Hospital Billing EHR Implementation

Transcription

1 Hospital Billing EHR Implementation Wish I Knew then What I Know Now Billie Jo DeBolt, CRCE System Director, Business Service Lee Memorial Health System 1

2 Agenda Overview of Lee Memorial Health System Epic Project Teams & Scope Project Phases Go Live Events & Post Go Live Meetings Tools for Monitoring Key Metrics Lessons Learned LMHS Metrics 2 2

3 The Eagles Best Band Ever! 3 3

4 Lee Memorial Health System, Lee County FL Non-profit, public healthcare system 1,500+ Acute Care beds 10,000+ employees Numerous outpatient departments/services 70 + outpatient practice locations Over 5 billion in gross revenue per year Healthpark Medical Center Golisano Children s Hospital Lee Memorial Hospital Rehabilitation Hospital Cape Coral Hospital Gulf Coast Medical Center 4 4

5 Peaceful Easy Feeling 5 5

6 LMHS Future IT Vision One Patient, One Record 6 6

7 7 LMHS High Level Timeline and Scope for Epic Program Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13 Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Project Kickoff Gulf Coast Medical Center Phase 1: Enterprise Standard Design Cape Coral Lee Memorial/Health Park/ OP Centers Epic Upgrade 2008 to 2010 Inpatient Interdisciplinary Documentation (including emar with barcoding, ICU, Device Integration, Stork with Fetal monitor integration, flowsheets, allergies, notes, patient ed, discharge writer, Zynx Plans of Care) Legend LMHS Epic Project Team Training Pharmacy (Willow) CPOE design with Med Dispensing Integration Inpatient Clerk Orders with design for CPOE Surgical Services (OpTime) (full suite peri-operative; integration with materials mgmt, instrument tracking) HIM Chart Tracking, Deficiency Tracking, Release of Information, Coding & Abstracting ADT (Prelude Registration) with barcoding patient identification, electronic eligibility verification, patient flow/tracking, EVS (environmental services housekeeping bed status) Hospital Billing (Resolute) with significant reporting, batch interfaces, etc. Enterprise Scheduling (Cadence) planning to replace Tempus at LMH/HP/CCH in 6/2010 included at big bang for Gulfcoast Stabilization & Rollout to Cape Coral, Lee/Health Park = Go-Live = Upgrade Initial Implementation Gulf Coast Rollout beyond Gulfcoast (LMH/ HP/CCH/Outpatient Bldgs) Phase 2 CPOM/Phys Doc 5/13 MyChart - Patient Web Access Acute 4/2014 Care Everywhere In Progress 2014 Upgrade 11/2104 Beacon Oncology - TBD Anesthesia - TBD Cardiant Cardiology- TBD Radiant Radiology - TBD Beaker - Epic Laboratory - TBD Non-Epic Application Mix (Siemens Lab, Radiology, Document Imaging, pieces of Softmed and miscellaneous other applications) Continue Rollout of EpicCare EMR to LPG Physicians, MSO Practice Management and Affiliate Physician Pilots

8 Heartache Tonight 8 8

9 Epic Project Team Teams were created for each Epic application: EPIC Clinical Clin Doc, ASAP, Optime, Williow, Orders, EpicCare Ambulatory EPIC Revenue Cycle Cadence, ADT, Resolute Hospital Billing, Health Information Management, Onbase Document Management, Professional Billing Each team consisted of: One team lead Existing IT analysts Borrowed operational staff (35 in total were borrows and were committed for 3 years to the project before transitioning back to original department Consultants added only when needed 9 9

10 New Kid In Town 10 10

11 Project Begins. Application teams were sent for Epic training in Madison Wi trained on Epic s 2009 version, but went live on the 2008 version Discovery sessions were held with Epic staff, team members and LMHS process owners Validation sessions were completed using the Stop Light Evaluation Worksheets with LMHS SME s Then came many refinement sessions 11 11

12 Wasted Time 12 12

13 Remaining Project Phases Analysis and Build Unit Testing Integrated Testing Work flow walk through demonstrated Super User and End User Training Cutover Testing Dress rehearsals GO LIVE 13 13

14 Go Live Timeline First live event on 6/1/11 Gulf Coast Medical Center 349 beds very minimal outpatient. Second live event on 12/1/11 Cape Coral Hospital 291 beds with outpatient services in a couple of locations Third live event on 8/1/12 Lee Memorial Hospital 415 beds, Healthpark Medical Center 368 beds and a significant number of outpatient locations

