Using EHR ROI to Invest in Quality Steve Robertson

Transcription

1 Using EHR ROI to Invest in Quality Steve Robertson DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.

2 4 hospitals 34,166 admissions 44+ clinic sites 1300 physicians Kapi olani Medical Center for Women & Children Serving our communities for more than a century Wilcox Health Straub Clinic & Hospital HIMSS Stage 6: All facilities Pali Momi Medical Center 2 FY09 data.

3 Our 2002 Challenge Mandates to Build an Electronic Health Record and Improve Quality Immediate Need to Reduce Costs System lost $34M in 2002 How do we accommodate a $32M EHR investment? 3

4 Average Hospital Operating Margins in 2003 Was Negative 6.5% Premiums Rank Among the Lowest in the Country (49 th ). Cost of Living is the Highest in the Country. 4 Presented with permission from the Honolulu Star Advertiser 01/18/2013

5 2002 WHO Sweden $2,585 Finland $2,027 Denmark $2,831 Norway $4,128 U.S. $5,453 We re different 5 Copyrighted and published by Project HOPE/Health Affairsas Katherine Becker and Amitabh Chandra, Medicare Spending, the Physician Workforce, And Beneficiaries Quality of Care, Health Affairs, 4/7/2004, doi: /hlthaff.w4.184, p 187. The published article is archived and available online at

6 What s the Business Case? Fewer Medical Errors, Adverse Drug Events Improved Outcomes through better care coordination, best practice alerts, health maintenance reminders Improved Patient Engagement Enhanced monitoring for improvements in clinical Quality. 6

7 What s the Business Case? Fewer Medical Errors, Adverse Drug Events Improved Outcomes through better care coordination, best practice alerts, health maintenance reminders Improved Patient Engagement Enhanced monitoring for improvements in clinical Quality. 7

8 Return on Investment Sources over 10 years Not Enough Hard Savings 8

9 and reconsidered 12 months later. Rather than Focus on Expenses Alone, We Focused on Net Revenue Improvement 2 to 5% of Net Revenue is lost from an inefficient Revenue Cycle. More than 50% of Business office activity is spent on rework getting information that should have been provided during the patient stay. Expenses Net Revenue ROI 9

