OHSU Healthcare

OHSU Point of Service Collections Initiative

HFMA - Oregon ChapterFebruary 2013

2

About OHSU

• Academic Medical Center w/schools of Medicine, Nursing, and Dentistry with 4,361 students

• One of two Level 1 Trauma centers in Oregon• Total visits 849,581

Admissions: 29,797 ED Visits: 46,399

Daypatients: 26,830 Ambulatory Visits: 735,279

Observation: 4,477 **Total Annual Patients: 235,801

• 48% of our patients are from outside tri-county area• Largest employer in the state, with over 14,000 employees• Employ more than 1,000 physicians & 450 Allied

Professionals

3

About OHSU

• Our EMR is EPIC (version 2010)• Started with EPIC Ambulatory August 2005,

implemented Prelude, Cadence, Resolute Professional billing and EpicCare

• Implemented inpatient EPIC in April of 2008– (HIM, Resolute HB, ADT, ASAP)

• Optime/Anesthesia January 2012• Upgrade to 2012 version in May

4

About OHSU

5

Agenda Today

• Drivers for change• Current state• 3 year Project scope• Patient Estimator• Re-engineered Process Flow

6

POS Collections – drivers for change?

• PricewaterhouseCoopers LLP Nov. 2010 Revenue Cycle Assessment

• POS Collections increase recommendation to industry benchmark of 1-2% of NPR

• Half of increased collection is cash acceleration, half is new money, reduces bad debt

• Every dollar collected up front decreases cost to collect• Consumer driven demand for price transparency

7

POS Collections – Drivers for Change

• Goal FY 12 Increase of $2 million (Hospital)• Goal FY 13 increase of $4 million (Hospital)• “Quick hit” opportunities identified included scheduled

inpatients, scheduled day surgery patients, ED visits, and high dollar Radiology

• Three phased approach to implementation

8

Current Process Flow

9

Current Process Flow

• Three areas (practices, anesthesia, hospital) all working independently of one another (Inconsistent practices)

• Limited use price estimator tool in medical practices for professional charges only

• Manually gather info for a “best guestimate”• Benefits/managed care & pre-registration are two separate

departments• Patients with day or inpatient services were not being informed

in advance of expectation to pay at admission• Creates a very poor patient experience

10

Phase I – Increase Hospital POS Collections

• Hospital only, needed to make a rapid change• Patient type inpatient, day surgery, ED • Commercial/Medicare singly insured patients• Increased amount requested from $100 to a range of

$300 to $600. Negotiate a lower amount if needed.• Informed patients of prepayment expectation during pre-

registration up to two weeks out (and collect over phone) • Added direct collection of $$ in the ED in May 2012 in

addition to copay envelopes

11

Phase I – Increase Hospital POS Collections

12

Phase 1 – Barriers to Overcome

• Staff resistance, reluctance to ask for money

(scripting, role playing, elbow support)

• No benefits information during pre-registration

• No estimate of total charges

(redirect to insurance company, scripting)

• Patient’s adjustment to the change – some may want to cancel

• Medical Practice staff adjustment to the change

• Common Documentation/Communication (had to create an EPIC ADT form)

13

14

Phase II – Integrated Project Goals

• Purchase a price estimator that would incorporate hospital, professional, and anesthesia charges into one estimate

• Re-engineer our POS processes to a single point of communication to convey payment expectations & collect payment

• Improve the patient experience

15

Phase 2 – Integration Project Structure

• Established work groups

1. Estimator RFP evaluations & selection panel

2. Steering committee of high level stakeholders

3. Process redesign work group (ENT, Plastics, Neurosurgery, Bariatric Surgery, Anesthesia, Billing, Patient Access)

4. Estimator technical team

• Ad hoc current state documentation group

• Patient Focus Group

• Use of CAP Tools (some LEAN)

16

Phase 2 – Integration Project Scope

In Scope: • Scheduled inpatients and day surgery • High dollar Radiology• ED visits• Patients with an anticipated balance due ie; copay’s,

deductible, and coinsurance

Out of Scope:• Same day/next day admits• Hospital transfers• Patients with no out of pocket

