fiscal year 2016-2017 patient access strategic plan · benchmark data as applicable. kmc needs to...

Fiscal Year 2016-2017Patient Access Strategic Plan

Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.”

William A. Foster

“If you fail to plan, you are planning to fail!”Benjamin Franklin

Service Line/Department: Admitting/Registration

Date: December 9, 2015

Table of Contents

1. Team Members2. Description of Service Line / Department3. Key Performance Measures and Industry Best Practices4. Key Descriptors regarding Current State and Desired Future Vision5. Physician Information6. Competitive Advantage Now and In The Future7. Environmental Trends and Impacts:8. Customer Needs and Expectations9. Identify the most significant five Strengths, Weaknesses, Opportunities, Threats 10. Critical Success Factors/Priorities in Support of Organizational Goals11. Quality Pillar12. Financial Pillar13. Employer of Choice Pillar14. Capital Equipment Requests

1. Team Members

• Edward Din, Patient Access Director

• Helen D. Cullen, Revenue Cycle Manager – Pre‐Service

• Andrea Del Rio, Revenue Cycle Manager – Clinic Registration & Financial Counseling

• Renee Ledwell, Revenue Cycle Manager‐ Admitting & ER Registration

• Julian Acosta, Front End Revenue Cycle Support Manager

• Laura Rocha, Patient Access Supervisor‐Clinic Registration

2. Description of Service Line/Department

The primary purpose of this Service Line / Department is to…

• Facilitate the accurate registration/admission in compliance with all regulatory and Hospital guidelines.

• Verify eligibility & benefits for health insurance coverage, estimating & collecting patient co‐insurance, deductibles and co‐pay amounts to improve front end revenue cycle operations.

• Provide financial counseling & payment assistance options for patients who are uninsured or determined to be ineligible for government programs.

• Provide patient centered service to all customers adhering to the Kern Medical Center code of conduct. Providing service recovery in accordance with industry best practices.

• Working in collaboration with physician offices, insurances, regulatory agencies, and ancillary and support departments.

3. Key Performance Measures & Industry Best PracticesRegistration Accuracy

• Quality of registration datao Duplicate medical recordso Controlling unknown users

• PFS claims rejections• Return mail (bad addresses)• Patient identification/NPSG

o Patient not present; Biometric finger scanningo Document patient identification/scanning

OSHPD Variance reporting• Admission source• DOB vs. DOA of newborn• Zip codes• Preferred language• SSN#

Customer Satisfaction:

Inpatient/Outpatient & Emergency Registration• Pre‐Registration will be increased to meet and/or exceed NAHAM Standard.

3. Key Performance Measures & Industry Best Practices – cont’dPatient Complaints

• Access and Training to MIDAS for Patient Access Leadership Team

Physician Complaints• Survey of physicians• Raise visibility of Patient Access Leadership presence

Front End Revenue Cycle

• CMS Billing Complianceo ABN/ Medical Necessity o MediCare Secondary Payoro Important Message from Medicare

Inpatient Elective (7‐days prior to procedure)

• COAo Policy Implementationo Part II COA o COA Clinic is annual for known patients.

Denials for No Authorization• Report out insurance denials when Patient Access was responsible for securing authorization. (‐2% )

POS Collections• Craneware training (Estimator/Calculator)• Scripting for Financial Counselors ( including Medicare)

HPE Conversions

KMWP Conversions (PRIME)

DNFB

3. Key Performance Measures & Industry Best Practices – cont’d

Employee Engagement• Turnover

• Recognitiono Face time o Timely Employee Evaluations

• Survey Resultso Meaningful

• Survey Monkey developed for Patient Access (Q12)

3. Key Performance Measures & Industry Best Practices – cont’dBest Practices Our “Rating” and Potential to Achieve Best Practices

Identify several industry “best practices” related to your Service Line/Department.

• ER Bedside registration: improved registration accuracy, improved opportunity for POS collections

• Upfront Collections: Ability to estimate & calculate patient liability prior to point of service/ prior to discharge for scheduled elective and urgent admissions.

• Front Office Scanning: Document imaging & retrieval technology.

• Service Delivery, Reducing patient wait times.

How does our performance currently compare? Use benchmark data as applicable.

KMC needs to improve the ED registration process though the implementation of bedside registration (pending acquisition and deployment of 2 Wow’s in the ER). With the implementation of RME using Six Sigma LEAN tools we should be tracking registration accuracy rate of > 95%, and collections increased on avg. by 15% year over year.

