Improving the
Productivity of Your
Financial Operations
Michael Holton
Manager
RSM McGladrey, Inc.
919-571-3266
Michael.Holton@RSMI.Com Subhead
GOALS TODAY
•Discuss the importance of systems in
monitoring
community health center
efficiency and operations.
•Identify system approaches and
methodologies to assist in managing health
center operations.
•Develop measurement tools for key
operational indicators.
Registration/
Certification
Patient Reception
Patient Clinical Visit –
Service Delivery
Appointment
Scheduling
The
Accounts Receivable
Management and
Collections
Revenue
Documentation &
Coding
Cycle
Denied Claims
Management
Charge Processing/Check Out
Claims & Patient Payments
Processing
Patient Statement &
Claim Production
EXAMPLE OF HEALTH CENTER OPERATIONS
Patient Flow
Intake/
Registration
Medical Records
Appointment
Scheduling
Business
Office
Follow Up/
Referral
Patient Flow
Patient Flow
Triage
Service
Delivery
IMPACT OF PATIENT FLOW/ACCESS
ON PRODUCTIVITY
• Before a physician sees a patient, the patient needs to register, have
their vital signs taken, and have their charts pulled.
• Make a commitment to improve efficiencies and remove
bottlenecks in the process
• How can we identify and improve on patient cycle time?
IMPACT OF PATIENT FLOW/ACCESS
ON PRODUCTIVITY
•
Evaluating the space needs and design layout of various areas, CHCs can
identify areas for potential patient flow improvement.
1. Is the space designed to maximize the flow of patients, to move them
through the health center as quickly and efficiently as possible?
2. Are there opportunities to relocate certain functions (registration,
cashiering) to more central areas nearer to the front desk?
3. Other?
•
How is exam room utilization? Are there times when the exam rooms are
full during the day, and other times when they are empty? What are your
health center hours? For staff, providers, patients?
What happens at lunch time?
•
EXAMPLE WORKFLOW OF INTAKE/REGISTRATION
Patient
Arrival
Notification
at Front Desk
Data
Collection
Eligibility
Verification
New or
Existing
Patient
Service
Delivery
MAIN COMPONENTS OF INTAKE/REGISTRATION
• Notification at Front Desk - The front desk staff ensures that all patients who
arrive for service identify themselves upon arrival.
• Determination of New or Established Patient -The front desk staff identifies
whether a patient is new to the center or is an existing patient (if this has not
been done when the appointment was made).
• Data Collection - New patients are referred to the patient registration staff for
data collection activities and eligibility determination.
• Eligibility Determination - Existing patients are referred to patient registration
staff upon arrival for eligibility determination and data updating.
IMPACT OF INTAKE/REGISTRATION
ON PRODUCTIVITY
• If the intake / registration process is not coordinated efficiently, then
there are potential bottlenecks including:
– Line for Patients Waiting to Notify Front Desk
– Line of Patients Waiting for Registration
– Line of Patients Waiting for Eligibility Determination
• If patients are backed up at intake / registration, then there will be
delays in getting patients into exam rooms. This problem could be
when the health center first opens in the morning and at lunch time.
• It is critical that there is a strong front desk to collect complete and
accurate data. This data is used for a variety of important functions.
SELECT PRODUCTIVITY MEASURES FOR
INTAKE/REGISTRATION
• Average Number of Patients Registered Per Hour Per Provider (new
and established patients)
• Average Waiting Time in Registration
• Average Time to Complete an Intake (new and established patients)
MAIN COMPONENTS OF APPOINTMENT SCHEDULING
• Reminder Phone Calls - The front desk staff calls all patients the day
or two before the appointment to confirm the date and time of the
scheduled visit.
• Check-in for Day’s Appointment - The front desk staff check the
patient in and note the time the person arrived for his or her scheduled
appointment. The person is put into the queue to be seen by the
provider. The encounter form for the patient is printed and placed in
the person’s medical chart.
MAIN COMPONENTS OF APPOINTMENT SCHEDULING
• Schedule Follow-up Appointments - The front desk staff identifies
whether a patient is new to the center or is an existing patient (if this
has not been done when the appointment was made).
