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HFMA R i 9 C fHFMA Region 9 ConferenceMAP Award Case Study
November 15, 2015
Purpose & Outline
o Purpose: Provide an overview of the HFMA MAP award and application process and share performance improvement pp p p pinitiatives at Baylor Scott & White Health
o Outline
o BSWH Organizational Overview
o BSWH – NTX Revenue Cycle Overview
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o MAP Award Overview
o Performance Improvement Examples
o Continuous Improvement Checklist
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BSWH Mission & Vision• Mission: Baylor Scott & White Health exists to serve all
people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing.
• Vision: To be the most trusted name in giving and receiving safe, quality, compassionate health care.
• Values: Our values define our culture and should guide every conversation, decision and interaction we have with each other and with our patients and their loved ones:
Integrity: Living up to high ethical standards and showing respect for others
Servanthood: Serving with an attitude of unselfish concern
Teamwork: Valuing each other while encouraging individual contribution and accountability
Excellence: Delivering high quality while striving for continuous improvement
Innovation: Discovering new concepts and opportunities to advance our mission
Stewardship: Managing resources entrusted to us in a responsible manner
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BSWH Locations
North Texas Division(Legacy Baylor Health Care System)
Central Texas Division(Legacy Scott & White Healthcare)
Baylor Scott & White Health*
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*Largest Not-For-Profit Health Care System in TX
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BSWH Revenue Cycle Org Structure
Vice President
Revenue Cycle
Access Services
Facility Registration
Pre-Service Call Center*
Revenue Integrity
Charge Capture Audit
Pricing
Clinical Resource Management
Utilization Review
Denial Resource Center
Central Business Office
Billing/Collections
Credits/Cash Posting
Revenue Cycle Improvement
Training & Development
Process Redesign
Revenue Cycle Services
Vendor Management
System Maintenance
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*Note: “Pre-Service Call Center” includes centralized Pre-Registration and Insurance Verification department for all BSWH facilities
Financial Counseling CDM Maintenance Customer Service Technology
ImplementationSystem
Optimization
BSWH-NTX Revenue Cycle Metrics
MetricTop QuartileBenchmark1
Desired Direction
FY11 FY12 FY13 FY14 FY15
Cash Collection % 100 0% 100 3% 100 4% 99 8% 100 6% 100 1%Cash Collection % 100.0% 100.3% 100.4% 99.8% 100.6% 100.1%
Cash Collections N/A $2.5B $2.5B $2.5B $2.6B $2.7B
AR Days 45.0 39.7 38.5 45.22 44.0 43.1
AWO % of Net Revenue3 0.6% 0.7% 0.6% 0.7% 1.09% 0.51%
AWO Dollars5 N/A $18.3M $16.6M $18.1M $28.3M $13.8M
Cost-to-Collect4 2.0% 2.0% 2.0% 1.9% 1.67% 1.60%
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1. “Top Quartile” performance metrics supplied by the Revenue Cycle Academy, LLC and the Healthcare Financial Management Association.2. “AR Days” increased at the beginning of FY13 as a result of an accounting rule change treating Bad Debt as a “deduction” from revenue3. “AWO” represents preventable Administrative Write-Offs for denials and other similar measures of lost net revenue4. “Cost-to-Collect” is calculated by dividing total Revenue Cycle Management Costs (corporate and facility) by total dollars collected. 5. “AWO’s” were higher than expected in FY14 due to increased RAC denials. FY14 RAC denials totaled $13.2M, while Baylor only experienced $3.7M in FY13.
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MAP Awards
MAP High Performance Award Winner
• 2015 B l S tt & Whit H lth• 2015 – Baylor Scott & White Health
• 2014 – Baylor Scott & White Health
• 2013 – Baylor Health Care System
• 2012
– Baylor All Saints Medical Center at Fort Worth
– Baylor Jack & Jane Hamilton Heart & Vascular Hospital
– Baylor Medical Center at Irving
– Baylor Medical Center at Waxahachie
HFMA’s MAP Award for High Performance in Revenue Cycle recognizes hospitals, health systems, and physician practices whose i ti d ff ti t t i h– Baylor Regional Medical Center at Grapevine
– Baylor Regional Medical Center at Plano
• 2011 - Baylor Medical Center at Irving
• 2010 – Baylor Medical Center at Irving
• 2009 – Baylor All Saints Medical Center at Fort Worth
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innovative and effective strategies have enabled them to achieve excellence in revenue cycle performance.
