Upload
lily-monroe
View
216
Download
1
Tags:
Embed Size (px)
Citation preview
Show Me the Numbers!How Strategic Planning Can Pay Off for Your Health Center
What Are the Numbers?• Key indicators chosen to measure a basic level of success• 14 Sites w/ completed evaluation results assessed by SNS 2006-2008• Where located: Massachusetts, Maine, Connecticut
– 10 FQHCs– 4 Non-FQHC CHCs
• Key indicators measured: – Net revenue– Number of patient visits– Gross charges – Number of unduplicated patients
Gross Charges Net Revenue # of Visits # of Unduplicated Patients
Baseline 12 Months Baseline 12 Months Baseline 12 Months Baseline 12 Months
39,523,721 48,732,525 19,659,879 22,410,721 178,769 206,799 64,871 84,572
Aggregate Data – 14 Health Centers
Average Increase Per Site – 14 Health Centers
Gross Charges Net Revenue # of Visits # of Unduplicated Patients
↑$657,771 ↑ $196,488 ↑ 2,147 ↑ 1,519
How Did They Get There?
Common Strategies Employed• Education of dental and administrative team related to
opportunities to maximize access and productivity• Improved scheduling systems to maximize productivity
and make best use of chairs given current staffing• Created or refined policies designed to reduce or
eliminate chaos (eg, emergencies, no-shows)• Tweaked patient mix to improve access for priority
populations (such as children) which also aided the practice financially
• Developed clinical protocols to standardize services provided to patients at each visit, which fostered the completion of treatment plans, ensured the avoidance of churning and maximized revenue opportunities
Common Strategies Employed (cont.)
• Adjusted fee schedules to be more in line with Usual and Customary Rates
• Revised encounter forms to enhance their functionality• Established access and productivity goals for the
practice, ensuring elimination of disease and creation of financial sustainability
• Met with dental and administrative staff to review current situation and present the action steps recommended for practice enhancement and/or recovery
• Showed the practice how to monitor success or lack thereof in achieving action plan goals
• Promoted the development of a process to reward and celebrate success on a regular basis
Common Strategies Employed (cont.)
• Reviewed monthly progress reports with dental leadership related to progress in accomplishing each action step according to the agreed upon timeline
• Adjusted action steps when needed • Reviewed SNS key data reports with practice at
6,12,18, and 24 months
Case StudySix-Chair Federally Qualified Health Center
Before After
Number of Visits 18,150 21,341
Net Revenue $1,464,116 $2,336,873
Total Expenses $1,723,007 $2,114,528
Profit/(Loss) ($258,891) $222,345
Revenue/Visit $81/visit $110/visit
Cost/Visit $95/visit $99/visit
About This Program
• Six-chair clinic located in Boston suburb (FQHC)• Six FTE dentists, each seeing an average of 13
patients per day• Fee-for-service reimbursement for Medicaid• Practice located in an area of enormous need and
demand for care• Only FQHC in service area• As a result of moving from red to black, this practice
is in the process of expanding from 6 to 12 chairs!
Case Study: How Did They Increase Visits?
Before AfterPractice was achieving a lot of visits, but high level of chaos detracted from productivity
Put systems in place to replace chaos with control
No show policy was not consistently enforced
Tweaked no-show policy and began enforcing it consistently
Scheduling system undermining productivity
Recreated the scheduling system; moved to 30-day schedule and developed new policy
Emergency policy was overly complex; practice overwhelmed by emergencies
Created new emergency policy and method of accommodating emergency patients into the practice without causing disruption to scheduled patient care
Strategies for Increasing Visits
• Managing Emergencies
• Managing No-Shows
• Scheduling
Managing Emergencies• Define what constitutes a true emergency• Create an emergency management system that meets
the level of need, but preserves regularly scheduled appointments
• Develop and implement an emergency policy, and stick to it
• Provide training for registration and reception staff in the triage of emergency walk-ins and calls
Managing No-Shows• Create and distribute no-show policy to patients and staff• Post the no-show policy in several areas• Have patients read, sign and insert signed policy in chart • Enforce the no-show policy consistently across the
practice • Track:
– No-shows– Cancellations– Fill-ins– Scheduled visits vs. actual appointments
Managing No-Shows (cont.)
Provide reminder messages for upcoming appointments
Schedule appointments no further out than 30-45 days
Schedule one follow-up appointment at a time
Improving Scheduling System
Some factors that affect scheduling policies:• Demographics of the patient population• Typical needs of the patient population • How far in advance appointments are scheduled• Appointment lengths• Number of appointments available
Improving Scheduling (cont.)
• Schedule appointments no further out than 30-45 days
• Schedule appointments one at a time Exception: patients undergoing complex procedures that require multiple visits to complete
• Determine basic appointment length by type of service provided: 30-45-60 minutes
Allocate10-15 minute increments for procedures requiring additional time
Case Study: How Did They Increase Net Revenue?
