AAHAM Spring Educational Meeting

Friday, May 21, 2010

Discussion Outline

Revenue Cycle Industry Trends Proposed Revenue Cycle Strategy PASC Goals and Objectives Building PASC Potential Barriers to Success Questions

Uninsured Population Nationwide, the number of uninsured increased

from 39.8 million in 2001 to 46.3 million in 2008. Private coverage is eroding under the status quo.

The percentage of people with employer-based coverage decreased from 69.8% of the population in 2001 to 64.5% in 2008.

More workers are being left without protection from health care costs.

The problem of the uninsured is a problem that crosses income brackets. The new Census numbers also drive home the fact that everyone is vulnerable to losing health insurance.

 

Many uninsured patients who do qualify for federal and state financial assistance programs do not utilize those programs.

If not captured at the time of service, the likelihood of conducting an eligibility evaluation is drastically reduced. 70% become bad debt.

Uninsured Seeking care in the Emergency Department According to a report issued in July

2009, uninsured patients comprise approximately one-fifth of all emergency room visits.

Emergency room care is not only expensive to the patient, it is expensive to provide.

Emergency room care is often non-emergent

“The average emergency room visit costs $1,000, as compared to the average clinic visit of $29 and an average primary care doctor visit that can range from $75 to $120”

Under-Insured Population Those considered “underinsured” have

health insurance that falls short of adequately covering health care needs, and often spend 10 percent or more of their annual income on health care costs. $40,000 annual income spends $4,000

National nonprofit health care group Community Catalyst reported in April 2009 that one-fifth of all insured adults in the US – about 25 million citizens – were underinsured in 2007.

Industry Trends On average, 70% of

all hospitals patient pay is written off to bad debt.

Bad Debt and Charity represent a combined 11% of hospital’s revenue in the Southeastern U.S.

Bad Debt Charity

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Charity 50.17% of Total

Bad Debt 49.83% of Total

“Rising Levels of Un-Insured & Under-Insured Populations Increase E/D Visits” Emergency Departments generate the majority

of bad debt when tracking by service. On average, 50% of a hospitals bad debt is from

the Emergency Department. On average, 50% of a hospitals

inpatient/observation admissions originate in the Emergency Department.

*HFMA Teleconference, Point of Service Collections

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Non-Urgent ED Visit Trending by Payer

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Industry Trends Physicians are also experiencing

decreased reimbursement, requiring them to become more administratively efficient.

Complexities in Managed Care ContractingDelays and billing/clinical requirements

Advent of Pay for PerformanceDocumentation – Clinical

Increases in self pay patients/portions RAC Recovery Audit Contractors

FY 2010 Revenue Cycle Strategy “Fortify” the Emergency Department Create a Patient Access Service Center

Centralized Scheduling ○ Promote Patient and Physician Satisfaction○ Increase accuracy and completeness of registration

data○ Improve compliance○ Identification and collection of self pay portions, co-

pays and deductibles at or before the time of service

○ Create opportunity for eligibility review prior to service

Overview and Objectives Increase accessibility and ease of use to Patients and

Physicians. Improve the accuracy and completeness of registration

and billing information, decreasing re-work and denials Provide comprehensive payment and funding options

at or before the time of service Ensure insurance verification and pre-authorization

processes and tools are utilized consistently in order to reduce related denials

Improve up-front cash collections and reduce bad debt. Introduce eligibility and charity programs before service.

Our ApproachPatient Access Service Center Development (PASC)

HBPI believes in adopting a “Case Management” mentality in patient access. That is, individuals “Own” patient encounters and are responsible for ensuring that ALL aspects of the scheduling, pre-registration, financial counseling and up-front cash collection functions are performed.

In summary, key aspects of HBPI’s approach to a PASC Unit development project are:

•Heavy physician and clinical department input and on-going support.•Establishment of “Specialty Scheduling Pods”•Leverage technologies that will keep physician office staff off of the phone while promoting accuracy and compliance •An electronic order facilitator•Elevated staff requirements that mirror a “Case Management” philosophy.

Phase I-Design and Budget First 60 Days

Prepare Budget/Obtain Approval

Phase II-ImplementationNext 90 Days

Plan, Train, Implement

Phase III-Monitor and MeasureFinal 60 Days

Go-live, “Tweaking,” Monitoring

Potential Barriers to Success & Collaborative ResponsesIssue Solution

Rigid planning the mirrors past unsuccessful attempts

Lack of control resulting in negative operational outcomes

Specialized knowledge of the department and its technical and process requirements

Responsiveness when issues arise

Orders, Orders, Orders

Brainstorming sessions with departments & physicians to understand concerns

Extensive training & documentation supported by enhanced technology

Establishment of “Specialty Pods” and quarterly scheduler “In-service”

Department/Physician Liaison

Adoption of an Electronic Oder Facilitator

How it Works…

Questions ?

AAHAM Spring Educational Meeting

Friday, May 21, 2010

Discussion Outline

Reasonable expectations Communication Measuring performance Rates, fees, performance incentives Level the playing field Annually

Set reasonable expectations Assemble an internal group to outline what

the organization expects from a vendor. Consider:Customer Service/SatisfactionTimelines, deadlines, close processUser-friendly performance reportingPerformance

Vendors also have to manage a budget Zero complaints is not a reasonable

expectation Understand vendors expectations

Communication Make sure that your vendor knows what is

important to the organization Communicate what you want. If the vendor

tries to fit it into “their” box; find another vendor Require early intervention feedback loops If something is not working, communicate until

it is resolved Identify vendor staff that will “get the job done”,

resolve issues with a sense of urgency Set standing communication meetings Focus on building “team approach” to the

vendor relationship

Measuring Performance Ensure that what you are measuring

reflects “what is important to the organization”

Outline exactly what you need on their performance reports, including data, format and delivery.

Do not waste time reviewing their statements in detail every month.

Monthly measure key indicators, not detail

Rates, Fees & Performance Incentives If you bargained for the lowest possible rate,

you cannot expect the highest level of service There is a vendor that wants your business…

no matter what you need…so be cautious in selecting a vendor that promises everything for much less than the competitors…performance will be short-lived

Consider performance incentives as motivation to be creative

Ask vendor “what incentives” they use with other clients, incentive ideas

Level the playing field

If you have multiple vendors in a competitive position, ensure that both programs are exactly the same

When comparing vendors ensure you are measuring the same outcomes

Look internally for obstacles that might hinder a vendor

Compare the rates/fees…if one gets paid more, they can do more

Annually

Conduct an internal assessment to identify: Overlap in contracts costing you $Missing elements to address your “job-to-

be-done”Opportunities to increase business and gain

economy with vendors that have outstanding performance

Obstacles hindering best practice

Contact Us…

Mary Anne Pace, Principalmpace@healthblueprints.com954-817-5772

Katrina Tompkins, Principalktompkins@healthblueprints.com214-674-1108