Future of Revenue Cycle: Hospital and Physician Collaboration. Rosemary R. Sheehan, Vice President Revenue Cycle Operations March 7, 2017

Transcription

1 Future of Revenue Cycle: Hospital and Physician Collaboration Rosemary R. Sheehan, Vice President Revenue Cycle Operations March 7, 2017

2 Agenda 1. Partners HealthCare at a Glance 2. Current State Revenue Cycle Operations 3. Collaborating to Overcome Challenges 4. Driving Value 5. Take Aways 2

3 Partners HealthCare System at a Glance $12.5 billion revenue (NPSR and research) $8.0 billion in NPSR 3,626 operating beds Includes 372 acute rehab, 323 TCU/SNF beds, 358 psych beds 66,000 employees Includes approx. 3,700 physicians and 1,900 residents and fellows Community commitment: $1.1 billion annual net uncompensated care $185 million annual investment in teaching $148 million annual investment in research $48 million annual investment in other community benefits 3

4 Partners HealthCare System at a Glance Annual patient care activity Approx. 172,000 inpatient discharges Approx. 35,000 observation cases Approx. 367,000 ED visits Approx. 67,000 day surgeries Approx. 1.2 million routine outpatient visits 4

5 - 5 - Boston, MA Boston, MA Jamaica Plain, MA Salem and Lynn, MA Newton, MA Belmont, MA Nantucket, MA Martha s Vineyard, MA Northampton, MA

6 - 6 -

7 Current State Revenue Partners 7

8 Current State Revenue Cycle Central Functions VP Revenue Cycle Hospital Hospital RCO Partners Professional Billing Office Shared Functions Professional Front: Patient Access Middle: Coding/RI Back: Billing, F/up Self Pay Customer Service & Collections MGPO Professional Billing Office Coding Billing, F/UP, Cash Applications BWPO Professional Billing Office Billing, F/UP, Cash Applications

9 PHS Revenue Cycle Operations Front End: Patient Access/Patient Service Center (PSC) Middle: Revenue Integrity (Charge Master, Error Resolution, Audit Functions) Hospital Coding Back End: Acute Hospital Central Billing Office Sub Acute Hospital Central Billing Office Professional Billing Office (Includes coding, charge entry, billing, collections and self-pay) Support Teams: Reimbursement and Revenue Analysis RCO Training Analysis and Administration Payer Relations Total Staff: 810 staff supporting the Hospital Functions 370 staff supporting the Physician Functions 9

10 Revenue Cycle Operations (continued) Hospital Tools: Epic (MGH, BWH, NWH, FH, NSMC, SRH and Home Health) 4 additional billing and accounts receivable systems Additional bolt on systems Huron Work listing Insurance Follow up and Denial Management VRS Remittance Posting XClaims Claims Editing and Transport Hyland Onbase Document Imaging Harvest - Contract Management MedeAnalytics - Reporting & AR Analysis Physician Billing Office Tools: Epic Additional bolt on systems Ingenix Claims Manager Claims Editing Hyland Onbase Document Imaging PHS is in the process of implementing Epic s revenue cycle and enterprise-wide clinical applications. 10

11 Historical Perspective. Hospital Shared service function for largest acute, psych and subacute hospitals Very siloed from the professional revenue cycle functions for many years Used a different system for each hospital Implemented Huron for the 5 acute hospitals Professional Centralized Billing function for well over 20 years for the MGPO Added 2 additional physician groups in 2007 Expanded community based practices Begin to form a more coordinated team with the Brigham and Women s Physician Organization 11

12 Current Physician > Hospital Collaboration Coding Radiology Surgical Day Care Cardiology Procedures Patient Access Outpatient Registration Clinical Referrals Epic Governance Shared system Governance of process and master files Self Pay Collections Customer Service Self Pay Collections One Patient Statement Charging Epic Charging workflows Shared charging Tools 12

13 Highly Decentralized Functions Practice Scheduling Clinical authorization processing Inpatient Clinical documentation improvement Case management/utilization Management 13

14 Drivers for change? Increased Patient Liability Increased need for Transparency Reduced/Stagnant Reimbursement cost reduction Focus on efficiency & Implementation of Epic across the enterprise Need to automate and standardize The focus on Hospital based rejections and write offs increase in physician administrative burden if not managed appropriately 14

