Presentation Transcript

1. Leading HIM Through Mergers, Acquisitions and Change

   Brenda K. Beckham, RHIA Executive Director, HIM Baptist Healthcare System Louisville, Kentucky April 29, 2014
2. Baptist Health Kentucky
3. Reasons to Standardize HIM Moving to a new Information System Standardize training and education for ICD-10 Coding audit showed major discrepancy in coding CDI processes Identify efficiencies and best practices within the system Implement those best practices as the “Baptist Way”
4. Start with CDI and Coding Create org chart Write job descriptions Determine job codes and salary ranges Identify best practices Write policies and procedures Adjust staffing
5. CDC Organization Chart Brenda Beckham, RHIA Executive Director of HIM, Coding and Transcription System Director Clinical Documentation and Coding System Manager OP Coding System Manager Clinical Documentation Improvement System Manager IP Coding IP Coding Auditor / Educator OP Coding Auditor / Educator CDI Auditor / Educator CDI Coordinators Coding Coordinators Surgery and OBS Coders Ancillary Coders and Coding Support IP Coders CDI Specialists
6. New Positions Coding Coordinators One for each facility CDI Coordinators One for each facility Coding and CDI Auditor / Educator Surgery Coders Code surgery and OBS Ancillary Coders Code ancillary orders and ED ED Charge Auditors Combine coding and auditing
7. Reasons to Merge CDI and Coding Facilitate seamless communication and collaboration Common goals and cooperation between coding, HIM and CDI Consistent education between coding and CDI Share information from ACDIS and AHIMA Need for clinical documentation to support coding Better structure to achieve standardization Standardize implementation of CDIS
8. CDI Merge process Met with Case Management Directors By phone and in person Met with VP’s at each facility Individually via phone conference Provided justification for the merge Agreed to disagree
9. Moving Staff – April 2012 Submitted job descriptions to HR Job codes and salary ranges established Identified HR Differences at each facility Met with staff to discuss transition Same pay rate for same job Different insurance options in different markets Different attendance policies Different reimbursement practices for education Placed staff in the new job codes
10. Acquisitions Richmond – September 1, 2012 Meditech Different abstracting policies Madisonville – November 1, 2012 HPF and Star 3 resignations within a month Different Abstracting Policies Difficulty accessing remotely
11. Change of revenue cycle structure and leadership New corporate CEO – March 2013 Change of revenue cycle leadership From AVP of Finance to AVP of Managed Care and Revenue Cycle New Revenue Cycle Structure Executive Director – Revenue Cycle Pt Access, Scheduling, Revenue Integrity Executive Director – HIM Chart Processing, ROI, Coding, Transcription Executive Director – Patient Financial Services Billing, Collections
12. Step Back Resignation of CDC Director – Sept 2013 Outside Assistance with ICD-10 education Contract Coding Assistance Contracted with KForce for coding, CDI and stakeholder education Potential for assisting with contract coding Need for Project Manager Hired HIM Coordinator Revamp the ICD-10 Steering Committees Include CMO in Physician ICD-10 Education
13. ICD-10 Preparedness Corporate ICD-10 Steering Committee Corporate VP’s, Directors, CMO’s Corporate Physician Education Committee Corporate CMO/CMIO, Facility CMO’s ICD-10 Liaisons Hospital ICD-10 Steering Committee Facility Directors, managers and representatives Market Physician Education Committee Facility CMO, Physician Leaders, Med Staff, Physician Services, HIM, CDI, Coding, Education, etc
14. Computer Implementations CDIS Initial Training – April 2013 Go live – April 2013 CAC Initial training – April 2013 Annotated – August 2013 Auto Suggested – September 2013 Go live – February 2014 OP CAC Initial training and auto suggested – April 2014 Paragon Training – October 2013 through March 2014 Go live – March 1, 2014 HDM Initial integration training – May 2013 Training – February 2014 Go Live – March 1, 2014
15. Transcription Structure Dictation and Transcription Vendors Nuance – 5 sites Softscript – 1 site Speech Motion – 1 site Outsourcing Outsource 100% - 3 Sites – 3 Different Vendors Employ all MT’s – 4 sites Employ MT’s – outsource overflow – 2 sites Pay Practices 1 Straight Productivity 1 Salary + Incentive based on productivity 2 Salary + Incentive based on quality
16. Transcription Staffing Transcription Manager for 2 Facilities Resigned in July 2013 Transcription Manager at Acquired Facility Transcription / HIM Supervisor at Smaller Facility Transcription direction and support in HIM at the other 3 facilities Work Type Differences Medical and Radiology at 4 Facilities Medical only at 3 facilities Radiology transcription performed in the radiology department
17. Transcription Organization Chart Brenda Beckham, RHIA Executive Director of HIM, Coding and Transcription System Manager Transcription Transcription Quality Auditor / Educator Transcription Supervisor 1st Shift Transcription Supervisor 2nd Shift Transcription Auditors 1st Shift Transcription Lead 2nd Shift MT’s 1st Shift MT’s Transcription Support
18. Transcription Next Steps Fill all open positions Evaluate pay practices Determine best pay practice Evaluate Outsource Vendors How many do we need? Which one? Transition all to Nuance platform Standardize dictation phones
19. Moving MT’s Submitted job descriptions to HR Job codes and salary ranges established Determine HR / Employee Health requirements Met with staff to discuss transition Same pay rate for same job Different insurance options in different markets Different attendance policies Different shift differential Placed staff in the new job codes
