Value Analysis Harnesses Internal Value Analysis Harnesses Internal Resources for Process ChangeResources for Process Change

June 2006 SAVE Government ConferenceJune 2006 SAVE Government Conference

Value Analysis (VA) is Value Analysis (VA) is notnot……Value Analysis (VA) is Value Analysis (VA) is notnot……

Simply consultants providing input…Simply consultants providing input…

Function-Based Work FlowchartFunction-Based Work Flowchart

VA Revenue Enhancement StudyVA Revenue Enhancement Study Pre-Study Orientation SessionsPre-Study Orientation Sessions

• Kick-off and Hospital Tour (1-day) Kick-off and Hospital Tour (1-day) • Current Work Flowcharts Discussed (2 days)Current Work Flowcharts Discussed (2 days)

Pre-Study Review of Revenue DataPre-Study Review of Revenue Data 5-day Value Analysis Workshop5-day Value Analysis Workshop

• Functions and Areas of Opportunity IdentifiedFunctions and Areas of Opportunity Identified• Creative PhaseCreative Phase• Evaluation/Analysis PhaseEvaluation/Analysis Phase• Development PhaseDevelopment Phase• Presentation PhasePresentation Phase

Post-Workshop Implementation MeetingPost-Workshop Implementation Meeting

Value Analysis ParticipantsValue Analysis Participants VA FacilitatorsVA Facilitators Hospital Executive Management (part time)Hospital Executive Management (part time) Hospital Departmental StaffHospital Departmental Staff

• Patient AccountsPatient Accounts• Registration from Major DepartmentsRegistration from Major Departments• AdmittingAdmitting• Utilization ManagementUtilization Management• Health Information ManagementHealth Information Management• FinanceFinance• Information ServicesInformation Services• PhysiciansPhysicians

Consultants (typically 3)Consultants (typically 3)• Healthcare Revenue Healthcare Revenue • Managed Care RevenueManaged Care Revenue• IT SystemsIT Systems

Parameters for a SuccessfulParameters for a Successful Value Analysis StudyValue Analysis Study

Commitment from Executive ManagementCommitment from Executive Management• Requires 8 days of participation by key staff membersRequires 8 days of participation by key staff members• Must agree to implement acceptable ideasMust agree to implement acceptable ideas

Open DiscussionOpen Discussion• Vow of Confidentiality Among ParticipantsVow of Confidentiality Among Participants

Listen to StaffListen to Staff• Ensure Clear Understanding of Current ProcessesEnsure Clear Understanding of Current Processes• Encourage Team to Suggest Alternative ApproachesEncourage Team to Suggest Alternative Approaches• Clarify if Resources are Preventing Revenue CaptureClarify if Resources are Preventing Revenue Capture

StaffStaff Printers, Computers, PaperPrinters, Computers, Paper Software ApplicationsSoftware Applications Reliability of Current TechnologyReliability of Current Technology

Judgment Withheld Until Appropriate TimeJudgment Withheld Until Appropriate Time Assign Person to Coordinate Implementation, Assign Person to Coordinate Implementation,

Track Progress and Record ResultsTrack Progress and Record Results

Recommendations CoveredRecommendations Covered

Utilization ManagementUtilization Management

Maximize ReimbursementsMaximize Reimbursements

Capture Unbilled RevenueCapture Unbilled Revenue

Improve Patient InformationImprove Patient Information

Denials ManagementDenials Management

Enhance Systems Enhance Systems

Upgrade Coding Capability Upgrade Coding Capability

Utilization ManagementUtilization Management

Key Proposals and ImpactsKey Proposals and Impacts Extend Clinic HoursExtend Clinic Hours ($3.5m)($3.5m) Create Charge Capture Czar ($8.0m)Create Charge Capture Czar ($8.0m) Perform Ancillary Tests on Weekends ($5.9m)Perform Ancillary Tests on Weekends ($5.9m) Hire Surgical Coordinator ($4.5m)Hire Surgical Coordinator ($4.5m) Modify Ambulatory SurgeryTesting and Modify Ambulatory SurgeryTesting and

Registration/Scheduling ($10.7m)Registration/Scheduling ($10.7m) Add Staff Selectively ($6.4m)Add Staff Selectively ($6.4m)

Utilization Management (cont.)Utilization Management (cont.)

Redesign Clinic Scheduling ($5.3m)Redesign Clinic Scheduling ($5.3m) Expand Services in Pediatrics, OB, Expand Services in Pediatrics, OB,

RehabRehab ($11.2m)($11.2m) Modify Provider Contracts ($41.1m)Modify Provider Contracts ($41.1m) Develop Revenue Scorecard ($7.0m)Develop Revenue Scorecard ($7.0m) Improve Community Outreach ($2.1m)Improve Community Outreach ($2.1m) Establish Redirect Office ($1.9m)Establish Redirect Office ($1.9m)

Maximize ReimbursementsMaximize Reimbursements

Key Proposals and ImpactsKey Proposals and Impacts Revise Approach to Self Pay Accounts Revise Approach to Self Pay Accounts

