keep the river blue hfma presentation 9/8/2017 the river blue hfma presentation 9/8/2017. ......

Ochsner Health System and General ElectricConfidential & Proprietary Information

1

Keep the River Blue

HFMA Presentation

9/8/2017


2

Agenda

Background

Overview of “Keep the River Blue”

Advances with Patient Access and Pre-service

Efficiencies in Business Office

Developing Goals and Proper Alignment

OHS Revenue Cycle Development Initiatives

Closing


3

Background on Ochsner Health SystemLargest integrated health system in the Gulf Coast

11 hospitals and more than 60 health centers

1,200 clinically integrated physicians

Largest private employer in Louisiana

Largest clinical trials program in the Gulf South

Nationally Recognized Quality• Top 1% Clinical Quality in U.S.• Top 10% Nationally In 13 Specialties• Top 100 Hospitals in U.S.• Ranked in 6 Specialties By US N&WR• Top Liver Transplant Center in U.S.


4

Statewide Ochsner Health Network Members

Alexan

dria

CHRIS

TUS

Financially

Integrated

Affiliated

*

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCILn26-5kMgCFYmfgAod9ToM1A&url=http://www.sthfoundation.org/hof&psig=AFQjCNH9HeZVg8zEMXcwZOBanwjF8T5FBg&ust=1443210805275905

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRxqFQoTCO3K-dG78MgCFcfZPgod4JQJ9g&url=http://www.mypatientpoint.com/Slidell-Memorial-Hospital&bvm=bv.106379543,d.cWw&psig=AFQjCNHbvgQnkT6bWGoTN5o4lagMAD4Ntg&ust=1446509952361504


5

Top 1% Nationally in Quality


6

Ochsner’s Revenue Cycle Theory“Keep the River Blue”


7

Revenue Cycle Functions

Front End

Middle Level

Back End

PB Codingand

Documentation

HB Coding and

Documentation

Charge Capture

CDM BillingFollow-

upCall

CenterCash App

Denial Mgmt

FinancialReports

SchedulingPre-Service Clearance

Medicaid / Financial

CounselingRegistration


8

Centralized clinic scheduling

Verification of demographics

Verify Insurance

Appointment reminders

Patient portal

Record calls for training

Scheduling


9

Pre-registration (outpatient testing, surgeries)

Obtain benefits, eligibility and authorization for patients prior to services rendered

Estimates

Communicate updates on authorization status to physicians and patients

Update patient insurance information


10

ePre-Check Patient Portal

Allows patient to Verify Demographics, Verify Insurance, Make Payments, Answer Pre-Visit Questionnaires

After completion the patient receives a barcode on their phone

At arrival they can scan the barcode on the kiosk and check in


11

Financial Call Center (FCC)

Ensure patients understand their insurance benefits and upcoming financial responsibility at the time of service so there are no surprises.

Increase upfront collections.

Reduce bad debt, early out, and collection costs

Identify patients who are unable to pay early in the revenue cycle, allowing time to meet with a financial counselor.


12

Registration

Working the Department Appointment Reports (DAR) in advance

― Verifying patient insurance benefits (RTE)

― Call patient to verify any missing info prior to arrival

― WQ’s for kiosks

Scheduling team obtaining most of the registration information or online scheduling

Developing a pre-registration team for clinics

― Pilot program

ePreCheck

QA system


13

Kiosks

Coach Registration staff to promote the kiosks after every registration

Digital signage/kiosks for wayfinding and interactive mapping for visitors

Refined kick out rules (i.e. too early for check-in)

Utilize dedicated Patient Access Greeters

Enabled patients to check-in for multiple appointments

Established a rapport with operations leaders

Early involvement with the construction of new clinics to ensure proper considerations for kiosks are taken during the build

Location, Location, Location

Pre Service

• Centralized System Based Team

• Teams divided based upon service line specialization

– Both clinical and non-clinical employees

105 total, 18 Nurses

• Verify Benefits and coverage, Obtain Authorizations, & Generate Estimates

• 278 Real Time Authorization Process

15©2016 Experian Information Solutions, Inc. All rights reserved. Experian Public.

Who we are

Pre-workflow

Case submitted with authorization request to payor

• Follow-up, follow-up, follow-up….

