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Show Me the Numbers! How Strategic Planning Can Pay Off for Your Health Center.

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Presentation on theme: "Show Me the Numbers! How Strategic Planning Can Pay Off for Your Health Center."— Presentation transcript:

1 Show Me the Numbers! How Strategic Planning Can Pay Off for Your Health Center

2 What Are the Numbers? Key indicators chosen to measure a basic level of success 14 Sites w/ completed evaluation results assessed by SNS Where located: Massachusetts, Maine, Connecticut –10 FQHCs –4 Non-FQHC CHCs Key indicators measured: –Net revenue –Number of patient visits –Gross charges –Number of unduplicated patients

3 Gross ChargesNet Revenue# of Visits# of Unduplicated Patients Baseline12 MonthsBaseline12 MonthsBaseline12 MonthsBaseline12 Months 39,523,72148,732,52519,659,87922,410,721178,769206,79964,87184,572 Aggregate Data – 14 Health Centers

4 Average Increase Per Site – 14 Health Centers Gross ChargesNet Revenue# of Visits# of Unduplicated Patients $657,771 $196,488 2,147 1,519

5 How Did They Get There?

6 Common Strategies Employed Education of dental and administrative team related to opportunities to maximize access and productivity Improved scheduling systems to maximize productivity and make best use of chairs given current staffing Created or refined policies designed to reduce or eliminate chaos (eg, emergencies, no-shows) Tweaked patient mix to improve access for priority populations (such as children) which also aided the practice financially Developed clinical protocols to standardize services provided to patients at each visit, which fostered the completion of treatment plans, ensured the avoidance of churning and maximized revenue opportunities

7 Common Strategies Employed (cont.) Adjusted fee schedules to be more in line with Usual and Customary Rates Revised encounter forms to enhance their functionality Established access and productivity goals for the practice, ensuring elimination of disease and creation of financial sustainability Met with dental and administrative staff to review current situation and present the action steps recommended for practice enhancement and/or recovery Showed the practice how to monitor success or lack thereof in achieving action plan goals Promoted the development of a process to reward and celebrate success on a regular basis

8 Common Strategies Employed (cont.) Reviewed monthly progress reports with dental leadership related to progress in accomplishing each action step according to the agreed upon timeline Adjusted action steps when needed Reviewed SNS key data reports with practice at 6,12,18, and 24 months

9 Case Study Six-Chair Federally Qualified Health Center BeforeAfter Number of Visits18,15021,341 Net Revenue$1,464,116$2,336,873 Total Expenses$1,723,007$2,114,528 Profit/(Loss)($258,891)$222,345 Revenue/Visit$81/visit$110/visit Cost/Visit$95/visit$99/visit

10 About This Program Six-chair clinic located in Boston suburb (FQHC) Six FTE dentists, each seeing an average of 13 patients per day Fee-for-service reimbursement for Medicaid Practice located in an area of enormous need and demand for care Only FQHC in service area As a result of moving from red to black, this practice is in the process of expanding from 6 to 12 chairs!

11 Case Study: How Did They Increase Visits? BeforeAfter Practice was achieving a lot of visits, but high level of chaos detracted from productivity Put systems in place to replace chaos with control No show policy was not consistently enforced Tweaked no-show policy and began enforcing it consistently Scheduling system undermining productivity Recreated the scheduling system; moved to 30-day schedule and developed new policy Emergency policy was overly complex; practice overwhelmed by emergencies Created new emergency policy and method of accommodating emergency patients into the practice without causing disruption to scheduled patient care

12 Strategies for Increasing Visits Managing Emergencies Managing No-Shows Scheduling

13 Managing Emergencies Define what constitutes a true emergency Create an emergency management system that meets the level of need, but preserves regularly scheduled appointments Develop and implement an emergency policy, and stick to it Provide training for registration and reception staff in the triage of emergency walk-ins and calls

14 Managing No-Shows Create and distribute no-show policy to patients and staff Post the no-show policy in several areas Have patients read, sign and insert signed policy in chart Enforce the no-show policy consistently across the practice Track: –No-shows –Cancellations –Fill-ins –Scheduled visits vs. actual appointments

15 Managing No-Shows (cont.) Provide reminder messages for upcoming appointments Schedule appointments no further out than days Schedule one follow-up appointment at a time

16 Improving Scheduling System Some factors that affect scheduling policies: Demographics of the patient population Typical needs of the patient population How far in advance appointments are scheduled Appointment lengths Number of appointments available

17 Improving Scheduling (cont.) Schedule appointments no further out than days Schedule appointments one at a time Exception: patients undergoing complex procedures that require multiple visits to complete Determine basic appointment length by type of service provided: minutes Allocate10-15 minute increments for procedures requiring additional time

18 Case Study: How Did They Increase Net Revenue? BeforeAfter Inconsistency in services provided to patients from provider to provider, resulting in lost revenue opportunities, as well as delays in completion of treatment plans and discontent Created clinical protocols to standardize services provided to patients, maximize revenue opportunities and foster the completion of treatment plans Large amount of money owed to the practice out past 90 days, primarily from Medicaid and other third-party payers Reviewed entire billing process to identify reasons for denied claims; developed strategies to improve the billing process (with the goal of getting clean claims out the door) (eg, assigned dental staff person to review each days encounters before they were submitted to billing) Practice (providers and support staff) did not know the Medicaid rules and regulations; were providing lots of non-covered services; also were not aware of many new covered services that had recently been added Created abbreviated guidelines for Medicaid showing covered services and accompanying rules and regulations. Practice began regularly educating and updating providers and staff

