1. OHSU Healthcare OHSU Point of Service Collections Initiative HFMA - Oregon Chapter February 2013

2. 2 About OHSU Academic Medical Center w/schools of Medicine, Nursing, and Dentistry with 4,361 students One of two Level 1 Trauma centers in Oregon Total visits 849,581 Admissions: 29,797ED Visits: 46,399 Daypatients: 26,830Ambulatory Visits: 735,279 Observation: 4,477**Total Annual Patients: 235,801 48% of our patients are from outside tri-county area Largest employer in the state, with over 14,000 employees Employ more than 1,000 physicians & 450 Allied Professionals

3. 3 About OHSU Our EMR is EPIC (version 2010) Started with EPIC Ambulatory August 2005, implemented Prelude, Cadence, Resolute Professional billing and EpicCare Implemented inpatient EPIC in April of 2008 – (HIM, Resolute HB, ADT, ASAP) Optime/Anesthesia January 2012 Upgrade to 2012 version in May

4. 4 About OHSU

5. 5 Agenda Today Drivers for change Current state 3 year Project scope Patient Estimator Re-engineered Process Flow

6. 6 POS Collections – drivers for change? PricewaterhouseCoopers LLP Nov. 2010 Revenue Cycle Assessment POS Collections increase recommendation to industry benchmark of 1-2% of NPR Half of increased collection is cash acceleration, half is new money, reduces bad debt Every dollar collected up front decreases cost to collect Consumer driven demand for price transparency

7. 7 POS Collections – Drivers for Change Goal FY 12 Increase of $2 million (Hospital) Goal FY 13 increase of $4 million (Hospital) “Quick hit” opportunities identified included scheduled inpatients, scheduled day surgery patients, ED visits, and high dollar Radiology Three phased approach to implementation

8. 8 Current Process Flow

9. 9 Three areas (practices, anesthesia, hospital) all working independently of one another (Inconsistent practices) Limited use price estimator tool in medical practices for professional charges only Manually gather info for a “best guestimate” Benefits/managed care & pre-registration are two separate departments Patients with day or inpatient services were not being informed in advance of expectation to pay at admission Creates a very poor patient experience

10. 10 Phase I – Increase Hospital POS Collections Hospital only, needed to make a rapid change Patient type inpatient, day surgery, ED Commercial/Medicare singly insured patients Increased amount requested from $100 to a range of $300 to $600. Negotiate a lower amount if needed. Informed patients of prepayment expectation during pre- registration up to two weeks out (and collect over phone) Added direct collection of $$ in the ED in May 2012 in addition to copay envelopes

11. 11 Phase I – Increase Hospital POS Collections May 2011

12. 12 Phase 1 – Barriers to Overcome Staff resistance, reluctance to ask for money (scripting, role playing, elbow support) No benefits information during pre-registration No estimate of total charges (redirect to insurance company, scripting) Patient’s adjustment to the change – some may want to cancel Medical Practice staff adjustment to the change Common Documentation/Communication (had to create an EPIC ADT form)

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14. 14 Phase II – Integrated Project Goals Purchase a price estimator that would incorporate hospital, professional, and anesthesia charges into one estimate Re-engineer our POS processes to a single point of communication to convey payment expectations & collect payment Improve the patient experience

15. 15 Phase 2 – Integration Project Structure Established work groups 1. Estimator RFP evaluations & selection panel 2. Steering committee of high level stakeholders 3. Process redesign work group (ENT, Plastics, Neurosurgery, Bariatric Surgery, Anesthesia, Billing, Patient Access) 4. Estimator technical team Ad hoc current state documentation group Patient Focus Group Use of CAP Tools (some LEAN)

16. 16 Phase 2 – Integration Project Scope In Scope: Scheduled inpatients and day surgery High dollar Radiology ED visits Patients with an anticipated balance due ie; copay’s, deductible, and coinsurance Out of Scope: Same day/next day admits Hospital transfers Patients with no out of pocket

