gritman medical center ben wood tessa scholl marc boisvert mimi sproul darren schnider ben wood...
Post on 23-Jan-2016
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TRANSCRIPT
Gritman Medical Center
Ben WoodTessa Scholl
Marc BoisvertMimi Sproul
Darren Schnider
Ben WoodTessa Scholl
Marc BoisvertMimi Sproul
Darren Schnider
Problems
DelaysInternal
Common among users of manual systemsEvery time someone comes in contact with a process, there is a 5% chance that an error will occur within the step
Unneeded queues build up
Charts are not taken by staff frequently because it reduces productivity
Every process that has a 95% chance of success (1- 5% of error) requires additional time in auditing to fix
Up to 10 minutes hands on time in system
Days out of system if returned by payee
ExternalPeople do not pay
Problems (continued)
Faster collections from insurance and payeeProblems:
Extended time for bill insurances
Non clean bills
Ideal scenario Collections would take place immediately post treatment
Problems solvedPossible error processing claims
Delay before Final DRG can be sent
Improved personnel allocation
Can be done with automated coding and billing system
Scope Statement
Modeling current billing process to determine accounts receivable days and chart processing times
Examining possible reengineering and mistake proofing of system
Determining NPV’s of implementing new systems
Objectives
Findings
Apparent long wait times in 6.5 day window processes
Enough errors in billing to make AR age 57.37 days average
Industry findings that AR can be reduced dramatically, to at most 30 days
Recommendations
Automate billing system
Add a new financial councilor Decrease self-pay time
If the system is unable to be automated, use improved business rules
Able to reduce queue times and improve throughput
Road map of remaining presentation
Model Description
Model Inputs
Sensitivity Analysis
Additional improvements
Emergency roomCurrent process and improvement
New billing program example
Accounts to concentrate on
Model Description
Gathered Information and assumptionsInputs
Hours worked, chart processing times, staffing schedules, average payee payment periods and 90 patient types
Information collected from actual Gritman medical staff member
Model PurposeAccurately model current billing cycle through Gritman medical center
Sensitivity AnalysisIndividual changes made and reviewed for improvement
Sensitivity Analysis
Our purpose is to reduce Gritman’s AR by 40% to improve costs
Changed general business rules reducing process time while keeping old system
We are also investigating 30%, 20%, 10% and comparing each NPV to find the break even point
Model Inputs
5 Types of PatientsOut-patient Sleep Study: OP Sleep Study
Out-patient Laboratory/Out-patient Radiology: OPL/OPR
In-patient/Out-patient Surgery/Observation: IP/OPS/Observation
Emergency Room: ER
Therapy/Series/Adult Day Health: Therapy/Series/ADH
3 Categories of Payment Amounts>$1,500
