From the CEO’s Desk: Lean Management Update

Brad Haws

We are proud that UPG has led the Health System in using Lean management practices in administrative operations in order to serve as efficient stewards of Health System resources. The following is an update on some important results of those efforts.

  • UPG has had Lean projects in every unit in the past 24 months.
  •  To date, UPG Lean projects have created $2.5M of value for the Health System. 
  • Generated margin in administrative unit in FY2016 and rebated $380K of fees back to clinical units.
  • Last year, UPG was the only organization in the Health System not to add a single FTE. UPG’s FY18 budget continues this trend.
  • Lean Successes include:
    • Zion Crossroads
      • Redesigned scheduling process, reducing rate of errors from 30% to near zero.
      • Reduced referral errors from 30% to near zero so that patient connects with the right physician for their condition the first time.
      • Improved communication between physicians and staff.
    • Life of a Surgical Charge
      • Developed automated OR log in Epic, used by 11 Clinical Departments
        • Estimated increase of $800K/year in collections by adding Accustream to identify missed charges.
        • Time savings of ~960 hours/year.
    • In FY17, Billing and Collections teams have seen a 20% increase in productivity while absorbing a 14% decrease in time processing.
      • Charges and collections are up 8.2%.
      • Timely adjustments are down 60% from $1,217,217 to $481,204.
      • 35 process improvements identified; 33 of which have been implemented.
    • Electronic Enrollment with Medicare, Medicaid and VA.
      • Reduces held charges and increases timely payment
    • Monthly Financial Close Cycle
      • Shortened close cycle from 16th to 10th business day
      • More timely financial statements to the Health System
      • Eliminated waste
      • Team freed up to work on other projects
    • Physician Hiring Platform
      • Creation of a streamlined hiring platform for providers, aligning credentialing and date of hire with ability to bill for services.

Workload Trends FY2017

Key Performance Indicators: Workload Trends

workloadtrends

Lean Successes: Zion Crossroads

When the Zion Crossroads Multi-Specialty Clinic opened in August 2013, it represented a new business model of outreach care for the UVA Health System. Housing 22 primary and secondary specialties, a pharmacy and imaging under one roof, the practice was intended to be a “one-stop-shop” of multi-disciplinary UVA health care for the community.

A little over three years later, after what Zion Crossroads Director of Clinical Operations Renee Viette refers to as “a few stumbles along the way”, the practice is thriving and growing, and leads by example when it comes to the high-quality, value-added lean success model. “We think of it as an intersection between the Be Safe initiative in patient care, and administrative process improvement,” says Viette.

According to Supervisor of Practice Teshema Anderson, one of the earliest hurdles they needed to surmount at the new practice was streamlining the scheduling process. “The challenge was to meet the needs of all the physicians and all the patients across the multi-disciplinary practice, but the way the scheduling was originally set up was inefficient and complicated,” says Anderson. The resulting lean project was to redesign the scheduling templates and work closely with physicians to accommodate their calendars and configure the best method for patient access. The results have been successful: Scheduling and referral errors have been reduced to near zero, and the communication between physicians and staff has improved measurably. “Being able to quell the frustrations of our physicians and staff has been really rewarding,” reflects Anderson. “They have all the tools they need to succeed.”

Michelle Young, Assistant Nurse Manager for the clinic, readily admits that at first she questioned whether or not nursing had a place in the lean model. Until, she says, the matter of patient medical records reached a critical juncture. The volume of information on a patient’s history was often extensive and at least partially irrelevant to their current situation. However, determining which information was important and what was obsolete lay outside the area of expertise of the administrative staff who were generally tasked with managing patient records. The result? Often inclusion of extraneous information which takes time and resources to go through. “One day,” Young recalls, “I just looked at it and said, “This is a nursing issue. We have the background to determine what medical history is relevant for a patient’s present care.”

Once nurses took charge of patient medical records, under Young’s leadership, the amount of time taken by physicians to scan records looking for vital information was greatly reduced. “What this translates to is exponentially more face-to-face time between doctor and patient,” says Young. “This allows us to provide the best, most personalized care possible – and that’s our ultimate goal.”

Michelle Young, Renee Viette, Jeffrey Moore, Teshema Anderson

 

 

Viette is quick to point out that while the clinic’s lean successes are certainly worth celebrating, the thing she is perhaps most pleased with is their team member engagement. “When I learned that we had measured in the 92nd percentile of employee engagement, I was just floored. I’m so proud of our team,” she says. “The spirit of collaboration can be felt throughout the clinic, from nurses to administration to physicians and housekeeping staff.”

