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December 2017

Dec 28
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The Ripple Effect of Reducing Data Entry Errors

The Ripple Effect of Reducing Data Entry Errors

By ASC Management, Leadership, Revenue Cycle Management No Comments

When claims are denied due to data entry errors made during patient registration, a ripple effect occurs. Payments are delayed, increasing accounts receivable days. Back office billing personnel must work with front desk staff to obtain corrected data, then resubmit claims, wasting precious time. Staff may blame one another for the errors, damaging employee morale and creating an unpleasant work environment. If denied claims build up, the potential to miss important follow up grows and valuable revenue can go uncollected. Profit margins decrease and ownership distributions suffer.

These were all concerns of mine when I faced my ASC’s data entry error rate of nearly 11% in January. I knew we could do better. We had to. So, I set a goal for our front desk staff: to reduce their data entry error rate to below 1%.

In August, we achieved that goal. Our error rate is currently 0.69%. Staff want to further reduce their errors. Given their determination and effort to achieve what they have, I believe they can accomplish any goal they set for themselves.

Here are some of the steps we took to achieve this impressive turnaround.

Review and Analyze Data Entry Error Log

Accountability is critical when striving to improve. To ensure we maintained momentum, we implemented weekly reviews of our data entry error logs. During these reviews, we evaluated each error to identify the cause. We then discussed what staff needed to do to avoid making similar errors in the future.

For example, we noticed our team made similar insurance errors month after month. Some of the errors related to not clearly identifying payers. Others were steeped in confusion around different plan types offered by a single payer. To reduce these errors, we printed examples of our most common insurance cards, highlighting key details needed by registration staff on the front and back of those cards. Laminating these examples provided staff with “cheat sheets” that helped improve accurate entry of insurance details.

Data Entry Double Check

Each morning, an assigned member of the front desk team printed out the schedule of the previous day’s cases. This individual then double-checked that patient data in our registration system to ensure accuracy. To minimize interruptions and distractions, this review was performed in a private office.

Staff also sought out opportunities to perform data checks during the registration process, particularly concerning error-prone areas. For example, the subscriber date of birth was a troublesome data set. When the patient is not the subscriber, both dates of birth (patient and subscriber) need to be recorded. These repetitive reviews helped our team increase data entry accuracy.

Front Desk Staff Input

To help further secure performance improvement, we frequently asked front desk personnel to share their ideas. After all, working these accounts every day gave them insight into areas leadership did not have. We carved out time during our meetings for staff to share thoughts and let us know where help was needed. We worked on fostering an environment where they felt free to express themselves and ask questions.

These meetings and conversations allowed leadership and staff to develop a closer relationship. I maintain an open-door policy. Staff are comfortable speaking with me outside of meetings which allows us to quickly respond to opportunities to make positive change.

To help our front desk team members succeed, we regularly ask if they have the tools they need to perform their jobs effectively. We are happy to honor requests when we understand how doing so will bring about improvements

Ongoing Front Desk Staff Meetings

Once our front desk staff achieved the data error entry rate goal and demonstrated an ability to maintain it, we didn’t stop our meetings. Rather, we decreased meeting frequency from weekly to monthly. Our monthly meetings provide us with time to review and discuss a summary of the previous month’s data entry error reports. Error trends are now a rarity. Our vigilance ensures new trends aren’t developing and significant time isn’t passing without detection of potential troublesome areas.

Eye on the Prize

Ongoing updates on performance is the primary reason our front desk team members were so successful in lowering their data entry error rate. As we instituted improvements, they anxiously awaited delivery of the next data entry error log. They wanted to gauge their performance and find out if their hard work was achieving the desired results. Disappointment set in when the error rate did not decline or drop as much as they hoped. Fortunately, they used their disappointment as motivation to be proactive and seek additional opportunities for improvement.

I see tremendous value in providing our front desk staff with achievable, measurable goals. This team is now working on a new objective – capturing information about patients’ primary employers. Because this is a new process for them, team members occasionally fail to capture this information. We evaluate staff performance in this area monthly and work to determine reasons why our capture rate is not 100%. That’s our goal, and we know it’s obtainable. Why? Because it is a figure achieved by other Pinnacle III managed facilities, and our staff knows it. Now there’s some friendly competition between facilities.