• Countless Non-value added touches

Limited number of cases a rep could touch

• Negatively impacted lead days

Post-workflow

Submit and send 278 through Epic to start RTA ping process

• Staff is able to “Set it and forget it”

• RTA notates the referral in Epic for each “ping”

• Workflow allows for escalation and manual follow-up if case is not approved by a specific day


16

Outcomes

Increased Volume, Productivity, & Lead Day

Reallocation of Staff

Happy Team Members

Positive Impact on the Patient

Real Time Authorizations On Epic Galaxy

“Managing Real Time

Authorizations with

a Clearinghouse”

• Increasing denials for

different procedures being

performed versus

authorized

• Creates rework often

without overturning the

denial

• Concurrent coding not

possible due to staffing

• Providers unclear on

proper fields for case

request entry

• No formal escalation

process

• No concurrent coding to

capture mismatched

authorized versus

performed cases

• Epic hard stop for OR

team to verify procedure

performed

• Verified procedure name

populates to Brief Op

Note

• Epic build identifies

procedure mismatch

between confirmed log

and case request

• Real time alert on Coding

Push Pin for mismatch

procedure

• Unique pre-cert status

created to route mismatch

cases within Epic to Pre

Service workqueue for

reauthorization

Annual project net value:

$3,900,000

• Reauthorized ~5,400

(95%) of OR change of

procedure events per year

• Expanded workflow to

Cath and EP Lab

• ~10% of Surgeries and

~15% of Cath/EP Lab

procedures reauthorized

• Updated workflow

standard across all Epic

service areas and user

assignments

Outpatient Surgery Change of Procedure Reauthorization

What was the PROBLEM?

What was the CAUSE?

What did we TRY?

Did it WORK?

1 2 3 4

0

100

200

300

400

500

600

700

$0

$1,000,000

$2,000,000

$3,000,000

$4,000,000

$5,000,000

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Fe

b

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Fe

b

Mar

Apr

May

Jun

Jul

Aug

Sep

2015 2016 2017

Surgery and Cath Lab Change of Procedure Reauthorizations

First Pass Net Revenue Total Direct Costs Count


18

Financial Counseling

Develops and facilitates payment plans for patients

Confirms level, terms of coverage, and benefit limits with health insurance providers

Advises patients of any alternative sources of funding

Prepares and files any documentation needed to complete payment arrangements

May arrange for referrals or second opinions

Educates patients with costs associated with the health care services


19

Business Office Efficiencies

Strategic Business partners embedded in Operations

Auto Claims Statusing Tool for improved follow-up operations

HB and PB Recovery Rate Report by Payor and Denial Code

PB Touch Report to identify repetitive actions on non-viable accounts

HB 30 Day No Touch Reports to find unworked accounts

Developing PB scorecard to improve follow-up activities

Bulk Refunds


20

Developing a Culture of Excellence and Innovation


21


22

Walmart’s Profile

Low prices

Selection

across

categories

Rural

convenience

Reliable prices

Quality

Suburban

convenience

Selection within

categories

Sales help

Ambiance1 2 3 4 5

Wal-Mart

Relative Performance

Most important

to Wal-Mart

customer

Least important

to Wal-Mart

customer


23

Keys to Strategic Success

How do you compare yourself to other facilities and payor mix?

When is good, good enough?

How are our goals aligned across the leadership team/system?

How are the goals cascaded down to the line level staff?


24

A Culture of People Development

A culture that a leader creates to inspire, motivate and engage


25

Development is Critical to Success

Why is it ignored or avoided?

― We tend to focus on the here and now

― Viewed as a bureaucratic exercise that is done to “check the box” rather than be acted upon

― Honest conversations can be challenging

― Lack of skill

― There’s just no time for it


26

What did you do to make your team better?


27

What does your team need?

Calibrations Hiring

Patterns

Succession

Planning

Engagement Survey

Comments

Observation HR Complaints Industry Best

Practices

Rounding Discussions


28

Revenue Cycle Initiative: Communication

2016 LEM: Implemented a 0% weighted personal development goal

Offline sessions

New hire meet and greets

Pre-hire:

― Job shadowing

― Pre-employment computer skills assessment

Rounding on direct reports

Senior leader rounding


29

Revenue Cycle Initiative: Competencies/Skill Building

Participation in professional organizations

Active participation in list serves, webinars, and avid reading of professional journals/attending conferences

Professional certifications (148 professional and seven Lean Green Belt)

Revenue Cycle Leader Academy (RCLA)

