Using Lean Techniques to Transform the Revenue Cycle Process

Transcription

1 MGMA 2017 ANNUAL CONFERENCE OCT ANAHEIM, CA Using Lean Techniques to Transform the Revenue Cycle Process Scott Abram, Fellow HFMA, Epic Resolute PB Certified General Manager and Vice President, Revenue Cycle Sutter Physician Services Sacramento, Calif. Scott Abram does not have any financial conflicts to report at this time. 1

2 Learning Objectives Describe the components of a successful Lean implementation Outline strategies for adopting Lean RCM best practices Analyze a Lean process improvement case study and lessons learned Agenda The revenue cycle landscape Transforming RCM with Lean techniques Internal changes Innovative approaches Rethinking analytics Lean implementation reflections & outcomes 2

3 Sutter Physician Services Overview Wholly owned subsidiary of Sutter Health 2,000+ employees in California and Utah Services highlights $3.6B in fee forservice collections Administering 400,000 managed care lives Over 7M patient access contacts annually Polling Question #1 Are you currently responsible for the daily operations and, ultimately, the results of your revenue cycle team? Yes No 3

4 The Revenue Cycle Landscape Does This Sound Familiar? Do more with less and reduce costs Backlog of receivables build due to shifting priorities Realigning resources to resolve built up issues Your best resources are often assigned to work the least valuable receivables Do You Have a Strategy? Where is the money and what are you doing with it? What problem are you trying to solve? What is within your control? Are you winning or losing? 4

5 Polling Question #2 Do you have a production strategy that provides sufficient control for you to effectively and consistently influence revenue cycle outcomes? 1. Yes, and it works flawlessly 2. Yes, but it s not perfect 3. No, I m constantly chasing issues and redirecting staff to special projects 4. No, I don t really feel like I m able to control the output and quality of my staff Historical Revenue Cycle Operating Methods Managing by Metrics Supervisors & Leads serve as Analysts Anecdotal based problem solving Decentralized, uncoordinated and reactive Endless firefighting 5

6 Premise of a New Strategy Time is our enemy People are necessary to address and resolve exceptions What is the efficacy of multiple efforts to resolve? Should complete all of the incoming work today today! Forensic Insight: A Paradigm shift Does this look familiar? Is this is a smart use of your most talented staff? Traditional Labor Distribution A more appropriate use of valuable resources under the Daily Engagement System (DES) DES Labor Distribution Labor % 100% 80% 60% 40% 20% 0% A/R Value Labor % 100% 80% 60% 40% 20% 0% A/R Value Labor Resources A/R Value Labor Resources A/R Value 6

7 Lean Principles Embracing Lean 1. Specify Value Value is defined from a customer perspective and expressed in terms of the product or service All activities should create value by continuous improvement projects and all waste is eliminated 5. Work to Perfection 2. Map the Value Stream Map all value added and non value added steps that bring a product or service to market Customer needs signal the demand which pulls the product or service through the value stream 4. Implement Pull 3. Establish Flow Think about the continuous flow and process of products or services from end to end Lean Learning & Application Identify and eliminate waste Learn the lingo or make your own Value stream, Gemba Walk, Coaching Kata, Takt Time Experience the process Developing A3 thinking Rapid improvement events or Kaizen Projects Just Do It 7

8 Polling Question #3 How do you rate your current competency regarding Lean tools and techniques? 1. Unaware of Lean 2. Have heard some bits & pieces 3. General understanding of Lean 4. Trained & currently embracing Lean 5. I m a Lean expert Nurturing a Cultural Shift Organizational & leader commitment Lean mentoring and coaching Staff engagement Easy access to metrics, data, insights Daily Engagement System Establish a new model: ODIN One Day s Inventory Now Lean Development & Implementation 8

9 Governance Structure Keys to Successful Lean Implementation Methodology Data Analytics Guidelines for Effective Governance Balanced Leadership Governance Ambitious Goals Accountability Experimentation Continuous Learning 9

10 Guidelines for Effective Lean Methodology Mentoring & Coaching Lean Staff Engagement PDSA & Daily Huddles Minimize Risk & Disruption Guidelines for Data & Analytics Most Important Thing Fresh Approach Data & Analytics Big Picture Lean Processes & Tools Planning & Studying 10

11 Keys to Success Lean Staff engagement through DES Standard work & visual management Adding value by Doing Work That Matters Analytics Analytics insights Early defect detection Workforce management & matching capacity with inventory Daily Dashboards System Optimization System optimization Business rules, edits, and work queue design Automation Why Daily Engagement System? Conditions are complex & dynamic Helps develop the ability to learn, adapt, grow, and evolve by practice, practice, and more practice Trains teams to execute successfully in uncertain conditions Builds capability for continuously improving and evolving Builds consensus and individual & team ownership 11

12 Running Daily Engagement System Learner Coaching / Teaching Coaching Cycles Coach Huddle Board 12

13 Coaching Kata What is the Target Condition? What is the Actual Condition now? What Obstacles are you facing? What is your Next Step? (Next experiment) What Have we Learned from taking that step? Visualizing Your Strategy 13

14 Actual Case Study Results Revenue Cycle FTE vs. A/R Days Trend AR Days FTE Count Polling Question #4 What are your barriers to implementing Lean? 1. No barriers that I can t jump over! 2. Insufficient time available to train and implement Lean 3. No money available to pay for Lean training 4. No executive/leadership support for Lean 5. I don t believe in Lean 14

15 Lean Journey Reflections Is this really new? CQI & TQM Not event driven, but a daily process Don t waste time if it doesn t feel right (RIE) Tie activities to the desired outcome Must be very close to the Gemba Staff engagement is crucial Measure, monitor, and provide actionable analysis Meaningful daily engagement huddles Doing Work That Matters PDSA often!! Lean Implementation Outcomes Transform data/insights into action Operational and production control for leadership Best practices and standard work Significantly increase efficiency and cost reduction impact Proactive vs. reactive approach Improved performance metrics and collection velocity Reduced defects and denials requiring manual intervention Transparency and knowledge of issues immediately Adding empowerment & value to staff Doing Work That Matters Keeping the most important thing the most important thing 15

16 Lean in to RCS Transformation Continuing Education ACMPE credit for medical practice executives. 1 AAPC Core A credit 1 ACHE credit for medical practice executives 1 CME AMA PRA Category 1 Credits.. 1 CNE credit for licensed nurses 1 CPE credit for certified public accountants (CPAs) 1.2 CEU credit for generic continuing education 1 Let the speakers know what you thought! Evaluations are available on the MGMA mobile app 16

17 Scott Abram Sutter Physician Services Old Placerville Rd. Sacramento, CA