Transcript Day Zero - Emergency Medical Services Consulting

Best Practices Discussion
Hosted by:
Presented by:
Copyright 2011 J.R. Henry Consulting Inc.
Disclaimer
• The consultant is not an attorney and does not
provide legal advice. The information contained in
this presentation is not intended and should not be
construed as legal advice or direction.
• The consultant plans to share knowledge and
practical experience with the attendees.
• All attendees are advised to obtain professional
legal advice from an attorney before implementing
any material change in their billing, administrative
or operational polices or any other matter which is
governed by law or regulation.
Copyright 2011 J.R. Henry Consulting Inc.
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Survival of the Fittest!
Hosted by:
Presented by:
Copyright 2011 J.R. Henry Consulting Inc.
Winds of Change
… coming soon to a neighborhood near you!
 Declining payments per trip:
 Medicare Fee Schedule (below our average
costs)
 Managed Health Care
Rising Deductibles
New Co-payment Requirements
 Medicaid Rates still below our costs!
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Winds of Change
… coming soon to a neighborhood near you!

Ever-increasing Labor and System Costs
 Limited Subsidy:
Do our local elected official take us for
granted???
 Expensive new Medications and
Technologies
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E.M.S. Revenue vs. Expenses
EMS Revenue vs. Expenses
700000
600000
500000
400000
300000
200000
100000
0
1
2
3
4
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Strategies for Success
• Reduce Expenses:
– Staffing – Productivity and Utilization
– Scheduling Efficiencies
– Purchasing of Services, Equipment and
Supplies
• Maximize Revenue:
– Billing: Accuracy, Compliant and Efficient
– Subscription, Donation & Capital Fund
Drives
– Federal and State Grants
– Municipal Subsidy
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Strategies for Success
• Utilization:
– Number of Ambulances Required
– Number of Crews Required @ Day & Shift
• Data Analysis:
– Review and Analyze Operational Data
– Call log (time & date of calls, turnaround time)
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Reducing Expenses
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Unit Hour Utilization
• Conduct a thorough Unit Hour Analysis
• Conduct a Demand Analysis
– Obtain starting and ending time for each detail
– Obtain deployment or total “turnaround” times
– Look for “overlapping” responses
– Identify number of hours that you have “0”, “1”,
“2”, “3”… ambulance deployed simultaneously
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2009 SVEMS Simutaneous Calls
(Jan. - Nov.)
2500
2173
2000
1952
1691
1500
1109
1000
593
500
271
122 55
14
7
2
1
1
1
1
0
1 Call
2
Calls
4
Calls
6
Calls
8
Calls
10
Calls
12
Calls
16
Calls
Note: Analysis based upon time of call reciept - does not factor total in-service times
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Total Demand Analysis
June 1, 2004 - Dec. 31, 2004
Medix - All EOA's
1200
Number of One Hour Time Periods
1000
800
600
400
200
435
761
974
921
723
535
326
248
102
54
32
13
6
4
1
0
1
2
3
4
5
6
7
8
9
10
11
12
13
17
0
Number of Simultaneous Ambulance Responses
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Demand Analysis
Total Responses vs. Staffed Hours
(excluding Irvine EOA)
8000
7000
6000
5000
4000
3000
2000
1000
0
Number of Calls
Staffed Hours
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Productivity Guidelines
Overall unit hour utilization (“UHU”):
.55 - .45 – High Utilization
.45 - .35 – Above Average Utilization
.35 - .25 – Average Utilization
.25 - .15 – Below Average Utilization
.15 - .01 – Low Utilization
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Key Issues
• Are you over or under staffed?
• Identify dates, times or shifts which can be
adjusted
• Do your current scheduling practices match
your company’s needs?
• Do your current scheduling practices match
your employee’s needs?
• Provide employee’s with input into the
decision making process!
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Key Issues
• How many calls do you “miss” of request
mutual aid on each month?
• What is an acceptable level of missed calls?
• Joint staffing solutions?
• Shared Employees?
• QRS alternatives?
• Employee on-call system?
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Key Issues
• What are your current Response Times?
• Response times by call priority?
• Low Response times typically equate to
higher costs!
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Employee Scheduling
• Conduct a thorough Overtime Analysis
• Overtime is inherent and unavoidable in our
industry;
• However, there is regular overtime vs.
“stupid” overtime!
– Failure to plan!
– Unbalanced Overtime!
– Unfair distribution of Overtime!
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Scheduling
“There has to be an easier way!!!
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Employee Scheduling
• How do you manage your current Schedule
and Overtime?
– Most “time consuming” and “least–liked”
management issue!
– Electronic Scheduling tools are available
– Obtain employee input on schedule and
implementation of new tools
– Develop consensus based scheduling rules
• Balance, Fairness, Seniority
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Bottom Line
Every system is different and must be
evaluated independently
• How much money can be saved through
schedule and staffing changes?
• How will staffing and schedule changes
affect patient care; response times and the
number of missed calls?
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Managing Expenses
• How many non-revenue support vehicles do you
have in service?
• Do you ask and verify governmental or non-profit
pricing and discounts?
• Participate in Co-Op purchasing?
• Can you purchase employee benefits or purchase
capital items through a group plan?
• Do you bid for Workers Compensation and
Insurance Programs?
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Maximizing Revenue
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Proactive Billing and Collection
• Conduct an objective review of your
entire billing and collection process
• 90-120 internal Collection Process
• Use of a clearinghouse and other
technology to achieve “Real Time”
Claim Access
• Offer discount for prompt payment!
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Proactive Billing and Collection
• Use of Electronic Funds Transfer
• Pre-verify Insurance Status:
– On every patient
– Prior to billing
– enhances cash flow; minimizes claim
and payment processing time
– Decreased number of claim rejections
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Proactive Billing and Collection
• Do you have a Indigent or Financial
Hardship Policy?
• Why is it necessary?
– Compliance
– Standardized “write off” policy
– Case by Case basis
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Proactive Billing and Collection
• Adjust hours for internal collection calls
• Use of internal / external “legal letters”
• Prompt turnaround to outside collection
• Magistrate hearing for repeat offenders
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Co-Pays and Deductibles
• Impact of Rising Co-Pays and
Deductibles:
– Have you conducted an actuarial analysis?
– Do you have subscription terms and
conditions?
– Conduct a thorough analysis to determine if
it is time to reconsider terms
• Hold patient’s responsible for either co-pay or
deductible amounts?
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Strategies for Success
• Reduce Expenses:
– Staffing – Productivity and Utilization
– Scheduling Efficiencies
– Purchasing of Services, Equipment and
Supplies
• Maximize Revenue:
– Billing: Accuracy, Compliant and Efficient
– Subscription, Donation & Capital Fund
Drives
– Federal and State Grants
– Municipal Subsidy
Copyright 2011 J.R. Henry Consulting Inc.
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Special Thanks
THANK YOU FOR PARTICIPATING
IN THIS SESSION!!!
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J.R. Henry, EMT-P
535 Perry Highway
Pittsburgh, PA 15229
(412) 736-4163
(412) 291-3434 (fax)
[email protected]
Copyright 2011 J.R. Henry Consulting Inc.