Aligning Organizational Priorities: Integrating the Physician to Drive Operational Success

Transcription

1 Aligning Organizational Priorities: Integrating the Physician to Drive Operational Success Mary Beth Briscoe, CPA, MBA, FHFMA, FACHE Chief Financial Officer-University Hospital Elizabeth Turnipseed, MD, MSPH, FACP Assistant Vice Chair of Clinical Affairs, Department of Medicine

2 Presentation Outline Organizational Overview Setting the Stage Strategic and Operational Opportunity Organizational Benefits and Purpose Putting it All Together Role and Responsibilities Organizational Structure Challenges Measuring Success Current Accomplishments Future Goals Questions / Discussion Page 2

3 Organizational Overview: UAB Medicine UAB Hospital UAHSF TKC & Other clinics Callahan Eye Hospital School of Medicine Page 3

4 Organizational Overview: UAB Medicine Largest academic medical center in Alabama and one of the top four largest academic medical centers in the United States. Nationally ranked Cardiovascular Center The National Cancer Institute (NCI)-designated Comprehensive Cancer Center Only Adult Level I Trauma Center in Alabama Only Level IV Regional Neonatal Intensive Care Unit in Alabama UAB s Comprehensive Transplant Center is a national leader in kidney transplants. Alabama s only Magnet-designated facility recognized for nursing excellence. The nation s first and only Level I Ocular Trauma Center. Page 4

5 Setting the Stage: Strategic and Operational Opportunity Quality Finance Satisfaction Quality Finance Satisfaction Deliver the Appropriate Care to Every Patient Every Time Eliminate Preventable Harm Alignment Clinical Documentation Academic Investment UAB Care Population Health Innovation Board Readmissions Bed Allocation Ensure the Financial Health of UAB Hospital Payer Partnerships ICD-10 Provider Integration Revenue Cycle Decision Support Bundled Payments Medicaid Program Design Preparation Consolidation of Services Improve Patient Experience Improve Employee Engagement Reaching for Excellence Leadership Development Institute Patient & Family Centered Care Patient Financial Communications Page 5

6 Setting the Stage: Organizational Benefits and Purpose Benefits: Alignment People Process Technology Purpose: Drive change through facilitating provider communication and encouraging providers to assume leadership roles Foster a collaborative culture by serving as the liaisons for education, accountability, and compliance across clinical and operational activities Page 6

7 Putting it all Together: Roles and Responsibilities Roles and Responsibilities: Promote clinical, financial, and compliance well-being in line with Hospital strategic initiatives and vision Clinical Documentation Improvement (CDI): Provide leadership in achieving the institutional Improve the Documentation of the Patient s Condition pillar goal Migration Into ICD-10: Monitor provider ICD-10 goals, expected outcomes, and facilitate operational challenges to ICD-10 adoption Provider Communication: Communicate clinical, operational, and regulatory changes and requirements to provider stakeholders (2 Midnight Rule) Provider Engagement Beyond Traditional Clinical Environment: Collaborate with non-provider stakeholders; educate colleagues, and communicate importance of comprehensive and compliant patient documentation Page 7

8 Putting it all Together Organizational Structure Chief Integration Officer ACIO Surgery ACIO Inpatient Medical ACIO Ambulatory Medical Surgical Provider Integration Champions Inpatient Medical Provider Integration Champions Ambulatory Medical Provider Integration Champions 51 Physicians engaging on status, peer to peer conversations, queries, denials Page 8

9 Putting it all Together: Challenges Organization Buy-in Integration other new initiatives (Quality / Rev Cycle / COS) Carrot vs. Cattle Prod with physicians Focused areas of attention versus oh, the PIN can take of that Page 9

10 Provider Integration Network: Current Accomplishments 2-Midnight Rule: Rapid rollout with extensive cross-functional team; Collaboration with IT to create auto text tool; and Developed physician order audit trail to monitor provider regulatory compliance activities and target education Condition Code 44: Urgency identified via PIN efforts to ensure 2-Midnight Rule compliance; Mechanism to comply developed in three weeks with Utilization Management; and PIN champions will be signatories for their divisions ICD-10 Readiness: Validated all providers and targeted areas of high risk Assigned specialty-specific training modules to each provider Page 10

11 Provider Integration Network: Current Accomplishments BCBS Denied Days: Created processes holding physicians accountable for timely conducting peer-to-peer denied day reviews with BCBS; and Financial impact of avoided denials attributed to the PIN is estimated at $1.1 million Medical Officer of the Day: Provide real-time clinical documentation and at key patient entry points (UED, HVC, Transfer Center) Physician Responsiveness: Timely: response to CDI clinical documentation, admission queries, and patient discharge MORE?????? Page 11

12 Provider Integration Network: Future Goals Clinical Documentation / Post ICD-10 Migration: Enhance specialty and provider education and monitor compliance Conduct documentation audits and provide focused feedback and education; and Participate in design and implementation of CDI software; Status Determinations: Monitor compliance with CMS 2-Midnight Rule certification, enhance education, and monitor performance Provider Education and Process Improvement: Monitor provider Future Changes education module compliance; and Identify, develop and implement standardized clinical protocols MORE?????? Page 12

13 Discussion Page 13