Leonid Gokhman, PharmD, manager of pharmacy business operations at Harris Health System, takes a proactive approach to running his operation, rather than being reactive. He encourages his pharmacy, nursing, IT and revenue cycle peers to adopt this mindset.
“If you’re reactive, you’re creating so many other issues — not only for yourself, but for multiple teams,” Dr. Gokhman says. “If you're able to put things in place that prevent issues from happening in the first place, you drastically cut down on a lot of clutter, errors and unnecessary work.”
Part of taking a proactive approach means working directly with the frontline staff not only on project development and implementation, but maintenance as well. Staying within the pharmacy walls and only working with your team means you’re not getting the bigger picture of how the hospital system operates, he says.
Plus, when major departmental initiatives are carried out in silos, crucial components may be overlooked. This oversight could result in either beneficial or detrimental downstream effects for other departments.
Five years ago, he was asked to participate in the hospital system’s vaccine redesign project. When he first started the project, the error rate was almost 50%. (Yes, you read that right. 5-0.)
“If you have errors in your clinical documentation and on your charges, you will not get paid or get paid inappropriately,” Dr. Gokhman says. “As I was digging through the system build and working with nursing leadership — it became clear to me that the system build was way too complicated. Our providers had five different workflows, requiring them to memorize numerous charge codes to manually post administration charges and contend with confusing order names. This diverted their attention away from direct patient care.”
Five workflows were four too many. His first step was to consolidate multiple provider and nursing workflows into one. Next, vaccine order names were updated according to ISMP (Institute for Safe Medication Practices) and Epic guidelines. Finally, a system build was implemented to automatically post vaccine and vaccine administration charges based on the documentation for each vaccine.
“Keep it simple,” Dr. Gokhman says. “When frontline staff are presented with too many options, they are prone to choosing incorrectly or resorting to workarounds. These workarounds might seem beneficial, but on the frontend, they lead to order entry and documentation errors. This causes multiple coding, billing and reimbursement issues on the backend.”
By simplifying and automating the workflow, they’ve drastically cut down the number of errors. Recently, a third-party audit revealed a 100% vaccine billing compliance rate, surpassing the industry standard of 95%.
