Making the Case for Central Scheduling Taking Control

Making the Case for Central Scheduling Taking Control of Your Schedules to Improve Revenues and Patient and Physician Satisfaction Jessica Mc. Kinney, AVP Patient Access January 16, 2015 © 2013 PARALLON BUSINESS SOLUTIONS, LLC

Introduction - Healthcare services, over the last few decades have trended from inpatient to outpatient settings - Outpatient visits doubled from 1990 – 2010, while inpatient admissions for that same period grew by just 13% - Efficient scheduling is vital to the financial health of the organization (hospitals, imaging centers, healthcare systems) - 2 Volume growth Physician and Patient satisfaction Maximizing the schedule Cost reduction Improved cash flow

Background - In 2009, Parallon was approached by HCA leadership with a request to create Central Scheduling units for 45 hospitals in 5 regional markets, concentrated in Florida, Georgia, and South Carolina - Parallon leadership leveraged experiences gained by the Richmond Shared Services Center which had implemented Centralized Scheduling in other HCA Markets - The project was completed over the course of a 1 year time period, with a new facility transitioning to each Central Scheduling location every 4 weeks - Subsequently Parallon has implemented this solution for additional HCA facilities and now operates 13 Central Scheduling Units, serving more than 110 hospitals and imaging centers - Parallon is also responsible for the management and support of a new consolidated Pre-Access center in Cincinnati, which will serve 21 hospitals in KY and OH for a non-HCA Parallon client 3

Building the Business Case for Central Scheduling The Challenges - Inconsistent scheduling department structure at each hospital - Some scheduling areas were decentralized and schedulers were managed by the ancillary departments while others were somewhat centralized into one department - Leadership of the departments had other priorities, not solely focused on the scheduling and pre-service process - Lack of sophisticated telephone system and other technology - No view into call volume, lost/abandoned calls, or hold times - No view into Customer Service issues - No view into volumes exiting the system when one facility had no availability for a particular modality - Inconsistent oversight, education and system knowledge - Inconsistent asset utilization with variability from hospital to hospital - Ancillary department staff had the access to block rooms and equipment 4

Centralized Scheduling Principles Increase Physician Office satisfaction – Offer physicians and patients a broader range of scheduling options – Have an “Always Yes” mentality – Consistency for physicians who practice at multiple facilities – Implement technology to prevent loss of orders Increase market share and optimize use of all assets – Reduce risk of losing patients to competing facilities as the result of appointment availability – Increase capacity by reducing variability in system setup – Conduct regular system reviews – Implement best demonstrated practices 5

Centralized Scheduling Principles Cont. Consolidate resources for scheduling – Reduce cost and improve productivity – Coverage for employees out on PTO – Optimize skill set utilization (clinical vs clerical resources) – Consistent education and standard policies and procedures Standardize and Increase Quality of Data Gathered – Define minimum data elements – Improve financial data quality to feed registration process 6

Centralized Scheduling Principles Cont. Provide Standardized Reporting – Resource availability – Call Center Statistics – Modality Comparisons – Physician Order Volumes Business Continuity – Weather Interruptions – System Downtime 7

Project Planning Leveraging Expertise from Within – Rapid design session – Data gathering – SME input – Toolkit development Leverage Parallon Project Services – Program timeline – Central unit timeline – Facility timeline 8

Central Scheduling Unit Locations Cincinnati Salt Lake City Richmond Denver Nashville Chattanooga Rome Atlanta Panhandle Why market based? • BCP purposes • Market based presence to retain quality staff • Management bandwidth • Successful model already tested 9 Orange Park Tampa Kansas City East Florida Houston

Centralized Scheduling Scope In Scope • Outpatient Diagnostic Imaging Services • Radiology • EEG/EMG/EKG • Cardio Pulmonary • Wound Care • Sleep Lab • IV Infusion • Respiratory Therapy • Special Procedures • Pre-admit testing • Cath Lab (in some facilities) Out of Scope • PT/OT/ST • OR/Surgery 10