• http://www.hcpro.com/REV‐226530‐2477/ED‐bedside‐registration‐works‐for‐facility.html

• http://www.accessmylibrary.com/article‐1G1‐126897515/ease‐switch‐bedside‐registration.html

• http://www.thefreelibrary.com/Switching+to+bedside+registration+increases+patient+satisfaction.‐a0206915033


Best Practices Our “Rating” and Potential to Achieve Best Practices

KMC is in the process of acquiring Craneware software to estimate and calculate patient liabilities for improved upfront POS collections and improved cash flow. PTAC training is targeted for December 2015 in preparation of the new calendar year. • http://findarticles.com/p/articles/mi_m3257/is_3_58/ai_n60

68757/?tag=rbxcra.2.a.11• http://www.hcmarketplace.com/prod‐3245/Managing‐

Upfront‐Collections‐Strategies‐for‐Effective‐Cash‐Collections.html

• http://www.accurohealth.com/pdf/ham.pdf

Acquisition & implementation of the FormsFast document imaging archive and retrieval system is scheduled for 3rd Q FY2016. Software licensing has been secured and hardware specifications are under review. Phase 1 of E‐Signature has been completed as of November 2015 for A‐Wing registration.

• http://www.hyland.com/onbase‐and‐ecm/onbase‐platform‐modules/imaging‐import‐and‐capture/front‐office‐scanning.aspx

• http://www.naviant‐inc.com/industry/revenue‐cycle‐registration.php

• http://www.edocutek.com/PDFs/onbase_sharp_healthcare.pdf


Best Practices Our “Rating” and Potential to Achieve Best Practices

KMC currently manually tracts OP wait times for Sagebrush clinics only and we are consistently < 10 minutes.

• http://www.healthcarefinancenews.com/news/small‐changes‐can‐reduce‐patient‐wait‐times‐ed

• http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Changes/IndividualChanges/Reduce+Wait+Time.htm

• http://www.infotech.com/research/medical‐kiosks‐reduce‐patient‐wait‐times

• http://www.entrepreneur.com/tradejournals/article/184643643.html

4. Key Descriptors ‐Current State & Desired Future VisionCurrent State Future Vision

List key descriptors regarding your service line/ department’s current‐state.

Admitting department is embedded in the back of ER. Difficult for patients to access (direct admissions) . Inefficient use of space and outdate decor.

Registration areas are fragmented throughout organization.

Unknown users in Registration modules, impacting DNFB adversely, and cancelled registrations in STAR. Example: Labor & Delivery.

ED Tracking Board,. Clinical staff does not update ED Tracker. Inability to automatically capture patient wait times for OP services.

Systems & Tools are inadequate.

o Unwillingness to move from manual to automated process in Card/RT.

o Scheduling/Consults does not report under Patient Access.

Staffing in ED is problematic due to shift rotation. Lack of adequate staffing during peak volume hours.

List key descriptors regarding your service line/ department’s desired future‐vision (1 to 2 years).

• Admitting department relocation (working with Plant Operations)

• CrossChx Kiosks, auto capture patient arrival times. Kiosks located Columbus, and A‐wing. ED Tracking Board retraining & review.

• Replace existing insurance verification eligibility system and Registration accuracy applications.

• Scheduling/Consult needs to be evaluated for possible integration under Patient Access (re‐instate the reporting to Patient Access).

• Improve ED registration staffing by converting to 12‐hour shifts. (Pending operational change and SEIU approval).

5. Physician InformationPhysician Profile Priority Issues to Address

List physicians, specialty, services provided, capacity and resource issues, other unique characteristics:Sagebrush

Cancellations of physician schedules; No relief coverage, patients sent home.Data loss due to system restrictions that do not allow transfer of information from canceled to re‐booked appointments.Lack of adequate centralized registration work space.

TruxtunLack of accountability. No regard for the standard of work. Ongoing dependence of pre‐registration to register and print charts.

A‐WingLack of adequate work space.Lack of standard of work for Non‐ED related visits.

Surgery Red/GoldLack of competency validation to perform Standard of work.

Identify high priority issues to address for success in the next 1 to 2 years:SagebrushCollaborate with clinic management to ensure appropriate allocation of resources for physicians who cancel clinics due to absenteeism. Work on developing a culture to accept reassigned patients. Ability to transfer schedules (physician to physician) without losing data. Work with administration and Plant Operation to address spatial needs.

TruxtunDevelop competency validation tools for all areas of Registration (pending) Reassign dedicated patient access staffing to pre‐register, register, and print charts (completed December 2015).

A‐WingProvide Re‐Education for clinic staff to perform transfers from outpatient to inpatient and observation status.Work with administration and Plant Operations to address spatial needs.Surgery Red/GoldDevelop competency validation tools for all areas of Registration.

