October 2011 Viewpoints – Bringing Workflow Optimization to Healthcare Organizations

Optimium Health: An Introduction

Vicki Harrison and Dr. Mark Stega have combined their respective healthcare experience to form Optimium Health Incorporated (OHI), a consulting and technology solutions firm that works with healthcare provider organizations, physician practices, hospitals and health systems. The changing needs of the market today require organizations to run more efficiently, optimizing their performance to gain financial benefit, while at the same time, improving quality and their bottom line. Thus, OHI’s mission is to drive operational excellence with leading-edge process management solutions designed to optimize enterprise workflow, improve financial return, and enhance the patient experience.

What we saw missing within current healthcare consulting and technology offerings is the ability to create repeatable and sustainable processes. These are needed to drive efficiency, provide rapid ROI, optimize the performance of both people and technology, and allow for measuring and improving quality. Technology vendors provide technology, which in most cases requires the user to modify the way they do work in order to utilize the technology. Consulting firms provide recommendations and some very modest tools and materials to implement change. Neither works particularly well in isolation over the mid to long term.

Optimium Health, Inc. approaches the problem from a different perspective. We can enhance the sustainability, accuracy, and repeatability by applying workflow automation tools to a complex set of processes.

Our workflow engine, known as OPTIMI$ER™, uses a set of automation tools that guide the worker through each step of a process, immediately alerting the worker to missed steps in the processes being performed before the missed step negatively impacts the process. OPTIMI$ER assures that steps in a process are identical from one worker to another, assuring consistent repeatable and sustainable processes that are documented and measurable. Reports are available in real-time and easily configurable.

OPTIMI$ER will provide leverage for consulting firms who want to enhance the deliverable to their client by increasing the areas of opportunity. OPTIMI$ER will enhance the efficiencies and interoperability of legacy technology systems within an organization by adding a process layer that monitors and orchestrates workflow.

The end result is that an ROI is achievable in less than three months, either through revenue recovery or reallocation of staff. Because OPTIMI$ER is working in the background, it has little to no impact on the way the work is done and the learning curve is nearly immediate.

Optimizing The Way Healthcare Systems Work

The Problem: Approximately 25% of all medical practice income is lost in one of the following ways: Under pricing, under coding, missed charges or non reimbursed claims. An average of 3-5% of annual practice revenue is lost because the practice failed to bill for services and procedures that the physicians performed.[Source : “Billing Problems? Consider Your Charge Ticket” by Deborah Grider, CPC-EM (Appeared in 2008 Physician Practice)] Many things can contribute to the problem. For example, how are the following questions being answered: Who is doing the coding? How are charge tickets processed through the practice? How are patients scheduled or seen in an emergent encounter? When a patient is seen at the hospital ED, how does the practice receive the billing information? How are charge tickets rectified?

Without processes in place to track workflows and identify breakdowns, a provider organization may have no idea how much revenue is being lost.

Our Philosophy: We begin by understanding the needs of people, reviewing the processes in place and then adapting the technology.

Our Solution:

OPTIMI$ER™ transforms predominantly manual labor intensive vertical “silo” workflows that unintentionally create an office environment ripe for errors, inefficiencies and inconsistencies into “integrated” horizontal workflows between department staff, practice managers, physicians and hospitals/surgi-centers.

Through the use of business intelligence, rules, alerts, and directing work to the appropriate person, OPTIMI$ER connects people, process and technology to create a dynamic horizontal workflow environment. It breaks down static, workflow “silos” and the accompanying barriers to efficiency. By optimizing clinical processes, an organization can realize improved financial returns, increased operational efficiencies and enhanced cross department communication while reducing errors, duplications and missed steps in the process.

Our Results:

The financial benefits of OPTIMI$ER tend to fall into three areas of improvement: a) throughput b) resource allocation c) revenue capture.

By way of example, in an orthopedic group with 9 physicians, OPTIMI$ER helped to find $950,000 in non-billed charges over a 12 month period. This resulted in approximately $350,000 in additional revenue that otherwise would have been lost.

Furthermore, due to the efficiency provided by OPTIMI$ER, the number of schedulers required to schedule procedures was reduced from 5.5 to 2.5 resulting in an additional savings of $100,000 in FTE overhead.

On the softer side, there were fewer missed surgeries due to scheduling mishaps which led to increased satisfaction for physicians, schedulers, and patients.

For a copy of OHI’s Orthopaedic Practice Whitepaper, please contact us using the contact form available in the menu above.

Top 10 IT Priorities for Healthcare

Healthcare IT News, August 17, 2011

Revenue cycle management, HIEs and Massachusetts are among the healthcare topics that every organization should have in mind for 2011 and beyond, according to HIMSS Analytics.

Included in the recent HIMSS Analytics report, “Essentials of the U.S. Hospital IT Market – 6th Edition,” is an outline of the top health IT issues that will have a significant impact on the industry in the next few years. Among them are:

Revenue Cycle Management

The PPACA regulations for Medicare reimbursements will pose a great challenge to hospitals as they work to maintain their revenue cycle operations. Keeping tabs on RCM vendors’ communications and strategies is key.

Interoperability

The Health Level 7 document proves that the industry is still paying attention to the need for standards, but vendors must see demand for its use. Semantic interoperability is another key issue – monitor ONC and meaningful use regulations for a standard medical vocabulary.

For the full article, click on this link.

OHI “Viewpoints”: What’s Ahead

While this issue of OHI “Viewpoints” is simply to provide a brief overview of who we are and what we do, subsequent issues will aim to open a two-way dialogue with our readers. Our focus will be on the various workflow challenges facing healthcare organizations today and how practices, hospitals and support services have overcome them. Additionally, we will highlight industry reports that may be useful references as you evaluate priorities for and options available to your enterprise.

We invite you to contact us using the “Contact Us” form from the menu above for further information about Optimium Health or with suggestions for future “Viewpoints” content. And please forward our newsletter to colleagues you think would be interested in hearing from us.

We intend to publish “Viewpoints” 4-6 times per year.

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