Spontaneous Combustion:
Making and sustaining change in Patient Access
Debi Stolic, Director of Patient Access,
Bethesda Memorial Hospital
Anne Habib, OputmInsight
Overview
• Introduction
• Bethesda Health System
• Continuous Improvement Culture
• Case Study – Up Front Cash Collections
• Sustainable Change
Bethesda Healthcare System
• Bethesda Memorial Hospital is located in Palm Beach County,
Florida.
• We have 401 beds, 525 physicians and 2,300 employees.
• Bethesda West Hospital opens in early 2013 with 80 beds; the
design facilitates growth to a 400 bed hospital in future years.
Bethesda Memorial Hospital
Patient Access at BMH
• Pt. Access
• Central Scheduling – 16.5 FTE’s
• Registration – 38.8 FTE’s
• 5 Patient Access Points of Entry
• Our Numbers
• 20,578 Admissions
• 60,001 ED Visits
• 175,558 Outpatient visits
• 141,195 Tests scheduled
• Systems
• QuadraMed Enterprise Scheduling
• Siemens Patient Management (Invision)
• Estimator Pro
BMH Payer Mix
Private Pay,
5%
Medicaid,
19%
Other, 4%
Medicare
Medicare,
41%
Managed Care
Medicaid
Private Pay
Managed
Care, 31%
Other
Continuous Improvement Culture
Overview
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Need to Improve Operations
Tired of IN & OUT Consulting Projects
Methodology/Structure for Independence
Identify and List Opportunities
Define Resolutions
Prioritization Criteria
Implement Solutions
Feedback Loop
Next Project
Identify Issues - SIPOC
Suppliers
Inputs
Physicians
Insurance Info
Payer
Charge Codes
Patient
Test Scripts
Associates
Demographic Data
Other Facilities
Appointments
Insurance Carriers
Process
Customer contacts
Central Scheduling
Scheduler answers
phone using
Symposium phone
system
Searches for Patient
in
QuadraMed Scheduling
Obtain/Review/Update
Patient’s
demographics
Schedules
appointment
Performs
Pre-registration
If possible
Outputs
Customers
Appointments
Patients
Directions
Families
Transportation
Insurance Subscriber
Follow Up Calls
Physicians/Nurses
Pre-Visit Information
Ancillary Departments
Other Facilities
Case Mangers
Define Opportunities
Document Process
Prioritize Projects
Benefit
Strategic
or
Tactical
List Prioritized
Projects
Measure , Analyze,
Improve, Control
Increase Cash
Collections
Quick Hits
Reduce Waste &
Cycle Time
Reduce Variation
& Defects
DMAIC
LEAN Projects
projects
OutPatient
Cash
Collections
ED Mobile
Computing
Through Put
Baseline
Measures
Improvement &
Standardization
Control Plan
Continuous Improvement
End Results
Document Projects
Benefit
Strategic
or
Tactical
List Prioritized
Projects
Measure , Analyze,
Improve, Control
Increase Cash
Collections
Quick Hits
Reduce Waste &
Cycle Time
Reduce Variation
& Defects
DMAIC
LEAN Projects
projects
OutPatient
Cash
Collections
ED Mobile
Computing
Through Put
Baseline
Measures
Improvement &
Standardization
Control Plan
Continuous Improvement
End Results
Implement Project
Benefit
Strategic
or
Tactical
List Prioritized
Projects
Measure , Analyze,
Improve, Control
Increase Cash
Collections
Quick Hits
Reduce Waste &
Cycle Time
Reduce Variation
& Defects
DMAIC
LEAN Projects
projects
OutPatient
Cash
Collections
ED Mobile
Computing
Through Put
Baseline
Measures
Improvement &
Standardization
Control Plan
Continuous Improvement
End Results
Feedback Loop
HIM
Pt. Access
Sch
PreReg
iVerify
Auth
Reg
Trspt
Code
PFS
ROI
CE
Bill
Collect
Pay
Post
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP1
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP2
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP3
SP4
SP4
SP4
SP4
SP4
SP4
SP4
SP4
SP4
SP4
SP4
SP4
Feedback
M E T R I C S
Case Study – Up Front Cash Collections
Prioritization
• Improved Cash Collections – High Priority
• Both strategic and tactical
• Lean Project
• Baseline Measurement – to determine results
• Analysis - to ensure Improvement & Standardization
• Implementation Plan – to ensure success
• Control/Monitoring Plan – for sustainability
Importance of Up Front Collections
• If patient leaves without making a payment; chances of
collection go down to 40%.
• Improved patient satisfaction when financial responsibility is
known.
• Receiving a large bill months after service can cause many
patients to think negatively about their experience.
• Without POS, the hospital is basically financing a service
interest free for 60 days.
• As collection costs increase, cash flow to pay salaries and
medical equipment may not be sufficient.
Baseline Measure
• Central Scheduling
• Zero
• Outpatient/Admitting
• $6,139
• Surgery Center
• $29,386
• Heart Institute
• $4,001
Implementing Technology
Price Estimator
• Have realistic expectations of the technology
• Understand the pros and cons of the technology and
work with the pros
• Keep your eye on the goal
• Communicate with your vendor and have regularly
scheduled meeting/conference calls to work through
issues quickly
Training
Technology, Process, & Collections
• Technology
• Basic training on Estimator
• Challenges – understanding terminology
• Process
• Inserting Estimates and Collection into the pathway
• Clearly documented process comparing current and future states
• Collection Scripts
• Developed statements that are said to patients in a consistent
manner including how to handle responses from the patient
• Speaking with confidence, use of empathy, identifying excuses vs.
the need for true financial assistance.
Motivating the Team
• Bonus Plans
• Movie Tickets
• Pizza Parties
• Lunch Passes
• Good Old Competition & Recognition
• Poster boards in departments
• Target goals
Tracking Collections
Out Patient Results
$25,000
$20,000
OP/Admitting Cash Collections
FY2012
OP/Admitting Cash Collections
FY2011
$15,000
$10,000
$5,000
$0
1
2
3
4
5
6
7
8
9
10
11
12
Central Scheduling Results
$7,000
$6,000
$5,000
Central Scheduling Cash Collections
FY2012
Central Scheduling Cash Collections
FY2011
$4,000
$3,000
$2,000
$1,000
$0
1
2
3
4
5
Ambulatory Surgery Results
$120,000
$100,000
ASC - Ambulatory
Surgery Center Cash Collections
FY2012
ASC - Ambulatory
Surgery Center Cash Collections
FY2011
$80,000
$60,000
$40,000
$20,000
$0
1
2
3
4
5
6
7
8
9
10
11
12
Bethesda Heart Results
$14,000
$12,000
$10,000
BHH - Bethesda Heart
Hospital Cash
Collections FY2012
BHH - Bethesda Heart
Hospital Cash
Collections FY2011
$8,000
$6,000
$4,000
$2,000
$0
1
2
3
4
5
6
7
8
9
10
11
12
Sustainable Change
Regular monitoring and early intervention avoids
discrepancies, reprocessing, and waste
Continuous
improvement
Regular review of
KPI reports to
ensure compliance
Regular consistent
communication
with staff about
what’s working and
what isn’t
Stress the importance
of adherence to the
standards and the
essential need to
continuously improve
On going monitoring
and audits of the
improved process
What will make the improvements stick?
• In improvement projects, make sure the root cause of
the problem has been resolved for the long-term
• Put metrics in place to notify management if the
problem begins to occur again