Reason for Action

1. Reason for Action • After good progress from prior years, average weekly ED Point-of-Service cash collections has plateaued at $4,411 in 2013 (up marginally from $4,202 in 2012).  The purpose of RIE is an “ED POS Re-Boot” to increase average weekly ED Point-of-Service cash collections to $6,923 in 2014 (which equates to $30,000 monthly) • Trigger: Bedside registration initiated • Done: Patient discharged from ED • Initial State: • Registration is completed at bedside after doctor sees patient. (Co-Pay identified at this step). • After discharge, patient stops at discharge desk to check out and pay co-pays, co-insurance or deductibles amount. • 1) Percentage Collected (based on what was identified) 10.2% • 2) HFS Eligibility Screen accurately transferred to Patient Account Responsibility forms at 70% • 3) Completed discharge desk notes at 54% • Target State: • An attempt is made to collect funds from all eligible patients. • Old balances are reviewed with patients and collection is attempted. • Patient no longer needs to stop at discharge desk before leaving. • Percentage Collected (based on what was identified) 15% • HFS Eligibility Screen accurately transferred to Patient Account Responsibility forms to 90% • Completed discharge desk notes to 85%

2. Team consisted of: Patient Services Manager, IS Coordinator, ED Registration Representatives, ED Nurse, ED Tech and ‘Fresh Eyes’

3. Current State Mapping: green indicates ‘barriers’ with ED Patient Process. Identified problems with Registration downtime, constant computer reboots freezing, no proper scripting for Registration asking for copays. The team also took a ‘GEMBA’ walk through the ED to view the Registration process

4. Solutions: Standardized work process and scripting to increase collections, assigned work areas for Registration staff, collecting copays at time of Registration. Solution Development:

6. Assigning designated areas for Registration staff allowed for reduction of staffing, eliminating 2.00 FTE per day. Staff was very accepting of their new assignments, stating they liked feeling accountable and responsible for their sections

7. First week of experimenting with collections at the time of Registration, staff exceeded the new target of $6,923 by collecting $9,098. The second week of this experiment resulted in $8,578 of Bedside collections. Third week of collections with the new process ended with $7,203 of ED collections.