Value Analysis Harnesses Internal
Resources for Process Change
June 2006 SAVE Government Conference
Value Analysis (VA) is not…
Simply consultants providing input…
Function-Based
WorkCONSULTANTS
Flowchart
OUTPATIENT INSURANCE
Registration Completed
Referred to Insurance
Consultants
Medicaid
Eligible?
Yes
Complete Application
Send Application to MAP
No
Application
Approved?
No
Patient Fee-Scaled
No
Managed
Care
Eligible?
Yes
Complete MC Application
Yes
Enter in Unity
VA Revenue Enhancement Study

Pre-Study Orientation Sessions
• Kick-off and Hospital Tour (1-day)
• Current Work Flowcharts Discussed (2 days)
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Pre-Study Review of Revenue Data
5-day Value Analysis Workshop
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Functions and Areas of Opportunity Identified
Creative Phase
Evaluation/Analysis Phase
Development Phase
Presentation Phase
Post-Workshop Implementation Meeting
Value Analysis Participants


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VA Facilitators
Hospital Executive Management (part time)
Hospital Departmental Staff
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•
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•
•

Patient Accounts
Registration from Major Departments
Admitting
Utilization Management
Health Information Management
Finance
Information Services
Physicians
Consultants (typically 3)
• Healthcare Revenue
• Managed Care Revenue
• IT Systems
Parameters for a Successful
Value Analysis Study

Commitment from Executive Management
• Requires 8 days of participation by key staff members
• Must agree to implement acceptable ideas

Open Discussion
• Vow of Confidentiality Among Participants

Listen to Staff
• Ensure Clear Understanding of Current Processes
• Encourage Team to Suggest Alternative Approaches
• Clarify if Resources are Preventing Revenue Capture
 Staff
 Printers, Computers, Paper
 Software Applications
 Reliability of Current Technology


Judgment Withheld Until Appropriate Time
Assign Person to Coordinate Implementation,
Track Progress and Record Results
Recommendations Covered

Utilization Management

Maximize Reimbursements

Capture Unbilled Revenue

Improve Patient Information

Denials Management

Enhance Systems

Upgrade Coding Capability
Utilization Management
Key Proposals and Impacts
 Extend Clinic Hours ($3.5m)
 Create Charge Capture Czar ($8.0m)
 Perform Ancillary Tests on Weekends ($5.9m)
 Hire Surgical Coordinator ($4.5m)
 Modify Ambulatory SurgeryTesting and
Registration/Scheduling ($10.7m)
 Add Staff Selectively ($6.4m)
Utilization Management (cont.)
Redesign Clinic Scheduling ($5.3m)
 Expand Services in Pediatrics, OB,
Rehab ($11.2m)
 Modify Provider Contracts ($41.1m)
 Develop Revenue Scorecard ($7.0m)
 Improve Community Outreach ($2.1m)
 Establish Redirect Office ($1.9m)

Maximize Reimbursements
Key Proposals and Impacts
 Revise Approach to Self Pay Accounts
($2.3m)
 Clear Up Unbilled Backlog ($8.0m)
 Bill for all Physician Services ($2.4m)
 Periodically Re-bill Medicaid ($5.0m)
 Add Staff Selectively to AR, ED, Admissions,
BH, Medicaid Enrollment ($15.1m)
Capture Unbilled Revenue
Key Proposals and Impacts
Bill for Nursing Visits, Blood, Drugs,
Devices ($2.3m)
 Enroll all Pediatric Patients in Insurance
Plans ($2.0m)

Improve Patient Information
Challenges

Patients Do Not Want to Share Their Patient
Information

Patients Give False Addresses

Patients Have Grown Accustomed to
Receiving Free Care
Improve Patient Information
Key Proposals and Impacts

Train all Registration Staff to gather Patient
Financial Information with Documentation
($2.5m)

Train Clinicians to Fully Document Medical
Record ($.9m)

Establish Field Units to Gather Documents
($6.3m)

Improve Mail Handling ($2.4m)
Denials Management
Key Proposals and Impacts
 Create Denials Management Task Force
($20.2m)
 Address Social Admissions Issues ($9.8m)
 Educate Clinicians re Denials ($2.5m)
 Add Staff to Work Denials ($9.2m)
 Focus on One-Day Stays/Close Clinic
Visits/Reconcile ED and Admit Dates ($4.5m)
Enhance Systems
Key Proposals and Impacts

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Enhance Capture of Full Medical
Documentation ($3.0m)
Implement Claim Scrubber ($6.8m)
Update MD lists, Codes, Provider Data
Tables ($2.7m)
Link EMR and Patient Accounting Systems
($4.0m)
Bar Code ED Charts/Put Online($4.5m)
Upgrade Coding Capability
Key Proposals and Impacts
Add Coding Validators ($3.1m)
 Add, Train and Credential
Coders/Upgrade Titles and Pay
($5.3m)

Value Analysis Results(6 Workshops)
Proposal Themes
Net Projected Revenue
Utilization Management
107.6m
Maximize Reimbursements
32.8m
Capture Unbilled Revenue
4.3m
Improve Patient Information
31.7m
Denials Management
46.2m
Enhance Systems
21.0m
Upgrade Coding Capability
8.4m
Potential Revenue Impacts
252.0m
What Makes VA Different?

Team-Based Approach

Utilize Hospital Staff as Members of Team

Supplement Team with Consultants
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Changes are Recommended by Credible Front-Line
Staff and are not Imposed from Outside
Function-Based Analysis of Current Processes

Limited Involvement of Executive Management

Sessions are Away from Normal Work Environs
Key Benefits of Value Analysis

Revenue Improvement

Team Building Among Staff

Staff Discussions of Current Processes
Identify Most Issues/Opportunities/Ideas
Consultants Provide Experience from Similar
Hospitals

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Team Becomes Change Agents

Change Implementation More Likely as Staff
Buy-in During Study

Morale Improves