1. Spontaneous Combustion: Making and sustaining change in Patient Access
Debi Stolic, Director of Patient Access, Bethesda Memorial Hospital
Anne Habib, OputmInsight

2. Bethesda Health System Continuous Improvement Culture
Overview
Introduction
Bethesda Health System
Continuous Improvement Culture
Case Study – Up Front Cash Collections
Sustainable Change
Transform the organization and foster a culture of continuous
improvement
Eliminate non-value added activities (waste) within processes
Reduce cycle time and touch time; increase communication and data driven decision making
Understand the value of integrating people, technology and operational processes and resources
Combine strategic thinking with tactical application of principles and change management.
Control and improve business processes through disciplined, predictable and repeatable solutions.
1- Describe how the Gold Standard methodology provides a foundation for disciplined problem solving. It is the means to success in making, promoting, and accomplishing sustainable improvements. The methodology ties together operational tasks and technological improvements.
2 -Discuss how upfront cash collections in Patient Access improves hospital viability.
3 - Evaluate and understand baseline metrics representing impacts on cash collections due to price estimates, verification of insurance and payment collection in Patient Access
4 -Understand the need for moving collection activity to the front end of the streamlined process in order to increase the opportunity to collect cash. This alleviates follow up activities in the business office
5 - Removes the duplication of effort and Bottlenecks throughout the process in order to collect cash. Reducing administrative back end costs.
6 -Understand the advantage of point of service collection
not making calls, sending out bills, incurring contingency collection fees
Introduction: Overview of Cash Collection activity in Patient Access (inpatient and outpatient) - Current State and Future State, Gap analysis and problem solving techniques
(Obj 1
WhY ' What was the purpose of putting in Price Estimator. The goals and objectives, What we hoped to accomplish by doing this.
How - the merging of the people, process, technology components
The Result - baseline measures, improvements, current and future states, value added activities and observations
The monitoring and control process - the QA follow up to ensure sustainability
Questions and Discussion
The Gold Standard successfully provides a
simplified process structure that when practically applied, transforms organizational performance. Some of the key
elements of this approach:
Empower associates to create change rather than providing them with solutions and telling them how to execute changes. Foster a culture of continuous
Eliminate non-value added activities (waste) within core processes

3. Bethesda Healthcare System
Bethesda Memorial Hospital is located in Palm Beach County, Florida.
We have 401 beds, 525 physicians and 2,300 employees.
Bethesda West Hospital opens in early 2013 with 80 beds; the design facilitates growth to a 400 bed hospital in future years.
Bethesda Memorial Hospital opened its doors in 1959 with 70 beds, a medical staff of 32 physicians, 65 employees and, as a not-for-profit hospital, a mission to serve the community.
Current Situation
Today Bethesda has 401-beds and 525 physicians in more than 40 areas of specialty, and a hospital staff of more than 2,300 employees. Bethesda Healthcare System is building an all-new, 80-bed hospital to serve the communities of western Boynton Beach. Construction for the new Bethesda West Hospital began in May 2010 and will be completed in early Bethesda West Hospital has been designed so that it can grow to become a 400-bed hospital in future years. Together with Bethesda Memorial Hospital and Bethesda Health City, we look forward to bringing Bethesda West Hospital into our family of healthcare services to better serve our western communities.

4. Bethesda Memorial Hospital

5. Patient Access at BMH Pt. Access Central Scheduling – 16.5 FTE’s
Registration – 38.8 FTE’s
5 Patient Access Points of Entry
Our Numbers
20,578 Admissions
60,001 ED Visits
175,558 Outpatient visits
141,195 Tests scheduled
Systems
QuadraMed Enterprise Scheduling
Siemens Patient Management (Invision)
Estimator Pro

6. BMH Payer Mix
Our payer mix

7. Continuous Improvement Culture
Overview
Need to Improve Operations
Tired of IN & OUT Consulting Projects
Methodology/Structure for Independence
Identify and List Opportunities
Define Resolutions
Prioritization Criteria
Implement Solutions
Feedback Loop
Next Project
Founded in 1959, Bethesda Healthcare System is a nonprofit health care organization
serving the medical needs of Florida’s South Palm Beach County, with a mission to
provide quality health services in a caring manner.
Bethesda wanted a partner that would help decrease those costs, particularly related to the revenue cycle.
Bethesda had already worked with Optum through its analytics, technology, services, and consulting company, OptumInsight™ (previously
known as Ingenix). Bethesda used several of its revenue cycle management and other products, and had been extremely impressed with the company’s industry-leading technology and world class process improvement expertise.

