Vetting Vendors, Boosting Performance, and Driving ROI

Transcription

1 Vetting Vendors, Boosting Performance, and Driving ROI

2 Current Healthcare Revenue Cycle Environment With today s changing healthcare landscape, ICD-10, shifting payment responsibility, reduced operating margins and 501R, it s important to build a comprehensive strategy that improves patient engagement and sets the health system up for success. Those who concentrate on outside-the-box thinking along with continuous process and technology improvement will be the leaders in the Revenue Cycle community. What this meant for Cone Health was that we needed to make some big changes to ensure financial viability.

3 Cone Health Cone Health is a 6 hospital, 1,253 bed health system with various outpatient clinics and 350 employed physicians. Cone Health is located in Greensboro, North Carolina. Key statistics ending September 30, Discharges 60,848 Average Daily Census 777 Observations 16,267 Revenue Cycle collected $1.2 billion in fiscal 2015 which was $24 million over net revenue goal ER Visits 355,753 OR Cases 41,610 Physician Visits 158,883 Paid FTE s 8,188

4 Cone Issues Cone did not have the latest technology to improve efficiency and productivity. Vendors that were in place were not being evaluated for performance, and contract rates were higher than present industry standards. Productivity standards were not established and some staff were only working 15 accounts a day.

5 Key Strategies, which Improved Cone Performance Built a comprehensive program, did not just tweak one little thing. Did a full reorganization of the Revenue Cycle department. Utilized best-of-breed vendors and technology.

6 Criteria for Vetting Vendors & Technology Is it Functional? Does it support the strategy and fill the need? Features: What features do you NEED? Are there features that are nice to have? What features are required for the future? Integration: Does the technology work well with your current systems? Is it easy to activate and scale as you add locations? Workflow: Does it enhance the workflow you re building? Does it add efficiencies?

7 Criteria for Vetting Vendors & Technology Is it Cultural? Do the values and culture align with the hospital? Patient-focused: Is it focused on creating a better experience for your patients? Does it pass the patient test? Integrity: Do the values of the company AND the people line up? Do you trust them? Innovative: Are they committed to the same outside-the-box thinking? Does the innovation actually improve something? Partnership: Do they view the relationship as a joint effort to continually improve? Do they back it up with their actions?

8 Criteria for Vetting Vendors & Technology Is it Logical? Does it make sense and do you feel good about it? Have you talked to other clients? Take the time to vet your vendors with the community. Are you confident in the potential impact? Do the benefits outweigh the risks? Does it fit your hospital? Does selecting this vendor align with the greater strategy of your health system?

9 Criteria for Vetting Vendors & Technology Is it Critical? Does this vendor serve the best interest of your hospital and patients? Is choosing this vendor at this time critical to the ongoing success and growth of your health system? What would happen if you didn t make the change?

10 1. Determine your appropriate business needs and create a business case document that justifies the requirement 2. Identify potential vendor candidates from a variety of sources 3. Create the project administrative infrastructure 4. Develop the RFP & demo script 5. Develop an evaluation scorecard 6. Send RFPs out to the vendors 7. Receive the RFPs & begin the evaluation process 8. Finalize the demonstration script and communicate it to the finalists 9. Execute the formal demonstrations and score their performance 10. Tally the results and review them as a team 11. Present the results & final recommendation to the executive steering team

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12 Tips for Preparation, Training, and Go-Live with New Technology 1. Have a plan. 2. Work with vendor to schedule out a full timeline with deliverables. 3. Rally staff around the improvements the technology will make. 4. Communicate regularly with vendor to stay on track and work through any challenges that may arise.

13 Normal Metrics to Define Success Monthly charges, payments, and adjustments in comparison to averages and historical data. A/R Aging by date of service Gross Collection % Net Collection % Days A/R Charge entry lag times Denial % Clean Claim Rate %

14 Patient Statement Metrics First Pass Rate Ave. % of Bal. Unpaid Total # of Statements Printed / Records Sent to Print Total Payments Received / Total Amount Due Payments Received Per Statement Ave. Days from Statement to Payment Total Number of Payments Received / Total # of Statements Mailed Payment Date Statement Date

15 Old Vendor + Web portal

16 New Vendor

17 One Vendor for All Patient Payment Activities Auto-posting Performance Reporting Statements Cone Health Online IVR Automated Reconciliation Lockbox Payment Plans Point-of-service

18 Total Patient Payments Self Service Adoption Payments Made Outside of Normal Business Hours

19 Conclusion 1. Use a comprehensive strategy. 2. Use best-of-breed technology. 3. Align technology, people, and process. 4. Look for partner vendors. 5. Measure, measure, measure.

20 Mike Simms VP Revenue Cycle Cone Health