D efine M easure A nalyze I mprove C ontrol Revenue Recovery February 23, 2007.
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Transcript of D efine M easure A nalyze I mprove C ontrol Revenue Recovery February 23, 2007.
DefineMeasure
AnalyzeImprove
Control
Revenue RecoveryFebruary 23, 2007
DefineMeasure
AnalyzeImprove
Control
Project Team
Team Members• Carla Rosier• John Rochelle• Auriel LaValla• Eric Wexler• Keith Poirer• Corey Younger• Dominick Watts
Team Facilitators• Phyllis Collins• Doug Higgins
Sponsor• John Wilson
DefineMeasure
AnalyzeImprove
Control
Define Phase
Problem statementAccuracy and insufficient QA of Patient Care Reports leaves room for errors thus causing a decrease in potential revenue recovery for Public Safety/EMS. The lack/failure to properly document has resulted in the payment of legal fees, compensation to patients (law suits), audits from Medicaid resulting in penalties paid, non-compliance with Florida Statues 401; Admin. Code 64-E-2.013 reference records and reports.
Justification for projectImproved overall documentation of Patient Care Reports (PCR) should realize an increase of 10% = $1.5 million over the next fiscal year.
DefineMeasure
AnalyzeImprove
Control
Project Impact
County objectiveGoal 2 Objective 3: Continue to actively
pursue technology systems that increase productivity, efficiency, and decrease costs.
Project goal Improved overall documentation of Patient
Care Reports (PCR) should realize an increase of 10% = $1.5 million over the next fiscal year.
DefineMeasure
AnalyzeImprove
Control
Project Scope
In scopeMedicare, Medicaid, Insurance payments, Self-
pay, Attorney’s Fees, Penalties, Restitution.
Out of scopeAny other revenues outside of the
documentation/ billing process.
DefineMeasure
AnalyzeImprove
Control
SIPOC Diagram
Suppliers Inputs Process Customers Requirements
Crews MD offices Patients Family Hospitals Skilled Nursing Fac
Step 1:Call Dispatched with PCR number
Outputs
Step 2: Crew inputs data to Healthware and uploads
Step 3:Admin Svcs reviews for completeness and codes call
Step 4: Admin Svcs pulls billable calls and uploads .txt files to billing vendor
See Below Accurate PCR Pt. Invoice Insurance Inv Hospital Inv Legal Document
EMS Patient Gov’t/Pvt Ins Hospital/ER Atty /Court
Step 5: Billing Vendor verifies data and bills patient.
Patients name, SSN,
DOB, Billing Address,
Phone, Insurance Info,
Treatment, procedures,
supplies, Key statements
and Narrative, All
required Signature,
Personnel, Medical Record
Number
Complete
Accurate and timely
Documentation of
Patient Care Report
from start to
finish of call.
DefineMeasure
AnalyzeImprove
Control
Process Flow ChartRevenue Recovery
12-1-06
911 call to Dispatch
What resources are
needed?No Unit
Unit Dispatched
Information loaded to MDC for call
Transfer information from
MDC to Hammerhead
Patient contact made
All hands needed for treatment
EMT gathers information
Patient treatment started
No
Yes
No
Yes
Continue next page
Transport decision
Call ends with all data gathered
Transport and treatment
Arrive at destination
Medical Record # obtained from Hospital and
Transfer of Care
Written report given to receiving
hospital
Upload PCR Station
Hospital
Stop
Yes
No
Yes
Yes
DefineMeasure
AnalyzeImprove
Control
Process Flow ChartRadio Log printed
for verification
Administrative ServicesProcess
MIA’sOn list
Review Heatthware for
MIA’s and contact EMS Command if
no notation
Compare Radio Log information with each PCR
record in Review Manager and
correct.
Pickup location, zip
code, mileage, and destination
hospital correct?
Correct PCR in Review Manager to match Radio
Log
Patient’s information
reviewed and addresses and zip
confirmed
No demographics in formation
Use MR # if available and get information from
Hospital
Address and zip code verified with
USP website
Procedures listed?
Must then read narrative for
coding of call
Review procedures and
code call
Yes
No
No
Yes
No
Yes
No
Yes
Cont. next
page
When Radio Log completed and all
calls coded pull .txt file for ADPI
Transfer .txt file via secure website to
ADPI
ADPI runs file and sends us a file to recheck coding
and mileage
Does ADPI’s report match Radio Log coding?
Make changes and email back to
ADPI for corrections
Notify ADPI that records are correct
and ready for billing.
