When work sits idle on an assembly line, manufacturers like Toyota lose money. Healthcare may not be delivered by conveyor belt, but slowdowns in the billing chain can still plug up the process of turning patient care into revenue.
Businesses have modeled "Lean" productivity-building frameworks off Toyota's hyper-efficient methods. Leaders in the healthcare industry shared their experiences implementing Lean policies in their organizations in an April 11 webinar titled "Improving cash flow through Lean efforts," hosted by Premier healthcare alliance.
Kathy Smith, business manager of Alamance Regional Medical Center Cancer Center in Burlington, N.C., kicked off the discussion by explaining the cancer center's adoption of Lean methods to confront its $2.3 million backlog in unbilled claims.
1. Meet. To begin, executives from her hospital in fall 2011 coordinated a week in which members from every step of the billing workflow, including nurses and hospital executives, met for five eight-hour days to brainstorm, goal set and devise a plan of attack.
"We really wanted to make sure we had everyone at the table to get involved with our goals," Ms. Smith said. At first, attendees were skeptical that convening employees from such broad roles throughout the hospital would be valuable to finding a solution. But, they realized by the end that sharing their interaction in the billing process gave needed insight to help find where waste occurred and where and how it could be feasibly prevented, she said.
Yes, the initial time commitment is significant, said Premier Senior Consultant Chad Grant Oakley, who works with Alamance. But, he said, frontloading the planning accomplishes 40 to 50 hours of planning in one week that would otherwise take a year of hour-long weekly meetings. That not only keeps all parties on the same page when changes are launched, but it allows for better accountability and easier on-the-spot adjustments while plans are implemented, he said.
2. Brainstorm and prioritize solutions. During the planning week, attendees made diagrams of the billing workflow using Post-its describing each step of the process and each department's role in advancing claims. From here, the team identified "pain points" that clogged up outputs.
Coders at the meetings visualized the coder workflow, showing how they first wrote codes on paper, sent those sheets to billing for processing, who finally submitted those claims to IT for entry into the company's database.
Once identified, attendees brainstormed possible solutions and improvements to the current system, then prioritized those solutions into four groups based on how cost and time effective each would be. That helped the team to see multiple ways to confront the problem at the lowest cost and with the greatest chance of successful follow-through, Ms. Smith said.
3. Implement. It was clear that coders were overworked at Alamance, Ms. Smith said, and that demands in billing were far greater than the manpower available. That led to hiring another employee to help ease the workload, which immediately improved productivity, but the greatest gains came from streamlining the process.
The hospital installed software that allowed coders to input codes directly into the database, which also increased accuracy and timeliness of coding entries by eliminating unneeded steps and unnecessary exchanges of information. That change took about three months to train staff members and install the necessary technology to make the plan possible, but other changes made at the ground level began producing positive results within the first week, Ms. Smith said.
4. Hold members accountable. Within 90 days after the week of meetings, the cancer center had sped up its revenue cycle turn around by 33 percent. And, the center's $2.3 million in backlogged claims shrank to approximately $1.55 million, Mr. Oakley said, but that still fell short of senior management's goal of bringing unbilled claims down to $500,000. The ideas were good ones, so Mr. Oakley wondered why the improvement wasn't reaching the desired target.
The team decided there was too little accountability for those responsible for implementing the changes. "One of the biggest challenges we faced was not realizing the importance of accountability and the way in which you turn the project over to the department or how the team members take ownership," he said. "I just don't think we understood how important that would be to the success of the team."
After adding accountability measures, the results jumped dramatically. Alamance's cancer center brought its monthly unbilled claims down further, from $1.55 million to just $92,000 in its best months, representing a 96 percent reduction from its high of $2.3 million in unbilled claims.
Constant tracking and tweaking to the billing process and staff expectations are needed to keep cash flow positive and eliminate stagnant unbilled claims from piling up, Mr. Oakley said. But empowering staff members to identify and address waste at the ground level helps to maintain those efficiency improvements organically without the need to devote an entire week to planning sessions. "Our solution, we think, is to educate more people, get more looking for waste in their area and using others to become more of a facilitator," he said, "giving more people the right education and the right tools so they can do a better job.
"It's as much a culture change and change management than anything else," he continued. "We were thinking more of the tools when we started, but it goes beyond that. I think you can be successful with the tools, but only to a certain point.
