A 360° Look at Patient AccessPresented by:Rodney R. AdamsDirector of Pre Service and Patient AccessMaury Regional Medical Center

Who is Maury Regional? Maury Regional Medical

Center is the largest hospital between Nashville and Huntsville

Serves a region consisting of more than a quarter-million people in southern Middle Tennessee.

Who is Maury Regional? Our 275-bed facility has a medical staff of more

than 185 physicians and 2,000 employees Top Recognitions in the last 3 years include:

Two Time Recipient of Thomson Reuters Top 10 Health System, Top 100 Hospital, Top 50 Health System

2009 TNCPE Excellence Award 2009 and 2010 Enterprise Best Practice

Customer Award winner by MedAssets Premier Quality Award

REWIND (about 5 years):Where were we in the

Revenue Cycle? We weren’t:

Doing full pre-registrations Doing estimates and were doing little on Point-of-

Service collections Doing QA on registrations Answering scheduling calls timely The list could go on and on…

We were relying heavily on Patient Accounts to collect all the cash

We looked like:

Realizing the Impact of Patient Access

Garbage in, garbage out 100% of patient demographics and insurance billing

information is obtained from registration Registration errors are the #1 complaint of billers Most denials come from pre-cert and registration The Registration department typically suffers from a

high turnover rate Registration accounts for over 65% of the fields on a

UB04

“You’re Killing Me Here!”

Where did we want to be? We wanted Patient Access to have an active role

in cash collection and the Revenue Cycle We wanted to do as much work as possible on

the front-end Resolve issues at the source, stop creating

work-arounds A leader in the Revenue Cycle

We wanted to look more like:

How do we get there?

What’s the real answer? Change in mindset

Increased Accountability Enhanced Focus Have a plan/work the plan

Move focus from back-end to front-end Revenue Cycle Redesign Redeployed staff Created a new department (Pre Service) Examined our processes and made changes

where needed A LOT OF WORK!

The New Department Pre Service would have responsibility for:

Scheduling Prior Authorizations/Pre-certs Pre Registration

Which would ultimately include Patient Estimates

Financial Counseling

Keys to SuccessMulti Departmental

Not just a Patient Access effort Must engage all departments that will be affected by

the changes Must engage and gain the support of your

Management Team and Senior Leadership Team (C-Suite)

Changing the culture of an organization and community takes everyone

Consistency

Keys to SuccessProcesses, Processes, Processes It is truly all about your processes Evaluate processes, change processes, refine

processes No system will compensate for

inadequate/antiquated processes Phased approaches Train the trainer Look for “bugs” in systems and processes

Improvements made by Patient Access/Pre Service

Improve Scheduling Process Improve Order Management Process Develop Pre Registration Process Install New Insurance Verification System Improve Pre Cert Process Develop POS Collection Process/Install Estimate

System

Improvements (cont.) Improve Customer Service in Access Areas Improve Medical Necessity Processes Implement Bank Loan Program Implement Uninsured Assistance and Disability

Assistance Programs Develop QA Processes and Install QA System

Improve Scheduling Process Determine scope (who are you scheduling for?) Determine hours of operation Determine staffing level Standardize data elements to be collected during

scheduling Cross-training is key

Scheduling Results

Jul-0

7

Sep-07

Nov-07

Jan-0

8

Mar-08

May-08

Jul-0

8

Sep-08

Nov-08

Jan-0

9

Mar-09

May-09

Jul-0

9

Sep-09

Nov-09

Jan-1

0

Mar-10

May-10

Jul-1

0

Sep-10

Nov-10

Jan-1

1

Mar-11

May-11

Jul-1

1

Sep-11

Nov-11

Jan-1

240.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

15 secs or less1 min or less

Improve Order Management Process Ask and ye shall receive (orders) Process to identify incorrect/incomplete orders

Take action now Process to identify missing orders

Take action now Scan orders into EMR prior to patient arrival

Develop Pre Registration Process Determine the scope-i.e. for which departments will

pre-reg be completed? Prioritize based on $’s at risk

Define Pre Registration Determine goal Determine staffing level Formulate actual rules for pre registration

Pre Registration Results

May-09

Jun-0

9Ju

l-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-1

0

Feb-10

Mar-10

Apr-10

May-10

Jun-1

0Ju

l-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-1

1

Mar-11

Apr-11

May-11

Jun-1

1Ju

l-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-1

282.00%

84.00%

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

Pre Reg Percentage

Install Insurance Verification System Stop manually rekeying patient info

This is rework and creates room for errors Chose a system that could be fully integrated into our

HIS system Historical transaction storage (you’re going to need

it!) Look for payer availability (80/20 Rule)

Should be able to electronically verify 80%+ of patients with this system

Improve Pre Cert Processes Stop “Gate Keeping” and be Proactive

Reduces rework by improving accuracy Creates partnership with referring MD’s and their

office staff Be Ready for Road Blocks

Payer requirements Payer updates/changes

Develop POS Collection Processes

Why Collect at the Point-of-Service?

Lower cost to collect Some studies show that if the patient leaves the facility

without paying, the chances of collecting drop by as much as 60%

Improve patient satisfaction? Started by setting up processes to collect co-pays and

remaining deductibles In the ED, OP, IP, Pre Reg areas Expanded into other access points (phased approach)

The Results of Changing Processes:

POS Collections

$-$20,000$40,000$60,000$80,000

$100,000$120,000$140,000$160,000$180,000$200,000$220,000$240,000

Aug-08

Sep-08

Oct-08

Nov-08

Dec-08

Jan-09

Feb-09

Mar-09

Apr-09

May-09

Jun-09

Jul-09

Aug-09

POS Collections

Now that our processes were in place:

We began the decision making process of how to provide patient estimates

We believed this would help us bridge the gap between deductibles and out-of-pocket max

Two Basic Options Homegrown system Partner with a vendor

We Chose a Partner

Giving Patient Estimates Implemented in Pre Service and Patient

Access first Expanded into other areas Helped staff with suggested ways to present

the estimates Created a cross-walk of exams and CPT codes for easier estimate creation Getting the “bugs” out

Easily determines and communicates the Patient’s estimated bill and payable portion using the insurance plan for calculating the estimated contractual allowance along with the patient co-pay, co-insurance and remaining deductible.

