Changing the Culture
at Oconee Medical Center
1 POS Collections: Changing The Culture 8/7/2013
CAHAM 2013 Annual Conference
Donna M. Smith oDirector, Patient Financial Services
oOconee Medical Center, located in Seneca, South Carolina
o28 Years Experience
Gary D. Patterson oDirector, Advisory Solutions
oMedAssets, located in Alpharetta, Georgia
o23 Years Experience
2 POS Collections: Changing The Culture 8/7/2013
Client Demographics
The Challenge
Project Workplan
Project Execution
Lessons Learned
Project Results
Keys to Success
3 POS Collections: Changing The Culture 8/7/2013
Population 75,000
Borders Georgia and North Carolina
Beautiful mountains, lakes and waterfalls
Part of Greenville, SC metro statistical area
120 miles from Atlanta, Georgia
4 POS Collections: Changing The Culture 8/7/2013
Per Capita Income $18,965
Median Household Income $36,666
10.8 % Population Below Poverty Line
14.1% Unemployment Rate (January 2010)
5 POS Collections: Changing The Culture 8/7/2013
Opened 1939
JCAHO Accredited
160 Licensed Beds
1,400 Employees
125 Affiliated Physicians
Services Include: Med/Surg, OB/GYN, Emergency, Cardiology, Rehabilitation, Pain Management, Long Term Care and Infusion Therapy
6 POS Collections: Changing The Culture 8/7/2013
Initial effort was internally driven
Performed POS collections training in March 2011
Saw short term increase then results fell off
Change of CFO led to MedAssets engagement
7 POS Collections: Changing The Culture 8/7/2013
Impact of recent recession on local economy:
Increase in charity consideration requests
Increase in self-pay patients (from 3% to 10 %)
In partial response to this negative trend, Oconee Medical Center, completed a revenue cycle consulting assessment with MedAssets to determine ways to improve its overall revenue cycle performance.
8 POS Collections: Changing The Culture 8/7/2013
“We recognized a need to bring a stronger culture of collections to OMC to help us implement best practices for POS collections. Incomplete patient access and registration staff knowledge and training, along with lack of key performance metrics and indicators, caused missed revenue opportunities, as well as missed opportunities to educate patients about their liability responsibility and available payment solution options.”
- Kevin Herbert OMC Chief Financial Officer
9 POS Collections: Changing The Culture 8/7/2013
10 POS Collections: Changing The Culture 8/7/2013
Collection Month 10/31/2010
11/30/2010
12/31/2010
1/31/2011
2/28/2011
3/31/2011
4/30/2011
5/31/2011
6/30/2011
7/31/2011
8/31/2011
9/30/2011
Grand Total
11
POS as % of Total Cash POS as % of Patient Payments 0.51% 6.61%
0.45% 6.53%
0.44% 6.62%
0.57% 7.92%
0.63% 10.04%
0.40% 6.20%
0.51% 7.87%
0.44% 6.40%
0.50% 7.00%
0.48% 7.20%
0.54% 7.40% 0.51% 7.00%
0.50% 7.21%
POS Collections: Changing The Culture 8/7/2013
• Implement POS Collections Program
• Implement Financial Clearance Policy
• Consolidate Pre-Services Workflow
• Centralize Registration Activities
12 POS Collections: Changing The Culture 8/7/2013
8 Week Engagement
On-site Consultant
Project Manager
Data Analytics Support
Patient Access Leadership Team
C-Suite Support
13 POS Collections: Changing The Culture 8/7/2013
From left to right:
Krystal Eagle ◦ Pre-Services Supervisor, OMC
Gary Patterson ◦ MedAssets Advisory Solutions
Mary Forrester ◦ Patient Access Manager, OMC
Donna Smith ◦ Patient Financial Services
Director, OMC
14 POS Collections: Changing The Culture 8/7/2013
Review Assessment Findings
Review Current PFS Training Materials
Shadow Staff in All Registration Areas
Identify Pre-Service Productivity Roadblocks
Document POS Collection Patient Encounters
Review Existing PFS Polices and Procedures
Identify Additional Areas for POS Opportunity
Develop Implementation Roadmap
15 POS Collections: Changing The Culture 8/7/2013