5. Physician Information

Physician Profile Priority Issues to Address

StockdaleTBD

Emergency Lengthy trauma registration process. Registration does not know when Medical Screening Exam (MSE) had been completed.

Omni & Clinica Sierra Vista (Other OB/GYN practices)Lack of appropriate referrals to Sagebrush Clinic,

Ancillary, and Financial Counseling.No access to our systems.

EmergencyDevelop quick registration for trauma registrationRevenue Cycle Manager to participate on RME CQI team to engage physician participation to fully utilize the ED Tracker board. (EDTB)

Omni & Clinica Sierra Vista (Other OB/GYN practices)Grant access to pre‐register patients and submit authorizations.Enhance hospital and clinic business relationship. (Include Natalee Garrett)

6. Competitive Advantage Now and In the FutureProcesses and Skills Providing Advantage Today? New/Different Processes and Skills Required

What processes, skills and services make your service line/ department unique and give us a competitive advantage today?

What new/different processes, skills and services will be needed to create competitive advantage and success in the next 1 to 2 years?

• Specialty Services offered by KMC not offered by surrounding hospitals.

• KMC only Trauma center in the service area. • Fresh Fracture Clinic Ortho Services is unique to

the county.• High Risk OB/NICU• Centralized Pre‐Service Unit. Ability to pre‐

register average of 8500 patients each month.• SafeChx; the ONLY Patient Access department in

Kern County currently using Biometrics to protect patient I.D.

• REACH Clinic

• To have all registrars credentialed as Certified Healthcare Access Associates (CHAA), promoting staff development, staff retention and increasing professionalism and service delivery.

• Have all Patient Access leadership certified as CHAM

• Continue to streamline the registration process, promoting outpatient fast track, discharge quick routines to be able to market “no patient waiting” @ Kern Medical Center, marketing on‐line pre‐registration to maximize service delivery options. Implement bill pay on‐line (DivDat).

• For centralized pre‐service will exceed NAHAM standard for productivity.

7. Environmental Trends and Impacts: What 3 to 5 markets, regulatory, technological or other factors will impact this service line / department over the next 1 to 2 years?Environmental Trend Impact Required Action Now

Transition from Public Hospital to Hospital Authority.• Increased market share• Improve payor mix• Rebranding

May require additional Human Resources/Recruitment due to potential employee turnover.

Identify potential employee resignation/retirements and continue to recruit and develop new staff (Ongoing). Hire the right persons with the right skill sets to minimize future turn over.

Continued growth in outpatient clinic volume• Stockdale Urology Clinic• South‐West Surgery Center• Recruitment of specialty providers

May require additional Human Resources/Recruitment

Hire the right persons with the right skill sets to minimize future turn over.

Scheduling/Consult needs to be evaluated for possible integration under Patient Access (re‐instate the reporting to Patient Access).

Work with Plan Operations and administration on the plan project to expand A‐Wing lobby area.

New Admitting Department at Kern Medical Center

Improved patient satisfaction

Improved employee engagement.

Work with Plant Operations and administration on the plan project to relocate admitting to D‐Wing lobby area.

To continue to attend scheduled meetings with COO and contractor to ensure project timeline management.

7. Environmental Trends and Impacts: What 3 to 5 markets, regulatory, technological or other factors will impact this service line / department over the next 1 to 2 years?

Cont’d

Replacement of existing hospital information systems and technologyCerner/AllscriptsInsurance Verification & EligibilityQAMedical NecessityEstimator (Craneware)DivDat

To adequately address resources to facilitate system wide conversion up to and including reeducation of staff in all system/applications, testing & validation, working with vendor/s, and I.T. designated staff.

Continue working RFP/Sole Source Processes for:

Insurance Verification & Eligibility

QA

Medical Necessity

Estimator (Craneware acquisition completed, training in progress)

Expand capabilities for on‐line bill payment under existing SLA.

8. Customer Needs and ExpectationsCustomer/End Users Future Needs/Expectations Required Action Now

Who are your internal and external customers?

What are their current and future needs and expectations? How will these change in the future?

What actions must be taken now to prepare?

Patients and their Families To be greeted in a friendly, welcoming manner, receiving prompt services with minimal to no waiting for registration acknowledgement and services. Customers will need to be provided with education about meeting their hospital financial obligations.

Ongoing training & feedback to patient access staff regarding customer expectations (AIDET) and reporting progress to staff, (meet with Press Ganey to revise customer satisfaction questions). Reinstitute outpatient P.O.S Service Survey.

