Hospital Billing EHR Implementation - AAHAM Florida …€¦ ·  · 2014-08-26Hospital Billing EHR...

36
1 Hospital Billing EHR Implementation Wish I Knew then…What I Know Now” Billie Jo DeBolt, CRCE System Director, Business Service Lee Memorial Health System

Transcript of Hospital Billing EHR Implementation - AAHAM Florida …€¦ ·  · 2014-08-26Hospital Billing EHR...

1

Hospital Billing EHR Implementation “Wish I Knew then…What I Know Now”

Billie Jo DeBolt, CRCE System Director, Business Service

Lee Memorial Health System

2

Agenda

Overview of Lee Memorial Health System

Epic Project Teams & Scope

Project Phases

Go Live Events & Post Go Live Meetings

Tools for Monitoring Key Metrics

Lessons Learned

LMHS Metrics

2

3

The Eagles – Best Band Ever!

3

4

Lee Memorial Health System, Lee County FL

♪ Non-profit, public

healthcare system

♪ 1,500+ Acute Care beds

♪ 10,000+ employees

♪ Numerous outpatient

departments/services

♪ 70 + outpatient practice

locations

♪ Over 5 billion in gross

revenue per year

4

Healthpark Medical Center

Golisano Children’s Hospital

Lee Memorial Hospital

Rehabilitation Hospital

Cape Coral Hospital Gulf Coast Medical Center

5

♪ Peaceful Easy Feeling

5

6

LMHS Future IT Vision “One Patient, One Record”

6

7

LMHS High Level Timeline and Scope for Epic Program

Stabilization & Rollout to Cape Coral, Lee/Health Park

Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 Jan-12 Apr-12 Jul-12 Oct-12 Jan-13

Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 P

roje

ct K

icko

ff

ADT (Prelude Registration) with barcoding patient identification,

electronic eligibility verification, patient flow/tracking, EVS

(environmental services – housekeeping bed status)

Hospital Billing (Resolute) with significant reporting, batch

interfaces, etc.

Enterprise Scheduling (Cadence) – planning to replace Tempus

at LMH/HP/CCH in 6/2010 – included at big bang for Gulfcoast

Inpatient Interdisciplinary Documentation (including eMAR with

barcoding, ICU, Device Integration, Stork with Fetal monitor

integration, flowsheets, allergies, notes, patient ed, discharge

writer, Zynx Plans of Care)

Pharmacy (Willow) CPOE design with Med Dispensing Integration

HIM Chart Tracking, Deficiency Tracking, Release of Information,

Coding & Abstracting

Surgical Services (OpTime) (full suite peri-operative; integration

with materials mgmt, instrument tracking)

LM

HS

Ep

ic

Pro

jec

t T

ea

m T

rain

ing

Inpatient Clerk Orders with design for CPOE

Non-Epic Application Mix (Siemens Lab, Radiology, Document

Imaging, pieces of Softmed and miscellaneous other applications)

Gulf Coast Medical

Center Cape Coral

Continue Rollout of EpicCare EMR to LPG Physicians, MSO Practice Management and Affiliate Physician Pilots

Lee Memorial/Health Park/

OP Centers

Phase 1: Enterprise Standard DesignEpic Upgrade

2008 to 2010

Legend

= Go-Live

= Upgrade

Initial Implementation – Gulf

Coast

Phase 2

CPOM/Phys Doc – 5/13

MyChart - Patient Web

Access Acute – 4/2014

Care Everywhere – In Progress

2014 Upgrade – 11/2104

Beacon Oncology - TBD

Anesthesia - TBD

Cardiant – Cardiology- TBD

Radiant – Radiology - TBD

Beaker - Epic Laboratory - TBD

Rollout beyond Gulfcoast (LMH/

HP/CCH/Outpatient Bldgs)

8

♪ Heartache Tonight

8

9

Epic Project Team Teams were created for each Epic application:

– EPIC Clinical – Clin Doc, ASAP, Optime, Williow, Orders,

EpicCare Ambulatory

– EPIC Revenue Cycle – Cadence, ADT, Resolute Hospital

Billing, Health Information Management, Onbase Document

Management, Professional Billing

Each team consisted of:

– One team lead

– Existing IT analysts

– Borrowed operational staff (35 in total were borrows and were

committed for 3 years to the project before transitioning back

to original department

– Consultants added only when needed

9

10

♪ New Kid In Town

10

11

Project Begins….

Application teams were sent for Epic training in Madison

Wi – trained on Epic’s 2009 version, but went live on the

2008 version

Discovery sessions were held with Epic staff, team

members and LMHS process owners

Validation sessions were completed using the Stop Light

Evaluation Worksheets with LMHS SME’s

Then came many refinement sessions…

11

12

♪ Wasted Time

12

13

Remaining Project Phases

Analysis and Build

Unit Testing

Integrated Testing

Work flow walk through demonstrated

Super User and End User Training

Cutover Testing

Dress rehearsals

GO LIVE

13

14

Go Live Timeline

First live event on 6/1/11 – Gulf Coast Medical Center

349 beds very minimal outpatient.

Second live event on 12/1/11 – Cape Coral Hospital 291

beds with outpatient services in a couple of locations

Third live event on 8/1/12 – Lee Memorial Hospital 415

beds, Healthpark Medical Center 368 beds and a

significant number of outpatient locations.

