Improving the Clinical Review Process for Home Care Patients

Team Members

Paul GorskiElani CookAnn PebelskeGreg HornerJackie KarebGeorge Krempel

Opportunity Statement and Desired Outcome

There are opportunities in Home Care to: Improve the clinical review process for sending out the Plans of Care (HCFA 485) for a more timely physician review and signature

Desired Outcomes:To decrease volumes of unsigned Plans of Care, which will then equal a concurrent decrease in our accounts receivableTo decrease the time between the patients start of care and the mailing of the HCFA 485 to the physician

Most Likely Causes for Current Opportunity

Non-efficient workflow of office processes that inhibited the timely creation of a HCFA

485 Staff responsibilities did not allow for efficient and timely creation of the HCFA 485 in their daily work

Solutions Implemented

The HCFA 485 workflow was streamlined with the creation of the Utilization Review specialist position. This position allows for other office staff to focus on their other duties. The UR position oversees the creation of the HCFA 485 and intervenes with appropriate personnel when delays occur. The net effect was FTE budget neutral.

Home Care Outstanding Charges

138,641172,563

302,028 299,217

232,987217,985

412,899

357,341

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

April May August September October November December January

Month

Dolla

rs

Dollar Amounts Target

Target Goal = $300,000

UR Position Inititated

Charges are representative of patient care episodes that occurred between 0-90 days from the start of care date

Percent of Signed HCFA 485 - Plans Of Care

66%60%

52%47%

36%

40%

31%31%

0%

10%

20%

30%

40%

50%

60%

70%

April May August September October November December January

Month

%

Percent of Signed

UR Position Initiated

Results of Data Analysis

In assessing the effectiveness of the UR position, the overall percentage of signed 485s that were created between 0-90 days from the start of care date has increased from 31% to 66%. Corresponding charges has decreased from an average of $385,020 to $228,903.

Recommendations and Next Steps

Continue to monitor the overall quality effect of the UR position and its supporting financial impact. This can be attained by analyzing the percentages of signed HCFA 485s and the outstanding charges.