"We may not have the perfect approach, but I think spreading it the right way…will definitely make us a better place," he concluded.
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Businesses have modeled "Lean" productivity-building frameworks off Toyota's hyper-efficient methods. Leaders in the healthcare industry shared their experiences implementing Lean policies in their organizations in an April 11 webinar titled "Improving cash flow through Lean efforts," hosted by Premier healthcare alliance.
Kathy Smith, business manager of Alamance Regional Medical Center Cancer Center in Burlington, N.C., kicked off the discussion by explaining the cancer center's adoption of Lean methods to confront its $2.3 million backlog in unbilled claims.
1. Meet. To begin, executives from her hospital in fall 2011 coordinated a week in which members from every step of the billing workflow, including nurses and hospital executives, met for five eight-hour days to brainstorm, goal set and devise a plan of attack.
"We really wanted to make sure we had everyone at the table to get involved with our goals," Ms. Smith said. At first, attendees were skeptical that convening employees from such broad roles throughout the hospital would be valuable to finding a solution. But, they realized by the end that sharing their interaction in the billing process gave needed insight to help find where waste occurred and where and how it could be feasibly prevented, she said.
Yes, the initial time commitment is significant, said Premier Senior Consultant Chad Grant Oakley, who works with Alamance. But, he said, frontloading the planning accomplishes 40 to 50 hours of planning in one week that would otherwise take a year of hour-long weekly meetings. That not only keeps all parties on the same page when changes are launched, but it allows for better accountability and easier on-the-spot adjustments while plans are implemented, he said.
2. Brainstorm and prioritize solutions. During the planning week, attendees made diagrams of the billing workflow using Post-its describing each step of the process and each department's role in advancing claims. From here, the team identified "pain points" that clogged up outputs.
Coders at the meetings visualized the coder workflow, showing how they first wrote codes on paper, sent those sheets to billing for processing, who finally submitted those claims to IT for entry into the company's database.
Once identified, attendees brainstormed possible solutions and improvements to the current system, then prioritized those solutions into four groups based on how cost and time effective each would be. That helped the team to see multiple ways to confront the problem at the lowest cost and with the greatest chance of successful follow-through, Ms. Smith said.
3. Implement. It was clear that coders were overworked at Alamance, Ms. Smith said, and that demands in billing were far greater than the manpower available. That led to hiring another employee to help ease the workload, which immediately improved productivity, but the greatest gains came from streamlining the process.
The hospital installed software that allowed coders to input codes directly into the database, which also increased accuracy and timeliness of coding entries by eliminating unneeded steps and unnecessary exchanges of information. That change took about three months to train staff members and install the necessary technology to make the plan possible, but other changes made at the ground level began producing positive results within the first week, Ms. Smith said.
4. Hold members accountable. Within 90 days after the week of meetings, the cancer center had sped up its revenue cycle turn around by 33 percent. And, the center's $2.3 million in backlogged claims shrank to approximately $1.55 million, Mr. Oakley said, but that still fell short of senior management's goal of bringing unbilled claims down to $500,000. The ideas were good ones, so Mr. Oakley wondered why the improvement wasn't reaching the desired target.
The team decided there was too little accountability for those responsible for implementing the changes. "One of the biggest challenges we faced was not realizing the importance of accountability and the way in which you turn the project over to the department or how the team members take ownership," he said. "I just don't think we understood how important that would be to the success of the team."
After adding accountability measures, the results jumped dramatically. Alamance's cancer center brought its monthly unbilled claims down further, from $1.55 million to just $92,000 in its best months, representing a 96 percent reduction from its high of $2.3 million in unbilled claims.
Constant tracking and tweaking to the billing process and staff expectations are needed to keep cash flow positive and eliminate stagnant unbilled claims from piling up, Mr. Oakley said. But empowering staff members to identify and address waste at the ground level helps to maintain those efficiency improvements organically without the need to devote an entire week to planning sessions. "Our solution, we think, is to educate more people, get more looking for waste in their area and using others to become more of a facilitator," he said, "giving more people the right education and the right tools so they can do a better job.
"It's as much a culture change and change management than anything else," he continued. "We were thinking more of the tools when we started, but it goes beyond that. I think you can be successful with the tools, but only to a certain point.
"We may not have the perfect approach, but I think spreading it the right way…will definitely make us a better place," he concluded.
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