14

15

Go Live Events

After each live event the project teams would support the

end users

Project teams would then focus on refinement and build

for the next go live

Staggering the live events allowed the teams to

continuously learn and improve on the process

Daily meetings held to report issues and implement fixes

Over time transitioned to weekly meetings for issues and

reviewing key metrics

15

16

Post Go Live Meetings

Daily Huddle – Revenue Tracker/Charging – review

current charging to base lines, department levels, overall

charge totals

Daily Huddle – Access/Revenue/HIM – review top edits,

access & revenue integrated issues, coding holds

Daily Issues Meeting – review status updates on

reported outstanding issues, prioritization & assignment

of issues

Weekly Graph Package Call – review tab by tab,

compare facility to baseline and other customers

16

17

♪ Life in the Fast Lane

17

18

Daily Revenue Tracker

Critical tool used to track daily charge posting and compare to

baseline

Detail review done to determine if volume driven, business shift or

Epic issue

18

19

♪ I Can’t Tell You Why

19

20

Epic’s Weekly Graph Package – Week 7

20

21

Epic Across Organization Comparison

21

22

♪ Get Over It

22

23

Epic Dashboard

23

Reviewed dashboard on a daily basis

Trouble spots are easily identified after becoming

familiar with all the sections

24

Epic Dashboard – Cont’d

24

Most important sections are the DNB’s and Stop Bills as well as

Claim Edits. Coding holds are after Min days.

25

♪ Lyin Eyes

25

26

LMHS Tracking Tool

26

♪ Key Indicator spreadsheet developed with thresholds to

track the most important holds and the responsible owning

area

♪ Emailed out to all stakeholders on Mon – Wed – Fri

27

Lessons Learned

Don’t convert the A/R if at all possible, we converted with Siemens

but did not with Epic and had much better outcomes

In house patient charge conversion, don’t use a tool called

Eggplant. Second go live we used the Epic Bridges charge

conversion tool and processing time was extremely good. Balancing

was a little more difficult

Front End cash drawers should all be enabled and tested

Significant shift in key responsibilities from ADT to Nursing or Case

Management. We underestimated the impact on event management

functions and the role the CBO would play in correcting the events

Be sure to document why decisions were made. We did a good job

on the big decisions but not so good on the smaller ones. This

information becomes very useful in the future when troubleshooting

27

28

Lessons Learned

Manage your workques! Look for black holes and then plug them.

Utilize the watch list section on the dashboard earlier rather than

later. We are still finding pockets of accounts not hitting the correct

WQ.

Utilize an aging report in conjunction with your WQ’s. This will also

help to identify accounts not routing properly.

Fully develop Epic for clean claims as opposed to depending on

your claims scrubber. This will shave some time off your claims turn

around if you are editing as much as possible within Epic.

Provide deeper training for job specific duties. Epic fundamentals

were taught in detail but we were lacking on the daily functions of

each job role.

28

29

Lessons Learned

Test and then test again and then test some more! Do more Break

testing and document what actions should be taken if an account is

“broken”. We did a really good job of unit testing as well as

integrated testing. Not nearly enough testing was done to identify

breaks or soft spots in our processes.

Assign specific duties to Readiness Role’s after each go live. Utilize

those that were provided additional training such as Readiness Role

owners and Super Users. Don’t be afraid to spread the wealth at

critical times after a go live.

Reporting in Epic can be problematic. Don’t go down the path of

duplicating existing reports in your legacy system. Fully understand

the limitations of Account Query and Reporting Workbench and

develop your new reporting needs either within Epic or in a bolt on

application such as Crystal, Diver, etc.

29

30

♪ Take it Easy

30

31

Net AR Impact of Each Go-Live

31

1 3 5 7 9 11 13 15 17 19 21 Current

0

10

20

30

40

50

60

70

80

Ne

t A

R D

ays

Months Post Live

72.3

58.5

42.8

68.7

55.2 55.5

57.1

45.6 41.1

Legend

Gulf Coast Medical Center (AR Baseline – 59 Days)

Lee Memorial Hospital & Health Park Medical Center (AR Baseline – 55 Days)

Cape Coral Hospital (AR Baseline – 49 Days)

32

♪ Desperado

32

33

High Level Candidate for Bill #’s

Candidate for Bill % of AR

60 Days Post Live Current

GCMC 23% 11%

CCH 33% 10%

LMH/HPMC 19% 10%

33

% of Candidate for Bill Held in Coding

60 Days Post Live Current

GCMC 10% 2%

CCH 18% 3%

LMH/HPMC 7% 2%

Note: Candidate for bill means the account is beyond the bill hold

period (for LMHS this is >5 days post discharge)

34

Overall Snapshot of LMHS – Before & After

34

May

2011

Net AR Days 53.18

% of Bad Debt 3%

Cost to Collect 1.37

*Exceeded Cash Goal 2.6%

May

2014

49.68

2.5%

1.25

6.1%

Note: LMHS finance department establishes a monthly cash goal using a formula that

uses partial cash collections from the previous 2 months.

35

♪ Take it to the Limit

35

36

In Summary

♪ In the Long Run, life goes on so go stay at…

♪ The Hotel California and have a nice…

♪ Tequila Sunrise since you are a…

♪ Victim of Love not a victim of Epic and…

♪ You are Not Alone, everyone has gone or is going through an

EHR Install

36