Services Included Centralized Scheduling and Related Services - Insurance Verification - Pre-Registration - Authorization/Pre-certification - Order capture/indexing - Medical Necessity Screening when possible - Upfront Collections when possible - “Outpatient Service Coordinators” in key markets 11

What is the “Outpatient Service Coordinator” Model? - 12 Our response to competition in the market Rather than receiving calls in, makes outgoing calls Receives faxed orders from participating physician offices Contacts patients to schedule and pre-register Contacts insurance to obtain authorization and pre-cert for facility services Send of day reports showing scheduled, status, authorizations, etc. Physician’s offices call this unit for everything – personal feeling Includes non-hospital based Imaging Centers, Clinics, etc. Avg time associated with one appointment is 7 - 15 minutes rather than normal 90 second incoming call; Higher cost, less efficient Difference is no handoff to other reps for pieces of the whole Physician and patient response very positive

Critical Success Factors - Staff retention and employee transfers - Maintain or improve relationships with physician and office staff - Maintain or improve relationships with Ancillary Directors - Staff competency and knowledge - Technology - Dictionary refinement, standardization and maintenance - No loss of personal touch - Well documented processes - Improve performance and volume 13

Technology - Management of Multiple HIS solutions within several of the units - Physician Order Management - - Call Routing and Recording Insurance Eligibility Medical Necessity Automated Notice of Admission - 14 Hyland Central Scheduling Workflow Existing Technology – SCI Order Facilitator UHC Aetna

Physician Order Management • Fax Management Solution • Imports documents for indexing at patient level • Leverages HL 7 from HIS system for autofill keywords • • Patient Name Account Number Medical Record Number Physician • Ability to route documents received for special processing • Incomplete Orders • Pending • Additional tools • Reporting • “Virtual Print Driver” 15

Physician Order Management- Strawman 16

Physician Order Management- Final Product 17

Reporting – Key Performance Indicators General Statistics - % of OP procedures scheduled - % of procedures preregistered - Scheduling Unit Activity - # Orders/documents received - # Scheduling requests - “Physician Booking Report” 18 Call Activity -Abandonment Rate -Hold time (seconds) -Talk time (seconds) -Call Volumes – Incoming/Outgoing -Calls Presented/Calls Answered

2013 Call Center Volume Key Stats 1, 536, 289 Calls 2. 74 % Abandonment Rate 23 Second Average Hold Time 19

Registration Turn Around Time Comparison 20

POS Collection Improvement 21

What the Numbers Say - Aventura Hospital and Medical Center saw significant improvement in 2011 - POS Collections improved by 19% - Registration lobby wait times decreased by 8% - Registration begin to registration end times decreased from 4. 03 minutes to 3. 09 minutes; a 23% reduction - Total registration time improved by 19% - The number of patients waiting 10 minutes or less averaged 99% - 98% of encounters were pre-registered prior to the date of service - 97% of all encounters were verified - 94% of encounters requiring authorization included complete authorization 22

Key Lessons Learned - Support from the top and facility buy-in is critical - It can take up to a full year to work out all of the challenges - Rollout process involves significant time of responsible executives - Common facility concerns (loss of business, loss of control, favoritism, loss of facility identity) can be addressed by education and communication of the processes - Hospitals are often unaware of the control the techs have on the schedule prior to centralizing - Existing system builds often do not reflect actual scheduler activity – much is retained in their heads rather than the technology 23

Key Lessons Learned Cont. - New Dictionary builds are critical and must be reviewed/approved by facility Department Directors - Relationship with hospital management is very important, radiology in particular - Use marketing/sales staff to assist with physician office onboarding - New phone numbers (1 -800) are more work but provide for better BCP and less operating issues - Hospitals usually couldn’t measure data or stats precentralization, but may imply they did 24

Summary and Questions 25