Overview of RHM SOP Project Copyright © 2014 – Lean Homecare Consulting Group, LLC. All Rights Reserved. This presentation is distributed for informational.
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Overview of RHM SOP Project
Copyright © 2014 – Lean Homecare Consulting Group, LLC. All Rights Reserved.
This presentation is distributed for informational and educational purposes only.No citation, quotation, duplication, or distribution without the expressed written permission of the author is permitted.
www.leanhomecare.com Helping Providers Elevate Performance TM
Outline of Discussion Provide an overview of the RHM SOP project
Define SOP, standard work (policy vs. procedure)
Understand the importance of SOPs and standard work
Introduce the RHM standard template for SOPs
Understand how to develop a SOP
Understand your role, expectations, deliverables, etc. as part of the RHM SOP project
Objectives of RHM SOP Project Improve consistency within branches and across the entire
company
Instill operational discipline
Build process literacy throughout the organization
Formalize all core process at branch level and company-wide
Build a central resource of RHM SOPs and policies and procedures
RHM SOP Standardization Project
Germantown respiratory
Germantown warehouse
(operations)
August 2014 Educational webinar - project kick-off – entire project team
Identify all core processes
1.Identify all existing core processes in each area2.Ensure actual practice matches what is written3.Edit existing SOP s as needed (if not current/accurate)4.Identify process that do not currently have a SOP5.Use standardized template to create draft SOP6.Develop initial SOP drafts
Begin to build SOP “catalog” on Sharepoint
Provide examples of completed SOPs to teams/branches –
replicate SOPs company-wide
First few SOP drafts to be reviewed by President
Use completed examples as models for continued SOP development by
teams throughout RHM
I.D. core processes
I.D. core processes
Build RHM SOP and P&P online catalog
Two phases- phase 1 for SOPs and Phase 2 for policies
Sequence of Key Tasks Two teams – operations (WH) and respiratory to work
with Giles and Ann and identify all core process in their respective areas (title, function)
Initial training/guidance provided to teams
Each teams to develop 2-3 SOPs
Completed SOPs to be reviewed/approved (leadership, branch managers)
Involve other staff in developing THEIR SOPs
Sequence of Events (cont.)
Teams to identify:
− Which processes do not have a SOP
− Which process have a SOP but SOP is outdated
− Which process are formalized with a SOP BUT performance/behavior of staff does not align with current SOP
Project Timeline
6-12 months to complete ALL core processes
Need to complete at least 3 processes per month
We are essentially recording/documenting, and cataloging our processes
Will then complete relevant policies that correspond to SOP as appropriate
Consistent Terminology
1. Process
2. Policy
3. SOP (standard operating procedure) aka “procedure”
3. Standard work
1. Processes
The specific tasks and activities that have to be carried out
Processes and Daily Work Nearly everything we do is part of a process
The entire company is made up of a series of processes
Typical to have at least 10-15 core processes in a HME operation/branch (intake, documentation, confirmation, on-call, delivery, co-pay, scheduling, dispatch, etc.)
Many more “sub-processes”
Typical Processes
Warehouse
Receiving Inventory management Shipping Equipment management Warehouse housekeeping
Respiratory
Scheduling Intake Confirmation Patient care (set-ups) PAP compliance
2. Policy
Guidelines or “laws” that drive the processes and procedures –
usually stated in more general terms (less detailed). Often
describes the “why” Example – co-pay policy: we will collect co-payments for all transactions at the
point of service or prior to providing service
Why: patient payment amounts represent an increasingly lager part of our A/R – helps to improve financial performance if we collect in a timely, consistent manner
What
3. Procedures
The detailed steps required to perform an activity within a process – how we “operationalize” the policy
Standard Operating Procedure
How
Procedures
Define the specific instructions necessary to perform a task or part of a Process
Procedures can take the form of:
A work instruction A quick reference guide SOP – standard operating procedure
Standard Operating Procedure
RHM will deploy up-to-date and accurate SOPs
Will implement across the entire company
Will use a standard SOP template
SOPs = standard operating procedure
Also referred to as Operational Policy Guide
Operational Policy Guide TEMPLATE
1.Title
What is the name of this procedure or specific key activity?
2.Vital Behaviors and Performance Expectations
Vital behaviors – describe the actual behaviors you expect people to exhibit – what they are supposed to do
Performance expectations – describe the things that you would like to have measured
•Purpose (Why)
Why are the behaviors important? How do they impact the revenue cycle? Make sure people can “see” what they impact.
