Patient Flow and Movement

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1 Solution in Detail Healthcare Executive Summary Contact Us Patient Flow and Movement

2 Efficient, Cost-Effective Access to Care Efficient Access to Care Improved Process Flow Better Care, Effectively With access to more information about the quality and cost of care, patients are deciding for themselves where to go for care, intensifying provider competition. At the same time, new healthcare technologies, as well as demographic changes and an increase in chronic diseases linked to unhealthy lifestyles, are pushing healthcare delivery costs higher. Capped treatment budgets and strained finances are leading to declining provider revenues. 38% Lower rate of emergency department readmission within 30 days for the top 25% of hospitals Source: SAP Performance Benchmarking To deliver excellent patient experiences, healthcare providers must provide fast response to care requests. Yet, without the ability to plan and use resources efficiently and to ensure complete and fast reimbursement of patient services, provider profitability goes down. Planning begins with appointments. Providers need to plan appointments to optimize profitability, using revenue-generating services. Patient access departments need to be able to allocate and move appointments flexibly. Preliminary financial checks are essential to managing the risk of patients who cannot pay for their care. Poor visibility into resources, such as hospital beds, can result in faulty planning and the inefficient operation of clinical departments. To avoid duplicate data entries and errors, providers must capture patient data at every patient access point. Up-to-date overviews of patient services help ensure full reimbursement. Finally, by minimizing manual document processes, providers can also minimize claims delays and payment rejections, while improving cash flow. 2 / 23

3 Integrated Processes for Providing Healthcare Efficient Access to Care Improved Process Flow Better Care, Effectively Healthcare providers can reduce costs and continuously improve processes and decision making through the integration of front- and back-office processes. The creation of a seamless workflow for clinical and supporting processes increases staff productivity and decreases the cost of care. Providers can use business intelligence for insights to manage cost per case, and for continuous improvement of all clinical and business processes. Best-Run Healthcare To address their business challenges, healthcare providers must maximize resource utilization and reduce patient wait times. Better planning of patient appointments, aligned with medical and business priorities, allows for higher patient throughput. At the same time, enriched appointment planning data leads to the improved utilization of wards, points of service, and staff. Using and sharing a central patient record allows providers to access the same patient data across the organization, resulting in less paperwork. Mobile devices allow the access and sharing of patient data at the point of care, such as the treatment room. By ensuring the proper documentation of all patient services as they occur and by making sure they are completely available to coding and billing the accurate accounting for individual patient cases increases. This makes it possible to claim these provided services to the payer. Making sure, from the start, that claims and invoices are correct and complete reduces the number of rejected claims, reduces inquiry calls, and increases cash collection. 3 / 23

4 Providing Better Patient Care Effectively Efficient Access to Care Improved Process Flow Better Care, Effectively SAP solutions enable the integrated tracking of patients access to care and payments to providers. By facilitating more efficient planning and use of resources, increasing cash collection, and ensuring fair services reimbursement, these solutions help increase an organization's profitability. A central patient record ensures a consistent, stable, and secure system, avoiding data redundancy and enabling more timely response to patient demand. Increase staff productivity Reduce average cost per case Increase patient satisfaction Increase physician satisfaction Optimize resource utilization 4 / 23

5 Efficient Access to Care Improved Process Flow Better Care, Effectively Breakthrough technologies in Big Data, including the SAP HANA platform, together with continuing innovations in mobility, analytics, and cloud-based solutions, are resulting in more opportunities for healthcare organizations to provide cost-effective, high-quality patient care. These innovations help providers to lower costs and improve patient collaboration, patient care, service delivery, staff productivity, and decision making on every level. Database and technology solutions powered by the SAP HANA platform provide healthcare organizations with better visibility into processes and deeper understanding of how they operate. With SAP HANA, these organizations can use real-time analytics to make sense of huge volumes of data including entire patient populations with unprecedented speed. What used to take days now takes minutes; what used to take minutes now takes seconds. With cloud-based solutions, such as the SAP Jam social software platform, healthcare providers are able to engage proactively with healthcare consumers in the growing world of social media and social media networks. Mobile solutions benefit healthcare providers by increasing patient and staff satisfaction. These devices make it easy for consumers and staff to access the information they need, whenever and wherever they need it. In addition, mobile devices capture data where it occurs enabling instant follow-up processes. Finally, analytics solutions give healthcare providers the capabilities they need to run a more efficient organization, budgeting and executing with precision. 5 / 23

