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10 Steps to Clinical Efficiency


Identifying the problem and communicate to key personnel ... Meetings scheduled weekly (except holiday weeks) ... Define MEPRS (personnel time, workload, expenses) ... – PowerPoint PPT presentation

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Title: 10 Steps to Clinical Efficiency

  • 10 Steps to Clinical Efficiency

  • Problem Statement
  • Getting Buy-in
  • Identifying the problem and communicate to key
  • Cooperation from all parties vital for success
  • How to Implement
  • The 10 Steps
  • Where they came from
  • What they are
  • Results
  • Data
  • Testimonial
  • Way Ahead

Problem Statement
  • Indicators point toward a need for improvement
  • Poor historical coding timeliness performance
  • Low RVU/ Encounter
  • Access grumblings
  • Process Improvement Teams (PIT Crew) developed
    and implemented FY04
  • Successful in clinics with strong leadership
  • Turnover in the clinics degraded performance over
  • Unsustained improvement due to leadership
  • A Permanent solution required a multi-faceted
  • Goal Improve everything about how the clinics
    work, make it easy for the clinics to perform

Getting Buy-in
  • Previously, problems were addressed independently
  • Leadership frustrated, tendency exists to fix
  • Solution build a framework that logically
    stepped through all business aspects of clinic
  • Sold to facility leadership as depot
    maintenance for clinics
  • Gave all support agencies a chance to work
  • Clinics allowed independent voice (no cookie
    cutter approach)
  • Must instill ownership
  • Identify a clinical rep and an admin rep for each
    clinic who own the results and are responsible
    to leadership
  • Engaged leadership

How to Implement
  • Build a Small Core Team
  • Leader someone with experience with clinic
    administration, data quality, and business
  • Direct support senior coding auditor, data
    quality manager
  • Role Keep project on track, report to leadership
  • Build expert specialty support teams
  • CHCS knowledge of file and tables, clinic
    design, keys, etc.
  • Documentation AHLTA application expertise,
    paired with coders
  • Others Manpower, coders, MEPRS, etc.
  • Create a shared place to share information
  • Responsibility, Documentation, Progress, Results

Rules of Engagement
  • Meetings scheduled weekly (except holiday weeks)
  • Consistent attendance from clinic leadership
  • Meetings last 1.5 hours and focus on agenda items
  • Some meetings will result in homework for clinic
  • Assist if needed, always review performance at
    each step
  • Senior leadership briefed at the conclusion of
    the project
  • All participants meet together to share
    experiences and learn from one another
  • Focus on 5 clinical areas at a time and realized
    great cross-feed amongst group

Identifying the 10 Steps
  • There is no one best way to run a clinic
  • There are certain things all clinics must
    accomplish to be successful
  • Each clinical environment has its own challenges
  • Clinic leadership must know WHAT must be done
  • As well as HOW to do it within their constraints
  • Objective Find the minimum necessary (process
    steps and execution detail) to ensure maximum
    production potential can be achieved
  • Ensure clinics know WHAT to do and then help them
    figure out HOW to do it without wasting time and

The 10 Steps
The Ten Steps to Clinical Business Efficiency
  • Staffing
  • Clinic Walk Through
  • CHCS Profiles
  • CHCS Templates and Schedules
  • Consult Process
  • AHLTA Use
  • Front Desk Process
  • Coding and Third Party Collection
  • Business Plan

  • Goal Let the clinic know what they earn and
    get feedback on how they utilize manpower
  • Invite Manpower personnel
  • Explain the manning documents
  • Clinic specific manpower documents are passed out
    in meeting so participants are familiar with
  • Discuss authorized versus assigned FTEs/ planned
    vs. reality
  • Explain proper procedures on how to correct
    disconnects (Authorized Change Request)
  • Share Whats New in Manpower
  • Outcome Reconcile manning documents, identify
    shortfalls for action (training, gap fill,
    contracts, rotations)

Clinic Walk Through
  • Goal Fix easy inefficiencies on the spot,
    identify clinic-specific barriers to success, and
    identify best practices
  • The core team visits each respective clinical
    area to review current business processes
  • Schedule visit during normal duty hours to
    observe clinic operations
  • Front desk check-in, flow of medical records if
    used, learn nuances of clinic, observe best
    practices to share with other clinics and take
    note of areas needing improvement
  • Visits should include NCOIC and Clinic Chief, no
    more than 2 hours
  • Outcome Clinic identifies with core team core
    team witnesses the real barriers

  • Goal Train clinic staff on impact and importance
    of MEPRS
  • Invite MEPRS personnel to meeting
  • Review roles and expectations of MEPRS monitors
    or designees in clinics
  • Define MEPRS (personnel time, workload, expenses)
  • Inpatient, Outpatient, Ancillary, Dental, Special
    Codes (External workload)
  • Review templates or procedures for accurate time
    reporting for clinical areas
  • Provide last personnel time submission to each
    specific clinical area during brief
  • Highlight common concerns such as annotating time
    for readiness and other special codes
  • Outcome MEPRS templates corrected, invigorate

