wsmgma annual meeting may 8-10, 2006 best practice delivery model based on efficiency principles...

WSMGMA Annual MeetingMay 8-10, 2006

Best Practice Delivery Model based on Efficiency Principles

Presented by:Barbara Derry, BSN, FACMPE Crystal Nolan, MHA, FACMPE

Principals: Derry, Nolan & Associates, LLC

DERRY, NOLAN & ASSOCIATES, LLC

Why are Efficiency Principles So Important? $350 Billion a year, or 22% of the total amount

spent on healthcare, is wasted through redundant paperwork. (Source: Forbes, May 24, 2004, “Sawbone Solutions, Stat” p. 96

Efficiency is one of the six dimensions of health care performance cited in the Institute of Medicine’s (IOM) landmark 2002 report: Crossing the Quality Chasm


US Health Care Needs a Face Lift Don M. Berwick, M.D. co-author of the

Institute of Medicine’s landmark report calls for nothing less than a redesign of the U.S. health care system, citing myriad inefficiencies throughout the work processes of health care.


Efficiency Defined According to the IOM’s report,

“Efficiency is the reduction of waste and, thereby, the reduction of the total cost of care should be never-ending, including, for example, waste of supplies, equipment, space, capital, ideas, and human spirit.”


Redesigning Delivery of Care Current efficiency design rule: Cost-

reduction is sought New efficiency design rule: Waste is

continuously decreased. Results: An increase in patient

satisfaction & revenue opportunities


DNA’s Approach to Efficiency Elimination of non-value added work to

achieve better patient, provider, & staff satisfaction while increasing revenue opportunities

Typically, we find a minimum of 40% of work-process steps do not improve outcomes and are not necessary


DNA’s Approach to Efficiency Most common reasons given by providers and

staff: We’ve always done it this way; This is the way I was trained; “What if” scenarios I don’t know….


Improvement Goals for Specialty Clinic—A Case Study Increase patient encounters by

increasing efficiency and patient flow Increase staff satisfaction through

workflow redesign Improve coding and documentation

practices All lead to increased revenue


Background Physicians came from diverse

backgrounds into a new clinic within an integrated health care system: Military HMO Free-standing, independent group


Challenges Encountered Despite new facility, physicians and staff were

unhappy Staff convinced more staff necessary Physicians’ schedules driven by nursing needs Patient volumes and revenue were flat Nursing-centered model rather than patient-

centered (patient & physician waits too long) Low charge per encounter


Identified Risks Lack of documentation to support level

of billed service Under coding (under valuing) Inefficient patient/workflow Decreased staff satisfaction


Phase I - Goal Successful Chart Audit through

development of clinical templates to capture essential documentation and billing elements


Action Plan Establish team work session to facilitate input

“All staff are responsible for the coordination of patient care”

Operational assessment of current information and flow Redesign Professional fee ticket Redesign Facility fee ticket Development of 2-3 clinical templates to capture

required documentation Provide education/training for new documentation tools Conduct coding and documentation audit on use of new

documentation tools


Coding to support level of service being provided

RVUw - % of MGMA Median

95%

72%

95%87%

115%107%108%

130%

0%

20%

40%

60%

80%

100%

120%

140%

MD #1 MD # 2 MD #3 Team Avg

Pre- Project 2004 Post-Project 2005

Outcomes


Charge per Encounter

$128

$102$96

$109

$144 $142

$123

$136

0.00

20.00

40.00

60.00

80.00

100.00

120.00

140.00

160.00



Outcomes (cont.)Documentation to support coding


Outcomes (cont.)Increase in Revenue

Gross Revenue

0

$511,565

$114,273

$174,891$222,401

$746,465

$116,532$126,033

$256,826$247,075

$0

$100,000

$200,000

$300,000

$400,000

$500,000

$600,000

$700,000

$800,000

MD #1 MD # 2 MD #3 New codecharges

Team Total



Phase II - Goal Continue to improve coding and

documentation practices, and increase patient encounters/visits

Increase staff satisfaction


Action Plan Continued teamwork sessions Provide on-going coding and documentation

support to accurately match level of service to CPT and ICD-9 codes

Monitor effectiveness of documentation template and modify as needed to maximize effectiveness


Action Plan (cont.) Redesign the staffing model and core

processes to ensure the right people are doing the right work at the right time

Transition from an “RN driven model” to an “MD and Patient driven model”

Determine MD capacity Analyze patient flow to determine bottle necks

and road blocks


Action Plan (cont.) Block MD schedules and open up the templates

to allow full use of clinic time (compressed schedules)

Re-align team functions of staff Encourage patients to arrive early for labs to be

drawn, or prior to appointment if appropriate Re-arranged work space Daily “team huddle” Lead Nurse assigned as “Air Traffic Controller” Discharge patient when care is “done” Design, implement and utilize flag system


Outcomes Completed final documentation

template Decreased length of stay from an

average of 114 minutes to 82 minutes. 28% improvement


Clinic Encounters

633

850728

2,211

802

993

633

2,427

0

500

1,000

1,500

2,000

2,500

3,000



Outcomes (cont.)


Clinic Procedures

167142

471

780

234 211

478

923

0

100

200

300

400

500

600

700

800

900

1000



Outcomes (cont.)


Outcomes (cont.) All staff take lunch and breaks Elimination of overtime Two “protected” afternoons to catch up

with chart review and clinic administrative functions


Into the Future Lead nurse mentoring Continued development of communication

among staff Staff to adopt goal for an average length of

stay in the clinic to be 60 minutes Continued management and physician support Reinforcement of changed behaviors and

successes Staff discussion forum


Summary Total investment: $83,000

Phase I $18,000 Phase II $65,000

Projected gross revenue improvement at: 1 Year $239,418 5 Years $1,197,092


Audience Participation Audience identifies a major time-

consuming, redundant work process Discuss possible solutions to re-design a

more efficient work process

wsmgma annual meeting may 8-10, 2006 best practice delivery model based on efficiency principles...

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