In today’s healthcare market, financial challenges rank as the number one issue hospitals face. To maintain a margin to support their mission, hospital CEOs must always be on the lookout for opportunities to boost revenue through improved reimbursement. In this webinar, Thibodaux Regional Medical Center’s Greg Stock, president and chief executive officer, and Mikki Fazzio, director, HIM and clinical documentation improvement, as they share how Thibodaux Regional leveraged analytics to provide actionable feedback to continuously improve the process, and how you can too. Managing ‘discharged not final billed’ (DNFB) cases is one important way hospitals can improve financial performance by increasing collection on bills with incomplete payment due to coding or documentation gaps. Historically, Thibodaux Regional’s DNFB caseload had reached 500 cases per month, with about a third of patients discharged without a completed bill due either to missing documentation or incomplete coding. Thibodaux Regional tackled this process problem by expanding the use of analytics to measure and track every aspect of their billing services. The results were impressive and sustainable. Three years after launching its initial DNFB redesign effort, Thibodaux Regional has realized $2.4M in additional annual reimbursement and a 61% relative reduction in DNFB dollars, as well as a 6.2 reduction in AR days, resulting in significantly improved cash flow. View this webinar to learn how to: - Increase reimbursement levels by optimizing workflow analytics - Ease the documentation burden on overloaded physicians with time-efficient communication - Provide critical analytics visibility to key stakeholders

1. Using Analytics to Increase Cash Flow
February 6, 2019
Greg Stock, MPA
President & CEO, Thibodaux Regional Medical Center
Mikki Fazzio, RHIT, CCS
Director, HIM and Clinical Documentation
Improvement, Thibodaux Regional Medical Center

2. Agenda
#4: The next time you have a melt down,
literally melt down. It is very impressive.
• Top financial challenges for hospitals
• Common strategies for improving
financial performance
• TRMC statistics prior to ‘discharged
not final billed’ (DNFB) implementation
• Assessing TRMC’s opportunities for
improvement
• Using analytics and process
improvement to achieve objectives
• Results through continuous
improvement
• DNFB application

3. © 2018
Health
Catalyst
How familiar are you with your facility’s ‘discharged not final billed’
(DNFB) process?
1. Unfamiliar (I am not sure if we have a DNFB process.) — 41%
2. Somewhat familiar (I know that we have a DNFB process, but I am unsure of the
details.) — 19%
3. Very familiar (I am involved in the DNFB process.) — 16%
4. Unsure or not applicable (What is DNFB?) — 24%
Poll Question #1
3

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Health
Catalyst
What is your facility’s greatest challenge as it relates to DNFB
accounts?
1. Incomplete physician documentation — 28%
2. Coding turnaround time — 6%
3. Billing/insurance issues — 15%
4. Other — 4%
5. Unsure or not applicable (What is DNFB?) — 48%
Poll Question #2
4

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Catalyst
185-bed Regional Medical Center in
South Louisiana
5

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Health
Catalyst
Culture of patient-centered excellence
• 99th percentile for patient satisfaction
• healthgrades Outstanding Patient Experience Award™—11 years in a
row
Employee engagement and satisfaction
• Top 5% in the country (Press Ganey)
Leader in quality
• Care transformation success—sepsis mortality rate down to 8%
• Early adopter of process improvement: Six Sigma and LEAN since 2000
• Commitment to process improvement since 2000
Continuous growth
• Recruitment of 100 physicians
– Heart program
– Excellence in providing cancer care
– Spine Center of Excellence, orthopedics
Continuous Pursuit of Excellence
6

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Catalyst
Cancer Institute of Thibodaux Regional
7

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Catalyst
Cancer Institute of Thibodaux Regional
8

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Catalyst
Wellness Center of Thibodaux Regional
9

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Catalyst
Wellness Center Phase II
10

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Health
Catalyst
#1 Issue Hospital CEOs Face –
Financial Challenges
11
Common Financial Challenges:
• Declining reimbursement and
rising costs
• Changes in payer mix
• Declining inpatient volume
• Documentation and coding issues
• Increase in payer denials
• Increase in regulatory and
compliance requirements
• Increasing amount of bad debt

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Health
Catalyst
Cash is King
12
Common Strategies for Improving Financial Performance:
Improving
documentation and
coding accuracy
Reducing the
number of
outstanding bill hold
accounts
Reducing Accounts
Receivable (A/R)
days
Managing DNFB
cases

13. © 2018
Health
Catalyst
TRMC Statistics –
Prior to DNFB Application Implementation
13
Total Net A/R Days =
43.1
2017 Standard and Poors
(S&P) target for AA top rated
hospital =
50.8
No Debt
DNFB Dollars
Outstanding =
$4 Million
Two largest components:
- Physician portion = $2.8M
- Coding portion = $1.1M
Delinquency
Rate =
47%

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Health
Catalyst
Opportunities for Improvement
14
Inefficient, time-consuming,
manual process à
Initiate automated,
efficient process
Lacking analytics à
Implement analytic
system to find greatest
areas of opportunity
Opportunity for
innovation through
change leader à
New paradigm
Overburdened physicians
and coders à
Implement “real-time”
alerts
Lower level coding à
Implement timely
documentation
process

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Health
Catalyst
Using Data Analytics and Process Improvement
to Achieve Goals
15
Invested in
analytics
Fine-tuned and
verified analytic
data
Revamped
processes
Revised
department
structure and
created new roles
Communicated
consistently with
physicians and key
departments
Educated key
departments on
DNFB application
and gave access
when appropriate

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Health
Catalyst
Discharged Not Final Billed Explorer
16
DNFB By Patient Type
DNFB By Aging
DNFB By Payer
DNFB By Location
DNFB By Charges
DNFB By Physician
DNFB By Coder
DNFB By Reason

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Catalyst
Excellent Results Through Continuous
Improvement
17
43.1
41.2
39.9
36.9
35
36
37
38
39
40
41
42
43
44
FY 2014 FY 2015 FY 2016 FY 2017
Accounts Receivable Days
6.2 Day
Reduction

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Health
Catalyst
Excellent Results Through Continuous
Improvement
18
47%
27%
19%
29%
23%
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
FY 2014 FY 2015 FY 2016 FY 2017 FY 2018
Delinquency Rate

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Catalyst
Excellent Results Through Continuous
Improvement
19
$4,009,399
$1,561,826
$2,879,238
$1,308,698$1,128,161
$187,113
$0
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
$3,500,000
$4,000,000
$4,500,000
FY 2014 FY 2015 FY 2016 FY 2017 FY 2018 (8 months)
DNFB Dollars
Total DNFB Physician Portion Coding Portion

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Catalyst
Excellent Results: Immediate Impact on
Efficiency
20
8 Hours
30 Minutes
0
1
2
3
4
5
6
7
8
9
FY 2014 FY 2015 FY 2016 FY 2017 FY 2018
Operational Efficiency of DNFB Process
Hours
96% Improvement

21. © 2018
Health
Catalyst
Lessons and Recommendations
21
Access and clarity of
data drives change.
Consistent data
sharing with
physicians promotes
physician
engagement.
Inaccurate analytic
data has no value and
can cause resistance
to change. Verify,
verify, and verify again!
Analytics
+
Efficient Processes
+
Accountability
=
Sustained Success

22. Q&A

23. Thank You!