SUMMER INTERNSHIP PROJECT REPORT ON

PROESS IMPROVEMENT IN
A SPECIALTY HOSPITAL

SUBMITTED BY

PARIKSHIT JAGTAP

ROLL NO: 139

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR

MMS 2015-2017

UNDER THE GUIDANCE OF

PROF. PURUSHOTTAM SABHERWAL

KJ SOMAIYA INSTITUTE OF MANAGEMENT STUDIES AND RESEARCH

Summer Internship Project Report

Process Improvement in Specialty Hospital

By
Parikshit Jagtap
Roll no: 139
Under the guidance of

Miss. Jigyasa Bedi Mr. Rakesh Sharma Prof. Purushottam Sabherwal

Operations Manager Senior Vice President Faculty

Currae Specialty Patni Healthcare K. J. Somaiya Institutte of

Hospital Management Studies

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Summer Internship Project Report

DECLARATION

I hereby declare, to the best of my knowledge and ability that my work on the Summer
Internship Project title” Process Improvement in Specialty Hospital” is a genuine
research work undertaken by me. It has not been published anywhere earlier and is
prepared after completion of the Summer Internship Program with Patni Healthcare.

Parikshit Jagtap

Roll no: 139

MMS 15-17

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Summer Internship Project Report

CERTIFICATE FROM SUMMER PROJECT GUIDES

THIS IS TO CERTIFY THAT PARIKSHIT JAGTAP, A STUDENT OF MASTER OF

MANAGEMENT STUDIES AT K J SOMAIYA INSTITUTE OF MANAGEMENT
STUDIES AND RESEARCH, HAS WORKED UNDER OUR GUIDANCE AND
SUPERVISION. THIS SUMMER PROJECT REPORT TITLE “PROCESS
IMPROVEMENT IN A SPECIALTY HOSPITAL” HAS THE REQUISITE
STANDANRD AND TO THE BEST OF OUR KNOWLEDGE HAS NO PART OF IT
BEEN REPRODUCED FROM ANY OTHER SUMMER PROJECT, MONOGRAPH,
REPORT OR BOOK.

Prof. P. Sabherwal Miss. Jigyasa Bedi

K J Somaiya Institute Operations Manager

Of Management Studies Currae Specialty Hospital

And Research Patni Healthcare

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Summer Internship Project Report

CERTIFICATE FROM THE COMPANY

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Summer Internship Project Report

ACKNOWLEDGEMENT

I would like to express my sincere gratitude to my company guide Miss. Jigyasa Bedi,
Operations Manager, Currae Specialty Hospitals, Patni Healthcare, for guiding and helping
me complete my Project Report. Her encouragement, time and effort are greatly
appreciated. I would also like to thank Mr. Rakesh Sharma, Senior Vice-president, Patni
Healthcare, Dr. Reshma Pawar, Centre Head Currare Speciality Hospital and Dr. Shamika
Phapale, TPA Head, Currae Specialty Hospital for their help and support.

I would also like to thank my faculty guide, Prof. Purushottam Sabherwal, for his valuable
inputs and constant support towards me and providing me an opportunity to learn. Till now,
it has been a truly wonderful learning experience.

I would like to thank all my friends who are doing their SIP from Patni Healthcare for their
valuable suggestions and support. I owe my wholehearted thanks and appreciation to the
entire staff of the company for their cooperation and assistance during the course of my
project.

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Summer Internship Project Report

Table of Contents
Process Improvement in Specialty Hospital ............................................................................................... 1
DECLARATION ............................................................................................................................................ 2
CERTIFICATE FROM SUMMER PROJECT GUIDES ............................................................................... 3
CERTIFICATE FROM THE COMPANY ..................................................................................................... 4
ACKNOWLEDGEMENT .............................................................................................................................. 5
Table of Contents ........................................................................................................................................... 6
Executive Summary........................................................................................................................................ 7
Introduction to Healthcare Industry ................................................................................................................ 8
Company Profile ............................................................................................................................................11
CURRAE Specialty Hospital .................................................................................................................11
CURRAE Eye Care Hospital .................................................................................................................11
CURRAE Gynaec | IVF | Birthing Hospital ..........................................................................................12
Principles and the P factors: ......................................................................................................................12
Project 1.........................................................................................................................................................13
Dischargr process flow ..............................................................................................................................14
Process Description ...................................................................................................................................16
Time Analysis ............................................................................................................................................17
Observations ..............................................................................................................................................19
Recommendations .....................................................................................................................................21
Conclusion .................................................................................................................................................22
Project 2.........................................................................................................................................................23
Cashless claims process flow ....................................................................................................................24
Process description ....................................................................................................................................25
Observations ..............................................................................................................................................28
Recommendations and conclusion ............................................................................................................29
Project 3.........................................................................................................................................................31
Process .......................................................................................................................................................32
Process flow ..............................................................................................................................................32
Time Analysis ............................................................................................................................................32
Observations and conclusion .....................................................................................................................33

