SCORE POINTS with Your Physicians and Improve Patient Satisfaction Scores—Using Online Orders
An Interview with Mark Gaulding, Director of Scheduling, Admitting and Revenue Cycle, Eisenhower Medical Center
The Problem: Inaccurate Physician Orders
In July 2005, the Chief Financial Officer of Eisenhower Medical Center (EMC) issued a directive that all claim denials were to be eliminated by year-end. Medical Necessity and ABN-related denials for Laboratory services were continuing to climb to an all-time high of nearly $23,000 per month. And illegible or incomplete referring physician orders led to extended delays in patient registration, plunging satisfaction scores and unacceptable ambulatory wait times. Searching for a means to meet the challenge head on, EMC identified the primary culprit: inaccurate physician orders.
The numbers in red made it painfully obvious that what was needed was more than an internal bandaid. EMC needed a solution that would encompass and improve orders from all the referring physicians.
Managing the large medical complex in Coachella Valley, California, EMC leadership concentrated their search by conducting a baseline performance assessment of the ABN-related order denials and registration process.
The EMC performance improvement benchmarks extended throughout the entire outpatient ordering process with the goal of lessening or eliminating non-compliant/illegible denials and improving overall workflow.
EMC identified the primary Admitting/Registration reasons for denials (in order of dollars denied):
- ABN issues related to Emergency Room services
- ABN issues related to Laboratory services
- No insurance benefits or eligibility
- No authorization
A root cause analysis of the reasons for ABN laboratory denials identified the primary challenges as illegible and incomplete orders, lack of physician understanding of Medicare Medical Necessity policies and a skill deficit among Admitting and Registration staff in the critical areas of coding and medical terminology.
Discovering impediments to placing an order for outpatient services was the first place to start. This entailed reviewing processes and tools used to complete orders, as well as the individuals responsible for placing the orders.
“We had no organizational policy with respect to outpatient order compliance and completion,” said Linda Reagan, office manager. “Historically, our organization has never had any revenue cycle-related policies that were enforced within the physician community.”
As to the thousands of dollars that EMC was incurring each month in ABN-related denial charges, a root cause study revealed a key finding: all of EMC’s orders were handwritten.
“We had a really bad compliance problem because we didn’t have policy with respect to submission of accurate orders,” said Mark Gaulding, director of revenue cycle, admitting and scheduling services. “So registration was tasked with the operation from start to finish, causing a lengthy registration process and wait for the patient due to poor clarity of orders and physician communication. This confirmed that the challenges EMC was facing were intrinsically linked to the physician orders.”
The Goal: Establish Quantifiable Objectives
EMC key indicators included poor Press Ganey patient satisfaction scores, increasingly lengthy patient waiting times, climbing denials totaling close to $23,000 monthly and decreasing physician satisfaction scores. Using Laboratory as a critical area of need for physician order improvement, objectives were formulated:
- Improve Patient Satisfaction Scores:
Press Ganey Scores (patient satisfaction) had fallen dramatically since August 2005 (from a high of 92.8 to a low of 80.5 in February 2006), when EMC implemented
comprehensive Medicare LCD review at registration for lab services. - Reduce Patient Wait Times:
Patient wait times for Laboratory services had fallen dramatically from a high of 89.2 to a low of 71.4 in January 2006, after EMC implemented comprehensive Medicare LCD
review at registration. - Eliminate ABN-related Denials:
ABN-related denials for Laboratory services continued to climb to an all-time high of $22,996 in October 2005 for Medicare Medical Necessity-related denials. - Improve Physician Satisfaction:
Physician satisfaction for Laboratory services was plummeting (dramatic increase in daily complaint calls to administration) due to:- Patients’ frustration with wait time and length of stay
- On average 20 faxed orders per day were lost or not received
The Solution: Order Facilitator™
Charged with choosing the appropriate software solution from one of several reputable Access Management organizations, Gaulding was impressed with the physician friendly component of Order Facilitator. “We were confident that SCI Solutions’ Order Facilitator would rise to the occasion and demonstrate real return—we just had no idea how fast it would happen,” said Gaulding. “We are only in the early stages of implementation and are already seeing marked improvements.”
Then still in its infancy, Order Facilitator was tasked with a comprehensive EMC system implementation followed by a quantifiable results initiative.
EMC set out to achieve 100% electronic outpatient order capture:
- With Medical Necessity checks and authorization details
- Elimination of lost, missing, incomplete and illegible orders
- Better communication between the hospital staff and physicians
- Check-ins without patient delays associated with order issues
Following the assessment, EMC and SCI Solutions developed and implemented an ordering solution (including updating policies, procedures, job descriptions and identifying supporting technology build requirements). Ongoing management of performance measurement activities and the project itself kept EMC on time and on track.
“Partnering with SCI Solutions versus trying to do all the work ourselves allowed us to maintain the quality of care for our patients and to minimize the drain on our clinical resources,” said Gaulding.
The Results
EMC implemented SCI Solutions’ Order Facilitator in April 2006 in all of its ancillary services: Outpatient Imaging Center, Laboratory, Radiology, Cardio-Pulmonary, Physical Rehab, Nuclear Medicine, Infusion/ Transfusion, Respiratory and Sleep Lab.
The goals were simple. Gaulding hoped to improve workflow and manage100% of orders, including faxes, to significantly lessen or eliminate ABN-related denials. He could only hope that physicians would respond.
Following implementation, the results surpassed EMC leadership’s forecasted expectations by
a wide margin. Initial Order Facilitator volume estimates were 400 to 500 per month. Today, the
volume
averages more than 3,230 tests ordered monthly! More than 25 physician practices
(representing 46 physicians), as well as multiple clinics, are participating with an average
of two new practices adopting Order Facilitator each week.
Patient satisfaction scores for registration processes more than doubled since implementation. With Order Facilitator, patient order information is distributed to pre-registration and ancillary departments automatically. Each order is signed, authorized and verified for payment before the patient arrives, attacking both the challenge of patient satisfaction and the registration process head on.
Most significantly, Order Facilitator enabled Gaulding to not only improve the denial rate, but to eliminate the challenge altogether. The rate dropped from close to $23,000 a month lost in Laboratory alone all the way to zero losses in denials. His hope for physician response was more than realized.
“Before implementing Order Facilitator, our telephone capacity wasn’t sufficient to accommodate all the telephone and fax orders coming in and we were losing an average of 20 orders daily,” said Gaulding. “Now we don’t have those missed calls or misplaced faxes because everything is coming in through Order Facilitator.”
Considering that physician communication had been one of the toughest barriers to overcome, EMC leaders were pleased they had finally found a tool to increase and improve communication between physician offices and EMC facilities.
Linda Reagan, office manager of one of the first physician offices to implement, had this to say. “I haven’t done a paper order in months and I wouldn’t go back to that ever again. This cuts our time faxing and calling to follow up unwritten orders.”
The response to Order Facilitator from the staff at EMC has been overwhelmingly positive. Gaulding comments, “This is one of the first times that we’ve seen patient access staff happy with a new tool that we’ve provided.”
Today, EMC is proud to set an example to healthcare organizations across the nation with its technological advances and measurable improvements in ordering and care delivery. Knowing where the challenges were, gave leadership a clear vision of how to overcome them. Selecting robust, flexible software gave them the means. And, receiving enthusiastic participation from their physician community gave them the support they needed for success.
Just what the doctor ordered.
client quote:
“With SCI we reduced our lab monthly denials from $23,000 to 0, and increased utilization from 400 average orders a month to 3,230, as well as improved patient, physician and staff satisfaction.”
Eisenhower Medical Center
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