Holistic Health Systems (HHS) operates 39 hospital facilities and clinics. The executive team has been reviewing key metrics over the last year and identified a need to improve Point of Service Collections or simply known as POS (pronounced P-O-S). POS is a patient payment that is received within 7 days after discharge. Increasing POS is important for HHS because hospitals are 60% less likely to receive payment once the patient leaves the hospital. The cost to collect on the patients account continues to go up while the chance of actually collecting payment goes down if there is a delay in collecting the payment after the patients discharge. Therefore, it is better to not delay collecting the payment.

Increasing POS reduces Bad Debts, provides a better cash position, reduces expenses, and increases patient satisfaction when conducted properly.

POS is calculated by dividing POS Payments by Total Patient Cash Collected.

HHS has identified the industry median benchmark for POS as 13.6% and the top 10% POS benchmark as 41.4%. HHSs current POS performance is 35.6% and the executive team has determined that a 5 percentage point increase is needed to stay competitive (target = 40.6%). A Lean Six Sigma team was formed.

POS is a metric that heavily relies on the Patient Access team or PA. PA is responsible for several taskspatient scheduling, registration, and financial clearance. The Scheduling tasks are typically completed by a centralized PA team for multiple hospital facilities. During Scheduling, PA reps receive a doctors order for a patient. The order is like a permission slip for specific medical services the doctor deems necessary.

The doctor or even the patient related to the order can call Scheduling to reserve an appointment for the services that correspond to what is written in the order. PA reps need to verify that the order is complete and accurate, coordinate time for services, and provide patients with pre-service instructions. After patients information is logged into the scheduling system, it will queue up to the PA registration team to complete the registration process. PA will call the patient and confirm the identity, collect demographics such as address, family, emergency contact, etc. PA registration will also confirm the patients health insurance provider(s). PA registration can be completed at a hospital facility or by a centralized team. Lastly, PA Financial Clearance will verify patient health benefits to ensure they exist and to determine if the procedure or service for the patient is covered. If authorization is required, the PA Financial Clearance will request authorization for services from the patients health insurance provider. Services performed without authorization lead to rejected claims. Also during PA Financial Clearance, the PA rep will Counsel the patient about their liability (how much their insurance provider says they need to pay for the services) and collect the payment. Any payment received is considered POS since its before 7 days post discharge. Financial clearance can also be performed at the hospital facilities or by a centralized team.

Summary patient cash data for HHSs 39 hospital facilities for a year is presented in Table 1. The table also indicates if the PA team for each facility is centralized or not.

Table 2 provides an overall monthly trend for POS Performance

The team identified the facilities with POS performance above the target and researched the activities they have in place hoping to find commonalities or key drivers.

They are:

ensure proper patient education on benefits and liability

ask for payment

have a financial counseling policy

reduce number of patients that leave without financial clearance

have accurate tools to help estimate Patient Liability or Responsibility

utilize devices that allow patient collections at patient bedside

Holistic Health Systems (HHS) operates 39 hospital facilities and clinics. The executive team has been reviewing key metrics over the last year and identified a need to improve Point of Service Collections or simply known as POS (pronounced P-O-S). POS is a patient payment that is received within 7 days after discharge. Increasing POS is important for HHS because hospitals are 60% less likely to receive payment once the patient leaves the hospital. The cost to collect on the patients account continues to go up while the chance of actually collecting payment goes down if there is a delay in collecting the payment after the patients discharge. Therefore, it is better to not delay collecting the payment.

Increasing POS reduces Bad Debts, provides a better cash position, reduces expenses, and increases patient satisfaction when conducted properly.

POS is calculated by dividing POS Payments by Total Patient Cash Collected.

HHS has identified the industry median benchmark for POS as 13.6% and the top 10% POS benchmark as 41.4%. HHSs current POS performance is 35.6% and the executive team has determined that a 5 percentage point increase is needed to stay competitive (target = 40.6%). A Lean Six Sigma team was formed.

POS is a metric that heavily relies on the Patient Access team or PA. PA is responsible for several taskspatient scheduling, registration, and financial clearance. The Scheduling tasks are typically completed by a centralized PA team for multiple hospital facilities. During Scheduling, PA reps receive a doctors order for a patient. The order is like a permission slip for specific medical services the doctor deems necessary.

