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Spontaneous Combustion: Making and sustaining change in Patient Access. Debi Stolic, Director of Patient Access, Bethesda Memorial Hospital Anne Habib, OputmInsight. Overview. Introduction Bethesda Health System Continuous Improvement Culture Case Study – Up Front Cash Collections - PowerPoint PPT Presentation
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Spontaneous Combustion: Making and sustaining change in Patient Access
Debi Stolic, Director of Patient Access, Bethesda Memorial Hospital
Anne Habib, OputmInsight
Overview
• Introduction
• Bethesda Health System
• Continuous Improvement Culture
• Case Study – Up Front Cash Collections
• Sustainable Change
Bethesda Healthcare System
• Bethesda Memorial Hospital is located in Palm Beach County, Florida.
• We have 401 beds, 525 physicians and 2,300 employees.• Bethesda West Hospital opens in early 2013 with 80 beds; the
design facilitates growth to a 400 bed hospital in future years.
Bethesda Memorial Hospital
• Pt. Access• Central Scheduling – 16.5 FTE’s• Registration – 38.8 FTE’s• 5 Patient Access Points of Entry
• Our Numbers• 20,578 Admissions• 60,001 ED Visits• 175,558 Outpatient visits• 141,195 Tests scheduled
• Systems • QuadraMed Enterprise Scheduling• Siemens Patient Management (Invision)• Estimator Pro
Patient Access at BMH
Medicare; 41%
Managed Care; 31%
Medicaid; 19%
Private Pay; 5% Other; 4%Medicare
Managed Care
Medicaid
Private Pay
Other
BMH Payer Mix
7
Continuous Improvement Culture
Overview
• Need to Improve Operations• Tired of IN & OUT Consulting Projects• Methodology/Structure for Independence• Identify and List Opportunities• Define Resolutions• Prioritization Criteria• Implement Solutions• Feedback Loop• Next Project
Identify Issues - SIPOC
Suppliers Inputs Process Outputs Customers
Physicians
Payer
Insurance Info
Demographic Data
Test Scripts
Customer contacts Central Scheduling
Appointments
Directions
Transportation
Patients
Families
Insurance Subscriber
Appointments Ancillary Departments
Physicians/Nurses
Other Facilities
Patient
Associates
Other Facilities
Insurance Carriers
Charge Codes
Follow Up Calls
Pre-Visit Information
Case Mangers
Scheduler answers phone using
Symposium phonesystem
Searches for Patientin
QuadraMed Scheduling
Obtain/Review/Update Patient’s
demographics
Schedulesappointment
PerformsPre-registration
If possible
Define Opportunities
Document Process
End Results
Prioritize Projects
Measure , Analyze, Improve, Control
List Prioritized Projects
Baseline Measures
ED Mobile Computing
LEAN ProjectsQuick Hits
Improvement & Standardization
Cash Collections
DMAIC
projects
Control Plan
Continuous Improvement
Reduce Variation
& DefectsReduce Waste &
Cycle TimeIncrease Cash
Collections
OutPatient
Through Put
Strategicor
Tactical
Benefit
End Results
Document Projects
Measure , Analyze, Improve, Control
List Prioritized Projects
Baseline Measures
ED Mobile Computing
LEAN ProjectsQuick Hits
Improvement & Standardization
Cash Collections
DMAIC
projects
Control Plan
Continuous Improvement
Reduce Variation
& DefectsReduce Waste &
Cycle TimeIncrease Cash
Collections
OutPatient
Through Put
Strategicor
Tactical
Benefit
End Results
Implement Project
Measure , Analyze, Improve, Control
List Prioritized Projects
Baseline Measures
ED Mobile Computing
LEAN ProjectsQuick Hits
Improvement & Standardization
Cash Collections
DMAIC
projects
Control Plan
Continuous Improvement
Reduce Variation
& DefectsReduce Waste &
Cycle TimeIncrease Cash
Collections
OutPatient
Through Put
Strategicor
Tactical
Benefit
SchPre-Reg
iVerify Auth Reg Trspt Code ROI CE Bill CollectPay Post
Pt. Access HIM PFS
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
SP1
SP2
SP3
SP4
Feedback
M E T R I C S
Feedback Loop
Case Study – Up Front Cash Collections
Prioritization
• Improved Cash Collections – High Priority• Both strategic and tactical
• Lean Project• Baseline Measurement – to determine results• Analysis - to ensure Improvement & Standardization• Implementation Plan – to ensure success• Control/Monitoring Plan – for sustainability
Importance of Up Front Collections
• If patient leaves without making a payment; chances of collection go down to 40%.
• Improved patient satisfaction when financial responsibility is known.
• Receiving a large bill months after service can cause many patients to think negatively about their experience.
• Without POS, the hospital is basically financing a service interest free for 60 days.
• As collection costs increase, cash flow to pay salaries and medical equipment may not be sufficient.
Baseline Measure
• Central Scheduling• Zero
• Outpatient/Admitting• $6,139
• Surgery Center• $29,386
• Heart Institute• $4,001
Implementing Technology
Price Estimator
• Have realistic expectations of the technology
• Understand the pros and cons of the technology and work with the pros
• Keep your eye on the goal
• Communicate with your vendor and have regularly scheduled meeting/conference calls to work through issues quickly
Technology, Process, & Collections
• Technology• Basic training on Estimator• Challenges – understanding terminology
• Process• Inserting Estimates and Collection into the pathway• Clearly documented process comparing current and future states
• Collection Scripts• Developed statements that are said to patients in a consistent
manner including how to handle responses from the patient• Speaking with confidence, use of empathy, identifying excuses vs.
the need for true financial assistance.
Training
Motivating the Team
• Bonus Plans
• Movie Tickets
• Pizza Parties
• Lunch Passes
• Good Old Competition & Recognition• Poster boards in departments• Target goals
Tracking Collections
Out Patient Results
1 2 3 4 5$0
$5,000
$10,000
$15,000
$20,000
$25,000
OP/Admitting - Cash Collections FY2012OP/Admitting - Cash Collections FY2011
1 2 3 4 5$0
$1,000
$2,000
$3,000
$4,000
$5,000
$6,000
$7,000
Central Scheduling - Cash Collections FY2012Central Scheduling - Cash Collections FY2011
Central Scheduling Results
1 2 3 4 5$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
ASC - Ambulatory Surgery Center - Cash Collections FY2012ASC - Ambulatory Surgery Center - Cash Collections FY2011
Ambulatory Surgery Results
1 2 3 4 5$0
$2,000
$4,000
$6,000
$8,000
$10,000
$12,000
$14,000
BHH - Bethesda Heart Hospital Cash Collec-tions FY2012BHH - Bethesda Heart Hospital Cash Collec-tions FY2011
Bethesda Heart Results
Sustainable Change
On going monitoringand audits of the improved process
Regular review of KPI reports to ensure compliance
Regular consistent communication with staff about what’s working and what isn’t
Continuous improvementStress the importance of adherence to the standards and the essential need to continuously improve
Regular monitoring and early intervention avoids discrepancies, reprocessing, and waste
What will make the improvements stick?• In improvement projects, make sure the root cause of
the problem has been resolved for the long-term• Put metrics in place to notify management if the
problem begins to occur again
THANK YOU!
