If Revenue Cycle is a Team Sport, then Patient Access is the Offense! Tackling Patient Access for the New Revenue Cycle

Presented by: Christine Kalish, MBA, CMPE Brittain- Kalish Group LLC February 25,2016

Objectives • List the market drivers that affect the healthcare revenue cycle today • Identify the roles and goals of patient access in the revenue cycle • Discuss the significance of a learning culture for a high performance revenue cycle • Name the challenges and opportunities in training and educating a truly diverse multi-generational workforce • Develop the success strategy for the next generation Patient Access Team

Changes in Healthcare ICD-10 and CDI Patient – Centered Medical Homes

Meaningful Use

Population Health

Healthcare Reform

Quality Initiatives/

ACO-Style Models

PQRS

ICD-10/11

Mergers and Acquisitions Mergers and Acquisitions

Value-Based Purchasing

CDI Healthcare Reform

Alternative Payment Models

Merit-based Incentive Payment System

Market Drivers • Ever-changing regulatory environment • Tying quality to financial function • Reduced payer reimbursement rates • Rapid growth in consumer payments • Shifting consumer expectations

Goals of Patient Access • Set a positive tone for the entire patient experience • Complete the patient financial clearance process correctly • Collect appropriate monies due at the time of service • Assure that patients get to the right place with the right provider at the right time

“Show me that you know me and that you care.”

The Revenue Cycle Patient Access Metrics

Care Delivery

Cash Optimization

Charge Capture

Follow-up, Processing and Rejections

Claims Submission

Definition: All administrative and clinical functions that contribute to the capture, management and collection of patient service revenue - HFMA

Learning Changes Things

What about learning?

Today’s Workforce Traditionalists

Baby Boomer

Gen X

Millennials

Date of Birth

Before 1945

1946-1964

1965-1978

1979-present

Cohort size

27 Million

76 Million

60 Million

88 Million

Total workforce

8%

43%

21%

27%

Healthcare Workforce

9%

48%

23%

27%

Workplace characteristics

Value practical experience and accountability

Driven by goals for success

Strong interpersonal skills

Believe in teamwork and emphasize relationship building

Value academic credentials

Career = identity

Loyalty to employer Believe promotions and recognition come with job tenure Accept limited resources

Expect loyalty from coworkers Want work-life balance

Self –reliant

Image-conscious

Highly educated and questioning

Need constant feedback and reinforcement

Risk-averse

Team-oriented

Want open communication

Want open communication

Most loyal employee but invest loyalty in a person, not an organization

Search for an individual who will help them achieve their goals

Value control of their time

Want to shed stress

Motivation Drives Training Reasons for Adults’ Participation in Work-Related Courses % giving reason by age group

66 years and older

51-65 years

41-50 years

31-40 years

16-30 years

To maintain/improve skills or knowledge

84%

95%

93%

94%

88%

To learn completely new skills or knowledge

75%

70%

74%

77%

84%

Because employer required/recommended it

68%

74%

74%

70%

79%

To receive a promotion/pay raise

11%

13%

14%

18%

26%

To get/keep certificate or license

35%

35%

34%

37%

27%

To help change job or career field

7%

13%

16%

18%

29%

Source: Pitt-Catsouphes, M., Smyer, M., Matz-Costa, C., & Kane, K. (2007). The National Study Report (Research Highlight No. 4). Chestnut Hill, MA: Boston College Center on Aging and Work/Workplace Flexibility.

Bridging the Gap • Align organizational systems with development objectives • Explain the reasons for the development and learning • Provide organizational resources • Well-designed and supported training can result in enhanced job-related knowledge and skills • Transfer of learning to the job is critical

Initial Revenue Cycle Training High Performers

1 day or less

2-3 days

3-5 days

5-10 days

> 10 days

Registrars

0%

14%

14%

14%

57%

Billers

0%

14%

14%

14%

57%

Collectors

0%

7%

21%

21%

50%

Financial Counselors

0%

7%

14%

14%

64%

All Others

1 day or less

2-3 days

3-5 days

5-10 days

> 10 days

Registrars

7%

11%

15%

25%

42%

Billers

4%

10%

7%

25%

54%

Collectors

5%

9%

10%

30%

47%

Financial Counselors

5%

7%

11%

26%

52%

Source: Strategies for a High Performance Revenue Cycle, HFMA,2009

Measure What You Do Domain

Access Key (KPI)

