Centralized Scheduling

Centralized Scheduling

Children’s Hospital’s Journey

Maribeth Quinn

Presentation Agenda

n

Background for Columbus Children’s Hospital

n

Project Background

n

Goals for Centralizing the Process

n

Initial Scheduling Process (Past State)

n

What We Wanted for the Future State

n

Steps We Took Along the Way

n

Before Approval

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After Approval

n

After Selection

Columbus Children’s Hospital

n

110 year history

n

Teaching hospital

n

Strong commitment to research

n

2004 statistics:

n

323 licensed beds

n

48 leased off-site beds

n

14,012 inpatient discharges

n

15,652 surgeries

n

64,851 ED visits, plus approx. 20,000 Urgent Care Visits

n

Approx. 47,000 off-site urgent care visits

Scheduling Project Background

n

Completely decentralized process

n

Almost all our clinics require a referral from a primary

care physician (pediatrician) and most clinics were

using a fax referral to schedule from

n

Some clinics were taking two weeks to “triage”

patient information and provide an appointment back

n

Most clinics were then relying on the primary care

physician to notify the patient of their appointment

date and time

+50 Clinics

& Procedures

Customers

(both

internal

and external)

Separate phone

call or fax for each

area with a different

process to follow

_{+15 Scheduling}

Systems

Original Scenario (2003)

* New form and process now being

used to create more consistency

Customer Service “Horror” Stories

Pickerington Family Practice

Debbie Foly - Nurse Manager

Phone: 833-0880 x230

•Main concern: Takes weeks to get an appointment. Ex-CHI nurse who understands the wait

times, but feels that weeks of waiting just to get an appointment is unacceptable. She spoke of

continuing problem but named the ENT and GI clinics as recent examples of poor service.

•ENT Clinic - Patient had painful ear infection with drainage. After two weeks of daily phone

calls requesting an appointment to see CHI specialist without any response, patient was forced

to go to ED for treatment. ENT Clinic finally called after ED visit, saying they were trying to

reach PCP and parent the whole time...

•After a frustrating two weeks of waiting for an appointment in the GI Clinic, they sent their

patient to another location for service.

•Pickerington belongs to a group of 26 family practice offices who share info like this along

with alternative locations to send their patients

Goals for Centralized Scheduling

Project

n

Improve customer service

to both referring physicians and parents by

providing “one-stop” shopping for all their scheduling needs

n

should also reduce the time required to register when they arrive for

their appointment

n

Increase productivity

associated with clinic and diagnostic schedules and

productivity

n

higher productivity will

increase revenue

n

provides an opportunity to create consistent policies across areas

n

Improve access

to clinics and diagnostic areas through better ability to fill

open slots

n

could

reduce overall wait times

in some of the areas

n

Reduce labor

associated with scheduling (estimated to be significant due

to decentralized system)

n

Improve the pre-registration process which will lead to

increased

collections

Scheduling

Center

+50 Clinics

& Procedures

Customers

(both

internal

and external)

One phone

call or fax

for everything

One Scheduling

System

Ultimate Proposed Scenario

Scheduling

System

View

* Referred to as Central ACCESS

Benefits of Ultimate Process

n

Customer Service

n

Physician Relations

- referring physician’s staff spend large amounts of

time trying to coordinate several appointments on behalf of the patient.

They are currently frustrated with our process.

n

Parent Relations

-providing parents with the ability to make one call for

all procedures and clinic visits

n

Consistency/Quality

- having one process allows for more

standardization of policies and procedures in scheduling

practices thus improving access to care. Rules will also

prevent tests being ordered in the wrong order, etc.

n

Patient Education

- having an intelligent robust system

allows for reliable information to be consistently provided to

the patient and family when scheduling procedures and

Benefits of Ultimate Process

n

Return on Investment

n

Increased revenue -

Many hospitals reported increases in

volume after implementing centralized scheduling through

better management of clinic throughput and easier access

n

Increased revenue

- currently it is estimated that most of our

clinics experience a 25% no-show rate and above. Although

some areas handle this through over booking many areas do

not. With a more customer friendly system it is estimated that

no-show rates will decline improving overall revenue.

n

Reimbursement

- centralized scheduling processes include

pre-registration and could ensure that required authorizations

are completed prior to any appointments

n

Time Savings

- hospital staff spend large amounts of time

trying to coordinate schedules between departments.

OhioHealth estimated a savings of over 20 FTE’s.

Issues/Concerns

n

Triage capability - Currently many of the areas practice

some type of triaging to determine how quickly a patient

should be seen. A new process for triage would have to be

developed than the current one.

n

Each area loses some control of their “immediate” schedule

in that except for emergencies, schedules would not be

changed. Long term schedules are determined by the areas

themselves.

n

It will take a lot of work to redesign all the current scheduling

processes.

n

A new system will need to be purchased to provide sufficient

search and education capabilities for one area to have the

knowledge and expertise to schedule for all areas.

