Centralized Scheduling

Transcription

1 Centralized Scheduling Children s Hospital s Journey Maribeth Quinn Director, Business Process Improvement

2 Presentation Agenda Background for Columbus Children s Hospital Project Background Goals for Centralizing the Process Initial Scheduling Process (Past State) What We Wanted for the Future State Steps We Took Along the Way Before Approval After Approval After Selection Outcomes Produced from the Project

3 Columbus Children s Hospital 110 year history Teaching hospital Strong commitment to research 2004 statistics: 323 licensed beds 48 leased off-site beds 14,012 inpatient discharges 15,652 surgeries 64,851 ED visits, plus approx. 20,000 Urgent Care Visits Approx. 47,000 off-site urgent care visits More than 400,000 outpatient visits

4 Scheduling Project Background Completely decentralized process Almost all our clinics require a referral from a primary care physician (pediatrician) and most clinics were using a fax referral to schedule from Some clinics were taking two weeks to triage patient information and provide an appointment back Most clinics were then relying on the primary care physician to notify the patient of their appointment date and time

5 Original Scenario (2003) Customers (both internal and external) Separate phone call or fax for each area with a different process to follow * New form and process now being used to create more consistency across clinics +50 Clinics & Procedures +15 Scheduling Systems

6 Customer Service Horror Stories Pickerington Family Practice Debbie Foly - Nurse Manager Phone: x230 Main concern: Takes weeks to get an appointment. Ex-CHI nurse who understands the wait times, but feels that weeks of waiting just to get an appointment is unacceptable. She spoke of continuing problem but named the ENT and GI clinics as recent examples of poor service. ENT Clinic - Patient had painful ear infection with drainage. After two weeks of daily phone calls requesting an appointment to see CHI specialist without any response, patient was forced to go to ED for treatment. ENT Clinic finally called after ED visit, saying they were trying to reach PCP and parent the whole time... After a frustrating two weeks of waiting for an appointment in the GI Clinic, they sent their patient to another location for service. Pickerington belongs to a group of 26 family practice offices who share info like this along with alternative locations to send their patients

7 Goals for Centralized Scheduling Project Improve customer service to both referring physicians and parents by providing one-stop shopping for all their scheduling needs should also reduce the time required to register when they arrive for their appointment Increase productivity associated with clinic and diagnostic schedules and productivity higher productivity will increase revenue provides an opportunity to create consistent policies across areas Improve access to clinics and diagnostic areas through better ability to fill open slots could reduce overall wait times in some of the areas Reduce labor associated with scheduling (estimated to be significant due to decentralized system) Improve the pre-registration process which will lead to increased collections Reduce no-show rate

8 Ultimate Proposed Scenario +50 Clinics & Procedures View Customers (both internal and external) One phone call or fax for everything Scheduling Center One Scheduling System Scheduling System * Referred to as Central ACCESS which is the top request for referring physicians

9 Benefits of Ultimate Process Customer Service Physician Relations - referring physician s staff spend large amounts of time trying to coordinate several appointments on behalf of the patient. They are currently frustrated with our process. Parent Relations -providing parents with the ability to make one call for all procedures and clinic visits Consistency/Quality - having one process allows for more standardization of policies and procedures in scheduling practices thus improving access to care. Rules will also prevent tests being ordered in the wrong order, etc. Patient Education - having an intelligent robust system allows for reliable information to be consistently provided to the patient and family when scheduling procedures and clinic visits.

10 Benefits of Ultimate Process Return on Investment Increased revenue - Many hospitals reported increases in volume after implementing centralized scheduling through better management of clinic throughput and easier access Increased revenue - currently it is estimated that most of our clinics experience a 25% no-show rate and above. Although some areas handle this through over booking many areas do not. With a more customer friendly system it is estimated that no-show rates will decline improving overall revenue. Reimbursement - centralized scheduling processes include pre-registration and could ensure that required authorizations are completed prior to any appointments Time Savings - hospital staff spend large amounts of time trying to coordinate schedules between departments. OhioHealth estimated a savings of over 20 FTE s.