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Summer Internship Project Report

Executive Summary

Envisioned by Patni Group one of the leading brands in the Indian IT industry, CURRAE
Hospitals is set to offer hassle-free healthcare by making use of latest medical technologies
under the supervision of highly adept healthcare experts. That explains why every effort of
ours goes into maintaining transparency at all costs, keeping convenience of every patient
on priority and delivering accurate treatments for your faster recovery. Currae offers its
hassle-free healthcare services through the following three hospitals: Currae specialty
hospital, Currae eye care hospital, Currae gynaec | ivf | birthing hospital

The following report is a study of how the various processes related to the patients are
carried out in the hospital, what are the different steps involved and the time analysis of
the process. The study aims at improving the process to make the hospital more efficient
and effective for the patients.

Currae specialty hospital offers secondary care in the fields of Orthopedics, Joint
replacement, spine care, laparoscopy, gastroenterology, urology and others. It is moving
towards becoming a boutique hospital.

It is relatively new organization, established 2 years ago and has 4 hospitals in India and it
plans to add 2 more in the span of one year. Currae aims to providing hassle free healthcare
to its patients. It provides cashless hospitalization and corporate empanelment to its
patients.

The organization had a team of around 12 interns who worked in the field of Marketing,
Operations and Finance. Interns were allotted different projects in their field at different
locations. The employees of the organization were very helpful in terms of guiding the
interns in their work. The top management of the organization took deep interest in the
project work. The CEO, Vice president and the heads of various department took timely
appraisals of the project work.

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Introduction to Healthcare Industry

Overview
Healthcare has become one of India's largest sectors - both in terms of revenue and
employment. The industry comprises hospitals, medical devices, clinical trials,
outsourcing, telemedicine, medical tourism, health insurance and medical equipment. The
Indian healthcare industry is growing at a tremendous pace due to its strengthening
coverage, services and increasing expenditure by public as well private players.

The Indian healthcare delivery system is categorized into two major components - public
and private. The Government, i.e. public healthcare system comprises limited secondary
and tertiary care institutions in key cities and focuses on providing basic healthcare
facilities in the form of primary healthcare centers (PHCs) in rural areas. The private sector
provides majority of secondary, tertiary and quaternary care institutions with a major
concentration in metros, tier I and tier II cities.

India's primary competitive advantage lies in its large pool of well-trained medical
professionals. Also, India's cost advantage compared to peers in Asia and Western
countries is significant - cost of surgery in India is one-tenth of that in the US or Western
Europe.

Market Size
According to estimates, the overall Indian health care market today is US$ 65 billion, of
which the hospital supplies and health care equipment segment is believed to be only
around US$ 4.5-5 million. Health care delivery, which includes hospitals, nursing homes
and diagnostics centers, and pharmaceuticals, constitutes 65 per cent of the overall market.
India requires 600,000 to 700,000 additional beds over the next five to six years, which
potentially throws an opportunity of more than US$ 25-30 billion. While the existing
hospitals would look at expanding their capabilities, a lot of new properties would also
come up.
Overall the number of transactions in the healthcare space is going to grow as companies
are seeking growth capital. The average investment size by private equity funds in
healthcare chains has increased to US$ 20-30 million which was around US$ 5-15 million.
The Indian medical tourism industry is pegged at US$ 1 billion per annum, growing at
around 18 per cent and is expected to touch US$ 2 billion by 2015.
There is a significant scope for enhancing healthcare services considering that healthcare
spending as a percentage of GDP is rising. Rural India, which accounts for over 70 per cent

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of the population, is set to emerge as a potential demand source. Only three per cent of
specialist physicians cater to rural demand.

