Six Sigma at The Urology Group

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Six Sigma at The Urology Group

• W. Charles Slaven PMP CSSBB CMC
• www.maxtrain.com 513.382.3511 charlie_at_maxtrain.co
  m
• James Rapp
• www.theurologygroup.cc 513.366.3400
  jrapp_at_theurologygroup.cc

ASQ Meeting May 20, 2008
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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

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Agenda

• Background
• The Vision and The Plan
• The Process of Education and Mentoring
• The Projects Performance
• Work in Process
• Implications for the Health Care Industry
• Thank You and Closing Remarks

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Six Sigma and Dilbert
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Background

• 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

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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

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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

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DMAIC Process Improvement
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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

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Project QualificationsWe 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.

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Critical Success FactorsWe 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

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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

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A Projects 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

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Sample Scope Statement

• Identify and evaluate CPCs 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.

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Voice of the Customer (VOC)

• CPCs
• Dont have time to review coding accuracy or
  doctors 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.

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Scores
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FMEA
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COPQ Financial Impact
Before
After
Improvement
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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

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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

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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

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Scores
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FMEA
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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.

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Work In Process

• Copays, insurance cards, copay letters.
• A/R processes.
• Collection process.
• Medication reconciliation.
• Division demographics.
• No Show/Cancellations.
• Prostate Biopsy Protocal.
• Scheduling

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Implications for Health Care

• 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.

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Thank You Closing Remarks

• Comments
• Questions

What are your lessons learned from todays
session?
Thank You!