6 Connecting Processes to Respond to Demand Patient Access Billing Patient Collaboration Why SAP? Patient Access Support inpatient and outpatient registration and scheduling for a high ratio of utilization, and to ensure eligibility for treatment and subsequent remuneration. Provide for the precise recording of basic medical data as the basis for costing concepts and accurate invoicing and reporting. Billing Reuse all relevant data collected during treatment for invoice creation, automatic distribution of payer-billable items, and direct posting to financial records. 6 / 23

7 Patient Flow and Movement Patient Access Patient Access Diagnostics and Treatment* Billing Billing Patient Collaboration Patient Relationship Management Patient Scheduling Patient Registration Why SAP? Clinical Care Inpatient and Outpatient Tracking Patient Treatment* Activity Capture* Medical Records Catalog Maintenance Verification Payer Communication Support Connect processes across departments to enable a timely, transparent, and highquality response to patient demand. Invoicing and Payments *Covered in solution in detail Clinical Treatment and Care Price Calculation Invoice Handling Payment Handling 7 / 23

8 Patient Access Patient Access Capabilities Benefits Healthcare providers use SAP solutions for patient access to integrate patient registration and scheduling processes with treatment and billing processes, ensuring a higher utilization of resources and higher-quality records and invoices. 86% More patients attended to per doctor by the top 25% of hospitals compared to average hospitals Source: SAP Performance Benchmarking SAP solutions for patient access help administrators to validate eligibility, book appointments, manage care history, and anticipate future needs. The software maintains a single overview of the patient's past, present, and future with the provider organization. Registration functions verify insurance allowances and flag coverage shortfalls. Booking functions support schedule changes in response to evolving resource availability. An automated waiting list manages priorities for special procedures. Resulting efficiencies save patient interaction time and reduce wait times, increasing not only patient satisfaction but also staff productivity. 8 / 23

9 Gain Insight into Demand and Resource Availability to Optimize Productivity Patient Access Capabilities Benefits Patient access solutions from SAP keep track of the patient's lifelong encounter history and movements with the provider organization. Integrated patient scheduling allows healthcare organizations to optimize the use of available resources. The use of past admission patterns to plan admissions allows the organization to reserve capacities for specific elective treatments, while allowing for unplanned emergency admissions on a department-bydepartment basis. Preregistrations enable the booking of an appointment for an outpatient consultation or an inpatient admission with just a few specifications on the patient. Providers can plan as early as possible with a minimum amount of data. Patient scheduling capabilities include access to present and future bed status and physician calendars. Validation and completion of patient preregistration data occurs in the patient registration process. Checking for patient insurance coverage and eligibility, as well as financial clearance, occurs before care is provided. Waiting-list management supports regulatory, medical, and business requirements. 9 / 23

10 Patient Access Capabilities Benefits Patient Registration and Scheduling Optimizes Utilization and Helps Ensure Eligibility Patient access solutions from SAP allow providers to set up a central, stable, and consistent patient record, including patient insurance eligibility and financial clearing, to ensure payment for all services. Streamlined processes speed patient flow, drive admission staff efficiency, and optimize resource use. Patient access solutions from SAP improve visibility into demand and resource availability to optimize productivity. They support efficient patient registration and scheduling processes, allowing patient-access specialists to save time, because appointments can be booked early for specific days. They also give flexibility by enabling staff to move appointments or rebook them in different care units at any time with a few key clicks. In addition, they provide an instant and up-to-date view of present and future (planned) bed status, enabling a high utilization of wards and service facilities. To ensure payment for all provided services, functionality supports insurance verification and eligibility checking, payment collection, and a check for open items at admission. Finally, patient access solutions increase patient throughput and admission staff efficiency by supporting admission processes that meet the requirements of different patient access scenarios. 10 / 23