MAP Award Overview
• Q. Who is eligible to apply for the MAP Awards?A. All acute care hospitals are eligible to apply for the High Performance individual or system awards, as appropriate. All physician practices regardless of affiliation or ownership may apply for the physician practice High Performance award. Your organization does not need to be a MAP App subscriber to apply.
• Q. How will HFMA determine the winners of these awards?A. Winners are determined through analysis of MAP Keys metrics (KPIs), narrative questions, additional materials required during the application process, and selected finalist interviews.
• Q. How do I access the application?A. Links to the applications can be found at hfma.org/mapawards when the online application system is open. You will be asked to log into your HFMA account to access the application. If you are not a member of HFMA, you can create an account by selecting the create an account link on the HFMA Login page. Once logged in, you will be able to access additional information about the application and submission process.
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Performance Improvement ExampleImproving the Pre-Arrival Process
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Pre-Arrival Process Timeline
Project Objective: To improve point-of-service collections, increase the number of scheduled patients pre-registered prior to their date of service, and reduce expenses through a more efficient workflow
2004
Standardized Processes for Pre-Arrival Functions
2009
2012
New Technology and Focused Process Improvement is
Implemented
First, detailed Pre-Registration goals are
outlined
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2009
Pre-Arrival Processes Centralized for Hospital
Operations“IV Days Out” increase
substantially, represents first Pre-Registration Focus
Significant leap in productivity and
collections
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Pre-Arrival Process
Before New Technology
• IV and Pre-Registration are Completed Manually• IV Must be Completed Before Pre-Registration
Scheduling InsuranceVerification Pre-Registration
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After New Technology • IV and Pre-Registration are Much Less Manual
• IV and Pre-Registrations can be Completed Simultaneously
Pre-Registrations Increase by Over 60%
Price Estimation Software and Benefits
o Product Description: an automated software solution that delivers an accurate statement of patient financial responsibility at or prior to point of servicep p y p p
o Key Features:
• Delivers estimate to the provider and patient prior to the delivery of care• Provides patient estimate and statement in real-time and is fully automated• Calculates patient out-of pocket estimates based on system chargemaster,
payer contracts, and individual benefit planso Benefits:
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• Increases patient satisfaction by presenting understandable and accurate estimates
• Improve cash collections and reduces bad debt and write-offs• Improve staff efficiency with automation of previously manual tasks
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Price Estimate Example
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Example Financial Return Model
BENEFITS FY '12 FY '13 FY '14 FY '15
Revenue
Increased self‐pay cash 191,891 383,782 383,782 383,782
Expense Reductionp
Reduced collection agency fees 122,211 244,421 244,421 244,421
Reduced FTEs 217,500 217,500 217,500 217,500
Total per period 531,601 845,703 845,703 845,703
COSTS FY '12 FY '13 FY '14 FY '15
Implementation Fee 20,000 0 0 0
Subscription Fee 100,000 200,000 200,000 200,000
Total per period 120,000 200,000 200,000 200,000
DISCOUNTED BENEFIT FLOW FY '12 FY '13 FY '14 FY '15
Discounted Benefits 531,601 845,703 845,703 845,703
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Discounted Costs 120,000 200,000 200,000 200,000
Total Cumulative Discounted Benefit Flow 411,601 645,703 645,703 645,703
FINANCIAL ANALYSIS FY '12 FY '13 FY '14 FY '15
Discount Rate 10% ‐ ‐ ‐
Net Present Value (NPV) 1,833,971 ‐ ‐ ‐
Internal Rate of Return #NUM! ‐ ‐ ‐
Note: All vendor fee information above is being used for illustrative purposes and does not correspond to actual BSWH data.