Investments

The hospital and diagnostic centres attracted foreign direct investment (FDI) worth US$
2,793.72 million between April 2000 and January 2015, according to data released by the
Department of Industrial Policy and Promotion (DIPP).
Some of the major investments in the Indian healthcare industry are as follows:
 Mylan Inc has signed a deal to acquire the female health care businesses of Famy
Care Ltd, a specialty women’s health care company, for US$ 750 million in cash
and additional contingent payments of up to US$ 50 million.
 Sanofi-Synthelabo (India) Ltd had invested Rs 90 crore (US$ 14.47 million) in
Apollo Sugar Clinics Ltd (ASCL), a unit of its subsidiary Apollo Health and
Lifestyle Ltd.
 Apollo Hospitals Enterprise (AHEL) plans to add another 2,000 beds over the next
two financial years, at a cost of around Rs 1,500 crore (US$ 241.24 million), as per
Mr Prathap C Reddy, Founder and Executive Chairman, Apollo Hospitals.
 Temasek Holdings Pte Ltd has acquired the entire 17.74 per cent stake of Punj
Lloyd Ltd in Global Health Pvt Ltd, which owns and operates the Medanta super
specialty hospital in Gurgaon, Haryana.
 CDC, the UK’s development finance institution, has invested US$ 48 million in
Narayana Hrudayalaya hospitals, a multi-speciality healthcare provider. With this
investment, Narayana Health will expand affordable treatment in eastern, central
and western India.
 Apollo Health and Lifestyle Ltd (AHLL), a wholly-owned subsidiary of Apollo
Hospitals Enterprise, has acquired Nova Specialty Hospitals at an estimated cost of
Rs 135-145 crore (US$ 21.71-22.32 million).

Government Initiatives

India's universal health plan that aims to offer guaranteed benefits to a sixth of the world's
population will cost an estimated Rs 1.6 trillion (US$ 25.73 billion) over the next four
years.
Some of the major initiatives taken by the Government of India to promote Indian
healthcare industry are as follows:
 The Competition Commission of India (CCI) in its meeting has approved the
proposed merger between Sun Pharma and Ranbaxy, subject to the parties inter alia

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Summer Internship Project Report

carrying out the divestiture of their products relating to seven relevant markets for
formulations.
 India and Sweden celebrated five years of memorandum of understanding (MoU).
The cooperation in healthcare between India and Sweden will help in filling gaps
in research and innovative technology to aid provisioning of quality healthcare.
 Generic drug maker Mylan Inc and the US-based Abbott Industries have received
the CCI’s nod to proceed with their merger.
 Under the National Health Assurance Mission, Prime Minister Mr Narendra Modi's
government would provide all citizens with free drugs and diagnostic treatment, as
well as insurance cover to treat serious ailments.
 All the government hospitals in Andhra Pradesh would get a facelift with a cost of
Rs 45 crore (US$ 7.23 million), besides the establishment of 1,000 generic medical
shops across the State in the next few months.

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Company Profile

Envisioned by Patni Group one of the leading brands in the Indian IT industry, CURRAE
Hospitals is set to offer hassle-free healthcare by making use of latest medical technologies
under the supervision of highly adept healthcare experts. That explains why every effort of
ours goes into maintaining transparency at all costs, keeping convenience of every patient
on priority and delivering accurate treatments for your faster recovery. CURRAE offers its
hassle-free healthcare services through the following three Hospitals

 CURRAE Specialty Hospital

 CURRAE Eye Care Hospital
 CURRAE Gynaec | IVF | Birthing Hospital

CURRAE Specialty Hospital

CURRAE Specialty Hospital, Thane houses Specialties such as Orthopedics and spine,
General Surgery, Bariatric Surgery, Urology, Plastic and Cosmetic Surgery,
Gastroenterology and post-surgical care. The quality treatments offered here makes it
among the top three players in knee replacement and spine surgeries in Thane region.
CURRAE shall offer an array of services like OPD consultations, surgical treatment,
Intensive care, In-patient Services, Endoscopy Suite, Physiotherapy, Health checks, Round
the clock Laboratory, Round the clock Pharmacy and cafeteria.

CURRAE Eye Care Hospital

Situated in Madhyamgram, Kolkata CURRAE Eye Care Hospital offers a variety of

treatments by making use of the latest scientific advancements and medical technologies
from the world of Ophthalmology to take care of health conditions that affect vision. From
consultations to check-ups to surgeries, CURRAE Eye Care has it all. Making it truly the
future of Eye Care! The broad categories of our specialties at CURRAE Eye Care Hospitals
are - General Eye Care, Women Eye Care, Paediatric Eye Care, Diabetic Eye Care, Eye
Check-ups, cataract treatments, retinal treatments, Other services offered include
Glaucoma Correction, Cornea Surgeries, Pediatric Ophthalmology, Occuloplasty & Facial
Aesthetics, Neuro Ophthamology, Low vision Aids.

