Big Bang Go Live – February 18, 2015

• 175+ sites• 700+ Physicians and 300+ AP’s• 90% converted from GE Centricity• 10% paper

▪ Inpatient Big Bang Go Live – August 1, 2015• 3 Inpatient Campuses – Cedar Crest, Muhlenberg, 17th Street• Included Hospital based Outpatient clinics • 100% converted from GE Centricity Enterprise – Revenue, Clinical, Radiology,

Pharmacy• Other major systems – T systems, PHS Scheduling, OR Tracker, RIS, Metavision

ICU/PICU, Teletracking, Orion portal

TIMELINE

Big Bang Implementation Guidelines

▪ Governance and Team structure▪ Project management support▪ Importance of scoping & direction setting▪ Build phase ▪ Testing phase▪ Training phase

Steps taken to minimize revenue impact

▪ Revenue cycle ownership and governance▪ Set expectations with department heads and

leadership▪ ARCR leads identified and leveraged▪ Identified Key KPI’s to monitor pre go-live

• Compute accurate baselines prior to go-live

▪ Testing

Testing▪ Charge testing▪ Parallel Revenue Charge Testing (PRCT)▪ Claims testing

Ambulatory Accounts Receivable

02/20/15

03/06/15

03/20/15

04/03/15

04/17/15

05/01/15

05/15/15

05/29/15

06/12/15

06/26/15

07/10/15

07/24/15

08/07/15

08/21/15

09/04/15

09/18/15

10/02/15

10/16/15

10/30/15

11/13/15

11/27/15

12/11/15

12/25/15

01/08/16

01/22/16

02/05/160

10

20

30

40

50

60

70

80

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Epic ARLegacy AR TotalTotal AR

Dolla

rs (M

)

Ambulatory Claims Acceptance

03/27

/15

04/03

/15

04/10

/15

04/17

/15

04/24

/15

05/01

/15

05/08

/15

05/15

/15

05/22

/15

05/29

/15

06/05

/15

06/12

/15

06/19

/15

06/26

/15

07/03

/15

07/10

/15

07/17

/15

07/24

/15

07/31

/15

08/07

/15

08/14

/15

08/21

/15

08/28

/15

09/04

/15

09/11

/15

09/18

/150

10,000

20,000

30,000

40,000

50,000

60,000

50%

60%

70%

80%

90%

100%

3370

5

3237

5 4027

2 4595

5

3748

1 4508

7

3720

7 4314

1

4045

0

3167

240

291

3751

6

3394

235

191

5340

5

3071

4 3452

9

3333

835

621 39

167

3751

1 4153

743

332

3720

6

3043

5

5100

9

630

393

792

715

807

553

437

480

474

320

846

446

134 21

1

253

123

213

526 58

453

1

573

910 78

9

2389

1765

277

98% 99

%98

% 98%

98% 99

%99

%99

%99

%99

%98

% 99% 10

0%99

%10

0%10

0%99

%98

%98

% 99%

98%

98% 98

%

94% 95

%

99%

Total Rejected

Total Accepted

Total % Accepted

# of

Cla

ims

Subm

itted

Clai

ms

Acce

ptan

ce R

ate

Ambulatory Charges to Baselines

Inpatient Focus Area Achievements

Revenue Cycle Management

4 Weeks

8/1 8/29 9/26 10/31 1/30

8 Weeks

Payments in Epic exceed baseline

weekly

13 Weeks(90 Days)

26 Weeks (180 Days)

Legacy AR Days <10% of Baseline

HB 100% charging

HB weekly claims sent exceed charges.

Achieved on/before target.Upcoming target.

Achieved after target.

HB go-live hold fully removed

HB first Epic-AR week over week

decrease

Inpatient Charges to Baseline

Inpatient Claims Acceptance Rate

Inpatient – Revenue Tracker

15

Daily Revenue Tracking Snap Shot

Inpatient Metric Guardrailsweek 7

MetricGuardrail/

Top 25%Long-term

Target Current Week Change StatusAR (Percent change from baseline) 17% - 3% - -2% 0%

Cumulative Charges 99% - 101% 100% 100% 0% Cumulative Cash Variance (in Weeks) -1.19 Weeks - -0.39

Weeks 0 -1.44 Weeks -0.04 Weeks CFB Days 12.03 Days - 7.68 Days - 10.56 Days -0.39 Days

Coding in CFB4.91 Days - 7.68 Days

- 3.6 Days -0.11 Days Claim Errors 4.18 Days - 1.68 Days - 3.02 Days 0.25Days

Open Denials Days<4 Days

- 0.13 Days 0.04 Days

Legacy AR % of baseline 38% - 31% - 33% -2%

Claims Acceptance % 90% - 99% - 93% 19%

= On track Improving = Watch = Serious Negative Trend

17

▪ Important to have SMEs and operational owners “on board” with Epic

▪ These are the people that will be key in helping shift focus of current state to new improved future state with Epic

Revenue Cycle Lessons Learned

Early buy-in from SMEs and

operational owners

18

▪ Identify and validate future workflows building off current workflows

• Build in Epic to maximize efficiencies in current workflows and process

▪ Focus on maximizing efficiencies within Epic and build to future state workflows

▪ Incorporate 3rd party tools upfront in design and planning workflows

Revenue Cycle Lessons Learned

Identify and validate future

workflows

19

▪ Revenue cycle representation needs to be included in decisions made at on the clinical side

▪ This ensures charges are captured and revenue is not impacted negatively at go-live

▪ Testing begins right away with unit testing of workflows and continues until go-live

Revenue Cycle Lessons Learned

ALL build, testing and

communication needs to include representation

across ALL modules within

Epic

20

▪ Align Epic’s project workplan with organization’s project workplan early and set expectations/targets

▪ Incorporate enough time in the project plan to build, test and validate for the revenue cycle 

▪ Users need to not only understand basic functionality within Epic but also to understand how to navigate within Epic so they can do their jobs efficiently and effectively

Revenue Cycle Lessons Learned

Revenue Cycle cannot wait for optimization to

get it right

21

▪ Important to begin new revenue cycle with clean slate

▪ Have a plan to support the legacy run down

Revenue Cycle Lessons Learned

Keep AR in legacy system

22

▪ Facility design is an integral part of the Epic’s core build - it touches every module within Epic

Revenue Cycle Lessons Learned

The facility structure is the

most crucial build in your Epic

system - once built, cannot be

“undone”

23

▪ Again - start the planning and build process in the very early stages in the project and involve both the hospital side and professional side

Revenue Cycle Lessons Learned

Payor/Plan is the another crucial

build in Epic because it is

shared between hospital and

Ambulatory in Epic

Takeaways

▪ Testing▪ Operations have to own the process▪ Knowing your current condition (baseline) pre go-live to

assess your success post go-live▪ Outsource or work down legacy A/R prior to go-live▪ Be ready to be flexible with your workflows (based on how build is

interacting with other modules or SME feedback)