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Example Financial Return Model
Notes:
Direct Benefits1. Increased self pay cash. Although there is no benchmark from XX or from their references regarding "new" cash, the timely and proactive calls collection calls are expected to result in a positive benefit to BHCS. Assuming a 0.5% increase from fiscal year 2011 (self pay collections = $76,756,346), BHCS will collect an additional $383,782/year. 2. Reduced collection agency fees. Reduced collection agency fees due to an increase in POS collections and self pay collections. BHCS expects to collect 5% of the cash previously collected by collection agencies. FY '11 Bad Debt Recoveries =$48,884,273. Assuming 5% of this cash ($2,444,214) is expected to be collected by BHCS CBS and Access Services, there is an approximate savings of $244,421 in agency fees (assuming an average fee of 10%). 3. Reduced FTEs. XX FTEs from the self pay department can be eliminated due to automated phone calls. The self pay team will move from being an outbound call team to an inbound call team that speaks with patients wanting to pay their balance.
Indirect Benefits1. Increased pre‐registration percentage. The XX solution will allow BHCS to contact and pre‐register more patients without adding FTEs. By increasing the pre‐registration percentage, BHCS can increase POS cash, increase patient satisfaction, reduce the number of FTEs required for registration at the facilities and "fast track" patients during the check‐in process
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Note: All vendor fee information above is being used for illustrative purposes and does not correspond to actual BSWH data.
the number of FTEs required for registration at the facilities, and fast track patients during the check in process.2. CostsA. Fiscal Year 2012: Implementation = $20,000; subscription fee pro‐rated assuming a January 2012 go‐live dateB. Fiscal Year 2013 ‐ 2015: Annual subscription costs = $200,000
North Texas DivisionWeekly Point of Service Collections
$900,000
$1,000,000
$200,000
$300,000
$400,000
$500,000
$600,000
$700,000
$800,000 Price Estimation Tool Go-Live
W kl A i t li $454 500
$0
$100,000
$ ,
7/8/
2011
8/12
/201
19/
16/2
011
10/2
1/20
1111
/25/
2011
12/2
9/20
112/
3/20
123/
9/20
124/
13/2
012
5/18
/201
26/
22/2
012
7/27
/201
28/
31/2
012
10/5
/201
211
/9/2
012
12/1
4/20
121/
18/2
013
2/22
/201
33/
29/2
013
5/3/
2013
6/7/
2013
7/12
/201
38/
16/2
013
9/20
/201
310
/25/
2013
11/2
9/20
131/
3/20
142/
7/20
143/
14/2
014
4/18
/201
45/
23/2
014
6/27
/201
48/
1/20
149/
5/20
1410
/10/
2014
11/1
4/20
1412
/19/
2014
1/23
/201
52/
27/2
015
4/3/
2015
5/8/
2015
6/12
/201
5
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Weekly Average prior to go-live = $454,500 Weekly Average post go-live = $632,958
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ED - % Accounts Where Financial Conversation Occurred With Patient
93.87%
90.00%
100.00%
59.50%60.00%
70.00%
80.00%
90.00%
Impact:Increased pricing transparency & improved point of service collections
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40.00%
50.00%
OP Surgery - % Accounts Where Financial Conversation Occurred With Patient
95.82%
90.00%
100.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Impact:Increased pricing transparency & improved point of service collections
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24.76%
0.00%
10.00%
20.00%
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OP Radiology - % Accounts Where Financial Conversation Occurred With Patient
100.00%
120.00%
40.91%
93.19%
40.00%
60.00%
80.00%
Impact:Increased pricing transparency &
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0.00%
20.00%
Feb‐13
Mar‐13
Apr‐13
May‐13
Jun‐13
Jul‐13
Aug‐13
Sep‐13
Oct‐13
Nov‐13
Dec‐13
Jan‐14
Feb‐14
Mar‐14
Apr‐14
May‐14
Jun‐14
Jul‐14
Aug‐14
Sep‐14
Oct‐14
Nov‐14
Dec‐14
Jan‐15
Feb‐15
Mar‐15
Apr‐15
May‐15
Jun‐15
Increased pricing transparency & improved point of service collections
% of Patients with a Financial Conversation
Daily email with rank ordering of facility performance drives accountability with staff and management
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Note: Data based on June 2015 performance
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Point of Service Collection Reporting by User
New Reporting Drives Accountability to the User Level• Collection Reasons by User (e.g., paid in full, payment plan requested, no payment method available)• Collections as a % of Estimated Amount Due
EmployeeAmount
CollectedAmount
EstimatedCollection %
Employee #1 $100 $1,000 10%
Employee #2 $300 $300 100%
Employee #3 $500 $1 000 50%
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Employee #3 $500 $1,000 50%
Employee #4 $2,500 $10,000 25%
Total $3,400 $12,300 28%
Example “ATP” Rates
“ATP Rate” is used to signify the number of price estimates that are produced automatically for scheduled patients, with no manual intervention.
