By Jason Bramwell
The lack of completed pain assessment documentation at Winchester Medical Center (WMC), Winchester, Va., concerned CNO Kathy Tagnesi.
While nurses were regularly assessing patients' pain, they were not completing the required documentation. A 2009 internal audit revealed that only 66 percent of WMC patients had their pain levels recorded by a nurse within one hour of receiving pain assessments and pain medication-well short of The Joint Commission's 100 percent requirement.
The reason: The pain management workflow was time-consuming and inefficient. Reassessing a patient's pain and manually inputting the patient's pain score in the electronic health record (EHR) took a nurse, on average, nine minutes to finish. "All nurses mean to do it, but they've got a lot on their plates," says clinical manager Susan Clark, RN, MSN.
Asked to develop a more efficient process, Clark and then administrative director Janet Palutke, RN, MSN, came up with a creative solution: Use the hospital's in-room televisions-which are connected to an interactive information, education, and entertainment platform-to enlist patients' assistance in assessing and documenting their pain.
"We thought: What if alert patients could assess their pain levels through a prompt on their TVs, which would automatically notify nurses via pager and document the pain assessment in real time in the EHR?" says Clark.
With the help of IT staff and others, the nurse leaders' idea came to life in 2009. In just one year, the hospital realized a 22.7 percent increase in pain assessment documentation-and, today, the documentation rate sits at just above 90 percent. More important, the hospital has seen a 21 percent increase on certain HCAHPS scores related to pain control.
Clark and Palutke, who retired in 2011, had to complete three steps before the automated pain management workflow system became a reality.
Gaining buy-in from other nurses. Clark and Palutke went before the hospital's Nurse Practice Council to explain their idea for an automated pain management workflow system. The council, which comprises representatives from all nursing departments, meets once a month to review process improvement proposals or rectify issues with how patient care is delivered.
"They felt it was a good process, and we received their blessing," says Clark.
Forming a team to work on the project. The next item on the nurse leaders' to-do list was to enlist the help and expertise of IT personnel and other staff from WMC, parent health system Valley Health, and the interactive patient education system vendor.
"When we can put all the pieces together and create better solutions, it makes for a good working environment," says Kraig Hawkins, integration architect, Valley Health.
Implementation steps ranged from building the drug codes into the existing interactive patient education system and creating a pain-level prompt application to ensuring the hospital's paging and nurse call systems linked with the new technology.
"It was a bit different than anything we had ever done before," says Sheri Shade, systems analyst, Valley Health.
Targeting a pilot unit. The last step was finding a unit in which Clark and Palutke could pilot the automated system. "We thought the cardiac-surgical unit would be best because it has many patients recovering from open heart surgery who are alert and oriented," says Clark.
The automated pain management workflow system was piloted in October 2009 and implemented hospitalwide one month later. The system worked smoothly during the pilot phase-except for one minor hiccup. "We had the prompt set so the pain scale of 0 to 10 popped up on the patient's TV screen one hour after their medication was scanned," says Clark. "However, their pain score didn't chart in the EHR until one hour and two minutes after the medication was scanned. So we made it a 50-minute prompt to get the documentation entered within an hour."
When a patient receives pain medication, the nurse brings in a portable computer that is equipped with a barcode reader. The nurse then scans and administers the medication at the bedside, and assesses and documents the patient's pain, including location, intensity, and type of pain.
Once the medication is scanned, the interactive patient education system is triggered. The system waits 50 minutes before delivering a prompt on the patient's TV screen, asking the patient to rate his or her pain on a scale of 0 to 10. According to Clark, WMC uses the Wong-Baker FACES pain rating scale for adult patients:
"Patients use the arrows on their nurse call bells, which are also their TV controllers, to increase or decrease the number on the TV screen," says Clark. Once the patient finds the number that best represents his or her pain level, they press the enter/select button on the call bell. Their pain score is then automatically documented in the EHR and a message is immediately sent to the nurse's pager.
This approach not only ensures documentation, it also prompts nurses so they can quickly help those patients in distress. Low pain scores of 3 or less do not require nurse intervention, and the nurses can focus on patients with higher scores.
For example, if a patient rates his pain level as "5," his nurse gets a page that says: "Patient in Room 0201 Rates Pain as 5." The nurse then compares the patient's pain level at that time to the pain score documented after the medication was administered.
"If the pain score did not drop, the nurse knows that another intervention is needed," says Clark. "The patient may have only taken one pain pill but could have two, so the nurse would offer the second pill."
If the patient does not respond to the pain-level prompt within 90 seconds, the system sends a message to the nurse's pager that says, "Patient in Room 0201 had NO Response to Pain Rating.""The nurse will immediately know to check on that patient," says Clark. "They like having that little reminder."
WMC's automated pain management process has enabled the hospital to meet its goal of improved efficiency. By eliminating the need for nurses to visit patients with a pain score of 3 or less, Winchester saved 1,526 nurse hours in 2010. "We're just trying to make the nurses' lives a little bit easier," says Clark.
Another positive result: HCAHPS patient satisfaction scores on survey questions related to pain management also increased. For example, the score for question "How often was your pain well controlled?" jumped from 56.7 percent in 2010 to 69 percent in March 2011.
Clark says patients of all ages enjoy using the new technology on their TVs. "The older patients get excited for the pain number to appear. They also like being able to communicate immediately with their nurse," she says. "Their families like how nurses know if their loved one didn't respond to the prompt.
"The younger, technology-savvy patients also love it. They would probably love it more if the pain-level prompt went right to their phone. We're not there yet!" says Clark with a laugh.
Jason Bramwell is associate editor of newsletters & Forums, HFMA (firstname.lastname@example.org).
Interviewed for this article:
Susan Clark, RN, MSN, is clinical manager, Winchester Medical Center, Winchester, Va. (email@example.com).
Kraig Hawkins is integration architect, Valley Health, Winchester, Va. (firstname.lastname@example.org).
Sheri Shade is a systems analyst, Valley Health (email@example.com).
Ontario Systems: Maximizing Self Pay Collections
The Claro Group: Helping Hospitals and Healthcare Systems Improve the Bottom Line
Deloitte: Helping Organizations Navigate MACRA
ClearBalance: Boosting Patient Payment through Consumer-Friendly Loan Programs
Deloitte Consulting LLP: Employing Innovative Solutions to Optimize Revenue Cycle Performance
Grant Thornton LLP: Maintaining and Improving Collections During an EMR Implementation
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.