rengineering patient access
TRANSCRIPT
Presented By:Mark Sammartano
Implement Preregistration Program
Centralize Registration Functions
Centralize Scheduling of Elective Services
Minimize patient wait times
Optimize departmental Productivity
Increase registration data quality
Increase productivity
Increase POS cash collections
Decentralized registration with 28 sites in one campus;
14,000 monthly encounters; 2,400 encounters registered in treating
departments; 35.8 FTE’s allocated to decentralized
registration areas; Manual QA process using small samples
which were not representative of overall quality – hap hazard.
Collapsed all points of registration into 3 locations (main lobby, OP pavilion, ED);
10% reduction in FTE’s;
Registration accuracy increased from 75% to 95% and improving – target = 98%
$90,000 average POS cash collections per month and increasing.
Expand scheduling to all elective services;
Coordinated scheduling, pre-registration, insurance verification, and POS collection;
Implemented staggered staffing model;
Expanded role of financial counseling:
Implementation of ED discharge process coordinated with clinicians and financial counseling,
Included recovery of bad debt in POS collections.
Implemented rules based QA software;◦ Interactive registration edit and
correction;◦ Robust analytical tools;
Implement Charity Care software;◦ Automate eligibility process◦ Reconciliation of 835 and approved
applications;◦ Robust analytical tools.
Volume analysis; Patient flow analysis; Departmental process review; System Design and Implementation:
◦ HIS◦ Scheduling◦ QA ◦ Charity Care
Policy and procedure development; Employee education
HOSPITAL SERVICES REGISTERED BY DEPARTMENTS
DECEMBER 1, 2008 THROUGH MARCH 16, 2008
PATIENT ADMIT DATE (Multiple Items)
Count of PATIENT/ENCOUNTER NUMBER Column Labels
Row Labels 1 2 3 4 5 6 7 Grand Total
OMH 1 614 663 530 617 567 1 2,993
CLI 255 506 296 489 247 1,793
WCC 275 158 181 178 211 1,003
CRH 108 129 184 321 107 88 937
CHC 12 189 112 124 100 85 622
IVM 3 74 86 89 75 82 409
HFC 71 101 83 85 340
PTH 9 123 59 35 60 38 15 339
RON 144 48 2 38 84 316
PHP 114 60 43 28 11 256
SLP 44 47 46 43 50 11 241
FHC 38 53 48 46 38 4 227
SPH 34 60 18 17 24 20 7 180
AUD 32 17 28 25 27 1 130
PPT 23 30 17 14 8 4 96
VRP 2 49 10 8 8 7 84
CHE 28 25 16 5 8 82
OBV 7 11 10 7 8 5 9 57
TRN 8 4 8 5 11 36
TCN 4 6 3 6 12 2 33
OTH 5 1 6 3 4 19
CVT 5 5
PMC 1 4 5
AHS 1 1
ORT 1 1
Grand Total 177 2,291 2,208 1,908 1,964 1,603 54 10,205
Reg Hour Sun Mon Tue Wed Thu Fri Sat Total
1 - - - - 2 1 - 3
2 - 1 - - 1 - 1 3
3 1 - - 1 - - - 2
4 - - 1 - - - - 1
5 - - 2 - - - - 2
6 - 1 - - - - - 1
7 - 1 2 2 2 1 - 8
8 3 83 85 124 89 50 1 435
9 54 195 187 173 139 148 6 902
10 20 495 451 307 349 249 10 1,881
11 15 343 376 278 299 204 7 1,522
12 3 234 239 220 161 179 8 1,044
13 19 196 99 109 94 162 2 681
14 40 219 246 234 252 200 1 1,192
15 2 156 223 224 265 183 1 1,054
16 6 141 103 117 182 103 - 652
17 - 50 115 58 32 41 2 298
18 2 61 23 9 32 14 1 142
19 4 47 6 6 14 15 - 92
20 6 14 1 2 7 4 - 34
21 1 52 47 44 43 49 12 248
22 - 1 - - - - 1 2
23 1 - 1 - 1 - 1 4
24 - 1 1 - - - - 2
177 2,291 2,208 1,908 1,964 1,603 54 10,205
Days in Period 15 16 15 15 15 15 15 106
Average Daily Registrations
Reg Hour Sun Mon Tue Wed Thu Fri Sat
1 - - - - 0.13 0.07 -
2 - 0.06 - - 0.07 - 0.07
3 0.07 - - 0.07 - - -
4 - - 0.07 - - - -
5 - - 0.13 - - - -
6 - 0.06 - - - - -
7 - 0.06 0.13 0.13 0.13 0.07 -
8 0.20 5.19 5.67 8.27 5.93 3.33 0.07
9 3.60 12.19 12.47 11.53 9.27 9.87 0.40
10 1.33 30.94 30.07 20.47 23.27 16.60 0.67
