powerful healing. - aipamaipam.net/doc/ph_centralization_presentation_9-2011_updated.pdf ·...

powerful

healing.

FRONT END CENTRALIZATION

Eleanor Michalek

System Director Patient Access

Background

Six-hospital Health System

Previously Centralized Business

Office CBO in 2007

Needed Improvement in Financial

Results – Consistent Process

Expense Reductions – Cost

Savings 2

Timeline

• Executive Sponsorship Kick Off January

2009

• High Level Oversight Committee

• Sub-committees Established March 2009

• First Hospital Implemented October 2009

• Phased Approach Implementation

• Sixth Hospital Implemented December 2009

3

• Hospital CEO, CNO, CFO, CMO,

Revenue Cycle, System Office,

Performance Improvement

Representation

• Lead: System Vice President Finance

• Review and Approval: Current State &

Future State Recommendations

• Discernment Process

• Monthly Meetings

4

Executive Sponsorship Committee

Work Groups

• Operations

• Communication Strategies

• Human Resources

• Financial – Develop Budget &

Capital Needs Assessment

• IT Telecommunications

5

Sub-committees

Operations

• Define Steps: Current State to

Future State Recommendation

• Service Level Agreement – Outline

Scope of Services

• Subject Matter Expertise

• Physical Move

• Technology Development 6

Operations

Focused Communication Strategy

• Physicians

• System Leadership

• Hospital Management

• Employees – “Everyone has a

Job”

• Web Link – FAQ’s

7

Key Audience Communication

HR

• Employee Impact

• Organizational Structure

• Management

• FTE’s – Staffing Model

• Job Descriptions

• Recruitment and Retention

8

Human Resources

Capital Needs Assessment

• Technology

• Space Build Out

• PC’s, Monitors, Phones, etc.

Develop Budget

• Needs Assessment

• 6 Hospital Departmental Budgets

Roll-up

9

Financial

IT – Telecommunications

• Equipment Purchase

• Unit Preparation

• Technology Deployment and

Support

10

Information Systems

What is currently standardized?

• Policies and Procedures

• Performance Reporting – KPI’s

• Tools and Technology

• Key Functions – Functional Grid

• Process Flows by Patient Type 11

Patient Access Current State

• Key Functions – Functional Grid –

Understand and Plan for Exceptions

1.What is scheduled through Central

Scheduling at each hospital?

2.What is scheduled within the

departments at each hospital?

3.What departments have registration

responsibility at each hospital?

12

Patient Access Current State

During the assessment phase the group

identified four options to centralize. 1. Centralize the Insurance Verification and

Pre-certification function only

2. Centralize the Insurance Verification and Pre-certification and the

Pre-Registration function of all non-community wide scheduled

patients (Surgery and Cath Lab)

3. Centralize the Insurance Verification and Pre-certification and the

Pre-Registration functions of all pre-scheduled patients including

CWS patients

4. Centralize the Insurance Verification and Pre-certification and the

Pre-Registration function of all pre-scheduled patients and all

community wide scheduling functions that currently exist 13

Future State Options

To Centralize the Following Functions

Order Management

Insurance Verification

Pre-certification/Payor

Authorization

Training

14

Future State Recommendation

• Reduced denials through specialization of

workgroups

• Increased efficiency with ability to batch some

activities to payers

• Consistency and continuity of training for all

access staff

• Better communication and deployment of

changes in process in a centralized

environment

• Increased Point of Service cash collections

15

Future State Benefits

Technology Development

How will we do this?

• Approached Current Vendor HealthWare Systems (HWS) to

Develop Overlay for 6 Hospitals

• Drafted Primary Process Flows for Future State

• Outlined Unit Responsibility for Each Function

• Define Work Triggers/Events

• Define Status for Each Work Trigger – Complete, In Progress, etc.

• Established Electronic Work Queues for Orders, Central

Scheduling, Pre-registration, Insurance Verification, Payor

Authorization 16

Technology Deployment

• Phased by Hospital Implementation

• Ongoing Meetings

• Collaboration Across System – Identify Opportunities –

Daily, Weekly, Monthly Meetings

• Subsequent Account Referral to Financial Counselors –

Forward and Track Functionality

17

• Be Sensitive and Respect the Culture Change

• Identify, Recognize and Address Potential Barriers

• Ongoing Communication to Key Audiences

• Train and Keep Training

• Recognize Talents and Contributions of

Leaders

18

Major Culture Change

• Standardized process flow across centralized and

de-centralized units

• Cited as “Leading Practice” by Auditors for

Insurance Verification and Medical Necessity

• System Policy on Requirements for Clinical

Diagnostic Orders

• Increased Point of Service cash collections

19

Current State

Questions ?

20

Discussion and Questions