Holistic Health Systems (HHS) operates 39 hospital facilities and clinics. The executive team has been...
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Holistic Health Systems (HHS) operates 39 hospital facilities and clinics. The executive team has been reviewing key metrics over the last year and identified a need to improve Point of Service Collections or simply known as POS (pronounced P-O-S). POS is a patient payment that is received within 7 days after discharge. Increasing POS is important for HHS because hospitals are 60% less likely to receive payment once the patient leaves the hospital. The cost to collect on the patients account continues to go up while the chance of actually collecting payment goes down if there is a delay in collecting the payment after the patients discharge. Therefore, it is better to not delay collecting the payment.
Increasing POS reduces Bad Debts, provides a better cash position, reduces expenses, and increases patient satisfaction when conducted properly.
POS is calculated by dividing POS Payments by Total Patient Cash Collected.
HHS has identified the industry median benchmark for POS as 13.6% and the top 10% POS benchmark as 41.4%. HHSs current POS performance is 35.6% and the executive team has determined that a 5 percentage point increase is needed to stay competitive (target = 40.6%). A Lean Six Sigma team was formed.
POS is a metric that heavily relies on the Patient Access team or PA. PA is responsible for several taskspatient scheduling, registration, and financial clearance. The Scheduling tasks are typically completed by a centralized PA team for multiple hospital facilities. During Scheduling, PA reps receive a doctors order for a patient. The order is like a permission slip for specific medical services the doctor deems necessary.
The doctor or even the patient related to the order can call Scheduling to reserve an appointment for the services that correspond to what is written in the order. PA reps need to verify that the order is complete and accurate, coordinate time for services, and provide patients with pre-service instructions. After patients information is logged into the scheduling system, it will queue up to the PA registration team to complete the registration process. PA will call the patient and confirm the identity, collect demographics such as address, family, emergency contact, etc. PA registration will also confirm the patients health insurance provider(s). PA registration can be completed at a hospital facility or by a centralized team. Lastly, PA Financial Clearance will verify patient health benefits to ensure they exist and to determine if the procedure or service for the patient is covered. If authorization is required, the PA Financial Clearance will request authorization for services from the patients health insurance provider. Services performed without authorization lead to rejected claims. Also during PA Financial Clearance, the PA rep will Counsel the patient about their liability (how much their insurance provider says they need to pay for the services) and collect the payment. Any payment received is considered POS since its before 7 days post discharge. Financial clearance can also be performed at the hospital facilities or by a centralized team.
Summary patient cash data for HHSs 39 hospital facilities for a year is presented in Table 1. The table also indicates if the PA team for each facility is centralized or not.
Table 2 provides an overall monthly trend for POS Performance
The team identified the facilities with POS performance above the target and researched the activities they have in place hoping to find commonalities or key drivers.
They are:
ensure proper patient education on benefits and liability
ask for payment
have a financial counseling policy
reduce number of patients that leave without financial clearance
have accurate tools to help estimate Patient Liability or Responsibility
utilize devices that allow patient collections at patient bedside
Holistic Health Systems (HHS) operates 39 hospital facilities and clinics. The executive team has been reviewing key metrics over the last year and identified a need to improve Point of Service Collections or simply known as POS (pronounced P-O-S). POS is a patient payment that is received within 7 days after discharge. Increasing POS is important for HHS because hospitals are 60% less likely to receive payment once the patient leaves the hospital. The cost to collect on the patients account continues to go up while the chance of actually collecting payment goes down if there is a delay in collecting the payment after the patients discharge. Therefore, it is better to not delay collecting the payment.
Increasing POS reduces Bad Debts, provides a better cash position, reduces expenses, and increases patient satisfaction when conducted properly.
POS is calculated by dividing POS Payments by Total Patient Cash Collected.
HHS has identified the industry median benchmark for POS as 13.6% and the top 10% POS benchmark as 41.4%. HHSs current POS performance is 35.6% and the executive team has determined that a 5 percentage point increase is needed to stay competitive (target = 40.6%). A Lean Six Sigma team was formed.
POS is a metric that heavily relies on the Patient Access team or PA. PA is responsible for several taskspatient scheduling, registration, and financial clearance. The Scheduling tasks are typically completed by a centralized PA team for multiple hospital facilities. During Scheduling, PA reps receive a doctors order for a patient. The order is like a permission slip for specific medical services the doctor deems necessary.
The doctor or even the patient related to the order can call Scheduling to reserve an appointment for the services that correspond to what is written in the order. PA reps need to verify that the order is complete and accurate, coordinate time for services, and provide patients with pre-service instructions. After patients information is logged into the scheduling system, it will queue up to the PA registration team to complete the registration process. PA will call the patient and confirm the identity, collect demographics such as address, family, emergency contact, etc. PA registration will also confirm the patients health insurance provider(s). PA registration can be completed at a hospital facility or by a centralized team. Lastly, PA Financial Clearance will verify patient health benefits to ensure they exist and to determine if the procedure or service for the patient is covered. If authorization is required, the PA Financial Clearance will request authorization for services from the patients health insurance provider. Services performed without authorization lead to rejected claims. Also during PA Financial Clearance, the PA rep will Counsel the patient about their liability (how much their insurance provider says they need to pay for the services) and collect the payment. Any payment received is considered POS since its before 7 days post discharge. Financial clearance can also be performed at the hospital facilities or by a centralized team.
Summary patient cash data for HHSs 39 hospital facilities for a year is presented in Table 1. The table also indicates if the PA team for each facility is centralized or not.
Table 2 provides an overall monthly trend for POS Performance
The team identified the facilities with POS performance above the target and researched the activities they have in place hoping to find commonalities or key drivers.
They are:
ensure proper patient education on benefits and liability
ask for payment
have a financial counseling policy
reduce number of patients that leave without financial clearance
have accurate tools to help estimate Patient Liability or Responsibility
utilize devices that allow patient collections at patient bedside
Read case study then answer the following questions
Exercise 1 Process Stability Using the data given in Table 2, determine if the POS performance is stable using a control chart. Explain why you used the type of control chart you selected.
Exercise 2 Scope Opportunity Using the data given in Table 1, how would you scope the focus area of the project?
Exercise 3 Testing a Theory Use the data from Table 1 and conduct a hypothesis test to determine if centralized teams impact POS collections.
Exercise 4 Solution Categories Based on the information provided what could be affinity categories for the key drivers that impact POS performance?