11 Innovations for Patient Access Patient Access Capabilities Benefits 40% Higher employee productivity where mobile access is provided to employees across all levels Source: SAP Performance Benchmarking Innovations for patient access include advances in applications integration, mobile, analytics, and cloud technologies. These innovations enable healthcare providers to access customer care processes, deploy mobile patient services, gain real-time visibility into patient care, and engage proactively with healthcare consumers. Applications Patient access includes integration with patient relationship management software to support customer care processes inside and outside the hospital, driving patient service and satisfaction. Mobile Mobile patient services can improve quality of care, benefits coverage, and patient service experience. Services include appointment reminders, vaccination calendars, prescription refill, and more. Analytics Real-time visibility into bed utilization and other key metrics enables staff to adapt quickly to address such issues as numbers of patients and patient acuity. Cloud Cloud-based, on-demand solutions help providers engage proactively with healthcare consumers through social media. These solutions can improve staff productivity and delivery of services. 11 / 23

12 Capabilities Benefits Precise recording and reporting of all rendered services facilitates fast, complete, and fair reimbursement for all services rendered, as well as compliance to regulatory reporting obligations. involves maintenance of the catalog of services, a means of verifying accurate recording of services, and software for calculating prices. of services, procedures, diagnoses, and materials is done on the basis of structured data repositories that are valid throughout the organization. Data can also be uploaded automatically from external sources. A coding workstation provides an entry point to all coding-relevant data, including diagnoses, diagnosis-related group (DRG) data, services and procedures, and case data. The coding workstation supports coding verification and transfer to the connected DRG grouper software. Simulations allow providers to gain insight into revenues according to current coding. Prior to its release to billing or reporting, coding verification allows providers to check medical documentation for completeness and compliance to coding rules. verification provides a complete picture of the medical documentation for a case so that all stakeholders can check and verify the data. 12 / 23

13 Consistent Medical Activity and Verification Based on Structured Repositories Capabilities Benefits Catalog maintenance software provides complete and consistent catalogs for planning, performance, billing, and reporting to all stakeholders. Because catalog entries are timedependent, catalog updating does not affect existing entries, reporting, or invoices. Performed by department-level physicians or the coding director, coding verification supports the review and validation of medical documentation prior to its release to billing or reporting. Using a rules engine, the software performs this same check automatically. The software can also generate billable items automatically, based on the medical services that were provided. Price calculation software provides predefined pricing rules and a flexible framework for insurance calculations. It supports the automatic calculation of billable prices and taxes based on predefined local pricing rules, enhanced with customer-defined pricing rules used to calculate surcharges or discounts. The software also supports the calculation, reporting, and distribution of fees to the financial accounts of individual doctors. 13 / 23

14 Faster Transfer of Patient Cases to Claims and Billing Capabilities Benefits For healthcare providers, the quick and accurate transfer of patient cases to claims and billing is essential to enabling timely remuneration. By ensuring the proper documentation of all patient services and by making the data directly available for verification, coding increases accuracy, resulting in fewer inquiries and rejections. The facilitation of efficient coding in a healthcare organization requires a dedicated coding workspace using integrated clinical and administrative data. The dedicated coding workplace provides staff, physicians, and coding directors with direct access to all relevant case data both administrative and clinical data. The software checks this case data for completeness and compliance to coding rules, and it triggers corrections. The coding workspace provides coding directors with an integrated interface that greatly simplifies their daily tasks. Complete with customized work lists and direct navigation to the DRG workstation, including the grouping function, the interface helps the directors to be more efficient in their work and ensures complete and consistent coding. This coding is available as a basis for subsequent billing and statutory reporting. 14 / 23

