Building an Automated Financial Clearance Process

Niobis Queiro, MBA

Corporate Vice President, Revenue Cycle Hartford HealthCare Corporation Hartford, CT

Hartford HealthCare

• • • • • • • • • • 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

• 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

Fee for Service versus Fee for Value

• Rewards chasing revenue, not margin/quality • Capitation payment encourages less volume • Evidence Based Care Plans are needed

Care Delivered in Silos Chronic Disease Patient Volume Increasing

• 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 • 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

ATB Data Address Validation Centralized Scheduling

HCIT Integration Post Go-Live

ADT Feed Reg Integrity Medical Necessity Patient Estimates Eligibility & Benefit Verification Automated Financial Clearance

201

Platform Patient Funding w/ Via Note (pilot) Prior Auth (pilot) Reporting & Metrics

1800 1600 1400 1200 1000 800 600 400 200 0

Point of Service Patient Liability Estimates 2011-2012

Linking Patient Access Errors to Denials

12%

Improved A/R Liquidation Rates Reduction in errors at Patient Access

20%

Hartford HealthCare KPIs

Key Performance Indicator Best Practice Targets Registration Accuracy 99% # of incoming calls answered Abandon calls after threshold

135 - 165

% calls Abandoned Avg Time on Call Avg Wait Time Max Ans Delay

2 < 2 % 4:00 - 6:00 15 - 30 sec 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 • • 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 • • • • • 9 Benefits Packages 4 Compensation Models Union job descriptions Employee transfer requires new employee paperwork HHC full homogenization by 2013

17

Leadership Behaviors

• • • • • • • • • • 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)