About Children’s Hospital Colorado
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About Children’s Hospital Colorado. Private, not-for-profit pediatric healthcare network Obtained Magnet status in 2006 In addition to one main campus facility 2 hospital locations within community hospitals 2 urgent care sites 1 urgent care site within another hospital - PowerPoint PPT Presentation
Transcript of About Children’s Hospital Colorado
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About Children’s Hospital Colorado
Private, not-for-profit pediatric healthcare network Obtained Magnet status in 2006 In addition to one main campus facility
2 hospital locations within community hospitals 2 urgent care sites 1 urgent care site within another hospital 1 free standing surgery center 9 satellite specialty care centers
Level I trauma center Maternal fetal medicine program opened in March 2011 Ranked among top 10 children’s hospitals for over a decade Statistics
318 licensed beds 517,873 outpatient clinic visits (2011)
Celebrating over 100 years of commitment to pediatric care!3
What is RAVE?
R- ReferralA- AuthorizationV-VerificationE-Eligibility
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Structure of Patient Access
• Prior to RAVE go-live Patient access included:
• Admissions (Main and ED)• Financial Counseling• IV staff (6 FTE)
Inpatient, Ambulatory Surgery, and Observation patient populations
• Both scheduled and non-scheduled cases
• Function as a safety net • Accounts worked via Ontrac tool
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Elements in Space
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Org Chart Pre RAVE
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Scattered Across the Universe
• Where did everyone live??? Outpatient clinics
• Each reported to outpatient floor specific manager• Team included scheduling, check-in/out, IV staff• Worked floor specific accounts
Administrative Pavilion• In charge of obtaining authorizations for range of
procedures Radiology procedure authorizations Radiology required authorization prior to scheduling
• Surgical initiation • Cardiac DME • Infusions
Network of Care locations 8
Planet Deficiencies
• Processes were sub-par workflows
• No dedicated back-up for these staff members
• No dedicated management structure for IV staff
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As the Planets Start to Align…
• Concept born 4 years prior VP of Ambulatory Services VP of Finance PFS PAS Managed Care
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Project Goal Statement• Goal Statement
The goal of centralization is to reduce the overall number of patient eligibility, no
referral/authorization, non-covered services, late/no notification, wrong insurance billed and medically
necessary denials The Children’s Hospital receives, and better align resources, training, education, and information to a single point of accountability within
the organization.
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Project Objectives• Increase secured at admit rate across the organization to
exceed 95% by the time the patient arrives for their scheduled appointment or admission. Currently, this rate is at 90% (per 4-week average as reported on week ending 8/27/10 IV Summary)
• Maintain staff productivity to consistently work 45 accounts per day per rep. Currently, this rate is at 50 across the organization (per weekly productivity rate week ending 8/27/10).
• Increase ‘days out’ in authorization rate (per 4-week average as reported on week ending 8/27/10 IV Summary):
• Goal: 0-3 days = 99% 4 days = 95%5 days = 90%.
• Reduce overall denied dollars and final write offs by 50%. 12
The Jurassic Age….
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Early Phases
• On-boarding outpatient clinics to Ontrac (2008-2010) Rolled out in phases
• Over 2 years • Main campus and network locations
• On-going meetings with management (2008-2010) To discuss centralization of IV
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Early Phases continued
• HR Meetings (Oct 2010) Employee transfer Job descriptions Reporting Structure Career Ladder
• Promotion Ladder Insurance Verification.doc Work from home model
• Ongoing Management Meetings (Oct 2010)
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Early Phases continued
• Blending the “Families” Monthly PSC meetings (Oct 2010)
• HR Involvement Communication Tool for staff
• SBI (Situation, Behavior and Impact) Training Team life cycle (Forming, Storming, Norming,
Performing)• Team building• Learning process flows• Naming department• Committee creation• Management Structure• IT Resources
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Neanderthal Stage
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“How centralize IV, Gorg want know”
RAVE go-live structure
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Our New Home…
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Gorg like!Me too!
