cindy dullea, rn-bc, mba, cham chief clinical coach marbella technologies, inc. assistant professor...
TRANSCRIPT
Cindy Dullea, RN-BC, MBA, CHAM
Chief Clinical CoachMarbella Technologies, Inc.
Assistant ProfessorUniformed Services University
Patient FocusedRevenue Cycle
Maximizing Efficiency
Patient Flow
Rules Based Scheduling
Referral Management
ICD-10
RAC Audits
Self Service Patient Loyalty
HCAHPS
POS Collections
Eligibility
FRONT DOOR Medicare and Medicaid Changes
Pre-Arrival Unit
Employee Retention
Electronic Orders
Clinical Management
Financial Clearance
Insurance Verification
Authorization Management
Referral Management
Self Scheduling
The Alphabet Soup of Access Management
Source: Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.
Medical Care …is the Fastest Growing CPI Category
Implications Consumer Driven Healthcare
Passing Medical Inflation to Consumer Spending Your Own $$ Curbs Excess Spending
High Deductible Insurance Catastrophic Coverage Only
Provider Impact Lower Utilization Increased Bad Debt Pricing Transparency
Patient Confusion Decreased Satisfaction
Patient Confusion
Quality Food Tastes Good and Everyone Was So Nice
Pricing Concerted Effort At Deception? Trend toward Efficiency
Service Convenient Friendly Easy
What was the Patient Experience?
Current Healthcare Environment
Credit Markets Frozen Economic Recession 17.% of All Americans Uninsured (2012) 60% of those Commercially Insured on High
Deductible Plans with 10 million + Beneficiaries
Bad Debt Skyrocketing Nationally National Debt Skyrocketing – averaging
$1.311 trillion per year Healthcare Reform – new taxes
Hospital Strategic Response Develop a Strategy for Market Consolidation
Assess acquisition opportunities Consider sale or affiliation opportunities Evaluate asset performance and ownership requirements Evaluate physician network strategies and ACO Adoption
Manage the Balance Sheet Deploy cash judiciously Manage relationships with financial entities Restructure long-term debt Monitor balance sheet closely Update strategic capital plan
Strengthen Operating Performance Improve throughput to increase capacity and revenue Fine tune growth strategies Rationalize programs and operations
Access ManagementOrdering, Scheduling, Registration Processes
Key to Success
Enable a ‘Smart’ Start to the Revenue Cycle
Care DeliveryProcesses
BillingProcesses
Enable a Great‘Front Door’ Experience
ConsumersPhysicians
Utilize Resources Accurately and
Optimally
Good Access Management Helps Hospitals Improves Physician Networks
Connectivity = Better Service = MD Stickiness Strengthens Operating Performance
Increase Utilization of Resources Decrease Labor/Supply Costs Reduce Bad Debt and Denial Write-offs Improve Cash Flow
Basis for Great Customer Service Convenience and Courtesy = Positive Patient
Experience Management Reporting
Continuous Operational Improvement Development of Marketing Initiatives
Keys to Good Access Management
100% Coverage Pre-Registration Revenue Cycle Activities
Identify Problems Early Start in the MD Office or Patient’s Home
Utilize “Smart” Systems Goal to Replace Labor Understand the Nuances of Healthcare
Learn From the Past Aggressive Data Collection and Feedback to Improve
Operations Know Your Customer’s Preferences
Self Service
What’s The Workflow?
Intelligent Scheduling
Key Features Rules Engine Ensures Accuracy All Locations Search across Enterprise Provider Portal
Self-Scheduling, Appointment Itinerary, and Online Order Submission
Consumer Portal Self-Scheduling, Re-Scheduling,
Appointment Details
What the Rules Engine Can Do…Based on the resource (or any resource
detail), the task (or any task detail), and/or the patient (or any patient detail), the Rules Engine can:
Prompt a question Insert a task Replace a task Delete a task Modify the duration of a task Delete a resource Add a resource Replace a resource Place an entry on a Worklist Update an entry on a Worklist …and, based on the answer
to a question, the rules enginecan do all this as well as promptanother question.