The Ripple Effect

The positive ripple effect our ASC experienced when our front desk team reduced their data entry error rate to less than 1% was significant.

  • In January, when our error rate was 11%, our average accounts receivable (A/R) days was 28. When we reduced the error rate to 0.69% in August, our average A/R days decreased to 20.
  • Our claims-to-payment days declined – from 34 days in the first quarter of 2017 to 31 days in the third quarter.
  • We experienced a reduction in bad debt – from 4% at the end of 3rd quarter 2016 to 3% during the same timeframe in 2017. While the drop in bad debt is attributable to the improved efforts around upfront collections, it underscores how focusing on troublesome performance indicators can produce meaningful change.

Financial improvements have not been the sole byproduct, however. A transformation has occurred among our front desk personnel.

  • They are more engaged and eager to learn about their performance.
  • They more fully understand how their efforts affect our facility which motivates them to continuously strive for excellence.
  • Their relationship with leadership is truly collaborative.
  • Our governing board, which reviews the financial data, has expressed pride in and appreciation of front desk staff performance.

My concern with the damaging ripple effect that could have occurred when our data entry error rate was 11% subsided as progress was made by our front desk team. Our focus on, and improvement in, this area has made a difference. Our ASC operations were positively transformed in a sustainable way.

Michaela Halcomb, Director of Operations

Dec 18
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Relieving the “Financial Pain” of Surgery via an ASC Financial Counselor

Relieving the “Financial Pain” of Surgery via an ASC Financial Counselor

By ASC Management, Leadership No Comments

With more employers offering high-deductible health plans as an affordable insurance alternative, health care providers recognize their patients’ out-of-pocket financial responsibility is steadily increasing. ASCs often struggle with adeptly handling patient communication regarding this monetary component of surgery. It is challenging enough for most patients to understand the nuances of their health insurance plans without adding the potential stress of thoroughly evaluating their personal financial obligations for each episode of care. Patient satisfaction surveys frequently reflect this stressor. However, this added challenge is easily avoidable with clear, advance communication. Many ASCs have responded to this patient need by adding a financial counselor to their staff.

Educating patients is the most effective way to minimize confusion, maximize time of service collections, and increase patient satisfaction. Reading an explanation of benefits (EOB) can be daunting. Deciphering up to four EOBs for one surgery can be downright overwhelming and, in some cases, shocking. In 2015, 77 percent of consumers reported they were confused by the explanation of benefits they received from their health plan. Seventy-six percent were confused by bills from their providers. By the time a patient is scheduled for surgery, they have often received an estimate of charges and made a payment to their physician’s office, not realizing there is a separate financial obligation to the facility and, in many cases, the anesthesiologist and/or pathologist.

Creating an ASC financial counselor role ensures your facility has a dedicated person responsible for patient communication and financial education in advance of surgery. The ASC financial counselor also plays an integral part in preparing cost-benefit analyses and providing the details to management for consideration.

When contemplating the addition of an ASC financial counselor, items you may want to evaluate include the following:

  • Is the ASC maximizing time of service collections?

    • A financial counselor will improve the percentage of up-front collections through patient education and setting expectations. Advance communication allows patients the time necessary to plan for their financial outlay. By adding an ASC financial counselor, patients receive this information in a timely manner, depending on when the surgery is scheduled.

  • Does the ASC have a high percentage of bad-debt write-offs or accounts in collections?

    • A high percentage of write-offs and accounts referred to collections is indicative of failure to maximize up-front collections or develop formal payment plans. In contrast, a dedicated financial counselor clearly communicates the financial obligation to the patient and formulates a plan for payment in advance of the patient’s episode of care. This includes a written contract if payment is not made in full by the day of surgery, thereby eliminating confusion and creating a firm commitment of payment from the patient.

  • Is the ASC aware of the costs associated with the cases they perform?

