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Value Analysis Harnesses Internal Resources for Process Change

Value Analysis Harnesses Internal Resources for Process Change. June 2006 SAVE Government Conference. Value Analysis (VA) is not …. Simply consultants providing input…. Function-Based Work Flowchart. VA Revenue Enhancement Study. Pre-Study Orientation Sessions

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Value Analysis Harnesses Internal Resources for Process Change

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  1. Value Analysis Harnesses Internal Resources for Process Change June 2006 SAVE Government Conference

  2. Value Analysis (VA) is not… Simply consultants providing input…

  3. Function-Based Work Flowchart

  4. VA Revenue Enhancement Study • Pre-Study Orientation Sessions • Kick-off and Hospital Tour (1-day) • Current Work Flowcharts Discussed (2 days) • Pre-Study Review of Revenue Data • 5-day Value Analysis Workshop • Functions and Areas of Opportunity Identified • Creative Phase • Evaluation/Analysis Phase • Development Phase • Presentation Phase • Post-Workshop Implementation Meeting

  5. Value Analysis Participants • VA Facilitators • Hospital Executive Management (part time) • Hospital Departmental Staff • Patient Accounts • Registration from Major Departments • Admitting • Utilization Management • Health Information Management • Finance • Information Services • Physicians • Consultants (typically 3) • Healthcare Revenue • Managed Care Revenue • IT Systems

  6. Parameters for a SuccessfulValue Analysis Study • Commitment from Executive Management • Requires 8 days of participation by key staff members • Must agree to implement acceptable ideas • Open Discussion • Vow of Confidentiality Among Participants • Listen to Staff • Ensure Clear Understanding of Current Processes • Encourage Team to Suggest Alternative Approaches • Clarify if Resources are Preventing Revenue Capture • Staff • Printers, Computers, Paper • Software Applications • Reliability of Current Technology • Judgment Withheld Until Appropriate Time • Assign Person to Coordinate Implementation, Track Progress and Record Results

  7. Recommendations Covered • Utilization Management • Maximize Reimbursements • Capture Unbilled Revenue • Improve Patient Information • Denials Management • Enhance Systems • Upgrade Coding Capability

  8. Utilization Management Key Proposals and Impacts • Extend Clinic Hours ($3.5m) • Create Charge Capture Czar ($8.0m) • Perform Ancillary Tests on Weekends ($5.9m) • Hire Surgical Coordinator ($4.5m) • Modify Ambulatory SurgeryTesting and Registration/Scheduling ($10.7m) • Add Staff Selectively ($6.4m)

  9. Utilization Management (cont.) • Redesign Clinic Scheduling ($5.3m) • Expand Services in Pediatrics, OB, Rehab ($11.2m) • Modify Provider Contracts ($41.1m) • Develop Revenue Scorecard ($7.0m) • Improve Community Outreach ($2.1m) • Establish Redirect Office ($1.9m)

  10. Maximize Reimbursements Key Proposals and Impacts • Revise Approach to Self Pay Accounts ($2.3m) • Clear Up Unbilled Backlog ($8.0m) • Bill for all Physician Services ($2.4m) • Periodically Re-bill Medicaid ($5.0m) • Add Staff Selectively to AR, ED, Admissions, BH, Medicaid Enrollment ($15.1m)

  11. Capture Unbilled Revenue Key Proposals and Impacts • Bill for Nursing Visits, Blood, Drugs, Devices ($2.3m) • Enroll all Pediatric Patients in Insurance Plans ($2.0m)

  12. Improve Patient Information Challenges • Patients Do Not Want to Share Their Patient Information • Patients Give False Addresses • Patients Have Grown Accustomed to Receiving Free Care

  13. Improve Patient Information Key Proposals and Impacts • Train all Registration Staff to gather Patient Financial Information with Documentation ($2.5m) • Train Clinicians to Fully Document Medical Record ($.9m) • Establish Field Units to Gather Documents ($6.3m) • Improve Mail Handling ($2.4m)

  14. Denials Management Key Proposals and Impacts • Create Denials Management Task Force ($20.2m) • Address Social Admissions Issues ($9.8m) • Educate Clinicians re Denials ($2.5m) • Add Staff to Work Denials ($9.2m) • Focus on One-Day Stays/Close Clinic Visits/Reconcile ED and Admit Dates ($4.5m)

  15. Enhance Systems Key Proposals and Impacts • Enhance Capture of Full Medical Documentation ($3.0m) • Implement Claim Scrubber ($6.8m) • Update MD lists, Codes, Provider Data Tables ($2.7m) • Link EMR and Patient Accounting Systems ($4.0m) • Bar Code ED Charts/Put Online($4.5m)

  16. Upgrade Coding Capability Key Proposals and Impacts • Add Coding Validators ($3.1m) • Add, Train and Credential Coders/Upgrade Titles and Pay ($5.3m)

  17. Value Analysis Results(6 Workshops)

  18. What Makes VA Different? • Team-Based Approach • Utilize Hospital Staff as Members of Team • Supplement Team with Consultants • Changes are Recommended by Credible Front-Line Staff and are not Imposed from Outside • Function-Based Analysis of Current Processes • Limited Involvement of Executive Management • Sessions are Away from Normal Work Environs

  19. Key Benefits of Value Analysis • Revenue Improvement • Team Building Among Staff • Staff Discussions of Current Processes Identify Most Issues/Opportunities/Ideas • Consultants Provide Experience from Similar Hospitals • Team Becomes Change Agents • Change Implementation More Likely as Staff Buy-in During Study • Morale Improves

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