Outpatient Radiology Baseline 1 Year
Post Go-LiveBaylor All Saints Medical Center at Fort Worth 19% 70%
Baylor Heart and Vascular Hospital 62% 60%
Baylor Medical Center at Carrollton 14% 65%
Baylor Medical Center at Garland 27% 84%
Baylor Medical Center at Irving 20% 80%
Baylor Medical Center at Waxahachie 4% 68%
Baylor Medical Center McKinney 21% 91%
Baylor Regional Medical Center at Grapevine 5% 66%
Baylor Regional Medical Center at Plano 24% 78%
Baylor University Medical Center Dallas 14% 77%
All facilities showing
significant improvement above their
implementation
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Baylor University Medical Center Dallas 14% 77%
The Heart Hospital Baylor Denton 43% 50%
The Heart Hospital Baylor Plano *- 100%
Total 17% 76%
implementation “baseline”.
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Pre-Registration Incentive Plan
Pre-Reg Incentive PlanCentralized Access Full Pre-Registration Representative (FPR) Point of Service Incentive Plan: The purpose of the FPR Rep Incentive Plan is to create a performance-based system that rewards employees who exceed monthly patient cash collection goals.
L h $48 000 $0
Full Pre-Registration Representatives will be awarded a monthly incentive bonus based upon their individual cash collections for a given month. In addition to the cash collection goal, the FPR Rep must meet the other requirements listed in the Bonus Structure section below in order to be eligible for the bonus.
FPR representatives must collect a minimum of $48,000 in order to qualify for a flat monthly bonus of $150. FPR Reps are also eligible for an additional bonus for each additional dollar collected over $48,000.
Bonus Structure:
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Less than $48,000 $0
$48,000 $150
$48,000 – $70,000 $150 + .25% on collections over $48,000
$70,000 - $100,000 $150 + .50% on collections over $48,000
$100,000 + $150 + .75% on collections over $48,000
Automated Dialing Software and Benefits
o Product Description: an automated software solution that places phone calls to patients identified for pre-registration activitiesp p g
o Key Features:
• Places automated calls to identified phone numbers• Provides ability to closely monitor staff activity• Allows staff to concentrate on speaking with patients, not on manual
dialingo Benefits:
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• Increases patient satisfaction by contacting patients in advance of service• Improve cash collections and reduces bad debt and write-offs• Improve staff efficiency with automation of previously manual tasks
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Example Staffing Improvement
IV Future Requirements FRP Current Requirements on the Phone
Total # of 34 Total # of 26
Required FTEs Required FTEs
Non‐Scheduled Scheduled Rad Pre cert FPR calls Actual 13 week average for 1
week 13 week average for 1 week13 week average for 1 week 13 week Average (Current)
Average Weekly Inflow 2672 Average Weekly Inflow 1512
Average Weekly Inflow 226
Average Weekly loaded Preregfull 4329
% Follow‐Up 50% % Follow‐Up 50% % Follow‐Up 0%Average Weekly loaded Preregonline 7518
Total Weekly Accounts 4008 Total Weekly Accounts 2268
Total Weekly Accounts 226
Total Weekly loaded Accounts X 33% 11847
Productivity/Rep/Day 45 Productivity/Rep/Day 45
Productivity/Rep/Day 30 Multiply by 33% 3909
Productivity/Rep Productivity/Rep
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Productivity/Rep/Week 225 Productivity/Rep/Week 225
Productivity/Rep/Week 150 Productivity/Rep/Day 35
Productivity/Rep/Week 175
Absence Rate 0.15 Absence Rate 0.15 Absence Rate 0.15 Absence Rate 0.15