10 Once per month, G/L personnel dial up and download flat files of paid or cleared checks from BOH and First Hawaiian. Users reformat the files in Excel and move to the GL server. Bi-weekly 7-9 flat files containing payroll data by individual are transferred. This provides input for productivity reports. DSO Daily Birth Date Updates Uploaded to SMS Via Screen Scraper TSI Weekly APR- DRG, Birth weights, Monthly file flat file transfer transfer of Rev from Cascade DOH BCData Electronic TSI, xfr APR/DRG s PCP/Discharge Daily Extract MJK001 3M APR-DRG OneStaff Cash Receipts (MS Access) Monthly Flat File Transfer User Transmitted 3 Report data. This file used for reconciliation. ADT and Procedures Daily File Download Cascade (MR Encoder) QA-Line??Flat File Transfer Daily SMS Flat File Extracts via VSDM & PA/PM Segment Handlers ADT Extract Daily File Download Real-time, ADT, TIF, GENIE HL7 SMS RTF GENIE HL7 thru Cloverleaf Classific. Data Employee Schedules, flat file Actual XFR Hours Once worked. per day. Not built, but ready to be worked. Employee Hours Worked Flat File XFR GEAC GL Budget Extract Flat file xfr Custom Code Code Data Control DOH Birth Certificate VPN SMS Reports Distribution Ceridian Ensemble Flat File Transfer Checks Issued Clinicomp KareLink Phone Connection Transcribe Recordings Pyxis Meds Dispensers KMC/PM Billing Informati Flat file on of PA Charge s sent monthly via Custom HHIC/NPIC Birth Data & Demographics Lab, Radiology, Dietary Orders Orders entered in manually KareLink. into SMS by unit secretaries. Rx Orders HCS Medics Pharmacy KMC/PM Printed Rx Order (Tubed) Employee Demographics, flags, update authorities Flat file, daily XRF Data Control Lanier System Recording Upload paid or cleared check file to Accounts Mainframe Payable End-of-month flat file RMS results into KareLink ADT, HL7 TSIS TACS Time & Attendance Flat File Transfer Checks Issued Daily Charge Manual File Copy Via Operators Via 48 Records Orders Patient TI F Management COR Lab Results, HL7 Dictation Transcribers All Rx Orders Tubed TIF, Custo m HL7 Check Reconciliation (Mainframe Custom Code) Res. Sched. ADTs, Lab Results, non-hl7 Custom Code Batch Day-end BLIP, RTIF RTIF, Custo m HL7 Cloverleaf Interface Engine Daily Charge FTP Upload Via 48 Records thru Cloverleaf SMS VPN ADT ADT Daily and Hourly & Orders Orders & Transtat & Medquist Custom HL7Results, Custom HL7 Procedure SMS RMS Status *At KMCWC, most (95%) (work list) radiology orders are placed in Invision. KMCPM place Procedurenearly 100% of all Orders in Status RMS. Once Order is entered in either RMS or Invision, (work list) Barcode is Laser printed from RMS. Charge is posted in Invision only after bar code Radiology is swiped. Write into RMS Pt Jacket Bar-code Reader Patient Accounting ADT, MPI Tempus Fax Server Encompass Voice Dialer Reconciliation Report: Open Check report ESI Paid Check Cleared Checks, flat file, once per month report Patient Refunds, flat file, bi-weekly SMS Lab Orders ADT, Custom HL7 SunQuest Clinical Labs Updates SMS ORSOS Work list (RTIF display) when a patient is scheduled. Registration uses this to register Lab Results, the patient. non-hl7 NEC Px Phone System Host Fax DCL Fax Machine Web Server ESI/Titan (A/P) Daily upload (flat file export). Converted to 48/49 records by custom code for posting ESI/Nova to PA. Issues by Department, report file. Once per (Materials month. Management) ORs generate a materials usage list of SPD items (inventory depletion based on sticker bar code Catalog system). OR send this Download list daily to SPD. OR SPD clerk manually (ESI manually enters enters MRN non-spd Items) and account # into charges (services) Daily, ESI. into SMS from Batch File ORSOS (future: create 48 Records and batch this via Claims via Data Control Catalog Download Hl7 Premis Modem Payer Billing: UB92 Claims sent daily at 5am (Paper (Young Street) prints out on 24 th floor). ~55% of all claims are Aloha Care electronic. Custom Some Provides 1500 s Code are sent out; tape of (mainframe) these are manually remittances entered into Premis. Aloha Care Formatted Remittance Flat file, weekly FTP, TBD) ORSOS KMCWC/KMCPM UB-92/ 1500 Flat Files List of claims sent out electronica lly. This is used to generate 7M records(co mments) in SMS. Flat file, Sent daily at 6pm. ERA Dual Entry of SMS ADT Clinics Registration prints Schedules Two flat files from ad hocs in SMS. One containing PA info for IVR. The other is guarantor info for out dial system. Xmit daily by 7:30am. Telepath Telephone Payer Remittance: HMSA and Medicare (HMSA posts on bulletin board, NDC provides Medicare remit files via clearing house). Flat files, HMSA is picked up on Thursday, Medicare is daily. Flat file containing payment, adjustment, and comments. Processed in SMS. HMSA is every Friday, Medicare is daily by 5:30pm. As of July 6, 2001 X4 1099s HMSA Mag Filer IRS HMSA: 1500 Claims sent EDI daily via Modem (separate from Payer Billing: 1500 Claims sent EDI daily to Clearinghous e (via clearinghouse Modem) ) +Medic KMS (KCC) CBO Praxis handles paper 1500s and electronic 1500s for Microtechn. Blood-Gas Data Manager Praxis Clinics (FDC/OB-GYN Ultrasound, PEDS) NIS3 NT (Gamma) Neonatal Database (Dr. Balaraman) Interfaces.ppt

11 A Clear Dependency Revenue Cycle Documentation Order Sets Edits and Alerts Transparency Electronic Health Record so, we Doubled Down: $32M $57M Replace Rev Cycle systems AND install an EHR

12 One Neck to Choke CEO Consolidated Registration, Hospital and Professional Billing, HIM into one Division under the CIO. Focus on System ROI not EHR ROI. 12

