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The Redesign of Patient Access Workflow Ensuring Payment Certainty
Debbi Cesari, MBA, CHAM, System Director for Patient Access, CHRISTUS Health
Dan House, MBA, Regional Director, Patient Access, CHRISTUS Santa Rosa
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International Catholic, faith-based, not-for profit health system comprised of almost 350 services & facilities, more than 50 hospitals and long-term care facilities, 175 clinics & outpatient centers and dozens of other health ministries & ventures.
Overview of CHRISTUS Health
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CHRISTUS operates in 6 U.S. states, 6 states in Mexico, and in Chile
Overview of CHRISTUS Health (con’t)
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• 25,000 associates • Over 350 medical
facilities owned/ managed
• $5 billion total assets • 4,500 staffed beds • 9,000 physicians
Overview of CHRISTUS Health (con’t)
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Jointly sponsored by the two religious congregations of the Sisters of Charity of the Incarnate Word in Houston and San Antonio
Overview of CHRISTUS Health (con’t)
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The mission of CHRISTUS Health is to extend the healing ministry of Jesus Christ
Overview of CHRISTUS Health (con’t)
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Beyond NEBO to eCare NEXT
Decision to move to eCare NEXT platform to enhance user experience with up-front tools
No more “bolt-on” systems
No more multiple logons for disparate systems
Integration - inter-connectivity between Meditech & eCare NEXT via Ipeople (Interface People)
Notes “post-back” for eligibility, medical necessity, patient payments
End User Work Queues to direct work
Management Report data for Revenue Cycle Dashboards
All interactions are stored on the patient’s record in eCare NEXT
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23 CHRISTUS Facilities Implement eCare NEXT
• Ark-La-Tex Region (2) • CHRISTUS St. Michael - Texarkana • CHRISTUS St. Michael - Atlanta (TX)
• Northern Louisiana Region (1) • CHRISTUS Highland Medical Center
Shreveport/Bossier
• Central Louisiana Region (2) • CHRISTUS St Francis Cabrini - Alexandria • CHRISTUS Coushatta (CAH) - Coushatta
• Southwest Louisiana Region (1) • CHRISTUS St. Patrick – Lake Charles
• Southeast Texas Region (3) • CHRISTUS Jasper Memorial Hospital - Jasper • CHRISTUS Hospital – St. Elizabeth & St. Mary • Beaumont & Port Arthur
Santa Rosa Region (San Antonio) (7) CHRISTUS – Children’s Hospital of San Antonio CHRISTUS Santa Rosa Hospital - Alamo Heights Medical Center - New Braunfels Westover Hills - Creekside ER Alon ER
Spohn Region (Corpus Christi) (6) CHRISTUS Spohn Hospital Corpus Christi - Shoreline Beeville - South Alice - Memorial Kleberg
Gulf Coast Region (1) (CHRISTUS & Houston Methodist JV) Houston Methodist St. John – Clear Lake
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CHRISTUS Health eCare NEXT project scope
eCare NEXT TOOLS 1 - 2 - 3 4 5 6 7 8 9 10 11 12
Verification (Ins / Addr)
Medical Necessity
NOA Notice of
Admission
Coverage Discovery
Patient Payment Estimator
Payment Safe
Charity Guide
Pay Nav
(Equifax)
Order Rite
Order Smart (eFax)
Order Smart (Physician
Portal)
Santa Rosa (7) NOV- 13 DEC- 13 FEB- 14 APR- 14 APR- 14 APR- 14 MAY- 14 pending MAY- 14 Planning
Development
SETX (3) NOV- 13 DEC- 13 FEB- 14 APR- 14 SEPT-14 MAY - 14 MAY- 14 pending
ALT (2) NOV- 13 DEC- 13 FEB- 14 MAY- 14 JUNE- 14 JUNE- 14 MAY- 14 pending JULY- 14 Planning
Development
CLA (2) NOV- 13 DEC- 13 FEB- 14 MAY- 14 JUNE- 14 SEPT-14 MAY- 14 pending JUNE- 14 Planning
Development
NLA (2)(1) NOV- 13 DEC- 13 FEB- 14 MAY- 14 JUNE- 14 SEPT-14 MAY- 14 pending AUG- 14 Planning
Development
SWLA (1) NOV- 13 DEC- 13 FEB- 14 MAY- 14 JUNE- 14 SEPT-14 MAY- 14 pending AUG- 14 Planning
Development
SPOHN (6) NOV- 13 DEC- 13 FEB- 14 MAY- 14 SEPT-14 JUNE- 14 MAY- 14 pending OCT-14 Planning
Development
GC - St John (1) NOV- 13 DEC- 13 AUG- 14 AUG- 14 OCT-14 OCT-14 JUNE- 14 pending OCT-14 Planning
Development
Implementations 72 24 24 24 24 24 24 23 20 22 281
Completed 72 24 23 23 14 19 24 23 11 0 233
Pending 1 1 10 5 9 22 48
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A theme for today
• Ask not what the technology can do for your process
• Ask how I need to change my process to use the technology
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Does this seem at all odd to hear? Why?