Hospital co‐workers and volunteers To be greeted in a friendly, welcoming manner, receiving prompt services now and in the future..

Ongoing training & feedback to patient access staff regarding customer expectations and reporting progress to staff. Create opportunities to cross train registration staff between the hospital and clinics (April 2016).

Physicians & their Office Managers To be greeted in a friendly, welcoming manner, receiving prompt services. Improve response time to physician and physician office management requests for information, in particular sharing information regarding managed care authorizations and non‐contracted services.

Ongoing training & feedback to patient access staff regarding customer expectations and reporting progress to staff. Work with administration to developing a delayed/deferred services policy and following escalation protocols to mitigate MD concerns with the registration process.

Vendors & Contractors To be greeted in a friendly, welcoming manner, receiving prompt services, now and in the future.

Ongoing training & feedback to patient access staff regarding customer expectations. Plan to provide education to staff regarding process changes that occur with the selection of vendors.

9. Identify the most significant five Strengths, Weaknesses, Opportunities, Threats for this Department/Service LineStrengths (Definition: Characteristics that generate revenue, patient volume, increased quality and service)

Weaknesses(Definition: Characteristics that detract from generating revenue, patient volume, quality and service)

Registration Accuracy Environmental challenges, spatial needs at Sagebrush and A-Wing and Admitting department. Inconsistent upfront cash collection performance.

High percentage of scheduled clinic pre-registrations Employee relations, lack of cohesive work relationship with L&D and Clinic Scheduling/Referrals teams. Hospital based ancillary departments lack of ABN compliance.

Collaboration with other Hospital based departments McKesson.

Payment assistance options (Family Pact, KMCHP, Every Woman Counts, BCCTP, HPE, Gateway)

Staff Development

Highly experienced Patient Access Management Team HR

a.) Position Control and lack of appropriate job description/classifications.

b.) Candidate selection process

9. Identify the most significant five Strengths, Weaknesses, Opportunities, Threats for this Department/Service Line

Opportunities(Conditions or situations with potential to significantly increase revenue, patient volume, quality and service)

Threats(External factors that threaten our ability to generate4 revenue, patient volume, quality of service)

Staff development, credentialing & ongoing education LWOBS/ELOPES due to long patient wait times (Emergency Dept.) due to inability to know when MSE completed. Poor communication and lack of bedside registration capacity

Improve Upfront P.O.S. collections. Competition from other hospitals/urgent care/surgery centers

Improve equipment & tools (software applications) Physician’s lack of documentation ( OpenVista)

Remodel Admitting department, A-Wing, Columbus Registration.

Lack of collaboration relationship with L&D and Clinic Scheduling/Referrals teams. Hospital based ancillary departments lack of ABN compliance..

Regulatory Billing Compliance improvement CMS Validation Survey

10. Critical Success Factors/Priorities in Support of Organizational GoalsFY2016‐2017 Operational Critical Success Factors Our Highest FY2016‐2017 Department Priorities Are:

Identify the critical success factors and priorities for your service line/department in support of the corporate goals, including I.T. requirements (such as training, software, devices, etc).

Developing Standards of Work.

Complete the installation of FormsFast eSignature:

Phase I A‐Wing (Completed November 2015); Phase II 2nd Floor; Phase III Sagebrush; Phase IV ER.

Digital image capture system scans images of typically non‐clinical documents such as insurance cards, driver's licenses, referral forms HIPAA notices and displays them on a desktop paneled window & will: Improves patient safety and workflow Increases productivity by eliminating re‐work Ensures HIPAA and CMS compliance Eliminates pre‐printed forms & associated cost Electronically routes documents

Developing process flows.

Developing an education plan and individual competencies.

Continue to formally recognize employees.

Staff development (CHAA)

Automated processes, integration of new technology and support.

Manager & Supervisors (CHAM)

10. Critical Success Factors/Priorities in Support of Organizational Goals – cont’d

FY2016‐2017 Operational Critical Success Factors Our Highest FY2016‐2017 Department Priorities Are:

For FY2016 KMC’s goal is to improve POS Cash Collection performance >15% over FY2015 For FY2017 KMC’s goal is to improve POS Cash Collection by >15% over FY2016.

Develop staff with scripting for improved Upfront POS Collections.

Policy Revision regarding POS Collection. Performing a monthly hindsight analysis for missed

opportunities & why. Performing a monthly review of individual collection

performance providing constructive feedback to employees for accountability.

Expand access and utilization of Craneware to estimate ER services.

Conduct ongoing quarterly staff Upfront POS collection training.

