Jho Outlaw AVP, Revenue Cycle

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1 Jho Outlaw AVP, Revenue Cycle 1 Jho Outlaw is Assistant Vice President, Revenue Cycle for Sisters of Charity Providence Hospitals. She is responsible for Centralized Scheduling, Patient Access Services, Charge Master Management, Health Information Management, Patient Financial Services and Denial Management. Providence Hospitals is a non-profit faith based organization licensed for 304 beds servicing Columbia, SC with two locations. It is comprised of four entities: Providence Hospital, Providence Heart & Vascular Institute, Providence Hospital Northeast and Providence Orthopaedic & Neuro Spine Institute and employees more than 1,500 caring individuals. Background and Affiliations Jho Outlaw received a BS in Business Management from The University of South Carolina and a Masters in Business Administration from Colorado Technical University. Prior to joining Providence Hospitals in June 2004, she spent 12 years in Florence, South Carolina holding various revenue cycle leadership positions first at McLeod Regional Medical Center and then at Carolinas Hospital System/Triad Corporation. Jho has been an active member of HFMA since Contact Information Jho Outlaw can be reached by telephone at (803) and/or by at jho.outlaw@providencehospitals.com.

2 Integrating Key Performance Indicators to Maximize Revenue Cycle Performance 2 JHO OUTLAW A V P, R E V E N U E C Y C L E S I S T E R S O F C H A R I T Y P R O V I D E N C E H O S P I T A L S

3 Today s Discussion 3 Current risk What are our biggest challenges? What is benchmarking? Defining key terms Dispelling myths What are Key Performance Indicators (KPIs)? Sister s of Charity Providence Hospitals Quest for Best Practice Performance What is a Results Only Work Environment? (ROWE)

4 Benchmarking with KPIs 4 KPIs: Measure performance and identify areas for improvement on select core processes Identify the metrics or Best Practice Identify areas of strength Identify areas of weakness Use measurement to prioritize improvement opportunities

5 What KPIs will NOT Do 5 Myth 1: KPIs will tell you why the problem is occurring KPIs will identify a potential problem area You and your team need to identify the weakness in your process Myth 2: KPIs will identify the solution KPIs will allow you to calculate the potential improvement value You and your team will need to identify and implement effective process improvement initiatives Myth 3: KPIs alone will prove that you are doing a great job! KPIs are only effective if the measurements selected are meaningful You ll need to sell the value of the measurement

6 What KPIs will NOT Do Continued 6 Myth 4: There are no KPIs that will work for us we re unique! Standardized and validated KPIs can provide comparison to Best Practice You and your team decide if best practice is appropriate Myth 5: Developing KPIs is just too much work KPIs allow you to measure success how else would you know? You and your team can identify success and gaps and/or shortfalls Myth 6: Developing KPIs alone will improve results KPIs are only effective if action is taken and changes are made You and your team will identify opportunities and implement performance improvement initiatives

7 The Excuses 7 The Master Excuse List: This is too much work The data is too hard to collect No one will look at it anyway Why is this really important The Solution: One measurement at a TIME!

8 Complacency 8 True or False 1) On most days I m comfortable at work 2) Most days at work are without confrontation 3) I feel like my work environment is stable 4) I execute most of my daily work tasks with ease 5) I make routine decisions on most days with little to no concern 6) I m on top of things and my responses are somewhat automatic 7) I am content at work 8) I am satisfied with my job 9) I do not have the need to take risks on a routine basis 10) On occasion I get bored at work 11) I don t depend on creativity to get my job done 12) Most of what I do at work every day I ve done before 13) It has been a while since I ve learned something new, really new, specific to my job 14) For the most part I have no problem leaving work at work 15) My work isn t broken so I do not have to think about fixing it

Complacency Results 9 If between 1 and 5 are true = If between 6 and 10 are true = If between 11 and 15 are true = Low risk of complacency Moderate risk of complacency

9 Complacency Results 9 If between 1 and 5 are true = If between 6 and 10 are true = If between 11 and 15 are true = Low risk of complacency Moderate risk of complacency High risk of complacency com pla cen cy : a feeling of being satisfied with how things are and not wanting to try to make them better : a complacent feeling or condition

10 Complacency Example 10 President s Commission on the Deepwater Horizon Oil Spill said that a root cause of the fatal explosion and subsequent colossal spill in the Gulf of Mexico was complacency. The Deepwater Horizon disaster, states the report, exhibits the costs of a culture of complacency There are recurring themes of missed warning signals, failure to share information, and a general lack of appreciation for the risks involved. Moreover, the report went on to detail how this can infect any culture, not just that of an energy giant.

11 Complacency Example 11 "A common trap to fall into is what's called normalization of deviance," Lochbaum told reporters on a conference call on Thursday. "You can get sucked in to the false belief that it will never get any worse, and because I've experienced it in the past... I don't have to do anything to fix it because it's annoying but it's not mission critical. "HISTORY OF COMPLACENCY The report noted that previous nuclear disasters, including at Three Mile Island in the United States in 1979 and in Chernobyl in 1986 became catastrophic because plant operators failed to fix known problems.