Financial arrangements can also be included on the patient estimate form.

Patient Estimate

The Results of Implementing an Estimator System:

Aug-08

Aug-08

Sep-08

Oct-08

Nov-08

Nov-08

Dec-08

Jan-09Feb-09M

ar-09M

ar-09A

pr-09M

ay-09Jun-09Jul-09Jul-09A

ug-09S

ep-09O

ct-09O

ct-09N

ov-09D

ec-09Jan-10Feb-10Feb-10M

ar-10A

pr-10M

ay-10Jun-10Jun-10Jul-10A

ug-10S

ep-10O

ct-10O

ct-10N

ov-10D

ec-10Jan-11Jan-11Feb-11M

ar-11A

pr-11M

ay-11M

ay-11Jun-11Jul-11A

ug-11S

ep-11S

ep-11O

ct-11N

ov-11D

ec-11Jan-12Jan-12

$-

$25,000.00

$50,000.00

$75,000.00

$100,000.00

$125,000.00

$150,000.00

$175,000.00

$200,000.00

$225,000.00 POS Cash

POS Collections (MRMC)

Does an Estimator System Really Help Improve Patient Satisfaction?

I’ve heard that statement before, but mostly from Estimate System Vendors

Truth or a myth? Do you believe it?

OP Customer Service Improvement

Why does an Estimator System Improve Patient Satisfaction? Able to plan and budget for medical expenses They feel like they are more involved in their care Increases patient awareness Gives us, as a provider, a time to actually explain to

them how their insurance will pay Improves pricing transparency

Improve Medical Necessity Processes

• Automate System, create processes, review issues daily and solve the root of the problem

WEEK 1

WEEK 5

WEEK 9

WEEK 13

WEEK 17

WEEK 21

WEEK 25

WEEK 29

WEEK 33

WEEK 37

WEEK 41

WEEK 45

WEEK 49

WEEK 53

WEEK 57

WEEK 61

WEEK 65

WEEK 69

WEEK 73

WEEK 77

WEEK 81

WEEK 85

WEEK 89

WEEK 93

WEEK 97

WEEK 10

1

WEEK 10

5

WEEK 10

90

10

20

30

40

50

60

70

80Medical Necessity Issues

Week

# of

Issu

es

Implement Bank Loan Program(we are a hospital, not a bank)

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-1

0

Feb-10

Mar-10

Apr-10

May-10

Jun-1

0Ju

l-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-1

1

Feb-11

Mar-11

Apr-11

May-11

Jun-1

1Ju

l-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-1

2

Feb-12

$-

$100,000.00

$200,000.00

$300,000.00

$400,000.00

$500,000.00

$600,000.00

$700,000.00

Gross Bank Loan $'s

Implement Uninsured Assistance Programs

IV Therapy/Cath Lab Many pharmaceutical companies and supply

companies have programs to provide free medication for patients who are indigent and/or uninsured

Jan-0

9

Feb-09

Mar-09

Apr-09

May-09

Jun-0

9Ju

l-09

Aug-09

Sep-09

Oct-09

Nov-09

Dec-09

Jan-1

0

Feb-10

Mar-10

Apr-10

May-10

Jun-1

0Ju

l-10

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-1

1

Feb-11

Mar-11

Apr-11

May-11

Jun-1

1Ju

l-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-1

2 $-

$50,000.00

$100,000.00

$150,000.00

$200,000.00

$250,000.00

OPIV Indigent Drug Program Assistance

Implement Disability Assistance Program

The uninsured patient NOTE: Current estimates of the uninsured in the US are

at 16.7% (according to latest US Census Bureau Survey) A successful way to identify patients eligibility

SSI/SSDI/Other Results

80+% of patients accepted in program are later approved Improved community relationships $1.13M+ annually in added cash Reduction in uncompensated care

Our newest “out of the box” concept-partnering with a local disability representation firm, saving $ and achieving results!

Implement Registration QA Processes and System

Implement Quality Assurance Process Per FTE Quality Checks

Time and Labor Intensive Not 100% Accurate or Effective

Implement Registration QA Software Number of Edits

We have just over 150 now Be prepared- you’re not as good as you think

you are!

Results of QA Processes and Software

Jan-1

1

Feb-11

Mar-11

Apr-11

May-11

Jun-1

1Ju

l-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-1

2

Feb-12

75.0%

80.0%

85.0%

90.0%

95.0%

100.0%

Accuracy RateClean Claim Rate

What Now? Lean Healthcare Automations Planetree (Patient Centered Care) Patient Portal

Online Scheduling Online Pre Registration Electronic Signatures Online Access to Medical Information Online MD Visits?

The Possibilities are Endless

Time to be “The Helm of the Revenue Cycle”

Reform is here, or at least it’s coming, or some strange combination of both. So are we going to put our heads in the sand, pretend the changing landscape of healthcare won’t affect us, and suffer tremendously…or are we going to implement better processes, challenge ourselves to always do better, never settle, and thrive in a changing market?

Remember-it all starts with Patient Access, are we creating cash or rework?

The time is NOW!

Thank you for attending “A 360° Look at Patient Access!”

Questions?

Rodney R. AdamsDirector of Pre Service and Patient AccessMaury Regional Medical Center(931) 490-7103radams@mauryregional.com