SUSTAINABLE BEHAVIORAL HEALTH SERVICES. Virna Little, PsyD, LCSW-R, SAP, CCM

Transcription

1 SUSTAINABLE BEHAVIORAL HEALTH SERVICES Virna Little, PsyD, LCSW-R, SAP, CCM

2 FYI Funding for some of these webinars and learning community calls was made possible in part by grant #5H79TI from SAMHSA. The views expressed in written conference materials or publications or speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

3 1. Developing a sustainability plan 2.Identify fiscal performance indicators 3.Learn optimize systems to support sustainability Objectives

4 The Front End and the Back End!

5 Considerations for Sustainability Staffing Productivity/Volume Direct Revenue Indirect Revenue Coding Contracting Optimization ( concurrent doc) Back end-denials, Dashboard development

6 Efficiency Revenues Expenses Count of visits Benchmarks Average Reimbursement rate per visit Necessary Data Points

7 Do You Know? Your cost per visit for behavioral health? Your average reimbursement for behavioral health? If not

8 Staffing Billing varies greatly with staffing What is the licensing of the staff you are hiring or who will be working in your program? Billing for Montana summary sheet Do your billing and reimbursement homework BEFORE you hire your staff Do you have staff now you cant afford to keep if grant funding goes away?

9 Workflows Often Equal $$$$ There are many different workflows Workflows can vary by location or provider Not set in stone Why do I need to do my reimbursement work before I figure out my workflows? Why do workflows matter? Example-Medicare, hand off to open slots

10 Review Payer Mix What payers does your organization or BH services get reimbursement from Make a grid to review each payers each service and each provider Review guidelines for each payers- are services part of the contract or do they need to be added Does the payer reimburse for all credentials, i.e. social workers vs. counselors Special payer programs-like depression

11 Make A Grid What payers does your organization bill to or contract with List all of your payers Individually- remember some have more then one plan List all of your billable staff Leave space for contracting possibilities

12 Contracts Can be second source if a provider or code is not billable Contrary to popular belief they are negotiable If you don t ask (is this the best rate you are offering in this state?) Check with other IMPACT or integrated projects in your statewhat are their arrangements (you cant partner) Medicare Advantage

13 Coding Code what you do!! Why code for things we cant bill for? Some fun codes to know 96127, Advanced Directives Case Conferencing Screening for substances Social determinants

14 You Cant Get Paid If you don t see enough patients Know the ratios Productivity needs to support sustainability

15 Efficiency Rate of Productivity: Number of billable visits per hour Benchmarks Necessary Data Points

16 Quantifying Efficiency EFFICIENCY PERFORMANCE INDICATORS Capacity: % of Face-to-Face time spent with patients producing visits out of the total time available for patient care Productivity: Count of Visits Provided related through Rate of Production: Visits per given time (e.g. hour, standard work day)

17 Efficiency Capacity Required to Break-even: Number of billable visits required in a period to break-even Benchmarks Necessary Data Points

18 Quantifying Efficiency EFFICIENCY PERFORMANCE INDICATORS Necessary Data Points: Face-to-Face time spent with patients producing visits Count of Visits Provided The total time available for patient care

19 Credentialing Not to be confused with professional appointments Why should I bother if most of our patients are Medicaid? What if my organization doesn t credential behavioral health providers? Subject to reviews by credentialing organizations Takes a long time- Delegated credentialing is a goal

20 Abstract Dollars Can help support IMPACT work Will vary by organization/setting/payer mix Time spent with PCP No show rates for PCP, specialty care Medication adherence Emergency room visits/utilization Productivity for behavioral health

21 Quality Dollars Disease Management industry Potential to have care management paid for ( at your site vs. by phone ) Special programs, like Aetna Brings in additional dollars above wrap Showcases your program/project Offer to be a pilot

22 Optimize By Knowing what you should be paid for all services Reviewing work flows, opportunities to up code Review same day billing, services Different diagnosis for same day visits NOS vs MDD

23 Medicare Does Pay For Two Visits on the same day Incident too visits Behavioral health providers in health centers Depression Screenings Form Completion

24 Getting Paid What You re Due Look closely at EOB s Not all payments are correct Review and Track your Denials Often Dx denials Review: Payer contracts Self-pay determinations Sliding fees Do you need a different sliding fee for behavioral health?