Stop
No
Yes
DefineMeasure
AnalyzeImprove
Control
Histogram
% of Information Missing
72.00% 70.72%
51.99%
31.63%
14.01%
0.88% 0.11%0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
MedicalRecord
Signature Insurance Phone #'s SS# DOB Name
DefineMeasure
AnalyzeImprove
Control
Analyze Phase
Author, Page Number, Date
Unable to Collect approximately 45 % of
Billable Revenue
Machinery Methods Materials
Mother Nature Measurement Manpower
Hammerhead
Training (2)
Time Constraints
Data
Collection
Healthware
Data Collection (1)
Data Collection
Training
Hospital Staff
Lack of Ownership
QA/QC for Compliance
ID False Info
Accountability/ Ownership (3)
Language Barrier
AMS
Time Constraints
Homeless
DefineMeasure
AnalyzeImprove
Control
Analyze Phase
Author, Page Number, Date
Data Collection
Machinery Methods Materials
Mother Nature Measurement Manpower
Device Compatibility
HH Reliability
Hospital Standards
Input Errors
Collection Techniques
Healthware (3)
Accountability
Personal & Corporate (2)
Training (1) (1)
(2)
Agency Standards
Consistency
Multiple Pts
Time Constraints
DefineMeasure
AnalyzeImprove
Control
Analyze Phase
Author, Page Number, Date
Training
Machinery Methods Materials
Mother Nature Measurement Manpower
Training Ewuipment
Mandatory/ Optional
Technique
Learning/ Teaching Methods
Equipment Usage/ Utilization
Use Subject Matter Expert
Delivery Media
Training Equipment
Quizzes
Compliance (2)
Subject Matter Experts
Participation (1)
QA/ QC Issues
DefineMeasure
AnalyzeImprove
Control
Analyze Phase
Author, Page Number, Date
Participation
Machinery Methods Materials
Mother Nature Measurement Manpower
Available Equipment
Define Expectations
Multi-track Sessions
(BLS/ALS)
Staff Development
Training Diversity
Teaching Learning Styles
Available Equipment
Attitude
Define Expectations
(2)
Staff Development
Ownership (1)
QA/ QC
Survey Needs and Expectations
DefineMeasure
AnalyzeImprove
Control
Root Cause Summary
Unable to collect approximately 45 % of Billable Revenue →
↓ ↓ → Data Collection →
↓ ↓
Training ← ← ← ← ↓ ↓
Ownership ← ← ← → → → DefineExpectations
DefineMeasure
AnalyzeImprove
Control
Improve Phase
Prioritization Matrix
Expectations
Ease/Speed Sustainable Measurable Feasible Total (49) Rank
Project/Wt. 0.24 0.29 0.14 0.33
Friendly Competition 28 6.86 28 8 20 2.86 26 8.49 26.20 1
Progressive Discipline 16 3.92 24 6.86 20 2.86 22 7.18 20.82 2
Incentive Program 18 4.41 17 4.86 23 3.29 17 5.55 18.10 3
Peer Pressure 15 3.67 14 4 8 1.14 14 4.57 13.39 4
Reason to Attend 10 2.45 11 3.14 15 2.14 12 3.92 11.65 5
12 14 7 16 49.00
DefineMeasure
AnalyzeImprove
Control
Improve Phase
Prioritization Matrix Expectations
Ease/Speed Sustainable Measurable Feasible Total (64) Rank
Project/Wt. 0.20 0.20 0.22 0.38
Data Collection Handbook 24 4.88 22 4.47 21 4.59 25 9.38 23.3125 1
Goals for Data Collection 19 3.86 26 5.28 23 5.03 20 7.5 21.671875 2
Bulletin Board (Desktop) 15 3.05 19 3.86 17 3.72 18 6.75 17.375 3
Supervisory F/U 17 3.45 9 1.83 18 3.94 13 4.88 14.09375 4
.
13 13 14 24 64
DefineMeasure
AnalyzeImprove
Control
Patient Treat No Transport and Refusal Signatures
7%3,360258Billing Sign. Captured:
94%1963,298Refusal Sign. Captured:
% CompliantNoYes
3,556Total ePCR Considered:
Call Disposition Considered: "Refusal of Medical Assistance" (40) and "Treated, No Transport" (45)
7%3,360258Billing Sign. Captured:
94%1963,298Refusal Sign. Captured:
% CompliantNoYes
3,556Total ePCR Considered:
Call Disposition Considered: "Refusal of Medical Assistance" (40) and "Treated, No Transport" (45)
Refusal Signature Captured
94%
6%
Billing Signature Captured
7%
93%
DefineMeasure
AnalyzeImprove
Control
Measure
July 05 to Aug 05 we had 316 new accounts with bad addresses and this equates to $179,282 in lost revenue.
