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Building an Automated Financial Clearance Process. Niobis Queiro, MBA Corporate Vice President, Revenue Cycle Hartford HealthCare Corporation Hartford, CT. Hartford HealthCare. 4 hospital system serving 63 towns in Connecticut 75,711 inpatient visits per year

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Building an automated financial clearance process

Building an Automated Financial Clearance Process

Niobis Queiro, MBA

Corporate Vice President, Revenue Cycle

Hartford HealthCare Corporation

Hartford, CT

Hartford healthcare
Hartford HealthCare

  • 4 hospital system serving 63 towns in Connecticut

  • 75,711 inpatient visits per year

  • 2 Million outpatient and homecare visits a year

  • 280,000 ED patients per year

  • 60% of all behavioral health visits in the state of CT

  • $52 million in charity care FY 2011

  • $14 million invested in research

  • 15,000 Employees

  • 2,100 Physicians

  • $2.0B Total Revenue

Current issues facing healthcare industry
Current Issues Facing Healthcare Industry

  • Hospitals will Never Be Paid as Well as They are Today

  • Losing 7.2% on Medicare Cases, losing 14% on Medicaid*

  • Medicare Reimbursement rates declining**

  • Increasing Medicare & Medicaid population

  • Increasing high deductable plans and bad debt

  • Fee for Serviceversus Fee for Value

  • Rewards chasing revenue, not margin/quality

  • Capitation payment encourages less volume

  • Evidence Based Care Plans are needed

  • Care Delivered in Silos

  • Physicians, hospitals, providers and plans not aligned (incentives)

  • Coordination lacking inside/outside walls of hospital

  • EMR Adoption/MU requires new processes**

  • Data is housed in silos

  • Chronic Disease Patient Volume Increasing

  • Rapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease***

  • 5% patients = 55% of admissions, care at Medicare rates

  • Health Plans shift risk to provider. Bundled care, ACO

*Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.

Traditional operating models will fail under the complexities of healthcare reform
Traditional Operating Models Will Fail UnderThe Complexities of Healthcare Reform

  • Short term:

  • Increased access to care

  • New shared reimbursed at government rates

  • Outcome risk

  • Reduced operating margins

  • On the horizon:

  • ICD-10

  • Outcomes Performance

  • Clinical integration

  • IT interoperability

  • ACO investments

  • Next generation gain sharing

  • Bundled payments

Greater Access – Reduced Reimbursement – Growing Operational Complexity

Patient access the root of much evil
Patient Access: The Root of Much Evil

  • Percent of data needed for billing originates at registration: 70%

  • National average registration error rate: 46%

  • Percent of denials that could be prevented at registration: >50%

Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10,

Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare

Hartford healthcare project goals
Hartford HealthCare Project Goals

  • Create an Optimal Patient Experience that Makes HHC the Provider of Choice

  • Create and Automate a Data Rich Financial Clearance Process

  • Produce Patient Liability Estimates for Transparency

  • Improve POS Cash Collections

  • Centralize Scheduling

  • Real-time Quality Assurance to empower the end-user

  • Enable Field Level Registration Edits

  • Link patient Access Errors to Denials and A/R Liquidation

  • Provide structure around E&B and Authorizations

  • Establish a Partnership with all HHC providers and assets

Hartford healthcare flashback 18 months
Hartford HealthCare: Flashback 18 months

  • No patient access standardization

  • Variable financial clearance process

  • No centralized scheduling

  • No patient liability estimates

  • < $1M/Yr in POS cash collections

  • No registration quality edits

  • No link between access & denials

  • IT patchwork across 4 hospitals

Current state hartford healthcare patient access


Current state:Hartford HealthCare Patient Access

  • ATB Data

  • Centralized Scheduling

  • ADT Feed

  • Eligibility & Benefit Verification

  • Automated Financial Clearance Workflow Platform

  • Reg

  • Integrity

  • Prior Auth

  • (pilot)

  • Medical Necessity

  • Patient Funding w/ Via Note

  • (pilot)

  • Patient Estimates

HCIT Integration

Reporting & Metrics

Post Go-Live

Joys of the open road1
Joys of the Open Road

  • Employee Engagement

    • HHC offers employees access to Local Community College

    • HHC covers tuition and salary for Wednesday afternoon coursework

    • Clear career path and education boost employee morale

    • HHC maintains a 99% employee retention rate

  • Team Building Exercises

  • Rewards For Outstanding Performance

Lessons from the road1
Lessons from the Road

  • Appraise organizational readiness

    • Finance will likely want to run faster than departments

    • Provide training to physicians and nursing staff

    • Communicate early and often with hospital leadership (CEO/CFO)

  • Appraise Financial Clearance Staff

    • Some personality types are not suited to ask for payments

  • Be aware of HR challenges

    • 9 Benefits Packages

    • 4 Compensation Models

    • Union job descriptions

    • Employee transfer requires new employee paperwork

    • HHC full homogenization by 2013

Leadership behaviors
Leadership Behaviors

  • Be In The Moment

  • Be Authentic & Humanistic

  • Volunteer Discretionary Effort Constantly

  • Model High Performance-Desired Behaviors that Drive Desired Results

  • Respect & Leverage Separate Realities

  • Be Curious vs. Judgmental

  • Look in the Mirror First – Be Accountable

  • Have Courageous Conversations

  • Provide Timely, Clear & Specific Performance Expectations & Feedback

  • Teach, Coach & Mentor - Spend at Least Half of Your Time Developing Others

Questions to ask yourself everyday
Questions to Ask Yourself Everyday

  • What more can I do right now to be a role model for those around me?

  • What more can I do right now to achieve the outcome we desire?

  • What more can I do right now to prevent something undesired from occurring?

  • What expectations or feedback can I deliver right now to make a positive difference?

  • What more can I do right now to seek or provide the clarity that I think does not exist?

  • What more can I do right now to make this meeting more productive?

  • When some outcome has not met my expectations, ask, “How did I contribute to that?” and “What more will I do next time to make it successful?”