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  • 1. Six Sigma at The Urology Group W. Charles Slaven PMP CSSBB CMC 513.382.3511 [email_address] James Rapp 513.366.3400 [email_address] ASQ Meeting May 20, 2008
  • 2. Welcome
    • Welcome and Introductions
      • Your Facilitators
        • Charlie Slaven MBA PMP CSSBB CMC
          • Vice President, MAX Solutions, LLC
        • Jim Rapp
          • Project Analyst, The Urology Group
      • Please Introduce yourselves
  • 3. Agenda
    • Background
    • The Vision and The Plan
    • The Process of Education and Mentoring
    • The Project’s Performance
    • Work in Process
    • Implications for the Health Care Industry
    • Thank You and Closing Remarks
  • 4. Six Sigma and Dilbert 5/20/2008
  • 5.
    • The Urology Group, a leader in Group Practice Management decides to implement Six Sigma
      • “ We selected and pursued Six Sigma because Six Sigma is statistical based and performance measured. Six Sigma has tremendous opportunity and potential in the healthcare industry.”
        • Earl Walz, COO
    Background 5/20/2008
  • 6. Background
    • “ The urology group believes that Six Sigma is one of the best ways to quantify quality in the work place. Implementing six sigma in a health care business requires a change in mind set that we are just now appreciating. Making it part of our work routine, rather than an addition to the work routine is a work in progress.”
    • Dr. William B. Monnig, CEO
  • 7. The Vision and The Plan
    • The Vision
      • To improve financial performance by orders of magnitude in an industry that is having margins collapse quickly due to many industry reasons and drivers
    • The Plan
      • Find a consultant and Implement the training
      • Identify projects to implement improvements
      • Get Certified as Black Belts
      • Show results and build momentum
  • 8. DMAIC Process Improvement 5/20/2008
  • 9. The Process
    • Education
      • White Belt – one half a day for many of those on staff
      • Yellow Belt – 3 days for the core team
      • Green Belt - 7 days with Minitab, a simulation, an exam and two projects for the core team
      • Black Belt – 10 days with an exam and two more projects for the core team
    • Mentoring
      • Every month, a read-out session was practiced
      • To prepare, the core team obtained just-in-time consultation
  • 10. Project Qualifications We met them!
    • There is a gap between current and desired performance.
    • The cause of the problem is not clearly understood.
    • The solution is not predetermined.
  • 11. Critical Success Factors We had them!
    • Dedicated Black Belts
    • Champion phase reviews
    • Black Belt has knowledge of processes to be improved
    • Historic data and repeated processes
    • Clearly defined deliverables
    • Committed process owners with the authority to modify the process
  • 12. Why Six Sigma was Different; Why it Worked in this Case!
    • Used statistical data to drive improvements
      • Cost of poor quality
      • Measurement and analysis of defects
      • Rigorous business analysis
    • Uses the voice of the customer, voice of the process, and voice of the employees
    • Infrastructure of trained individuals – the Belts
    • More rigorous and statistically based than previous quality initiatives.
    • Provides bottom line results
    • Senior Management was involved
    • Organizational support
    • Short cycle time 2 - 4 months
    • Clearly defined outcomes and measures of success
  • 13. A Project’s Business Case
    • From Jan 2005 to Dec 2006 we experienced an average grade of 75% in coding. With a target grade of 100%, this gap of 25% leads to a Cost of Poor Quality of $xxx,xxx
  • 14. Sample Scope Statement
    • Identify and evaluate CPC’s in the coding process. Identify and evaluate doctors on E & M coding process. Identify methods to improve the coding process for both doctors and coders. Identify and evaluate communication methods, such as audit tools and templates, to improve coding and documentation. Identify and evaluated doctor – coder relationship to improve training and communication of errors and questions.
  • 15. Voice of the Customer (VOC)
    • CPCs
    • Don’t have time to review coding accuracy or doctor’s charts.
    • Doing audits, however, is a way to learn coding better (learning by doing).
