Healthcare
Service To Cash Improvement
Challenge:
Claims submitted to insurance providers resulted in an unacceptable level of denials. In these cases, service to cash transactions were breaking down. Services were provided but were either not paid for, or were paid at a level less than expected. This led to lost revenue and excessive time spent following up on denials. The objective was to reduce the number of denials and act upon remaining denials quickly, resulting in increased revenue and shorter collection.
ASI Solution:
Analysis of service to cash, in particular the denials, revealed that required information was often missing from billings; providers had not been adequately challenged in some denials and people submitting billing often coded in a manner that led to lower payment. Process improvements were made to ensure that required information was provided to the people submitting billing. The collections process was changed to more rigorously review all payments and denials.
Achieved Benefit:
Billing receipts for denials increased over 60% and other ‘policy constrained’ areas of the operation were reviewed.
Outpatient Testing
Challenge:
There was an unacceptable level of no-shows and last minute cancellations of outpatient tests, leading to wasted materials, unutilized test capacity and overtime. There was also a belief that there was a high level of payment denials because pre-cert procedures were not being followed. Reduce the number of no-shows and last minute cancellations, and ensure that provider pre-cert requirements are fulfilled.
ASI Solution:
Telephone surveys of patients revealed that a large number of patients who missed appointments often forgot them, or were unclear about the location of the test. Some patients arrived improperly prepared because they had forgotten the preparation requirements. It was discovered that while overall payment denials for the hospital were substantial, those attributable to pre-cert failures were much smaller than previously believed.
Achieved Benefit:
Test cancellations were reduced by 50%. Pre-cert denials were not addressed, but a separate project was launched to address all denials.
Operating Room Scheduling
Challenge:
Operating room schedules were nearly full despite the fact that there were many unutilized hours. Some surgeons were not moving patients to the hospital because they could not obtain time in the schedule. Plans were being made to add another endoscopy room at a cost of $300,000. Increase the amount of time the operating rooms are used for procedures. If possible, eliminate the need to build an additional endoscopy room
ASI Solution:
Analysis of the scheduled and used hours revealed that many prime hours were allocated to specific surgeons in blocks without regard to the procedure load. Unused block time could be assigned to other surgeons, but typically too late to be of practical use. It was also discovered that procedures scheduled to start at 8:00 am typically did not start until 8:30 am. The endoscopy room was found to be only 35% utilized, despite the appearance of being fully booked. Work was reorganized to ensure that the first procedures of the day started promptly at 8:00 am. Block time scheduling was revised to allow for easier reallocation of unutilized time slots.
Achieved Benefit:
Operating room scheduling changes resulted in 20% more procedures completed. In addition, the addition of the second endoscopy room was cancelled.
Neuroscience Institute for Seniors
Challenge:
A hospital wanted to create a unique neuroscience institute for seniors that targets seniors with symptoms like neuro pain, balance, and/or cognitive functions without having a template of prior success to guide the creation and implementation.
ASI Solution:
We recommended using LEO to identify and Listen to the internal and external customers in the new process; Enrich the new process by identifying the existing process with measures and then designing a new process with measures that created a world-class level of service; and Optimize this new process by not only implementing it, but ‘designing in’ the quality so that very few changes needed to be made once the new process was implemented.
Achieved Benefit:
External customers (both the patients and the caregivers of the patients who were often times the sons/daughters of the patients) were grateful for the reduced time of patient service from 3 weeks down to 2 days and the internal customers (the doctors and administrators) were grateful that they could work quickly, effectively and collaboratively to help their patients. Patient care and satisfaction increased as did revenues while costs decreased.
Medical Instrumentation
Challenge:
A large, successful American medical instrumentation company was experiencing increasing difficulty competing with Japanese and German offerings. The company enjoyed a proprietary technology. However, the competitors were gaining market share with lower cost, more reliable products.
ASI Solution:
The company engaged ASI Consulting Group to help improve their Product Development Process. Enhancements to the Product Development Process included intense interactions between engineers and customers, Quality Function Deployment, Pugh Concept Generation and Selection, and a disciplined Verification and Validation Process which met FDA requirements. Verification and Validation are associated with Prototype and Pilot Fix Cycles respectively. Earlier development programs needed several Prototype Cycles to achieve performance goals and meet FDA regulatory requirements. The new process called for a single Prototype Cycle with the intent to drive completion of product and process design prior to undertaking the manufacturing intent Prototype Cycle.
Achieved Benefit:
The next new product development programs far exceeded expectations. The development schedule was cut in half and the early introduction of the new, superior offerings helped the company to regain market share.
Emergency Department Wait Time
Challenge:
The most frequent complaint voiced about emergency department wait time to the Hospital CEO was that new patients experience long waits throughout their experience. Long waits to be admitted, long waits before receiving treatment, and even longer waits in the overall treatment process. Reduce the total wait time experienced by patients and increase their satisfaction with the overall emergency department experience. There were no expectations of financial results for this project.
ASI Solution:
Mapping the issues that were causing emergency department wait time to be longer, ASI examine key emergency department processes. Team members were observed operations and recorded data for actual visits on all shifts. The following were discovered: inconsistencies between shifts non-value-added activities opportunities to better coordinate scheduling of procedures patients often were unaware of their status. Differences between shifts were analyzed and best practices implemented. Some of the non-value-added steps were eliminated. Blood testing and other procedures were coordinated to minimize waiting. Patients were more thoroughly advised of current activities.
Achieved Benefit:
Overall wait time was reduced by 25%, resulting in improved patient satisfaction. In addition, the streamlining of the processes yielded annual savings of $200,000 in operating expenses.