• Complete Lab / Specialty Referral Forms - The front desk staff
completes any referral or insurance forms that are required.
• Documentation and Notification of No-Shows - The front desk makes
note of the patients who missed appointments and places follow-up
phone calls to those patients to schedule a new appointment.
IMPACT OF APPOINTMENT SCHEDULING
ON PRODUCTIVITY
• Due to the high no-show rate, it is important to efficiently manage appointment
scheduling and ensure that there is a routine flow of patients for providers to
see. CHC’s must account for walk-in rates when scheduling appointments.
• Health centers should develop policies on how to block schedule their patients
(e.g., standard time slots for different appointment types); what percentage of
slots should be double and triple booked; and how walk-ins should be treated.
• The distribution of new and established patient visits throughout the day must
be well-thought out in order to maximize provider productivity and must be
flexible and changed when appropriate.
IMPACT OF APPOINTMENT SCHEDULING
ON PRODUCTIVITY
• Scheduling staff must make every attempt to make appointments as
quickly as possible. The goal should be that the next available
appointment which is convenient for the patient be scheduled.
• On a regular basis, someone should review and monitor the
scheduling of new patient visits, check that appointments are being
double-booked as appropriate, and review the impact of any special
requests on appointment scheduling.
.
IMPACT OF APPOINTMENT SCHEDULING
ON PRODUCTIVITY
• If volume permits, routine ancillary services should be available onsite and scheduling for ancillary services should be coordinated
through a central scheduling function.
• Automated scheduling systems should provide:
 Automatic reminders for standard visits (flu shots in the fall);
 The ability to discretely schedule different length visits and
different physicians;
 Access to schedules for all physicians in all clinics (e.g., medicine,
pediatrics, women’s health, HIV); and
 Access to scheduling for specialty appointments.
SELECT PRODUCTIVITY MEASURES FOR
APPOINTMENT SCHEDULING
Percentage of Reminder Phone Calls / Postcards Completed
(attempted and completed)
• No-Show Rates By Provider (new and established patients)
• Waiting Time from Check-In to Provider Visit (scheduled
appointments and walk-ins)
• Percentage of Walk-In Visits
• Average Appointment Waiting Time (Urgent Medical Visit,
Routine / Well Visit, and Non-Urgent Sick Visit)
• Percentage of Unfilled Patient Slots
COMPONENTS OF SERVICE DELIVERY
Triage / Data
Collection
Exam Room
If No
Patient
Waits
Is Provider
Ready?
If Yes
Patient
Exam
Business
Office
Ancillary Service
IMPACT OF SERVICE DELIVERY ON PRODUCTIVITY
• Patients must be in exam rooms when providers are ready and all
necessary information must be available prior to the arrival of the
provider (e.g., complete medical record).
• Medical support staff must be focused on ensuring that each patient is
efficiently managed throughout the service delivery process.
• Each patient should be assigned a primary physician and the majority
(>80%) of that patient’s visits to the health center should be with the
same physician.
• All providers should be educated in managed care.
SELECT PRODUCTIVITY MEASURES
FOR SERVICE DELIVERY
• Average Number of Visits Per Provider (e.g., General and Internal Medicine,
Family Practice, Pediatrics and Well-Baby, OB/GYN)
• Number of Referrals / Primary Care Visit (specialty and ancillary)
• Percentage of Eligible Patients with Up-to-Date Immunizations
• Percentage of Patient No-Shows that are Evaluated to Determine Follow-Up
• Provider Turnover Rate
• Average Turn-Around Time for Test Results After Referral is Made (acute and
non-acute)
• Percentage of Abnormal Laboratory Results with Appropriate Follow-Up
• Average Exam Room per Provider
• Average Support (direct medical and administrative) per Provider
COMPONENTS OF BUSINESS OFFICE/FOLLOW-UP
Exam
Room
Business
Office
If Yes
Appt.
Sched.
Is there F/U or
Referral?
If No
Patient
Exits
IMPACT OF BUSINESS OFFICE ON PRODUCTIVITY
• The business office should check each encounter form to ensure that
the critical information is included (e.g., service documented,
patient data complete, etc.), prior to claims submission.
• Providers are responsible for accurate coding, thus they must
correct any errors.
