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