Equation

Good Early Implementation Phase or Manual Process

Better Middle Implementation Phase or SemiAuto Process

Best Mature Implementation Phase or Auto Process

Collections

POS Collections to Total Patient Collections

POS Collections Total Patient Collections

30%

40%

50%

Collections

POS Collected Accounts Rate

Accounts Collected Total Registrations

20%

40%

60%

Patient Experience

Average Wait Time

Total Minutes Spent Waiting Total Registrations

15 mins

10 mins

5 mins

Critical Process

Insurance Resolution Rate

Insurance Failures Resolved Insurance Failures Identified

50%

70%

90%

Critical Process

Address Resolution Rate

Address Failures Resolved Address Failures Identified

N/A

N/A

98%

Productivity

Insurance Verification Rate

Verified Registrations Total Registrations

80%

90%

98%

Quality

Registration Accuracy Rate

Error-Free Registration at POS Total Registrations

80%

85%

90% Source: NAHAM Access Keys

Integrate Education with Work Redesign • Create and achieve new work systems that are efficient and flexible • Use bottom up and top down approach to identify and work on ideas for change • Recognize the increasing importance of new technologies, facility designs, and intricate patient protocols • Build collaborative teams  All staff should make maximum use of their present education and experience

• Incorporate and make human resource techniques easy for staff

Taking a Career Approach Baylor All Saints – Fort Worth Career Ladder

Staff work in support services, pulling data for management and other staff

Staff progress into billing, credit balance adjudication, or payment and adjustment posting

Source: Strategies for a High Performance Revenue Cycle, HFMA

Staff progress into collections

Staff progress into contract compliance, transplant claims adjudication and customer service

Staff progresses into management positions, including coordinators, managers, directors.

Blending The Training Delivery

Training Delivery Identify Training Need • Develop content • Develop curriculum

• Self-directed learning • Virtual Instructor-led training • On-site instructor led training • Peer led – lunch and learns

Track Progress

Sustain Learning

• Learning assessment • Measure results

• Encourage change • Provide mentors

Transfer and apply the knowledge

Tie into Performance Plan and Career Ladder

Mobility and Ease of Use

CONTENT

API / APPS

AUTOMATION/ADMIN

DELIVERY

Watch

Mobile Phone

Course Builder

API

Compliance 200 Courses HIPAA, PCI, OSHA

Television Mac/PC

Assessment Builder

Learning Paths

CONTENT APPS

Healthcare Revenue Cycle 300 Courses

Reminders

Registration

CRM APPS

Soft Skills Leadership 300 Courses

Tablet

Analytics

HR APPS

Sales & Customer Service (coming soon)

Improve the Overall Patient Financial Experience • Discuss trends within the industry, the department and the clinic • Understand the patient is a consumer • Teach the payment process • Complete training sessions for staff that include a specific review of patient bills • Create an environment of expectation with patients that payment will be handled at the time of service • Utilize technology to support processes

Thoughts to Ponder • Revenue cycle is a team sport • Maintain a sense of urgency • Measure what you do • Leverage your resources • Find a new normal

Brittain-Kalish Group, LLC • BKG provides a portfolio of management consulting services to healthcare and non-profit organizations to support strategic, organizational and process improvement initiatives while improving overall performance. • Our expertise includes: – Business planning and program development – Interim and fractional practice management – Revenue cycle and business process assessment and improvement – Healthcare reform advisory services – ICD-10 transition services – Clinical documentation improvement services – Workforce management and training – Strategic planning – Trusted advisor services – Project management

Thank You! Please Contact: M. Christine Kalish MBA,CMPE [email protected] Cell: 817.980.4317 For course and platform information visit: Litmos.com/healthcare