    • ASCs, like other businesses, must evaluate which surgeries consistently lose money. The ASC financial counselor is tasked with flagging such surgeries and assisting with minimizing up-front losses. Oftentimes, properly evaluating and documenting these surgeries will provide your payor contracting team with the leverage they need to negotiate proper reimbursement.

  • Is the ASC receiving negative feedback regarding finance on patient satisfaction surveys?

    • Patients will be much more pleased with their overall experience if they fully understand their financial obligation and do not face unexpected or minimal post-surgery expenses when their EOBs arrive.

  • Does the ASC have the case volume to support a full-time or part-time position or can this responsibility be added to an existing employee’s job description?

    • A high-volume center will benefit from adding this position as a full-time role. This person provides a final verification of demographics, as well as confirmation of insurance authorization, leading to fewer avoidable denials. A financial counselor is valuable to every ASC, regardless of size. If the center cannot support this position independently, consider adding the responsibilities to an existing front-desk role.

An ASC financial counselor typically reduces frustration for patients as well as staff. Having a person dedicated to this role improves collections, reduces bad-debt, decreases avoidable insurance denials, and minimizes financial losses due to poor reimbursement, all of which bringing substantial value to the ASC.

Lori Tamburo, Director of Operations

Dec 13
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Responding Appropriately to a Disruptive Employee

Responding Appropriately to a Disruptive Employee

By ASC Management, Leadership No Comments

A thriving ASC runs like a well-oiled machine. However, even the gears of a well-oiled machine can slip creating minor issues that disrupt performance or major issues that can bring performance to a halt.

Some of the gears in your ASC are your employees. When they follow outlined procedures and fulfill their job responsibilities, operations typically run smoothly. However, when an employee becomes disruptive, like a malfunctioning gear, significant problems can occur. Disruptions can –

  • Undermine the culture of safety,
  • Distract staff from attending to their responsibilities which can affect safety, financial performance, and regulatory compliance,
  • Contribute to a decline in staff morale,
  • Increase staff turnover,
  • Weaken staff confidence in management/leadership, or
  • Create legal issues (e.g., patient negligence, physical or verbal abuse).

While there are common steps taken in response to any disruptive employee, different types of disruptive employees require different approaches.

Long-Term Well-Performing Employee Who Suddenly Becomes Disruptive

Good employees are hard to find. Well-performing, experienced employees are difficult to replace. But even the best employees can become disruptive. An employee may act out due to an internal conflict or an external issue that carries into the workplace.

Make time to have a one-on-one discussion with this employee. Be honest and direct about why you are engaging in the conversation. Provide the employee with a description of the disruptive behavior and share personal observations. Straightforwardly pose the question, “What’s going on?” That may be all it takes to obtain an explanation. Provide assistance, when it’s appropriate to do so.

If this conversation fails to bring about a resolution, turn to your human resources policies. If you are dealing with a safety and/or behavior issue, and a policy speaks to these matters, review the applicable language with the disruptive employee. Share a copy of the policy with the employee. Then provide a performance improvement plan outlining expected behavioral changes. Identify a specific timeframe to demonstrate improved performance. Clearly explain the consequences of failure to comply with the plan.

New Hire

You’ve put in the time to find, interview, hire, and orient a new employee. When you learn this individual is disruptive, take a deep breath. Before you stress about having to go through the hiring process all over again, understand that new hires often struggle during their initial employment period.

But don’t stop there! Immediately sit down with the employee and discuss the disruptive behavior. Share your observations. Explain why the employee’s actions are not acceptable. Review your employee handbook with the employee, specifically focusing on pertinent areas – your code of professional conduct and disciplinary procedures, for example. Outline what the employee needs to do to avoid discipline and possible loss of position.

Note: The hiring and training process is time-consuming. Losing a new employee, while easier to handle than losing a senior employee, is not optimal. Ensure you employ a sound interview process that affords you the best chance of hiring the right people the first time around. Ask appropriate questions and dig below the surface to gain insight into your candidates’ answers. Develop a comprehensive onboarding process and sound competency training program. Hiring smart and clearly establishing expectations at the outset positions new employees for success.