Project Steps Before Approval

n

Interviewed all clinics to determine how they were scheduling

n

What system they were using

n

How much staff time it was taking

n

A sense of the process they were following

n

Compiled that data into a table to present to the Steering

Committee

n

Contacted other hospitals to determine if they had achieved a

Central Scheduling process

n

ROI Analysis based on estimated costs using improved

throughput (projected)

n

Took a site visit with key physicians to Cincinnati Children’s who

Initial Data Collection

Summary of Current Scheduling Areas Using SMS

Department/Clinic

Pre-Register? Scheduling System

FTE's

Estimated

Monthly

Volumes

Adolescent/Teen Health Clinic

No

SMS

0.90

543

Allergy Clinic

No

SMS

0.50

136

Bone Density

No

SMS

0.25

Cardiology Clinic

No

SMS

0.75

603

Central Scheduling

Yes

SMS

8.00

2394

Cerebral Palsy

No

SMS

0.67

91

CT Interventional

No

SMS

0.38

2376

Dermatology Clinic

No

SMS

0.50

222

Developmental Disability

No

SMS

0.60

42

Down Syndrome

No

SMS

0.60

Endocrinology

Yes

SMS

0.50

435

Eye Clinic

No

SMS

0.25

550

Fluoroscopy

No

SMS

0.13

506

General Radiology

No

SMS

0.13

5512

Hematology

No

SMS

1.00

866

Myelomeningocile

No

SMS

0.60

41

MRI

No

SMS

1.00

907

Nuclear Medicine

No

SMS

0.13

377

Orthopedics including hand clinic

No

SMS

0.67

606

Physical Medicine/Rehab

No

SMS

1.25

282

Primary Care

Yes

SMS

Sleep Lab

No

SMS

0.50

341

Sports Medicine

No

SMS

0.67

108

Ultrasound

No

SMS

0.13

731

Cleft Palate/Cranio Facial

Yes

Paper/Pencil & SMS

0.75

59

ENT

No

Paper/Pencil & SMS

0.75

422

Family Development

No

Paper/Pencil & SMS

0.38

85

Immune Deficiency (IDC)

Yes

Paper/Pencil & SMS

0.38

71

Department/Clinic

Pre-Register? Scheduling System

FTE's

Estimated

Monthly

Volumes

Behavioral Health

Yes

CMS

6.00

700

Behavior/Learning Disability

Yes

CSM database

1.50

106

Physical Therapy

Yes

Excel

0.75

808

Occupational Therapy

Yes

Excel

853

Pediatric Surgery (King, Teisch)

No

Medical Manager

1.00

838

Pulmonary Clinic - CF

No

MS Access

0.50

508

Arthritis Clinic/Rheumatology

No

Outlook

0.38

176

Infant Pulmonary Lab

No

Outlook

0.13

Interpreters

Not Applicable

Outlook

0.31

Nephrology

No

Outlook

0.38

162

Neurology

Yes

Outlook

0.75

446

GI Procedures Clinic

Yes

Outlook & SMS

1.50

743

Cardiology Diagnostic

No

Paper/Pencil

1.00

Dialysis

Yes

Paper/Pencil

0.03

EEG

Yes

Paper/Pencil

0.33

383

Genetics Clinic

No

Paper/Pencil

0.75

Infectious Disease Clinic

No

Paper/Pencil

35

Infusion

Yes

Paper/Pencil

0.19

170

Neonatology

No

Paper/Pencil

0.63

172

Pediatric Surgery (not King, Teisch)

No

Paper/Pencil

1.00

Pulmonary Lab

No

Paper/Pencil

0.13

561

Speech

No

Paper/Pencil

0.33

1278

Sweat Lab

No

Paper/Pencil

0.03

Dental Clinic

No

Softdent

1.50

2333

Estimated Monthly Total Not on SMS

19.10

10270

Initial Data Collection

Comparison with Other

Hospital Systems

Area Hospital’s with Centralized

Scheduling

n

Cincinnati Children’s Hospital

n

Mount Carmel

n

OhioHealth (Radiology Only)

n

Tod Children’s Hospital (Youngstown)

n

St. Elizabeth North Unit (KY)

n

TriHealth System (Cincinnati)

n

Health Alliance System (Cincinnati)

Area Hospitals not using Centralized

Scheduling

n

Ohio State University Medical Center

n

Rainbow Children’s

n

Akron Children’s

n

Dayton Children’s

n

Toledo Children’s (plans to offer it within

next two years)

Other Hospitals Using Centralized Scheduling

n

Beaumont Hospital (MI) *

n

Riverside Walter Reed Hospital (VA) *

St. Elizabeth North Unit (KY)