$1,500 - $7,500
<$7,500
6 Payment OptionsMedicare
Medicaid
Blue Cross
Commercial
Self-Pay
Charity
Current Emergency Room Process
Proposed Emergency Room process
Comparison of Processes
This new process reduces both time and error increasing revenue
Sage Intergy EHR system
Largest AR issues
Average % of AR
1-Jan-09 0.91% 12.54% 0.87% 0.00% 3.71% 8.05% 1.31% 6.17% 1.52% 10.45% 0.00% 9.97% 0.00% 2.86% 0.00% 1.61% 8.90% 1.89% 0.46% 10.68% 2.21% 1.89% 14.00% 100.00%
1-Feb-09 1.27% 10.28% 1.11% 0.00% 4.26% 7.88% 1.30% 7.52% 1.76% 10.28% 0.00% 7.68% 0.00% 2.40% 0.00% 1.94% 9.50% 2.16% 0.44% 11.29% 1.56% 1.71% 15.66% 100.00%
1-Mar-09 0.82% 6.95% 0.82% 0.00% 4.15% 8.37% 1.08% 7.50% 1.73% 8.22% 0.00% 8.57% 0.00% 1.39% 0.00% 2.09% 8.66% 2.20% 0.41% 11.55% 2.00% 2.15% 21.34% 100.00%
1-Apr-09 0.79% 7.57% 0.56% 0.00% 4.54% 9.67% 1.11% 4.87% 1.59% 13.24% 0.00% 7.51% 0.00% 2.54% 0.00% 2.09% 7.94% 2.35% 0.41% 11.79% 1.56% 2.39% 17.47% 100.00%
1-May-09 0.68% 6.16% 1.24% 0.00% 4.47% 6.59% 0.90% 7.30% 2.82% 8.74% 0.00% 7.15% 0.00% 2.56% 0.00% 2.44% 9.01% 2.56% 0.44% 10.82% 0.92% 1.64% 23.54% 100.00%
1-Jun-09 0.71% 10.23% 1.20% 0.00% 5.73% 7.24% 0.80% 7.02% 3.77% 9.37% 0.00% 7.39% 0.00% 2.06% 0.00% 2.72% 8.70% 2.44% 0.41% 10.31% 1.47% 0.93% 17.51% 100.00%
1-Jul-09 0.64% 7.74% 0.73% 0.00% 4.97% 5.82% 0.53% 7.30% 3.86% 8.49% 0.00% 7.26% 0.00% 2.28% 0.00% 2.68% 9.59% 2.55% 0.31% 11.74% 1.32% 1.17% 21.02% 100.00%
1-Aug-09 1.01% 6.20% 1.17% 0.00% 4.61% 4.30% 0.95% 10.13% 4.38% 7.07% 0.00% 8.37% 0.00% 1.94% 0.00% 2.21% 9.96% 2.63% 0.33% 12.30% 2.09% 1.50% 18.88% 100.00%
1-Sep-09 0.94% 8.76% 0.86% 0.00% 4.37% 4.36% 0.93% 8.14% 3.03% 7.21% 0.00% 8.05% 0.00% 1.66% 0.00% 2.37% 10.79% 2.67% 0.36% 11.24% 2.23% 1.74% 20.29% 100.00%
1-Oct-09 0.51% 7.48% 1.14% 0.00% 4.46% 4.12% 0.87% 7.49% 2.53% 8.27% 0.00% 6.79% 0.00% 1.31% 0.00% 2.12% 9.89% 2.74% 0.30% 10.95% 1.48% 2.36% 25.19% 100.00%
1-Nov-09 0.64% 7.78% 1.27% 0.00% 3.57% 6.17% 0.85% 7.31% 2.78% 8.46% 0.00% 8.43% 0.00% 1.18% 0.00% 2.14% 11.68% 2.95% 0.34% 9.60% 2.76% 1.90% 20.20% 100.00%
2-Dec-09 0.62% 12.39% 0.70% 0.00% 5.06% 3.81% 1.08% 7.28% 2.38% 12.12% 0.00% 8.31% 0.00% 0.82% 0.00% 2.05% 10.96% 2.92% 0.31% 8.97% 2.90% 2.14% 15.18% 100.00%
1-Jan-10 0.77% 8.74% 1.31% 0.00% 4.21% 4.55% 1.14% 5.58% 2.32% 6.58% 0.00% 9.44% 0.00% 1.85% 0.00% 2.30% 11.85% 3.26% 0.32% 11.27% 3.00% 2.91% 18.62% 100.00%
average % of AR 0.79% 8.68% 1.00% 0.00% 4.47% 6.23% 0.99% 7.20% 2.65% 9.12% 0.00% 8.07% 0.00% 1.91% 0.00% 2.21% 9.80% 2.56% 0.37% 10.96% 1.96% 1.88% 19.15% 100.00%
Largest AR issues
The highlighted percentages are how many more days each of the corresponding insurances are taking over the average
% above or below average AR days
1-Jan-09 -13.17% -43.49% -17.61% 0.00% -36.14% 36.60% 47.47% -48.85% 29.40% -66.62% 0.00% 32.47% 0.00% 14.40% -100.00% -74.43% 41.96% -69.83% -92.65% 70.29% -14.09% 27.87% -86.06% 0.00%
