[ANSWER]SBAR Assignment 1: The Report

TASK DESCRIPTION

SBAR

SBAR

Assignment 1

This assignment consists of 2 deliverables:

  • A report to senior management. USE THE SBAR process improvement template provided for your report. Length is to be no more than 5 pages – APA FORMAT.  MUST BE REVIEWED BY THE FIU WRITING CENTER!  Proof of writing center must be submitted with report.
  • A PPT presentation is a subset of the report and is intended to be as if you are presenting your findings in 10 minutes to Senior Leadership (you will not actually be presenting).

ASSIGNMENT 1 “The Report”

Consider that you are a Healthcare Informaticist. You have been asked to evaluate the current internal workflow and make a recommendation regarding the workflow, communications, protocol and software required in order to select a new healthcare information system for a hospital, clinical department or other provider entity. This report will consist of filling out the SBAR Process Improvement template provided, 5 pages MAX. APA FORMAT.  MUST BE REVIEWED BY THE FIU WRITING CENTER!  Proof of writing center must be submitted with report.

By completely filling out the SBAR template, be sure the below are addressed:

  • Describe the “real” or hypothetical work environment, provider objectives and current information systems configuration, as well as any unmet needs or issues.
  • Situation
  • Background
  • Assessment
  • Recommendation

Much of the information required for this assignment is available from the Web and industry journals (e.g., Modern Healthcare, Healthcare Informatics, Hospitals & Health Networks, etc) and your course text.

You may also wish to request product literature from vendors or obtain it through your own or another organization. Although not required, you may also wish to interview one or more individuals with relevant experience and expertise. Be sure to provide appropriate APA interview citations. [ SBAR]

SYLLABUS/UNIT OUTLINE/GUIDELINE

Title: Southlake Clinic Service Area and Billing TransitionDate:  3/22/2017
To: AdministrationFrom: Revenue Cycle
Impacted Parties: all VMC departments within IT, Revenue Cycle, Finance and the Clinic Network

Review Team: Maren May, Kailey Tollefson, Mat Riddle, Amber Henley, Laura Marquez, Loris Kudela, Julie Hall, Megan Leahy, Debra Tesch, Victoria Rendon, Leslie Weber, Wendy Graveley, Andrea Gannon, Elaine Tam, Katje Kaczmarek, Kim McClung, Lisa Rogers, Mary Van Hoomissen

S Situation (a concise statement of the problem)  VMC has plans to acquire Southlake Clinic Specialty Services.  The acquisition is important to VMC to continue to grow, optimize and diversify our multi-specialty presence in the community.   
Key components of the decision include:
1. Providing patient continuum of care
2. Availability of community medical care
3. Record of patient history in Valley’s Epic
4. One portal for patient information (MyChart)
5. Response to changing business environment  
B Background (pertinent and brief information related to the situation)  The decision to acquire SLC has several operational and business implications especially as it relates to timeline and the current VMC project portfolio.   

The purpose of this SBAR and background is to focus on the specific impacts to managing the revenue and financial aspects of the transition – from the creation of a patient registration through to billing a claim, collection of outstanding accounts receivable balances and the management of critical financial reporting mechanisms such as banking, General Ledger, etc.  The initial thought process was that VMC could leave SLC in its current configuration under Service Area 56 for approximately 6+ months, but upon further investigation this has huge impacts in both Patient Financial Services and Finance.  

SLC is currently an eChart Connect customer utilizing VMC’s instance of Epic.  All clinical build is based on VMC’s build but there are several deviations on the billing build.  As an example, VMC has always been a Single Business Office build (professional and technical charges are billed for patient statements on a single statement) and SLC is a non SBO build.  Where possible, ‘like’ third party contracts or vendors exist but under separate contractual arrangements [ SBAR].  A short list is below but this is not an exhaustive one and does not include Support Services as one example:

1. Apex Statements
2. RTE-in process of rolling into Valley’s contract
3. Trust Commerce-MyChart online bill pay
4. Lab Daq
5. Credit Card swiping
6. Televox for telephony (not utilizing Aspect)
As previously noted, there is also a direct Project Portfolio impact as this work effort was not part of the current FY planning.  It is likely that that projects must be re-prioritized to accommodate the SLC requirements.
A
Assessment (analysis and considerations of options — what you found/think)		 The team has evaluated three options [ SBAR] based on the above information: 
 
Option 1
Leave SLC on eChart as SA56 with a final transition in later FY 2018.  Provides minimal work for IT but has a huge impact on Revenue Cycle, Finance, and Reporting; also, SLC still ‘looks’ like SLC
Option 2
Update SLC and SA56 to reflect VMC ownership.  Provides a fair amount of IT build work without clear and valuable outcome; will also require a good deal of Operational time
Option 3
Rebuild all SLC departments in VMC SA 10.  Best practice.  We’ve done it before and can do it again.  Does not have the Billing/Finance concerns of #1 and is a clean cut overall.  On the Con side, it is a big project that is not currently staffed with a tight timeline.

