MAXIMIZING EFFICIENCY
Karen Clancy, MT, MBA Associate Director, University Health Service Adjunct Instructor, College of Public Health University of Kentucky
Some things change
Some things never change
Dr. Daniel Drake Dr. Benjamin Dudley Dr. William Richardson
Physician Leadership The Power of Connectedness
Practice Models and Organizations Customer Service and Marketing Registration and Recordkeeping Finance and Billing Human Resources Operations Information Technology Risk Management and Compliance Contracting Accreditation
Practice Models
Finding Yourself Mission, Vision, Values SWOT Analysis Objectives, Strategies
University Health Service Our Mission The mission of University Health Service is to provide preventive and primary health care and education to the students and other members of the University of Kentucky community in a manner which exhibits compassion, professionalism, and excellence. Our Vision University Health Service will be recognized as a leader and an innovator in the field of college and university health, and is committed to meeting the evolving health care needs of the campus community through its responsibilities for student primary and preventive care, employee health care, and campus public health. Our Values The University Health Service values: Pursuit of excellence by high quality, easily accessible services Ethical practices in patient care and confidentiality Integrity on the part of our employees earning trust from our patients A nonjudgmental secure environment for students and employees A diverse workplace which is supportive and encouraging to staff, treating all staff with fairness, respect and honesty Responsibility and accountability to other staff, to our patients, and for our sources of support Continued professional education and development for all staff Public service, both in the form of public health activities, and other activities as appropriate for the University community and the community at large Support of the academic mission of the University to improve educational performance and improve retention of students Further overall improvement of student life by efforts in primary and secondary prevention and programs in cooperation with the University s Division of Student Affairs
University Health Service UHS Goal: Retain accreditation through the Accreditation Association for Ambulatory Healthcare (AAAHC). Indicators (Assessment Method) Attend AAAHC meeting on accreditation. Communicate new AAAHC standards. Conduct AAAHC self study process. Complete and submit accreditation survey application. UHS Goal: Expand health care facilities available to support University of Kentucky students. UK is currently ranked at the bottom of 20 benchmarks for student t health square footage per student. t Indicators (Assessment Method) Complete construction of the new student health center. Prepare for and occupy the new facility. Provide on-going information to the community. UHS Goal: Implement pre-matriculation immunization requirements to support a safer environment for students. Indicators (Assessment Method) Communicate immunization requirements to students and parents. Provide on-line capabilities for students to comply with the requirements. Educate the university community about the needs for immunizations. UHS Goal: Continuously improve the quality of the clinical process through ongoing review, evaluation, intervention, and re-evaluation. Conduct and use benchmark studies to assess and improve student access to health care. Indicators (Assessment Method) Conduct a minimum of four peer review, benchmarking, or safety monitoring quality studies per year.
Show Me the Money Business plan Operating budget, capital budget, balance sheet Cash flow and revenue cycle Containing expenses Contract negotiations, outsourcing, relationships
Know What You Don t Know Explore resources Empower people
First Things First Manage Your Human Resources Organizational structure Recruitment and compensation Hire, train, evaluate, retrain Job descriptions and PEs Orientation Oi ti
University Health Service
University Health Service
First Things First Manage Your Human Resources (cont.) Best fit Work groups Rewards and incentives Staff meetings
University Health Service UHS Management Committee (Mondays, 8:30 a.m. - 9:30 a.m.) Chair:Director The UHS Management Committee is comprised of senior management staff and clinician representatives and the charge is to: Advise the director. Provide leadership for UHS staff. Determine the mission, goals, objectives and long-range plans of the organization. Provide feedback for operation, performance and financial oversight. Review and approve policies, procedures, and standards of practice. Help to ensure that facilities and personnel are adequate and appropriate to carry out the mission. Assure that quality of care is evaluated and that identified problems are appropriately addressed. Maintain effective communication throughout the organization including ensuring a linkage between quality management and improvement activities and other management functions of the organization. Disseminate information. Ensure compliance to university, local, state, and federal policies, rules, laws and regulations and the standards of the Accreditation Association for Ambulatory Health Care. Ensure adherence to contractual agreements. Operate the organization without limitation because of race, creed, sex or national origin. Develop a policy on continuing education for personnel. Ensure that the organization operates in a safe manner. Adopt policies and procedures to resolve grievances and patient complaints. Establish processes for identification, reporting, analysis and prevention of adverse incidents. Management Subcommittee (Wednesdays, 7:30 a.m. 9:00 a.m.) Chair:Associate Director The UHS Management Subcommittee comprised of UHS mid-level supervisors and the charge is to: Be comprised of UHS mid-level supervisors. Make policy recommendations to Management Committee and other appropriate committees regarding computing, EMR, medical records, forms, registration, billing, employee health, student health and other service initiatives, space utilization, patient flow and other issues impacting UHS. Develop and implement strategies to meet the day-to-day operating goals of the Health Service. Disseminate information to and solicit feedback from UHS staff.