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CURRAE Gynaec | IVF | Birthing Hospital

Located in Thane, CURRAE Gynaec | IVF | Birthing Hospitals is where you get introduced
to a whole new world which offers a comprehensive consultancy and treatment services
related to woman's health, fertility treatment and birthing in hassle-free and joyful
environment. Bouquet of services include - Consultation with specialist Counseling cell ,
Diet & nutrition consultation , Birth preparation classes, Required diagnostics with latest
technology High risk pregnancy management for fertility problems from required
screening of couple to treatment like IVF, IUI etc.

PRINCIPLES AND THE P FACTORS:

We at Currae Hospitals are always committed towards following our vision and abiding by
four principles that form the pillars of our work ethics

• Take Ownership of giving the patients a convenient, personal and proactive care
during entire patient cycle.
• Provide an efficient medical support system for patients which will receive the
visiting doctors of stress.
• Propagate transparency for the doctors and patients in terms of billing and
consumables.
• To take conscious measures to leave a distinct impression in people’s daily lives
which is hard for them to forgo

The P Factor:

• Proactive: To anticipate the action of other person and act before he or she asks for
it.
• Pre Approach: It is being prepared with the necessary and relevant information
required to execute a task.
• Pleasant Atmosphere: A Pleasant atmosphere and environment plays a major role
in altering the course of recovery and wellness of patients.
• Profiling Customer: It is about knowing the likes and dislikes of the customers or
studying the behavioral pattern of the customer and accordingly interact with them.

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Project 1

Understanding
And
Improving
In-patient discharge process
At
Currae Specialty Hospital

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OVERVIEW
The discharge process for an Inpatient is the process during which the patient is allowed to
leave the hospital after he has achieved a stable medical condition after the treatment. The
process begins when the treating physician observes the patient and declare him fit for
discharge. The process involves completing all patient related documentation, providing
post discharge medication, bill preparation and clearance and cashless claim settlement if
applicable.

In order to complete the project, the principle of business process reengineering were
applied.

In the first step, the need of the process and the expectations of the patients were
understood. The discharge process must be smooth and speedy. Quicker discharge would
free up the beds for next patients and help in increasing utilization. As far as the patient is
concerned, he is interested in leaving the hospital as soon as possible after the discharge is
announced by the treating the doctor. Secondly, a target time for discharge process was
defined. In case of cash patient it was 2 hours, whereas for cashless patient it was defined
at 5 hours.

In the second step, the existing process was understood. The complete process was
observed from start to end and the time was recorded. The data was collected for total 50
patients. The disconnects into the process were found out which were leading to delay in
information transfer.

In the next step, an alternative to the current situation was considered. The benchmarking
for the process was studied by gathering information from other hospital. Jupiter hospital,
which is a 296 bed hospital in thane, handles around 30 discharges a day. They have a
discharge time of 1 hour for cash patients, whereas 5 hours for cashless claims patient.
Their TPA department has a staff of 7 employees which includes 4 medical personals. The
possible area for improvements were identified and the best possible methods were
identified. The certain process of the reengineered process were implemented wherever
possible.

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DISCHARGR PROCESS FLOW

Discharge Discharege
Medicine
Intimation by Summary
Indent/Return
Doctor Creation by RMO

Bill preparation
Pharmacy Charge sheet
and check by
Clearance completion
CRO

Mailing
Final Bill
documents to TPA Approval
clearance
TPA/Insurer

Discharge Gifting by Angles

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PROCESS DESCRIPTION

 Doctor’s Intimation
The consultant Doctor who treats and operates on the patients declares discharge if he
is satisfied with the progress of the patient’s health. The declaration is done when the
Doctor is on his rounds. The Doctor mentions about the discharge to the patient, the
nursing staff and the resident medical officer (RMO).

 Discharge Summary Creation

The discharge summary is a document which contains all the patient details, diagnosis
history, treatment, operation, medication and other details. It gives a brief description
of the treatment provided to the patient.

 Medicine Indent / Return

The nursing staff is supposed to check all the medicines which were provided to the
patient during his stay in hospital. If any medicines were not consumed, they are
supposed to be returned. The nursing staff must also procure the post discharge
medicine as suggested by the doctor. This process is to be completed using the HIS.