17

Patient Estimator

• FHS Clear Quote/Transunion selected• One estimate that includes hospital, professional, and anesthesia charges• Patient estimate considers: benefits, median charges, contracts, provider

variance• Contracted payers were notified • Loaded all hospital and professional contracts • One years worth of charge data, monthly refresh• Clear Code Auto Add Feature• HL7 ADT out interface with patient data

18

Patient Estimator

HL7 ADT out interface:

1. Patient demographics

2. Patient benefits documented in EPIC from a 270-271

query. (Can be manually entered in estimate)

3. Payer/plan maps to contract/contract allowance

4. Can include the procedure (ours doesn’t at this time)

5. Populates a work list (contact driven)

6. No ADT “in” to EPIC at this time

19

Patient Estimator

• Can create “shopper” estimates• Accommodates prompt pay/self pay/charity care

discounts• Scripting embedded in tool• Dictionary of healthcare terms• Common procedure groups• Work lists• Payment reason codes• Reporting

04/21/23

21

Patient Estimator – Lessons learned

• ICD-9 Procedure coding• Budget for increased 270-271• Lowered the threshold for inclusion of charges to 50%• Multiple procedure discounts and modifiers • Contract alignment

22

Patient Focus Group Feedback

• Employee/spouses of employees. Members of billing statement focus group recruited for continuity

• Positive reaction overall

• Concerned about use of healthcare “lingo”• Willing to pay 50% of balance due in advance of

services, depending on the total amount due and amount of time provided to prepare

• Staff’s ability to negotiate is critical• How you say it is everything

23

Phase II – Process Redesign

Single point of communication• Who will create the estimate and tell the patient? • How much will the patient need to pay? • Do we schedule before or after patient pays?• What if the patient can’t meet payment expectations?• How and where will we document payment expectations?• Will we cancel or reschedule if patient doesn’t pay?• Who gets the money if the patient cannot pay the full

amount?

24

Phase II – Process Redesign

The “Cloud People”

• Phone number on estimate• Explain charges & allowables• Negotiate payment, receive payment• Create payment plans • Screen for charity care eligibility• A newly defined work unit was born: Combined Customer

Service

25

Phase II – Process Redesign

26

Phase II – Process Redesign Challenges

• Interface or work list trigger• How to post pre-service collections and payment plans

with no account number• Selecting planned procedure code - accuracy of estimate

depends on it!• Common documentation

Phase II – Process Redesign    Operations Criteria Patient Experience Criteria

Process

Who performs process?

Estimator and 

Interface are date driven

Reschedules Cancellations

HAR available for payment?

HAR available for common 

documentation?

Pre-Auth. and Benefit 

process

Ability to achieve 

standardization of pt. 

experience across all 

departments

My health vs. 

your money

Ability to view 

estimate at time of 

explanation

Pay at time of 

estimate: one stop shopping

Smooth billing 

experience

Ability to answer 

questions about 

the estimate

#1 Patient receives estimate - Payment received - Procedure Scheduled.

Practice        Practice or CCS               Practice

1 3 1 1 1 1 1 3 3 1 2

#2 Patient receives estimate - Procedure Scheduled (HAR) - Payment Received

Practice        Practice               CCS

1 1 3 2 2 2 2 1 1 2 2

#3 Procedure Scheduled - Patient Receives estmate - Payment received

Practice             CCS                    CCS

3 1 3 3 3 3 3 1 1 3 1

18/19/25

28

Phase II – Process Redesign

Operational Criteria• Estimator/Interface are date driven• Reschedules & Cancelations• Account available to post payment• Account available for documentation• Facilitate Pre-Auth and benefit processing

29

Phase II – Process Redesign

Patient Experience Criteria• Achieve standardization of patient experience• My health vs. your money• Ability to view estimate at time of explanation• Pay at time of estimate (one stop shopping)• Smooth Billing Experience• Ability to respond to patient questions

30

Phase II Redesign

What’s next?• Wrap up build of estimator• Validate 271 data interfacing• Validate accuracy of estimates (ongoing!!) • Detailed level draft of many sub work flows• Develop training materials• Train end users• Pilot May 6, 2013

31

32

Questions?

Mela Gant – Director, Patient Access Services

gantm@ohsu.edu (503) 494-6588

Kelly Smith – Assistant Director, Patient Business Services

smkelly@ohsu.edu (503) 494-9617

Stephanie Winchester – Director, Healthcare Operations Support

winchess@ohsu.edu (503) 494-9816