Cindy Dullea, RN-BC, MBA, CHAM Chief Clinical Coach Marbella Technologies, Inc. Assistant Professor...

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Cindy Dullea, RN-BC, MBA, CHAM

Chief Clinical CoachMarbella Technologies, Inc.

Assistant ProfessorUniformed Services University

Patient FocusedRevenue Cycle

Maximizing Efficiency

Patient Flow

Rules Based Scheduling

Referral Management

ICD-10

RAC Audits

Self Service Patient Loyalty

HCAHPS

POS Collections

Eligibility

FRONT DOOR Medicare and Medicaid Changes

Pre-Arrival Unit

Employee Retention

Electronic Orders

Clinical Management

Financial Clearance

Insurance Verification

Authorization Management

Referral Management

Self Scheduling

The Alphabet Soup of Access Management

Source: Organization for Economic Co-operation and Development (2010), "OECD Health Data", OECD Health Statistics (database). doi: 10.1787/data-00350-en (Accessed on 14 February 2011).Notes: Data from Australia and Japan are 2007 data. Figures for Belgium, Canada, Netherlands, Norway and Switzerland, are OECD estimates. Numbers are PPP adjusted.

Implications Consumer Driven Healthcare

Passing Medical Inflation to Consumer Spending Your Own $$ Curbs Excess Spending

High Deductible Insurance Catastrophic Coverage Only

Provider Impact Lower Utilization Increased Bad Debt Pricing Transparency

Patient Confusion Decreased Satisfaction

Patient Confusion

Quality Food Tastes Good and Everyone Was So Nice

Pricing Concerted Effort At Deception? Trend toward Efficiency

Service Convenient Friendly Easy

What was the Patient Experience?

Current Healthcare Environment

Credit Markets Frozen Economic Recession 17.% of All Americans Uninsured (2012) 60% of those Commercially Insured on High

Deductible Plans with 10 million + Beneficiaries

Bad Debt Skyrocketing Nationally National Debt Skyrocketing – averaging

$1.311 trillion per year Healthcare Reform – new taxes

Hospital Strategic Response Develop a Strategy for Market Consolidation

Assess acquisition opportunities Consider sale or affiliation opportunities Evaluate asset performance and ownership requirements Evaluate physician network strategies and ACO Adoption

Manage the Balance Sheet Deploy cash judiciously Manage relationships with financial entities Restructure long-term debt Monitor balance sheet closely Update strategic capital plan

Strengthen Operating Performance Improve throughput to increase capacity and revenue Fine tune growth strategies Rationalize programs and operations

Access ManagementOrdering, Scheduling, Registration Processes

Key to Success

Enable a ‘Smart’ Start to the Revenue Cycle

Care DeliveryProcesses

BillingProcesses

Enable a Great‘Front Door’ Experience

ConsumersPhysicians

Utilize Resources Accurately and

Optimally

Good Access Management Helps Hospitals Improves Physician Networks

Connectivity = Better Service = MD Stickiness Strengthens Operating Performance

Increase Utilization of Resources Decrease Labor/Supply Costs Reduce Bad Debt and Denial Write-offs Improve Cash Flow

Basis for Great Customer Service Convenience and Courtesy = Positive Patient

Experience Management Reporting

Continuous Operational Improvement Development of Marketing Initiatives

Keys to Good Access Management

100% Coverage Pre-Registration Revenue Cycle Activities

Identify Problems Early Start in the MD Office or Patient’s Home

Utilize “Smart” Systems Goal to Replace Labor Understand the Nuances of Healthcare

Learn From the Past Aggressive Data Collection and Feedback to Improve

Operations Know Your Customer’s Preferences

Self Service

What’s The Workflow?

Intelligent Scheduling

Key Features Rules Engine Ensures Accuracy All Locations Search across Enterprise Provider Portal

Self-Scheduling, Appointment Itinerary, and Online Order Submission

Consumer Portal Self-Scheduling, Re-Scheduling,

Appointment Details

What the Rules Engine Can Do…Based on the resource (or any resource

detail), the task (or any task detail), and/or the patient (or any patient detail), the Rules Engine can:

Prompt a question Insert a task Replace a task Delete a task Modify the duration of a task Delete a resource Add a resource Replace a resource Place an entry on a Worklist Update an entry on a Worklist …and, based on the answer

to a question, the rules enginecan do all this as well as promptanother question.

