Changing the Culture at Oconee Medical Center

Changing the Culture

at Oconee Medical Center

1 POS Collections: Changing The Culture 8/7/2013

CAHAM 2013 Annual Conference

Donna M. Smith oDirector, Patient Financial Services

oOconee Medical Center, located in Seneca, South Carolina

o28 Years Experience

Gary D. Patterson oDirector, Advisory Solutions

oMedAssets, located in Alpharetta, Georgia

o23 Years Experience


Client Demographics

The Challenge

Project Workplan

Project Execution

Lessons Learned

Project Results

Keys to Success


Population 75,000

Borders Georgia and North Carolina

Beautiful mountains, lakes and waterfalls

Part of Greenville, SC metro statistical area

120 miles from Atlanta, Georgia


Per Capita Income $18,965

Median Household Income $36,666

10.8 % Population Below Poverty Line

14.1% Unemployment Rate (January 2010)


Opened 1939

JCAHO Accredited

160 Licensed Beds

1,400 Employees

125 Affiliated Physicians

Services Include: Med/Surg, OB/GYN, Emergency, Cardiology, Rehabilitation, Pain Management, Long Term Care and Infusion Therapy


Initial effort was internally driven

Performed POS collections training in March 2011

Saw short term increase then results fell off

Change of CFO led to MedAssets engagement


Impact of recent recession on local economy:

Increase in charity consideration requests

Increase in self-pay patients (from 3% to 10 %)

In partial response to this negative trend, Oconee Medical Center, completed a revenue cycle consulting assessment with MedAssets to determine ways to improve its overall revenue cycle performance.


“We recognized a need to bring a stronger culture of collections to OMC to help us implement best practices for POS collections. Incomplete patient access and registration staff knowledge and training, along with lack of key performance metrics and indicators, caused missed revenue opportunities, as well as missed opportunities to educate patients about their liability responsibility and available payment solution options.”

- Kevin Herbert OMC Chief Financial Officer



Collection Month 10/31/2010

11/30/2010

12/31/2010

1/31/2011

2/28/2011

3/31/2011

4/30/2011

5/31/2011

6/30/2011

7/31/2011

8/31/2011

9/30/2011

Grand Total

11

POS as % of Total Cash POS as % of Patient Payments 0.51% 6.61%

0.45% 6.53%

0.44% 6.62%

0.57% 7.92%

0.63% 10.04%

0.40% 6.20%

0.51% 7.87%

0.44% 6.40%

0.50% 7.00%

0.48% 7.20%

0.54% 7.40% 0.51% 7.00%

0.50% 7.21%

POS Collections: Changing The Culture 8/7/2013

• Implement POS Collections Program

• Implement Financial Clearance Policy

• Consolidate Pre-Services Workflow

• Centralize Registration Activities


8 Week Engagement

On-site Consultant

Project Manager

Data Analytics Support

Patient Access Leadership Team

C-Suite Support


From left to right:

Krystal Eagle ◦ Pre-Services Supervisor, OMC

Gary Patterson ◦ MedAssets Advisory Solutions

Mary Forrester ◦ Patient Access Manager, OMC

Donna Smith ◦ Patient Financial Services

Director, OMC


Review Assessment Findings

Review Current PFS Training Materials

Shadow Staff in All Registration Areas

Identify Pre-Service Productivity Roadblocks

Document POS Collection Patient Encounters

Review Existing PFS Polices and Procedures

Identify Additional Areas for POS Opportunity

Develop Implementation Roadmap


Inconsistent POS Collections Scripting

Revenue Cycle Knowledge Gaps

Need for Standardized Training

Lack of Payment Policy Signage

Inconsistent Use of Verification Tools

Untimely Pre-Registration of Scheduled Patients

Additional POS Opportunity for Inpatient, OB and Diagnostic Testing Areas


November

2011

Detailed Assessment

Comprehensive

Recommendations

Develop POS Training and

Job Aids

Deliver POS Training

Plan for New POS

Opportunities

December

2011

Shadow Staff Post

Training for Feedback

Update PFS Policies

Implement New POS

Collection Opportunities

Initiate Weekly KPI

Meetings

January

2012

Executive Summary

Presentation

Transition KPI Reporting

Set Follow-Up Schedule

Feb-Dec

2012

Quarterly Site Visits

Weekly Status Calls

Ongoing Revenue

Cycle Education

Celebrate Success

Address Challenges

Project Close


POS Collections Staff Training to Address: ◦ Patient Liability Fundamentals

Importance of Collection to Hospital Margin

What to Collect

How to Determine Patient Liability

◦ Psychology of Collections

POS Collections Scripting

Responding to Patient Objections

Role Playing Exercises

Corresponding Job Aids for Staff Reference


Shadowing Staff Post Training

◦ Coaching for improved performance

◦ Leadership rounding

Reviewed Positive and Negative Encounters

◦ What worked well?

◦ What didn’t?

Gauge Staff’s Buy-in

◦ Who needs more coaching?


POS Collections as Monthly Staff Meeting Topic

Posting POS Results on Bulletin Boards

Signage for Check In Areas

Email Blasts to Staff

Leadership Rounding

20

Payment of co-pays or coinsurance is expected at time

of service. Thank You!