11 1.00 21.44 25.07 18.53 19.93 13.60 0.47
12 0.20 14.63 15.93 14.67 10.73 11.93 0.53
13 1.27 12.25 6.60 7.27 6.27 10.80 0.13
14 2.67 13.69 16.40 15.60 16.80 13.33 0.07
15 0.13 9.75 14.87 14.93 17.67 12.20 0.07
16 0.40 8.81 6.87 7.80 12.13 6.87 -
17 - 3.13 7.67 3.87 2.13 2.73 0.13
18 0.13 3.81 1.53 0.60 2.13 0.93 0.07
19 0.27 2.94 0.40 0.40 0.93 1.00 -
20 0.40 0.88 0.07 0.13 0.47 0.27 -
21 0.07 3.25 3.13 2.93 2.87 3.27 0.80
22 - 0.06 - - - - 0.07
23 0.07 - 0.07 - 0.07 - 0.07
24 - 0.06 0.07 - - - -
26.80 159.19 162.20 142.20 145.93 121.87 18.60
MAN HOURS
Reg Hour Sun Mon Tue Wed Thu Fri Sat
1 - - - - 0.03 0.02 -
2 - 0.02 - - 0.02 - 0.02
3 0.02 - - 0.02 - - -
4 - - 0.02 - - - -
5 - - 0.03 - - - -
6 - 0.02 - - - - -
7 - 0.02 0.03 0.03 0.03 0.02 -
8 0.05 1.30 1.42 2.07 1.48 0.83 0.02
9 0.90 3.05 3.12 2.88 2.32 2.47 0.10
10 0.33 7.73 7.52 5.12 5.82 4.15 0.17
11 0.25 5.36 6.27 4.63 4.98 3.40 0.12
12 0.05 3.66 3.98 3.67 2.68 2.98 0.13
13 0.32 3.06 1.65 1.82 1.57 2.70 0.03
14 0.67 3.42 4.10 3.90 4.20 3.33 0.02
15 0.03 2.44 3.72 3.73 4.42 3.05 0.02
16 0.10 2.20 1.72 1.95 3.03 1.72 -
17 - 0.78 1.92 0.97 0.53 0.68 0.03
18 0.03 0.95 0.38 0.15 0.53 0.23 0.02
19 0.07 0.73 0.10 0.10 0.23 0.25 -
20 0.10 0.22 0.02 0.03 0.12 0.07 -
21 0.02 0.81 0.78 0.73 0.72 0.82 0.20
22 - 0.02 - - - - 0.02
23 0.02 - 0.02 - 0.02 - 0.02
24 - 0.02 0.02 - - - -
FTE'S
Reg Hour Sun Mon Tue Wed Thu Fri Sat
1 1.00 1.00 1.00 1.00 1.00 1.00 1.00
2 1.00 1.00 1.00 1.00 1.00 1.00 1.00
3 1.00 1.00 1.00 1.00 1.00 1.00 1.00
4 1.00 1.00 1.00 1.00 1.00 1.00 1.00
5 1.00 1.00 1.00 1.00 1.00 1.00 1.00
6 1.00 1.00 1.00 1.00 1.00 1.00 1.00
7 1.00 1.00 1.00 1.00 1.00 1.00 1.00
8 1.00 1.30 1.42 2.07 1.48 1.00 1.00
9 1.00 3.05 3.12 2.88 2.32 2.47 1.00
10 1.00 7.73 7.52 5.12 5.82 4.15 1.00
11 1.00 5.36 6.27 4.63 4.98 3.40 1.00
12 1.00 3.66 3.98 3.67 2.68 2.98 1.00
13 1.00 3.06 1.65 1.82 1.57 2.70 1.00
14 1.00 3.42 4.10 3.90 4.20 3.33 1.00
15 1.00 2.44 3.72 3.73 4.42 3.05 1.00
16 1.00 2.20 1.72 1.95 3.03 1.72 1.00
17 1.00 1.00 1.92 1.00 1.00 1.00 1.00
18 1.00 1.00 1.00 1.00 1.00 1.00 1.00
19 1.00 1.00 1.00 1.00 1.00 1.00 1.00
20 1.00 1.00 1.00 1.00 1.00 1.00 1.00
21 1.00 1.00 1.00 1.00 1.00 1.00 1.00
22 1.00 1.00 1.00 1.00 1.00 1.00 1.00
23 1.00 1.00 1.00 1.00 1.00 1.00 1.00
24 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Implementation Process
Decentralized Model;
Manual and software based process
Increased departmental productivity:
◦ Adjusted available hours of operation based on market demand;
◦ Minimized slack time;
◦ Increased revenue per paid hour;
Improved management of uninsured and under insured elective services;
Minimized registration time when patient presents;
Treatment authorization control moved from referring physician to facility.
Departmental Review, on-site observation of all shifts;
Data gathering and modeling:
◦ Inbound call volumes
◦ Call distribution analysis by shift and day-of-week
Scheduling System Build:
◦ Reviewed departmental scheduling protocols:
◦ Identify resources for scheduling (technicians, equipment, rooms, etc)
Implement telephony solution,
Establish toll free numbers
Nursing unit education;
Physician education;
Staff recruitment
Staggered implementation
Exhibit 1
Count of No Column Labels
Hour mon tues wed thurs fri Grand Total
Group1 3 3 5 12 7 30
Group2 3 6 7 18 3 37
Group3 5 2 11 8 1 27
Group4 12 3 6 13 1 35
Group5 2 1 4 1 8
Group6 2 2
Group7 9 11 6 3 1 30
Group8 13 7 15 8 7 50
Group9 11 15 16 18 11 71
Group10 9 14 20 14 11 68
Group11 7 10 5 7 5 34
Grand Total 76 72 95 101 48 392