RAVE Begins
• Go live 4/6/11 (27 employees) (Phase 1) Gained Efficiencies
• Merging worklist• Cross training
High Volume High Dollar Radiology Auth
• Scheduling prior to authorization allowed• Back-filling for absences• Installed robust QR process• “Working Smarter not Harder”
Electronic Eligibility Verification Restructure Creation of iRAVE (NOT TO BE CONFUSED WITH RAVE!!)
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iRAVE (NOT TO BE CONFUSED WITH RAVE!!!)
• What is iRAVE? Online resource
• Insurance reference• Available to all staff• Documents payer specific requirements
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iRAVE continued
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iRAVE continued
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• What is iRAVE not to be confused with?
A prize winning pony
A planet
Gorg
RAVE
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The Next Planned Phases
• Phase 2 – July 2011 (OT/PT, 3 FTE’s)
• Phase 3 – August 2011 (Psych/CDU, ST, 4 FTE’s)
Why did we stagger these?
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Growth• Expanding RAVE scope
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Date Clinic Monthly VolumesAdditional FTE to RAVE
Jun-11 MFM- Clinic & Auth Pool 40 No
Jul-11Pain Clinic- Clinic & Auth
Pool 460 No
Sep-11SIE Downs- Clinic & Auth
Pool 70 No
Oct-11 Neurology Auth Pool Unsure at this timeYes- moved 1FTE from
Neuro Dept
Dec-11Plastics, Urology, ENT, Ped
Surg-Auth Pool 675 No
Dec-11 North Campus-Auth Pool Unsure at this timeYes – Moved 0.8 FTE
to RAVE
TBDSouth Campus and CO
Springs 2600 Yes – 1 to be hired
Maintaining Communication• Employees bringing issues they otherwise would not
have Now employees have a ‘voice’
• Monthly meetings with clinic management• Close working relationship with Patient Financial
Services Work to decrease denials
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Current state (36 FTE)• Restructure of Radiology authorization workflow
Upgrade of Epic EMR for how workflow viewed• Allows for better reporting
• Continued work to document process flows Team and workflow specific
• Anticipating efficiencies• Network of Care site addition to centralization• Medicaid PAR’s for Radiology services• Promotion of two employees to Rep III status
Multiple duties• Modular training
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Current state RAVE structure
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The Jetson’s Era
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Future State
• Move from safety net to initiation For Inpatient, Amb Surg & Obs cases
• Benchmark our existing pilot person from Orthopedics
• Standardizing Psych processes• Adding more clinics
Create a RAVE services ‘Application process’ • Service level agreement
• Creation of Registration Accuracy Task Force
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Carbon Dating
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So How Did We Do?
Secure at AdmitPre RAVE= 90%GOAL= 95%Actual 2011 EOY= 94%
Staff ProductivityPre RAVE =50 accts per dayGoal= Maintain 45 acct per dayActual 2011 EOY= 68 accts per day
Write-offs for No AuthorizationGoal= Decrease by 50%Actual 2011 EOY= Increase by 235%
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So How Did We Do? Continued…
Increase “Days Out”Pre RAVE=
0-3 days = 81%4 days = 60%
5 days = 41%. Goal=
0-3 days = 99% 4 days = 95%5 days = 90%
Actual 2011 EOY=0-3 days = 94% 4 days = 75%5 days = 60%
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More Data……
• Quality Reviews• Diligent monthly QR Process
Increased Team Average from 2.68 to 2.9 (out of 3)
• Dashboard – SAVE RECENT COPY
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Lessons Learned• Employee Satisfaction
Dynamics of a large department• What exactly are we taking on?
Responsibilities transferred with employees• Some tasks are out of scope of Insurance Verification Rep level
Roles and Responsibilities – Saw a need once RAVE went live.• Cleaner registrations• Clearly defined roles
• Work From Home Re-evaluate current structure to help maintain relationships
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Questions?
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