The doctor or even the patient related to the order can call Scheduling to reserve an appointment for the services that correspond to what is written in the order. PA reps need to verify that the order is complete and accurate, coordinate time for services, and provide patients with pre-service instructions. After patients information is logged into the scheduling system, it will queue up to the PA registration team to complete the registration process. PA will call the patient and confirm the identity, collect demographics such as address, family, emergency contact, etc. PA registration will also confirm the patients health insurance provider(s). PA registration can be completed at a hospital facility or by a centralized team. Lastly, PA Financial Clearance will verify patient health benefits to ensure they exist and to determine if the procedure or service for the patient is covered. If authorization is required, the PA Financial Clearance will request authorization for services from the patients health insurance provider. Services performed without authorization lead to rejected claims. Also during PA Financial Clearance, the PA rep will Counsel the patient about their liability (how much their insurance provider says they need to pay for the services) and collect the payment. Any payment received is considered POS since its before 7 days post discharge. Financial clearance can also be performed at the hospital facilities or by a centralized team.

Summary patient cash data for HHSs 39 hospital facilities for a year is presented in Table 1. The table also indicates if the PA team for each facility is centralized or not.

Table 2 provides an overall monthly trend for POS Performance

The team identified the facilities with POS performance above the target and researched the activities they have in place hoping to find commonalities or key drivers.

They are:

ensure proper patient education on benefits and liability

ask for payment

have a financial counseling policy

reduce number of patients that leave without financial clearance

have accurate tools to help estimate Patient Liability or Responsibility

utilize devices that allow patient collections at patient bedside

Read case study then answer the following questions

Exercise 1 Process Stability Using the data given in Table 2, determine if the POS performance is stable using a control chart. Explain why you used the type of control chart you selected.

Exercise 2 Scope Opportunity Using the data given in Table 1, how would you scope the focus area of the project?

Exercise 3 Testing a Theory Use the data from Table 1 and conduct a hypothesis test to determine if centralized teams impact POS collections.

Exercise 4 Solution Categories Based on the information provided what could be affinity categories for the key drivers that impact POS performance?

Table 1: 2015 POS by Facility Facility POS Payments | All Patient Payments | POS% | Centralized Teams 015 $1,301,746 $2,964,730 $625,428 $849,646 076 3,348,748 $6,854,164 1,709,452 2,141,211 LAK CGH 37% 9,710,312 6,062,173 241 2,250,807 GSM $2,621,784 $1,713,107 5,936,564 $1,215,112 SMH Yes PGH 5,395,09 41% $1,311,286 $2,997,636 3,611,438 7,494,091 WBO 26% Yes $2,358,653 8,133,287 5,286,184 BAR $1457,038 236 $1,076,377 $2,145,483 $2,428,480 $2,253,084 2,979,026 5,249,186 7,833,806 7,080,683 739,024 7,262,268 $13,946,130 357 $4,624,894 6,929,016 446,048 9,134,398 $4,378,487 9,188,848 3,939,240 503 $4,971,199 7,850,558 999,804 $10,909,840 IND 41% 31% 32% $2,455,353 $3,486,532 534,470 $2,416,085 $2,182,243 GBH BMC 25% FRH HNM LPX NMC PMC PPH 31% 45% $3,379,727 $1,946,885 $2,885,804 $1,969,620 31% SES SFH $1,940,017 $3,254,250 3,051,755 $2,658,292 $1,606,482 $1,297,858 No 41% 44% SRM 24% $5,225, 755 25% No Table 2: 2015-2016 POS Trending POS Payments All Patient Payments $22,105,614 20,449,785 25,357,473 $24,320,414 24,815,250 Feb-14 Mar-14 $7,452, 507 Jun-14 $8,975,992 $20 Aug-14 $6,804,829$23,349,092 Sep-14$7,898,465 $20,829,620 Oct-14 $7,888,816 $18,506,142 Nov-14 S5,834,679$17,386,881 Dec-14 $9,021,591 $18,659,23:7 18,956,764 19,008,749 22,971,163 Mar-15$7,696,772 $22,168,016 $7,852,119$21,971,590 Aug-156933,100 $23,650,610 Sep-15$8,623,086 $26,860,403 21,346,585 Nov-15 $7,691,110$23,004,295 22,939,623 Jun-15 7,436,050 Oct-15$7,850,627