• How many processes are designed and modified overtime to solve a problem?
• How many problems that were solved, no longer exist?
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First step, replacement technology Insurance/Address Verification, ABN’s or
Medical Necessity
• eCare NEXT work queues make for easy audits and improve usage and/or compliance
• Incorporate these audits into your Denial action plan for Past Filing Deadline
• Need to further automate these audits:
– # Registrations vs # Registrations in eCare NEXT
– # Registrations with no insurance verification
– ABN’s administered
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Patient Payment Estimator (PPE)
• Value is based on where you are starting from (show of hands)
– No technology, using charge master and maybe a contract matrix
– Unreliable technology, queries only historical data or paid claims
– Predictive, using contracts and charge master to calculate
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PPE challenges
• Getting CPT codes for surgical procedures
• Easy look-up for outpatient diagnostic procedures
• Estimating Inpatients, getting DRG’s
• Estimating ER patients
• Involves PFS, Managed Care Contracting, and Patient Access to Test
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PPE impact on operations
• Greater confidence in the estimate can be leveraged during negotiation, increasing collections
• Time savings in estimating can be dramatic, Preregistration volumes increase from 25-30 accounts per day to 30-35 accounts and growing
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Charity Guide (show of hands)
• Who does paper applications?
• Who has had to reduce staff dedicated to this process? And who believes public demand has been reduced in kind?
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Creating a paperless application process
• Who is your target patient population? (ED, IP, OP or surgery)
• Pre-registration strategy
• De-mystified the expertise, simplify and give knowledge to all, de-centralize
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OrderSmart – Document Management Solution
(show of hands)
• Who has a home-grown system for managing incoming/faxed orders?
• Who has a document management solution designed for tracking incoming orders?
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Implementation process
• We shared our existing process
– Index the order to find it
– Match an order to an appointment that was scheduled without an order
– Or, get the order set-up to be scheduled
• They shared how their system is designed
– Indexing creates work queues that can track orders until the scheduling process is complete…
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Process and management issues
• Work queues by modality, daily work strategy for staff
• Are we getting orders indexed timely for front desk staff to find
• Track follow-up calls to appoint
• Report unscheduled volume by facility
• Report unscheduled volume by modality
• Age the order from receipt to completion
• Track incomplete orders for follow-up
• Track appointments scheduled without an order
• Never lose a fax, or give the perception of losing a fax again
• Any other ideas from the group?
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Coverage Discovery
• Simple work flow
• Reduce vendor expense
• Reduce timely filing denials
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Post go-live: Tool maximizing
• We should have “de-cluttered” the process for our staff…verify this
• Improve the Charity Guide hand-off from Pre-reg to front desk operations
• Using PPE for ER and Inpatients
• Revisiting how we can use the work queues for audits
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Thank you
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Questions and answers