Business Case Advantages and Disadvantages

Transcription

1 Business Workflow Assessment A New Look at Ourselves Brenda Kennedy, RN, BSN, MBA Quality Director Greg Wolverton, Chief Information Officer

2 Today s Game Plan Framework based on the business case and re-design Understanding current workflows Operational Clinical Use process mapping to develop ideal workflows Apply concepts to HIT/EMR

3 Why talk about the business case? Leaders struggle with aligning the work of planned care with the business of the health center. This struggle has led many to question whether adoption of the business case is a suitable strategy for health centers. It is the right thing to do!

4 Evolution of the Business Case and Re-Design Framework Senior leaders need to focus on the business case for leveraging resources Lessons learned from high performing organizations about financial success while implementing the re-design and the business case concepts TRANSPARENCY IS KEY!!!!

5 Early Observations Lack of discipline in documenting the core business case Lack of alignment of financial and administrative systems to support planned care Silos in organizations creating barriers to achieving optimal results

6 Typical Organizational Chart Big Boss Little Boss 1 Little Boss 2 Little Boss 3 Not Enough workers Way Too Many workers Who Knows Here

7 Organizational Continuum External Internal Clinical Admin Support Finance Our Customer Operations HIT

8 Where we are Clinical Billing Case Management PM Pharmacy Labs Patient

9 Where we need to be Clinical Billing Case Management CUSTOMER Pharmacy Labs Support

10 Potential for Prosperity Ability to Convert Solutions into Reality AREA of SUCCESS Ability to Generate Solutions

11 Process Improvements No waits or delays 45 minute wait vs. 15 minute visit Match demand and capacity Reduced no shows more visits Decreases waste! Increases patient satisfaction Time to provide care Timely, quality billing

12 Sources of Data UDS Registry Reports Practice Management Reports Medical Record Audits Tracking Logs Insurance/Billing Reports Financial Reports

13 Reporting Measures Cost per Encounter Revenue per Encounter Cycle Time Value Added Time No Show Rate BILLABLE Encounters per month Payor Source Analysis

14 Why Re-Design? Leaders struggle with aligning the work of planned care with the business of the health center Quality without a business case is not sustainable. Without transparent data we do not know! You cannot afford NOT to!

15 How do we get anything done? Process Inspect Wait Administrative Move

16 Process Mapping Approach Shows the Big Picture Describes a process as it works today High touch, low-tech Identifies strengths and opportunities Captures the complexity and disconnects of key operational issues Identifies outside areas involved in the process Removes automatic defense mechanisms Involve everyone

17 The Business Case: Margin = Revenue - Expense There are only 2 ways to increase profit margin: Reduce Costs Lean Thinking Increase Revenue More volume through improved productivity More reimbursement per unit of service

18 Value to the Customer Focus on Value - From the Customer s perspective Understand the Value Stream Seek Perfection Optimize Flow Design systems to Pull demand Every Problem Matters

19 Decision Support Accountability for Productivity Clinic report cards User/Encounter reports on virtual office Patient Utilization Patterns Chronic No-Shows & No-show Graphs Utilization of Capacity Provider Productivity RVUs PECS/UDS Reports Business Office reports Publish data on Intranet

20 High Leverage Points Optimize teams Apply lean principles to reduce cost and minimize waste Eliminate waits Improve access Revenue maximization strategies Make full use of capacity Create transparency of information

21 Transparent Results Training on proper E & M coding, billable services increased by 36%, even though the number of encounters increased by only 8%. Self-pay collections increased from 42% to 77% in two months

22 More Transparent Results With RVU analysis, we determined we needed to raise fee schedule by 25% = $80K annual revenue increase Improved coding = $25K annual revenue increase Patient co-pay for discounted services was increased from $10 to $15 = $20K annual revenue increase

23 June-October Revenue Comparison $2,500, $2,301, $2,000, $1,500, $1,000, $1,858, Revenue 23% increase in Revenue $500, $ June-October Encounter Comparison % decrease in Encounters Encounters

24 Yet More Results Opened additional clinical sites without federal funding Added services DSME Literacy Program RSVP Augusta Wellness Center WRRHC Leadership University Community Initiatives Each Owner received a $1000 Holiday Bonus New Pharmacies, 2 New Health Centers Cash Reserves - < 15 days to >200 days $100,000 to over $3M

25 The Visual Results

26 The New WRRHC Mission The mission of White River Rural Health Center, Inc. is Health for All with a focus on: Customer health Community health Employee health Organizational health

27 The New WRRHC Vision VISION: White River Rural Health Center, Inc. will be the provider of first choice in our communities, the largest primary care provider in Arkansas, and a national leader of community health centers.

28 The New WRRHC Values The values of White River Rural Health Center, Inc. guide employees in providing superior service to fulfill our mission and achieve our vision. Stewardship valuing our resources daily to insure our mission tomorrow Positive Attitude empowering employees to create an energetic work environment Integrity honest, ethical, and dedicated to all we do Respect appreciating all people, work, and ideas Improvement always striving for performance excellence Teamwork achieving our goals together

29 Decisions to Support Change Know where you are currently at Map all areas and processes Know where you want to go Decide what can change after mapping Know & Utilize the business case Nothing is ever changed successfully without determining where you are and deciding on where you want to be.

30 Ability to Convert Solutions into Reality Average Maximum Minimum The Challenge Where are You? Average Ability to Generate Solutions Maximum

31 Questions?