Building an Automated
Financial Clearance Process
Niobis Queiro, MBA
Corporate Vice President, Revenue Cycle
Hartford HealthCare Corporation
Hartford, CT
Hartford HealthCare
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4 hospital system serving 63 towns in Connecticut
75,711 inpatient visits per year
2 Million outpatient and homecare visits a year
280,000 ED patients per year
60% of all behavioral health visits in the state of CT
$52 million in charity care FY 2011
$14 million invested in research
15,000 Employees
2,100 Physicians
$2.0B Total Revenue
Current Issues Facing Healthcare Industry
Hospitals will Never
Be Paid as Well as
They are Today
Fee for Service
versus
Fee for Value
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Losing 7.2% on Medicare Cases, losing 14% on Medicaid*
Medicare Reimbursement rates declining**
Increasing Medicare & Medicaid population
Increasing high deductable plans and bad debt
• Rewards chasing revenue, not margin/quality
• Capitation payment encourages less volume
• Evidence Based Care Plans are needed
Care Delivered in
Silos
• Physicians, hospitals, providers and plans not aligned
(incentives)
• Coordination lacking inside/outside walls of hospital
• EMR Adoption/MU requires new processes**
• Data is housed in silos
Chronic Disease
Patient Volume
Increasing
• Rapid increase in patients with multiple chronic diseases
(CHF, COPD, Diabetes); 133M Americans have a chronic
disease***
• 5% patients = 55% of admissions, care at Medicare rates
• Health Plans shift risk to provider. Bundled care, ACO
*Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate
Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.
Traditional Operating Models Will Fail Under
The Complexities of Healthcare Reform
Short term:
• Increased access to care
• New shared reimbursed
at government rates
• Outcome risk
• Reduced operating
margins
On the horizon:
• ICD-10
• Outcomes Performance
• Clinical integration
• IT interoperability
• ACO investments
• Next generation gain
sharing
• Bundled payments
Greater Access – Reduced Reimbursement – Growing Operational Complexity
Patient Access: The Root of Much Evil
• Percent of data needed for
billing originates at
registration: 70%
• National average registration
error rate: 46%
• Percent of denials that
could be prevented at
registration: >50%
Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10,
Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare
Cash Collection Curve
Hartford HealthCare Project Goals
• Create an Optimal Patient Experience that Makes HHC the
Provider of Choice
• Create and Automate a Data Rich Financial Clearance Process
• Produce Patient Liability Estimates for Transparency
• Improve POS Cash Collections
• Centralize Scheduling
• Real-time Quality Assurance to empower the end-user
• Enable Field Level Registration Edits
• Link patient Access Errors to Denials and A/R Liquidation
• Provide structure around E&B and Authorizations
• Establish a Partnership with all HHC providers and assets
Hartford HealthCare: Flashback 18 months
•No patient access standardization
•Variable financial clearance process
•No centralized scheduling
•No patient liability estimates
• < $1M/Yr in POS cash collections
• No registration quality edits
• No link between access & denials
• IT patchwork across 4 hospitals
Current state:
Hartford HealthCare Patient Access
Address
Validation
Centralized
Scheduling
ATB Data
Eligibility &
Benefit
Verification
ADT Feed
Automated
Financial
Clearance
Workflow
Platform
201
Reg
Integrity
Prior Auth
(pilot)
Patient
Funding
w/ Via
Note
Medical
Necessity
HCIT Integration
Patient
Estimates
(pilot)
Post Go-Live
Reporting & Metrics
Point of Service Patient Liability Estimates
Patient Estimates Produced as a
%Improvement Over Baseline
1800
1600
1400
1200
1000
800
600
400
200
0
2011-2012
Linking Patient Access Errors to Denials
12%
Reduction in
errors at
Patient Access
Improved A/R
Liquidation
Rates
20%
Hartford HealthCare KPIs
Key Performance Indicator Best Practice Targets
Registration Accuracy
99%
# of incoming calls
answered
135 - 165
Abandon calls after
threshold
2
% calls Abandoned
<2%
Avg Time on Call
4:00 - 6:00
Avg Wait Time
15 - 30 sec
Max Ans Delay
2:00 - 3:00
POS Collections
Pre-Registrations by
Schedulers
Trace Fax completion time
$50,000 per month
20% or greater
1 business day
Joys of the Open Road
Joys of the Open Road
• Employee Engagement
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HHC offers employees access to Local Community College
HHC covers tuition and salary for Wednesday afternoon coursework
Clear career path and education boost employee morale
HHC maintains a 99% employee retention rate
• Team Building Exercises
• Rewards For Outstanding Performance
Lessons From The Road
Lessons from the Road
• Appraise organizational readiness
• Finance will likely want to run faster than departments
• Provide training to physicians and nursing staff
• Communicate early and often with hospital leadership
(CEO/CFO)
• Appraise Financial Clearance Staff
• Some personality types are not suited to ask for payments
• Be aware of HR challenges
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9 Benefits Packages
4 Compensation Models
Union job descriptions
Employee transfer requires new employee paperwork
HHC full homogenization by 2013
Leadership Behaviors
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Be In The Moment
Be Authentic & Humanistic
Volunteer Discretionary Effort Constantly
Model High Performance-Desired Behaviors that Drive
Desired Results
Respect & Leverage Separate Realities
Be Curious vs. Judgmental
Look in the Mirror First – Be Accountable
Have Courageous Conversations
Provide Timely, Clear & Specific Performance Expectations
& Feedback
Teach, Coach & Mentor - Spend at Least Half of Your Time
Developing Others
Questions to Ask Yourself Everyday
• What more can I do right now to be a role model for those around
me?
• What more can I do right now to achieve the outcome we desire?
• What more can I do right now to prevent something undesired
from occurring?
• What expectations or feedback can I deliver right now to make a
positive difference?
• What more can I do right now to seek or provide the clarity that I
think does not exist?
• What more can I do right now to make this meeting more
productive?
• When some outcome has not met my expectations, ask, “How did
I contribute to that?” and “What more will I do next time to make it
successful?”
A journey of a thousand miles begins with a single step.
Lau-Tuz, Chinese philosopher (604 BC - 531 BC)