15 1 The PHS Case for Relieving Margin Pressure 1 Pricing With continued pressure from the external local market as well as member/patient price exposure especially for secondary services, we need to retain flexibility to move our prices 2 Talent Acquisition Our people are what make our organization the incredible place it is today; we want to continue to be able to attract top talent to our ranks 3 Innovation Innovation is a hallmark of who we are; we want to continue to invest in our future

16 Everything is On the Table Research Administration Ancillary This will involve both financial discipline and change management; we are approaching this differently than we have in the past Physician Education Administration Other direct Patient care Health plan Provider & Pharmacy Nursing Components of Partners Budget 16

17 Revenue Cycle Vision Lower Provider Administrative Burden Standard Data Driven Well Coordinated Patient Focused Highly Efficient Automated Very Effective 17

18 Change is Hard 18

19 Overcoming Major Challenges 1. Culture 2. Politics 3. Change management 4. IT Capacity & Prioritization (Epic)

20 How will we get to our vision? Identify and execute on value opportunities. 20

21 Building Value Opportunities Lower Provider Administrative Burden 1. Virtual/In Room Scribes 2. Automate clinical Authorization process leveraging decision support tools 3. Automate coding/charging from clinical documentation 4. Reduce clicks in Epic by analyzing Epic provider efficiency data Patient Focus 1. Expand functionality in the PatientGateway 2. Direct and Open Scheduling 3. One stop call for scheduling and financial clearance 4. Expand the use of Epic Welcome Kiosks 5. Wait List Scheduling automation 6. Self Service Patient Estimates through the Patient Gateway 7. Proactive push of estimates to patients for scheduled appointments

22 Building Value Opportunities Standardization/Centralization 1. Central scheduling teams 2. Financial Clearance Automation 1. Charging/coding - NLP 2. Clinical authorizations 3. Center of excellence of Utilization Review appeals 4. Combine Clinical Documentation Improvement

23 Building Value Opportunities Data Driven 1. Proactive use of data for clinical and administrative decision support 2. Predictive analytics to analyze future performance 3. Predictive analytics to determine prioritization of workflow Highly Efficient/Very Effective 1. Leverage technology to increase exception based processing (Claims status) 2. Combine hospital and professional revenue cycle functions where efficiency and effectiveness can be gained 3. One touch processes, ensure that work done upstream in revenue cycle is accurate 4. Improved reimbursement, reduced cost improved margins

24 12 month Focus for Partners Revenue Cycle? Leveraging the Partners 2.0 Steering Committee Develop the right projects to execute from each work stream & execute those projects o o o Denials Improvement Business Office Optimization Front End Reorganization Develop a 3-5 year Patient Engagement Vision o Execute Year 1 of that Vision Improve the middle of the revenue cycle o o o o Clinical Documentation Improvement Coding UR Charging Vision Focus on NOT increasing administrative burden as above projects are executed 24

25 How do you manage EMR Workflows in your organization: (check all that apply) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Dedicated committee to provide direction to the workflow needs of the group Bring providers into group on the same EMR workflows by specialty Tailor workflows according to individual provider demands Other (please specify) We do not manage EMR workflows

26 Groups use patient experience, financial and quality metrics, with fewer using organizational engagement to measure physician performance. 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% What type of metrics do you use to measure physician performance? (check all that apply) 0% Financial Patient experience / satisfaction Clinical/Quality Organizational engagement (eg, staff meeting attendance) Other (please specify)

27 How do you engage physicians on performance metrics: (check all that apply) Compensation tied to metrics Performance review meetings Specialty input to metrics Metric-based action plans PCP input to metrics Metrics published for group review Other (please specify) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

28 How do you engage physicians in billing/coding? (check all that apply) Regular audits with training as needed Billing/coding training during onboarding Training re: CPT code changes Training re: payer regulations Other (please specify) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

29 On a scale of 1-5, with 5 being the highest, how would you rate your physicians level of engagement and knowledge on the following: (n=30) Patient satisfaction EMR Optimization Office workflow optimization Documentation and coding issues Performance Measures

30 Please rate your organization on the following: How would you rate physician stress and burnout as an issue within your organization? How effective is your organization at addressing physician stress and burnout?

31 Questions? Thank you for your time! 31