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transcript
9/4/2018
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LEAN PROCESS IMPROVEMENTTAKING CARE OF BUSINESS
TODAY’S AGENDA
• What and Why Lean Introduction
• Value Added• Revenue Cycle Project Highlights
Customer Perspective and
Results
• 5S• Value Stream Mapping• Standardization
Some Powerful Lean Tools
WHAT IS LEAN
Problem Solving Muscle
A lean culture empowers employees
and focuses on the customer.
Lean is about a culture of continuous quality and process
improvement:
Creating Value
Reducing costs
Improving efficiency
Improving productivity and
Improving quality-higher standards
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FOUR QUESTIONS TO CONSIDER
1. What % of your representative day is spent re-working something someone else started?
2. What percentage of your day is spent doing something someone else has to re-do
3. What percentage of your day is non-value added?The first 3 questions, should not exceed 100%
4. How would your customers rate you in terms of how well you provide for their needs and requirements on a scale of 1-10?
To be value added, the activity needs to meet three criteria:
1. Change form, fit or function
2. Be valued by the customer
3. Done right the first time
Quality/Cost = Value
VALUE ADDED
COMBINING LEAN AND SIX SIGMA
Variation in a process is what customers feel –not the average
Six Sigma measures variation• 6 sigma level – 3.4
DPMO or less than 4 customers/million
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LEAN SIX SIGMA AT WORK
The relentless pursuit of the perfect process through waste elimination…Eliminating all non-value added time, motion and stepsResults driven – significant business impact to move one sigma level
We Spend 75-95% of Our Time Doing Things That Increase Our Costs and Create No Value for the Customer!
8 TYPES OF WASTE“DOWNTIME”
D: Defects
O: Overproduction
W: Waiting
N: Non-utilized resources
T: Transportation
I: Inventory
M: Motion
E: Excessive Processing
REVENUE CYCLE PROJECTS
Getting Results
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LATE CHARGE REDUCTION
Purpose: Reduce Late Charge AWO’s.
Why this Project:
• Needed to ID why
• Trending growth upwards
• Significant financial impact
• First 8 months of the year $3.1 million in late
charges, of which $1.12 million adjusted off
without billing for the services provided.
LATE CHARGE REDUCTION
1121 1123
13291375
1196
1307
1205
1277
1177
1452
1180
995957
661
494
383
294 270320
361
222174
225 219
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
NOV
DEC
JAN
FEB
MAR
APR
MAY
JUN
JULY
AUGUST
SEPT
OCT
NOV
DEC
2016 2017
Late Technical Charges for Clinics2016‐2017
Achieved $735,000 bottom dollar impact in 2017 alone
REDUCING DUPLICATE PATIENT RECORD GENERATION
Purpose: Ensuring patient identification data integrity to enhance the cleanliness of our master patient index (MPI).
Why this project- The solid principles of accuracy, completeness, and data integrity are the foundation for patient safety in the EHR.
Current State Problem Statement Key Points:
• Error rate - 21.7%, compared to the best practice benchmark of 2%. (National average is 12%).
• Averaging > 400 errors/month that need to be re-worked at an average cost of $50/error ($240,000 annually).
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REDUCING DUPLICATE PATIENT RECORD GENERATION-RESULTS
0.082%
0.045%0.042% 0.041%
0.060%
0.046%
0.029%
0.051%0.053%
0.044%
0.056% 0.055%
0.059%
0.065% 0.065%
0.074%
0.062%
0.053%
0.031%
0.000%
0.010%
0.020%
0.030%
0.040%
0.050%
0.060%
0.070%
0.080%
0.090%
Jan Feb March April May June July August Sept Oct Nov Dec Jan Feb March April May June July
RATE
2017‐2018 YTD
Monthly Trend of M Number Errors
Achieved and sustaining greater than best practice goal of 2% or less.