1-Feb-09 2.96% -52.93% -2.33% 0.00% -32.33% 37.75% 53.69% -33.66% 36.53% -68.42% 0.00% 1.58% 0.00% 3.40% -100.00% -69.95% 46.91% -66.63% -93.17% 74.73% -22.49% 21.33% -84.34% 0.00%
1-Mar-09 6.27% -65.19% -26.77% 0.00% -40.16% 23.21% 58.30% -32.21% 39.89% -75.38% 0.00% 8.47% 0.00% -39.10% -100.00% -67.32% 35.25% -65.67% -93.60% 80.53% 27.14% 44.52% -78.66% 0.00%
1-Apr-09 1.28% -57.12% -46.28% 0.00% -36.44% 19.02% 62.85% -54.69% 42.79% -60.76% 0.00% -5.39% 0.00% 6.42% -100.00% -70.04% 13.71% -66.30% -94.15% 68.91% 0.42% 48.01% -82.53% 0.00%
1-May-09 11.21% -64.11% 4.67% 0.00% -40.56% -25.23% 56.45% -34.39% 61.31% -73.83% 0.00% -10.09% 0.00% 1.31% -100.00% -62.80% 37.01% -61.12% -93.27% 64.67% -23.93% 6.73% -76.45% 0.00%
1-Jun-09 -2.99% -40.49% -9.68% 0.00% -30.28% -19.37% 42.61% -35.56% 47.71% -71.48% 0.00% -5.99% 0.00% -20.60% -100.00% -57.57% 35.39% -62.15% -93.66% 60.56% 2.64% -23.42% -82.39% 0.00%
1-Jul-09 1.99% -56.55% -50.62% 0.00% -38.95% -27.46% -23.69% -38.48% 35.99% -73.25% 0.00% -4.78% 0.00% -10.68% -100.00% -60.40% 41.72% -62.28% -95.44% 73.44% -5.13% -3.59% -78.98% 0.00%
1-Aug-09 -22.12% -66.77% -8.16% 0.00% -40.36% -42.45% 20.93% -13.69% 39.26% -76.45% 0.00% 6.32% 0.00% -30.63% -100.00% -68.91% 40.35% -62.98% -95.40% 73.25% 4.71% 1.78% -81.12% 0.00%
1-Sep-09 -20.08% -54.97% -26.10% 0.00% -39.25% -38.44% -7.21% -27.87% 33.19% -76.06% 0.00% 1.61% 0.00% -34.28% -100.00% -68.77% 42.03% -64.79% -95.32% 48.02% 14.50% 6.89% -79.71% 0.00%
1-Oct-09 -23.06% -62.13% -14.05% 0.00% -40.30% -46.05% 2.91% -31.11% 19.14% -71.72% 0.00% -13.88% 0.00% -31.86% -100.00% -74.35% 19.51% -66.92% -96.34% 32.34% -28.57% 49.99% -74.81% 0.00%
1-Nov-09 -21.26% -58.83% 4.15% 0.00% -50.75% -26.85% 5.99% -33.13% 9.66% -71.89% 0.00% 7.57% 0.00% -24.39% -100.00% -74.38% 40.00% -64.67% -95.97% 15.06% 27.89% 42.36% -79.80% 0.00%
2-Dec-09 28.19% -34.04% -46.66% 0.00% -33.83% -54.00% 61.74% -32.34% 13.99% -60.15% 0.00% -3.12% 0.00% -35.04% -100.00% -73.19% 43.42% -61.83% -95.94% 17.33% 21.04% 76.44% -84.82% 0.00%
1-Jan-10 42.15% -56.12% -7.12% 0.00% -47.81% -40.83% 93.63% -45.24% 35.74% -78.09% 0.00% 12.24% 0.00% 3.72% -100.00% -67.72% 66.16% -54.23% -95.52% 58.07% 26.75% 83.41% -81.38% 0.00%
average % of deviation -0.66% -54.83% -18.97% 0.00% -39.01% -15.70% 36.59% -35.48% 34.20% -71.08% 0.00% 2.08% 0.00% -15.18% 0.00% -68.45% 38.72% -63.80% -94.65% 56.71% 2.38% 29.41% -80.85% 0.00%
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A/R Totals
1-Jan-09 0.91% 12.54% 0.87% 0.00% 3.71% 8.05% 1.31% 6.17% 1.52% 10.45% 0.00% 9.97% 0.00% 2.86% 0.00% 1.61% 8.90% 1.89% 0.46% 10.68% 2.21% 1.89% 14.00% 100.00%
1-Feb-09 1.27% 10.28% 1.11% 0.00% 4.26% 7.88% 1.30% 7.52% 1.76% 10.28% 0.00% 7.68% 0.00% 2.40% 0.00% 1.94% 9.50% 2.16% 0.44% 11.29% 1.56% 1.71% 15.66% 100.00%
1-Mar-09 0.82% 6.95% 0.82% 0.00% 4.15% 8.37% 1.08% 7.50% 1.73% 8.22% 0.00% 8.57% 0.00% 1.39% 0.00% 2.09% 8.66% 2.20% 0.41% 11.55% 2.00% 2.15% 21.34% 100.00%
1-Apr-09 0.79% 7.57% 0.56% 0.00% 4.54% 9.67% 1.11% 4.87% 1.59% 13.24% 0.00% 7.51% 0.00% 2.54% 0.00% 2.09% 7.94% 2.35% 0.41% 11.79% 1.56% 2.39% 17.47% 100.00%