 Charge sheet completion

The nursing staff is supposed to complete the patient charge sheet. The charge sheet
mentions all the bedside procedures performed, the visits by doctors and all the medical
and radiology test performed.

 Pharmacy clearance
After the nursing staff has completed their work, the pharmacy department is supposed
to provide medicines as requested if available to the nursing staff. They are supposed
to enter details of medicines given to a patient.

 Bill preparation and checking

The Customer Relationship officer (CRO) or the receptionist checks the charge sheet
and enters the charges into the HIS which appear in the patient bill. The CRO is
supposed to co-ordinate with pharmacy department for the pharmacy clearance.
 Mailing documents to TPA/Insurer

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If the patient is availing cashless benefit, the discharge summary and bill is sent to the
TPA department. The TPA department is supposed to send the same to the Insurer for
approval and respond to any query raised by the insurer.

 TPA Approval
The TPA/Insurer would approve part or full bill amount based on patient’s policy. Once
the approval is received, the amount is updated in HIS and the same is conveyed to the
CRO.

 Final Bill clearance

After the TPA approval for cashless patient, the CRO is supposed to make final bill.
The bill amount is collected from the patient. In case of cashless patient, the balance
amount if any is collected. The CRO is supposed to give receipt to the patient and close
the final bill.

 Gifting by Angels
Every patient admitted to hospital is provided a gift by the Angels or the patient welfare
team. They are also supposed to see off the patient till the exit and help them in any
way if required.

TIME ANALYSIS
In order to find the time consumed by each step in the process and identify bottlenecks, a
timing analysis was done. Data was collected by manual observation of process and with
the help of the HIS. As the hospital did not have a pre-defined time tracking mechanism.
The whole process was first studied and then a method was devised to track data. Data for
30 patients was collected using the method. The doctor’s intimation time was collected
from the patient record where the doctors write all details related to a patient while on
round. The discharge summary creation time was noted when it would be send to the TPA
department. The medicine indent/return timing was collected from the Pharmacy
department. The time required for charge sheet creation was collected when the charge
sheet was received by the CRO. The pharmacy clearance time was noted by asking the
CRO, whereas the bill preparation time was obtained from the time at which the bill was
printed which is mentioned at the bottom of the bill. The time required for TPA proposal
was obtained from the time at which the mail was sent by TPA department whereas the
TPA approval time was obtained from the approval received time from mail inbox. The
final clearance time was again obtained from the bill. Whereas the gifting and final
discharge time was obtained from the Angles.

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Based on the data collected, the mean and median of time required for each step is as
follows:

Process Cashless Cash

Mean Median Mean Median
Discharge 03:22 02:35 02:08 01:07
Summary
Preparation
Charge 03:25 01:41 02:22 01:21
sheet/Indent
Preparation
Pharmacy 01:11 00:57 01:24 00:30
Clearance &
Bill preparation

TPA Proposal 01:25 00:46 - -

Making
TPA Approval 05:55 03:24 - -

Final Clearance 00:36 00:25 01:21 00:45

Total 10:06 09:30 05:10 04:07

It can be observed from the data that the discharge summary creation is the bottle neck in
both the cash and cashless patient discharge process. TPA approval is done by the third
party administrator or the insurance company hence it is an outlier and beyond the control
of the hospital.

It is observed that mean time for Cashless patient is about 12 hours, whereas ideally it
should be 6 or maximum 8 hours. On the other hand the discharge time for cash patient is
4 hours but ideally it should be about 2 hours.

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OBSERVATIONS
In order to completely understand the process and its shortcomings, each step in the process
was observed and analyzed to understand errors and delays.

 Discharge summary creation

Discharge summary creation is carried out in using software like MS Word. It is created
by the resident medical officer. As it is not done through HIS, all patient details have
to be manually typed which increases the time required. The RMO has to find out
details regarding the patient from file containing about 50 pages. The RMO are also
not trained to type at faster rate.
The RMO also face problems if there are no clear post discharge instructions from the
consultant Doctor. In such case the RMO has to contact the doctor and then complete
the details. In case the doctor is busy then the process gets stalled.
There is also a problem regarding understanding the handwriting on the patient records.
As the records are updated by the doctors and nursing staff who are in hurry to complete
the writing work, it is highly unclear and creates problem for the reader.
In addition to this work, the RMO is supposed to attend to other patients, give
instructions to nursing staff and attend to any emergency situation in the ICU and
emergency center. The discharge summary is handed to the housekeeping staff who
take it to the concerned department. If the housekeeping staff is busy elsewhere it can
increase the delay.