17. 17 Patient Estimator FHS Clear Quote/Transunion selected One estimate that includes hospital, professional, and anesthesia charges Patient estimate considers: benefits, median charges, contracts, provider variance Contracted payers were notified Loaded all hospital and professional contracts One years worth of charge data, monthly refresh Clear Code Auto Add Feature HL7 ADT out interface with patient data

18. 18 Patient Estimator HL7 ADT out interface: 1. Patient demographics 2. Patient benefits documented in EPIC from a 270-271 query. (Can be manually entered in estimate) 3. Payer/plan maps to contract/contract allowance 4. Can include the procedure (ours doesn’t at this time) 5. Populates a work list (contact driven) 6. No ADT “in” to EPIC at this time

19. 19 Patient Estimator Can create “shopper” estimates Accommodates prompt pay/self pay/charity care discounts Scripting embedded in tool Dictionary of healthcare terms Common procedure groups Work lists Payment reason codes Reporting

20. 9/15/2015

21. 21 Patient Estimator – Lessons learned ICD-9 Procedure coding Budget for increased 270-271 Lowered the threshold for inclusion of charges to 50% Multiple procedure discounts and modifiers Contract alignment

22. 22 Patient Focus Group Feedback Employee/spouses of employees. Members of billing statement focus group recruited for continuity Positive reaction overall Concerned about use of healthcare “lingo ” Willing to pay 50% of balance due in advance of services, depending on the total amount due and amount of time provided to prepare Staff’s ability to negotiate is critical How you say it is everything

23. 23 Phase II – Process Redesign Single point of communication Who will create the estimate and tell the patient? How much will the patient need to pay? Do we schedule before or after patient pays? What if the patient can’t meet payment expectations? How and where will we document payment expectations? Will we cancel or reschedule if patient doesn’t pay? Who gets the money if the patient cannot pay the full amount?

24. 24 Phase II – Process Redesign The “Cloud People” Phone number on estimate Explain charges & allowables Negotiate payment, receive payment Create payment plans Screen for charity care eligibility A newly defined work unit was born: Combined Customer Service

25. 25 Phase II – Process Redesign

26. 26 Phase II – Process Redesign Challenges Interface or work list trigger How to post pre-service collections and payment plans with no account number Selecting planned procedure code - accuracy of estimate depends on it! Common documentation

27. Phase II – Process Redesign Operations CriteriaPatient Experience Criteria Process Who performs process? Estimator and Interface are date driven Reschedules Cancellations HAR available for payment? HAR available for common documentation? Pre-Auth. and Benefit process Ability to achieve standardizati on of pt. experience across all departments My health vs. your money Ability to view estimate at time of explanation Pay at time of estimate: one stop shopping Smooth billing experience Ability to answer question s about the estimate #1 Patient receives estimate - Payment received - Procedure Scheduled. Practice Practice or CCS Practice 13111113312 #2 Patient receives estimate - Procedure Scheduled (HAR) - Payment Received Practice Practice CCS 11322221122 #3 Procedure Scheduled - Patient Receives estmate - Payment received Practice CCS CCS 31333331131 18/19/25

28. 28 Phase II – Process Redesign Operational Criteria Estimator/Interface are date driven Reschedules & Cancelations Account available to post payment Account available for documentation Facilitate Pre-Auth and benefit processing

29. 29 Phase II – Process Redesign Patient Experience Criteria Achieve standardization of patient experience My health vs. your money Ability to view estimate at time of explanation Pay at time of estimate (one stop shopping) Smooth Billing Experience Ability to respond to patient questions

30. 30 Phase II Redesign What’s next? Wrap up build of estimator Validate 271 data interfacing Validate accuracy of estimates (ongoing!!) Detailed level draft of many sub work flows Develop training materials Train end users Pilot May 6, 2013

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32. 32 Questions? Mela Gant – Director, Patient Access Services gantm@ohsu.edugantm@ohsu.edu (503) 494-6588 Kelly Smith – Assistant Director, Patient Business Services smkelly@ohsu.edusmkelly@ohsu.edu (503) 494-9617 Stephanie Winchester – Director, Healthcare Operations Support winchess@ohsu.eduwinchess@ohsu.edu (503) 494-9816