Min. Reqd.21
Min. Reqd.12
Min. Reqd. 1 Min. Reqd.26
FTEs FTEs FTEs FTEs
Example Staffing Improvement
IV Requirements FRP Current Requirements
Total # of 34 Total # of 20
Required FTEs Required FTEsRequired FTEs Required FTEs
Non‐Scheduled Scheduled Rad Pre cert FPR calls Actual
13 week average for 1 week 13 week average for 1 week 13 week average for 1 week 13 week Average (Current)
Average Weekly Inflow 2672 Average Weekly Inflow 1512
Average Weekly Inflow 226
Average Weekly loaded Preregfull 4329
% Follow‐Up 50% % Follow‐Up 50% % Follow‐Up 0%Average Weekly loaded Preregonline 7518
Total Weekly Accounts 4008 Total Weekly Accounts 2268
Total Weekly Accounts 226
Total Weekly loaded Accounts X 33% 11847
Productivity/Rep/D 45 P d ti it /R /D 45
Productivity/Rep/D 30 M lti l b 33% 3909
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Day 45 Productivity/Rep/Day 45 Day 30 Multiply by 33% 3909
Productivity/Rep/Week 225 Productivity/Rep/Week 225
Productivity/Rep/Week 150 Productivity/Rep/Day 45
Productivity/Rep/Week 225
Absence Rate 0.15 Absence Rate 0.15 Absence Rate 0.15 Absence Rate 0.15
Min. Reqd.21
Min. Reqd.12
Min. Reqd. 1 Min. Reqd.20
FTEs FTEs FTEs FTEs
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Next Steps for Continued Improvement with Pre-Arrival Process
• Incorporate ‘preferred communication’ method into contact strategy – in progress
– Implement text messaging technology to improve contact and increase percentage of pre-registered patients
d– Implement Spanish automated messaging for Spanish-speaking patients - completed
• Enhance online pre-registration capabilities
– Develop mobile-friendly website
– Provide online price estimation capabilities – in progress
– Provide patient with ability to make payment online prior to service
• Centralize outpatient diagnostic scheduling to move towards “Schedgistration” model to schedule and pre-register patient in single phone call - in progress (Centralization completed for 5 facilities)
• P id i t t f l ti i t i t i t ti t ith i th i ti t d t f• Provide interest-free loan option prior to service to assist patients with paying their estimated out-of-pocket obligation – in progress
– Attempt collections on prior open balances
• Provide ‘work from home’ option for pre-registration staff once new contact center allows for remote recorded phone calls (Note: Insurance Verification staff already work 100% remote) – in progress
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Performance Improvement ExampleImproving Post-Discharge Patient Collections
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Self Pay Collection Timeline
Project Objective: To increase internal patient collections to improve the overall patient experience and reduce collection agency fees and costs associated with statements
2000
Facility Business Offices Centralized at
Corporate in One CBO
2003
Q2 2012
New Technology & Focused Process Improvement Implemented
Q4 2012
Manual Phone Calls Placed to Patients with Outstanding
Balance
Significant leap in collections
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2003
Online WorkdriverUsed to Identify Self
Pay Accounts Requiring Follow Up
Q4 2012
Customer Service & Self Pay Collection
Departments CombinedAutomated Phone Calls Placed to Patients with Outstanding Balance
Patient Billing & Collection Workflow
Patients now receive 3 statements and 4 phone calls over 120 days from the day the balance is due from the patient. Prior to implementing automated dialing technology, patients received 4 statements over 120 days and most patients did not receive any phone calls prior to being referred to a collection agency.