Scheduled Rounding in ALL Areas

Project Plan Presentation to Hospital Leadership

Weekly KPI Meeting with Patient Financial Services Director

Candid Discussions Regarding Staff Culture

Creative Communication of Results

◦ Weekly KPI Report Distributed to Staff and CFO

Competition for Emergency Department Shifts

Celebrating Success


Created Pre-registration Process for OB Patients

Revised Process for Financial Counselors

◦ Benefit Review, Pricing Admission

◦ Patient Liability Discussion

◦ Payment Plan Discussion

Requesting Payment During ABN Discussion

Deposits for Diagnostic Testing (PPO, Indemnity)


Trust Insurance Verification Tool

◦ Inservice on interpreting results

◦ Reduce unnecessary phone calls

◦ Reduce manual account documentation

Daily Team Huddles

◦ Measure today’s volume and adjust resources


Focus on Value Added Activities

◦ Authorization for add-on procedures

◦ Reduce phone calls for patients with no liability

◦ Shifting work to other areas


Measure Results Weekly ◦ Email blast to staff

◦ Bulletin boards

◦ Leadership Review

Total Cash Collections ◦ 8-week trend line

ED Cash Collections ◦ Breakdown by shift

Pre-Services Productivity ◦ Days out by service line


Hospital Leadership Support

Physician Communication

Financial Clearance Process

◦ Pricing

◦ Payment arrangements

◦ Postponement when necessary


Corporate Wide

Financial Clearance Policy

Departmental Policies Supporting Initiative

◦ POS Collection Guidelines and Scripting

◦ Patient Liability Payment Options

◦ Estimating Patient Liability

◦ Guidelines for Liability Estimation Tool

Self-Pay Surgery Policy


8 Week Onsite Engagement Ends

POS Collections Training Completed

Updated Policies Adopted

KPI Measurements Instituted

New Cash Opportunities Implemented

Increased Pre-Services Productivity

Post Project Follow-Up Plan Identified


Weekly Leadership KPI Call with MedAssets

◦ Review Results

◦ Discuss Challenges

◦ Explore Solutions

Quarterly Site Visits by MedAssets

◦ Present Revenue Cycle Education at Staff Meeting

◦ Rounding with Leadership and Staff



Developing a Culture of Collections

◦ Weekly leadership rounding

◦ Staff feedback

◦ Weekly KPI staff communication

◦ Weekly KPI leadership meetings

◦ Success celebrations

◦ Executive support

Educating the Community

◦ Increased consistency in obtaining payment

Identifying New POS Cash Opportunities

Increasing Teamwork in Pre-Services


Support for Inpatient Collections

◦ Hospital nursing staff

◦ Family member complaints

Obtaining Support for Self-Pay Surgery Policy

◦ Stakeholder buy-in timeframe

Pre-Services Staffing

◦ Daily fluctuations affecting productivity


Pre-Services Teamwork

◦ Daily huddle to gauge work and adjust resources

◦ Cross training for short staffing situations

◦ Working supervisor

Educated and Engaged Staff

◦ Collection culture is now “who we are”

Friendly Competition in Emergency Department

◦ Weekly report of shift collections keeps staff motivated


Pre-Services Team Cross Training Support

New Hire POS Training in Place

Results Communicated Regularly

Weekly Leader Rounding



36

2009 2010 2011 2012

ED $117,149 $187,240 $177,099 $257,705

Pt Access $314,383 $329,781 $416,758 $806,691

Total $431,532 $517,021 $593,387 $1,064,396

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000OMC Year over Year POS Cash Collections

79% increase - 2012 over 2011


2012 Year End = .95% of Total Cash

◦ Project start average was .50%

2012 Year End = 12.41% of Patient Payments

◦ Project start average was 7.21%


38

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

2010 $30,937 $32,715 $50,512 $40,731 $53,772 $45,909 $45,425 $45,499 $46,346 $45,817 $41,103 $37,765

2011 $44,193 $59,132 $41,061 $49,612 $35,511 $41,455 $41,299 $49,109 $41,919 $46,394 $61,461 $82,241

2012 $131,062 $92,611 $103,495 $67,502 $96,135 $87,043 $75,562 $82,986 $89,977 $77,625 $97,326 $61,815

$0

$20,000

$40,000

$60,000

$80,000

$100,000

$120,000

$140,000OMC - Monthly POS Cash Collections 2010-2012


Project Team and C-Suite Support for Rapid Implementation

Staff Buy-In of Project Goals

Instructor Led Training for POS Collections

Job Aids for Overcoming Patient Objections

Removing Roadblocks to Pre-Services Process

Communication of KPIs to Staff and OMC Leadership

Updated Policy and Procedures for Financial Clearance

Capitalizing on Additional POS Collection Opportunities


Project Team and C-Suite Support for Rapid Implementation

Staff Buy-In of Project Goals

Instructor Led Training for POS Collections

Job Aids for Overcoming Patient Objections

Removing Roadblocks to Pre-Services Process

Communication of KPIs to Staff and OMC Leadership

Updated Policy and Procedures for Financial Clearance

Capitalizing on Additional POS Collection Opportunities


Donna Smith

[email protected]

41

Gary Patterson

[email protected]



Documents

Changing the Culture at Oconee Medical Center