Inconsistent POS Collections Scripting
Revenue Cycle Knowledge Gaps
Need for Standardized Training
Lack of Payment Policy Signage
Inconsistent Use of Verification Tools
Untimely Pre-Registration of Scheduled Patients
Additional POS Opportunity for Inpatient, OB and Diagnostic Testing Areas
16 POS Collections: Changing The Culture 8/7/2013
November
2011
Detailed Assessment
Comprehensive
Recommendations
Develop POS Training and
Job Aids
Deliver POS Training
Plan for New POS
Opportunities
December
2011
Shadow Staff Post
Training for Feedback
Update PFS Policies
Implement New POS
Collection Opportunities
Initiate Weekly KPI
Meetings
January
2012
Executive Summary
Presentation
Transition KPI Reporting
Set Follow-Up Schedule
Feb-Dec
2012
Quarterly Site Visits
Weekly Status Calls
Ongoing Revenue
Cycle Education
Celebrate Success
Address Challenges
Project Close
17 POS Collections: Changing The Culture 8/7/2013
POS Collections Staff Training to Address: ◦ Patient Liability Fundamentals
Importance of Collection to Hospital Margin
What to Collect
How to Determine Patient Liability
◦ Psychology of Collections
POS Collections Scripting
Responding to Patient Objections
Role Playing Exercises
Corresponding Job Aids for Staff Reference
18 POS Collections: Changing The Culture 8/7/2013
Shadowing Staff Post Training
◦ Coaching for improved performance
◦ Leadership rounding
Reviewed Positive and Negative Encounters
◦ What worked well?
◦ What didn’t?
Gauge Staff’s Buy-in
◦ Who needs more coaching?
19 POS Collections: Changing The Culture 8/7/2013
POS Collections as Monthly Staff Meeting Topic
Posting POS Results on Bulletin Boards
Signage for Check In Areas
Email Blasts to Staff
Leadership Rounding
20
Payment of co-pays or coinsurance is expected at time
of service. Thank You!
POS Collections: Changing The Culture 8/7/2013
Scheduled Rounding in ALL Areas
Project Plan Presentation to Hospital Leadership
Weekly KPI Meeting with Patient Financial Services Director
Candid Discussions Regarding Staff Culture
Creative Communication of Results
◦ Weekly KPI Report Distributed to Staff and CFO
Competition for Emergency Department Shifts
Celebrating Success
21 POS Collections: Changing The Culture 8/7/2013
Created Pre-registration Process for OB Patients
Revised Process for Financial Counselors
◦ Benefit Review, Pricing Admission
◦ Patient Liability Discussion
◦ Payment Plan Discussion
Requesting Payment During ABN Discussion
Deposits for Diagnostic Testing (PPO, Indemnity)
22 POS Collections: Changing The Culture 8/7/2013
Trust Insurance Verification Tool
◦ Inservice on interpreting results
◦ Reduce unnecessary phone calls
◦ Reduce manual account documentation
Daily Team Huddles
◦ Measure today’s volume and adjust resources
23 POS Collections: Changing The Culture 8/7/2013
Focus on Value Added Activities
◦ Authorization for add-on procedures
◦ Reduce phone calls for patients with no liability
◦ Shifting work to other areas
24 POS Collections: Changing The Culture 8/7/2013
Measure Results Weekly ◦ Email blast to staff
◦ Bulletin boards
◦ Leadership Review
Total Cash Collections ◦ 8-week trend line
ED Cash Collections ◦ Breakdown by shift
Pre-Services Productivity ◦ Days out by service line
25 POS Collections: Changing The Culture 8/7/2013
Hospital Leadership Support
Physician Communication
Financial Clearance Process
◦ Pricing
◦ Payment arrangements
◦ Postponement when necessary
26 POS Collections: Changing The Culture 8/7/2013
Corporate Wide
Financial Clearance Policy
Departmental Policies Supporting Initiative
◦ POS Collection Guidelines and Scripting
◦ Patient Liability Payment Options
◦ Estimating Patient Liability
◦ Guidelines for Liability Estimation Tool
Self-Pay Surgery Policy
27 POS Collections: Changing The Culture 8/7/2013
8 Week Onsite Engagement Ends
POS Collections Training Completed
