fostering innovation in the revenue cycle

FOSTERING INNOVATION IN THE REVENUE CYCLE

August 13, 2015

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Introduction to Baptist Health System

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ORGANIZATIONAL OVERVIEW

Located in Central Alabama

MISSION:

As a witness to the love of God, revealed through Jesus Christ, Baptist Health System is committed to ministries that

enhance the health, dignity and wholeness of those we serve, through Integrity, Compassion, Advocacy,

Resourcefulness and Excellence.

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BHS ORGANIZATIONAL OVERVIEW

HOSPITALS

37 Owned Clinics 62 Employed Physicians 29 Non-Physician Providers (CRNPs, PAs) 41 Hospitalists (FT & PT) and Nocturnists229,000 Visits $36M Net Revenue

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BHS ORGANIZATIONAL OVERVIEW

2011 32.9% 20.5% 11.1% 23.4% 4.2% 2.0% 5.9%2012 33.0% 20.9% 11.2% 22.1% 4.3% 2.0% 6.4%2013 32.2% 21.9% 11.2% 21.6% 3.8% 2.7% 6.6%2014 31.9% 21.8% 11.4% 20.6% 3.8% 4.4% 6.2%

2014 NET OPERATING REVENUE Citizens $36,146,088 Princeton $218,040,483 Shelby $152,885,932 Walker $94,265,228

BHC $51,924,732 Other $12,511,797 System $565,774,260

2013 COMMUNITY BENEFIT: $ 37,881,293 (1.39% of Gross Revenue)

Payor Mix 2011-2014

Medicare Medicare HMO

Medicaid & Medic-aid Pend-

ing

Blue Cross HMO/PPO OTHER Private Pay

0.0%

10.0%

20.0%

30.0%2011201220132014

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Baptist Health System Hospital Locations

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BHC ORGANIZATIONAL OVERVIEW

CLINICS39 BHC Clinics161 Physicians (120 FT/41 PT); 26 Mid-Levels$65.3M BHC Net Revenue12 MSO Clients40 MSO Physicians(35 FT/5PT); 12 Mid-Levels$11.7M MSO Net Revenue

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BAPTIST HEALTH CLINIC LOCATIONS

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BAPTIST PHYSICIAN ALLIANCEORGANIZATIONAL OVERVIEW

Physician Led Physician Driven Physician Governed402 Members

27 Specialties

6 Clinical Programs & Quality Committees

4 Hospital Efficiency Programs

• Supply Cost

• Pharmacy Cost

• Employee Health Cost

• Patient Throughput

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• What Has Created the Need for Change?

• Response to Changes in Healthcare

• Building and Sustaining a Culture of Innovation

• HFMA MAP: Opportunities and Solutions

SUMMARY OF TOPICS

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What Has Created the Need for Change?

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Pre-Payment Audits

Increased Patient Responsibility

Government Restructuring of Reimbursement

Expansion of Medicaid – or not

Changes in Reimbursement

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ICD-10• What is the Big Deal?

Biggest change in healthcare since implementation of DRGs in early ‘80sNot a simple update of ICD-9

• Impact on Coding Productivity155,000 ICD-10 codes30% increase in physician queries50% reduction in coding productivity first six months30% of productivity may never be recouped

• Planning for ICD-10 Coding Support31% of hospitals are hiring more coders29% of hospitals are using computer assisted coding28% of hospitals are contracting with outsourced coding companies

Government Mandates

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Two Midnight Rule

• Proposing to change the standard by which inpatient admissions generally qualify for Part A payment based on feedback from hospitals and physicians to reiterate and emphasize the role of physician judgement

• Announcing a change in the enforcement of the standard so that Quality Improvement Organizations (QIOs) will oversee the majority of patient status audits, with the Recovery Audit Program focusing on only those hospitals with consistently high denial rates

• CMS will accept comments on the Two Midnight portion of the proposed rule until August 31, 2015 and will respond to comments in a final rule to be issued on or around November 1, 2015

Government Mandates

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Affordable Care Act – ACA

• In 2012, ACA established the Medicare Shared Savings Program to encourage the development of ACOs

• Main provisions intended to resolve underlying problems in how healthcare is delivered and paid

Testing new delivery models and spreading successful onesEncouraging the shift toward payment based on the value of care providedDeveloping resources for system-wide improvement

Government Mandates

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Accountable Care Organization – ACO

• In 2015, there are more than 400 Shared Savings ACOs serving nearly 7.2 million beneficiaries, or 14 percent of the Medicare population

• Several programsMedicare Shared Savings Program

A program that helps Medicare fee-for-service program providers become an ACO

Advanced Payment ACO ModelA supplementary incentive program for selected participants in

the Shared Savings ProgramPioneer ACO Model

A program designed for early adopters of coordinated care

Government Mandates

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Electronic Health Record - EHR

Telemedicine/Telepsychiatry

Social Networking/Media

Analytics

Remote Patient Vitals Monitoring

Technology

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Response to Changes in Healthcare

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• Why? Higher quality care at a lower cost

• Generation of efficiencies

• Size and scale = better adherence to clinical guidelines with less variation in cost

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Response to Changes in HealthcareHealth System Consolidation

New Models for Care and Payment

Response to Changes in Healthcare

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Accountable Care Organizations – ACOs

• Hospitals, medical groups and other providers agree to manage the medical care for a group of patients with the goal of achieving quality and cost control targets

• Provides financial incentives for ACOs that lower growth in healthcare costs while meeting performance standards on quality of care and putting Medicare beneficiaries first

• Payments effective January 1, 2016~Upfront, fixed payment~Upfront, variable payment~Monthly payment of varying amount depending on size of ACO


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Patient Centered Medical Homes

