CAHAMSeptember 1, 2015Susan Labow, ROI

KERN COUNTY MEDICAL CENTER

TOTAL BEDS : 222ANNUAL ADMITS: 32,000ANNUAL OUTPATIENT CLINIC VISITS: 140,000ANNUAL ED VISITS: 45,000ANNUAL OPT SURGICAL PROCEDURES: 4,0000HOSPITAL FINANCIAL SYSTEM: MCKESSON-STARPRACTICE MANAGEMENT SYSTEM: MCKESSON PRACTICE PLUSEMR: OPEN VISTA

PAYER MIX: 75% M/CAL AND M/CAL MANAGED CARE8% MEDICARE12% COMMERCIAL/WORKER’S COMP./JAIL5% SELF-PAY

KERN MEDICAL CENTERSTATISTICS

A/R DAYS AS OF 6/30/13 TOTAL A/R 166 DAYS- BILLED A/R 151A/R DAYS AS OF 3/01/14 TOTAL A/R 94 DAYS- BILLED A/R 84A/R DAYS AS OF 6/30/14 TOTAL A/R 77 DAYS- BILLED A/R 57

CASH COLLECTIONS AS OF 9/30/13 $6 MILLIONCASH COLLECTIONS AS OF 9/30/14 $13 MILLION

FTE’S 6/30/13 TOTAL FTE’S 30, PLUS 3 SUPERVISORSFTE’S 6/30/14 TOTAL FTE’S 12, PLUS 2 SUPERVISORS

OVERVIEW –MAJOR BARRIERS

2 Registration platforms Star for hospital services Practice Plus for clinic visits & pro fees

Clinic and OP diagnostic registration staff reported to clinic leadership

Hospital registration staff only responsible for ED, INPT and scheduled surgeries

Zero quality and Zero authorizations

OVERVIEWMAJOR BARRIERS

Multiple scheduling systems Surgery -open vistaDiagnostic and pre-op – starClinic visits- practice plus

EMR is non-functional and not user friendly

Diagnostic test performed during clinic visit, were posted in STAR but manually credited and debited in practice plus. TOTAL DISASTER

OVERVIEWMAJOR BARRIERS

Case management focused on Medicare certification M/Cal and M/Cal Managed care No concurrent review or authorizations

for commercial payers No authorization bill hold in financial

system. business office had to scramble once claim

was produced or just bill with records

PROCESS IMPROVEMENTENGAGEMENTS AT KMC

Various firms and solutions had already failed “CONSULTANT” was a bad word

Process improvement opportunities are not visible to everyone. Most common practice is to just add

bodies to broken process Adding bodies, is like adding layers of

clothes to hide your extra weight Nothing is solved

PROCESS IMPROVEMENTDAWNING OF A NEW DAY

Kern was bitten with the improvement bug Once they were given some direction and

ideas they took off and continue to look for opportunities

Watch words are- maximize technology pre-register every type of scheduled service streamline check in- Customer first automate claims submission expect 100%

clean claims don’t take no for an answer

PATIENT ACCESS JOURNEY

Divided registration No pre-registration No insurance verification No co-pay collection Full registration Long wait times Surgery scheduled w/out pre-op

PATIENT ACCESS TURNS THE SHIP

Implement pre-registration On-line payments Quality control over registration Assembly line for patient packets Developed check-in process Assumed registration for diagnostic

testing Assumed registration for clinic

services

PATIENT ACCESS HAS SAILED

Quality and eligibility software implemented

Focus on every error Build edits to correct errors Pre-Registration 250-400 a day On-line credit card and check

processing No bottle-neck at registration Maximize reimbursement

HOSPITAL BUSINESS OFFICEPAPER, PAPER EVERYWHERE

Inpatient claims produced without authorizations Staff had to secure the authorization or

Claims were billed with medical records, majority of time

Room charges were often missing Designated staff member was forwarded acct.

to add missing charge Auto insurance was always billed as prime

California does not subrogate and only ERISA health plans require payment or denial. This does not include Medicare.

Claims were often written off as commercial payer was not billed timely

PATIENT FINANCIAL SERVICES

A NEW DAY ARRIVES Replaced existing claims editing vendor 10% clean claims and even then “clean

claims were re-billed New claims editing vendor programmed

majority of errors to improve clean claims, now at 60%

M/Cal paper claims can now be sent electronically with automated program

Continually striving to improve clean claims to virtually eliminate errors

PATIENT FINANCIAL SERVICES

A NEW DAY ARRIVES Claims editing vendor automatically validates eligibility & changes destination and rules of claim as appropriate report indicates the appropriate payer so

financial system can be updated. report indicates patients with no coverage

Eligibility errors are non-existent due to front-end efficiencies

M/caid denials are automatically adjusted, as defined

Non-covered charges are automatically adjusted Eliminated re-work and re-processing of denials

PATIENT FINANCIAL SERVICESA BRAVE NEW WORLD

12 staff members and 2 Supervisors Working toward 100% clean claims Goal for Medicare and M/Cal A/R greater

than 30 days from billed date – 10% Goal for Commercial A/R greater than 90

days from billed date- 10% Automate anything and everything Empower staff to be fierce agents of war

PROCESS IMPROVEMENT CONCEPTS

Process improvement cannot be achieved with a cookie cutter approachone solution does not fit allnor does one product solve “everything”

Equally dangerous is the self-help approachStaff take courses and obtain certificates and

titlesthe process involves others outside of the

focused areathe problem is – you don’t know what you don’t

know. how can the best solution be achieved without experience garnered at other providers

LESSONS LEARNED Challenge everything Why can’t it be automated? Does the task add value Ask your colleagues Network with fellow financial leaders Don’t be afraid to ask the presenter,

happy to help. THANK YOU

Susan Labow- slabow@roi-corp.com (562) 843-1211