When asked what the future holds for the Zion Crossroads Clinic, Viette answers: “Growth. We have grown so fast, which is wonderful. We’ve maxed out our current operating space and are ready to expand.” She has proposed expanding hours, and the team is ready to make use of the 8000 square feet of reserved space at their facility. “We are clearly meeting a need here,” she remarks. “Both serving regional patients closer to home, and attracting new patients to the UVA Health System.”

 

ZCR Halloween 2016

Zion Crossroads Halloween Celebration

From the CEO’s Desk: Delay in Pension Plan Changes

Brad Haws

Brad Haws

UPG Executive Leadership is consistently trying to strike a balance between representing our individual employees, and managing our legal and fiscal responsibilities to the group and to the UVA Health System.

Recent discussion about the upcoming changes to the clinicians’ pension plan highlighted the delicacy of that balance, and as a result the UPG Board of Directors has resolved to temporarily delay the plan changes that were to become effective at the end of this calendar year.

The letter below from Jim Rutrough, Chairman of the UPG Board of Directors, and myself, outlines the landscape surrounding this complex matter. This letter was sent out to UPG Clinicians earlier this week.

 

Dear UPG Clinician,

In anticipation of a January 1, 2017 transition date for revised Clinicians Supplemental Retirement Plan (CSRP) pension benefits, multiple meetings were held to provide faculty members with the opportunity to discuss the upcoming changes. During these meetings, some faculty members indicated that they did not feel that their demographic was adequately represented during the CSRP review process.

We write this letter, and have taken the actions it describes, in response to those identified concerns.

The CSRP, which is the pension plan for full-time clinicians hired since August 1, 1985, has undergone an intensive review over the past two years. The primary reason for review was that the plan has reached a critical point where it is likely to fail federal testing requirements in the near future. Should this occur, all plan participants will immediately be taxed a lump sum amount on the current value of their CSRP benefit. We feel a keen responsibility to prevent this from happening. The secondary reason for review was financial. Over the last few years we have seen increasing spikes in the cost of maintaining the current plan. These spikes were caused by external market forces and changing actuarial tables leading to double digit increases each year in pension expense to the clinical departments. For these reasons we find it necessary, as so many medical centers across the U.S. have already done, to change to a defined contribution plan from a defined benefit plan.

In order to mitigate these risks, the UPG Board of Directors convened a CSRP Review Committee and hired an actuarial firm, AON Hewitt, to evaluate the viability of the CSRP and research alternative options. The Review Committee was comprised of a cross-section of representatives from faculty, the UPG Board, the Dean’s Office, UPG Legal Affairs and School of Medicine Administration. Their objective was to make recommendations that balance offering a competitive plan and the legal and financial constraints: an extraordinarily difficult process due to the many competing variables.

During the course of the Review Committee’s work, the Board received regular progress updates and carefully weighed multiple factors that would affect their decisions. The Board sought to protect the best interests of our clinicians while balancing their fiduciary responsibility.

After substantial actuarial analysis of data, multiple projections and consideration of legal consequences as advised by counsel, the Review Committee brought its recommendation to the UPG Board of Directors for their deliberation at the December 9, 2015 Board Meeting. The Board approved the recommended resolution, and resolved that the changes to the CSRP would become effective January 1, 2017.

Although substantial analysis had been completed by the Committee in arriving at their recommendation, it is important to address the issues raised most recently by members of our faculty before moving forward. With that in mind, UPG convened a Special Board Meeting on November 11, 2016, and passed a resolution to delay any changes to the CSRP to permit time for re-evaluation of potential scenarios.

In the spirit of collaboration with the dedicated, excellent physicians who enable UVA to achieve and maintain our shared goal of providing the highest standard of patient care, this pause in the decision-making process is important. We encourage you to continue to engage in the discussion as we work together through a mutually beneficial outcome.

Please don’t hesitate to reach out with further questions or concerns. Your feedback is most certainly valued, and we will keep you informed of our progress. Please check the website regularly for updates: https://med.virginia.edu/upg-retirement/

As always, thank you for being a part of the UPG community.

 

Sincerely,

Brad Haws

Chief Executive Officer, UPG

 

Jim Rutrough

Chairman of the Board of Directors, UPG