Revenue Impact with Big Bang Implementation Presented by: Jack Hueter & Novi Vinod
Jan 18, 2018
Revenue Impact with Big Bang Implementation
Presented by: Jack Hueter & Novi Vinod
Agenda for today
▪ Introductions▪ LVHN organization and timeline▪ Steps taken throughout implementation▪ End results▪ Lessons learned
• 5 Campuses• 1 children’s Hospital• 140+ Physician practices• 17 Community Clinics• 12 Health Centers• 10 ExpressCARE locations• 80 Testing and Imaging Locations• 13,100 Employees• 1,340 Phsycians• 582 Advanced Practice Clinicians• 3,700 Registered Nurses• 60,585 Admissions• 208,700 ED Visits• 1,161 Acute Care Beds
Scope at LVHN▪ Ambulatory Big Bang Go Live – February 18, 2015
• 175+ sites• 700+ Physicians and 300+ AP’s• 90% converted from GE Centricity• 10% paper
▪ Inpatient Big Bang Go Live – August 1, 2015• 3 Inpatient Campuses – Cedar Crest, Muhlenberg, 17th Street• Included Hospital based Outpatient clinics • 100% converted from GE Centricity Enterprise – Revenue, Clinical, Radiology,
Pharmacy• Other major systems – T systems, PHS Scheduling, OR Tracker, RIS, Metavision
ICU/PICU, Teletracking, Orion portal
TIMELINE
Big Bang Implementation Guidelines
▪ Governance and Team structure▪ Project management support▪ Importance of scoping & direction setting▪ Build phase ▪ Testing phase▪ Training phase
Steps taken to minimize revenue impact
▪ Revenue cycle ownership and governance▪ Set expectations with department heads and
leadership▪ ARCR leads identified and leveraged▪ Identified Key KPI’s to monitor pre go-live
• Compute accurate baselines prior to go-live
▪ Testing
Testing▪ Charge testing▪ Parallel Revenue Charge Testing (PRCT)▪ Claims testing
Ambulatory Accounts Receivable
02/20/15
03/06/15
03/20/15
04/03/15
04/17/15
05/01/15
05/15/15
05/29/15
06/12/15
06/26/15
07/10/15
07/24/15
08/07/15
08/21/15
09/04/15
09/18/15
10/02/15
10/16/15
10/30/15
11/13/15
11/27/15
12/11/15
12/25/15
01/08/16
01/22/16
02/05/160
10
20
30
40
50
60
70
80
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Epic ARLegacy AR TotalTotal AR
Dolla
rs (M
)
Ambulatory Claims Acceptance
03/27
/15
04/03
/15
04/10
/15
04/17
/15
04/24
/15
05/01
/15
05/08
/15
05/15
/15
05/22
/15
05/29
/15
06/05
/15
06/12
/15
06/19
/15
06/26
/15
07/03
/15
07/10
/15
07/17
/15
07/24
/15
07/31
/15
08/07
/15
08/14
/15
08/21
/15
08/28
/15
09/04
/15
09/11
/15
09/18
/150
10,000
20,000
30,000
40,000
50,000
60,000
50%
60%
70%
80%
90%
100%
3370
5
3237
5 4027
2 4595
5
3748
1 4508
7
3720
7 4314
1
4045
0
3167
240
291
3751
6
3394
235
191
5340
5
3071
4 3452
9
3333
835
621 39
167
3751
1 4153
743
332
3720
6
3043
5
5100
9
630
393
792
715
807
553
437
480
474
320
846
446
134 21
1
253
123
213
526 58
453
1
573
910 78
9
2389
1765
277
98% 99
%98
% 98%
98% 99
%99
%99
%99
%99
%98
% 99% 10
0%99
%10
0%10
0%99
%98
%98
% 99%
98%
98% 98
%
94% 95
%
99%
Total Rejected
Total Accepted
Total % Accepted
# of
Cla
ims
Subm
itted
Clai
ms
Acce
ptan
ce R
ate
Ambulatory Charges to Baselines
Inpatient Focus Area Achievements
Revenue Cycle Management
4 Weeks
8/1 8/29 9/26 10/31 1/30
8 Weeks
Payments in Epic exceed baseline
weekly
13 Weeks(90 Days)
26 Weeks (180 Days)
Legacy AR Days <10% of Baseline
HB 100% charging
HB weekly claims sent exceed charges.