($2.3m)($2.3m) Clear Up Unbilled BacklogClear Up Unbilled Backlog ($8.0m)($8.0m) Bill for all Physician Services ($2.4m)Bill for all Physician Services ($2.4m) Periodically Re-bill Medicaid ($5.0m)Periodically Re-bill Medicaid ($5.0m) Add Staff Selectively to AR, ED, Admissions, Add Staff Selectively to AR, ED, Admissions,

BH, Medicaid Enrollment ($15.1m)BH, Medicaid Enrollment ($15.1m)

Capture Unbilled RevenueCapture Unbilled Revenue

Key Proposals and ImpactsKey Proposals and Impacts

Bill for Nursing Visits, Blood, Drugs, Bill for Nursing Visits, Blood, Drugs, DevicesDevices ($2.3m) ($2.3m)

Enroll all Pediatric Patients in Insurance Enroll all Pediatric Patients in Insurance Plans ($2.0m)Plans ($2.0m)

Improve Patient InformationImprove Patient Information

ChallengesChallenges

Patients Do Not Want to Share Their Patient Patients Do Not Want to Share Their Patient InformationInformation

Patients Give False AddressesPatients Give False Addresses

Patients Have Grown Accustomed to Patients Have Grown Accustomed to Receiving Free CareReceiving Free Care

Improve Patient InformationImprove Patient Information

Key Proposals and ImpactsKey Proposals and Impacts Train all Registration Staff to gather Patient Train all Registration Staff to gather Patient

Financial Information with Documentation Financial Information with Documentation ($2.5m)($2.5m)

Train Clinicians to Fully Document Medical Train Clinicians to Fully Document Medical Record ($.9m)Record ($.9m)

Establish Field Units to Gather DocumentsEstablish Field Units to Gather Documents($6.3m)($6.3m)

Improve Mail Handling ($2.4m)Improve Mail Handling ($2.4m)

Denials ManagementDenials Management

Key Proposals and ImpactsKey Proposals and Impacts Create Denials Management Task Force Create Denials Management Task Force

($20.2m)($20.2m) Address Social Admissions Issues ($9.8m)Address Social Admissions Issues ($9.8m) Educate Clinicians Educate Clinicians rere Denials ($2.5m) Denials ($2.5m) Add Staff to Work Denials ($9.2m)Add Staff to Work Denials ($9.2m) Focus on One-Day Stays/Close Clinic Focus on One-Day Stays/Close Clinic

Visits/Reconcile ED and Admit Dates ($4.5m)Visits/Reconcile ED and Admit Dates ($4.5m)

Enhance SystemsEnhance Systems

Key Proposals and ImpactsKey Proposals and Impacts Enhance Capture of Full Medical Enhance Capture of Full Medical

DocumentationDocumentation ($3.0m) ($3.0m) Implement Claim ScrubberImplement Claim Scrubber ($6.8m) ($6.8m) Update MD lists, Codes, Provider Data Update MD lists, Codes, Provider Data

Tables ($2.7m)Tables ($2.7m) Link EMR and Patient Accounting SystemsLink EMR and Patient Accounting Systems

($4.0m)($4.0m) Bar Code ED Charts/Put Online($4.5m)Bar Code ED Charts/Put Online($4.5m)

Upgrade Coding CapabilityUpgrade Coding Capability

Key Proposals and ImpactsKey Proposals and Impacts

Add Coding ValidatorsAdd Coding Validators ($3.1m)($3.1m) Add, Train and Credential Add, Train and Credential

Coders/Upgrade Titles and Pay Coders/Upgrade Titles and Pay ($5.3m)($5.3m)

Value Analysis Results(6 Workshops)Value Analysis Results(6 Workshops)

Proposal Themes Net Projected Revenue

Utilization Management 107.6m

Maximize Reimbursements 32.8m

Capture Unbilled Revenue 4.3m

Improve Patient Information 31.7m

Denials Management 46.2m

Enhance Systems 21.0m

Upgrade Coding Capability 8.4m

Potential Revenue Impacts 252.0m

What Makes VA Different?What Makes VA Different?

Team-Based Approach Team-Based Approach

Utilize Hospital Staff as Members of TeamUtilize Hospital Staff as Members of Team

Supplement Team with ConsultantsSupplement Team with Consultants

Changes are Recommended by Credible Front-Line Changes are Recommended by Credible Front-Line Staff and are not Imposed from OutsideStaff and are not Imposed from Outside

Function-Based Analysis of Current ProcessesFunction-Based Analysis of Current Processes

Limited Involvement of Executive ManagementLimited Involvement of Executive Management

Sessions are Away from Normal Work EnvironsSessions are Away from Normal Work Environs

Key Benefits of Value AnalysisKey Benefits of Value Analysis

Revenue ImprovementRevenue Improvement

Team Building Among StaffTeam Building Among Staff

Staff Discussions of Current Processes Staff Discussions of Current Processes Identify Most Issues/Opportunities/IdeasIdentify Most Issues/Opportunities/Ideas

Consultants Provide Experience from Similar Consultants Provide Experience from Similar HospitalsHospitals

Team Becomes Change AgentsTeam Becomes Change Agents

Change Implementation More Likely as Staff Change Implementation More Likely as Staff Buy-in During StudyBuy-in During Study

Morale ImprovesMorale Improves