Workflow Analysis final webinar · PDF fileDevelop a SIPOC* diagram of each process area 3. ... Create a process map ... Complete current workflow analysis

Workflow Analysis: A founda)onal piece of transi)oning to ICD-‐10

Triche Guenin 303-‐777-‐9680

Partners Through Change, Inc. [email protected]

CMS – ICD-10 Impact

Triche Guenin 303-777-9680 www.partnersthroughchange.com 2

Robin Schiffbauer Elizabeth Etzler

  Facilitator

  Guest Volunteers Triche Guenin


What Why Identify where, in daily operations, the ICD-9 codes are used

Better understand where the new ICD-10 codes could make an impact

Train personnel on how to read and draw process maps

Provide foundation for ongoing capability to standardize and document processes

Identify opportunities for improvement

Chance to streamline process while making changes to accommodate ICD-10 compliance


  Demonstrate how understanding workflow can facilitate the transition to ICD-10.

  Show how workflows can: ◦  be leveraged as the umbrella that supports all other

studies/initiatives; ◦  provide a construct from which all other changes to

organization/policies & procedures can be shared and shown how they interconnect.

  Specifically points to where ICD-9 activity currently occurs and will be impacted by changes to ICD-10.



  Pictoral description of work   Shows the “big picture”   Quickly surfaces unexpected complexity, problem

areas, redundancy, unnecessary loops   Focuses on work, not WHO does it   Shows interconnectedness of work activities   Identifies locations where additional data can be

collected and problem areas investigated





  In development

patient balance?

Complete consideration

form (incl claim/appeal

form)

Coding

N

Y

Y

N Billing

Medical

Records

Correct claim

Receive status from

payor

Print & send to payor

Spool claims & forward to

clearinghouse

Distribute to insurance rep

(internal)

Review outstanding

claims

Fix error

Electronic?

Errors found?

Charge pt Write-off

Contact payor

Receive & post payment

3rd denial?

Is claim correctible?

Approved? End

N

N

N

Y

Y

Y

Y

N

Write-off criteria

  Completed and in electronic format (e.g. ppt)

1.  Identify key process areas in organization 2.  Develop a SIPOC* diagram of each process area 3.  For each process area, understand current state ◦  Gather stakeholders together ◦  Create a process map ◦  Identify not only work activities but other areas of interest (e.g.

ICD-9 touch point, systems used, metrics) ◦  Identify opportunities for improvement ◦  Validate with “others”

4.  Perform analysis of workflow for changes towards compliance and streamlining for efficiency


Triche Guenin 303-777-9680 www.partnersthroughchange.com 7 *SIPOC = Supplier, Input, Process, Output, Customer

  Start with patient processes ◦  Example 1: Patient Pre-Encounter, Patient/Doc Encounter, Fulfill

Physician Order, Patient Discharge

◦  Example 2: Patient Intake, Nurse Visit, Patient Encounter, Physician Orders, Patient Exit

  Identify “other” supporting processes: •  Medical Records •  Coding •  Claims •  Billing/Superbill/Documentation •  Referrals/Precerts/Pre-Authorization •  Contracting •  Analytics •  Risk Mgmt



There is no “right” number/series/naming for your processes!

•  Internal Auditing •  EMR/IT Updates/Maintenance •  Research Participation •  Appeals •  Public Health Reporting



PROCESS

Supplier 1

Supplier 2

Supplier 3

Customer 2

Customer 1

output

input

output

input

input

Definitions: •  Supplier - whomever provides input into the process •  Input – materials, resources, information, data, guidelines, etc. required to execute the process •  Process - sequence of related activities that transform inputs into outputs to provide value for the customer •  Output – products/services resulting from the process, addressing the customer’s needs •  Customer – whomever receives the output(s) of the process – may be an internal or external entity



Suppliers Input Process Output Customers

Patient Encounter

Patient

Physician

Admit Team

Ancillary Services

Payor

Self

Pt Hx/Vitals

Pre- Authorization

SME

D/C Team

Physicians Orders

Ancillary Services

ReferringPhysician

Physicians Orders

Test/ Lab Results

Encounter Form Information/ Physician Notes Coding

Personnel

Physicians Orders

  Identify scope (start/stop) points   Understand the handoffs between other processes