15 Go Live Events After each live event the project teams would support the end users Project teams would then focus on refinement and build for the next go live Staggering the live events allowed the teams to continuously learn and improve on the process Daily meetings held to report issues and implement fixes Over time transitioned to weekly meetings for issues and reviewing key metrics 15 15

16 Post Go Live Meetings Daily Huddle Revenue Tracker/Charging review current charging to base lines, department levels, overall charge totals Daily Huddle Access/Revenue/HIM review top edits, access & revenue integrated issues, coding holds Daily Issues Meeting review status updates on reported outstanding issues, prioritization & assignment of issues Weekly Graph Package Call review tab by tab, compare facility to baseline and other customers 16 16

17 Life in the Fast Lane 17 17

18 Daily Revenue Tracker Critical tool used to track daily charge posting and compare to baseline Detail review done to determine if volume driven, business shift or Epic issue 18 18

19 I Can t Tell You Why 19 19

20 Epic s Weekly Graph Package Week

21 Epic Across Organization Comparison 21 21

22 Get Over It 22 22

23 Epic Dashboard Reviewed dashboard on a daily basis Trouble spots are easily identified after becoming familiar with all the sections 23 23

24 Epic Dashboard Cont d Most important sections are the DNB s and Stop Bills as well as Claim Edits. Coding holds are after Min days

25 Lyin Eyes 25 25

26 LMHS Tracking Tool Key Indicator spreadsheet developed with thresholds to track the most important holds and the responsible owning area ed out to all stakeholders on Mon Wed Fri 26 26

27 Lessons Learned Don t convert the A/R if at all possible, we converted with Siemens but did not with Epic and had much better outcomes In house patient charge conversion, don t use a tool called Eggplant. Second go live we used the Epic Bridges charge conversion tool and processing time was extremely good. Balancing was a little more difficult Front End cash drawers should all be enabled and tested Significant shift in key responsibilities from ADT to Nursing or Case Management. We underestimated the impact on event management functions and the role the CBO would play in correcting the events Be sure to document why decisions were made. We did a good job on the big decisions but not so good on the smaller ones. This information becomes very useful in the future when troubleshooting 27 27

28 Lessons Learned Manage your workques! Look for black holes and then plug them. Utilize the watch list section on the dashboard earlier rather than later. We are still finding pockets of accounts not hitting the correct WQ. Utilize an aging report in conjunction with your WQ s. This will also help to identify accounts not routing properly. Fully develop Epic for clean claims as opposed to depending on your claims scrubber. This will shave some time off your claims turn around if you are editing as much as possible within Epic. Provide deeper training for job specific duties. Epic fundamentals were taught in detail but we were lacking on the daily functions of each job role

29 Lessons Learned Test and then test again and then test some more! Do more Break testing and document what actions should be taken if an account is broken. We did a really good job of unit testing as well as integrated testing. Not nearly enough testing was done to identify breaks or soft spots in our processes. Assign specific duties to Readiness Role s after each go live. Utilize those that were provided additional training such as Readiness Role owners and Super Users. Don t be afraid to spread the wealth at critical times after a go live. Reporting in Epic can be problematic. Don t go down the path of duplicating existing reports in your legacy system. Fully understand the limitations of Account Query and Reporting Workbench and develop your new reporting needs either within Epic or in a bolt on application such as Crystal, Diver, etc

30 Take it Easy 30 30

31 Net AR Days Net AR Impact of Each Go-Live Months Post Live Current Legend Gulf Coast Medical Center (AR Baseline 59 Days) Lee Memorial Hospital & Health Park Medical Center (AR Baseline 55 Days) Cape Coral Hospital (AR Baseline 49 Days) 31 31

32 Desperado 32 32

33 High Level Candidate for Bill # s Candidate for Bill % of AR 60 Days Post Live Current GCMC 23% 11% CCH 33% 10% LMH/HPMC 19% 10% % of Candidate for Bill Held in Coding 60 Days Post Live Current GCMC 10% 2% CCH 18% 3% LMH/HPMC 7% 2% Note: Candidate for bill means the account is beyond the bill hold period (for LMHS this is >5 days post discharge) 33 33

34 Overall Snapshot of LMHS Before & After May 2011 Net AR Days % of Bad Debt 3% Cost to Collect 1.37 *Exceeded Cash Goal 2.6% May % % Note: LMHS finance department establishes a monthly cash goal using a formula that uses partial cash collections from the previous 2 months

35 Take it to the Limit 35 35

36 In Summary In the Long Run, life goes on so go stay at The Hotel California and have a nice Tequila Sunrise since you are a Victim of Love not a victim of Epic and You are Not Alone, everyone has gone or is going through an EHR Install 36 36