Presentation on theme: "Building an Automated Financial Clearance Process"— Presentation transcript:
1 Building an Automated Financial Clearance Process Niobis Queiro, MBACorporate Vice President, Revenue CycleHartford HealthCare CorporationHartford, CT
2 Hartford HealthCare 4 hospital system serving 63 towns in Connecticut 75,711 inpatient visits per year2 Million outpatient and homecare visits a year280,000 ED patients per year60% of all behavioral health visits in the state of CT$52 million in charity care FY 2011$14 million invested in research15,000 Employees2,100 Physicians$2.0B Total Revenue
3 Current Issues Facing Healthcare Industry Losing 7.2% on Medicare Cases, losing 14% on Medicaid*Medicare Reimbursement rates declining**Increasing Medicare & Medicaid populationIncreasing high deductable plans and bad debtHospitals will Never Be Paid as Well as They are TodayRewards chasing revenue, not margin/qualityCapitation payment encourages less volumeEvidence Based Care Plans are neededFee for Service versus Fee for ValuePhysicians, hospitals, providers and plans not aligned (incentives)Coordination lacking inside/outside walls of hospitalEMR Adoption/MU requires new processes**Data is housed in silosCare Delivered in SilosRapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease***5% patients = 55% of admissions, care at Medicare ratesHealth Plans shift risk to provider. Bundled care, ACOChronic Disease Patient Volume IncreasingWhat we know for sure is that we will never get paid more than we are today and that likely we will get paid less and more like Medicare rates across the board.This required Hartford Healthcare to identify areas to rapidly remove cost from the delivery mechanism and standardize process and accelerate revenue.Pick one of the below to speak to and then move on to the next slide:larger % of patient vol will be medicare/medicaid (due to reform, aging population, recession), and those rates are being reduced. Also with VBP where reimbursement tied to Quality Performance (30-day Readmits, Avoidable Admissions, HACs/HAIs, RAC audits), those that fall short on a broadening list of quality metrics, have more rev at risk.Fee for Service: Whether or not the nth service would be beneficial to the patient and the payer. Excessive fixed cost structure, abundance of access for competing entities for well insured population of patientsCare Delivered in Silos – EMR/MU are great enablers but require revised processes to take advantage of the powerful information available for decision making on patient care.Chronic Disease Patient volume increasing – think about segmenting patients. 4 groups – healthy group, relatively healthy with scheduled elective procedures/emergencies. 3rd group is single chronic disease but healthy. 4th group is complex, multi-chronic disease. The 3rd and 4h groups require most care. Frequent flier in-patients. Chronic disease, and Complex Chronic disease wave is coming, where 7 out of 10 deaths are from chronic diseases. Heart disease, cancer and stroke account for 50% of all deaths each year. Require focused care plans that is 24/7, from an integrated care system. Monitoring the patient at home.Contracted Health Plans shift risk to providers, and pursue bundled care as a 3 yr focus on managing specific beneficiaries. ACO is program to be launched.*Source:Modern HC , pg 16 MEDPAC . FierceHealthFinance, **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.
4 Traditional Operating Models Will Fail Under The Complexities of Healthcare Reform Short term:Increased access to careNew shared reimbursed at government ratesOutcome riskReduced operating marginsOn the horizon:ICD-10Outcomes PerformanceClinical integrationIT interoperabilityACO investmentsNext generation gain sharingBundled paymentsHealthcare change is not new – BUT the difference this time is the rapid implementation of changes.In a very short time period, providers will be treating more patients and paid less per encounter (the only absolute of healthcare reform)If you are not working now to optimize patient revenue and aggressively control expense, your long-term viability will be challengedThe demands of healthcare reform will require new investments and result in underinvestment in key operating areas (Patient Access, business office, supply expense)Providers must focus on and invest in core competencies (managing the health of a population)Importance of a centralized and organized access area to ensure Hartford’s success in an accountable care model to improve access and patient transitions between/across care providers across the HHC system.Greater Access – Reduced Reimbursement – Growing Operational Complexity
5 Patient Access: The Root of Much Evil Percent of data needed for billing originates at registration: 70%National average registration error rate: 46%Percent of denials that could be prevented at registration: >50%Healthcare Informatics Research Series DataPatient Access Resource Center -NAHAM -Modern Healthcare -HCPro Quarterly benchmarking report 12/10Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10,Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare
6 Cash Collection CurveCash collection probability and absolute dollar amount declines with passing time. Moral of the story: collect early and often.
7 Hartford HealthCare Project Goals Create an Optimal Patient Experience that Makes HHC the Provider of ChoiceCreate and Automate a Data Rich Financial Clearance ProcessProduce Patient Liability Estimates for TransparencyImprove POS Cash CollectionsCentralize SchedulingReal-time Quality Assurance to empower the end-userEnable Field Level Registration EditsLink patient Access Errors to Denials and A/R LiquidationProvide structure around E&B and AuthorizationsEstablish a Partnership with all HHC providers and assets
8 Hartford HealthCare: Flashback 18 months No patient access standardizationVariable financial clearance processNo centralized schedulingNo patient liability estimates< $1M/Yr in POS cash collectionsNo registration quality editsNo link between access & denialsIT patchwork across 4 hospitals
14 Joys of the Open Road Employee Engagement Team Building Exercises HHC offers employees access to Local Community CollegeHHC covers tuition and salary for Wednesday afternoon courseworkClear career path and education boost employee moraleHHC maintains a 99% employee retention rateTeam Building ExercisesRewards For Outstanding Performance
16 Lessons from the Road Appraise organizational readiness Finance will likely want to run faster than departmentsProvide training to physicians and nursing staffCommunicate early and often with hospital leadership (CEO/CFO)Appraise Financial Clearance StaffSome personality types are not suited to ask for paymentsBe aware of HR challenges9 Benefits Packages4 Compensation ModelsUnion job descriptionsEmployee transfer requires new employee paperworkHHC full homogenization by 2013
17 John Godfrey Saxe"The Blind Men and the Elephant" by John Godfrey Saxe (1816–1887).It was six men of Hindostan To learning much inclined, Who went to see the Elephant (Though all of them were blind), That each by observation Might satisfy his mindAnd so these men of Hindustan Disputed loud and long, Each in his own opinion Exceeding stiff and strong, Though each was partly in the right And all were in the wrong.
18 Leadership Behaviors Be In The Moment Be Authentic & Humanistic Volunteer Discretionary Effort ConstantlyModel High Performance-Desired Behaviors that Drive Desired ResultsRespect & Leverage Separate RealitiesBe Curious vs. JudgmentalLook in the Mirror First – Be AccountableHave Courageous ConversationsProvide Timely, Clear & Specific Performance Expectations & FeedbackTeach, Coach & Mentor - Spend at Least Half of Your Time Developing Others
19 Questions to Ask Yourself Everyday What more can I do right now to be a role model for those around me?What more can I do right now to achieve the outcome we desire?What more can I do right now to prevent something undesired from occurring?What expectations or feedback can I deliver right now to make a positive difference?What more can I do right now to seek or provide the clarity that I think does not exist?What more can I do right now to make this meeting more productive?When some outcome has not met my expectations, ask, “How did I contribute to that?” and “What more will I do next time to make it successful?”
20 A journey of a thousand miles begins with a single step. Lau-Tuz, Chinese philosopher (604 BC BC)