POINT OF SERVICE (POS)COLLECTIONS
Purpose: Address root cause of patient complaints and improve cash collections
Why this project:
• Customer complaints upon receiving their
bill that does not give credit for the POS payments made.
• Over $600,000 in unapplied dollars secondary to gaps in our POS Collection
process that lead to challenges in knowing what encounter and/ or account to apply the credit to (11,000 encounters )
POS COLLECTIONS- RESULTS
$‐
$100,000
$200,000
$300,000
$400,000
$500,000
Unknown Unapplied(account level)
Clinics (encounter level)
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POS COLLECTIONS - RESULTS
$234,239.00
$208,898.00 $221,821.00
$195,121.00
$346,623.00
$303,400.00
Q1 2016 Q2 2016 Q1 2017 Q2 2017 Q1 2018 Q2 2018
POS Collections by Quarter
Achieved >$200,000 in POS Cash Collections in first 2 quarters of year from previous 2 years
SCRUBBING REPORT ERROR REDUCTION
Purpose: Improve clean claim rate timeliness of payment
Why this project:
• Average number of errors per day - 2,038 and the errors were not being corrected in a timely matter.
• Have achieved and sustained a 72-79% decrease in errors per day.
PRE-AUTHORIZATIONS
Purpose: Reduce the administrative burden and challenges of obtaining pre-authorization
Why this project:
• Increasing number of denials secondary to pre-authorization
• Growing volume of re-working accounts
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PRE –AUTHORIZATION TOOLKIT
General Info•Glossary of commonly used terms•Office contact information•Patient Medical Info – how to export •Pre-Authorization definitions
Payer Info•Evicore•Medicaid•Tricare•Insurance Contact Numbers•Payer Summaries- processes, tips and challenges
Pre-Authorization Manuals•Meditech Authorization process•Next Gen Authorization process•Matrix Care Authorization Process•Senior Services Authorization Form
Care Coordination Authorization Info•Authorization for Surgery Form•Flights•Medical Necessity for Air Medical Transportation•Office Contact info•Tool – IP Only Procedures
Portals – Payer portal info and web addressees
SOME POWERFUL LEAN TOOLS
• 5S
• Value Stream Mapping
• Standardization
SORTSET IN ORDERSHINESTANDARDIZESUSTAIN
5S
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MAKING IT VISUAL
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VALUE STREAM MAPPINGGOING TO THE GEMBA –WALKING THE PROCESS
NEW EMPLOYEE ONBOARDING
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VALUE OF WALKING PROCESSONBOARDING PROCESS
MISSING ORDERS
Service provided, no order?
THE VALUE OF WALKING THE PROCESSMISSING ORDERS
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THE VALUE OF WALKING THE PROCESSMISSING ORDERS
MISSING ORDERS PROJECT RESULTS
Improved to 2.4 Sigma level within 2 months• Baseline Sigma level – 1.9
Prevented Write off of $635,274 (at 40% reimbursement rate = $254,109.60 revenue )
Days to Final Abstract Status by Coding Decreased: • Baseline = 23.97 Days• 3 months post implementation=11.25 Days
Increased cash flow in one time collections by $705,177
ACCOUNTING – MONTHLY CLOSING PROCESS
Saved 29 hours out of current process and reduced 2 days in monthly closing process
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STANDARDIZATIONELIMINATING PROCESS VARIATION
ATTACK VARIATION
Which is the major cause of variation in results?
People Materials
Equipment Work Methods
Results
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TEAM PROJECT
You and your team have to be able to produce a pig upon request to meet customer demand.
It is very important for your customers to have a consistent product that they can rely on when needed.
IN SUMMARY
• LEAN is about a culture of continuous improvement. It is a journey and is a very effective problem solving methodology
• Toolbox tools highlighted:
5S
Value Stream Mapping
Standardization
THANK YOU
LAURA MERCHANT, PT, MBA/HCM, FACHE, CERTIFIED LEAN SIX SIGMA BLACK BELT
PARAGON CONSULTING, LLC, GREAT FALLS, MT.