8. Pre-Visit Information Ancillary Departments Obtain/Review/Update
Identify Issues - SIPOC
Suppliers
Inputs
Process
Outputs
Customers
Physicians
Insurance Info
Customer contacts
Central Scheduling
Appointments
Patients
Payer
Charge Codes
Directions
Families
Scheduler answers
phone using
Symposium phone
system
Patient
Test Scripts
Transportation
Insurance Subscriber
Associates
Demographic Data
Searches for Patient in
QuadraMed Scheduling
Follow Up Calls
Physicians/Nurses
Other Facilities
Appointments
Pre-Visit Information
Ancillary Departments
Obtain/Review/Update
Patient’s
demographics
Insurance Carriers
Other Facilities
Schedules
appointment
Case Mangers
Performs
Pre-registration
If possible

9. Define Opportunities

10. Document Process

11. Prioritize Projects Benefit Strategic or Tactical
Increase Cash Collections
Reduce Waste & Cycle Time
Reduce Variation
& Defects
End Results
Benefit
Strategic or
Tactical
Quick Hits
LEAN Projects
DMAIC
projects
Cash Collections
ED Mobile Computing
OutPatient
Through Put
List Prioritized Projects
One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects.
All 3 techniques require baseline measures, improvement and control plans.
The data drives the prioritization and type of project.
Baseline Measures
Improvement & Standardization
Control Plan
Measure , Analyze, Improve, Control
Continuous Improvement

12. Document Projects Benefit Strategic or Tactical
Increase Cash Collections
Reduce Waste & Cycle Time
Reduce Variation
& Defects
End Results
Benefit
Strategic or
Tactical
Quick Hits
LEAN Projects
DMAIC
projects
Cash Collections
ED Mobile Computing
OutPatient
Through Put
List Prioritized Projects
One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects.
All 3 techniques require baseline measures, improvement and control plans.
The data drives the prioritization and type of project.
Baseline Measures
Improvement & Standardization
Control Plan
Measure , Analyze, Improve, Control
Continuous Improvement

13. Implement Project Benefit Strategic or Tactical
Increase Cash Collections
Reduce Waste & Cycle Time
Reduce Variation
& Defects
End Results
Benefit
Strategic or
Tactical
Quick Hits
LEAN Projects
DMAIC
projects
Cash Collections
ED Mobile Computing
OutPatient
Through Put
List Prioritized Projects
One of the ways that senior leaders stay  in touch with how Lean Six Sigma is working within their teams is through the project selection and review process. In these reviews leaders assure that Lean Six Sigma is aligned with their long term strategies and delivering meaningful business results. The Gold Standard approach provides 3 lean sigma based techniques to achieve successful problem solutions: Quick Hits, LEAN and traditional DMAIC projects.
All 3 techniques require baseline measures, improvement and control plans.
The data drives the prioritization and type of project.
Baseline Measures
Improvement & Standardization
Control Plan
Measure , Analyze, Improve, Control
Continuous Improvement

14. Feedback Loop Feedback M E T R I C S HIM PFS Pt. Access Sch Auth Reg
Pre-Reg
iVerify
Auth
Reg
Trspt
Code
ROI CE
Bill
Collect
Pay Post
SP1
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Feedback
M E T R I C S

15. Case Study – Up Front Cash Collections
Prioritization
Improved Cash Collections – High Priority
Both strategic and tactical
Lean Project
Baseline Measurement – to determine results
Analysis - to ensure Improvement & Standardization
Implementation Plan – to ensure success
Control/Monitoring Plan – for sustainability

16. Importance of Up Front Collections
If patient leaves without making a payment; chances of collection go down to 40%.
Improved patient satisfaction when financial responsibility is known.
Receiving a large bill months after service can cause many patients to think negatively about their experience.
Without POS, the hospital is basically financing a service interest free for 60 days.
As collection costs increase, cash flow to pay salaries and medical equipment may not be sufficient.

17. Outpatient/Admitting
Baseline Measure
Central Scheduling
Zero
Outpatient/Admitting
$6,139
Surgery Center
$29,386
Heart Institute
$4,001

18. Implementing Technology
Price Estimator
Have realistic expectations of the technology
Understand the pros and cons of the technology and work with the pros
Keep your eye on the goal
Communicate with your vendor and have regularly scheduled meeting/conference calls to work through issues quickly

19. Technology, Process, & Collections
Training
Technology, Process, & Collections
Technology
Basic training on Estimator
Challenges – understanding terminology
Process
Inserting Estimates and Collection into the pathway
Clearly documented process comparing current and future states
Collection Scripts
Developed statements that are said to patients in a consistent manner including how to handle responses from the patient
Speaking with confidence, use of empathy, identifying excuses vs. the need for true financial assistance.

20. Good Old Competition & Recognition
Motivating the Team
Bonus Plans
Movie Tickets
Pizza Parties
Lunch Passes
Good Old Competition & Recognition
Poster boards in departments
Target goals

21. Tracking Collections

22. Out Patient Results

23. Central Scheduling Results

24. Ambulatory Surgery Results

25. Bethesda Heart Results

26. Sustainable Change What will make the improvements stick?
Regular monitoring and early intervention avoids discrepancies, reprocessing, and waste
On going monitoring and audits of the improved process
Regular review of KPI reports to ensure compliance
Regular consistent communication with staff about what’s working and what isn’t
Continuous improvement Stress the importance of adherence to the standards and the essential need to continuously improve
Bring a close to the Milestone 3 presentation by identifying the critical steps necessary for sustained success and continued growth. Discuss regular monitoring by client staff and biweekly/monthly visits from Ingenix process SMEs to support their efforts.
What will make the improvements stick?
In improvement projects, make sure the root cause of the problem has been resolved for the long-term
Put metrics in place to notify management if the problem begins to occur again

27. Thank You!