11 Issues/Concerns Triage capability - Currently many of the areas practice some type of triaging to determine how quickly a patient should be seen. A new process for triage would have to be developed than the current one. Each area loses some control of their immediate schedule in that except for emergencies, schedules would not be changed. Long term schedules are determined by the areas themselves. It will take a lot of work to redesign all the current scheduling processes. A new system will need to be purchased to provide sufficient search and education capabilities for one area to have the knowledge and expertise to schedule for all areas.

12 Project Steps Before Approval Interviewed all clinics to determine how they were scheduling What system they were using How much staff time it was taking A sense of the process they were following Compiled that data into a table to present to the Steering Committee Contacted other hospitals to determine if they had achieved a Central Scheduling process ROI Analysis based on estimated costs using improved throughput (projected) Took a site visit with key physicians to Cincinnati Children s who were in the process of centralizing the scheduling process

13 Initial Data Collection Summary of Current Scheduling Areas Using SMS Estimated Monthly Volumes Department/Clinic Pre-Register? Scheduling System FTE's Adolescent/Teen Health Clinic No SMS Allergy Clinic No SMS Bone Density No SMS 0.25 Cardiology Clinic No SMS Central Scheduling Yes SMS Cerebral Palsy No SMS CT Interventional No SMS Dermatology Clinic No SMS Developmental Disability No SMS Down Syndrome No SMS 0.60 Endocrinology Yes SMS Eye Clinic No SMS Fluoroscopy No SMS General Radiology No SMS Hematology No SMS Myelomeningocile No SMS MRI No SMS Nuclear Medicine No SMS Orthopedics including hand clinic No SMS Physical Medicine/Rehab No SMS Primary Care Yes SMS Sleep Lab No SMS Sports Medicine No SMS Ultrasound No SMS Cleft Palate/Cranio Facial Yes Paper/Pencil & SMS ENT No Paper/Pencil & SMS Family Development No Paper/Pencil & SMS Immune Deficiency (IDC) Yes Paper/Pencil & SMS Estimated Monthly Total on SMS

14 Initial Data Collection Summary of Current Scheduling Areas Not Using SMS Department/Clinic Pre-Register? Scheduling System FTE's Estimated Monthly Volumes Behavioral Health Yes CMS Behavior/Learning Disability Yes CSM database Physical Therapy Yes Excel Occupational Therapy Yes Excel 853 Pediatric Surgery (King, Teisch) No Medical Manager Pulmonary Clinic - CF No MS Access Arthritis Clinic/Rheumatology No Outlook Infant Pulmonary Lab No Outlook 0.13 Interpreters Not Applicable Outlook 0.31 Nephrology No Outlook Neurology Yes Outlook GI Procedures Clinic Yes Outlook & SMS Cardiology Diagnostic No Paper/Pencil 1.00 Dialysis Yes Paper/Pencil 0.03 EEG Yes Paper/Pencil Genetics Clinic No Paper/Pencil 0.75 Infectious Disease Clinic No Paper/Pencil 35 Infusion Yes Paper/Pencil Neonatology No Paper/Pencil Pediatric Surgery (not King, Teisch) No Paper/Pencil 1.00 Pulmonary Lab No Paper/Pencil Speech No Paper/Pencil Sweat Lab No Paper/Pencil 0.03 Dental Clinic No Softdent Estimated Monthly Total Not on SMS

15 Comparison with Other Hospital Systems Area Hospital s with Centralized Scheduling Cincinnati Children s Hospital Mount Carmel OhioHealth (Radiology Only) Tod Children s Hospital (Youngstown) St. Elizabeth North Unit (KY) TriHealth System (Cincinnati) Health Alliance System (Cincinnati) Area Hospitals not using Centralized Scheduling Ohio State University Medical Center Rainbow Children s Akron Children s Dayton Children s Toledo Children s (plans to offer it within next two years) Other Hospitals Using Centralized Scheduling Beaumont Hospital (MI) * Riverside Walter Reed Hospital (VA) * St. Elizabeth North Unit (KY) Other Hospitals not using Centralized Scheduling Mayo Clinic (MN) * Johns Hopkins Hospital (MD) * University of Michigan Medical Center (MI) * Massachusetts General Hospital (MA) Barnes-Jewish Hospital (MO) University of California San Francisco Medical Center (CA) Stanford University Hospital (CA) Brigham & Women s Hospital (MA) * One phone number to call

