Overview of RHM SOP Project Copyright © 2014 – Lean Homecare Consulting Group, LLC. All Rights Reserved. This presentation is distributed for informational.

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

[email protected]

734-709-5487

Questions ?