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Audit and Productivity Assessment in the Health Care Revenue Cycle Jason E. Gillikin, CPHQ Manager, Revenue Cycle Informatics Spectrum Health Hospitals.

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Presentation on theme: "Audit and Productivity Assessment in the Health Care Revenue Cycle Jason E. Gillikin, CPHQ Manager, Revenue Cycle Informatics Spectrum Health Hospitals."— Presentation transcript:

1 Audit and Productivity Assessment in the Health Care Revenue Cycle Jason E. Gillikin, CPHQ Manager, Revenue Cycle Informatics Spectrum Health Hospitals Joint Statistical Meetings, Miami -- August 2, 2011

2 Spectrum Health Integrated health network in West Michigan consisting of a major regional health plan, a medical group with more than 200 physicians,seven acute hospitals (mix of teaching, urban, rural, CAH) and a rehab hospital. More than 1,500 total licensed beds. Roughly 1.5m annual patient registrations for the hospitals. Thompson Reuters Top 10 hospital for second year in a row. Recipient of multiple quality awards, including from Leapfrog Group and HealthGrades. Winner of HFMA's "high performing revenue cycle" award last two of three years.

3 Scary Stats JSM presentations require stats. It's the law. National Patient Safety Agency reports 236 wristband ID issues resulting in patient harm, Nov 03 to July 05. CDC finding: Wristband error rate in 712 hospitals, median bed size of 265, was =10% in 9%. Very little clinical research on the root causes of wristband error.

4 Productivity Assessment Benchmarking: Unit of Service What is the right UOS for patient registration? What counts as a transaction? Views Update/modify "Cold" registrations What are the right numerators and denominators? Department FTE roll-ups Problem of false precision Benchmarking across organizations Process/procedure variations Can't schedule a person's ankles to work

5 Auditing Today Behold, the power of self-selection! Staff pick "face sheets" for review, submit to senior staff Seniors review for errors and presence/absence of data Items weighted and a percent-accurate score issued Inconsistent practice across departments... but we compare them anyway Auditors have no knowledge of data accuracy No additional reviews performed Not much accountability

6 Auditing Tomorrow Focus on outputs, not inputs! 100% review of claim edits 100% review of payer denials 100% review of STARS incident reports Spot checks of face sheets/RevRunner use Scores: DPTO Unified audit log Standard audit/productivity reports to supervisors

7 Industry Barriers "We got some 'splaining to do." Revenue cycle vendors/consultants focus on percent- accurate scores and sell "QA" products that merely check for field-level completeness. Institutional schitzophrenia Clinial departments "get" quality tools Revenue cycle heavily tilted towards CPAs who focus on ROI but with less capacity for statistical thinking

8 Wrap-Up Questions Brief discussion Wild-eyed praise for the presenter


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