Updated Policies Adopted
KPI Measurements Instituted
New Cash Opportunities Implemented
Increased Pre-Services Productivity
Post Project Follow-Up Plan Identified
28 POS Collections: Changing The Culture 8/7/2013
Weekly Leadership KPI Call with MedAssets
◦ Review Results
◦ Discuss Challenges
◦ Explore Solutions
Quarterly Site Visits by MedAssets
◦ Present Revenue Cycle Education at Staff Meeting
◦ Rounding with Leadership and Staff
29 POS Collections: Changing The Culture 8/7/2013
30 POS Collections: Changing The Culture 8/7/2013
Developing a Culture of Collections
◦ Weekly leadership rounding
◦ Staff feedback
◦ Weekly KPI staff communication
◦ Weekly KPI leadership meetings
◦ Success celebrations
◦ Executive support
Educating the Community
◦ Increased consistency in obtaining payment
Identifying New POS Cash Opportunities
Increasing Teamwork in Pre-Services
31 POS Collections: Changing The Culture 8/7/2013
Support for Inpatient Collections
◦ Hospital nursing staff
◦ Family member complaints
Obtaining Support for Self-Pay Surgery Policy
◦ Stakeholder buy-in timeframe
Pre-Services Staffing
◦ Daily fluctuations affecting productivity
32 POS Collections: Changing The Culture 8/7/2013
Pre-Services Teamwork
◦ Daily huddle to gauge work and adjust resources
◦ Cross training for short staffing situations
◦ Working supervisor
Educated and Engaged Staff
◦ Collection culture is now “who we are”
Friendly Competition in Emergency Department
◦ Weekly report of shift collections keeps staff motivated
33 POS Collections: Changing The Culture 8/7/2013
Pre-Services Team Cross Training Support
New Hire POS Training in Place
Results Communicated Regularly
Weekly Leader Rounding
34 POS Collections: Changing The Culture 8/7/2013
35 POS Collections: Changing The Culture 8/7/2013
36
2009 2010 2011 2012
ED $117,149 $187,240 $177,099 $257,705
Pt Access $314,383 $329,781 $416,758 $806,691
Total $431,532 $517,021 $593,387 $1,064,396
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
$1,200,000OMC Year over Year POS Cash Collections
79% increase - 2012 over 2011
POS Collections: Changing The Culture 8/7/2013
2012 Year End = .95% of Total Cash
◦ Project start average was .50%
2012 Year End = 12.41% of Patient Payments
◦ Project start average was 7.21%
37 POS Collections: Changing The Culture 8/7/2013
38
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC
2010 $30,937 $32,715 $50,512 $40,731 $53,772 $45,909 $45,425 $45,499 $46,346 $45,817 $41,103 $37,765
2011 $44,193 $59,132 $41,061 $49,612 $35,511 $41,455 $41,299 $49,109 $41,919 $46,394 $61,461 $82,241
2012 $131,062 $92,611 $103,495 $67,502 $96,135 $87,043 $75,562 $82,986 $89,977 $77,625 $97,326 $61,815
$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000OMC - Monthly POS Cash Collections 2010-2012
POS Collections: Changing The Culture 8/7/2013
Project Team and C-Suite Support for Rapid Implementation
Staff Buy-In of Project Goals
Instructor Led Training for POS Collections
Job Aids for Overcoming Patient Objections
Removing Roadblocks to Pre-Services Process
Communication of KPIs to Staff and OMC Leadership
Updated Policy and Procedures for Financial Clearance
Capitalizing on Additional POS Collection Opportunities
39 POS Collections: Changing The Culture 8/7/2013
Project Team and C-Suite Support for Rapid Implementation
Staff Buy-In of Project Goals
Instructor Led Training for POS Collections
Job Aids for Overcoming Patient Objections
Removing Roadblocks to Pre-Services Process
Communication of KPIs to Staff and OMC Leadership
Updated Policy and Procedures for Financial Clearance
Capitalizing on Additional POS Collection Opportunities
40 POS Collections: Changing The Culture 8/7/2013
Donna Smith
41
Gary Patterson
POS Collections: Changing The Culture 8/7/2013
42 POS Collections: Changing The Culture 8/7/2013