1-May-09 0.68% 6.16% 1.24% 0.00% 4.47% 6.59% 0.90% 7.30% 2.82% 8.74% 0.00% 7.15% 0.00% 2.56% 0.00% 2.44% 9.01% 2.56% 0.44% 10.82% 0.92% 1.64% 23.54% 100.00%
1-Jun-09 0.71% 10.23% 1.20% 0.00% 5.73% 7.24% 0.80% 7.02% 3.77% 9.37% 0.00% 7.39% 0.00% 2.06% 0.00% 2.72% 8.70% 2.44% 0.41% 10.31% 1.47% 0.93% 17.51% 100.00%
1-Jul-09 0.64% 7.74% 0.73% 0.00% 4.97% 5.82% 0.53% 7.30% 3.86% 8.49% 0.00% 7.26% 0.00% 2.28% 0.00% 2.68% 9.59% 2.55% 0.31% 11.74% 1.32% 1.17% 21.02% 100.00%
1-Aug-09 1.01% 6.20% 1.17% 0.00% 4.61% 4.30% 0.95% 10.13% 4.38% 7.07% 0.00% 8.37% 0.00% 1.94% 0.00% 2.21% 9.96% 2.63% 0.33% 12.30% 2.09% 1.50% 18.88% 100.00%
1-Sep-09 0.94% 8.76% 0.86% 0.00% 4.37% 4.36% 0.93% 8.14% 3.03% 7.21% 0.00% 8.05% 0.00% 1.66% 0.00% 2.37% 10.79% 2.67% 0.36% 11.24% 2.23% 1.74% 20.29% 100.00%
1-Oct-09 0.51% 7.48% 1.14% 0.00% 4.46% 4.12% 0.87% 7.49% 2.53% 8.27% 0.00% 6.79% 0.00% 1.31% 0.00% 2.12% 9.89% 2.74% 0.30% 10.95% 1.48% 2.36% 25.19% 100.00%
1-Nov-09 0.64% 7.78% 1.27% 0.00% 3.57% 6.17% 0.85% 7.31% 2.78% 8.46% 0.00% 8.43% 0.00% 1.18% 0.00% 2.14% 11.68% 2.95% 0.34% 9.60% 2.76% 1.90% 20.20% 100.00%
2-Dec-09 0.62% 12.39% 0.70% 0.00% 5.06% 3.81% 1.08% 7.28% 2.38% 12.12% 0.00% 8.31% 0.00% 0.82% 0.00% 2.05% 10.96% 2.92% 0.31% 8.97% 2.90% 2.14% 15.18% 100.00%
1-Jan-10 0.77% 8.74% 1.31% 0.00% 4.21% 4.55% 1.14% 5.58% 2.32% 6.58% 0.00% 9.44% 0.00% 1.85% 0.00% 2.30% 11.85% 3.26% 0.32% 11.27% 3.00% 2.91% 18.62% 100.00%
average % of AR 0.79% 8.68% 1.00% 0.00% 4.47% 6.23% 0.99% 7.20% 2.65% 9.12% 0.00% 8.07% 0.00% 1.91% 0.00% 2.21% 9.80% 2.56% 0.37% 10.96% 1.96% 1.88% 19.15% 100.00%
% above or below average AR days
1-Jan-09 -13.17% -43.49% -17.61% 0.00% -36.14% 36.60% 47.47% -48.85% 29.40% -66.62% 0.00% 32.47% 0.00% 14.40% -100.00% -74.43% 41.96% -69.83% -92.65% 70.29% -14.09% 27.87% -86.06% 0.00%
1-Feb-09 2.96% -52.93% -2.33% 0.00% -32.33% 37.75% 53.69% -33.66% 36.53% -68.42% 0.00% 1.58% 0.00% 3.40% -100.00% -69.95% 46.91% -66.63% -93.17% 74.73% -22.49% 21.33% -84.34% 0.00%
1-Mar-09 6.27% -65.19% -26.77% 0.00% -40.16% 23.21% 58.30% -32.21% 39.89% -75.38% 0.00% 8.47% 0.00% -39.10% -100.00% -67.32% 35.25% -65.67% -93.60% 80.53% 27.14% 44.52% -78.66% 0.00%
1-Apr-09 1.28% -57.12% -46.28% 0.00% -36.44% 19.02% 62.85% -54.69% 42.79% -60.76% 0.00% -5.39% 0.00% 6.42% -100.00% -70.04% 13.71% -66.30% -94.15% 68.91% 0.42% 48.01% -82.53% 0.00%
1-May-09 11.21% -64.11% 4.67% 0.00% -40.56% -25.23% 56.45% -34.39% 61.31% -73.83% 0.00% -10.09% 0.00% 1.31% -100.00% -62.80% 37.01% -61.12% -93.27% 64.67% -23.93% 6.73% -76.45% 0.00%
1-Jun-09 -2.99% -40.49% -9.68% 0.00% -30.28% -19.37% 42.61% -35.56% 47.71% -71.48% 0.00% -5.99% 0.00% -20.60% -100.00% -57.57% 35.39% -62.15% -93.66% 60.56% 2.64% -23.42% -82.39% 0.00%
1-Jul-09 1.99% -56.55% -50.62% 0.00% -38.95% -27.46% -23.69% -38.48% 35.99% -73.25% 0.00% -4.78% 0.00% -10.68% -100.00% -60.40% 41.72% -62.28% -95.44% 73.44% -5.13% -3.59% -78.98% 0.00%