 Medicine Indent/Return and Charge sheet completion

The nursing staff carries out the process of medicine indent/return and charge sheet
completion. The staff uses the HIS to request medicine for the patient and also return
the same. As the nursing staff is not efficient in handling computers, more time is
required to complete the process. The staff sometimes has to face the problem due to
unavailability of medicine in the pharmacy. In some cases if the discharge is postponed
or the doctors thinks so, there is a change in medication and the process has to be carried
out again.
While creating charge sheet, sometimes there can be a problem regarding unavailability
of some procedure charges in the HIS. In such case they have to consult the IT
department and get the charges entered in the HIS.

 Bill preparation
In this process the CRO has to complete and check the bill. Many times it happens that
other departments have not applied their charges and their work is incomplete. For

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example the OT department is supposed to enter the OT posting charges for each
patient. If the work is incomplete, the bill completion is delayed. In the same way if
there is delay in pharmacy clearance and clearance from other departments, bill
preparation takes more time. Sometimes there is a communication gap between the
concerned departments. Even if the charges have been entered but if it is not
communicated further, there is a delay.
In case of a cashless claims, many insurance companies have a decided fixed sum of
amount to be passed for a particular surgery, which is called a package and includes a
fixed amount for bed charges, procedure cost, medication cost, doctor visit charges and
lab and radiology charges. In such case it is necessary to mention the package on the
bill instead of individual charges. Many times the package for the particular surgery is
not created in the system and the process gets delayed. Also after the inclusion of
package in a bill, the CRO must manually delete the other charges which are the part
of the package. If the CRO is not well trained, same charges gets applied in the bill
twice, which increases the bill amount.

 Pharmacy Clearance
After the medicine return/indent is filled by the nursing staff, the pharmacy department
have to accept it, sometimes there is delay if the concerned person is busy in other
work. If the requested medicine or brand is not available, they have to forward the
problem to the nursing staff who in turn must co-ordinate with the doctor to address
the issue. The pharmacy department has the right to suggest a different medicine with
same content if a particular brand is not available. But it is observed that they always
get it confirmed from the concerned doctor which increases the delay.

 TPA proposal making

The TPA department has to mail the patient bill and discharge summary to the
concerned Insurer/TPA in case of a cashless claim. In this process, the bill is printed
by the CRO, stamped, signed and then sent to TPA. The TPA then again scans the same
bill which was printed through HIS and along with the discharge summary, sends it to
insurer. The Printing and scanning consumes time as for each patient more than 8 pages
have to be scanned.
Sometime it is observed that the discharge summary is incomplete or some important
points are missing which are necessary for the approval of the claim, in that case the
summary has to be send back to the RMO. Hence it increases the total time.

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Service Blueprint for discharge process

RECOMMENDATIONS
 Discharge summary creation
In order to save time, the HIS must have a discharge summary creation module, which
would automatically enter all the patient details which are already into the HIS and
save time. It should also include the medication and procedure details. The RMO would
then have to enter few basic details and post discharge medication and follow up details
only.
Until this new module is created, a template can be created in the HIS which would
have the basic structure of the discharge summary and save time required for manually
entering the headings.
Since all the surgeries undertaken at this hospital are planned, the doctor know the
tentative discharge day and he can intimate the same to the RMO who can prepare
much of the summary well in advance. Also the RMO who is posted at night can daily
update the discharge summary of all the admitted patients as the work load at night is
comparatively lower.
In order to track the process more accurately, the discharge summary must have a time
stamp which would mention the time of printing and help in tracking the process more
accurately.

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 Medicine Indent/Return and Charge sheet completion

The nursing staff must be trained to handle the HIS efficiently to avoid delays. Also
the staff must escalate any issues occurred to the concerned department as soon as
possible to solve the problems on time.

 Bill preparation
In order to avoid errors in package and charges application, advance intimation must
be given to the concerned CRO before making bill. Also before the bill is finalized, it
must be checked once by the TPA or the operations manager for cashless patients. In
case of cash patients, an interim bill must always be provided to avoid last minute
scuffle over the bill. Also the system must develop a module to show pending works to
all the related departments through a discharge mode for timely completion of work.