25 Getting Paid What You re Due Review Charges, and how they are determined and updated. Service definitions change Get on notification list for your state Medicaid Percentage of paid invoices

26 The Goal Operate fiscally sustainable clinics that demonstrate the efficient conversion of resources (employee time and effort) into effective patient care

27 Quantifying Efficiency EFFICIENCY PERFORMANCE INDICATORS Necessary Data Points: Face-to-Face time spent with patients producing visits Count of Visits Provided The total time available for patient care

28 Measuring Efficiency Methods to measure these pieces of data will vary clinic to clinic based on resources available *Modeling instead of measuring:

29 Defining Efficiency Benchmarks FISCAL PERFORMANCE INDICATORS Operating Surplus (Loss): Difference between revenues and expenses Break-even point: Revenues equal expenses Communicated in terms of Productivity Communicated in terms of Capacity

30 Defining Efficiency Benchmarks FISCAL PERFORMANCE INDICATORS Necessary Data Points: Revenues Expenses Count of visits Average Reimbursement rate per visit

31 Defining Efficiency Benchmarks FISCAL PERFORMANCE INDICATORS Annual Expense Salary 1.0 FTE $ 65, necessary data point 25%Fringe $ 16, =C4*A5 25%Overhead $ 20, =(sum(c4:c5))*a6 Total Personnel Expense $ 101, =sum(c4:c6) Break Even Calculations: Reimbursement per Visit $ necessary data point Annual Visits required to Break Even 1693=C7/C10 Weekly Visits required to Breakeven 38=C11/44 Rate of Production (visits per hour) Face to face time required for weekly visist production Avaliable weekly time for patient care Capacity required to break even 1.20 prior calculation 32.1 =C12/C necessary data point 80%=C15/C16

32 Enhancing Efficiency SCHEDULING PERFORMANCE INDICATORS Scheduling Days Out: Count of days between the date on which an appointment was made and the date for which it is scheduled No-Show Rate: % of scheduled appointments for which a patient does not present, or that a patient cancels within 24 hours OPEN SLOTS ARE WHAT COUNTS!! YOU CANT TREAT A SEAT!!!!!

33 Enhancing Efficiency SCHEDULING PERFORMANCE INDICATORS Necessary Data Points: Date Appointment was Made Date of Appointment Appointment Outcome Cancellation Date ( when is a no show)

34 Identify days with high open slots

35 Identify times with high open slots

36 Create Strategic Access Schedule Time Monday 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM Dr. Whatt s Schedule *shadow schedule: not a real provider Tuesda y Slot Wednesda y Slot Thursday Friday Slot Slot Slot Saturda y

37 Enhancing Efficiency SCHEDULING PERFORMANCE INDICATORS Date Made Appoinment Date Days Out Appointment One 1/18/2013 1/21/ Appointment Two 1/2/2013 3/16/ Apoointment Three 2/5/2013 2/5/ Formula necessary data point necessary data point =C2-B2

38 Defining Benchmarks What is your ideal maximum number of days out?

39 Decrease Days Out--Intakes Pull Forward Currently Scheduled Intakes 1. Identify high areas of no shows-predictive modeling 2. Create strategic overbooking slots in the times of frequent no shows- we call them access slots 3. Take appointments scheduled furthest out and pull them forward into new slots 4. As show rate increase, adjust number of access slots 5. HOTSPOTTING

40 Identify days with high open slots

41 Identify times with high open slots

42 Create Strategic Access Schedule Time Monday 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM Dr. Whatt s Schedule *shadow schedule: not a real provider Tuesda y Slot Wednesda y Slot Thursday Friday Slot Slot Slot Saturda y

43 Decrease Days Out--Ongoing Care Discontinue the habit of recurring individual therapy appointments, instead schedule week-to-week. What is average length Of care?

44 Decrease Days Out--Ongoing Care Consider walk-in only medication management follow-ups. 1. Psychiatrist tells patient at end of visit to walk-in the week of and provides available hours 2. Reminders based on who has been instructed to come in the week of

45 Maintain Quick Access Identify a right-sized number of intake slots How many ongoing cases can you clinic support at a time given current staffing? What is your average length of treatment? What percentage of intake convert into care- as opposed to case closure? What is your no-show rates on intakes now? Use data to tell your story!

46 start slow and small Open Access

47 start with one provider Open Access

48 start with one population Open Access

49 start with one session Open Access

50 Dashboard Development Where do we think your biggest holes are? What information would we need to know to patch the holes daily, weekly, monthly, quarterly? How would we get this information? Who would get this information and how would they share it?

51 Dashboard Beginnings What do I need to know? When do I need to know it? Where can I get this information?

52 Post-Webinar Survey Please be sure to complete the survey that will appear on your screen after the webinar ends.

53 THANK YOU!