Other Hospitals not using Centralized Scheduling

n

Mayo Clinic (MN) *

n

Johns Hopkins Hospital (MD) *

n

University of Michigan Medical Center (MI) *

Massachusetts General Hospital (MA)

Barnes-Jewish Hospital (MO)

n

University of California San Francisco Medical

Center (CA)

n

Stanford University Hospital (CA)

Brigham & Women’s Hospital (MA)

($1,405,997) NPV using 10% and 1% improvements $4,713,822 NPV using 10% and 5% improvements

Centralized Scheduling

Return on Investment Analysis

Average Monthly Clinic Billing

Average Monthly Scheduled Diagnostic Billing

MRI, Ultrasound, CT, Nuclear Med., EEG, Cardiology $3,181,137

Average Monthly Clinic/Diagnostic Denials

Increased Revenue Year 1 Year 2 Year 3 Year 4 Year 5 Total Decrease breakrate and/or increase physician productivity

by 1% assuming 70% collection rate $165,103 $165,103 $165,103 $165,103 $165,103 $825,513 1% increase in diagnostic productivity $267,215 $267,215 $267,215 $267,215 $267,215 $1,336,077 1% decrease in denials $11,640 $11,640 $11,640 $11,640 $11,640 $58,200

$443,958 $443,958 $443,958 $443,958 $443,958 $2,219,790 Decrease breakrate and/or increase physician productivity

by 5% assuming 70% collection rate $825,513 $825,513 $825,513 $825,513 $825,513 $4,127,565 5% increase in diagnostic productivity $1,336,077 $1,336,077 $1,336,077 $1,336,077 $1,336,077 $6,680,387 5% decrease in denials $58,200 $58,200 $58,200 $58,200 $58,200 $291,000 $2,219,790 $2,219,790 $2,219,790 $2,219,790 $2,219,790 $11,098,952 Required cash flow to break even using NPV $852,000 $852,000 $852,000 $852,000 $852,000 $4,260,000 (Equates to approximately a 2% decrease in breakrate and

or physician productivity and diagnostic productivity)

Investment & Ongoing Expenses Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Total

Equipment Software $ 800,000 $ 160,000 $ 160,000 $ 160,000 $ 160,000 $ 160,000 $ 1,600,000 Hardware $ 90,000 Implementation $ 500,000 $ 200,000 $ 700,000 Ongoing IT support $ 234,000 $ 117,000 $ 117,000 $ 117,000 $ 117,000 $ 117,000 $ 819,000 Scheduling Manager $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 78,000 $ 468,000

Total Initial Investment $ 1,702,000 $ 555,000 $ 355,000 $ 355,000 $ 355,000 $ 355,000 $ 3,677,000

Net Cash Flow

Net Cash Flow Annual using 1% $ (1,702,000) ($111,042) $88,958 $88,958 $88,958 $88,958 ($1,457,210) Net Cash Flow Annual using 5% $ (1,702,000) $ 1,664,790 $ 1,864,790 $ 1,864,790 $ 1,864,790 $ 1,864,790 $ 7,421,952 Net Cash Flow Cumulative using 1% $ (1,702,000) $ (1,813,042) $ (1,724,084) $ (1,635,126) $ (1,546,168) $ (1,457,210)

Net Cash Flow Cumulative using 5% $ (1,702,000) $ (37,210) $ 1,827,581 $ 3,692,371 $ 5,557,161 $ 7,421,952

Net Cash Flow Required to Break Even $ (1,702,000) $ 297,000 $ 497,000 $ 497,000 $ 497,000 $ 497,000 $ 583,000 (1,702,000)

$ $ (1,405,000) $ (908,000) $ (411,000) $ 86,000 $ 583,000

What Sold the Project?

n

The site visit to Cincinnati Children’s Hospital where

we took 3 physicians (one of whom was particularly

against the idea) was a key step. Cincinnati was

having success and there were physicians there to

attest that the centralization had not been a problem

for them.

n

Also, the small improvement required in throughput to

pay for the system while improving customer service

sold the project to Administration

Project Steps Once Approved

n

Created a “Planning Committee” to write the RFP

n

Using workflows what “exactly” did we need a scheduling system to

be able to do (Rules Based System)

n

Which needs were critical or which would be nice to be met

n

Mostly clinical staff (including 3 physicians) so we met at 7:00 for

an hour each week

n

Sent out and scored the RFP responses

n

Invited back the top 5 vendors

n

Went on site visits for the top 2 vendors

n

Selected a system in Summer, 2003 and then entered into

contract negotiations

Project Steps After Selection

Process Completed

n

System Manager training September, 2003 and

began really building the system in October

n

Central Scheduling moved to Westerville (off-site)

February 27

th

_{, 2004}

n

Training completed the last week of February, 2004

n

Began scheduling for Primary Care, ENT, Eye and

Derm March 6, 2004

n

Radiology live in April, 2004

Baseline for Goals to Determine the

Impact of the Project

n

Physician and parent surveys

n

The director conducted a parent survey late 2003 for baseline

n

A fax survey was sent to approximately 300 referring physician

offices

n

Clinic throughput (# of patients actually seen per day)

n

Gather current wait times for being seen in clinic areas

n

Cost per appointment measured before and after scheduling

process/system is implemented

n

Measure denials before and after (will not be affected until

pre-registration is implemented)

Children’s Hospital Scheduling

Benchmarking Survey

April 2004

1.

