Optimization: Is it all about the timing?

Optimization: Is it all about the timing?


You know that saying, “Timing is everything?” With the torrent of change that has hit healthcare, it seems as if the timing has not felt right for many organizations to attempt optimization. Why optimize if we cannot predict and factor in the next change? Optimization can come in 31 flavors!, our first blog in this series, introduced the methodology to manage the diversity of an optimization project by breaking it down into incremental, achievable goals. In this second article of the series, let’s discuss a real scenario.

St. Charles Medical Group, located in the Pacific Northwest, collaborated with Galen Healthcare Solutions to define its optimization approach. This organization’s business strategy aligned with the current industry trend of acquiring smaller practices, which meant its long-term success depended upon a well-documented, metric-driven, and, more importantly, repeatable processes that met the needs of both existing and newly on-boarded practices. St. Charles’ initial goal prior to beginning its optimization project was much like many other clients we’ve worked with through the years. As had quickly grown from 30 providers to more than 180+ providers with 19 specialties, the focus was solely on-boarding and adoption, not necessarily optimization.

During the initial engagement, our team lead laid out a plan based on Galen’s methodology and highlighted the importance of having baseline benchmarks and clearly-defined metrics that could be used at any time to gauge the optimization project’s success. The joint St Charles-Galen optimization project team began to brainstorm a plan, and, as is often the case, objectives for optimization differed depending on the audience. Obvious goals ranged from achieving quality improvement, to increasing efficiency and productivity of providers, to improving patient safety and compliance. However, there was one universal priority that everyone agreed to work toward: improving the provider experience.

One challenge to address is how to measure success. Provider satisfaction surveys are often too subjective, and if concerns are not acknowledged in a timely and meaningful way, they can have the opposite impact. With this and the fact that much of the EHR is driven by time- and date-stamped tasking, it was decided that analyzing visit numbers, tasks counts, and times to completion for certain tasks would produce a solid baseline. Analysis of several different types of tasks offered a definitive way to gauge overall operational efficiency. Investigating on a more granular level allowed for the identification and resolution of workflow issues.

By design, this well-rounded project plan aligned leadership, providers, and staff toward common goals. Both senior leadership and the provider end user base acknowledged that the time it took a provider to document a patient visit was impacting satisfaction. They mutually agreed that times to complete tasks and sign notes could serve as a direct correlation to benchmark goals and measure the overall efficacy of the project. Additionally, this fed into quality outcomes and patient safety goals, considering that prescription renewals and reviewing pending results also fell into trackable task types. They could monitor diminishing completion times for these tasks, which translated to patients getting their medications refilled on time without missing doses, as well as receiving quick, as needed changes in treatment plans based on lab results. This was a quick win for all involved and could be easily tracked on dashboards for progress throughout the project’s duration.

Task Optimization

Actual baseline metrics and outcome of task completion time pre- and post-optimization.

The time it took a provider to sign a note was an inventive way to evaluate the reduction in time it took a provider to document a visit. The complaint from providers was that they were charting way past clinic hours to close out their patient visit documentation. The Galen team developed a query to identify the percentage completed by the end of patient hours (6 PM) versus the percentage completed in the evening on the providers’ off-hours (10 PM). Looking at these numbers on a monthly basis at both the practice and the individual level showed trending patterns of who was struggling and who was succeeding. This data helped the HIT staff discover the best practice workflows that could be adopted across the organization. An added bonus was the allowance of more efficient, cohesive support with a consistent workflow approach. Sharing the statistics monthly buoyed the spirit of collaboration around a topic providers were passionate about, and it set the tone for provider participation in other optimization exercises. Ultimately, they were able to increase the percentage of notes completed during office hours, which improved provider satisfaction. At the same time, daily documentation completion was a positive impact for revenue purposes.

Finalized 6PM

Example report of Pre- and Post-Optimization benchmarks for note signing completion.

According to a Medical Group Management Association (MGMA) survey from 2008, the average physician’s work RVUs (relative value units) is 18.4 per day, based on 20 visits per day. This could fluctuate depending on the specialty and practice, but using this reference as an example, an 18% improvement could mean seeing an additional 3-4 patients per day. With new healthcare payment models and value-based care programs focusing on quality outcomes versus volume of patients seen, this could equate to potential open appointments for same-day access and lead organizations into quality programs such as PCMH and ACOs that they haven’t enrolled in yet. Optimization activities can lead to increased revenue, but avoiding them may cause more financial loss than expected.A different but equally impactful reporting point revolved around verifying patient results. Streamlining the best practice workflow for provider efficiency was the first step, and, by studying the data, an organizational workflow was developed. Time-saving efficiencies for the providers were generated with the development of Order-Result Management Worklists and text templates for result notes. The second part of the optimization involved retraining users on how patient communication tasks were triaged. Originally, all result tasks were routed to the clinical staff. However, in the new scenario, Call Patient with Results tasks were automatically sent to the Nurse Team View, and Mail Result to Patient tasks were automatically assigned to the Front Desk Staff View. Redistributing tasks to more appropriate staff members resulted in quicker handling and allowed clinical staff to remain focused on clinical matters, ultimately having a positive impact on patient care.

As many are preparing for alternative payment models where quality, efficiency, and patient satisfaction are key elements, now is the perfect time to conduct the optimization conversation. Assessing how your organization will transform with healthcare payment reform not only forces you to evaluate your EHR for optimal configuration, but it also helps ensure that your highly trained staff aren’t stuck in menial data entry mode to meet quality programs. It also helps ensure that all staff are performing at the top of their skill set and licensed capabilities. We have highlighted two of the many examples of how Galen’s methodology and reporting tools can positively impact many different areas, such as revenue and efficiency, which ultimately translate to improved patient care. Contact us below for more information:

References:
http://www.aafp.org/fpm/2009/0900/p31.html

 

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2 Comments

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  1. 1
    Shannon

    Hello!

    We have developed a custom crystal report for our requisitions and installed it on our server. We are unable to see this as an option in the print dialogue box. Is there something specific that we need to do to pull this into Allscripts so that we can select it as the document info template?

    Thank you!

    Shannon

  2. 2
    Justin Nakamura

    Hi Shannon,

    There is a stored procedure called SetPrintDocumentsDE that can be used to insert the rpt record to the Print_Documents_DE table. We always recommend that you validate it in your test environment first, as making changes to the database poses a risk. Also, make sure to save a current copy of the report somewhere, as we’ve seen them get wiped out during upgrades and HF’s. If you need additional assistance, let us know and we can put you in touch with one of our analysts!

    Thanks,
    Justin

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