Lean Success Stories--the Charge Capture Project

“Jaded Julie, I think it’s time for us to share some success stories.”

“If these ‘Curmudgeon Chronicles’ really do depict success, I can be certain that they won’t be autobiographical.”

“Don’t be disparaging, Julie. For some senior citizens, just getting out of bed in the morning is a success story. But we want to talk about how implementing the Lean culture and using Lean tools led to process improvements right here at Affinity. These stories will be told by the people who did the work and made things happen, or you and I will tell the story for them. We’ll start with Deb Voyles and her charge capture project.”

“Okay, Curmudge, just what is ‘charge capture,’ anyway? You know that I can’t understand the story unless I learn the language.”

“A person’s hospital bill is the summation of the charges for each treatment or service performed for the patient. This cannot be done correctly unless each service and its duration are recorded on the patient’s chart. These data are then transferred to a charge sheet, given a billing code, and sent to Patient Billing. If any step in this process is overlooked, the bill will be low; and the hospital will not receive its full payment from Medicare, the patient’s insurance, or the patient himself.”

“So what was the problem?”

“The nurses considered the charge capture process to be extra work. Their job was to care for the patients, not collect money. When Deb met with the nurses to plead for their cooperation, they—to use a common phrase—just blew her off.”

“Very frustrating! But we wouldn’t be talking about this if it hadn’t somehow become a success. What—and who—turned the process around?”

“The economy went south, Affinity instituted a margin improvement hoshin, and the hospital president provided the support necessary to put the charge capture project in high gear. Deb Voyles was appointed project leader with Stan Shelver co-leader to aid in communication and provide a director’s ‘inspiration.’ Carol Jansen was Lean facilitator. A ‘charge specialist,’ the unit clerk in each patient care unit, was designated; a new FTE was created in each emergency department to fill that roll.”

“Okay, Curmudge, we’ve got the team. Now what?”

“The first step was to change the prevailing mindset about charge capture. Deb did that by looking at charts from the previous month, computing the ‘forgotten charges,’ and posting the results on each patient care unit in the nurses’ break room.”

“That sounds like visual management. Good move!”

“She followed that up by meeting with the staff of each patient care unit to explain the financial impact of the forgotten charges and to demonstrate the effectiveness of utilizing the Universal Chargesheet. Stan joined Deb at the meetings and ‘encouraged’ the staff to begin using the new chargesheet.”

“Curmudge, as an old chemist like you would say, ‘Management provided an essential catalyst.’”

“Twice weekly, Deb would meet with charge specialist staff, training them on effective charge capture, and addressing charge issues. She made herself available to them 24/7 (via phone and email) to answer charge capture questions. The specialists would track the additional charges they found using the new charge capture process. They posted these results every week in the break room. At the end of the first month, Deb was able to pull the financial data from the monthly finance reports. She created a chart that compared the revenue per patient from the previous month to the current month. These charts illustrated the success of the new charge capture process and were posted on every patient care unit every month. The staff responded with enthusiasm, and the charge capture project gained momentum. Deb’s weekly meetings with the charge specialists became less focused on training and more focused on reviewing new procedures to develop charges. She saw a new culture emerging at the hospitals. It was exciting!”

“There is, of course, more to the story.”

“Deb continued tracking their success on a larger scale in which last year’s charges (with money left on the table) were compared with this year’s (with all charges properly captured). The three-month trial yielded a 40% increase in revenue capture per patient.”

“That undoubtedly attracted people’s attention.”

“It’s like our Flywheel posting on 3/26/08, Julie. One person with enthusiasm and determination was needed to get the project moving and to attract others to the effort. That was Deb Voyles.”

“Curmudge, despite this project’s resounding success, it didn’t seem to require many of the classical Lean tools.”

“You’re correct, Julie. The project was well defined without needing value stream mapping. It had abundant top-level support, extraordinary leadership, a team with accelerating enthusiasm, and a result that should be enduring. One essential Lean tool was visual management. Perhaps we should summarize by saying, ‘All’s well that ends well.’”

“You’ve got that right, Mr. Shakespeare.”

Affinity’s Kaizen Curmudgeon