Using Internal Resources to Improve Productivity

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• Using Internal Resources to Improve Productivity

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What We Really Did

• Improving Patient Care
• Through A Team Approach

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Introduction

• Impetus for Change
• Large budget shortfalls based on Business Plan
  RVU goals not being met
• Low leadership/provider knowledge in the
  relationship of clinical to business operations
• Suboptimal use of patient care resources
• Coding and business operations feedback to
  clinics staff was not linked well

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Introduction

• Challenges
• Maximize provider and staff education with a
  minimal loss of provider productivity
• Funding not available for external help
• Level of risks acceptable?

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Introduction

• Ground Rules
• Practice good medicine.
• No draconian measures, no off with their heads
  attitude. Marginalize but no direct attacks.
• No medical or coding fraud, no 5 page exams for
  sniffles
• Keep the needs of both the provider and patient
  in the forefront. Patient and provider centered
  care!

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Introduction
Our View
Patient centered care and provider centered care
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Approach

• Draft and Adopt a charter
• Engage Providers and CLINIC STAFF in interactive
  education
• Prioritize clinic training schedule based on need
• Focus on team improvement not individual bashing
• Establish timely performance reports for each
  clinic down to the provider level
• Command emphasis

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Implementation

• The command established total commitment towards
  this project.
• A multi disciplinary contact team was organized
  to analyze and educate every clinic.
• Key metrics provided feedback on performance

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Contact Team Schedule

• Aggressive schedule completed all clinics within
  six months.
• 4 Hour block of time
• 2 hour interactive presentation to all clinic
  staff
• Returned to clinic setting for one on one
  training
• and evaluation

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Sample Contact Team Brief
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Why Does It Matter?

• Better documentation of the health care being
  delivered
• Enable better tracking of chronic conditions
• Budget now based upon both the workload performed
  and the efficiency of producing
• To earn additional resources to re-invest in care
  services

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Total Appointments
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Primary Care RVUs
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Family Health Clinic RVUs
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Individual Provider RVUs
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Individual Provider Encounters
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The Difference 4 Hrs Makes
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The Difference 4hrs Makes
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The Difference 4hrs Makes
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RVU Improvement Basics

• Accurately record time spent performing patient
  care, performing administrative duties and
  unavailable time
• Thorough documentation of each encounter to
  include procedures performed
• Fully maximize clinic time by efficient use of
  appointment templates
• Properly train Providers on use of AHLTA

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FY 07 Raw RVUs
30 Growth
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Outpatient (RVU) Workload Earnings
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Coding Accuracy
If using BGAA Target of 16 RVU/FTE/day If using
BDAA Target of 14.74 RVU/FTE/day
36/33
18/16
12/11
Coders divided into teams of three Coders placed
in assigned clinics Personal working relationship
between coders and Providers Coders provide
training and immediate feedback to Providers
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Follow On Coding Support

• Weekly random audits by each coding team leader (
  Specialty, TMC, Primary Care)
• Immediate feedback to Providers on findings
• Prompt scheduling of one on one training when
  necessary

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Training and Education

• Coders and AHLTA trainer worked as a team to
  build customized templates
• 3 hours of coding AHLTA usage over-the-shoulder
  training (after briefing as needed customized
  training)
• Coders compared AHLTA coding screens with AHLTA
  provider screens
• Cleaned deleted codes from favorites list
• Ensure all codes are updated annually

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Next Steps

• Providers/Spt Staff (45 minutes) Clinical Process
  Group
• Staff use optimization - scheduling
• Coding
• AHLTA templates
• Clerks/NCOIC (45 minutes) Administrative Support
• DHMRSi
• Reception
• Summary