    • Insurance Companies
    • Correct payments for services performed.
    • Over-utilization of higher level codes.
    • Physicians
    • Decrease risk of outside audits as well as fines.
    • Money collection increases with higher correct coding.
    • Decrease worrying that coding is done right the first time.
    • Patients
    • Does not want over-billing of treatment.
    • Better/correct medical record.
    • Divisional Managers
    • Heavy oversight from Corporate Management.
    • Heavy oversight would decrease when CM sees progress of audits being done correctly and timely.
    • Billers
    • Less refilling of “wrong” claims with insurance companies.
    • Correct coding would decrease days in A/R by decreasing rework.
    • Group Malpractice Insurance Company
    • Monthly audits reduce chance of fraud claims against doctors and corporation.
    • Ohio State Medical Association
    • Monthly audits reduce chance of fraud claims.
  • 16. Scores
  • 17. FMEA
  • 18. COPQ: Financial Impact Before After Improvement
  • 19. Project II Business Case
    • For January 1 through June 30, 2006, we experienced 21 days that our receivables sat in collections. With a target of 19 days, this gap of 2 days led to a Cost of Poor Quality of $XXX,XXX. While there are several divisions that make up this total, this project will focus on Division 8, which had 23 days in receivables. With the target of 19 days, this gap of 4 days led to a Cost of Poor Quality of $XX,XXX.
    • From January 1 through June 30, 2006, TUG experienced a gap of 2 days in collections. Of this gap, incorrect demographic entry and the collection of insurance cards in Division 8 represented 10.4% of the overall problem. This 10.4% leads to a Cost of Poor Quality of $XX,XXX.
    • The goal of this project is to reduce the days in collections in Division 8 from 23 to 19 days by the end of 2006 by collecting and copying insurance cards and having correctly completed demographic forms to increase our cash flow by $XX,XXX. We will focus on the preparation of the demographic sheet and its entry into the MISYS system. The resources used will be the Division 8 front office staff, office manager, and the Norwood business office staff. For this case, the clinical process is out of scope
  • 20. Sample Scope Statement
    • Who – Josh, Norwood business office staff
    • What – Presence of correct name, insurance company, insurance plan, and correct entry into MISYS will be tested via phone contact with new patients
    • Where – After patient visit
    • When – Random monthly sampling
    • How – Division 8 front desk staff will copy registration forms and insurance cards as they are received. These forms will be given to Josh, who will take a sample of the patients and verify that the information is correct by calling the patient. Correct entry into MISYS will be verified by checking the information in the system against the form.
    • Frequency – 10% of the patients will be selected at random
  • 21. Voice of the Customer
    • Patient
    • - Insurance not filed in timely manner
    • Received a bill stating no insurance coverage
    • Business Office
    • There is no insurance company listed
    • Claims refused because of incorrect data
    • Insurance Companies
    • There is no patient listed by that name
  • 22. Scores
  • 23. FMEA
  • 24. Executive Summary
    • The Days in A/R calculation has been reduced from 23 to 21 days thus far through collection and correct entry of patient demographics.
    • There has been a total savings of $XX,XXX to date.
    • There are still potential savings through the data collection process. These will be explored.
  • 25. Work In Process
    • Copays, insurance cards, copay letters.
    • A/R processes.
    • Collection process.
    • Medication reconciliation.
    • Division demographics.
    • No Show/Cancellations.
    • Prostate Biopsy Protocal.
    • Scheduling
  • 26. Implications for Health Care 5/20/2008
    • Healthcare is decentralized and poorly integrated.
    • Lack of standardization – different approach to common problems.
    • Forces that make healthcare delivery more complex and difficult include: aging baby boomers, scarce financing, staffing shortages, as well as litigation.
    • Overburdened by inefficiencies.
  • 27. What are your lessons learned from today’s session? 5/20/2008 Thank You & Closing Remarks Thank You!
    • Comments
    • Questions