The first step was deciding on key performance indicators (KPIs) to track. "We started by deciding which process points were critical to the outcomes, and decided that one of them was eligibility," says Koons. "Eligibility is tied to significant dollars, and our uncompensated care was running at over 6.5% on over $1 billion gross revenue—so even a 10% movement in that [uncompensated care] number would be significant."
Centra Health needed to screen not only its inpatient population, but also outpatients and visitors to the emergency department. Centra Health fields over 92,212 emergency department visits annually and 26,824 admissions across the system.
"Prior to us implementing the use of KPIs, from an eligibility standpoint, most of the data we gathered was subjective and not at all measured. We made a decision that we would measure as much as we could to identify those metrics that would bring the most value to the revenue cycle, and from there put together a KPI strategy with a hierarchy approach. So, depending on [the person's] level of accountability, that's the data they have access to," says Koon.
Koons was tasked with identifying and tracking the KPIs, such as bad debt and charity care as a percent of gross revenue, insurance acceptance and approval rates, cycle times from referral to insurance approval, and approval to pre-certification authorization.
After adding a dashboard to compile data from their systems, Koons worked with Chamberlin Edmonds, a consultant that is a subsidiary of Emdeon, to establish best practices for its eligibility and enrollment program and the ability to work with a third-party vendor who could track quantitative measures to prove success.