Well-Performing Employee in Their Department, Disruptive Employee Elsewhere

You have an employee who is great at their job. They fulfill their responsibilities and receive high marks from managers and co-workers within their department. But when they step outside of their work area, they become disruptive. It’s an unfortunate development that requires action.

Investigate the situation. Speak with the individuals affected by the employee’s disruptive behavior to learn as much as you can about the employee’s actions. Sit down with the employee and explain how his or her actions may be indirectly affecting the performance of their own department and the ASC’s ability to deliver the best possible patient experience. Sometimes, these employees need to be reminded they are expected to maintain the high level of professionalism and excellence they demonstrate in their department throughout the entire facility.

Long-Term Disruptive Employee Who Was Never Disciplined

A new ASC manager learns of an employee whose disruptive actions and/or behavior were ignored by previous leadership. Unfortunately, this is not an ideal start to a new position. If the new leader wants to earn the respect of all ASC staff, action is imperative.

Review the employee’s personnel file to find out if previous managers spoke to the individual or took any action. Speak with affected staff members to learn all you can, documenting any information not included in the file.

Again, sitting down with the employee is necessary. Make it clear the disruptive actions were never acceptable and must now stop. Establish clear expectations regarding future behavior. Provide the employee an opportunity to share their perspective and address whether they believe they can meet your expectations.

While a new manager will not know this employee well, a respectful discussion is vital. Avoid a confrontational tone and negative expressions. The employee may not have realized their behavior was disruptive or understood the harm caused by their actions. A supportive manager who provides positive guidance may be all that is necessary to resolve even a long-term problem.

Rely on Your Policies

Managers faced with any type of disruptive employee behaviors are well-served when they follow their ASC’s policies and procedures. Doing so helps ensure consistency in addressing behavioral incidents and maintaining regulatory compliance.

Managers should prepare to follow through on outlined consequences even if it means firing a valued employees. A disruptive employee can place significant strain on your well-oiled ASC; but a manager who does not respond appropriately may cause irreparable damage.

Jennifer Arellano, Director of Operations

Dec 06
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Overcoming ASC Management Nightmares: Physician Engagement

Overcoming ASC Management Nightmares: Physician Engagement

By ASC Management, Leadership No Comments

Third installment in the “Overcoming ASC Management Nightmares” blog series. Click here for Part 1 and Part 2.

ASC Management Nightmare #3: Physician Engagement

There’s no denying the importance of physicians performing procedures in ASCs. After all, without procedures, there is no ASC business. When physicians view performing procedures as their primary purpose in supporting an ASC, they may overlook the importance of physician engagement – a vital component of ASC operations.

Regulatory bodies expect to see ASC physicians – specifically owners – involved in all aspects of the organization. Compliance issues may arise when physicians fail to take an active role.

In addition, when physician engagement is lacking, financial problems can quickly arise. For example, in the absence of physician oversight, an individual’s desire to perform more procedures may lead to the addition of cases or purchasing of equipment that does not deliver a positive return on investment.

When physicians hire ASC management staff, they often intend to pass off the responsibility of running the ASC business. Managers must ensure physicians understand their required role in operations and its critical importance to the ASC’s success. This task is typically easier said than done.

Solution

Data is naturally attractive to physicians. Many of them likely chose to pursue a career in health care because it is a data-driven business. Consider statistics like life expectancy, death expectancy, surgical success rate, percentage of risk – physicians are used to sharing this type of information with patients.

To improve our ASC’s physician engagement, we’re working to cater to their love of empirical decision-making. In the past, we often relied on providing hand-collected and anecdotal data to help physicians make informed decisions regarding business operations. But since this data was not scientifically objective, it was not always effective in achieving our desired results.

To combat this perception, we are implementing computer programs that allow us to refine that data so it’s “hard and true.” These programs measure numerous data points in areas such as quality, volume, and case costing. We have used this concrete data in presentations to physicians and witnessed an emotional change. They are more willing to accept, assess and respond to the information. Physician engagement in ASC management is shifting from passive to active.

Lisa Austin, VP, Facility Development