Building an Automated Financial Clearance ProcessNiobis Queiro, MBACorporate Vice President, Revenue CycleHartford HealthCare CorporationHartford, CT

Hartford HealthCare

• 4 hospital system serving 63 towns in Connecticut• 75,711 inpatient visits per year • 2 Million outpatient and homecare visits a year• 280,000 ED patients per year• 60% of all behavioral health visits in the state of CT• $52 million in charity care FY 2011 • $14 million invested in research • 15,000 Employees• 2,100 Physicians• $2.0B Total Revenue

Current Issues Facing Healthcare Industry

*Source:Modern HC 6-29-09, pg 16 MEDPAC . FierceHealthFinance, 12-15-09 **ObamaCare Impact this for Primary care Physicians. 1 – Appropriate Tort Reform when practice pattern reflects standard. ***CDC 2005 Chronic Disease Prevention and Health Promotion Report.

• Losing 7.2% on Medicare Cases, losing 14% on Medicaid*• Medicare Reimbursement rates declining**• Increasing Medicare & Medicaid population• Increasing high deductable plans and bad debt

Hospitals will Never Be Paid as Well as

They are Today

• Rewards chasing revenue, not margin/quality • Capitation payment encourages less volume• Evidence Based Care Plans are needed

Fee for Serviceversus

Fee for Value

• Physicians, hospitals, providers and plans not aligned (incentives)

• Coordination lacking inside/outside walls of hospital • EMR Adoption/MU requires new processes**• Data is housed in silos

Care Delivered in Silos

• Rapid increase in patients with multiple chronic diseases (CHF, COPD, Diabetes); 133M Americans have a chronic disease***

• 5% patients = 55% of admissions, care at Medicare rates• Health Plans shift risk to provider. Bundled care, ACO

Chronic Disease Patient Volume

Increasing

Traditional Operating Models Will Fail UnderThe Complexities of Healthcare Reform

Short term:• Increased access to

care• New shared reimbursed

at government rates• Outcome risk

• Reduced operating margins

On the horizon:• ICD-10

• Outcomes Performance• Clinical integration

• IT interoperability• ACO investments

• Next generation gain sharing

• Bundled payments

Greater Access – Reduced Reimbursement – Growing Operational Complexity

• Percent of data needed for billing originates at registration: 70%

• National average registration error rate: 46%

• Percent of denials that could be prevented at registration: >50%

Patient Access: The Root of Much Evil

Sources: Patient Access Resource Center: HCPro Quarterly Benchmarking Report 12/10, Healthcare Informatics Research Series Data, NAHAM, Modern Healthcare

Cash Collection Curve

Hartford HealthCare Project Goals

• Create an Optimal Patient Experience that Makes HHC the Provider of Choice

• Create and Automate a Data Rich Financial Clearance Process• Produce Patient Liability Estimates for Transparency• Improve POS Cash Collections• Centralize Scheduling• Real-time Quality Assurance to empower the end-user• Enable Field Level Registration Edits• Link patient Access Errors to Denials and A/R Liquidation• Provide structure around E&B and Authorizations• Establish a Partnership with all HHC providers and assets

Hartford HealthCare: Flashback 18 months

• No patient access standardization• Variable financial clearance

process• No centralized scheduling• No patient liability estimates• < $1M/Yr in POS cash collections• No registration quality edits• No link between access & denials• IT patchwork across 4 hospitals

201

Current state:Hartford HealthCare Patient Access

Automated Financial Clearance Workflow Platform

AddressValidation

Centralized Scheduling

Eligibility & Benefit

Verification

Prior Auth(pilot)

Patient Funding w/ Via Note(pilot)Patient

Estimates

Medical Necessity

RegIntegrity

ADT Feed

ATB Data

Reporting & MetricsPost Go-Live

HCIT Integration

Point of Service Patient Liability Estimates

July

Augus

t

Septem

ber

Octobe

r

Novem

ber

Decem

ber

Janu

ary

Febura

ryMarc

h0

200

400

600

800

1000

1200

1400

1600

1800

2011-2012

Patie

nt E

stim

ates

Pro

duce

d as

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%Im

prov

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Linking Patient Access Errors to Denials

Improved A/R Liquidation

Rates

Reduction in errors at

Patient Access

12%

20%

Hartford HealthCare KPIs

Key Performance Indicator Best Practice TargetsRegistration Accuracy 99%# of incoming calls answered 135 - 165Abandon calls after threshold 2% calls Abandoned < 2 %Avg Time on Call 4:00 - 6:00Avg Wait Time 15 - 30 secMax Ans Delay 2:00 - 3:00

POS Collections $50,000 per monthPre-Registrations by Schedulers 20% or greater

Trace Fax completion time 1 business day

Joys of the Open Road

Joys of the Open Road

• Employee Engagement• HHC offers employees access to Local Community College• HHC covers tuition and salary for Wednesday afternoon coursework• Clear career path and education boost employee morale• HHC maintains a 99% employee retention rate

• Team Building Exercises

• Rewards For Outstanding Performance

Lessons From The Road

Lessons from the Road

• Appraise organizational readiness• Finance will likely want to run faster than departments• Provide training to physicians and nursing staff • Communicate early and often with hospital leadership

(CEO/CFO)• Appraise Financial Clearance Staff

• Some personality types are not suited to ask for payments• Be aware of HR challenges

• 9 Benefits Packages• 4 Compensation Models• Union job descriptions• Employee transfer requires new employee paperwork• HHC full homogenization by 2013

17

Leadership Behaviors

• Be In The Moment• Be Authentic & Humanistic• Volunteer Discretionary Effort Constantly• Model High Performance-Desired Behaviors that Drive

Desired Results• Respect & Leverage Separate Realities• Be Curious vs. Judgmental• Look in the Mirror First – Be Accountable• Have Courageous Conversations• Provide Timely, Clear & Specific Performance Expectations

& Feedback• Teach, Coach & Mentor - Spend at Least Half of Your Time

Developing Others

Questions to Ask Yourself Everyday

• What more can I do right now to be a role model for those around me?

• What more can I do right now to achieve the outcome we desire?• What more can I do right now to prevent something undesired

from occurring?• What expectations or feedback can I deliver right now to make a

positive difference?• What more can I do right now to seek or provide the clarity that I

think does not exist?• What more can I do right now to make this meeting more

productive?• When some outcome has not met my expectations, ask, “How did

I contribute to that?” and “What more will I do next time to make it successful?”

A journey of a thousand miles begins with a single step.Lau-Tuz, Chinese philosopher (604 BC - 531 BC)