How long does it take to schedule an appointment at Children’s Hospital:

Radiology Department?

_____ Minutes _____ Hrs. _____ Days

Sub-specialty Clinic?

_____ Minutes

_____ Hrs. _____ Days

2.

Please rate your satisfaction with Children’s Hospital’s current time (processing time) to schedule an appointment.

Very Satisfied Satisfied

Neutral

Unsatisfied

Very Unsatisfied

Radiology

o

o

o

o

o

Subspecialty Clinics

o

o

o

o

o

EEG’s

o

o

o

o

o

4.

Does an RN in your office schedule the appointment?

_____ Yes _____No

3.

Could your office accommodate the process of keeping the parent in your office while an appointment at

Children’s Hospital is booked over the phone?

_____ Yes _____No

5.

How would you rate your overall satisfaction with the scheduling process at Children’s Hospital? (e.g. Including ease of

use, time required, response time received…)

Very Satisfied Satisfied

Neutral

Unsatisfied

Very Unsatisfied

o

o

o

o

o

Thank you for your time! Your feedback is greatly appreciated and will be used to help improve our scheduling process.

Please forward any questions to Joan Euans, Central Scheduling Supervisor at 722-5910.

Results from 1

st

Survey

Current time(processing time) to schedule an appt.

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

Radiology

15

8

0

0

0

65.2%

34.8%

Subspecialty Clinics

2

3

6

9

3

23

8.7%

13.0%

26.1%

39.1%

13.0%

EEG's

4

9

10

0

0

23

17.4%

39.1%

43.5%

0.0%

0.0%

Could your office accommodate the process of keeping the parent in your office while an appt at CHI is booked over the phone?

Yes

No

14

9

Does an RN in your office schedule the appt?

Yes

No

16

7

Overall satisfaction with scheduling process at CHI

Very Satisfied

Satisfied

Neutral

Unsatisfied

2

12

6

4

Results from 2nd Survey

Very Satisfied

Satisfied

Neutral

Unsatisfied / Etc.

Radiology

18

10

4

2

%

53%

29%

12%

6%

Subspecialty Clinics

5

15

10

2

%

16%

47%

31%

6%

EEG's

8

14

8

2

%

26%

43%

25%

6%

%

Yes

18

51%

No

17

49%

%

Yes

19

52%

No

17

48%

Very Satisfied

Satisfied

Neutral

Unsatisfied

Very Unsatisfied

12

9

7

5

0

37%

27%

21%

15%

0%

4. Does an RN in your office schedule the appt?

5. Overall satisfaction with scheduling process at CHI

2. Current time(processing time) to schedule an appt.

3. Could your office accommodate the process of keeping the parent in your office while an appt at CHI is booked

over the phone?

Some Comments from 2nd Survey

n

Once you get a scheduler it moves fairly fast but the experience I've had with

wait times has been too long. It seems to be getting a little better

n

Much better than previously

n

Some kids need to get in quicker especially behavioral. We love Children's, the

only problem was getting in, that has been corrected. Thanks

n

Very nice change / improvement

n

Some of the specialty clinic utilize a triage system - this is probably the best way

to schedule

n

No complaints or problems; very good system. Thanks

n

I love the new scheduling process! Usual wait time on phone is minimal.

Telephone operators are always helpful and pleasant.

n

Response time ("on hold" time) prior to scheduling is a little lengthy

n

For the subspecialty clinics, I would much rather send/fax a written referral.

That is easier than calling. I have been on the phone for as much as 20 min.

Radiology is o.k. except for when you need an appt. STAT because a lot of

times the scheduline dept needs to contact radiology which is also time

consuming.

Monthly Average Phone Queue Time

0

20

40

60

80

100

120

140

160

Seconds

Parent Surveys – Primary Care

Rating of Primary Care Scheduling Process

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

50.0%

Excellent Very Good

Good

Fair

Poor

Dec-03

Apr-04

Sep-04

Radiology Throughput Increases

Compared to Expenses

Revenue/Margin Gains in Radiology

$0

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

MRI

Fluoroscopy

Ultrasound

CT

Nuclear

_Medicine

Increased Revenue

'03-04 (Sept. YTD)

Increased Margin '03-'04

(Sept. YTD)