Billing Practices for Adverse Events

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An AHA Member Teleconference Series
Billing Practices for Adverse Events
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Billing Practices for Adverse Events
Childrens Hospital Regional Medical Center
Takes on Adverse Events and Billing June 24,
2008, 300 pm ET/1200 PM PT
Featured Speakers Patrick J. Hagan, President
and COO David M. Stallings, Director of Risk
Management
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Welcome to Childrens
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Who We Are

• 250 bed pediatric academic medical center
• Academic affiliation with the University of
  Washington School of Medicine
• Almost 4,000 employees
• 232,569 Annual Patient Visits
• 12,785 Admissions
• 10,869 Surgeries
• 33,773 Emergency Room Visits
• 176,608 Outpatient Visits

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Childrens Regional Service Area

• Regional Clinics
• Childrens Bellevue
• Childrens Everett
• Childrens Federal Way
• Childrens Olympia
• Childrens Tri-Cities
• Odessa Brown Childrens Clinic
• Outreach Clinics
• Central Washington
• Alaska
• Montana

• Neonatology and Hospitalists
• Evergreen Medical Center
• Providence-Everett Medical Center
• Overlake Medical Center
• Kadlec Medical Center
• Missoula, Montana
• University of Washington
• U

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What We Believe
Our Mission We believe all children have unique
needs and should grow up without illness or
injury. With the support of the community and
through our spirit of inquiry, we will prevent,
treat and eliminate pediatric disease. Our
Vision We will be the Best Childrens Hospital
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Leaning Out Adverse Events Building in
Quality

• Continuous Performance Improvement (CPI)
• Lean Methodology
• Standard Method of Improvement
• Engagement

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CPI- Our House
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Billing/Reporting Requirements

• Joint Commission Sentinel Events
• WA State Department of Health (late 1990s)
• The Leapfrog Group
• CMS
• WA State Hospital Association adopts policy to
  waive charges for care related to never events
  (2008)

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Handling Adverse Events

• Adverse Event Review Process
• Report In person or online incident reporting
• Determine appropriate review group
  (departmental QI vs. serious event review team)
  abbreviated)
• Investigate and Analyze
• Develop action plan
• Ensure complete PDCA cycle

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Handling Adverse Events

• Sentinel Event/Never Event Process
• Engage in any immediate steps needed to protect
  patients/staff
• Immediate notification to senior administration
  leaders, patient safety officer and risk manager
• Initial disclosure to patient/family based on
  current knowledge
• Investigate and develop action plan including
  follow- up with patient/family.
• Report to appropriate areas and assess for
  learning opportunities.

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Tool and Process Development

• Process improvement relies upon providing
  standardized methods and tools to staff
• We identified an information gap that made it
  more difficult to manage adverse events
• Gaps included knowledge of event action
  needed and action progress

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Data Management

• 5 years ago we switched from a paper based
  incident reporting system to an online system
• Incident input requirements were streamlined to
  make filing an incident easier with less impact
  on staff time
• The system allows us immediate access to an
  incident once submitted
• Automatic notification is set into the system to
  notify particular people/depts. when a certain
  type of incident occurs

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Bill Hold Development

• We encountered an increasing number of complaints
  that were coming in through our patient account
  specialists
• Some staff apparently didnt think through the
  down stream effect of not addressing
  complaints/issues at the time of service
• It takes time to review these situations and
  doing that so long after the time care is
  provided was problematic

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Bill Hold Development

• We developed a simple email list which enabled
  all staff to send a message to a core group that
  could place a hold on any bill
• Bill Hold list members represent Business
  Services/Patient Accounts, Patient Relations,
  Risk Management and CUMG.
• Bill Holds used for serious/sentinel events,
  quality complaints, service complaints and charge
  corrections.

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Bill Hold Development
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Tool Development
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Tool Development
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Tool Development
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Wed Rather Not Break It At All
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Knowledge Management

• We recognize that we cant optimize patient
  safety and performance improvement unless we are
  able to make all staff aware of problems and
  solutions
• Created a monthly patient safety conference
  series
• Developed a patient safety newsletter PSFYI
  which is distributed to all staff

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What questions do you have?