1. Low Hanging Fruit
Open Patient Encounters
Etter Hoang, Business Intelligence Manager
Renee Blanding, VP Medical Affairs

2. About Us: Mission
• Mission
– The mission of Johns Hopkins Medicine is to improve the health of the community
and the world by setting the standard of excellence in medical education, research,
and clinical care
Medical Education
Clinical CareResearch

3. About Us: Johns Hopkins Medicine
• Facilities
• The Johns Hopkins Hospital
• 1,192 licensed beds
• Johns Hopkins Bayview Medical Center
• 527 licensed beds
• Johns Hopkins All Children’s Hospital (St. Petersburg, FL)
• 259 licensed beds
• Howard County General Hospital (Columbia, MD)
• 284 licensed beds
• Sibley Memorial Hospital (Northwest Washington, D.C.)
• 318 licensed beds
• Suburban Hospital (Bethesda, MD)
• 236 licensed beds

4. About Us: People & Visits
• Quick Facts
• 41,000 + combined full-time equivalent employees
• Medical and doctoral students: over 1,200
• Full-time faculty: over 2,700
• Part-time faculty: over 1,300
• Annual Outpatient Visits: Over 2.8 million
• Annual Emergency Department Visits: Over 360,000
• Annual Hospital Admissions: Over 115,000

5. Analytics: Business Intelligence
Source: Analytics: Farre, Tom; The Analytical Competitor; Analytics: The Art and Science of Better; pg 11.

6. Process: Open Encounters
• Assumed Workflow
• Provider Compliance Requirements
– < 20 open encounters that are <= 7 days old
Patient Sees
Provider
Provider
Examines
Provider EMR
Documentation
Provider Sees
Next Patient

7. Challenge: Open Encounters
• Non-Compliance
• 39 providers did not meet
requirements out of 400 =
9.75%
• Accounts for $1.6M in pending
charges = 4061 of the 6188
open encounters
Compliant
91%
Non-Compliant
9%

8. Challenge: Open Encounters
• Consistent Issue

9. Problem: Open Encounters
• Clinical Impact
• Open encounters unavailable until closed
• Accuracy of provider documentation beyond initial encounter
• Financial Impact
• Unbooked revenue for Professional Fee Billing
• $1 Million
• Bad debt/free cash flow for booked Hospital Billing
• $2 Million
ProFee
34%
Hospital
Billing
66%

10. Problem: Open Encounters
• How were open encounters tracked?
• EPIC Report  Excel Pivot Table

11. Investigation: Process & Policy
• Other Institutions
• Emory / Texas / Wisconsin / University of Florida
• Shared policies
JHBMC
Emory
Texas
Wisconsin
University
of Florida

12. Investigation: Process & Policy
• Other Institutions
• What policies did we set up?
• What did we borrow from their policies
• Operational definitions
• Time parameters
• Departmental / Administrative Responsibilities
• Mechanism for suspension (Florida/Emory)

13. Application: Build Methodology

14. Application: Build Challenges
• Visualization Requirements
• Mirror original excel report
• Customize parameters
• Monthly Trends with custom targets
• Track providers on suspension list
• Age of open encounters
• Financial impact (estimated vs charged)
• Provider Open Encounter Risk Scoring

15. Application: Demo

16. Impact: Who is Involved?
• Multi-disciplinary Team VP Medical
Affairs
VP Revenue
Cycle
Clinical
Administrators
Medical Board
Departmental
Chairs/Division
Chiefs
Health
Information
Management
(HIM)
Business
Intelligence

17. Impact: Policy and Enforcement
• Methodology and Impact
• Key items to the policy
• Administrative suspension
• Revoke clinical privileges at JHBMC
• Suspension list criteria (>20 open encounters that are open for >= 7 days )
• Regulatory suspension
• Practice license revoked
• Must be on suspension list more than 3 times
• Enforcement Methodology
• HIM involvement, written letter from VPMA with agreement from departmental chairs
• Weekly meetings with Clinical Administrators

18. Impact: Policy and Enforcement
• Methodology and Impact
• Enforcement Impact
• Reduction of open encounters by 44% in 4
months
• Revoke clinical privileges at JHBMC
• Suspension list criteria (>20 open encounters that are
open for >= 7 days )
• Institutional suspension
• Practice license revoked
• Must be on suspension list more than 3 times
• Enforcement Challenges
• Providers given 7 days to close encounters
after letters sent out
• Providers are hitting suspension list multiple
times
6188
5881
3906 3819
3492
5%
34%
2%
9%
0%
5%
10%
15%
20%
25%
30%
35%
40%
0
1000
2000
3000
4000
5000
6000
7000
16-Nov 16-Dec 17-Jan 17-Feb 17-Mar
Open Encounters % Reduction

19. Impact: Financials
• $ Savings / # Encounters Closed
• How did we estimate the $ savings
• Average charges by provider
• How did we track savings
• Pulled data from HIB and Profee Billing (both loaded into EPIC Clarity)
• For Maryland, how is $ savings impacted by GBR
• Hospital billing affected by booked revenue – affects bad debt / free cash-flow
• Profee Billing affected by unbooked revenue – affects revenue stream

20. Application: Sustainability
• Engagement
• Bi-Weekly meetings with clinical administrators
• Enabling broader access
• Providing resources to help manage open encounters
• Predictive Model
• Identify ”high risk” providers that do not close their encounters
• Targeted intervention prior to suspension status

21. Predictive: How to Operationalize
• High Risk Providers
• Demo in Qlik® application

22. Summary: Open Encounters
Financial Operational Clinical
~$3 Million Savings Opportunity cost gain 44% reduction in open
encounters

23. Questions, Comments?