Project Progress Overview

1. Project Progress Overview Define Measure Analyze Improve Control Tollgates: Planned Completed 04/18/2006 05/23/2006 06/27/2006 07/25/2006 10/31/2006 03/16/2006 04/20/2006 05/25/2006 mm/dd/yyyy mm/dd/yyyy   10 Define & Validate Measurement System X’s 11 Determine Process Capability 12 Implement Process Control 7 Screen Potential Causes 8 Discover Variable Relationships 9 Establish Operating Tolerances • Establish Process Capability • Define Performance Objectives • Identify Variation Sources • Select CTQ Characteristics • Define Performance Standards • Validate MSA & Data Collection Plan Steps:   • Identify Customer CTQs • Develop Team Charter • Define Process Maps          Key Deliverables: • List of Customer(s) and Project CTQs • Team Charter • High Level Process Map (COPIS) • CAP Plan (Optional) • QFD / CTQ Tree • Operational definition, Specification limits, target, defect definition for Project Y(s) • Data Collection Plan • Measurement System Analysis • Baseline of Current Process Performance • Normality Test • Statistical Goal Statement for Project • List of Statistically Significant Xs • Preliminary CBA, if applicable • List of Vital Few Xs • Transfer Function(s) • Optimal Settings for Xs • Confirmation Runs/Results • Tolerances on Vital Few Xs • MSA Results on Xs • Post Improvement Capability • Statistical Confirmation of Improvements • Process Control Plan • Process Owner Signoff • Final CBA, if applicable • Basic Statistics • Histogram • Dot Plots • Box and Whisker Plots • Run Charts • Normality Testing • Continuous/Discrete Zst, Zlt • Benchmarking • Detailed Process Mapping • Moments of Truth • Nature of Work • Flow of Work • Fishbone • Hypothesis Testing • Regression Analysis • Other ______________ • Survey • Focus Groups • Interviews • ARMI, Stakeholder Analysis • In/Out of Frame • Threat vs. Opportunity Matrix • /COPIS • Other ______________ • DOE • Pugh Matrix • New Process Mapping • FMEA on new process • Process Modeling / Simulation • Other ______________ • Continuous Gage R&R • Discrete Gage R&R • Control Charts • Hypothesis Testing • CAP Plan • Control Plan • Other ______________ • QFD • FMEA (1st half) • Data Collection Plan • Continuous Gage R&R • Discrete Gage R&R • Sample Size Calculator • Other ______________ Tools:

2. Define Step B Develop Team Charter • Business Case: • Aurora has a target to achieve a 1.7% operating margin for 2006. One operating expense is a write off of over $4.7 M due to a lack of issuing ABN’s to patients. Reducing the ABN write offs by 50% will contribute [x]% to the operating margin. • Reducing the number of ABN write-offs using the DMAIC process will affect three strategic objectives: • Financial Performance: Direct improvement to operating margin. • Department Efficiency: Improved processes capture information necessary to perform medical necessity check in a timely manner. • System Integration: Enhanced sharing of key data elements across affected departments. Start / Stop Points for Project: Start: Physician places MRI order for Medicare patient at least 24 hours prior to the procedure being performed. Stop: Procedure is scheduled and patient receives ABN. • In Scope: • MRI procedures for Medicare outpatients. • SLMC MRI (potentially will extend to CT). • Patient access workflow for the purpose of scheduling the procedure and capturing relevant patient demographic and insurance data. • Medical records workflow for the purpose of generating ICD9 code based in reason for visit. Problem Statement: Aurora writes off over $4.7 million annually due to a lack of ABN’s issued to patients when the CPT4 (procedure) / ICD9 (diagnosis) fails a medical necessity check. The issue is occurring in [#*] departments across all sites, with the metro region imaging service being most impacted due to a high volume of high cost procedures. This problem is tracked monthly and is currently being reported on a monthly basis on the leadership dashboard. Aurora is either NOT performing the medical necessity check (likely for low $ procedures), or NOT generating the ABN and subsequently presenting it to the patient. • Out of Scope: • Non SLMC MRI departments (pending outcome of process improvements) • Procedures other than MRI (and potentially CT), such as lab or other low dollar procedures. Defect:Lack of Medical Necessity Check Missing, unreadable, or inappropriate data elements required to legally perform an MRI Unit:MRI Orders for Medicare patients Opportunity:MRI orders accompanied by a written order with the diagnosis, followed by a Medical Necessity check Any of the five elements of a valid order Goal Statement: (“SMART”: Specific, Measurable, Attainable, Relevant, Timebound) By August 2006, the SLMC MRI department will perform a medical necessity check for 100% of outpatient Medicare patients for MRIs scheduled at least 24 hours prior to the procedure being performed. * Will be determined in Measure Phase

3. Six Sigma Metrics Key Terms:

4. Define Step C Define Process - COPIS 1. WHO are your primary customers?(From Step A) 2. WHAT does the customer receive? (Think of their CTQ’s) 3. What STEPS are Included in the Process today? (high level) 4. What is provided to START the process? 5. Who PROVIDES the input? Customer Output Process Input Supplier (Who) (Nouns) (Verbs) (Nouns) (Who)

5. In control Measure Step 1 What Data to Measure?

6. Potential Project Y Metrics Medical Nec Check Operating Margin Order Quality Denial Rates CTQ Output Characteristic Ease of collection of appropriate data elements Notification to physicians of potential ABN Provide data elements to HIM Measure Step 1 Generate ABN’s in a timely manner Perform the medical necessity check Strong relationship Moderate relationship Weak relationship Select the CTQ Characteristic (Y) CTQ Drill Down Tree CTQ (Y) Perform Medical Necessity Check y1 = Denial Rates y2 = Order Quality y3 = Operating Margin x1 = 5 elements x2 = ICD9 code x3 = Med Nec / ABN CTQ Translation Matrix                       