Hayes Review: Winter 2009

Note from Pete

By Pete Butler, President

Welcome to our first 2009 edition of the Hayes Review.  I have enjoyed all the great feedback about our new website, and encourage you to comment on how this newsletter can be of value to you.

During my recent travels, I have learned a great deal about our clients’ and prospects’ various initiatives.  A common theme has been the need to demonstrate immediate ROI on projects. This is no surprise. The current economic climate requires a reflection on current day-to-day operations and how to make them as efficient and as cost-effective as possible.  

To this end, we have been busy working with clients to fine-tune existing operations and prepare them for future initiatives. Our MDapproach™ service offering has played a key role in helping clients find efficiencies, cost savings and revenue opportunities in all areas of their operations.

In this edition, we share stories of how we have helped clients reduce expenses through efficient operations. We hope that these examples are helpful to you in your organization, and we look forward to the opportunity to help you squeeze every penny from your revenue cycle during these challenging times.

Case in Point: Billing Office Turnaround

Hayes performed an MDapproach™ review of operational and accounts receivable performance for the Centralized Billing Office (CBO) of a Management Service Organization (MSO) client. The assessment revealed that there were significant opportunities for improvement in management structure, staff roles, workflow and process improvements, application optimization, and A/R collection. A Hayes consultant was then engaged as Interim Business Office Director to implement changes according to the assessment recommendations.

Working closely with senior management, the Hayes Interim Business Office Director performed the following activities to improve CBO operations:

• Led turnaround strategy for a 90-physician practice 
• Implemented system applications and improvements with client’s practice management system and other accounting and practice applications
• Guided change management process during staff reorganization and training
• Developed denial management strategy
• Assisted in managing the acquisition of a new medical group
• Developed and implemented new departmental and company-wide policies and procedures focused on improving the revenue cycle

A complete re-organization of the CBO occurred over the next ten months, and a successful transition was made to the new director. Before the Hayes consultant left, results included:

• The successful turnaround of a network physician practice
• Two months of the highest collections the practice had ever achieved
• Revenue cycle improvements that resulted in increased collections of over three million dollars annually
• A gross collections increase of three percentage points over a four-month period
• The successful acquisition of a medical center
• Increased staff satisfaction

The implementation of policies and procedures helped ensure that the new strategies would continue to be implemented consistently, which greatly increased senior management’s confidence in the CBO’s ability to continue to contribute to the bottom line.

Front-end Tune-up for GE Centricity Business Clients
By Susan Hopper

How long has it been since you monitored the effectiveness of the front-end processes?  Are any red lights appearing on your daily and weekly dashboards monitoring patient access and advanced web workflows?  Are there simple improvements that can be made to the workflow that will increase end-user productivity?

Maybe it is time for a spring tune-up.  Here is an example that can improve process efficiencies in areas accessed multiple times daily by front-end staff.

Advanced Workflow Grids:

• Does the REG Patient Lookup grid display information that users should be verifying such as date of birth, sex, telephone and address? 
• Warning signal: The MRN appears in the initial screen of the patient lookup grid but is not part of key criteria for patient selection. 
• Tune-up recommendation: You can modify the REG Patient Lookup grid to display key patient lookup criteria to decrease duplicate patients.
  
  
• Are key elements displayed in patient appointment grids presented in a consistent order? 
• Warning signal: Key data in grids that display appointment information such date, day, time, status, type and provider do not appear in the same order in:
  1. Scheduling Homebase Appointment
  2. Patient Appointment List
  3. Bump List
  4. Appointment/Visit Manage
• Tune-up recommendation: You can tailor the grids so information is displayed consistently in similar views so users do not have to search through the same data shown in different order.

Additional improvement suggestions follow:

• Create Form Letters to print patient instructions for follow-up appointments.  This can replace stacks of handouts in the check-out area and allow the follow-up appointment information to appear on the same page as instructions.
• Review and audit cash control policy compliance.
• Coordinate modification of fee tickets to print as a post arrival routine which 1) will ensure current patient demographic information is printed (where flows verify and update demographics when patients present), and 2) create efficiency as staff will no longer need to sort fee tickets printed in batch the night before.
• Update training documentation and job aides to reflect new features and processes incorporated with last (or upcoming) upgrade.

MDapproach Q&A

What is MDapproach™ and how does it help clients save money?
MDapproach is Hayes’ methodology to provide clients with a time-bound action plan for streamlining operations and improving performance.  It is a scalable assessment that can be tailored to focus on one or more of the following areas: patient access, patient billing, clinical workflow, and IT.

How is it different than other revenue cycle or clinical improvement analyses?
We realize that analyzing revenue cycle operations or clinical workflow isn’t something that our clients are doing for the first time.  We don’t spend time and money simply to restate the obvious; we move quickly to uncover root causes.  This allows us to spend more time evaluating strategic alternatives for each challenge.

What is the difference between recommendations and strategic alternatives?
Recommendations suggest “what to do” about a specific challenge.  Strategic alternatives present options for “how to do it” within the constraints of your organization.  Let’s face it, two organizations may share the same challenge, but their approach to solving it may be completely different.  We typically provide three strategic alternatives for each recommendation. The costs, benefits, and challenges for each strategic alternative are provided to help clients choose which alternative is best for them. It’s different for each organization. We don’t believe in one-size-fits-all.

Another key aspect of the approach is “defining guiding principles.”  What does this mean?
Many organizations do not make the time to consciously identify the risks they are willing to take, the cultural challenges they are willing to confront, or the investments that they are willing to make in order to reach their goals. This is why most improvement efforts ultimately stall.  Creating principles isn’t easy, but it is essential to an organization’s long-term success.  During an MDapproach engagement, we will work with organizations to create a list of specific principles that will guide our efforts and continue to help them reach their goals in a focused, expedient manner.

What is the roadmap?
At the end of an MDapproach engagement, we deliver a high-level, time-based work plan that synchronizes recommendations and their associated strategic alternatives (i.e., costs, benefits, and challenges). The roadmap illustrates the sequence, magnitude – and most importantly, the benefit of improvements to all stakeholders.

What do clients like best about MDapproach?
Clients appreciate our participative approach. For example, instead of going off on our own and coming back with a stack of written recommendations, we have scheduled milestones along the way to create principles, review findings, draw conclusions, make recommendations, choose strategic alternatives, and develop a time-bound roadmap.

New Hayes Product! MDaudit Hospital
Streamlining billing reviews for hospitals

Our MDaudit family is expanding. MDaudit Professional™, our current solution for physician practice audit productivity, will soon have a companion product for hospital audits.

Currently in development, MDaudit Hospital™ frees compliance staff from time-consuming administrative tasks that do not directly reduce risk. This saves clients time and money while reducing potentially costly fines and protecting revenue.

MDaudit Hospital automatically:

1. Loads inpatient and outpatient hospital billing data from your billing system, via UB04, 837I, or flat files.
2. Allows you to select focused areas to review based on rules you define, pulling from any of the fields in the UB04.
3. Informs you of the number of cases in your system that match your criteria, allowing you to determine the sample size that gives the desired percentage of available services to review.
4. Pulls a random sample of cases from those that match your criteria.
5. Allows you to drill down and view the details of each case.
6. Captures the reviewer’s corrections to the case, including corrections to ICD Diagnosis order, procedures, POA, CC And MCC, Discharge Dispositions, DRG.
7. Tracks the specific ‘findings’ or problems with each audit.

For more information on this exciting offering, please email us at mdaudit@hayesmanagement.com.

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