16 ROI Spreadsheet ($1,405,997) NPV using 10% and 1% improvements $4,713,822 NPV using 10% and 5% improvements Centralized Scheduling $184 NPV using 10% and 2% improvements Return on Investment Analysis Average Monthly Clinic Billing $1,965,507 Average Monthly Scheduled Diagnostic Billing MRI, Ultrasound, CT, Nuclear Med., EEG, Cardiology $3,181,137 Average Monthly Clinic/Diagnostic Denials $97,000 Increased Revenue Year 1 Year 2 Year 3 Year 4 Year 5 Total Decrease breakrate and/or increase physician productivity by 1% assuming 70% collection rate $165,103 $165,103 $165,103 $165,103 $165,103 $825,513 1% increase in diagnostic productivity $267,215 $267,215 $267,215 $267,215 $267,215 $1,336,077 1% decrease in denials $11,640 $11,640 $11,640 $11,640 $11,640 $58,200 $443,958 $443,958 $443,958 $443,958 $443,958 $2,219,790 Decrease breakrate and/or increase physician productivity by 5% assuming 70% collection rate $825,513 $825,513 $825,513 $825,513 $825,513 $4,127,565 5% increase in diagnostic productivity $1,336,077 $1,336,077 $1,336,077 $1,336,077 $1,336,077 $6,680,387 5% decrease in denials $58,200 $58,200 $58,200 $58,200 $58,200 $291,000 $2,219,790 $2,219,790 $2,219,790 $2,219,790 $2,219,790 $11,098,952 Required cash flow to break even using NPV $852,000 $852,000 $852,000 $852,000 $852,000 $4,260,000 (Equates to approximately a 2% decrease in breakrate and or physician productivity and diagnostic productivity) Investment & Ongoing Expenses Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Total Equipment Software $ 800,000 $ 160,000 $ 160,000 $ 160,000 $ 160,000 $ 160,000 $ 1,600,000 Hardware $ 90,000 Implementation $ 500,000 $ 200,000 $ 700,000 Ongoing IT support $ 234,000 $ 117,000 $ 117,000 $ 117,000 $ 117,000 $ 117,000 $ 819,000 Scheduling Manager $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 468,000 Total Initial Investment $ 1,702,000 $ 555,000 $ 355,000 $ 355,000 $ 355,000 $ 355,000 $ 3,677,000 Net Cash Flow Net Cash Flow Annual using 1% $ (1,702,000) ($111,042) $88,958 $88,958 $88,958 $88,958 ($1,457,210) Net Cash Flow Annual using 5% $ (1,702,000) $ 1,664,790 $ 1,864,790 $ 1,864,790 $ 1,864,790 $ 1,864,790 $ 7,421,952 Net Cash Flow Cumulative using 1% $ (1,702,000) $ (1,813,042) $ (1,724,084) $ (1,635,126) $ (1,546,168) $ (1,457,210) Net Cash Flow Cumulative using 5% $ (1,702,000) $ (37,210) $ 1,827,581 $ 3,692,371 $ 5,557,161 $ 7,421,952 Net Cash Flow Required to Break Even $ (1,702,000) $ 297,000 $ 497,000 $ 497,000 $ 497,000 $ 497,000 $ 583,000 $ (1,702,000) $ (1,405,000) $ (908,000) $ (411,000) $ 86,000 $ 583,000

17 What Sold the Project? The site visit to Cincinnati Children s Hospital where we took 3 physicians (one of whom was particularly against the idea) was a key step. Cincinnati was having success and there were physicians there to attest that the centralization had not been a problem for them. Also, the small improvement required in throughput to pay for the system while improving customer service sold the project to Administration

18 Project Steps Once Approved Created a Planning Committee to write the RFP Using workflows what exactly did we need a scheduling system to be able to do (Rules Based System) Which needs were critical or which would be nice to be met Mostly clinical staff (including 3 physicians) so we met at 7:00 for an hour each week Sent out and scored the RFP responses Invited back the top 5 vendors Went on site visits for the top 2 vendors Selected a system in Summer, 2003 and then entered into contract negotiations Contract signed late August, 2003

19 Project Steps After Selection Process Completed System Manager training September, 2003 and began really building the system in October Central Scheduling moved to Westerville (off-site) February 27 th, 2004 Training completed the last week of February, 2004 Began scheduling for Primary Care, ENT, Eye and Derm March 6, 2004 Radiology live in April, 2004 Rolled out clinics every few months after that

