Penn State Hershey Medical Center

1. Penn State Hershey Medical Center

2. Penn State Hershey Medical CenterOutpatient Pre Arrival Services • Presenters • Mary Stephens, Manager, Inpatient Access – Previously a Coordinator in Outpatient Pre Arrival Services (6 yrs) • Linda Cranston, Manager, of Out Patient Pre Arrival Service • LeAnn Stringer, Manager, Eclipsys Application

3. Penn State Hershey Medical Center • 500 bed Tertiary Care Academic Medical Center • Adult and Children’s Hospital • Level 1 Trauma Accreditation (adult/pediatric) • Penn State Cancer Institute • 588 Faculty Physicians

4. Annual Clinical Activity • Inpatient admissions – 27, 615 • OR Cases • Inpatient – 10,125 • Outpatient – 6,564 • Emergency Room visits – 47,163 • Outpatient Visits • Booked - 1,412,255 • Actual - 779,520

5. HMC Systems • Eclipsys AM/PFM • Eclipsys Registration data interfaces to 20 systems Other Systems used at HMC • Cadence (Scheduling) • Cerner Clinicals • GE Centricity (Radiology) • Mysis (Laboratory) • Pyxis • Seimens (Signature-Professional Billing)

6. Redesign of Front End Processes • Multi-Disciplinary Team Approach • Patient Financial Services (PFS) • Nursing • Physicians • Inpatient Access • Health Information Services • Information Technology • Representatives from various outpatient clinics

7. HMC Identified Financial Opportunities • Reduce Accounts Receivable • Hospital & Physician AR • Reduce write offs (revenue deductions) • Decrease check in time for outpatients

8. Team Recommendation • Form the Outpatient Pre Arrival Services (OPAS) Department (2001) • OPAS Goal • Obtain accurate patient and insurance information prior to the outpatient visit to ensure full reimbursement of services • Facilitate gathering and verification of sensitive information to ensure HIPAA compliance and increase patient satisfaction

9. OPAS Department Goals • Decrease facility accounts receivable days from 86 to 45-55 • Decrease professional account receivable days from 81 to 51-57 • Decrease facility write offs from 3.2% to 1.3-1.7% • Decrease professional write offs from 2.8% to 1.3-1.6% • Decrease average check in time from approximately 6 minutes to less than 1minute

10. OPAS Staffing • Initial Pilot (3 month period in 2001) • 4 new FTEs • 2 clinics (Dermatology and OB/GYN) • Currently • 70 FTE’s (existing and new staff) • 43 clinics

11. Pre-Arrival Processes

12. Pre-Arrival Processes

13. System Enhancements • Scheduled appointments 28 days out (Cadence Report) • Eclipsys pre-clinic visit creation • Eclipsys Worklists by service and location • Identify & refer S/pay accounts to Financial Counselor

14. Self Pay Process • Price estimate of service is obtained • Review patient’s account for payment history • Credit report • Patient is contacted • Provide estimated cost of service • 75% of estimate is requested • MA process is discussed • Financial Risk process • Physician makes the decision (based on medical necessity) whether appointment is canceled or postponed

15. Improved Outcomes in Clinics • Decreased denials due to 100% verification of insurance and ability to obtain referrals and authorizations prior to the clinic visit • Reduced check in/check out time for patients • Increased point of service cash collection • approximately $750,000 monthly

16. Financial Improvement Outcomes • Facility accounts receivable days reduced from 86 to 45 • Professional accounts receivable days reduced from 81 to 45.2 • Facility write offs reduced from 3.2 % to less than 0.5 % of revenue • Professional write offs reduced from 2.8% to less than 0.5 % of revenue

17. Conclusion • Questions