Spontaneous Combustion: Making and sustaining change in Patient Access

1. Spontaneous Combustion: Making and sustaining change in Patient Access Debi Stolic, Director of Patient Access, Bethesda Memorial Hospital Anne Habib, OputmInsight

2. Overview • Introduction • Bethesda Health System • Continuous Improvement Culture • Case Study – Up Front Cash Collections • Sustainable Change

3. Bethesda Healthcare System Bethesda Memorial Hospital is located in Palm Beach County, Florida. We have 401 beds, 525 physicians and 2,300 employees. Bethesda West Hospital opens in early 2013 with 80 beds; the design facilitates growth to a 400 bed hospital in future years.

4. Bethesda Memorial Hospital

5. Patient Access at BMH • Pt. Access • Central Scheduling – 16.5 FTE’s • Registration – 38.8 FTE’s • 5 Patient Access Points of Entry • Our Numbers • 20,578 Admissions • 60,001 ED Visits • 175,558 Outpatient visits • 141,195 Tests scheduled • Systems • QuadraMed Enterprise Scheduling • Siemens Patient Management (Invision) • Estimator Pro

6. BMH Payer Mix

7. Continuous Improvement Culture Overview • Need to Improve Operations • Tired of IN & OUT Consulting Projects • Methodology/Structure for Independence • Identify and List Opportunities • Define Resolutions • Prioritization Criteria • Implement Solutions • Feedback Loop • Next Project

8. Identify Issues - SIPOC Customers Suppliers Outputs Inputs Process Customer contacts Central Scheduling Physicians Insurance Info Appointments Patients Payer Directions Charge Codes Families Scheduler answers phone using Symposium phone system Insurance Subscriber Test Scripts Patient Transportation Associates Demographic Data Searches for Patient in QuadraMed Scheduling Follow Up Calls Physicians/Nurses Other Facilities Appointments Pre-Visit Information Ancillary Departments Obtain/Review/Update Patient’s demographics Insurance Carriers Other Facilities Schedules appointment Case Mangers Performs Pre-registration If possible

9. Define Opportunities

10. Document Process

11. Prioritize Projects Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategicor Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections OutPatient Through Put ED Mobile Computing List Prioritized Projects Improvement & Standardization Control Plan Baseline Measures Measure , Analyze, Improve, Control Continuous Improvement

12. Document Projects Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategicor Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections OutPatient Through Put ED Mobile Computing List Prioritized Projects Improvement & Standardization Control Plan Baseline Measures Measure , Analyze, Improve, Control Continuous Improvement

13. Implement Project Increase Cash Collections Reduce Waste & Cycle Time Reduce Variation & Defects End Results Benefit Strategicor Tactical Quick Hits LEAN Projects DMAIC projects Cash Collections OutPatient Through Put ED Mobile Computing List Prioritized Projects Improvement & Standardization Control Plan Baseline Measures Measure , Analyze, Improve, Control Continuous Improvement

14. Feedback Loop Pt. Access HIM PFS Auth iVerify ROI Pre-Reg Code Sch Trspt Reg CE Pay Post Collect Bill SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP1 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP2 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP3 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 SP4 Feedback M E T R I C S

15. Case Study – Up Front Cash Collections Prioritization • Improved Cash Collections – High Priority • Both strategic and tactical • Lean Project • Baseline Measurement – to determine results • Analysis - to ensure Improvement & Standardization • Implementation Plan – to ensure success • Control/Monitoring Plan – for sustainability

16. Importance of Up Front Collections • If patient leaves without making a payment; chances of collection go down to 40%. • Improved patient satisfaction when financial responsibility is known. • Receiving a large bill months after service can cause many patients to think negatively about their experience. • Without POS, the hospital is basically financing a service interest free for 60 days. • As collection costs increase, cash flow to pay salaries and medical equipment may not be sufficient.

17. Baseline Measure • Central Scheduling • Zero • Outpatient/Admitting • $6,139 • Surgery Center • $29,386 • Heart Institute • $4,001

18. Implementing Technology Price Estimator • Have realistic expectations of the technology • Understand the pros and cons of the technology and work with the pros • Keep your eye on the goal • Communicate with your vendor and have regularly scheduled meeting/conference calls to work through issues quickly

19. Training Technology, Process, & Collections • Technology • Basic training on Estimator • Challenges – understanding terminology • Process • Inserting Estimates and Collection into the pathway • Clearly documented process comparing current and future states • Collection Scripts • Developed statements that are said to patients in a consistent manner including how to handle responses from the patient • Speaking with confidence, use of empathy, identifying excuses vs. the need for true financial assistance.

20. Motivating the Team • Bonus Plans • Movie Tickets • Pizza Parties • Lunch Passes • Good Old Competition & Recognition • Poster boards in departments • Target goals

21. Tracking Collections

22. Out Patient Results

23. Central Scheduling Results

24. Ambulatory Surgery Results

25. Bethesda Heart Results

26. Sustainable Change • What will make the improvements stick? • In improvement projects, make sure the root cause of the problem has been resolved for the long-term • Put metrics in place to notify management if the problem begins to occur again Regular monitoring and early intervention avoids discrepancies, reprocessing, and waste

27. Thank You!