Title: Billing Practices for Adverse Events
1An AHA Member Teleconference Series
Billing Practices for Adverse Events
2Billing Practices for Adverse Events
Childrens Hospital Regional Medical Center
Takes on Adverse Events and Billing June 24,
2008, 300 pm ET/1200 PM PT
Featured Speakers Patrick J. Hagan, President
and COO David M. Stallings, Director of Risk
Management
3Welcome to Childrens
4Who We Are
- 250 bed pediatric academic medical center
- Academic affiliation with the University of
Washington School of Medicine - Almost 4,000 employees
- 232,569 Annual Patient Visits
- 12,785 Admissions
- 10,869 Surgeries
- 33,773 Emergency Room Visits
- 176,608 Outpatient Visits
5Childrens Regional Service Area
- Regional Clinics
- Childrens Bellevue
- Childrens Everett
- Childrens Federal Way
- Childrens Olympia
- Childrens Tri-Cities
- Odessa Brown Childrens Clinic
- Outreach Clinics
- Central Washington
- Alaska
- Montana
- Neonatology and Hospitalists
- Evergreen Medical Center
- Providence-Everett Medical Center
- Overlake Medical Center
- Kadlec Medical Center
- Missoula, Montana
- University of Washington
- U
6What We Believe
Our Mission We believe all children have unique
needs and should grow up without illness or
injury. With the support of the community and
through our spirit of inquiry, we will prevent,
treat and eliminate pediatric disease. Our
Vision We will be the Best Childrens Hospital
7Leaning Out Adverse Events Building in
Quality
- Continuous Performance Improvement (CPI)
- Lean Methodology
- Standard Method of Improvement
- Engagement
8CPI- Our House
9Billing/Reporting Requirements
- Joint Commission Sentinel Events
- WA State Department of Health (late 1990s)
- The Leapfrog Group
- CMS
- WA State Hospital Association adopts policy to
waive charges for care related to never events
(2008)
10Handling Adverse Events
- Adverse Event Review Process
- Report In person or online incident reporting
- Determine appropriate review group
(departmental QI vs. serious event review team)
abbreviated) - Investigate and Analyze
- Develop action plan
- Ensure complete PDCA cycle
11Handling Adverse Events
- Sentinel Event/Never Event Process
- Engage in any immediate steps needed to protect
patients/staff - Immediate notification to senior administration
leaders, patient safety officer and risk manager - Initial disclosure to patient/family based on
current knowledge - Investigate and develop action plan including
follow- up with patient/family. - Report to appropriate areas and assess for
learning opportunities.
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15Tool and Process Development
- Process improvement relies upon providing
standardized methods and tools to staff - We identified an information gap that made it
more difficult to manage adverse events - Gaps included knowledge of event action
needed and action progress
16Data Management
- 5 years ago we switched from a paper based
incident reporting system to an online system - Incident input requirements were streamlined to
make filing an incident easier with less impact
on staff time - The system allows us immediate access to an
incident once submitted - Automatic notification is set into the system to
notify particular people/depts. when a certain
type of incident occurs
17Bill Hold Development
- We encountered an increasing number of complaints
that were coming in through our patient account
specialists - Some staff apparently didnt think through the
down stream effect of not addressing
complaints/issues at the time of service - It takes time to review these situations and
doing that so long after the time care is
provided was problematic
18Bill Hold Development
- We developed a simple email list which enabled
all staff to send a message to a core group that
could place a hold on any bill - Bill Hold list members represent Business
Services/Patient Accounts, Patient Relations,
Risk Management and CUMG. - Bill Holds used for serious/sentinel events,
quality complaints, service complaints and charge
corrections.
19Bill Hold Development
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21Tool Development
22Tool Development
23Tool Development
24Wed Rather Not Break It At All
25Knowledge Management
- We recognize that we cant optimize patient
safety and performance improvement unless we are
able to make all staff aware of problems and
solutions - Created a monthly patient safety conference
series - Developed a patient safety newsletter PSFYI
which is distributed to all staff
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27What questions do you have?