ROI through Quality Improvement: Davies Winner Lessons from the Field Steve Robertson Dale Glenn, MD

Transcription

1 ROI through Quality Improvement: Davies Winner Lessons from the Field Steve Robertson Dale Glenn, MD DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 Conflict of Interest Disclosure Steve Robertson and Dr. Dale Glenn Have no real or apparent conflicts of interest to report HIMSS

3 Learning Objectives 1.Learn various methods by which an EHR can produce return on investment. 2.Learn how the EHR can improve clinical quality. 3.Learn how data can be used to further enhance revenue in negotiating with payers. 3

4 4 hospitals 34,166 admissions 44+ clinic sites 1300 physicians Kapi olani Medical Center for Women & Children Straub Clinic & Hospital Serving our communities for more than a century Wilcox Health Pali Momi Medical Center 4 FY09 data.

5 Our 2002 Challenge Mandates to Build an Electronic Health Record and Improve Quality Immediate Need to Reduce Costs System lost $34M in 2002 How do we accommodate a $32M EHR investment? 5

6 Average Hospital Operating Margins in 2003 Was Negative 6.5% Premiums Rank Among the Lowest in the Country (49 th ). Cost of Living is the Highest in the Country. 6 Presented with permission from the Honolulu Star Advertiser 01/18/2013

7 Data We re different 7 Copyrighted and published by Project HOPE/Health Affairs as Katherine Becker and Amitabh Chandra, Medicare Spending, the Physician Workforce, And Beneficiaries Quality of Care, Health Affairs, 4/7/2004, doi: /hlthaff.w4.184, p 187. The published article is archived and available online at

8 What s the Business Case? Fewer Medical Errors, Adverse Drug Events Improved Outcomes through better care coordination, best practice alerts, health maintenance reminders Improved Patient Engagement Enhanced monitoring for improvements in clinical Quality. 8

9 Return on Investment Sources over 10 years Not Enough Hard Savings 9

10 Rather than Focus on Expenses Alone, We Focused on Net Revenue Improvement 2 to 5% of Net Revenue is lost from an inefficient Revenue Cycle. More than 50% of Business office activity is spent on rework getting information that should have been provided during the patient stay. Expenses Net Revenue 10 ROI Net Rev = Contracted Rev (Bad Debt + Avoidable Writeoffs)

11 A Clear Dependency Revenue Cycle Documentation Order Sets Edits and Alerts Transparency Electronic Health Record so, we Doubled Down: $32M $57M Replace Rev Cycle systems AND install an EHR

12 One Neck to Choke CEO Consolidated Registration, Hospital and Professional Billing, HIM into one Division under the CIO. Focus on System ROI not EHR ROI. 12 Photo by Steve Robertson

13 2 Project Manager s Success evolved into a Dedicated Revenue Integrity Team if you don t document, it s Experience: Compliance Officer, Case Management, Coder, Patient Accounting, Nursing, Patient Access, Pharmacy Tech, Information Technology, Project Managers 13

14 A Few Examples Avoiding Controllable Losses Avoidable Write off 2008 Improvement How EHR Enabled Improvement Late charges $728,000 Physician charges created by documentation update in EHR instead of paper charge sheet process Missing or inaccurate National Drug Code (NDC) for drug billing $629,000 Order and medication administration record (MAR) available to central pharmacy biller 14

15 A Few Examples Avoiding Controllable Losses Avoidable Write off 2008 Improvement How EHR Enabled Improvement Medical Necessity Denials $315,000 Improved Medical Necessity documentation. Improved reporting and better communication. Past Claim Filing Deadlines $154,000 Eliminated paper chase between Clinical departments and the business office. Drive Accountability through workqueues. 15

16 Hospital Bad Debt and Avoidable Write-Offs ~$4M Net Revenue saved annually 0.68% Reduction 16

17 Cost to Collect $1 Goal Pre Conversion Post Conversion 17

18 Hospital Gross AR Days Pre Conversion Post Conversion Goal 18

19 In thousands ROI = 9.0% without ARRA 12.3% with ARRA 19

20 +ROI Sources Over 10 Years 20

21 The Second Mandate: Improved Clinical Quality In 2009, we began to apply the same focus on improving Clinical Quality, and to leverage our capabilities to negotiate Pay for Performance contracts with payers. 21

22 The Second Mandate: Improving Clinical Quality Dr. Dale Glenn 22

23 Who s Driving the Boat? Providers are bailing the boat instead of patching the holes /Gamma Rapho/Getty Images. Licensed by Getty Images.