• Medicare is paying a risk adjusted, per member, per month fee to cover the costs of care-coordination staff

• Consists of four contributes and attributes 1) Physician-Led Practice2) Whole Person Orientation3) Integrated and Coordinated Care4) Focus on Quality and Safety


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Patient Centered Medical Homes

• Baptist Health System Health Coaches~ Certified through National Society of Health Coaches~ Worked primarily with our primary care physicians~ Identified opportunities with patients who had high utilization of ER and Admissions~ Evolution~ Success at Baptist Health System~ Opportunities to Improve at Baptist Health System

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Retail Clinics

• Offering basic services such as flu shots, throat cultures, etc. to fill the gap in care by making certain services more accessible and therefore diverting patients away from costly ED care

• CVS• CVS Health is set to acquire big box retailer Target Corp.’s pharmacy business for $1.9 billion• CVS Minute Clinic has 901 sites• 50% of Market Share

• Walgreens• Walgreens expects to reach about half the country by the end of the year with a new

telemedicine service• Walgreens Healthcare Clinic has 437 sites• 24% of Market Share


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Dual Eligibles

• Those covered by Medicare and Medicaid

• 40% of total Medicaid spending and 27% of Medicare spending is due to dual eligible beneficiaries

• Goal is all-inclusive care for the elderly


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Bundled Payments• January 2015, CMS announced a goal of having 50% of

payments tied to quality or value based payment models by 2018

• Most common clinical episodes paid for with bundled payments

• Joint Replacement• Congestive Heart Failure• Pulmonary Disease• Pneumonia

• Future bundled payment rollout in 2016• Cancer Care – Oncology Care Model• Joint Replacement Model


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Population Health Management

• The need to analyze huge quantities of data from EHR and insurance claims to manage the care of high cost patients and those with chronic diseases

• Population Health Management is the key to accountable care and healthcare reform

• Challenge with Population Health Management


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• System Consolidation

• BHS Initiatives

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Expense Control

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●System consolidation of revenue cycle and/or outsourcing of revenue cycle

◊ Pre-certification in-house◊ Pre-registration in-house

Baptist Health System InitiativesThree year plan to focus on innovation and innovative thinking with a goal of $11 million in savings or enhanced revenue• 2014

• 2014 Goal: $2M in Operating Income Improvement• 200 ideas were submitted through the innovation portal

• 90 (45%) ideas submitted were by the revenue cycle team• Savings to the system realized: $2.2M

• 2015• 2015 Goal: $4M in Operating Income Improvement• 60 ideas have been submitted through the innovation portal• Savings to the system projected currently $2.8M

• 2016• 2016 Goal: $5M

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Expense Control

Building and Sustaining a Culture of Innovation: Everyone’s Job, All the Time

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Know Yourself: Culture

Organizational

ReadinessStructu

resBehaviors

: Risk Aversion

Goals People


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Aligning Innovation and Strategy Generating Revenue Accelerating Growth and Expansion

Just Do It Be Decisive and Have a Vision Understand the Importance of Momentum


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Embrace Failure: Understand the Value of

Failure• What Would You Do If

You Weren’t Afraid?• Fail Fast and Hard• Embrace Failure

• Fail Forward


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Fostering Good Ideas That Come From Staff

Put people at the center of the initiative

Encourage expansive thinking beyond senior leadership

Create a pipeline of ideas


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Lead Infectiously

Communicate Your Vision

Foster the Climate


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HFMA MAP: Opportunities and Solutions

Map Award Winner 2010Map Award Winner 2011

Map AwardWinner2012Map AwardWinner2015

Baptist Health System

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MAP KPI: RESULTS vs GOALS

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What Opportunities Did We Identify?

•→ HCAHPS Results•→ Expense Reduction•→ Productivity Enhancement

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What Did We Accomplish?●HCAHPS Results Insurance Exchanges• CAC Certification of 30 Revenue Cycle Employees • Hospital-Based Enrollment Events

20 events over 3 months = 128 patients enrolled• Letters to Private Pay Patients

4-5 ED visits, over a two year period – 3,833 letters sent = 50 patients enrolled

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What Did We Accomplish?●Expense Reduction Pre-Certification Services In-House

Electronic Submission of physician orders and signatures ●Results

◊ Physician and office staff satisfaction◊ Lower cost to collect: 2.1% vs Best Practice of 3%

Real Time AnalyticsMonitoring KPIs daily/weekly/monthly - compared to HFMA MAP Best Practice/Median


What Did We Accomplish?Pre-Bill Patient Status and Documentation Audits

BC Audit for 2014 had an accuracy rate of 98% -- 5% improvement from prior year

Electronic Audit of Vendor InvoicesUsed analytics tool and Excel to audit payments to contract

agreements -- $15K rebate to the SystemNext steps: Send invoice to partners rather than the other way

around

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What Did We Accomplish?●Productivity Enhancement

Created Automation for Non-Covered Charges

AL Medicaid denial workflow (venipunctures and observation charges without an ED visit) which lowered the overall number of denials.

Decreased Medicaid denials by 39%.

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ICD-10 Initiatives●Coder Retention Incentive●Post Grad Program

Launched in January 2014Two year commitment ●Must achieve a 96% or above for three consecutive weeks before moving off a service line

Success at Baptist Health System ●Post Grads trained on all IP or OP service lines in 10 months ●Five Post Grads have successfully transferred to full time coding positions at BHS when vacancies occurred with no

downtime, no orientation or training, and no overtime incurred due to those vacancies. ●Salary Expense Savings = $600K

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ICD-10 Initiatives

●Hot Line Go LiveICD-10 coding support established by working with vendor to

develop a “Coding Hot Line”

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Q & A

fostering innovation in the revenue cycle

Documents