Replace existing insurance verification & eligibility system with an alternate online insurance verification & eligibility system

Other comments: Other comments:

11. Quality PillarPillar: Top Quartile Quality Performance

Department Goal

State a specific time-bound, measurable, department goal that supports the Quality Performance pillar. Customer Satisfaction with the registration process will be consistently > 80% per month.

Measurable Outcomes

Identify how the achievement of this goal will be measured. Reported from Press Ganey scores with the question: Helpfulness of Registration.

Tactics Dept. Cross-

Reference*

Target Date

Responsible Individual

Identify specific tactics for achieving the targeted outcomes.

Results will be tracked for the 3 patient types: Emergency, Inpatient and Outpatient. Performance will be reported monthly @ staff meetings using data from Press Ganey (to be pulled on the 5th of the month for performance). The stretch goal for this indicator is 90%.

Front End Revenue Cycle Department

Ongoing All Registration Staff

Risk Response

Identify risks that may prevent achieving the goal. Identify risk mitigation strategies.

Poor service delivery, loss of market share, and physician dissatisfaction.

Regular department huddle meetings & emphasizing hardwiring for success.

*Note all other departments and individuals who share responsibility for and involvement with, this tactic.

12. Financial PillarPillar: Financial Performance

Department Goal

State a specific time-bound, measurable, department goal that supports the Financial Performance pillar .Daily review of patient volumes, review of the staffing schedules and review of the BIWEEKLY PRODUCTIVITY REPORTs

Measurable Outcomes

Identify how the achievement of this goal will be measured. .

Productivity for dept. 8561, 8562, 8551, and 8560 will be cumulatively & consistently > 98%.


Reference*

Target Date

Responsible Individual


Employees are scheduled to work based upon volume. The Patent Access Supervisors will monitor productivity on a daily basis, making adjustments as necessary. Any/all expenditure of premium pay must have Manager approval. Management will continue to pursue operational changes as necessary to achieve targeted outcomes.

Front end Revenue Cycle

Ongoing Edward Din & Team

Risk Response


Unauthorized overtime.

Unexpected LOA

Lack of Supervisory follow through on monitoring productivity and patient volume.

Continue to work Redwood and STAR Census reports to identify patient volume daily.

Weekly Accountability Review with Director Bi-Weekly productivity report to review OT expenditures, and

variance reporting

13. Employer of Choice PillarPillar: Employer of Choice

Department Goal

State a specific time-bound, measurable, department goal that supports the Employer of Choice pillar above.

Ongoing promotion of an environment focused on employees feeling valued and accomplished.

Continue monthly one-on-one meetings with Manager/Employee.

Daily huddles reviewing upcoming changes and goals. Understanding the importance of their job, feeling they have made a difference.

Measurable OutcomesIdentify how the achievement of this goal will be measured. Survey Monkey survey developed that determines the level of staff engagement (using Q12 template).


Reference*

Target Date Responsible Individual


Survey Monkey survey to be rolled out by 01/31/2016 and ongoing.

Analyze survey findings and develop strategic plan to address employee findings by 3/31/2016

Conduct focus group meetings to prioritize next steps toward increasing employee engagement.

Continue to formally recognize employees

Survey Monkey to be rolled out 11/30/2016 to compare against 3/31/2016 findings.

Front end Revenue Cycle

Immediately and ongoing

Edward Din & Team

Risk Response


Lack of resources for staff development,

Unwillingness of employees to embrace organizational changes affecting workload,

Identify budgetary opportunities for staff development.

Continue to develop solid working relationships with employees by actively engaging and listening to their ideas, being responsive.

14. Capital Equipment Requests

Capital and/or Equipment Requests Approximate Cost Rationale

Name and briefly describe the item. Give an approximate cost for each item.

What is the rationale and support for requesting this item?

CrossChx Kiosk; MPI Clean up; Marketing Tools. TBD Kiosk is to improve patient flow and hospital base and community clinics. MPI Clean Up is required in prep of replacement EMR system. Marketing Tools to be integrated with re-branding and new KMC marketing strategy.

DivDat (Online bill payment) Completed To improve the patient experience by providing on-line payment options.

Craneware (Estimator) Completed Technology and support to improve POS Collection

Replacement of aged Network and Non-Network Printers across Patient Access spectrum.

TBD Eliminate waste; improve processing time, Go Green.

Automation of CHDP forms process TBD To improve clinical documentation and billing practices.

FormsFast TBD Upgrade existing desktop scanners.

fiscal year 2016-2017 patient access strategic plan · benchmark data as applicable. kmc needs to...

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