24 The Question: How many of the patients seen in your organization today will experience lasting improvement in their health? 24

25 Customer Driven Care The Virtual Patient Centered Medical Home Team Care Measure and Reward Success Standardized best practices (Electronic Protocols) Electronic Health Record 25

26 Disease management Prescription refills Preauths Education Phone calls Physician scheduling Orders Documentation Patient 26 Fee for Sickness Medicine

27 Disease management Prescription refills Preauths Education Phone calls Patient scheduling Doctor Orders Documentation Doctor 27 Team Care

28 We Practice the Science of Medicine in Teams so we can practice the art of medicine as Individuals 28

29 Team Care is.. Multiple people using the same chart Protocols that promote efficiency and quality Patient controlled An extension of the physician Ideally an advanced payment model: pay for quality, capitation, PMPM management fee. Treating sick people is the opposite of keeping people healthy 29

30 Can be seen by doctor, nurse, AND patient Allow easy order entry One place to see all necessary tests Do the DUE Protocols 30

31 Leadership Issues Whose Mammogram guidelines do you follow? Getting everyone to agree on the guidelines All GI docs using the same prep Access to all office schedules and all mammogram units All a1c>9 referred for education 31

32 Care Team Health Manager Nurse Educator Care Coordinators Nurse/MA Physician YOU Quality Service Convenience Value 32 32

33 33 Population Management Appointments Scheduled

34 Virtual Team Care Teams do not have to be in one physical space Teams can service private physicians Team members MUST have the trust and permission of primary care providers Team members must be empowered to act independently within their protocols 34

35 Care Coordinators Can Book a mammogram in any one of 7 locations. Schedule a colonoscopy directly in the OR and fax the prep to a local pharmacy. Order and perform preventative tests. Do basic education. Schedule a follow up for any of 60 doctors What you need when and where you need it. 35

36 Align Incentives to Improve Quality 36 36

37 Reality Check 37

38 75% Blood Pressure Control: All Hypertension Patients 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

39 85% 90% Percentile Breast Cancer Screening 80% 75% Percentile 75% 50% Percentile 70% 65%

40 85% 90% Percentile Cervical Cancer Screening 80% 75% Percentile 50% Percentile 75% 70%

41 80% Colon Cancer Screening 75% 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

42 70% LDL Control Diabetes Patients 65% 90% Percentile 60% 75% Percentile 55% 50% 50% Percentile 45%

43 75% BP Control in Diabetes Patients 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

44 55% A1C Good Control Diabetes Patients 50% 90% Percentile 75% Percentile 45% 50% Percentile 40%

45 Population Management Revenue FY11 breakdown: PMPM revenue $1,294,859 Payer HA Quality Investment 845,059 Total Revenue $ 2,139,918 Total Expenses $1,249,368 Net $850,550 FY12 budget: PMPM revenue $1,425,000 Payer HA Quality Investment $2,416,669 Total Revenue $3,841,669 Total Expenses $1,255,404 Net $2,586,265 45

46 The Patient Centered Medical Village 46

47 Next Steps Further develop EHR efficiency Over 100 Community doctors now using our system Direct access to charts from two other Hawai i hospital systems. 47

48 Steve Robertson Thank You! Executive Vice President and Chief Information Officer, Hawai i Pacific Health Steve.Robertson@hawaiipacifichealth.org Dale Glenn, M.D. Medical Director, Patient Centered Medical Home, Straub Clinics and Hospital dglenn@straub.net