Making the Case for Central Scheduling
Taking Control of Your Schedules to Improve Revenues
and Patient and Physician Satisfaction
Jessica McKinney, AVP Patient Access
January 16, 2015
© 2013 PARALLON BUSINESS SOLUTIONS, LLC
Introduction
- Healthcare services, over the last few decades have trended from
inpatient to outpatient settings
- Outpatient visits doubled from 1990 – 2010, while inpatient
admissions for that same period grew by just 13%
- Efficient scheduling is vital to the financial health of the
organization (hospitals, imaging centers, healthcare systems)
-
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Volume growth
Physician and Patient satisfaction
Maximizing the schedule
Cost reduction
Improved cash flow
Background
- In 2009, Parallon was approached by HCA leadership with a request
to create Central Scheduling units for 45 hospitals in 5 regional
markets, concentrated in Florida, Georgia, and South Carolina
- Parallon leadership leveraged experiences gained by the Richmond
Shared Services Center which had implemented Centralized
Scheduling in other HCA Markets
- The project was completed over the course of a 1 year time period,
with a new facility transitioning to each Central Scheduling location
every 4 weeks
- Subsequently Parallon has implemented this solution for additional
HCA facilities and now operates 13 Central Scheduling Units, serving
more than 110 hospitals and imaging centers
- Parallon is also responsible for the management and support of a
new consolidated Pre-Access center in Cincinnati, which will serve
21 hospitals in KY and OH for a non-HCA Parallon client
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Building the Business Case for Central
Scheduling
The Challenges
- Inconsistent scheduling department structure at each hospital
- Some scheduling areas were decentralized and schedulers were
managed by the ancillary departments while others were somewhat
centralized into one department
- Leadership of the departments had other priorities, not solely focused
on the scheduling and pre-service process
- Lack of sophisticated telephone system and other technology
- No view into call volume, lost/abandoned calls, or hold times
- No view into Customer Service issues
- No view into volumes exiting the system when one facility had no availability
for a particular modality
- Inconsistent oversight, education and system knowledge
- Inconsistent asset utilization with variability from hospital to hospital
- Ancillary department staff had the access to block rooms and equipment
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Centralized Scheduling Principles
Increase Physician Office satisfaction
– Offer physicians and patients a broader range of scheduling options
– Have an “Always Yes” mentality
– Consistency for physicians who practice at multiple facilities
– Implement technology to prevent loss of orders
Increase market share and optimize use of all assets
– Reduce risk of losing patients to competing facilities as the result of
appointment availability
– Increase capacity by reducing variability in system setup
– Conduct regular system reviews
– Implement best demonstrated practices
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Centralized Scheduling Principles Cont.
Consolidate resources for scheduling
– Reduce cost and improve productivity
– Coverage for employees out on PTO
– Optimize skill set utilization (clinical vs clerical resources)
– Consistent education and standard policies and procedures
Standardize and Increase Quality of Data Gathered
– Define minimum data elements
– Improve financial data quality to feed registration process
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Centralized Scheduling Principles Cont.
Provide Standardized Reporting
– Resource availability
– Call Center Statistics
– Modality Comparisons
– Physician Order Volumes
Business Continuity
– Weather Interruptions
– System Downtime
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Project Planning
Leveraging Expertise from Within
– Rapid design session
– Data gathering
– SME input
– Toolkit development
Leverage Parallon Project Services
– Program timeline
– Central unit timeline
– Facility timeline
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Central Scheduling Unit Locations
Salt Lake City
Cincinnati
Richmond
Denver
Nashville
Chattanooga
Rome
Atlanta
Panhandle
Why market based?
•BCP purposes
•Market based presence to
retain quality staff
•Management bandwidth
•Successful model already
tested
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Orange Park
Tampa
Kansas City
East Florida
Houston
Centralized Scheduling Scope
In Scope
• Outpatient Diagnostic Imaging Services
• Radiology
• EEG/EMG/EKG
• Cardio Pulmonary
• Wound Care
• Sleep Lab
• IV Infusion
• Respiratory Therapy
• Special Procedures
• Pre-admit testing
• Cath Lab (in some facilities)
Out of Scope
• PT/OT/ST
• OR/Surgery
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Services Included
Centralized Scheduling and Related Services
- Insurance Verification
- Pre-Registration
- Authorization/Pre-certification
- Order capture/indexing
- Medical Necessity Screening when possible
- Upfront Collections when possible
- “Outpatient Service Coordinators” in key markets
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What is the “Outpatient Service Coordinator”
Model?
-
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Our response to competition in the market
Rather than receiving calls in, makes outgoing calls
Receives faxed orders from participating physician offices
Contacts patients to schedule and pre-register
Contacts insurance to obtain authorization and pre-cert for facility services
Send end of day reports showing scheduled, status, authorizations, etc.
Physician’s offices call this unit for everything – personal feeling
Includes non-hospital based Imaging Centers, Clinics, etc.
