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Building an Automated Financial Clearance Process. Niobis Queiro, MBA Corporate Vice President, Revenue Cycle Hartford HealthCare Corporation Hartford, CT. Hartford HealthCare. 4 hospital system serving 63 towns in Connecticut 75,711 inpatient visits per year - PowerPoint PPT Presentation
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Building an Automated Financial Clearance ProcessNiobis Queiro, MBACorporate Vice President, Revenue CycleHartford HealthCare CorporationHartford, CT
Hartford HealthCare
• 4 hospital system serving 63 towns in Connecticut• 75,711 inpatient visits per year • 2 Million outpatient and homecare visits a year• 280,000 ED patients per year• 60% of all behavioral health visits in the state of CT• $52 million in charity care FY 2011 • $14 million invested in research • 15,000 Employees• 2,100 Physicians• $2.0B Total Revenue
Current Issues Facing Healthcare Industry
*Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.
• Losing 7.2% on Medicare Cases, losing 14% on Medicaid*• Medicare Reimbursement rates declining**• Increasing Medicare & Medicaid population• Increasing high deductable plans and bad debt
Hospitals will Never Be Paid as Well as
They are Today
• Rewards chasing revenue, not margin/quality • Capitation payment encourages less volume• Evidence Based Care Plans are needed
Fee for Serviceversus
Fee for Value
• Physicians, hospitals, providers and plans not aligned (incentives)
• Coordination lacking inside/outside walls of hospital • EMR Adoption/MU requires new processes**• Data is housed in silos
Care Delivered in Silos
• Rapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease***
• 5% patients = 55% of admissions, care at Medicare rates• Health Plans shift risk to provider. Bundled care, ACO
Chronic Disease Patient Volume
Increasing
Traditional Operating Models Will Fail UnderThe Complexities of Healthcare Reform
Short term:• Increased access to
care• New shared reimbursed
at government rates• Outcome risk
• Reduced operating margins
On the horizon:• ICD-10
• Outcomes Performance• Clinical integration
• IT interoperability• ACO investments
• Next generation gain sharing
• Bundled payments
Greater Access – Reduced Reimbursement – Growing Operational Complexity
• Percent of data needed for billing originates at registration: 70%
• National average registration error rate: 46%
• Percent of denials that could be prevented at registration: >50%
Patient Access: The Root of Much Evil
Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10, Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare
Cash Collection Curve
Hartford HealthCare Project Goals
• Create an Optimal Patient Experience that Makes HHC the Provider of Choice
• Create and Automate a Data Rich Financial Clearance Process• Produce Patient Liability Estimates for Transparency• Improve POS Cash Collections• Centralize Scheduling• Real-time Quality Assurance to empower the end-user• Enable Field Level Registration Edits• Link patient Access Errors to Denials and A/R Liquidation• Provide structure around E&B and Authorizations• Establish a Partnership with all HHC providers and assets
Hartford HealthCare: Flashback 18 months
• No patient access standardization• Variable financial clearance
process• No centralized scheduling• No patient liability estimates• < $1M/Yr in POS cash collections• No registration quality edits• No link between access & denials• IT patchwork across 4 hospitals
201
Current state:Hartford HealthCare Patient Access
Automated Financial Clearance Workflow Platform
AddressValidation
Centralized Scheduling
Eligibility & Benefit
Verification
Prior Auth(pilot)
Patient Funding w/ Via Note(pilot)Patient
Estimates
Medical Necessity
RegIntegrity
ADT Feed
ATB Data
Reporting & MetricsPost Go-Live
HCIT Integration
Point of Service Patient Liability Estimates
July
Augus
t
Septem
ber
Octobe
r
Novem
ber
Decem
ber
Janu
ary
Febura
ryMarc
h0
200
400
600
800
1000
1200
1400
1600
1800
2011-2012
Patie
nt E
stim
ates
Pro
duce
d as
a
%Im
prov
emen
t Ove
r Bas
elin
e
Linking Patient Access Errors to Denials
Improved A/R Liquidation
Rates
Reduction in errors at
Patient Access
12%
20%
Hartford HealthCare KPIs
Key Performance Indicator Best Practice TargetsRegistration Accuracy 99%# of incoming calls answered 135 - 165Abandon calls after threshold 2% calls Abandoned < 2 %Avg Time on Call 4:00 - 6:00Avg Wait Time 15 - 30 secMax Ans Delay 2:00 - 3:00
POS Collections $50,000 per monthPre-Registrations by Schedulers 20% or greater
Trace Fax completion time 1 business day
Joys of the Open Road
Joys of the Open Road
• Employee Engagement• HHC offers employees access to Local Community College• HHC covers tuition and salary for Wednesday afternoon coursework• Clear career path and education boost employee morale• HHC maintains a 99% employee retention rate
• Team Building Exercises
• Rewards For Outstanding Performance
Lessons From The Road
Lessons from the Road
• Appraise organizational readiness• Finance will likely want to run faster than departments• Provide training to physicians and nursing staff • Communicate early and often with hospital leadership
(CEO/CFO)• Appraise Financial Clearance Staff
• Some personality types are not suited to ask for payments• Be aware of HR challenges
• 9 Benefits Packages• 4 Compensation Models• Union job descriptions• Employee transfer requires new employee paperwork• HHC full homogenization by 2013
17
Leadership Behaviors
• Be In The Moment• Be Authentic & Humanistic• Volunteer Discretionary Effort Constantly• Model High Performance-Desired Behaviors that Drive
Desired Results• Respect & Leverage Separate Realities• Be Curious vs. Judgmental• Look in the Mirror First – Be Accountable• Have Courageous Conversations• Provide Timely, Clear & Specific Performance Expectations
& Feedback• Teach, Coach & Mentor - Spend at Least Half of Your Time
Developing Others
Questions to Ask Yourself Everyday
• What more can I do right now to be a role model for those around me?
• What more can I do right now to achieve the outcome we desire?• What more can I do right now to prevent something undesired
from occurring?• What expectations or feedback can I deliver right now to make a
positive difference?• What more can I do right now to seek or provide the clarity that I
think does not exist?• What more can I do right now to make this meeting more
productive?• When some outcome has not met my expectations, ask, “How did
I contribute to that?” and “What more will I do next time to make it successful?”
A journey of a thousand miles begins with a single step.Lau-Tuz, Chinese philosopher (604 BC - 531 BC)