19 Case Study: Increasing Net Revenue BeforeAfter Fee schedule was low (in some cases, below what Medicaid would pay) Increased fee schedule to 75 th percentile of UCR Practice did not have a sliding fee scale for self-pay patients Created a sliding fee scale that balanced affordability for self-pay patients with need to achieve financial sustainability

20 Strategies That Increase Revenue Documentation of Eligibility Flow charting and establishing accountability for every step of the eligibility process through staff orientation and training Management of Self-Pay Patients Define the responsibilities of patients and staff Communicate expectations for payment at the time of the visit Support front desk staff to perform this crucial task through training and scripting; use objective performance measures to evaluate staff success Billing Efficiencies Flow charting and establishing accountability for each step in the process from patient registration through reconciliation Identify barriers to successful billing and develop strategies to resolve Staff training to increase probability of success through the billing process

21 Strategies That Increase Revenue Cross-train staff (receptionists, registration staff, dental assistants) to fill in as needed, according to priority The consideration of incentive programs to reward the dental team (not just providers) Use of DAs and RDHs for expanded duty to maximize availability of dentists for treatment Staff are regularly educated and trained relative to the rules and regulations of the practices primary third- party payers (especially Medicaid) Determination of a defined scope of service fostering elimination of disease, yet preserving financial viability

22 Strategies That Increase Revenue Establishment of a fee schedule, sliding fee scale and nominal fees that sustain the practice yet do not pose barriers to care Non-emergent procedures requiring prior authorization should not be initiated until PA is received or patient agrees to self-pay status Verification of patients eligibility before and at each visit Skillful utilization of IT systems to maximize clinical effectiveness and enable the practice to obtain the data needed to evaluate program performance

23 Self-pay patients and those with insurance co-payments need to pay at the time of the visit Patients should be educated about the true value of the services they are receiving and the discounts they are eligible for Policies That Increase Revenue

24 Slide fees from full charges (set at th percentile of UCR) based upon household income and Federal Poverty Guidelines Slide categories are typically 100% FPL and below; % FPL, % FPL, with percentage discounts offered for each category (patients above 200% FPL pay full charges) In setting sliding fee scale, need to create a balance between compassion and financial sustainability FQHCs – set a nominal fee for patients 100% of FPL and below –Can be determined by setting a dollar amount (e.g. $30), a percentage of 20% of full fee, or the Medicaid adult fee for same service –Make every effort to collect, but those 100% of FPL and below who are unable to pay are subsidized by the practice [330 funds?] Developing a Sliding Fee Scale

25 Strategies for Creating an Effective Billing System Utilization of an up-to-date, practice-friendly encounter form A policy that all staff responsible for any part of the billing process be trained and held accountable A policy guiding the transfer of information from dental to billing with built-in accountability The creation of a flow chart that defines each step in the billing process and assigns accountability for each step

26 A policy that guides the reconciliation of remittances and the resubmission of denials with designated accountability A prior approval policy and process A billing manual and orientation/training process for accountable staff Creating an Effective Billing System

27 Sample Billing Flow Chart Patient calls for appointment; registration documents eligibility and schedules appointment Patient comes in for appointment; eligibility is checked again; patient is asked to pay any co-pays due at the time of the visit Encounter form (or routing slip) is generated; patient sits in chair; provider sees patient and documents services on encounter form or on routing slip Patient meets with patient accounts specialist to review follow-up care needed and estimated costs For patients covered by Medicaid or other third-party insurers, DA takes encounter form and puts it in holding cart Encounter form goes to billing, where it is reviewed by dental specialist Patients with co-payments (self-pay or commercial insurance) take encounter form to registration and check out

28 If patient agrees to care plan, next appointment is made Encounter form goes to billing, where it is reviewed and patient invoice is generated for balance due, if any Patient accounts specialist takes encounter form Third Party insurance Self-Pay Patient gets bill and pays or continues to get billed Written off Claim is filed Claim is paid or denied PaidDenied Reconciled against patient account Investigated, corrected and rebilled Claim is paid or denied Reconciled against patient account Paid Written off Hopeless Submitted for payment again Still Hope Sample Billing Flow Chart (cont.) Encounter form goes to billing, where it is reviewed by dental specialist Reconciled against patient account PaidHopeless

29 Strategic Planning After establishing where it is (through practice analysis), the practice needs to decide where it wants to go and how it will get there –Define the practices mission and explore scope of service –Develop an action plan to get the practice to achieve the goals of: The dental practices mission (access and services) The overall health center mission Financial sustainability Quality dental health indicators Completion of Phase 1 Treatments Develop policies, procedures, and operations that foster the attainment of the dental practices goals Develop long- and short-term goals and action steps Regularly review practice data to monitor performance of dental program

30 What Data Should We Gather? Gross Charges Net Revenue Expenses (Direct and Indirect) Total Number of Visits Revenue per visit Cost per visit Number of Completed Phase 1 Treatments Number of New Patients Number of Unduplicated Patients Number of Transactions (by ADA Code) No-Show Rate Emergency Rate Number of FTE Dentists Number of FTE Hygienists Number of FTE Dental Support Staff Any Change in Scope of Service? Any Change in hours of operation?

31 Partnering to Strengthen and Preserve the Oral Health Safety Net 2400 Computer Drive, Westborough, MA Tel: Fax: A PROGRAM OF THE

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