This is 11.82% of the calls for that month at an average cost per patient $567.34.
For a one year period this could equate to 4186 calls with bad addresses and lost revenue of $2,374,885.
If we were to increase the accuracy and input of the Medical Record Number collection from LMH hospitals by 63% we could increase revenue by $1.5 million.
DefineMeasure
AnalyzeImprove
Control
Signature Pilot
At the in-service for January 16, 17, 18, 2007 a presentation was made to announce the Pilot of the two signatures that are required on patient’s refusal calls. Staff were only obtaining the “refusal of service” signature and not billing signature. Screen captures were shown to staff who attended to ensure everyone was obtaining the correct two signatures (refusal and billing). A total of 181 personnel attended the in-service training. The remainder of the personnel are required to receive the information through a recorded presentation.
DefineMeasure
AnalyzeImprove
Control
Signature Pilot
A more aggressive solution to the signature “bottleneck” was discovered and implemented after the in-service training.
This involved a change in the Healthware software that was previously thought to be impossible.
The change was made to the refusal screen in the software to allow for both the refusal statement and the billing statement to be combined on one screen and thus only requiring one signature.
DefineMeasure
AnalyzeImprove
ControlIn-service Participation FY 06
# Employees Attended % to total Field Personnel
Jan 62 32%
Feb 110 56%
Mar 63 32%
Apr 91 47%
May 98 50%
July 94 48%
Sept 137 70%
81.875 42%
DefineMeasure
AnalyzeImprove
Control
Improve PhaseMedical Record Number/ Supervisory
Follow-up Pilot
A second pilot has been designed and will be implemented.
Utilizing the PCR Compliance website, the supervisors will be instructed to follow-up daily on any missing Medical Record Numbers of LMH Hospitals not collected by the crews.
Duration: 0700 hrs, 15 Mar 2007 to 0700 hrs, 15 Apr 2007 Each EMT and Paramedic will verify for their supervisor
that they know how to utilize the PCR Compliance site. Supervisors will ensure that any trends of missing Medical
Record Number can be rectified. All data collected will be analyzed upon completion of the
pilot.
DefineMeasure
AnalyzeImprove
Control
Improve Phase
Two separate solutions are being developed in addition to the above pilots:
• A Data Collection Handbook will be implemented as a guide and reference for data collection activities and training.
• An active-desktop/ whiteboard will be incorporated into our current software and hardware at each station to allow for timely statistics and data dissemination. This will foster friendly competition and respectful peer pressure.
DefineMeasure
AnalyzeImprove
Control
Control Phase
Phyllis Collins – Administrative Support Supervisor will monitor the signatures needed for billing purposes and PCR Compliance will be tracked by supervisors and the Administrative Support Supervisor.
This data will be tracked utilizing an “Average Dollars per Call” collected due to the differing timeframes in which bills are paid by our customers. We will also track the Signature and Medical Record Collection rates.
This results in a significant lag time in verifying and obtaining our goal.
DefineMeasure
AnalyzeImprove
Control
Control Phase
Refusal Signature Jan Prior 19th 7%Feb 91%MarAprMayJunJulAugSeptOct
Refusal Signatures CollectedMonthly
0%
20%
40%
60%
80%
100%
Refusal Signature
DefineMeasure
AnalyzeImprove
Control
Control Phase
Rev Collected# of Calls Avg Per call
FY04 11,507,829 41672 $276.15
FY05 13,900,943 45873 $303.03
FY06 15,629,409 47475 $329.21
DefineMeasure
AnalyzeImprove
Control
Control Phase
Lee Memorial Health SystemMedical Record Numbers Obtained
28%35%
63%
0%
10%
20%
30%
40%
50%
60%
70%
80%
2/20/2007 % to Achieve Goal Goal
DefineMeasure
AnalyzeImprove
Control
Hand-off Issues(Parking Lot Issues)
Healthware Solutions needs to be replaced with a user friendly software that will help with accountability on all levels of a PCR. This will make us proactive instead of reactive.
Enhance In-service to entice more individuals to attend and obtain information that is provided.
Accountability – include in performance appraisal for field personnel
Focus on Billing and Coding Process.
DefineMeasure
AnalyzeImprove
Control
Conclusion
Questions?