Achieved on/before target.Upcoming target.
Achieved after target.
HB go-live hold fully removed
HB first Epic-AR week over week
decrease
Inpatient Charges to Baseline
Inpatient Claims Acceptance Rate
Inpatient – Revenue Tracker
15
Daily Revenue Tracking Snap Shot
Inpatient Metric Guardrailsweek 7
MetricGuardrail/
Top 25%Long-term
Target Current Week Change StatusAR (Percent change from baseline) 17% - 3% - -2% 0%
Cumulative Charges 99% - 101% 100% 100% 0% Cumulative Cash Variance (in Weeks) -1.19 Weeks - -0.39
Weeks 0 -1.44 Weeks -0.04 Weeks CFB Days 12.03 Days - 7.68 Days - 10.56 Days -0.39 Days
Coding in CFB4.91 Days - 7.68 Days
- 3.6 Days -0.11 Days Claim Errors 4.18 Days - 1.68 Days - 3.02 Days 0.25Days
Open Denials Days<4 Days
- 0.13 Days 0.04 Days
Legacy AR % of baseline 38% - 31% - 33% -2%
Claims Acceptance % 90% - 99% - 93% 19%
= On track Improving = Watch = Serious Negative Trend
17
▪ Important to have SMEs and operational owners “on board” with Epic
▪ These are the people that will be key in helping shift focus of current state to new improved future state with Epic
Revenue Cycle Lessons Learned
Early buy-in from SMEs and
operational owners
18
▪ Identify and validate future workflows building off current workflows
• Build in Epic to maximize efficiencies in current workflows and process
▪ Focus on maximizing efficiencies within Epic and build to future state workflows
▪ Incorporate 3rd party tools upfront in design and planning workflows
Revenue Cycle Lessons Learned
Identify and validate future
workflows
19
▪ Revenue cycle representation needs to be included in decisions made at on the clinical side
▪ This ensures charges are captured and revenue is not impacted negatively at go-live
▪ Testing begins right away with unit testing of workflows and continues until go-live
Revenue Cycle Lessons Learned
ALL build, testing and
communication needs to include representation
across ALL modules within
Epic
20
▪ Align Epic’s project workplan with organization’s project workplan early and set expectations/targets
▪ Incorporate enough time in the project plan to build, test and validate for the revenue cycle
▪ Users need to not only understand basic functionality within Epic but also to understand how to navigate within Epic so they can do their jobs efficiently and effectively
Revenue Cycle Lessons Learned
Revenue Cycle cannot wait for optimization to
get it right
21
▪ Important to begin new revenue cycle with clean slate
▪ Have a plan to support the legacy run down
Revenue Cycle Lessons Learned
Keep AR in legacy system
22
▪ Facility design is an integral part of the Epic’s core build - it touches every module within Epic
Revenue Cycle Lessons Learned
The facility structure is the
most crucial build in your Epic
system - once built, cannot be
“undone”
23
▪ Again - start the planning and build process in the very early stages in the project and involve both the hospital side and professional side
Revenue Cycle Lessons Learned
Payor/Plan is the another crucial
build in Epic because it is
shared between hospital and
Ambulatory in Epic
Takeaways
▪ Testing▪ Operations have to own the process▪ Knowing your current condition (baseline) pre go-live to
assess your success post go-live▪ Outsource or work down legacy A/R prior to go-live▪ Be ready to be flexible with your workflows (based on how build is
interacting with other modules or SME feedback)