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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
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Current Process Flow
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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
04/19/23
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
[email protected] (503) 494-6588
Kelly Smith – Assistant Director, Patient Business Services
[email protected] (503) 494-9617
Stephanie Winchester – Director, Healthcare Operations Support
[email protected] (503) 494-9816