 Pharmacy Clearance
During pharmacy clearance, it is often observed that the indent is not accepted in time.
In order to avoid such delay the HIS must have an alert facility, which would notify the
pharmacy department after the indent is filled by the nursing staff. Same is applicable
to the CRO and TPA department. Also the pharmacy department must complete the
clearance on a daily basis to avoid last minute rush. They must also suggest alternative
medicine of the same content when a particular brand is unavailable.

 TPA proposal making

The HIS must include digital signature and digital stamp to avoid the process of
printing and rescanning. The TPA department must get the discharge summary through
HIS itself rather than manually. The HIS must also give alert regarding completion of
the process by previous concerned department to save time wasted between manually
communication messages.

CONCLUSION
From the observations it is clear that a lot of time is wasted due to communication gap. As
the concerned employees have to look after other work, the work related to discharge falls
behind in priority over other work. In order to solve this issue completely, the HIS must
include a Discharge mode. Once a discharge has been declared for a patient, he or she must
be put on discharge mode, which would alert all the concerned departments. When a step
would be completed it should automatically alert the next department. This would eliminate
the communication gap to a large extent.

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Project 2

Studying
And
Improving
Cashless claims process flow
At
Currae Specialty Hospital

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CASHLESS CLAIMS PROCESS FLOW

Submission of
prerequisites Preauthorization Preauth
document to TPA request filing Query/Approval
department

Final Final authorization

Final Bill Closure Authorization request filing at
Query/Approval time of discharge

Preparation of Dispatch of patient Final Scrutiny by

Patient Docket Docket TPA/Insurer

Crosscheck with
database by Amount received Query/Final
Accounts against claim settlement
department

Final entry &

Closure
settlement

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PROCESS DESCRIPTION
 Submission of prerequisites document to TPA department
In this process, the cashless claim process is initiated by the TPA department. For the
approval of cashless claim, the hospital must send a copy of insurance policy, insurance
card, photo identity card, medical investigation reports and details of the procedure
suggested by the doctor along with a complete preauthorization request form.

 Preauthorization request filling

The preauthorization request form has to be filled by the hospital staff and signed by
the patient and the consulting doctor. The preauthorization form contains personal
details of the patient, policy details, medical procedure details and cost estimate of the
surgery.
The TPA department has to coordinate with the patient to get all their policy details
and documents. The patient is provided with the type of room which would fit in his or
her policy. The Insurance Company approves 1% of the total policy cover as the room
rent charges. It also makes deduction to other charges if the room rent could not be
covered fully. Hence the room is finalized after a discussion with the patient and an
estimate of the surgery is made in consultation with the doctor.
After this the preauthorization request is filled with the Insurer/TPA by email or online
portal.

 Pre authorization Query/Approval

If the insurer/TPA feels the need for additional information, they may raise a query by
email. The query has to be replied as soon as possible with required documents in order
to pass the preauthorization request.
After the query is sorted, the insurer/TPA approves the cashless claim request and
sanctions an initial amount.

 Final authorization request filling

At the time of discharge, the discharge summary and hospital bill is send to the
TPA/Insurer. The documents are mailed or send through online portal.

 Final Authorization Query/Approval

If the insurer feel the need for additional information, they may raise a query which is
to be replied as soon as possible.

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After the query is solved, the TPA or Insurer approves a final authorization amount for
the claim.

 Final Bill Closure

The amount sanctioned by the Insurer is entered into the HIS. The balance amount if
any is collected from the patient and the final bill is closed.

 Preparation of Patient Docket

After discharge, a docket containing all required documents which are to be send to the
TPA/Insurer are prepared. The patient docket contains the pre authorization form,
initial and final approval copy, final bill, discharge summary, original lab reports,
radiology reports, Operation notes etc. In addition to this the insurance copy, patient
ID card and insurance card are also send.

 Dispatching of Patient Docket

The documents have to be dispatched within 3 days of patient discharge according to
standard procedure. It is supposed to reach the Insurer within 7 days. If the patient has
undergone lab tests like Histopathology which takes 4 days for the reports, the
documents are dispatched after the reports are received.
The hospital receives an acknowledgement email after the documents are received by
the concerned TPA or Insurer.

 Final Scrutiny by Insurer

Once the documents are received by the Insurer or TPA, they undertake a final scrutiny
of the documents before final settlement of the claim. This process may sometime go
on for about 20 days or more after discharge.

 Query/Final settlement
If the insurer finds any problem in the claim, they may raise a query to provide
additional details. The query must be replied as soon as possible and the same document
must be dispatched within 2 days.
Once all the queries are resolved, the Insurer will sanction a final settlement amount by
deducting a discount of 20% according to the MOU with the hospital. They will also
deduct a 10% TDS. This final amount is then transferred to the hospital.