Before After
Inconsistency in services provided to patients from provider to provider, resulting in lost revenue opportunities, as well as delays in completion of treatment plans and discontent
Created clinical protocols to standardize services provided to patients, maximize revenue opportunities and foster the completion of treatment plans
Large amount of money owed to the practice out past 90 days, primarily from Medicaid and other third-party payers
Reviewed entire billing process to identify reasons for denied claims; developed strategies to improve the billing process (with the goal of getting clean claims out the door) (eg, assigned dental staff person to review each day’s encounters before they were submitted to billing)
Practice (providers and support staff) did not know the Medicaid rules and regulations; were providing lots of non-covered services; also were not aware of many new covered services that had recently been added
Created abbreviated guidelines for Medicaid showing covered services and accompanying rules and regulations. Practice began regularly educating and updating providers and staff
Case Study: Increasing Net Revenue
Before After
Fee schedule was low (in some cases, below what Medicaid would pay)
Increased fee schedule to 75th percentile of UCR
Practice did not have a sliding fee scale for self-pay patients
Created a sliding fee scale that balanced affordability for self-pay patients with need to achieve financial sustainability
Strategies That Increase RevenueDocumentation of Eligibility• Flow charting and establishing accountability for every step of
the eligibility process through staff orientation and trainingManagement of Self-Pay Patients• Define the responsibilities of patients and staff• Communicate expectations for payment at the time of the visit• Support front desk staff to perform this crucial task through
training and scripting; use objective performance measures to evaluate staff success
Billing Efficiencies• Flow charting and establishing accountability for each step in
the process from patient registration through reconciliation• Identify barriers to successful billing and develop strategies to
resolve• Staff training to increase probability of success through the
billing process
Strategies That Increase RevenueCross-train staff (receptionists, registration staff, dental
assistants) to fill in as needed, according to priority• The consideration of incentive programs to reward
the dental team (not just providers) • Use of DAs and RDHs for expanded duty to
maximize availability of dentists for treatmentStaff are regularly educated and trained relative to the
rules and regulations of the practice’s primary third-party payers (especially Medicaid)
• Determination of a defined scope of service fostering elimination of disease, yet preserving financial viability
Strategies That Increase RevenueEstablishment of a fee schedule, sliding fee scale and nominal fees that sustain the practice yet do not pose barriers to careNon-emergent procedures requiring prior authorization should not be initiated until PA is received or patient agrees to self-pay statusVerification of patient’s eligibility before and at each visitSkillful utilization of IT systems to maximize clinical effectiveness and enable the practice to obtain the data needed to evaluate program performance
Self-pay patients and those with insurance co-payments need to pay at the time of the visit
Patients should be educated about the true value of the services they are receiving and the discounts they are eligible for
Policies That Increase Revenue
• Slide fees from full charges (set at 75-80th percentile of UCR) based upon household income and Federal Poverty Guidelines
• Slide categories are typically 100% FPL and below; 101-150% FPL, 151-200% FPL, with percentage discounts offered for each category (patients above 200% FPL pay full charges)
• In setting sliding fee scale, need to create a balance between compassion and financial sustainability
• FQHCs – set a nominal fee for patients 100% of FPL and below
– Can be determined by setting a dollar amount (e.g. $30), a percentage of 20% of full fee, or the Medicaid adult fee for same service
– Make every effort to collect, but those 100% of FPL and below who are unable to pay are subsidized by the practice [330 funds?]
Developing a Sliding Fee Scale
Strategies for Creating an Effective Billing System
• Utilization of an up-to-date, practice-friendly encounter form
• A policy that all staff responsible for any part of the billing process be trained and held accountable
• A policy guiding the transfer of information from dental to billing with built-in accountability
• The creation of a flow chart that defines each step in the billing process and assigns accountability for each step
• A policy that guides the reconciliation of remittances and the resubmission of denials with designated accountability
• A prior approval policy and process • A billing manual and orientation/training process for
accountable staff
Creating an Effective Billing System
Sample Billing Flow ChartPatient calls for appointment; registration
documents eligibility and schedules appointment
Patient comes in for appointment; eligibility is checked again; patient is asked to pay any co-pays due at the time of the
visit
Encounter form (or routing slip) is generated; patient sits in chair; provider sees patient and documents services on
encounter form or on routing slip
Patient meets with patient accounts specialist to review follow-up care needed and
estimated costs
For patients covered by Medicaid or other third-party insurers, DA takes encounter
form and puts it in holding cart
Encounter form goes to billing, where it is reviewed
by dental specialist
Patients with co-payments (self-pay or commercial insurance) take encounter form to
registration and check out
If patient agrees to care plan, next appointment is made
Encounter form goes to billing, where it is reviewed and patient invoice is generated for balance due, if any
Patient accounts specialist takes encounter form
Third Party insurance Self-Pay
Patient gets bill and pays or continues to get billed
Written off
Claim is filed
Claim is paid or denied
Paid Denied
Reconciled against patient account
Investigated, corrected and
rebilled
Claim is paid or denied
Reconciled against patient account
Paid
Written off
Hopeless
Submitted for payment again
Still Hope
Sample Billing Flow Chart (cont.)
Encounter form goes to billing, where it is reviewed
by dental specialist
Reconciled against patient
account
Paid Hopeless
Strategic Planning
• After establishing where it is (through practice analysis), the practice needs to decide where it wants to go and how it will get there
– Define the practice’s mission and explore scope of service– Develop an action plan to get the practice to achieve the goals of:
• The dental practice’s mission (access and services) • The overall health center mission• Financial sustainability• Quality dental health indicators• Completion of Phase 1 Treatments
• Develop policies, procedures, and operations that foster the attainment of the dental practice’s goals
• Develop long- and short-term goals and action steps• Regularly review practice data to monitor performance of dental
program
What Data Should We Gather?Gross Charges
Net Revenue
Expenses (Direct and Indirect)
Total Number of Visits
Revenue per visit
Cost per visit
Number of Completed Phase 1 Treatments
Number of New Patients
Number of Unduplicated Patients
Number of Transactions (by ADA Code)
No-Show Rate
Emergency Rate
Number of FTE Dentists
Number of FTE Hygienists
Number of FTE Dental Support Staff
Any Change in Scope of Service?
Any Change in hours of operation?
Partnering to Strengthen and Preserve the Oral Health Safety Net
2400 Computer Drive, Westborough, MA 01581 Tel: 508-329-2280 Fax: 508-329-2285 www.dentaquestinstitute.org
A PROGRAM OF THE