“ Building A Patient Access Service Center” Presented By: Health Blueprints, Inc.

1. AAHAM Spring Educational Meeting Friday, May 21, 2010 “Building A Patient Access Service Center”Presented By:Health Blueprints, Inc.

2. Discussion Outline • Revenue Cycle Industry Trends • Proposed Revenue Cycle Strategy • PASC Goals and Objectives • Building PASC • Potential Barriers to Success • Questions

3. Industry Trends Affecting Revenue Cycle

4. Uninsured Population • Nationwide, the number of uninsured increased from 39.8 million in 2001 to 46.3 million in 2008. • Private coverage is eroding under the status quo. The percentage of people with employer-based coverage decreased from 69.8% of the population in 2001 to 64.5% in 2008. • More workers are being left without protection from health care costs. • The problem of the uninsured is a problem that crosses income brackets. The new Census numbers also drive home the fact that everyone is vulnerable to losing health insurance.

5. Many uninsured patients who do qualify for federal and state financial assistance programs do not utilize those programs. If not captured at the time of service, the likelihood of conducting an eligibility evaluation is drastically reduced. 70% become bad debt.

6. Uninsured Seeking care in the Emergency Department • According to a report issued in July 2009, uninsured patients comprise approximately one-fifth of all emergency room visits. • Emergency room care is not only expensive to the patient, it is expensive to provide. • Emergency room care is often non-emergent

7. “The average emergency room visit costs $1,000, as compared to the average clinic visit of $29 and an average primary care doctor visit that can range from $75 to $120”

8. Under-Insured Population • Those considered “underinsured” have health insurance that falls short of adequately covering health care needs, and often spend 10 percent or more of their annual income on health care costs. • $40,000 annual income spends $4,000 • National nonprofit health care group Community Catalyst reported in April 2009 that one-fifth of all insured adults in the US – about 25 million citizens – were underinsured in 2007.

9. Industry Trends • On average, 70% of all hospitals patient pay is written off to bad debt. • Bad Debt and Charity represent a combined 11% of hospital’s revenue in the Southeastern U.S. Charity 50.17% of Total Bad Debt 49.83% of Total

10. “Rising Levels of Un-Insured & Under-Insured Populations Increase E/D Visits” • Emergency Departments generate the majority of bad debt when tracking by service. • On average, 50% of a hospitals bad debt is from the Emergency Department. • On average, 50% of a hospitals inpatient/observation admissions originate in the Emergency Department. *HFMA Teleconference, Point of Service Collections

11. Non-Urgent ED Visit Trending by Payer

12. Industry Trends • Physicians are also experiencing decreased reimbursement, requiring them to become more administratively efficient. • Complexities in Managed Care Contracting • Delays and billing/clinical requirements • Advent of Pay for Performance • Documentation – Clinical • Increases in self pay patients/portions • RAC Recovery Audit Contractors

13. Revenue Cycle Strategy

14. FY 2010 Revenue Cycle Strategy • “Fortify” the Emergency Department • Create a Patient Access Service Center • Centralized Scheduling • Promote Patient and Physician Satisfaction • Increase accuracy and completeness of registration data • Improve compliance • Identification and collection of self pay portions, co-pays and deductibles at or before the time of service • Create opportunity for eligibility review prior to service

15. PASC Goals and Objectives

16. Overview and Objectives • Increase accessibility and ease of use to Patients and Physicians. • Improve the accuracy and completeness of registration and billing information, decreasing re-work and denials • Provide comprehensive payment and funding options at or before the time of service • Ensure insurance verification and pre-authorization processes and tools are utilized consistently in order to reduce related denials • Improve up-front cash collections and reduce bad debt. Introduce eligibility and charity programs before service.

17. Building PASC

18. Our Approach • Patient Access Service Center Development (PASC) • HBPI believes in adopting a “Case Management” mentality in patient access. That is, individuals “Own” patient encounters and are responsible for ensuring that ALL aspects of the scheduling, pre-registration, financial counseling and up-front cash collection functions are performed. • In summary, key aspects of HBPI’s approach to a PASC Unit development project are: • Heavy physician and clinical department input and on-going support. • Establishment of “Specialty Scheduling Pods” • Leverage technologies that will keep physician office staff off of the phone while promoting accuracy and compliance • An electronic order facilitator • Elevated staff requirements that mirror a “Case Management” philosophy.

19. Phase I-Design and Budget First 60 Days Prepare Budget/Obtain Approval

20. Phase II-ImplementationNext 90 Days Plan, Train, Implement

21. Phase III-Monitor and MeasureFinal 60 Days Go-live, “Tweaking,” Monitoring

22. Potential Barriers to Success & Collaborative Responses • Rigid planning the mirrors past unsuccessful attempts • Lack of control resulting in negative operational outcomes • Specialized knowledge of the department and its technical and process requirements • Responsiveness when issues arise • Orders, Orders, Orders • Brainstorming sessions with departments & physicians to understand concerns • Extensive training & documentation supported by enhanced technology • Establishment of “Specialty Pods” and quarterly scheduler “In-service” • Department/Physician Liaison • Adoption of an Electronic Oder Facilitator Issue Solution

23. How it Works…

24. Questions ?

25. AAHAM Spring Educational Meeting Friday, May 21, 2010 “Revenue cycle vendor management”Presented By:Health Blueprints, Inc.

26. Discussion Outline • Reasonable expectations • Communication • Measuring performance • Rates, fees, performance incentives • Level the playing field • Annually

27. Set reasonable expectations • Assemble an internal group to outline what the organization expects from a vendor. Consider: • Customer Service/Satisfaction • Timelines, deadlines, close process • User-friendly performance reporting • Performance • Vendors also have to manage a budget • Zero complaints is not a reasonable expectation • Understand vendors expectations

28. Communication • Make sure that your vendor knows what is important to the organization • Communicate what you want. If the vendor tries to fit it into “their” box; find another vendor • Require early intervention feedback loops • If something is not working, communicate until it is resolved • Identify vendor staff that will “get the job done”, resolve issues with a sense of urgency • Set standing communication meetings • Focus on building “team approach” to the vendor relationship

29. Measuring Performance • Ensure that what you are measuring reflects “what is important to the organization” • Outline exactly what you need on their performance reports, including data, format and delivery. • Do not waste time reviewing their statements in detail every month. • Monthly measure key indicators, not detail

30. Rates, Fees & Performance Incentives • If you bargained for the lowest possible rate, you cannot expect the highest level of service • There is a vendor that wants your business…no matter what you need…so be cautious in selecting a vendor that promises everything for much less than the competitors…performance will be short-lived • Consider performance incentives as motivation to be creative • Ask vendor “what incentives” they use with other clients, incentive ideas

31. Level the playing field • If you have multiple vendors in a competitive position, ensure that both programs are exactly the same • When comparing vendors ensure you are measuring the same outcomes • Look internally for obstacles that might hinder a vendor • Compare the rates/fees…if one gets paid more, they can do more

32. Annually • Conduct an internal assessment to identify: • Overlap in contracts costing you $ • Missing elements to address your “job-to-be-done” • Opportunities to increase business and gain economy with vendors that have outstanding performance • Obstacles hindering best practice

33. Contact Us… Mary Anne Pace, Principal mpace@healthblueprints.com 954-817-5772 Katrina Tompkins, Principal ktompkins@healthblueprints.com 214-674-1108