CHCS Profiles
  • Goal Ensure maximum utility of CHCS PAS Menus
  • Review current profiles (Clinic Profile-CPRO,
    Provider Profile-PPRO)
  • Explain the purpose of each field (i.e. address
    and phone number fields are used by DMDC on
    enrollment letters for primary care locations)
  • Discuss importance of maintaining accurate
    settings in both CPRO and PPRO
  • Appointment detail codes, workload type (COUNT
    vs. NON-COUNT is very important in PPRO),
    durations, auto-reconfiguration
  • Inactivate providers that are no longer working
    in clinic
  • CHCS email bulletin is sent to SDSMGR mail group
    for other cleanup activities (NED groups,
    Provider and User files)
  • Outcome all clinic CPRO and PPRO fields

CHCS Templates/Schedules
  • Goal Ensure maximum schedule transparency and
    flexibility with minimum maintenance
  • Discuss the importance of schedule optimization
  • Review appointment demand in clinics to ensure
    enough appointments are offered to meet the
    access standards
  • Total duration of offered appointments should be
    compared to Clinical Available time in MEPRS
  • Remove old templates to eliminate inappropriate
  • Utilize Auto-Reconfiguration to maximize access
  • Ensure at least 30-45 days of the clinic schedule
    is open
  • Outcome Reconfigured templates and schedules
    with a minimum of 30 days of appointments open

Consult Management
  • Goal Educate clinic on consult routing process
    (ordering, appointing, and resulting)
  • Invite representation from Consult Appointing and
    Management Office (CAMO) and Referral Management
    Center (MTF)
  • Overview of current process
  • Discuss review statuses and routing procedures
  • Review current consult resulting metrics
  • Outcome Update electronic SOPs

  • Goal Integrate coding/ documentation/ clinic
  • Invite AHLTA trainers and Clinical Staff
  • Review updates since initial training
  • Recent software updates
  • Tips Tricks
  • SG Memorandum regarding compliance (utilization
    and appropriate use)
  • Discuss issues in each clinic
  • If they cannot be resolved in meeting, schedule
    follow-up meeting with staff
  • Outcome Increased AHLTA utilization, RVU per
    Encounter, Encounter per day

Front Desk Functions
  • Goal Identify all the must dos at the front
  • Customer service
  • Friendly, welcoming
  • Review primary duties of front desk personnel
  • DEERS eligibility checks
  • End of Day reconciliation between AHLTA and CHCS
  • Medical Records
  • Notice of Privacy, DD2569 etc.
  • Outcome Speedy front desk that gets all required

Clinical Coding
  • Goal Optimize documentation practice
  • Review coding practices
  • Measure coding timeliness (i.e. BDQAS)
  • Review recent coding audits
  • Address accuracy concerns, common errors
  • Review sample of record documentation (AHLTA and
  • Identify deficiencies
  • Recommend additions to AHLTA templates
  • Explain supervising provider vs. co-signer vs.
  • Outcome Improved documentation practice

Third Party Collections (TPC)
  • Goal Educate clinic on how TPC can help the
    facility, improve collection rate
  • Invite TPC personnel
  • Provide an overview of TPC program
  • Discuss mandate to collect DD2569
  • Discuss local procedures for optimization (i.e.
    Use of scanners to review OHI in CHCS)
  • Present clinic specific data for Billed vs.
  • QA with clinic staff
  • Outcome Streamlined 2569 collection process
    within the clinic operation

Business Plan
  • Goal Educate staff on how all the previous steps
    lead to productivity as measured by the business
  • Explain business plan
  • Provider productivity, RVUs, Prospective Payment
  • Educate the Staff
  • Reading the outcomes graphs
  • How to plan for future targets
  • Identifying areas for improvement from the raw
    performance data
  • Outcome Trained staff who can sustain
    performance with limited interaction and an
    increased business output

A Quick Note on Data
  • This endeavor begins and ends with data
  • Consistency of reporting tools is essential
  • We used three essential products
  • M2, BDQAS, and CHCS Ad-Hocs
  • We used an analysis cell that consolidated all
    the data into the reports you will see here then
    distributed them via SharePoint
  • While you dont need an analysis cell or
    SharePoint it makes the project much more

Results (Quad View)
  • RVU/Encounter 0.8 to 1.1 (38 increase)
  • RVU 17,229 to 20,630 (20 increase) monthly
    1,435 to 1,765
  • Encounters 22,819 to 21,433 (6 decrease)

Results (Quad View)
  • RVU/Encounter 1.07 to 1.50 (40 increase)
  • RVU 22,661 to 30,729 (36 increase) monthly
    1,631 to 1,941
  • Encounters 21,164 to 21,803 (3 increase)

Results (AHLTA Utilization)
Results (AHLTA Utilization)
Results (Testimonial)
  • It was challenging but being a new element leader
    I learned a lot about how my clinic should be
    running to be successful. I am very thankful
    (even though it was painful at times) for what I
    came away with and am still using those same
    processes today.
  • - Capt Foster, GYN Element Leader

  • It just works
  • The best outcome is business savvy leaders
  • The second best outcome is teamwork between admin
    and clinical staff
  • Way ahead/ lessons learned
  • Develop tools to better measure demand and access
    supply close to real time (i.e. David Grant
    Appointment HUD)
  • The unit of production is the appointment RVUs
    are only a consequence of this production
  • Although touched on in templates and schedules,
    there could be much more work done to really
    boost production
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