15 Innovations for Capabilities Benefits Healthcare organizations can use technological innovations in mobile and analytics to enable timely, accurate, and complete documentation of medical activity. Analytics solutions can provide immediate and up-to-date insight into both actual circumstances and simulations. 8 out of 10 Decision makers think access to the right information at the right time is critical to their business Source: SAP Performance Benchmarking Mobile Mobile solutions enable a healthcare organization to react proactively, detecting coding issues early and reacting faster to them. Patient care stakeholders can use their mobile devices to view up-to-date coding information from anywhere and at any time. They can simulate grouping results quickly and easily. Analytics Innovations in Big Data software and the availability of the SAP HANA platform are arming healthcare providers with an unprecedented real-time view of their organizations. Staff, physicians, and coding directors have real-time insight about delivery costs per service or per diagnosis-related group (DRG) and associated reimbursements. These insights help healthcare providers to create an optimized case mix to help ensure cost-effective use of resources. 15 / 23

16 Billing Billing Capabilities Benefits The billing solution reuses previous treatment data to automatically distribute billable items to payers and make direct postings to financial records. A flexible, rule-based pricing engine calculates service prices automatically. The billing solution also assigns the bills to the payers automatically and manages all self-pay processes. The billing solution uses a workflow concept that pushes a patient case to the accountants integrated workstation, where the selection of billable cases starts invoice processing. The billing workstation provides the accountant with all needed information to bill a single case or a whole group of cases at once. A test mode performs all relevant service rule checks for consistency and compliance of the entered data. During the test, the workstation displays error and information messages, allowing the accountant to trigger corrective actions or to correct the relevant data and start the billing process. Ensuring that claims and invoices are correct and complete at the start reduces the number of rejected claims and inquiry calls. Accurate billing also reduces the number of days from discharge to cash collection. 16 / 23

17 Billing Reuses Data to Automate Distribution to Payers and Posting to Financial Reporting Billing Capabilities Benefits Best-run healthcare organizations optimize invoice management and handling for account managers and billing staff with a concise, complete, real-time picture of each billable case and item. The solution's invoice management and handling software provides an accurate, up-to-date, comprehensive overview of all billing-relevant information provided by all stakeholders in the case. The software also fully automates the complete billing process, including the posting and clearing of documents in financial accounting. In addition, to gain cost and time efficiencies, best-run healthcare organizations rely on payer communication support. This permits easy and open collaboration, communication, and sharing of information between healthcare provider institutions and payers at all steps during the billing process. Open communication support leads to faster issue resolution and remuneration. The solution also includes payment management and handling functionality that supports the monitoring and tracking of claims to their completion as well as receipt of payments. 17 / 23

18 Billing Capabilities Benefits Increase Billing Staff Efficiency and Ensure Fast Reimbursement for Provided Services Direct access to all billing-relevant information, automatic built-in billing checks, and native integration into financial accounting help ensure the submission of accurate, defensible claims. Accurate billing reduces rejected claims and inquiries, while speeding up cash collection. 28% Lower error rate in bills sent out where billing system is integrated to accounts receivable and re-entering information is completely eliminated Source: SAP Performance Benchmarking Significant increases occur in billing department efficiency when complete and relevant billing and financial information appears in a unified environment with full visibility for all billing staff. Reuse of relevant data collected during the treatment process, automatic assignment of billable items to the correct payers, and built-in billing checks all help ensure the creation of complete and accurate claims and invoices. In this way, the software helps to reduce the number of inquiries and rejected claims and invoices, while simultaneously reducing the time spent from discharge until cash collection. Through integration of billing with financial accounting, the software is able to clear, in real time, all incoming payments and open items posted onto the payer's customer accounts. The accountant can check postings immediately from the billing work station. Such integration substantially increases transparency and reduces administrative costs. 18 / 23

