Challenge of a Non-Billable Patient Ratio
The Floating Hospital (TFH) is a Federally Qualified Health Center, providing 57,000 patient visits annually to homeless individuals and families from all New York City boroughs. Wherever possible, TFH bills the Medicaid program for medically necessary services; however, TFH provides services free of charge to patients not eligible for Medicaid or those covered under Medicaid managed care plans. The Capstone team analyzed TFH's reimbursement collection processes for homeless families with Medicaid fee-for-service coverage and discovered that TFH is unable to submit reimbursement claims for 48% of visits provided and is denied reimbursement for over 4% of submitted claims. To address these figures, the Capstone team identified factors contributing to TFH's 48% non-billable ratio, researched New York State Medicaid Policy, and conducted interviews with similar homeless healthcare providers. The team also conducted an assessment of intake and disenrollment processes to maximize workflow efficiencies at TFH clinics. Lastly, to enhance TFH's capacity to serve homeless patients, the team made recommendations to improve reimbursement through Medicaid.
Improving Community Patient Access to Specialty Healthcare Services
New York City Health and Hospitals Corporation
The New York City Health and Hospitals Corporation (HHC) is the largest public hospital system in the country, serving 1.3 million patients annually. The Capstone team was asked to identify barriers to specialty care access for community-referred patients at select HHC facilities (Bellevue, Elmhurst, Kings, Lincoln, and Woodhull) and to develop an implementation plan for strategies to improve access. Phase I of the project focused on interviewing stakeholders at the participating hospitals, root cause analysis, data analysis, and literature review. Phase I ended with recommendations and strategies that could be implemented across facilities to better manage the specialty care access. Phase II included interviewing stakeholders at the participating hospitals for best practices associated with the recommended strategies and the prioritization of identified strategies with HHC leadership. The final product was a customized implementation plan for each participating facility to address specialty care access and the development of metrics to measure efficacy of the recommended strategies.
Improving the Accuracy of Reporting Graduate Medical Education Reimbursements
New York University Langone Medical Center
New York University Langone Medical Center (NYULMC) is a top-tier medical institution that provides graduate medical education to residents and fellows. NYULMC receives graduate medical education (GME) funding from Medicare when residents train in licensed settings or in non-licensed provider settings if appropriate agreements are in place. NYULMC was concerned that time spent by residents in non-provider settings may not be entered accurately into its resident time tracking system. The role of the Capstone team was to determine whether residents were being trained in non-provider settings, establish the length and time of these rotations, and analyze the financial impact on GME reimbursement. The team evaluated 85 programs to determine resident training locations, summarizing the information into a comprehensive document. The team also made recommendations to improve the accuracy of resident reporting. Finally, the team worked with NYULMC to define criteria for letters of agreement with identified non-hospital providers.
An Inquiry Into Administrative Operations and Process Flow at CERC
Rose F. Kennedy University Center for Excellence in Developmental Disabilities
The Children's Evaluation and Rehabilitation Center (CERC) is one of the primary centers in New York City and New York State providing health care services to children with developmental disabilities. In 2004, President Bush mandated that all healthcare providers convert to an Electronic Medical Record (EMR) by the year 2014. To fulfill this mandate and streamline their quality customer and provider service, CERC asked the Capstone team to observe and analyze current processes and procedures at its facilities, identifying areas of similarity and convergence across units. To obtain a stronger understanding of procedure and workflow for each unit, the team interviewed administrative staff in various units and analyzed internal processes beginning with initial patient contact and ending with determination and execution of treatment (or end of contact, if the patient was moved to another CERC unit or outside of CERC). The team's observations and recommendations are intended to assist CERC with the implementation of its EMR system and to generate general improvements in process and operational flow.