Our EPIC Conversion Florence Davis Director, Patient Access Children’s Healthcare of Atlanta

Children’s Healthcare of Atlanta 489 Bed 600,000 Patient Visits 3 Hospital Campuses 4 Immediate Care Centers 13 Neighborhood Centers 3 Hospitals-Egleston, Scottish Rite and Hughes Spalding 4 Immediate Care Centers 13 Neighborhood Centers which include the Marcus Autism Center, Primary Care, Sports Medicine, Rehabilitation and Surgical Services

Patient Access Department Functional Areas Scheduling Order Management Pre-Registration Insurance Verification/Authorization Financial Counseling/Charity Registration 300 Access Staff

Why Do We Care? Our mission: To enhance the lives of children through excellence in patient care, research and education. Clinical excellence Develop people, cultures and resources Quality Innovations Establish common goals with accountability

Lessons Learned It’s a Girl!!! Not a Boy!!!

Lesson Learned 1: Be Prepared for Surprises!! Coverage Conversion Guarantor Conversion Security Access Access to Delete/Term/Update Coverage Access to Event Management Hardwiring Required Data Elements It’s a girl, not a boy!!! The Coverage field definition in EPIC didn’t match our previous system's definition for coverage field because it wasn’t apples to apples. We had over 5,000 patient coverages we had to “clean up”! This affected the guarantors as well! Hardwiring Data elements- we relaxed the minimum required data elements for the appointment conversion but forgot to “turn it on” at go live!

Lessons Learned 2: Key Workflows Out Patient Verification Workflow Reports vs. WQ Benefit Page vs. Forms Referrals Coverage Management Attach to Hospital Account and Guarantor Account Subscriber Relationship to Patient Benefit Management (Retro Adjudication) Effective Date of Coverages Bedded Patients vs. Inpatient Cash Drawer Understanding change in key workflows: Auth WQ is great but depended on the referrals shells being created. For outpatient workflow. At time of scheduling Reports however, are based on all appointments scheduled and will ensure no patient slips through . Multiple Screens to document for the verifiers calling insurance companies. We record all communications to payers using PCCall, Pixcert or Faxcert- products of TRACE. Referrals- if you do not need an authorization then you don’t need to create a referral shell! Example X-rays, ultra sounds, etc Attaching coverage to both HAR and guarantor is a BIG Change for end users. Most difficult for staff to grasp, even now. Duplicate Coverage as a result! Example, an MRI patient with sedation is considered Bedded in EPIC which is treated as IP. A change for our staff! Cash Drawer- who should have this and how to ensure it is balanced and closed daily.

Lessons Learned 3: Training Strategy Technical Training vs. Operational Training COB Billing indicators Skill Sets of Super Users Report Crosswalk Coverage Crosswalk Workqueue Management Allow enough time for training! Operational training: COB, Overage age kids, Occurrence codes, TPL, etc Some super users were not good communicators, while some were just not comfortable playing this role. Coverage mapping is helpful if you have changed your insurance master file WQ management, keep it simple! Define who is accountable and the frequency it should be worked.

Lesson Learned 4:EPIC is One System! Create a change control process Changes to one team’s workflow, will affect another team’s! Changes made to data in one module will affect data in another module! Example: changed the category of Authorization status types. Impacted Utilization (Auth Pended, Auth Approved, Auth Not Required) Review Coverage changes made in Scheduling will impact another account not yet billed out! Changes in Billing (resolute) impacts ADT and Changes in Radiant (Radiology) impacts ADT!

Key Success Factors Change Management Communication Plan Employee: Video/Newsletter Community Physicians Parents Leader Engagement Risk Assessment for Department Lead Sub Teams Define Project Goals/Scope Project Design Teams Outliers Standardization Outliers- Scoliosis Clinic (do not Bill), Series Patients, etc Standardization: Schegistration

Key Success Factors Cont’d ID Resources SMEs (Knowledge Experts) Roles & Responsibilities Created/updated Policies Guarantor Account Management Point of Service & Refunds Self Pay HR impact Job Description Changes Job Grade Defined Roles and Responsibilities for Workflow, Work Queue owners, etc We had Clinical staff scheduling appointments. Had to work through t what this will mean for teams whose clinical staff will be required to collect demographic and financial information at scheduling, since we decided that we will complete pre-registration. At time of scheduling.

Outcome EPIC has enabled us to: Improve Efficiencies Standardization Hardwiring Processes Accountability Streamline Front End Processes “Schegistration” Reports (Trending & Decision Making) Required minimum data to schedule/register WQs helped to identify staff who are making errors and perform focused training Collect financial data at time of scheduling- helps reduce registration delay s and also improves ability to get patient financially cleared f prior to date of services All of these led to increase point of service collections Reduction in denials due to front end processes (eligibility, prior authorization, wrong payer, etc) Physician satisfaction scores have gone up by 20 points! Clean claims ratio now 97%. AR days below 40. Schegistration Timing 4-7 minutes