Capacity Management: Patient Throughput and Case Management Improvement. February 25, 2015

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1 Capacity Management: Patient Throughput and Case Management Improvement February 25, 2015

2 Agenda Introduction Impetus for Change Approach to Improving Case and Capacity Management Client Case Study Key Takeaways 1

3 Speaking Today: Christine Sullivan, Manager, KPMG LLP Background Christine is a manager in KPMG s Advisory Services practice with experience advising a wide variety of healthcare providers in revenue cycle engagements. Areas of expertise include Patient Access, pre-service and point of service collections, charge capture, Patient Financial Services, denials management and managed care contract reimbursement. Professional and Industry Experience Christine Sullivan Manager KPMG LLP 312 Walnut St. Suite 3400 Cincinnati, Ohio Tel Fax Cell Professional Associations Healthcare Financial Management Association, Member Education, Licenses & Certifications MHSA, Xavier University BA, Summa Cum Laude, Xavier University Project Management Certificate, Xavier Consulting Group Licensed Nursing Home Administrator (L.N.H.A.), State of Ohio Christine has extensive experience partnering with academic medical centers, community health systems, physician practices and continuing care retirement communities on revenue cycle initiatives. She has conducted comprehensive acute care provider end-to-end revenue cycle assessments and led implementations, using a proven methodology to increase cash flow and revenue performance. Her background includes leading projects in financial clearing services, financial counseling, charge capture functions, root cause denial analysis and Central Business Office internal controls and dashboard development. Revenue Cycle Assessments Conducted extensive qualitative interviews with key hospital management and staff to assess areas of opportunities within Patient Access and Patient Financial Services. Reviewed internal policies, dashboards and reporting tools for effectiveness and metrics compared to industry standards and benchmarks. Revenue Cycle Implementations Reorganized hospital and clinic services into a centralized Business Office model, developed a comprehensive AR strategy, created and implemented policies and procedures for all aspects of the Business Office and completed extensive training for all staff. Led a comprehensive denials reduction project with a five hospital system in a major metropolitan area. The findings and recommendations resulted in the implementation of a denial management dashboard, a dedicated physician advisor role to assist with clinical denials and a payer liaison role in Patient Financial Services to address denial trends with payers. 2

4 Impetus for Improving Capacity Management Bridging the gap between financial and clinical departments Reduce hospital readmissions Decrease average length of stay Improve both patient and staff satisfaction Mitigate financial pressures related to RAC and Value Based Purchasing Program from CMS Streamline patient throughput operations 3

5 Additional Benefits to a Focused Case and Capacity Management Program The financial pressures on hospitals cannot be ignored. Ensuring that your case management department is a powerful resource and ally in supporting the revenue cycle is a vital approach for success. Adaptability: Increased flexibility, scalability, to react to changes in the industry. Reliability: Processes are repeatable, automated, and more streamlined, which helps reduce variability. Profitability: Aligning RC activities closely with high-value outcomes may positively impact the bottom line, including increased net revenue and ROI. Improved efficiency: Identifying the next highest value activity for maximum value in a repeatable processes contributes to smoother operations. Predictability: More projects and tasks will be completed on time with a reduced cost model. Increased productivity and efficiency: Higher request resolution means that end users have what they need to do their jobs. 4

6 Key Attributes of a Standardized Patient Throughput and Care Management Continuum Streamline the Case Management Workflow through prioritization of patients based on risk, rapid and guided documentation and view of multiple concurrent guidelines Review the supporting evidence Protect revenue with strong documentation Reduce preventable readmissions Access evidence and clinical rationales that support the medical necessity of inpatient care decisions Admission Indicators, Level of Care Determination, Daily Optimal Recovery Milestones, Hospital Care Planning and Discharge Planning Establish medical necessity with intuitive, easy-to learn interface designed to quickly document care decisions Use the latest clinical evidence that has broad adoption in the payer industry Interactive, easy to look up and interpret guidelines Develop an easy to read encounter summary Readmission risk indicators Readmission alerts built into real time workflows Reporting tools and dashboards Use of clinical criteria that mimics the payer guidelines 5 5

7 Approach to Capacity Management Improvement Access to Care Coordination of Care Post Acute Care Direct / Scheduled Admits Emergency Department Observation Patient Placement Case Management Physician Advisors Nursing Clinicians Social Work Support Services The Process The Result 1 2 Patient Throughput/Case Management processes are modeled to document current state. The bed management processes are simulated in order to identify gaps. An undefined, inconsistent, and over-complicated process... A D B E C = The processes are streamlined through reengineering to fill gaps and eliminate bottlenecks. Automation is introduced into the processes wherever possible. The processes are monitored to ensure improved outcomes are achieved. BECOMES A simplified, consistent, and streamlined process. A B C Unnecessary steps and task variability are reduced while efficiencies are gained and financial outcomes are improved. = 6

8 Client Case Study: Improving Capacity Management Client Overview: 700+ bed, Northeastern multi-disciplinary health system, High Average LOS Client Objectives: Enhancing end-to-end patient throughput and capacity management capabilities and processes Enhancing inpatient case management capabilities and processes Establishing the necessary target operating model, infrastructure and level of stakeholder engagement to enable and sustain meaningful change Outpace Greater standardization of processes and reduced process and resource redundancy/ duplication Solution Improve Reduce Improved service alignment (bed allocation/ utilization vs. demand) Enhanced support for effective clinical decision making and interdisciplinary teaming Equip Increased service responsiveness (for patients and staff) Increased patient access and throughput levels 7

9 Client Case Study (continued): Engagement Overview Case / Capacity Management Process Overview Access to Care Coordination of Care Post Acute Care Registration Medical Necessity Screening Patient Placement MDR Rounds Concurrent Denials / Appeals Utilization Review Referral to Continuing Care Retro Denials / Appeals Stage 1 (4-6 Weeks) Stage 2 (6-8 Weeks) Stage Stage 3 (6-8 Months) 1 Opportunity Identification 2 Future State Operating Model and Roadmap Development 3 Initial Implementation Identification of potentially high-impact action items in-line with organization s goals, values, capabilities and resources Development of a plan to implement an appropriate and sustainable set of future state processes, structures and capabilities for capacity and inpatient case management Support in implementing the FSOM leveraging a set of initial pilot activities and milestones (to be included in the roadmap from stage 2) b Organization/ Infrastructure current state e FSOM Development f Roadmap Development h Program deployment/ training a Engagement initiation/ baseline performance review c Capacity management processes current state Prioritized improvement opportunities Collaborative/ Iterative Process Stakeholder engagement/ Input HUMC approved FSOM and Roadmap i Progress Monitoring Progress reports/ roadmap update d Case management processes current state g FSOM and Roadmap Review and Refinement j Project management 8

10 In Summary: Converging Markets = New Business Model At KPMG, we believe that health care providers should be thinking beyond transformation and focus on healthcare convergence and the broader implications of operating in a more collaborative and integrated U.S. healthcare delivery model. While transformation of current operations is likely going to be a business requirement, the real question for forward-looking organizations is what role they plan to play in a new and more converged health system. 9

11 What should you do next? Evaluate patient throughput processes in your current environment Evaluate reporting capabilities Build appropriate business case to support Capacity Management deployment Gain insight into revenue cycle and case management processes and drive significant benefits 10

12 Contact Information: Christine Sullivan, Manager, Advisory KPMG LLP

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