How do we do more with less?

How do we do more with less?
Kaizen, MPI and patient collections
Company History
Legacy Carilion Labs
1995
Consolidated lab
formed within
Carilion Clinic
2006
For-profit
subsidiary of
Carilion Clinic
formed
2006
Completed
a small
acquisition of
Rockbridge
Medical
Laboratory
February 2011
Carilion-Spectrum
becomes
Solstas Lab Partners
2008
Completed second large
acquisition of Innovative
Pathology Services (IPS)
2007
Completed
first major
expansion,
acquiring
Presbyterian
Reference
Laboratory
from Novant
Health System
March 2010
Merger of
Carilion Labs
and Spectrum
Laboratory
Network
October 2010
Completed
acquisition of
Doctors
Laboratory,
Inc. (DLI) of
Valdosta, GA
June 2011
Acquired Select
Diagnostics, Inc.,
adding offices in
Greensboro and
Raleigh, NC and
Lexington, VA
July 2011
Acquired Southern
Diagnostics
Laboratories of
Birmingham, AL
and expands into
the Southern region
June 2011
Acquired
Wilmington,
NC-based
Nextwave
Diagnostic
Laboratories
and Wilmington
Pathology
Associates
2000
Started growing
existing and
marketing new,
non-hospital
outreach clinics
and doctors
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2004 Acquired
Tennessee-based
MEDEX’s clinical
laboratory business and
Wellmont Hospital
Systems laboratory
operations
August 2011
Acquired Oracle
Diagnostic
Laboratories of
South Florida
Geography
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Solstas Billing
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Goals
• 
• 
• 
• 
Increase cash collection
Reduce bad debt
Reduce DSO
Reduce inventories
–  Data Entry
–  Order Edit - Unbilled
–  Claim Check
–  Submissions
–  Back End Denials
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Kaizen
People and Process
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Kaizen
“Improvement” or “Change for the best”
Refers to a philosophy or practice that is focused upon
continuous improvement.
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Vision Session
Who, What, When?
•  Overview of functional area and work process
•  Align Kaizen leader, introduce challenges, review
process
•  Target specific measurable gains & timeline
•  Identify resources
 Staff level (workers)
 Whole process
 Outside but supporting
•  Prepare…
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Kaizen Objectives
↓ DSO
↓ Inventory
↓ Expense
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The Kaizen
week
Day 2 Day 3 Day 1 Day 4 Day 5 10 10
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Process Mapping
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Kaizen #1
Order Edit
Current process:
•  Work assigned by edit type
•  Limited job aids and resources
•  Errors in data entry
•  Staff specialized in solving the edit types they were
assigned
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Kaizen #1
Order Edit
Results:
•  Work assigned by accession
“Single-piece-flow”
•  Intranet page generated to house resources and job
aids
•  System edits to prevent Input errors during data
entry
•  Training specific to error type across all staff
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Kaizen #2
Claim Check (Eligibility Verification)
Current process: •  Work assigned by problem, searching across mul=ple web sites •  Manual entry of notes to document ac=ons taken •  Time spent logging on to various web sites •  Inconsistent knowledge across staff of payer syntax and search techniques 14
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Kaizen #2
Claim Check (Eligibility Verification)
Results:
•  Formed teams of two, group and assign work by
payer, rotate quarterly
•  Automation of notes
•  Productivity Increase
•  Ongoing quarterly training
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Kaizen #3
Cash
Current process:
•  Manual process to create batches for posting
electronic remittance
•  High volume of paper for manual remittance
•  Productivity measures tracked manually
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Kaizen #3
Cash
Results:
•  Automate the process for creating &
assigning batches for electronic
remittance
•  Combine prepping & posting into a
single process
•  Paperless workflow – manual
remittance
•  Automated productivity reporting
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What did we gain?
•  “Work smarter, not harder”
•  Staff level empowerment
•  Continuous improvement – the cycle never
ends
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Master Patient Index
Technology
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MPI
Episodic  “Patient-Centric”
Leveraging eligibility and paid claims data
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Incomplete billing data
Patient Demographics Issues
“Dirty” or missing data
•  Patient address
•  DOB or gender
•  Partial insurance information
•  Eligibility failures
•  Accession-centric 21
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Master Patient Index
•  Patient-centric
•  Utilize paid claims demographics
•  Eliminate unnecessary eligibility
verification
•  Rapid implementation
•  Familiar product
•  Trusted vender relationship
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Data and Matching
Review data elements available for matching
•  Confirm position/location of data
•  Verify definition and use
•  Determine what data elements will be updated
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Data and Matching
Data used for patient matching
•  Patient first and last name
•  Patient address
•  Gender
•  DOB
•  SSN
•  Home telephone number
•  Client MRN
•  Policy number
•  Patient data is not client centric
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Data and Matching
Data update rules
Person Data
•  Patient demographics
Billing Data
•  Responsible party
•  Insurance information
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Validation of our ‘rules’
•  Allow data to process through MPI
•  Produce report of “MPI actions” to validate
Validation included
•  ‘Autofixes’ trump MPI
•  Date parameters for successful eligibility and paid
claims set correctly
•  MPI data matched 270/271 output or human
research
•  Identified need to modify our default billing type
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Beta
Isolate production activation to a select group of ‘safe’
clients
•  Nursing Home clients
•  Additional clients added a few at a time
Big Bang
Impact
Weekly inventory: 18k  10k
Continues to drop as MPI ages
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What we learned
•  Needed an ‘Exclude list’ of clients
o  Mix of client and insurance bill types
o  Client bill only accounts
o  Sensitive clients
•  Refine the timing of MPI updates
•  Store secondary insurance data
•  Added automated notes to accessions updated
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MPI stats
•  3.4M MPI records to date
•  1.5M MPI records verified
April
•  MPI updated 30% of our volume
Nov-Apr
•  1.9M patients seen
•  41% of patients seen more than once
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Next Steps
• 
• 
• 
• 
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Begin to eliminate 270/271 for ‘verified’ patients
Refine eligibility and paid claims dates by payer
Challenge ‘excluded list’
Align MPI updates with data entry queues
Patient Collections
Technology
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Patient collections
Issue
•  Limited POS cash collection
•  Largest contributor to bad debt
Objective
•  Increase patient collections
•  Decrease volume sent to outside agency
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LiveVox
Automated dialer
•  Outbound calling application
•  Select past due accounts (between 2nd and 3rd
mailer)
•  Dialer active during Customer Service hours & two
Saturday’s/month
•  Calls given priority in Customer Service queues
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LiveVox
Automated dialer
32% increase in Customer Service collections over
prior year
•  Existing staff
•  Nominal vendor expense
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Results
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2013
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2013
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2013
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Questions
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