Question

Answer

Rule

Expert Scheduling Knows the Rules

Question

Answer

Rule

• First available time/date at each location where test is performed

Spreads demand across health system

Multiple Locations – Service and $$

• First available time/date at each location where test is performed

Spreads demand across health system

Consumer Convenience

Start the Revenue Cycle EarlyGoal is 100% Coverage

Work Flow Mandatory MD Office

Authorization and Referral Management Medical Necessity Checking (Coding)

Pre-Registration as part of Scheduling Call Smart Eligibility Data QA

Support Financial Counseling/Self-Pays Pricing Transparency Automate ABNs Screening for Govt and Charity Programs

• View of All Arrivals

• Rules define when items are ‘escalated’

• Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)

Work Flow Insures 100% Coverage

• View of All Arrivals

• Rules define when items are ‘escalated’

• Notes can be captured regarding pre-reg status (i.e., “called Betty Jones at 10 AM, left message”)

Order Process Captures CPT & Authorizations

Real Time Insurance Verification

Beware!! Insurance Authorization Required

Identify Self-Pays Early for Financial Counseling

Details Allow POS Collection for Co-Pays

Financial Counseling

During the FC Visit self-pay pricing and

other payment optionsare discussed.

Printout Notice of Non-Coverage

Physician Stickiness Improve Their Efficiency

On-line Ordering and Results Reporting Fewer Disruptions

Medical Necessity Issues Illegible Orders

Improve Their Office Efficiency Faster Scheduling (One Call or Web) Fewer Disruptions

No Lost Orders Happy Patients

Convenience with No Surprises Reminders (Appointments actual and preventative)

Timely Scheduling Avoids Problems

Eliminate Office Disruption from Illegible Orders

Results Reporting

Attach results to the order or referral

MD to MD Referrals Includes PHI Information

View Entire Schedule by Day, Week, Month

Exporting appointments to Outlook can be done right from the Appointment Book with a few clicks

Download to Smart Phone

Customer Self-Service Convenience

Scheduling Pre-Registration Appointment Reminders No Lost Orders or Schedule

Delays Patient Arriving

Check-in Update Registration Payment Location Maps

Option topick preferred

location

Scheduling Convenience

Option to pre-register for appointment

Avoid Registration Lines

Links to onlineforms

Eliminate Bad Prep Cancellations

Links to onlineforms

Patient Itinerary Avoids Confusion

Patient Arrives – No Waiting

Patient Selects Appointment

Patient Updates Personal Data

Patient Signs Forms – Eliminates Paper

Patient Pays Co-Pay

Wayfinding

Why Not?

Check In With Personal Devices

Labor Optimization

Centralized Call Centers MD Referral Patient Scheduling Order Collection Pre-Registration Revenue Cycle Activities

Resource Utilization Eliminates “Country Club” Scheduling Automates Manual Tasks (e.g. Eligibility, Order

Tracking) Decreases “No Shows”

Call Center Productivity   Average Speed Abandonment Inbound Calls Appointments Schedulers

  to Answer (ASA) Rate /Day /Scheduler /Day /Scheduler /Day

Call Center 29 seconds 2% 69 62 9

Hospital #2 19 seconds 3% 38 45 8

Hospital #3 97 seconds 10% 81 55 9

Hospital #4 n/a n/a 76 42 8

Hospital #5 30 seconds 8% 34 36 5.5

Hospital #6 20 seconds 4.4% 45 53 3

Hospital #7 9 seconds 2.2% 34 40 4

The Key is Expert AM Systems because - Faster Training - Cheaper Labor - Multi-Task Performance - Multiple Facility Coverage - Better, Consistent Customer Service

Better Patient Experience!

Resource Optimization

Open Slots that may be overlooked

Block Times AllocatedOn Experience

Resources Only Allocated for Time Required

Ritz Ritz Carlton Service Too Many Places to Call Lack of Information Integration Constant Replication of Information Patient Dissatisfaction Long Wait Times Confusing Campus Discourteous Employees

Marketing for Better Community Health

Individual Health Initiatives Follow-ups MD Orders Not Followed Through Preventive Health Initiatives (Mammograms,

Chronoscopes

LettersPartner

Reminder LettersNo-Show Letters

Reporting / Access to Data

ProductionDatabase

Reports(and extracts)

Operational Reports & Patient

Itineraries

Statistical, Management,

Ad-Hoc Reporting

iReports

Secure FTP

Email

Power-User

Itineraries faxed to MD offices

Email

ScheduleViewer

CallsPartner

Reminder CallsNo-Show Calls

Leaving the “WHY” For Last• A record 2.8 million Baby Boomers qualified for Medicare in 2011, rising to 4.2 million a year by 2030 •51 million members of Generation X •Generation Y – The New Millennials are 70 million strong -Young, Brash and Smart

•Gen Z - 1994 and before 2004•Highly connected – home computer obsolete•No life before the advent of mass technology!

Access To Healthcare Next?

Cindy Dullea, RN, MBA, BC, CHAMcadullea@verizon.net