tools and strategies for success - becker's hospital review 22, friday/f… · background: why...
TRANSCRIPT
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Tools and Strategies for Success
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• Jodi Frei, PT, MSMIIT, Northwestern Medical Center
• William Presley, Vice President , Acmeware
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Background: Why Optimize Revenue Cycle?
Areas of Opportunity
o Registration, Billing, Collections
Metrics that Matter
Optimizing Quality Outcomes and Reimbursement
Financial Impacts of Patient Engagement
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o External environment cinching the belt on payments
o Incentives and penalties driving effective, cost efficient care
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In Vermont,
o Reduced Disproportionate Share (DSH) Payments
o Revenue Cap
o Risk Based Payment Models: Population Health
• Risk 1: Costs exceed payments
• Risk 2: Costs of participants seeking care outside of “network”
o Ambulatory Surgical Centers & Urgent Cares
• Directing high revenue procedures elsewhere
o ACO Federal Funding Deficits funded by hospital
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Registration
Medical Necessity
Supply Chain
Clinical Documentation Improvement
Charge Reconciliation
Coding
o To automate or not?
Billing
Denials Management
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Back to the Basics:
o Every field, Every encounter, Every time
o No assumptions
Build logic to support workflow
o Reg Types drive specific coding lists, drive billing – CLIs all go to
coders
o Location drives dept specific coders worklists (Lab CLI vs DI CLI)
Educate, Educate, Educate!!!
o Above logic and workflows are specific and complex
o Solid orientation program with ongoing elbow support
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System generated ABNs
Ideal at Order Entry
If not, at Point of Care
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Lesson Learned: Eliminate paper processes!
Effective automated systems
Require reliable workflows
How does stocking occur?
Centralized or decentralized?
How do clinicians decrement?
Is there a delay between pulling and distributing?
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Saves time by eliminating manual transaction process
Eliminates manual costs
o “A major electronics manufacturer calculates the cost of processing
an order manually at $38 compared to just $1.35 for an order
processed using EDI”
Allows staff to focus on other high value areas
Improved transaction quality - reduced errors and rework
Increased business efficiency/ transaction turnaround time
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Appropriateness and Specificity of documentation
o Goal – Bill DRG best aligned with patient presentation
o BMI/Obesity/Morbid Obesity/Malnutrition
o Failure to Thrive as opposed to weakness
Complications & Comorbidities: CCs and MCCs
Many on line resources available
o Certifications of CDI Specialists
o Program implementation12
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Impact Readmissions Scoring as well
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Revenue Generating Departments
Charge check before transmission to billing
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Dept
Coding Billing
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Use of Computerized Coding
Understand ROI
Determination of which services are and are not coded by
coders
o ED? Inpatient? Rehab? Clinics? Labs?
Evaluation and Management Coding: Manual or
automated?
o Extent of history, extent of examination can be automated
o MDMing more difficult to automate
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Days in AR: Accounts Receivable: Low
UR: Unbilled Receivables: Low
DNFB: Days Not Final Billed: Low
If upgrading, expect these to go up – plan for increased
need for cash on hand based on projected number of days
increase and ave charges per day.
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http://www.cms.gov/eHealth/downloads/eHealthU_PQRSQualityManagement101.pdf
= Public Reporting Focus for Hospitals/ CAHs/ Eligible Providers
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2,573 hospitals will receive cuts in Medicare payments up
to 3% starting in Oct 2017
Equates to a projected 564 million dollar federal savings
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0.0%
1.0%
2.0%
3.0%
4.0%
5.0%
6.0%
7.0%
2014 2015 2016 2017 2018 2019
IQR EHR VBP HAC HRRP
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Medicare Hospital Value Based Purchasing (VBP) Impact
Analysis
Provider Statistical & Reimbursement (PS&R) Report
Inpatient Prospective Payment System (IPPS) Federal Fiscal
Year Analysis
Readmissions Reduction Program Analysis
Hospital Acquired Condition (HAC) Reduction Program
Analysis
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Physician Quality Reporting System (PQRS) Payment
Adjustment Feedback Reporting
Annual Quality and Resource Use Report (QRUR)
Physician Quality Reporting System (PQRS) Measures:
eCQM Benchmarks
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$30,955,000.00
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“…in the 2016 Healthcare Management Forum, there was a
study from McGill University [on strong patient engagement]
that showed a 20% improvement in patient experience of
care, a 25% decrease in C. diff and antimicrobial-resistant
infections, and they calculated savings of $340,000 in one
year,”
• Joe Kiani, founder of the Patient Safety Movement Foundation and
chairman and CEO of Masimo
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Use of Impact reports to determine areas of focus
Provider Cost Analysis by DRG
Using EHR to present cost data at order entry
o Meds
o Labs
o High Risk Medications
Qualified Clinical Data Registry (QCDR) to promote patient
engagement
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Disparate Systems
Difficult to assess performance across settings
Creation of Clinical Alerts
Coding occurs post discharge
Understanding workflow required by eCQMs
Transition from free text and customized reporting
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Transformation
Disruptive Innovation
Mission/Vision/Values trump Personal Preference
Provider, Staff, Patient Engagement
Relate, Don’t Compare
o Benchmark yourself against the outside world
Accountability and Execution
Perseverance
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Jodi Frei, PT MSMIIT Northwestern Medical Center
William Presley, Vice President Acmeware
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https://www.studergroup.com/resources/articles-and-
industry-updates/articles-and-whitepapers/why-patient-
engagement-matters
http://www.commonwealthfund.org/~/media/files/publicat
ions/fund-
report/2015/jun/1821_davis_aca_and_medicare_v2.pdf
http://www.ahima.org/topics/cdi
https://www.edibasics.com/benefits-of-edi/
https://e-medtools.com/drg_modifier.html