•Operational Definitions
Timely, faster, better, accurate: All words have to be combined with numbers – for example, don’t just say “be on time” or be consistent – define what “timely” and consistent means in terms of numbers
•Monitoring Method
What methods/mechanisms do leaders use to ensure adherence to established procedures? Are there specific reports they should be reviewing?
Operational Policy Guide 1. Title
Co-insurance/Co-pay/Non-covered Service Payment Collection
2. Vital Behaviors and Performance Expectations
All staff having patient contact regarding an order will collect from the patient or patient’s representative the co-insurance, co-pay or payment for non-covered equipment, supplies and services at the time the order is placed or the delivery is made.
Notify patient or patient’s representative of their cost for the equipment, supplies or
service being requested. Document discussion of financial obligation in the Order screen in HMA. Ask for payment by credit/debit card for all telephone orders. Always collect payment from the patient via cash, check or credit card in the
Showroom and Repair Service departments. For inpatients at hospitals and other facilities, make best effort to secure payment
prior to delivery at the hospital. Print the amount to be collected on the Delivery Ticket when a credit card payment is
not obtained over the telephone. Delivery Technicians, Service Technicians, Respiratory Therapists and other
Delivery personnel should not leave a product with the patient without collecting the amount due indicated on the Delivery Ticket. Exceptions: Supervisor or Branch Manager approval must be obtained and noted on the Delivery Ticket.
Delivery department Supervisor must log the amount to be collected on the Delivery Technician Route sheet and confirm that the payments have been collected when the Delivery Technician turns in the Delivery Tickets.
Print and reconcile the RHM Daily Transmittal Reconciliation report of confirmed tickets and payments daily.
Settle all credit card terminals and online payments daily. Deposit all checks and cash in the bank daily.
3. Purpose (Why)
Timely and consistent payment collection is a vital part of managing and reducing the outstanding Accounts Receivable balances and reduces the number of days sales outstanding (dso) in the revenue cycle. Collecting payments at the time the product and/or service is provided eliminates the additional labor and material costs associated with invoicing and collections activities. The company goal is to provide products and services and be paid for them as soon as possible.
Operational Policy Guide
1. Title
Service Standard Expectation for Delivery Tickets
2. Vital Behaviors and Performance Expectations
Delivery Ticket confirmation is an important part of the revenue cycle – consistent delivery ticket confirmation is required to ensure a smoother flow and more even distribution of delivery tickets for delivery ticket release and to allow sufficient time for post-confirmation required tasks performed by the Billing Staff. An influx of confirmed tickets at End-Of-Month (EOM) creates large batches of tickets and heavy EOM workloads for billing staff. Suspend amount also increases and fluctuates, based on confirmation patterns and payors’ responses to HIVC inquiries.
3. Operational Definitions
Timely:
Deliver Technicians (Drivers) are expected to delivery all signed delivery tickets, as soon as
their runs are completed or by Monday mornings, before payroll is submitted. Delivery tickets are confirmed the same day they are brought in. Confirmation “cut-off” time for EOM process day will be no later than 72 hours after the monthly
inventory is completed, prior to finalization of the P & L.
Consistent:
Ticket confirmation is performed daily by Warehouse/Supply Technicians. Warehouse/Supply Technicians will reinforce process to Delivery Technicans that it is the
requirement that they adhere to time expectations Staff performs revenue-related tasks daily (processing drug cards, obtaining Rx, CMNs, etc.)
and do not ramp up effort at EOM.
5. Monitoring Method
HIVC Billing Supervisor will monitor all delivery ticket processing, including assurance that Warehouse/Supply Techs and Delivery Techs are compliant.
HIVC Billing Supervisor will create an EOM report for those tickets not billed, due to missing authorizations, with reason(s) stated.
