Best Practices for Vetting Vendors, Boosting Performance, and Driving ROI

Transcription

1 Best Practices for Vetting Vendors, Boosting Performance, and Driving ROI

2 Mike Simms Vice President Revenue Cycle Cone Health

3 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.

4 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 First Quarter through December, 2014 Discharges 15,272 Average Daily Census 762 Observations 3,984 Revenue Cycle collected $1.1 billion in fiscal 2014 which was $72 million over net revenue goal ER Visits 87,250 OR Cases 10,601 Physician Visits 39,779 Paid FTE s 8,041

5 Cone Background Converted to EPIC in February Conversion did not go well as indicated by Billed AR Days below:

6 Cone Issues Previous Revenue Cycle management were not involved in the EPIC conversion process thus lots of black holes with WQ s created. 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. Many of the management and staff had been at Cone a significant number of years and were not adaptable to the change that was needed. Productivity standards were not established and some staff were only working 15 accounts a day.

7 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.

8 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?

9 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?

10 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?

11 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?

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 Avg. % of Bal Paid Total # of Statements Printed / Records Sent to Print Total Payments Received / Total Amount Due Payments Received Per Statement Avg. 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.