Hospital Billing EHR Implementation - AAHAM Florida …€¦ · · 2014-08-26Hospital Billing EHR...
Transcript of Hospital Billing EHR Implementation - AAHAM Florida …€¦ · · 2014-08-26Hospital Billing EHR...
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Hospital Billing EHR Implementation “Wish I Knew then…What I Know Now”
Billie Jo DeBolt, CRCE System Director, Business Service
Lee Memorial Health System
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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
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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
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Healthpark Medical Center
Golisano Children’s Hospital
Lee Memorial Hospital
Rehabilitation Hospital
Cape Coral Hospital Gulf Coast Medical Center
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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)
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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
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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…
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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
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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.
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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
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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
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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
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Epic Dashboard
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Reviewed dashboard on a daily basis
Trouble spots are easily identified after becoming
familiar with all the sections
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Epic Dashboard – Cont’d
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Most important sections are the DNB’s and Stop Bills as well as
Claim Edits. Coding holds are after Min days.
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LMHS Tracking Tool
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♪ 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
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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
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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.
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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.
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Net AR Impact of Each Go-Live
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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)
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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%
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% 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)
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Overall Snapshot of LMHS – Before & After
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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.