This report will also be monitored by the Director of Reimbursement
Standard Work
Different people working in the same process, doing the same things, doing the work in a similar manner
Key components include trust, fairness, values, and respect - i.e. how people like to be treated by others, both at work and outside of work
Why It Matters
All of our work is carried out through a series of processes
Processes need to be formalized, documented, standardized, communicated, and monitored
Critical part of financial vitality
Breaking Down the Work
Work (processes) can be broken down into three basic steps:
Important steps
Key points about each step within the process
Reasons for each step (the “why”)
Important steps
Key points about each step within the process
Reasons for each step (the “why”)
Setting the Stage
Different people approaching similar work in a similar manner
Standard work:
– We “say” what we do – Leaders make sure we do what we say
Accountability
Leaders ensure that we adhere to SOPs and standard work
Accountability is key
You can’t really hold people accountable – you can only hold them accountable to “something”
Standard work is an agreed-upon set of work procedures that establish the
most reliable methods and sequences for each process and each worker
Standard Work – The Foundation
Without standard work, continuous improvement activities are not manageable
Difficult to improve a process that is random and informal
Content, sequence, timing, outcome
Role clarification – no guessing
Key to reducing variation in processes
Presence of Standard Work
Variation = Waste Errors
Rework
Duplication
Excessive delays and waiting
Handoffs, workarounds
Reducing the “Four Cs”
Standard work and waste awareness can help reduce:
– Confusion – Chaos– Complexity – Conflict
Critical Success Factors Who – clarifying roles
What – steps, tasks
When – sequence
How – the methods and approach
Why
Referral/order received
Referral/order entered into tracking log
received
Order is entered into system
(within 60 minutes of referral receipt)
Initial review for acceptance
If order is a “go”, file is created
Rx reviewed
Check same or similar
Initial data-entry – demographics, payer,
referral, order type
Does patient reside in service area? Is there a payor/
contract issue?
Verify coverage and eligibility
Do you have a valid Rx with all required
elements?
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HME Intake/Customer Service Model
Print forms (EOB, EOC, etc.)
Verify inventory availability
Complete and send CMN
Via fax, phone call, e-mail
Inform patient of co-pay, cost, status of order, etc
Check /verify any secondary coverage
Confirm via e-mail, page, fax, phone
Confirmation sent to referral that order has been
receieved
New order is checked (Q/A)
prior to contacting patient
Goal: Zero “no-gos” Due to lack of inventory
Complete and send CMN
Contact patient Print ticket for delivery/ship
Process START
Process STOP
Note: ALL orders are entered into the system for
tracking purposes and marketing opportunities
Performance Expectations
- Intake staff process 10-15 orders each per day
- 100% referral confirmation
- 100% tracking log entry
- All orders entered into system within 60 minutes
- 100% complete & accurate at Q/A step
- Zero “No-Go” orders due to lack of inventory
- 100% check for Same/Similar
- Daily reconcile of tracking log with orders entered
1. What is the level of performance at key parts of the intake process?
2. What metrics/methods do you use to monitor/measure performance?
1. What is the level of performance at key parts of the intake process?
2. What metrics/methods do you use to monitor/measure performance?
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Intake Checklist
1. Process Receipt of Referral: (fax, e-mail, phone, walk-in)
Name Address Phone number DOB HT, WT Emergency contact Employer Diagnosis Social security number Drug allergies Advanced directives ___Yes ___No
2. Process Rx:
Diagnosis noted on Rx Equipment/supplies noted on Rx Equipment/supplies appropriate for diagnosis Oxygen Rx – elements of O2 Rx complete Proper signature
3. Process Insurance:
Verify eligibility of primary Secondary payer? Determine deductible/co-pay amount Inform of co-pay amount
4. Prepare Documents:
Print required forms Print educations material Estimate of Patient Cost
Every piece of
information required at
time of initial intake!
Every piece of
information required at
time of initial intake!
Job Breakdown Instruction Sheet
Job Breakdown Sheet: Daily Hospital Visits Unit: Hospitalists
Important Steps Key Points Reasons
Step #1 The Welcome
The patient needs to be given hope and wants to be healed
Sit down You are not rushed and you have time for the patient
My name is (AIDET) Knows who you are
My connection with your referring doc is…….. Knows that there is continuity in care
I have reviewed your information and know how to care for you
Knows that you have the knowledge to make the right and safe decisions
Step #2 The Care
The patient needs to feel safe and in control
Here is what I am going to do and why
Here are the next steps
Ask if patient understands the plan
Ask for patient’s needs
Step # 3 The Goodbye
A Few Tips and Key Points Some processes will be the same/similar for every location
(intake, WH, resp. confirmation, co-co-pay collection, etc.)
Some processes may be more branch-specific
Will focus first on common processes
Branch managers will review completed WH & resp. processes to ensure they “fit” their operation
Many of your processes may already be formalized – just
need to convert them using the new template
Expected Outcomes Will end up with a central collection of SOPs that apply to all
branches
Branches may also have a few SOPs that are more applicable to their operation (branch-specific)
Will also have a central collection of updated policies that apply to entire company
Objective is to increase understanding and formalization of all processes
Promote consistency and maintain operational discipline
Tools & Resources
SOP Template
Sample SOP (Orders)
Sample SOP (Co-pay collection)
Job Breakdown Worksheet
More details and guidance will be provided within the next few days
Note: Click Here to access the samples and templates
Assistance Available
Chris Calderone
chrisc@leanhomecare.com
734-709-5487
Questions ?
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