Avg time associated with one appointment is 7 - 15 minutes rather than
normal 90 second incoming call; Higher cost, less efficient
Difference is no handoff to other reps for pieces of the whole
Physician and patient response very positive
Critical Success Factors
- Staff retention and employee transfers
- Maintain or improve relationships with physician and office
staff
- Maintain or improve relationships with Ancillary Directors
- Staff competency and knowledge
- Technology
- Dictionary refinement, standardization and maintenance
- No loss of personal touch
- Well documented processes
- Improve performance and volume
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Technology
- Management of Multiple HIS solutions within several of the
units
- Physician Order Management
-
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Call Routing and Recording
Insurance Eligibility
Medical Necessity
Automated Notice of Admission
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Hyland Central Scheduling Workflow
Existing Technology – SCI Order Facilitator
UHC
Aetna
Physician Order Management
• Fax Management Solution
• Imports documents for indexing at patient level
• Leverages HL7 from HIS system for autofill keywords
•
•
•
•
Patient Name
Account Number
Medical Record Number
Physician
• Ability to route documents received for special processing
• Incomplete Orders
• Pending
• Additional tools
• Reporting
• “Virtual Print Driver”
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Physician Order Management- Strawman
P h ysicia n F a xe s
D o cu m e n t to
F a cility D e sig n a te d
F a x L in e
E a sy L in k D e live rs
D o cu m e n t via F T P
to S S C O n b a se
S e rve r in .tif F ile
F o rm a t
F ile is sa ve d in a
F a cility S p e cific
F o ld e r b a se d o n
In co m in g F a x
N um ber
H yla n d W o rkflo w
S tra w D o g
W o rk F lo w
R e trie ve s
D o cu m e n t
W o rk F lo w
A u to In d e xe s
D o cu m e n t:
* F a cility
* D a te /T im e In
W o rk F lo w p u sh e s
D o cu m e n t to “In d e xe r”
Q u e u e s b a se d o n
F a cility a n d F irst In
If S ch e d u le r ste p s a w a y fro m
w o rksta tio n o r lo g s o u t,
d o cu m e n ts a re re -ro u te d to
a n o th e r u se r
In d e xe r g e ts
d o cu m e n t fro m
Q ueue
In d e xe r se n d s
d o cu m e n t to
“O th e r” Q u e u e
O th e r R e q ’d
D o cu m e n t?
YES
NO
In d e xe r A n a lyze s D o cu m e n t
* O rd e r vs O th e r D o cu m e n t
* S e p a ra te s P a g e s in to
se p a ra te d o cu m e n ts b y
p a tie n t
* C o m p le te n e ss
* S ch e d u le
O rd e r?
YES
NO
In d e xe r se n d s
d o cu m e n t to
“D e le te ” Q u e u e
R e q u ire s
SCH?
NO
In d e xe r a d d s to In d e x
fo r P a tie n t N a m e a n d
P h ysicia n
In d e xe r C o m p le te s a s
“In d e x O n ly”
In d e xe r se n d s
d o cu m e n t to
“P e n d e d ” Q u e u e
S ch e d u le r
co n ta cts P a tie n t/
P h ysicia n a n d
S ch e d u le s P a tie n t
YES
P a tie n t
S ch e d u le d ?
NO
YES
S ch e d u le r/S ta ff
co n ta cts p h ysicia n
o ffice fo r co rre cte d
o rd e rs
In d e xe r se n d s
d o cu m e n t to
“In co m p le te /
In va lid ” Q u e u e
NO
N e w In co m p le te D a te
A d d e d b y S yste m
N e w IN C “R e a so n ” a d d e d Y E S
N e w O rd e rs
R e c’d a n d S C H
C o m p le te ?
YES
NO
SCH
C o m p le te ?
S ch e d u le r la u n ch e s
A p p E n a b fro m M T to
A u to In d e x
NO
S ch e d u le r
In d e xe s O rd e r
S ch e d u le r D e le te s
O rig in a l O rd e r
S ch e d u le r co m p le te s a s
“In d e xe d a n d S ch e d u le
C o m p le te ”
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N e w P e n d D a te
A d d e d b y S yste m
N e w P e n d “R e a so n ” a d d e d
O rd e rs m a tch
S ch e d u le d S e rvice
a n d C o m p le te ?
YES
In d e x
F a cility
D a te /T im e In
P a tie n t N a m e
SSN
A cco u n t
MRN
E le m e n ts
G ender
DOB
P ro ce d u re
P h ysicia n N a m e
P h ysicia n M n e m
Physician Order Management- Final Product
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Reporting – Key Performance Indicators
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General Statistics
Call Activity
- % of OP procedures
scheduled
- % of procedures preregistered
- Scheduling Unit Activity
- # Orders/documents
received
- # Scheduling requests
- “Physician Booking Report”
-Abandonment Rate
-Hold time (seconds)
-Talk time (seconds)
-Call Volumes –
Incoming/Outgoing
-Calls Presented/Calls Answered
2013 Call Center Volume
Key Stats
1,536,289 Calls 2.74 % Abandonment Rate 23 Second Average Hold Time
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Registration Turn Around Time Comparison
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POS Collection Improvement
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What the Numbers Say
- Aventura Hospital and Medical Center saw significant
improvement in 2011
- POS Collections improved by 19%
- Registration lobby wait times decreased by 8%
- Registration begin to registration end times decreased from 4.03
minutes to 3.09 minutes; a 23% reduction
- Total registration time improved by 19%
- The number of patients waiting 10 minutes or less averaged 99%
- 98% of encounters were pre-registered prior to the date of service
- 97% of all encounters were verified
- 94% of encounters requiring authorization included complete
authorization
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Key Lessons Learned
- Support from the top and facility buy-in is critical
- It can take up to a full year to work out all of the challenges
- Rollout process involves significant time of responsible
executives
- Common facility concerns (loss of business, loss of control,
favoritism, loss of facility identity) can be addressed by
education and communication of the processes
- Hospitals are often unaware of the control the techs have on
the schedule prior to centralizing
- Existing system builds often do not reflect actual scheduler
activity – much is retained in their heads rather than the
technology
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Key Lessons Learned Cont.
- New Dictionary builds are critical and must be
reviewed/approved by facility Department Directors
- Relationship with hospital management is very important,
radiology in particular
- Use marketing/sales staff to assist with physician office
onboarding
- New phone numbers (1-800) are more work but provide for
better BCP and less operating issues
- Hospitals usually couldn’t measure data or stats precentralization, but may imply they did
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Summary and Questions
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