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North Texas DivisionCBS Customer Service Patient Collections
$2,262,744.26$2,500,000
$1,000,000
$1,500,000
$2,000,000
Average Monthly CollectionsFY 2012 Monthly Average = $779KFY 2013 Monthly Average = $1 3M
Automated Dialing Implemented
$590,367.70
$-
$500,000
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FY 2013 Monthly Average $1.3MFY 2014 Monthly Average = $1.8MFY 2015 Monthly Average = $2.0M
North Texas Division Online Patient Payments
$1,900,000
$2,100,000
$900,000
$1,100,000
$1,300,000
$1,500,000
$1,700,000
$ , ,
One-Time Payment Option Implemented
$500,000
$700,000
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Average monthly online collections increased by $500K with implementation of ‘One Time’ payment option. Patients previously had to enroll for online service to make payment.
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Collection Agency Fees
Reduced average monthly collection fees by $124K from FY 2012 to FY 2015. Annualized savings = $1.5M
$500 000 00
$600,000.00
$200,000.00
$300,000.00
$400,000.00
$500,000.00
Automated Dialing Implemented
Total Fees Monthly AvgFY 12 $3,307,579 $275,632FY 13 $2,461,060 $205,088FY 14 $2,121,745 $176,812FY 15 $1,824,824 $152,069
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$-
$100,000.00
Customer Service Incentive PlanCustomer Service Incentive PlanCentralized Business Services Customer Service Incentive Plan: The purpose of the Customer Service Rep Incentive Plan is to create a performance-based system that rewards employees who exceed monthly patient cash collection goals.
C S i R i ill b d d hl i i b b d h i i di id l h ll i f iCustomer Service Representatives will be awarded a monthly incentive bonus based upon their individual cash collections for a given month. In addition to the cash collection goal, the Rep must meet the other requirements listed in the Bonus Structure section below in order to be eligible for the bonus.
Customer Service representatives must collect a minimum of $75,000 in order to qualify for a flat monthly bonus of $150. Customer Service Reps are also eligible for an additional bonus for each additional dollar collected over $75,000.
Customer Service Representatives are not eligible for the broader Centralized Business Services monthly incentive plan that is based on total cash collections for the organization.
Bonus Structure:
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Less than $75,000 $0
$75,000 $150
$75,000 - $125,000 $150 + .25% on collections over $75,000
$125,001 - $150,000 $150 + .50% on collections over $75,000
$150,001 + $150 + .75% on collections over $75,000
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Old Baylor Statement New BSWH – NTX Statement
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Next Steps for Continued Improvement with Patient Collection Process
• Implement return mail and defaulted payment plan calling campaigns – completed
• Implement interest-free loan option for patients who are unable to pay balances in p p p p yfull – completed
• Implement new, patient-friendly statement – completed
• Implement electronic statements to reduce statement costs and improve patient experience – in progress
• Incorporate ‘preferred communication’ method into contact strategy – in progress
– Implement text messaging technology to remind patients of their outstanding balance
• Provide ‘work from home’ option for customer service staff once new contact center allows for remote recorded phone calls (Note: Billing & Collections staff are already 100%
remote) – in progress
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Continuous Improvement Overview
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Continuous Improvement Checklist
Engage leadership and staff at all levels to identify areas of opportunity Draft clear current state and future state process flows Identify key information technology needs and vendors who can meet those needs Maintain a written plan with systematic expectations and dedicated points of review Centralize and standardize functions where possible Develop dashboard of most important metrics and track at appropriate intervals (i.e.,
daily, weekly, monthly) Implement a staff incentive plan tied to most important metrics Translate efficiency gains into economic benefit (i.e., revenue or expense benefit) Audit new processes closely with staff level performance metrics
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Audit new processes closely with staff level performance metrics
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Contact Information
Sarah Knodel, CHFP, CRCE-I, CHAM
Baylor Scott & White Health
System Vice President, Revenue Cycle
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214-820-6842