(e.g. SIPOC)   Determine what additional info needed ◦  ICD-9 use ◦  Metrics ◦  System interface ◦  Opportunities for Improvement

  Can be used when mapping current (As-Is) or future state (To-Be) work environments







Starting/Stopping Point

Activity

Decision

Process (out of scope)

Work Movement

13

Data Movement

*caveat: there are many more standard icons, but these are the basic few needed to get started…some follow standard convention and others don’t to facilitate ease of use



Suppliers Input Process Output Customers

Patient Encounter

Patient

Physician

Admit Team

Ancillary Services

Payor

Self

Pt Hx/Vitals

Pre- Authorization

SME

D/C Team

Physicians Orders

Ancillary Services

ReferringPhysician

Physicians Orders

Test/ Lab Results

Encounter Form Information/ Physician Notes Coding

Personnel

Physicians Orders



Review pt. symptoms Assess pt. Treat pt.

Further

testing?

Further

testing?

Provide clinical

summary

N N

Y Y

Basic Process Start

Stop

*WIP = Work in process




Further

testing?

Further

testing?

Provide clinical

summary

Patient Exit

Physician

Order

Patient Intake

Physician

Order Coding

N N

Y Y

Validate handoff processes (and associated inputs/outputs) from SIPOC

Coding




Further

testing

Further

testing

Provide clinical

summary

Patient Exit

Physician

Order

Patient Intake

Physician

Order

Coding

N N

Y Y

Gather additional information

EHR EHR EHR

Key: System ICD-9 Metrics

90%

10% 65%

35%

x%



Dig deeper in area need to investigate

Document diagnosis/

findings/notes

Validate pt complaint/hx

Determine initial

diagnosis

Perform Physical

Confirmation

EHR

Coding

.

  Changes needed to achieve ICD-10 compliance ◦  Content knowledge – clinical personnel/staff (FT/PT) ◦  Template conversions (e.g. forms/screens/documents/policies/

training materials) ◦  Payor coverage ◦  Referral acceptance ◦  Systems & system integration (e.g. # digits, vendor timing/

compliance capabilities) ◦  …

  Streamlining for efficiency ◦  Incorporate opportunities for improvement ◦  Implement “lean” principles ◦  Automate where possible ◦  Clarify roles & responsibilities ◦  Align skill sets ◦  …



 Complete current workflow analysis  Get more specific where ICD-9 touches   Identify “other” opportunities for improvement  Learn nuances of ICD-10 codes applicable to specific practice

(e.g. content, combinations, # characters)  Develop “new” improved compliant process(es)  Determine appropriate roles & responsibilities  Document via standard operating procedures  Integrate systems to handle/recognize the new codes  Train personnel on new processes/roles/forms/codes…..  ….


Deadline is Oct 2014!


  “this session helped to expose areas where ICD9 shows up that I’d forgotten”

  “now have an appreciation of how my work intersects with my co-workers”

  “this is exciting to see our work laid out like this – I get it!”   “wish I could have been in all other mapping sessions – learned a

lot”   “the referral process concerning ICD is huge”   “it created an awareness of other colleague and departmental

responsibilities”   “really show how interconnected our processes are and how to tie

information between each”   “should be done for whole organization”   “not just for ICD 10 transition – great to show where

improvements & streamlining can be done”   “rude awakening, quite enlightening”



  Questions on workflow?   If don’t know where to start or need help in  Facilitating mapping sessions  Analyzing workflows  Identifying opportunities for improvement  Developing streamlined work processes  Determining roles & responsibilities  Documenting new policy/procedures  …

Triche Guenin 303-777-9680 [email protected]


CMS – ICD-10 Impact (NWP)

* Working for you! www.cms.org/icd-‐10

Documents

Workflow Analysis final webinar · PDF fileDevelop a SIPOC* diagram of each process area 3. ... Create a process map ... Complete current workflow analysis