Question
Answer
Rule
Expert Scheduling Knows the Rules
Question
Answer
Rule
• First available time/date at each location where test is performed
Spreads demand across health system
Multiple Locations – Service and $$
• First available time/date at each location where test is performed
Spreads demand across health system
Consumer Convenience
Start the Revenue Cycle EarlyGoal is 100% Coverage
Work Flow Mandatory MD Office
Authorization and Referral Management Medical Necessity Checking (Coding)
Pre-Registration as part of Scheduling Call Smart Eligibility Data QA
Support Financial Counseling/Self-Pays Pricing Transparency Automate ABNs Screening for Govt and Charity Programs
• View of All Arrivals
• Rules define when items are ‘escalated’
• Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)
Work Flow Insures 100% Coverage
• View of All Arrivals
• Rules define when items are ‘escalated’
• Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)
Order Process Captures CPT & Authorizations
Real Time Insurance Verification
Beware!! Insurance Authorization Required
Identify Self-Pays Early for Financial Counseling
Details Allow POS Collection for Co-Pays
Financial Counseling
During the FC Visit self-pay pricing and
other payment optionsare discussed.
Printout Notice of Non-Coverage
Physician Stickiness Improve Their Efficiency
On-line Ordering and Results Reporting Fewer Disruptions
Medical Necessity Issues Illegible Orders
Improve Their Office Efficiency Faster Scheduling (One Call or Web) Fewer Disruptions
No Lost Orders Happy Patients
Convenience with No Surprises Reminders (Appointments actual and preventative)
Timely Scheduling Avoids Problems
Eliminate Office Disruption from Illegible Orders
Results Reporting
Attach results to the order or referral
MD to MD Referrals Includes PHI Information
View Entire Schedule by Day, Week, Month
Exporting appointments to Outlook can be done right from the Appointment Book with a few clicks
Download to Smart Phone
Customer Self-Service Convenience
Scheduling Pre-Registration Appointment Reminders No Lost Orders or Schedule
Delays Patient Arriving
Check-in Update Registration Payment Location Maps
Option topick preferred
location
Scheduling Convenience
Option to pre-register for appointment
Avoid Registration Lines
Links to onlineforms
Eliminate Bad Prep Cancellations
Links to onlineforms
Patient Itinerary Avoids Confusion
Patient Arrives – No Waiting
Patient Selects Appointment
Patient Updates Personal Data
Patient Signs Forms – Eliminates Paper
Patient Pays Co-Pay
Wayfinding
Why Not?
Check In With Personal Devices
Labor Optimization
Centralized Call Centers MD Referral Patient Scheduling Order Collection Pre-Registration Revenue Cycle Activities
Resource Utilization Eliminates “Country Club” Scheduling Automates Manual Tasks (e.g. Eligibility, Order
Tracking) Decreases “No Shows”
Call Center Productivity Average Speed Abandonment Inbound Calls Appointments Schedulers
to Answer (ASA) Rate /Day /Scheduler /Day /Scheduler /Day
Call Center 29 seconds 2% 69 62 9
Hospital #2 19 seconds 3% 38 45 8
Hospital #3 97 seconds 10% 81 55 9
Hospital #4 n/a n/a 76 42 8
Hospital #5 30 seconds 8% 34 36 5.5
Hospital #6 20 seconds 4.4% 45 53 3
Hospital #7 9 seconds 2.2% 34 40 4
The Key is Expert AM Systems because - Faster Training - Cheaper Labor - Multi-Task Performance - Multiple Facility Coverage - Better, Consistent Customer Service
Better Patient Experience!
Resource Optimization
Open Slots that may be overlooked
Block Times AllocatedOn Experience
Resources Only Allocated for Time Required
Ritz Ritz Carlton Service Too Many Places to Call Lack of Information Integration Constant Replication of Information Patient Dissatisfaction Long Wait Times Confusing Campus Discourteous Employees
Marketing for Better Community Health
Individual Health Initiatives Follow-ups MD Orders Not Followed Through Preventive Health Initiatives (Mammograms,
Chronoscopes
LettersPartner
Reminder LettersNo-Show Letters
Reporting / Access to Data
ProductionDatabase
Reports(and extracts)
Operational Reports & Patient
Itineraries
Statistical, Management,
Ad-Hoc Reporting
iReports
Secure FTP
Power-User
Itineraries faxed to MD offices
ScheduleViewer
CallsPartner
Reminder CallsNo-Show Calls
Leaving the “WHY” For Last• A record 2.8 million Baby Boomers qualified for Medicare in 2011, rising to 4.2 million a year by 2030 •51 million members of Generation X •Generation Y – The New Millennials are 70 million strong -Young, Brash and Smart
•Gen Z - 1994 and before 2004•Highly connected – home computer obsolete•No life before the advent of mass technology!
Access To Healthcare Next?