Supervisor Leadership Academy

Toastmasters


30

Educational Tracks

Performance Management: Crucial Conversations for Positive Results- 4hrs

Dealing with Difficult Behaviors- 2hrs

Performance Management: Crucial Conversations for Positive Results 1hr

Myers-Briggs: Understanding Type to Improve Interpersonal Effect - 4hrs

Effective Presentation Skills- 4hrs

Leadership: Influencing and Motivating -1.5hrs

Facilitation Skills- 2hrs

Time Management: Analyzing your Use of Time- 1hr

Personal Productivity Improvement: Managing Tasks and Maximizing Productivity- 1hr

Communicating Across Cultures – 2hr

Business Writing: How to Write Clearly and Concisely – 1hr

• Budgeting Operating Rhythm- 4 hrs

• KPIs/Dashboards- 4 hrs

• Building the Business Case- 2.5 hrs

• Action Planning in Action Pro- 1hr

• Essentials of Project Management- 7hrs

• Influencing and Motivating– 4 hrs

• Financial Acumen – 3 hrs

Track 2 – Management Skills

Classroom Training & Online E-Learning

Courses at Attendees Convenience

Total Hours: 23.5

Track 1 – Strategy

Classroom Training

June & November: (Proposed Timeline)

Estimated Total Hours: 25.5

Revenue Cycle Academy: Building the Talent Bridge O

nli

ne

Co

urs

e


31

Suggested Educational Tracks for RCSPTrack 2

Classroom Training & Online E-Learning

Courses at Attendees Convenience

Total Hours: 8

Track 1

Classroom Training

Estimated Total Hours: 30

Live

• Leadership and Social Media - 3 hrs

• Time Management for the Revenue Cycle

Leader - 4hrs

• Managing Across Peers and Developing Peer

Relationships -3hrs

• LEM for Revenue Cycle 2 hrs

• Business Behavior – 2 hrs

• Presentation Skills – Delivering at DMOR

and Other Meetings – 4hrs

• Competencies & Leadership – 3hrs

• Coaching Skills – 3hrs

• Rapid Process Improvement Process -4hrs

• Quick Tips & Q & A with our HR Business

Partner – 2hrs

Live

• Managing Generations - 3hrs

• Creating a Culture of Engagement - 3hrs

• Conflict Management– 4 hrs.

Online

• Communicating With Different Cultures – 1 hr

• Personal Productivity Improvement: Managing

Tasks and Maximizing Productivity- 1hr (Also

Track 2 of RCLA)

• Communicating with Professionalism and

Etiquette- 1hr

Revenue Cycle Supervisor Program


32

Revenue Cycle Initiative: Competencies/Skill Building (cont.)

Lunch and learns

Revenue Cycle Fellowship

Coding Courses

Finance Executive Coaching Academy

“Journey Through the Revenue Cycle”


33

Revenue Cycle Initiative: Coaching/Mentoring/Sponsorship

Presentations at national and regional conferences

Publications in national and regional magazines/publications

Hosted peer groups from other health systems

Networking (internal and external)

Mentoring: one-on-one and group

Action planning on ALL goals in LEM


34

Revenue Cycle Initiative: Coaching/Mentoring/Sponsorship (cont.)

Stretch assignments

Divisional Power of One events

LEAN education and sponsorship of projects

Frontline staff process improvement projects

Rotating director through system MORs


35

Results: Engagement of Team Members

28.4%31.6%

36.3%

50.0% 51.0%

2012 2013 2014 2015 2016

Actively Engaged

13.0%

11.4%10.5%

7.6%

6.0%

2012 2013 2014 2015 2016

Actively Disengaged

95% of our leaders are above the

healthcare benchmark of 33%


36

Operational Results

Since 2013

― Reduced consolidated AR days from 49 days down to 41 days

─ Clinic at 25 days; Hospital at 44 days

― Reduced AR over 90 days from 28% to 16%

― Reduced Admin Adjustments over baseline period (2016 = $14.3M benefit)

― Reduced Cost per Claim by 25% and Cost to Collect by 26%

― Improved clean claim rate and DNFB through collaboration w/ Operations and Revenue Cycle

― Recognized as Department of the Year by Ochsner Health System


37

Key Takeaways

A culture that values personal development and career progression will see the results of its investment in an engaged, happy, and productive workforce

Talent development is not “one more thing to do,” it is part of our responsibility as leaders and the key to success from a metrics standpoint

Value added touches & innovation


38 38

keep the river blue hfma presentation 9/8/2017 the river blue hfma presentation 9/8/2017. ......

Documents