Class work
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featuring all of the conditions of the job, including dogs, bad weather, etc., as well as positive aspects of the position, is now shown to all prospective candidates. An online assessment tool will likely be added to the recruitment and interview process. It only takes 10 minutes to complete, and will quickly eliminate those candidates who don’t possess the right attributes to succeed on the job. The team proposed that, if the candidates pass this assessment, they should take a behavioral psychological battery to determine if their personal traits include reliability, follow-up, ability to follow directions, etc. These assessments are meant to help managers make better decisions about who they put into the job in the first place. The project provided for tracking turnover data on a rolling 12-month cycle, rather than quarterly or annually. This change is really part of the Sustain stage of the project. It will help management monitor the turnover situation to make sure that the changes made will lead to overall improvement in the turnover rate.
Although not all of the solutions have been fully implemented at the time of this writing, progress has been made. The goal of the project was to reduce turnover to a rolling 12-month rate of 15 percent or less. The current rate is 31 percent, but the rate has been as high as 74 percent during the last 12 months. The HPI practitioner cautions that this noteworthy improvement could be partly explained by the Hawthorn effect and other factors not related to the project. But clearly, these recommendations and recent improvements in the turnover rate have things headed in the right direction.
Medicare Reimbursement Coding Errors
Hospitals have to file paperwork in order to obtain reimbursement from Medicare. It’s up to the physicians to place the appropriate codes onto the forms so that the proper reimbursement is requested. Improper coding has both legal and financial implications. If you are audited by the government and they find errors, then you are subjected to a major audit. This is a huge investment of time and should be avoided.
The initial request from the compliance office was for online training for physicians on how to properly code office visits for Medicare reimbursement. This project would affect over 400 physicians at the hospital.
The project team consisted of a physician, a project manager, and the HPI practitioner. The team had an advisory council made up of the head administrator of the hospital, the head of medicine, the head of surgery, the head of neurology, the compliance officer, and the technology officer. There was yet another team who was charged with handling the change management process that included the head of training and the head of nursing.
The project began with a meeting with the senior executives of the hospital. They didn’t like the idea of pulling 400+ doctors off of the floor to participate in the training. The HPI practitioner began a root cause analysis by asking the physician on the team to look at all of the coding errors that had occurred. The team was able to determine that 11 root causes caused 90 percent of the errors. They also concluded that most of the causes required a small intervention to correct the problem. They resolved that a short 15-minute intervention could solve 80 percent of the coding errors.
One of the solutions proposed was to hire professional coders. A second alternative solution was to devise an electronic performance support system (EPSS) that a group of auditors could use when randomly selecting charts to determine if there were coding problems. The tool would track error rates. It would then pull from over 100 different feedback statements that would deal with a particular physician error. This, ultimately, was the solution that the client entertained.
The team added a technology designer who could create the very sophisticated database. It needed to be web-based and have high security. But when the design of the system was begun, it became apparent that not all auditors interpreted the coding rules the same way. So the first step was to have a large meeting to determine the hospital’s stance on each rule. Once those rule interpretations were agreed upon, the system
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could be developed. The final electronic tool would produce an audit report for each physician. In the past, it would take two
to three hours to audit a physician, and all 400+ physicians required an audit. With the new tool in place, the hospital will be able to audit all 400? physicians in six months. The goal is for each physician to have the results of two audits per year. With the new tool, practically anyone can conduct the audits. In fact, the audit process has been offshored to a company in India.
The role of the internal auditor is now that of coach. After the physicians attend an initial 90-minute service meeting to explain the new system and the importance of accurate coding, the auditors need only spend about 15 minutes to review the audits with each physician in the future to coach the physician on any errors that were made. The tool also provides all sorts of trend reports so that larger issues can be addressed proactively.
The HPI practitioner took a risk by abandoning the initial request for training, but it paid off. When the project concluded, the client admitted that she had