20 Baseline for Goals to Determine the Impact of the Project Physician and parent surveys The director conducted a parent survey late 2003 for baseline A fax survey was sent to approximately 300 referring physician offices Clinic throughput (# of patients actually seen per day) Gather current wait times for being seen in clinic areas Cost per appointment measured before and after scheduling process/system is implemented Measure denials before and after (will not be affected until preregistration is implemented) Measure no-show rates before and after

21 Children s Hospital Scheduling Benchmarking Survey April How long does it take to schedule an appointment at Children s Hospital: Radiology Department? Minutes Hrs. Days Sub-specialty Clinic? Minutes Hrs. Days 2. Please rate your satisfaction with Children s Hospital s current time (processing time) to schedule an appointment. Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied Radiology o o o o o Subspecialty Clinics o o o o o EEG s o o o o o 3. Could your office accommodate the process of keeping the parent in your office while an appointment at Children s Hospital is booked over the phone? 4. Does an RN in your office schedule the appointment? Yes Yes No No 5. How would you rate your overall satisfaction with the scheduling process at Children s Hospital? (e.g. Including ease of use, time required, response time received ) Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied o o o o o Thank you for your time! Your feedback is greatly appreciated and will be used to help improve our scheduling process. Please forward any questions to Joan Euans, Central Scheduling Supervisor at Please fax completed surveys to Lee Velo, Dept. of Process Improvement

22 Some Outcomes

23 Results from 1 st Survey Current time(processing time) to schedule an appt. Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied Radiology % 34.8% Subspecialty Clinics % 13.0% 26.1% 39.1% 13.0% EEG's % 39.1% 43.5% 0.0% 0.0% Could your office accommodate the process of keeping the parent in your office while an appt at CHI is booked over the phone? Yes No 14 9 Does an RN in your office schedule the appt? Yes No 16 7 Overall satisfaction with scheduling process at CHI Very Satisfied Satisfied Neutral Unsatisfied % 50.0% 25.0% 16.7%

24 Results from 2nd Survey 2. Current time(processing time) to schedule an appt. Very Satisfied Satisfied Neutral Unsatisfied / Etc. Radiology % 53% 29% 12% 6% Subspecialty Clinics % 16% 47% 31% 6% EEG's % 26% 43% 25% 6% 3. Could your office accommodate the process of keeping the parent in your office while an appt at CHI is booked over the phone? % Yes 18 51% No 17 49% 4. Does an RN in your office schedule the appt? % Yes 19 52% No 17 48% 5. Overall satisfaction with scheduling process at CHI Very Satisfied Satisfied Neutral Unsatisfied Very Unsatisfied % 27% 21% 15% 0%

25 Some Comments from 2nd Survey Once you get a scheduler it moves fairly fast but the experience I've had with wait times has been too long. It seems to be getting a little better Much better than previously Some kids need to get in quicker especially behavioral. We love Children's, the only problem was getting in, that has been corrected. Thanks Very nice change / improvement Some of the specialty clinic utilize a triage system - this is probably the best way to schedule No complaints or problems; very good system. Thanks I love the new scheduling process! Usual wait time on phone is minimal. Telephone operators are always helpful and pleasant. Response time ("on hold" time) prior to scheduling is a little lengthy For the subspecialty clinics, I would much rather send/fax a written referral. That is easier than calling. I have been on the phone for as much as 20 min. Radiology is o.k. except for when you need an appt. STAT because a lot of times the scheduline dept needs to contact radiology which is also time consuming.

26 Monthly Average Phone Queue Time Seconds JAN 04 SEPT 04 MAY 05

27 Parent Surveys Primary Care Rating of Primary Care Scheduling Process 50.0% 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Excellent Very Good Good Fair Poor Dec-03 Apr-04 Sep-04

28 Radiology Throughput Increases Compared to Expenses

29 Revenue/Margin Gains in Radiology $1,600,000 $1,400,000 $1,200,000 $1,000,000 $800,000 $600,000 $400,000 $200,000 $0 Increased Revenue '03-04 (Sept. YTD) Increased Margin '03-'04 (Sept. YTD) MRI Fluoroscopy Ultrasound CT Nuclear Medicine

30 Clinic Throughput Increases