How do we do more with less? Kaizen, MPI and patient collections

Transcription

1 How do we do more with less? Kaizen, MPI and patient collections

2 Legacy Carilion Labs Company History 1995 Consolidated lab formed within Carilion Clinic 2006 For-profit subsidiary of Carilion Clinic formed 2008 Completed second large acquisition of Innovative Pathology Services (IPS) February 2011 Carilion-Spectrum becomes Solstas Lab Partners 2006 Completed a small acquisition of Rockbridge Medical Laboratory 2007 Completed first major expansion, acquiring Presbyterian Reference Laboratory from Novant Health System March 2010 Merger of Carilion Labs and Spectrum Laboratory Network October 2010 Completed acquisition of Doctors Laboratory, Inc. (DLI) of Valdosta, GA June 2011 Acquired Select Diagnostics, Inc., adding offices in Greensboro and Raleigh, NC and Lexington, VA June 2011 Acquired Wilmington, NC-based Nextwave Diagnostic Laboratories and Wilmington Pathology Associates July 2011 Acquired Southern Diagnostics Laboratories of Birmingham, AL and expands into the Southern region August 2011 Acquired Oracle Diagnostic Laboratories of South Florida 2000 Started growing existing and marketing new, non-hospital outreach clinics and doctors 2004 Acquired Tennessee-based MEDEX s clinical laboratory business and Wellmont Hospital Systems laboratory operations 2

3 Geography 3

4 Solstas Billing 4

5 Goals Increase cash collection Reduce bad debt Reduce DSO Reduce inventories Data Entry Order Edit - Unbilled Claim Check Submissions Back End Denials 5

6 Kaizen People and Process 6

7 Kaizen Improvement or Change for the best Refers to a philosophy or practice that is focused upon continuous improvement. 7

8 Vision Session Who, What, When? Overview of functional area and work process Align Kaizen leader, introduce challenges, review process Target specific measurable gains & timeline Identify resources Staff level (workers) Whole process Outside but supporting Prepare 8

9 Kaizen Objectives DSO Inventory Expense 9

10 The Kaizen week Day 1 Day 2 Day 3 Day 4 Day

11 Process Mapping 11

12 Kaizen #1 Order Edit Current process: Work assigned by edit type Limited job aids and resources Errors in data entry Staff specialized in solving the edit types they were assigned 12

13 Kaizen #1 Order Edit Results: Work assigned by accession Single-piece-flow Intranet page generated to house resources and job aids System edits to prevent Input errors during data entry Training specific to error type across all staff 13

14 Kaizen #2 Claim Check (Eligibility Verification) Current process: Work assigned by problem, searching across mul=ple web sites Manual entry of notes to document ac=ons taken Time spent logging on to various web sites Inconsistent knowledge across staff of payer syntax and search techniques 14

15 Kaizen #2 Claim Check (Eligibility Verification) Results: Formed teams of two, group and assign work by payer, rotate quarterly Automation of notes Productivity Increase Ongoing quarterly training 15

16 Kaizen #3 Cash Current process: Manual process to create batches for posting electronic remittance High volume of paper for manual remittance Productivity measures tracked manually 16

17 Kaizen #3 Cash Results: Automate the process for creating & assigning batches for electronic remittance Combine prepping & posting into a single process Paperless workflow manual remittance Automated productivity reporting 17

18 What did we gain? Work smarter, not harder Staff level empowerment Continuous improvement the cycle never ends 18

19 Master Patient Index Technology 19

20 MPI Episodic Patient-Centric Leveraging eligibility and paid claims data 20

21 Incomplete billing data Patient Demographics Issues Dirty or missing data Patient address DOB or gender Partial insurance information Eligibility failures Accession-centric 21

22 Master Patient Index Patient-centric Utilize paid claims demographics Eliminate unnecessary eligibility verification Rapid implementation Familiar product Trusted vender relationship 22

23 Data and Matching Review data elements available for matching Confirm position/location of data Verify definition and use Determine what data elements will be updated 23

24 Data and Matching Data used for patient matching Patient first and last name Patient address Gender DOB SSN Home telephone number Client MRN Policy number Patient data is not client centric 24

25 Data and Matching Data update rules Person Data Patient demographics Billing Data Responsible party Insurance information 25

26 Validation of our rules Allow data to process through MPI Produce report of MPI actions to validate Validation included Autofixes trump MPI Date parameters for successful eligibility and paid claims set correctly MPI data matched 270/271 output or human research Identified need to modify our default billing type 26

27 Beta Isolate production activation to a select group of safe clients Nursing Home clients Additional clients added a few at a time Big Bang Impact Weekly inventory: 18k 10k Continues to drop as MPI ages 27

28 What we learned Needed an Exclude list of clients o Mix of client and insurance bill types o Client bill only accounts o Sensitive clients Refine the timing of MPI updates Store secondary insurance data Added automated notes to accessions updated 28

29 MPI stats 3.4M MPI records to date 1.5M MPI records verified April MPI updated 30% of our volume Nov-Apr 1.9M patients seen 41% of patients seen more than once 29

30 Next Steps Begin to eliminate 270/271 for verified patients Refine eligibility and paid claims dates by payer Challenge excluded list Align MPI updates with data entry queues 30

31 Patient Collections Technology 31

32 Patient collections Issue Limited POS cash collection Largest contributor to bad debt Objective Increase patient collections Decrease volume sent to outside agency 32

33 LiveVox Automated dialer Outbound calling application Select past due accounts (between 2 nd and 3 rd mailer) Dialer active during Customer Service hours & two Saturday s/month Calls given priority in Customer Service queues 33

34 LiveVox Automated dialer 32% increase in Customer Service collections over prior year Existing staff Nominal vendor expense 34

35 Results 35

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39 Questions 39