19 Innovations for Billing Billing Capabilities Benefits Solutions for healthcare providers from SAP leverage technological innovation to streamline and accelerate billing and to analyze cost and profitability information. By providing in-depth insight into the delivery of health services, these solutions help providers improve efficiency and effectiveness. Applications Billing is fully integrated with patient-related front-office processes and back-office processes in financials, thus increasing transparency and reducing administration and process costs. Mobile Data entry at the patient s bedside on a mobile device can automatically trigger administrative back-office processes. For example, a planned discharge date entered during the doctor s rounds can begin the process to prepare for discharge and billing. Analytics Planning and real-time monitoring of current cases and case-related costs and revenues, as well as cash flow, enables faster detection and analysis of deviations. Simulation capabilities help providers to identify appropriate adjustments. 19 / 23

20 Patient Dialogue and Collaboration Value Map Patient Access Billing Patient Relationship Management Marketing Physician Partner Management Patient Services Patient Collaboration Patient Flow and Movement Patient Access Billing Why SAP? Personal Health Excellence E-Care Data Connect E-Care Plan Connect E-Care Social Connect Attract patients, optimize outcomes, and facilitate collaboration. 20 / 23

21 Why SAP? Patient Access Billing Patient Collaboration Why SAP? Solutions from SAP for healthcare organizations include support for processes that track patient care from registration through to payment. Integration of these processes contributes to cost-effective healthcare delivery by simultaneously improving productivity across the enterprise and patient experience. Increase Staff Productivity Administrative and clinical processes share one central patient record as a single source of truth, driving data consistency and staff efficiency throughout the organization. Reduce Total Cost of Ownership Healthcare providers benefit from seamless process integration in a natively integrated environment of patient-related front-end and back-office applications. Leverage Key Innovations Based on one of the industry s most innovative technology foundations, SAP solutions help to enable business process optimization and efficiency at the lowest possible cost. 21 / 23

22 Find Out More About How Your Organization Can Become Best-Run Benchmark Your Performance Position your organization for dominance in this new economy with the business performance benchmarking program from SAP available free to SAP customers and select prospects. The SAP benchmarking program has helped more than 3,000 organizations assess their strengths, uncover areas for improvement, and identify best practices and IT strategies that generate clear, tangible value not someday, but today. Go Live in Weeks Here s the fastest way to run your business better: our rapid-deployment solutions. In one package, you get everything you need to be up and running quickly including preconfigured software and implementation services in just weeks. With a defined scope and predictable costs, there are no surprises. Join Your Community of Practices Visit valuemanagement.sap.com >> Visit sap.com/solutions/rds >> Every day, SAP Community Network (SCN) changes the way that thousands of SAP users work. It lets members help one another solve problems, learn, and invent new ways to get things done faster. Find out how to connect with people, content, and resources. Visit scn.sap.com >> 22 / 23

23 Solution in Detail Healthcare Executive Summary Contact Us CMP (13/07)

24 No part of this publication may be reproduced or transmitted in any form or for any purpose without the express permission of SAP AG. The information contained herein may be changed without prior notice. Some software products marketed by SAP AG and its distributors contain proprietary software components of other software vendors. National product specifications may vary. These materials are provided by SAP AG and its affiliated companies ( SAP Group ) for informational purposes only, without representation or warranty of any kind, and SAP Group shall not be liable for errors or omissions with respect to the materials. The only warranties for SAP Group products and services are those that are set forth in the express warranty statements accompanying such products and services, if any. Nothing herein should be construed as constituting an additional warranty. SAP and other SAP products and services mentioned herein as well as their respective logos are trademarks or registered trademarks of SAP AG in Germany and other countries. Please see for additional trademark information and notices.

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