13 Straub Clinics & Hospital Kapi ola ni Health Wilcox Health EMR Abandoned June 2002 EMR Kaua i Med Clinic Nov 2004 Rev Cycle Wilcox/KMC Feb 2005 Rev Cycle Kapi olani Sep 2006 Full EMR Pali Momi Jun 2008 Full EMR Straub Hosp Oct 2009 Stage 6 Merger EMR Planning Dec 2001 Contract Signed Sep 2003 EMR Straub Clinics Feb Rev Cycle Straub Jul 2007 Full EMR Kapi'olani Nov 2008 Full EMR Wilcox Oct 2010 One System Rev Cycle Pali Momi May 2005 Registration/Scheduling/ADT Inpatient Clinicals Hospital Billing Ancillaries Ambulatory Clinicals Professional Billing Community Physicians EMR/Practice Management Health Information Exchange Seven Year Project, 105 Major Implementations Spanning dozens of locations Governance & Culture Challenges 13

14 2 Project Manager s Success evolved into a Dedicated Revenue Integrity Team if you don t document, it s Experience: Compliance Officer, Case Management, Coder, Patient Accounting, Nursing, Patient Access, Pharmacy Tech, Information Technology, Project Managers 14

15 A Few Examples Avoiding Controllable Losses AvoidableWrite-off 2008 Improvement HowEHR Enabled Improvement Late charges $728,000 Physician charges created by documentation update in EHR instead of paper charge sheet process Missing or inaccurate NationalDrug Code (NDC) for drug billing $629,000 Order and medication administration record (MAR) available to central pharmacy biller 15

16 A Few Examples Avoiding Controllable Losses AvoidableWrite-off 2008 Improvement HowEHR Enabled Improvement Medical Necessity Denials $315,000 Improved Medical Necessity documentation. Improved reporting and better communication. PastClaim Filing Deadlines $154,000 Eliminatedpaper chase between Clinical departments and the business office. Drive Accountability through workqueues. 16

17 Hospital Bad Debt and Avoidable Write-Offs ~$4M Net Revenue saved annually 0.68% Reduction 17

18 Cost to Collect $1 Goal Pre-Conversion Post-Conversion 18

19 Hospital Gross AR Days Pre- Conversion Post-Conversion Goal 19

20 In thousands ROI = 9.0% without ARRA 12.3% with ARRA 20

21 +ROI Sources Over 10 Years 21

22 6.0% Combined Operating Margin 4.0% 2.0% 0.0% % -4.0% -6.0% -8.0%

23 The Second Mandate: Improved Clinical Quality In 2009, we began to apply the same focus on improving Clinical Quality, and to leverage our capabilities to negotiate Pay for Performance contracts with payers. 23

24 I can tell if we are going to have a good financial month for the system by how many really sick babies we have in our NICU. There is something morally wrong in hoping for sick babies. We are switching our payment systems so we are rewarded for the quality of care we provide, not the number of sick babies in our hospital. Ray Vara, President and CEO, Hawaii Pacific Health

25 Customer Driven Care The Virtual Patient Centered Medical Home Team Care Measure and Reward Success Powered through electronic Clinical Integration Standardized best practices (Electronic Protocols) Electronic Health Record 25

26 Tools Embedded in the Doctor s Workflow: Make it Easy Can be seen by doctor, nurse, AND patient Allow easy order entry One place to see all necessary tests Do the DUE 26

27 27 Reality Check

28 75% Blood Pressure Control: All Hypertension Patients 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

29 85% 90% Percentile Breast Cancer Screening 80% 75% Percentile 75% 50% Percentile 70% 65%

30 85% 90% Percentile Cervical Cancer Screening 80% 75% Percentile 50% Percentile 75% 70%

31 80% Colon Cancer Screening 75% 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

32 75% BP Control in Diabetes Patients 90% Percentile 70% 75% Percentile 65% 50% Percentile 60%

33 55% A1C Good Control Diabetes Patients 50% 90% Percentile 75% Percentile 45% 50% Percentile 40%

34 What s Next? Clinically Integrated Physician Hospital Organization: Hawai i Physician Partners Leverage our internal experience 120 private plus 360 employed physicians working collaborative to transform care in Hawai i.

35 SUSTAINABLE HEALTH CARE ACCOUNTABLE CARE ORGANIZATION Wellness Patient Experience Chronic /Complex Disease Management Quality Patient Engagement Efficiency Clinically Integrated Physician Hospital Organization (CIPHO) Primary Care Access KEYS TO SUCCESS Population Management Technology

36 Health Information Exchange 122 Hospitals/Systems Hawai i Pacific Health 4 Hospitals 49 Outpatient Centers 120 Community Physicians 145 US Mainland Care Systems 36

37 Steve Robertson Thank You! Executive Vice President and Chief Information Officer, Hawai i Pacific Health [email protected]