12 The Root of All Evil 12 What is the root of all evil for the Revenue Cycle? Complacency! - A feeling of contentment or selfsatisfaction, especially when coupled with an unawareness of danger, trouble, controversy, or deficiencies

13 Kick-Start 13 What will get you going? For me it was a yearly evaluation My boss wanted MO JHO! My reaction Maybe he s crazy I work SOOOOOOOOO hard I already work long hours We ve been maintaining slightly above average performance Our numbers are fine! What more do they want?!?! Blah, blah, blah

15 Providence Hospitals Where to Start? 15 Key Performance Indicators (KPIs) Where are we now? How do we compare? Where do we need to go? How do we get there

16 Brainstorming Begins 16 Big Hairy Audacious Goals (BHAGs) Limit each department to 1 or 2 KPIs (Focus on those that drive the other KPIs) They must be easy to understand They must be measurable and easy to monitor Results must be delivered real time

17 How do we compare? 17 AR Greater than 90 Days Old Point of Service Cash Collected Patient Satisfaction

18 How will we get there? 18 Reorganization? Self Directed Work Teams? Clear concise goals? Real time feedback? Incentives? Trust plus Accountability? Results ONLY Work Environment?

19 Convincing Others 19 Key Stake Holders Chief Financial Officer Controller The Board ME!

20 Reorganize the CBO? 20 How can we do this? What can we try that we ve not tried before? Are them some ideas we should try again? Can we reorganize the CBO to Self-Directed Work Teams? How will we build such dynamic teams from what we have now? Who will need to be retrained? Who will do the retraining? What do the bosses do if teams are self-directed?

21 Are Incentive Plans Important? 21 Incentive Plans? What and How and Who? How to convince our leaders? How do we earn respect and buy-in? Can we at least try it?

22 Parachute Packers World War II 22 3% of parachutes failed!

23 Establishing a ROWE 23 Results Only Work Environment (ROWE) What is this? How does it work? How do you define accountability? To what standard are you held accountable?

24 Recommended Reading 24 Drive The Surprising Truth About What Motivate US By Daniel H. Pink Hacking Work Breaking Stupid Rules for Smart Results by Bill Jensen, Josh Klein Work Sucks How to Fix It - The Results-Only Revolution by Cali Ressler, Jody Thompson

26 AR Greater than 90 Days 26 20,000,000 AR Greater than 90 18,000,000 16,000,000 14,000,000 12,000,000 10,000,000 8,000,000 6,000, Sep-14

27 Aged AR Accountability Defined 27 The overall AR greater than 90 days will decrease each month. The team AR aging, the individual PAR aging, and a comparison of teams to each other and PARs to each other will be used to document success. Each PAR will be held accountable for accomplishing at least 75% of the overall decrease as well. If the team overall and/or any one of the PARs did not accomplish a decrease of 75% or more of the overall decrease the corrective action process will begin and/or continue.

28 Incentive Program 28 If the department meets the AR Greater than 90 Goal - 1) AR Greater than 90 days: a. Tier 1: If the Team AR greater than 90 is between $XXMM and $XXMM, each team member will receive $300 for that month s performance. b. Tier 2: If each member of the Team s AR is between $XXMM and $XXMM, each staff member will receive $400 for that month. c. Tier 3: If each member of the Team s AR is below $XXMM each staff member will receive $600 for that month. 3) AR Greater than 90 days Winning Team: The incentives listed above are doubled for the team with the lowest total AR Greater than 90.

29 So Then What Happened? 29

30 AND Then What Happened? 30

31 Using ROWE in HIM * Accountability 31 BHAGs Coders Quality Results - Quarterly Productivity Monthly Technicians Quality Results - Monthly Total Dollar Amount Unbilled Due to Deficiencies Monthly

32 Using ROWE in HIM * Incentive 32 1) Unbilled greater than lag MONTHLY: a. Tier 1: If the month end discharged unbilled is between $8MM and $10MM, each staff member will receive $300 for that month s performance. b. Tier 2: If the month end discharged unbilled is between $6MM and $7.99MM, each staff member will receive $400 for that month. c. Tier 3: If the discharged unbilled is less than 5.99MM or less, each staff member will receive $600 for that month. 3) Unbilled greater than lag WEEKLY: The incentives listed above are doubled as appropriate when the unbilled averages at that particular level weekly during that month.

34 What Happened Next? Providence Hospitals Days in Discharged Unbilled Goal Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14

35 How Have Things Changed? 35 Self-directed work teams Clearly defined goals Real time monitoring and measuring of success Accountability Celebration And did I say ACCOUNTABILITY!

36 Your (OUR) Take-A-Way 36 Organizations must continue to do more with less Greatest opportunity is the value of your data Don t keep sticking your tow in the water to check the temperature do something about it! JUMP IN! The way to achieving high performance is through benchmarking, performance tracking, and ACCOUNTABILITY!

37 Exercise: Setting Goals 37 Define a set of desired outcomes for improvement What are the most important financial and operational goals to work towards? Goal 1: Goal 2: Goal 3:

POS Collections. Changing the Culture at Oconee Medical Center

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