20. Transcription Challenges Different EMR’s Mosaiq – Oncology System Allscripts – Ambulatory System Assistance for Employed Physician Change of MRN and Visit ID format Transcription Support
21. HIM Coverage BH Louisville / BHLaGrange 24 x 7 (minus a few hours on 3rd shift) BH Lexington – 24 x 7 BH Paducah – 6:00 a.m. – 2:00 a.m. daily BH Corbin – 4:30 a.m. – 11:30 p.m. daily BH Madisonville – 7 days, hrs vary, no 3rd BH Richmond – Mon – Fri 4am to 4:30pm
22. First merge - 2001LaGrange and Louisville Identified processes to be done at LaGrange Chart pick-up Physician Suspension ROI assistance to walk-ins Answering phone calls during business hours Prepping when time permits Identified processes that could be moved to Louisville Prepping, scanning and indexing ROI Chart Analysis Support for transcription and coding
23. Opportunities identified Moved imaging back to LaGrange Reduce cost and risk of transporting PHI Improved TAT One person at facility managers entire imaging process (prep, scan and index) Centralized physician suspension Eliminate duplicate notification for physicians with incomplete records at both facilities Standardized chart analysis Transfer of all calls to Louisville In preparation for a corporate call center Set an example for PBX
24. HIM management Staffing Louisville / LaGrange – HIM Director for 2 Facilities HIM Manager for both HIM Supervisor for 1st and 2nd shift (one each) Lexington – HIM Director Assistant director for HIM and another for coding Several supervisors within HIM Paducah – HIM Director Coding Manager HIM Supervisor Corbin – HIM Director HIM / Transcription Supervisor Madisonville – HIM Manager at Acquired Facility No supervisors – coding in another department Richmond – HIM Director at Acquired Facility HIM/Coding Supervisor
25. HIM Director / Manager Transition BH Lou / LaG Dir – transferred to Executive Director HIM HIM Manager remained as manager BH Cor Director – retired LTACH HIM Manager transferred to hospital HIM Manager BH Lex Director – transferred to Manager of Regulatory Affairs BH Lou/BH LaG 2nd shift supervisor promoted and transferred as HIM Manager BH Pad Director – changed to HIM manager BH Ric Director – transferred to IT / CIT BH Lex manager will cover both facilities BH Mad Manager – remained as manager
26. HIM Organization Chart Brenda Beckham, RHIA Executive Director of HIM, Coding and Transcription HIM Manager BH Madisonville HIM Manager BH Paducah HIM Manager BH Corbin HIM Manager BH Richmond / BH Lexington HIM Manager BH Louisville / BH LaGrange HIM Supervisors HIM Supervisors HIM Supervisors HIM Supervisors HIM Supervisors HIM Leads HIM Leads HIM Leads HIM Leads HIM Techs and Clerks HIM Techs and Clerks HIM Techs and Clerks HIM Techs and Clerks HIM Techs and Clerks
27. Moving HIM Submitted list of employees No new job descriptions to submit Job codes and salary ranges established Met with staff to discuss transition Same pay rate for same job Different insurance options in different markets Different attendance policies Different shift differential Placed staff in the new job codes
28. HIM Structure EMR Vendors HPF – 6 Sites (different version at acquired site) Meditech – 1 site ROI Process Internal using McKesson ROI Module – 3 sites Outsource to HealthPort – 3 sites Partial outsource to HealthPort – 1 site Birth Certificate Process Mother / Baby – 4 sites HIM – 3 sites
29. ROI Transition Centralized ROI Department Located at the corporate office in Louisville Need to identify space Pull FTE’s from facilities Outsourcing Options All ROI processed internally – 3 sites Outsource to Healthport – 3 sites Combination of Healthport and staff – 1 site
30. ROI Organization Chart Brenda Beckham, RHIA Executive Director of HIM, Coding and Transcription System Manager Release of Information Supervisor Regulatory Requests Supervisor Commercial Requests Commercial ROI Techs Regulatory ROI Techs
31. Future state Employed Physician Pro-fee coding Coding manager Paper records Employed Physician ROI Paper records Employed Physician HIM Services Imaging Abstracting Employed Physician Transcription Services Different EMR vendors
32. Upcoming Initiatives Meaningful Use Stage 2 In progress Conversion to ICD-10 October 2015 (???) Implementation of EPIC / Cerner By end of year 2015 Implementation of ARMS Some time after EPIC / Cerner
33. HIM Accomplishments Standardized Clinical Documentation and Coding department (CDC) IP Coding OP Coding CDI Re-evaluated the OP Coding Team Include ED Charge Auditors Manage the review and correction of APC edits Standardized Transcription Department In progress Formalized HIM Management Structure Standardized policies and procedures
34. In progress Transcription Standardization Standardize pay practices Standardize outsource vendors Standardize IT vendor ROI Centralization Identify space Determine FTE’s needed Allocate resources from facilities HIM Standardization Identify best practices Create and implement standard policies
35. What we did well Collaboration Solicit opinions from current managers On-site manager meetings Share best practices Teamwork Assign policies to different managers Share forms Share research or background information Internal Communication Weekly HIM manager meetings
36. Lessons Learned Communicate Communicate Communicate Reassure staff of job security Monthly updates to hospital VP’s from Exec Directors Monthly updates to hospital VP’s from on-site managers Quarterly visits by Exec Director
37. Questions???