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

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

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

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

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?

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

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

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

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

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?

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

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?

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…

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?

Coverage Discovery

• Simple work flow

• Reduce vendor expense

• Reduce timely filing denials

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

Thank you

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Questions and answers