Option One:
Pros
1. Continue business as usual [ SBAR ]
2. Minimal IT resources needed
3. Lessened impact to project portfolio
4. Allows opportunity to discover discrepancies in practices
Cons
1. Billing and Finance resources impacted.
2. Operations would operate with both non-SBO (bill PB and HB separately) and SBO (use HB to bill PB/HB together)
3. SLC still looks like they are SLC (all documents printed, i.e. statements, letters, AVS; MyChart and Televox calls all say SLC)
4. SLC data becomes our QA responsibility
5. Requires separate GL processes
6. Creates transparency for financial data between SLC & VMC – Compliance concern?
7. Creates expectation of liability of claims processing for SLC?
8. No reserve process
9. No work RVU attribution
10. No ability to integrate reporting [ SBAR]
11. No compliance department support – UW
12. SLC has already had significant findings for billing audit
13. Must acquire additional FTEs to continue support services

Option Three:
Pros
1. SLC becomes a part of VMC
2. This is a complete transition, no interim solution
3. Providers are re-credentialed using existing NPI and TIN
4. PFS resources minimally impacted
5. SLC is integrated as a VMC clinic
6. Do the work once; no redo [ SBAR]
7. Integration of Support Services
8. GL and other financial reporting processes exist

Cons
1. New build
2. Significant IT resources including likely restructure of the project portfolio for FY18 Q1
3. Less impact to Resolute team than Option 2, but more to other applications
4. May result in urgent retraining or similar requirements to deal with unanticipated/known build gaps
5. Unclear what SLC clinical quality looks like and impact to VMC MU or other reporting mechanisms

After reviewing all the implications and risks around Option Two, it was removed as a serious consideration but is presented here so that the IT Steering Leadership is aware that evaluation did occur.
 
Summary of detailed concerns that cross the boundaries, i.e. impact multiple teams
1. No GL is built in SA 56
2. VMC billing staff do not have access to SA 56
3. VMC billing staff do not know how to support non-SBO site; would need training [ SBAR]
4. Statements will be separate and reflect SLC information, rather than VMC
5. Collections files are not the same in SA 56 and the vendor is not contracted with VMC
6. Refund process is not set up in SA 56 to support VMC processes
7. A/R is separate and dollars cannot be transferred between service areas
8. Must create a new TIN and NPI for billing (for an interim); then credential providers for an interim period
9. Patient balance follow-up is outsourced at VMC and not in SA56, would have to set up the process in non-SBO location
10. Presumptive Charity and Propensity to Pay is set up in SA10 and would have to be set up in non-SBO location
11. No contract review is set up in SA56
12. No process for lockbox/cash management payments are set up in SA56.[ SBAR]
13. No credit card processing through Epic is set up in SA56; no devices that integrate with Epic either
14. MyChart is separate and reflects SLC information
15. Separate guarantors – Presumably we’d want them to use ours? The transition on this across the “go live” date within the same SA could be tricky.
16. Reporting Considerations – Reports would have to be written around the go live dates for everything that should exclude SLC pre VMC purchase.
17. Reg workflows – They have their own, we’d need to implement ours [ SBAR]
18. Documents – They have their own doc list, presumably we’d want them to use ours.
19. Department/WQ Names – Small, but adjustments here require adjustments in profiles for Epic Care and other areas.
20. Visit Types and visit type names – We’d likely have to adjust these in some manor, likely in name in the very least.
21. Referral orders – We’ll have to look at these no matter what, but an interim solution could me having to do the work twice
22. SLC specialty specific orders and preference lists changes
23. Meaningful Use impact [ SBAR]
24. Batch jobs?
25. E signature documents differences
26. No Work RVU attribution processes
27. Reserve process:  contractual allowances on AR
28. Banking differences between the organizations

The high-level estimate of hours to complete Option 3 is as follows:
Team Hours
Resolute/Access 300
Ambulatory 300
Revenue Cycle Operations ?
Finance ?
R Recommendation (action requested/recommended — what you want)The overall recommendation of the review team is that VMC proceed and plan around Option 3 with the awareness that additional project prioritization must occur to accommodate the recommendation

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