1-Aug-09 -22.12% -66.77% -8.16% 0.00% -40.36% -42.45% 20.93% -13.69% 39.26% -76.45% 0.00% 6.32% 0.00% -30.63% -100.00% -68.91% 40.35% -62.98% -95.40% 73.25% 4.71% 1.78% -81.12% 0.00%
1-Sep-09 -20.08% -54.97% -26.10% 0.00% -39.25% -38.44% -7.21% -27.87% 33.19% -76.06% 0.00% 1.61% 0.00% -34.28% -100.00% -68.77% 42.03% -64.79% -95.32% 48.02% 14.50% 6.89% -79.71% 0.00%
1-Oct-09 -23.06% -62.13% -14.05% 0.00% -40.30% -46.05% 2.91% -31.11% 19.14% -71.72% 0.00% -13.88% 0.00% -31.86% -100.00% -74.35% 19.51% -66.92% -96.34% 32.34% -28.57% 49.99% -74.81% 0.00%
1-Nov-09 -21.26% -58.83% 4.15% 0.00% -50.75% -26.85% 5.99% -33.13% 9.66% -71.89% 0.00% 7.57% 0.00% -24.39% -100.00% -74.38% 40.00% -64.67% -95.97% 15.06% 27.89% 42.36% -79.80% 0.00%
2-Dec-09 28.19% -34.04% -46.66% 0.00% -33.83% -54.00% 61.74% -32.34% 13.99% -60.15% 0.00% -3.12% 0.00% -35.04% -100.00% -73.19% 43.42% -61.83% -95.94% 17.33% 21.04% 76.44% -84.82% 0.00%
1-Jan-10 42.15% -56.12% -7.12% 0.00% -47.81% -40.83% 93.63% -45.24% 35.74% -78.09% 0.00% 12.24% 0.00% 3.72% -100.00% -67.72% 66.16% -54.23% -95.52% 58.07% 26.75% 83.41% -81.38% 0.00%
average % of deviation -0.66% -54.83% -18.97% 0.00% -39.01% -15.70% 36.59% -35.48% 34.20% -71.08% 0.00% 2.08% 0.00% -15.18% 0.00% -68.45% 38.72% -63.80% -94.65% 56.71% 2.38% 29.41% -80.85% 0.00%
Pro-Active Bill Collection Example
Different communication forms will reduce collection time of accounts
Increase the likely-hood of collection on a Self-pay Account
Students are less likely to receive/respond to letters
Should collect email at admissions
Send out an email on day 15 reiterating the 15% bill reduction if paid within the 20 days
On day 18 call and remindAsk if bill can be paid by credit/debit card
Automated Solution Example
XactiMed Revenue Cycle SolutionsMedAssets’ SolutionsAutomated System
*DHMC: Dartmouth-Hitchcock Medical Center; NH**JPS: John Peter Smith Hospital; Fort worth, TX
Decreased A/R Times
Medical Facility Original Now Reduction
*DHMC: Medicare 27 19 30%
**JPS: third party AR 30 22 27%
**JPS: Commercial AR Fell an average of 90.4 days 44%
Fox Chase Cancer Center 73.1 40.8 56%
Average: 39%
Target for Gritman: 40%
5 Day Window Reduction
Current Process for IP/OP Surgery
Admission Patient Documentation Manual Discharge On Site or Off Site Coder if Off Site: Hold Charge Entry . Auditing Final DRG AR Queue Billed to Payee
Steps: 10 Time: 6+ days
New Process with automated billing and coding
Admission Patient Documentation Manual Discharge Billed to Payee
Steps: 4 Time: 3 days**This minimum time is designated by Federal regulation and is out of the scope of this project to reduce
NPV
Present Value with 40% reduction$980,000
NPV of -$1.89 million
About $400,000 per year reduction in costs
Factors to considerDoesn’t account for savings of reducing employee costs
Reduction of employee time for billing none value added for other processes
Doesn’t account for additional financial counselor