• Claims filing and patient statements must be generated timely.
SELECT PRODUCTIVITY MEASURES
FOR BUSINESS OFFICE
(Handout 1)
• Percentage of Accurate and Complete Encounter Forms
• Percentage of Rejected Bills
• Percentage of Allowable Co-Pays / Sliding Fees Collected
• Days in Accounts Receivable
• Percentage of Bills Submitted Electronically
COMPONENTS OF MEDICAL RECORDS
The key issues in the area of medical records are as follows:
• Incomplete Records
• Compliance
• Quality Assurance
• Technology Opportunities
• Availability
IMPACT OF MEDICAL RECORDS ON PRODUCTIVITY
• If providers complete the medical chart documentation immediately
following the service delivery, then the information is more likely to be
accurate than if this activity occurs weekly, or only once per day.
• Medical records compliance includes:
 Diagnosis - The diagnosis must be included in the medical record and must be
supported by the chart notes.
 Encounter Form - The CPT Code on the encounter form must be consistent with
the diagnosis in the chart.
 Bill/Claim - The bill or claim submitted must be consistent with the encounter
form.
• Common missing data includes:
– Results of Ancillary Services (e.g., lab tests)
– Results of External Referrals for Service
IMPACT OF MEDICAL RECORDS ON PRODUCTIVITY
• CHCs should conduct regular internal chart audits, to monitor the
quality of the care provided and to ensure that services provided meet
the established clinical pathways.
• Standard clinical quality indicators should be used
• Compliance audits should be conducted regularly to ensure that the
medical records, encounter forms and bills or claims are accurate and
complete.
IMPACT OF MEDICAL RECORDS ON PRODUCTIVITY
• Using EMRs or Computer-Based Patient Records (CPR) can assist
community health centers in improving the accuracy of medical data
captured in the medical record, decrease the number of lost medical
charts, and provide a powerful management tool.
SELECT PRODUCTIVITY MEASURES
FOR MEDICAL RECORDS
• Percentage of Medical Records Available at Patient Visit (scheduled
and walk-in)
• Percentage of Incomplete Medical Records
IDENTIFYING BOTTLENECKS
•
There are several ways in which CHCs can identify which
operational area(s) require examination and possible
reengineering.
– Routinely Reviewing Productivity,
Management, and Financial Data
Quality
– Conducting Internal Workflow Analyses
– Administering Patient Satisfaction Surveys
Assurance,
IDENTIFYING BOTTLENECKS
•
Operations Committee - CHCs can bring together a small team of
individuals including providers, administrators, and finance /
billing staff in order to develop strategies aimed at addressing the
operational issue(s).
•
Established by CEO, chaired by COO.
•
The team should identify issues and problems that would improve
operations if resolved.
•
The team should propose recommendations to the CEO,
identifying the lowest “hanging fruit” first, and then prioritizing
other issues that involve more time and money.
PROVIDER MONITORING
•
Monitoring providers can assist health centers in many areas,
including the following:
– Improving Productivity
– Improving Quality of Care
– Improving Patient Satisfaction
– Providing Cost Efficient Care
WHY MONITOR PROVIDERS?
Competitive Environment
• Health centers are facing increased competition for Medicaid and
other insured populations.
•
Health center cost per visit is 30% - 50% greater than the cost per
visit for private physicians and other competitors.
•
Health centers must understand the components of their costs and
identify strategies to increase efficiency.
•
Health center costs can be 30% - 50% greater than the revenue
streams for managed care and commercial patients.
WHY MONITOR PROVIDERS?
Optimize Efficiency
Given limited funding resources for the uninsured and under-served,
the more efficient a health center is in the delivery of services:
 The more services can be provided to these populations, and
 The greater the access to services.
WHY MONITOR PROVIDERS?
Optimize Efficiency
• Health centers must optimize the efficiency and effectiveness with which
services are delivered in all areas without compromising quality of care.
• Optimum efficiency will vary based on the unique characteristics of
individual health centers and their specific missions.
CONCLUSION
•
Operational efficiency should focus on maximizing provider
productivity.
•
Productivity is affected by all operations at a health center.
•
Systems should be developed and monitored for their impact
on provider productivity.
•
Focus on opportunities!