Operation Operations Supervisors Team Policies Policies, Procedures Protocols and Standing Orders Reform Your Forms
Access Routine Appointments t Urgent Care After Hours Prescription Refills Questions and Call Backs Referrals
Patient t Flow Design Where does the flow begin and end? What is best for the customer?
Quality Assurance Safety Clinical outcomes and peer review
University Health Service Quality Improvement/Assurance (3rd Thursday, 8:15 a.m. 9:00 a.m.) Chair: Quality Assurance Coordinator Chaired by a physician and having the requisite number of physicians to function as a peer review committee; includes additional representatives from mental health, medical records, nursing, and billing. The charge of the committee is to recommend and carry out studies (with the assistance of other Health Service staff as appropriate and necessary) and to make recommendations to Management Committee based upon the results of their findings. This committee s basic responsibilities include establishing or recommending priorities for the study of problems or problem resolution to develop means to actually perform certain studies, which include surveys, time studies, safety studies, chart reviews, peer reviews, and benchmark studies. The Quality Improvement/Assurance Committee has the following general responsibilities to: Identify current or potential problems, issues, or trends for study Analyze identified d issues by conducting appropriate studies Recommend action or corrective measures to solve identified problems Prepare findings and recommendations in the forms of minutes which are available to staff and for presentation to distribution for the Management Committee for appropriate review and action Conduct follow-up studies as appropriate or necessary to re-evaluate whether corrective measures are taken Maintain a written record of all activities
University Health Service Key elements of the program include: Quality improvement studies that address clinical, administrative, patient flow, cost of care, and similar issues from which come recommendations to the Management Committee for improvement in quality of care in its broadest sense. A peer review program in which physicians, nurse practitioners, and other designated personnel review medical records and other data to monitor appropriate aspects of care and/or service delivery. Periodic surveys to determine patient satisfaction levels and appropriateness/adequacy of services. Assurance of licensure and credentialing of all clinical personnel.
University Health Service The goals of the quality improvement/assurance program are: To assure general compliance with the mission, vision, and values of the University it Health Service and Chandler Medical Center To assure excellence in patient care within the broadest definitions applicable to a college health setting and within the context of available resources To determine and apply clinically valid criteria to improve patient care and clinical performance To provide accurate and objective methods of documentation of quality improvement activities To identify and resolve known or suspected problems affecting patient care To provide accurate and objective methods of documentation in quality improvement activities To insure confidentiality of quality assurance findings in accordance with appropriate local, state or federal regulations To provide continuing education for affected Health Service personnel related to quality assurance findings To reduce liability exposure and improve overall management and cost effectiveness in patient care To monitor corrected problems to assure sustained resolution To avoid duplication of quality improvement activities
Accreditation Association for Ambulatory Health Care www.aaahc.org
Accreditation Marketing State requirements (CA, FL, NY, IN, etc) Medicare deemed status for ASCs
Accreditation Self Study & Site Survey 1. Rights of Patients 2. Governance and Administration 3. Clinical Records 4. Quality of Care 5. Quality Improvement, QA, and Peer Review 6. Facilities and Environment 7. Surgical and Anesthesia Services 8. Pharmaceutical Services 9. Path, Lab, Rad, PT, & Ancillary Services 10. Immediate/Urgent Care Services
Most Important Key to Meaningful Accreditation
Compliance Non Negotiable Federal, state, local l laws and regulations Medicaid, id Medicare Fraud and abuse Anti-kickback kb k Anti-discrimination HIPAA
To Be or Not to Be Information Technology Clinical management systems registration, billing, data management Electronic medical records Intranet services IT support
Communicate, Communicate, Communicate Staff,p peers, administration External customers Patient feedback Marketing Management team
Resources Ho, Lynn. 7 Strategies t for Creating a More Efficient i Practice Family Practice Management. September 2007. Renz, Anne. American Medical Association. Integration Strategies for the Medical Practice. The Coker Group. Norcross, GA. 1996. Satinsky, Marjorie; Curnow, Randall. Medical Practice Management in the 21 st Century. Radcliffe Publishing. Oxford, NY. 2007. Stahl, Michael.; Dean, Peter. The Physician s Essential MBA. Aspen Publishers, Inc. Gaithersburg, Maryland. 1999. Wright, John D. Jr. Transylvania Tutor to the West. University Press of Kentucky. 1980. Wikipedia. http://en.wikipedia.org/wiki/daniel_drake Wolper, Lawrence. Physician Practice Management. Jones and Bartlett Publishers Inc. Sudbury, MA. 2005. www.aaahc.org