 Amount received against claim

Once the final settlement is done, the amount is transferred into the account of Patni
Healthcare Ltd.

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 Crosscheck with database by Accounts department

The accounts department crosschecks the amount received with the patient details. If
they are unable to resolve, the TPA department is contacted who then provides details
regarding final settlement to the Accounts department.

 Final entry & settlement

Once the accounts department sorts the amount received against a particular patient,
the final amount is tallied with the bill. If the complete amount is received the security
deposit is refunded to the patient.

 Closure
Once the patient collects his refund amount, the case is closed by the hospital.

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OBSERVATIONS

In order to completely understand the process and its shortcomings, each step in the process
was observed and analyzed to understand errors and delays.

 Submission of prerequisites document to TPA department

In this process, the TPA department has to collect all the pre requisites documents from
the concerned patient. It has to give an estimate to the TPA/Insurer about the surgery
cost. It also needs to send the diagnosis reports and the further treatment note from the
doctor.
Most of the time it is observed that a query is raised regarding diagnosis. TPA/Insurer
ask about the time from which patient started have particular problem in order to make
sure that it did not happen before the policy period.

 Final authorization request filling

It has been observed that during final authorization request filling, billing error takes
place frequently due to non-application or incorrect application of one liner packages.
In case of dealing with TPA, sometimes there is no instruction to the CRO regarding
application of package which result in application of higher charges. If the wrong bill
is sent to the TPA/Insurer, a query is raised by them which delays the approval process.

 Final Bill Closure

There is a delay in final bill closure due to non-availability of one liner packages in the
system. There is sometimes delay from IT department in creation of packages which
delays the bill closure.

 Preparation of Patient Docket

During preparation of patient docket, the process gets delayed often due to
unavailability of lab or radiology reports. Some lab reports takes up to 3 days for
completion. But in the meantime it is not clear on which exact day the reports will be
ready and there is communication gap regarding this which further delays the process.

 Final settlement by TPA/Insurer

It is often observed that a query is raised during final settlement after around 2 to 4
weeks after patient discharge. Since the patient has now been discharged, the query is

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not replied on a priority basis, which further delays the final settlement. Also as a query
database is not maintained, there is a high chance of forgetting to reply to the query
which may lead to cancellation of claims.

 Final Scrutiny by Insurer

It is often observed that the TPA/Insurer make further deductions to the amount
sanctioned during discharge and the reason for the deductions are mentioned only
during final settlement. Hence there is a loss of revenue for the hospital as the claim
has now been closed.

 Crosscheck with database by Accounts department

When the amount is received in the company’s account, the accounts department does
not know regarding which patient’s money has been deposited as many insurer does
not furnish that detail. Also sometimes the insurer deposit money in bulk which give
rise to the same problem.

 Final entry & settlement

As the accounts department is unaware about which patient’s claim has been settled,
they are unable to make final entry of money receipt from insurer against that patient.
This increases the waiting time for the patient to get his refund which lowers the
satisfaction level.

RECOMMENDATIONS AND CONCLUSION

In order to avoid multiple queries during pre-authorization process, there must be a through
scrutiny of documents submitted by the patients regarding diagnosis be done by the TPA
department. Also the TPA department must confirm in coordination whit the insurer
whether any one liner package is applicable and then make an estimate.

During final authorization, the TPA department must scrutinize the bill before sending to
avoid delays due to query. It must make sure that proper one liner package if applicable, is
applied to the bill. Also it must keep a copy of MOU handy to solve any problems due to
wrongful deduction done by TPA which can occur sometimes.

The TPA must regularly update the IT department with information regarding new
packages from various insurers and take a follow up of the package creation activity. Also
if a patient with a new package requirement is admitted, they must follow up with the IT
department right from the admission of the patient, to avoid last minute package creation
delay.

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Summer Internship Project Report

There must be a frequent follow up with various labs for getting patient reports on time.
They must be requested to complete the reports of TPA patients on priority for early
dispatch of documents.

The TPA department must maintain a Kanban card like method to track the progress of a
claim from initial approval to final settlement. It would have various sections depicting the
status of the claim like pre-authorization request, approval, discharge, dispatch of docket,
query raised and final settlement. It would help in knowing the status of each claim
instantly. Also it would not lead to delay in replying to queries as the status of such claims
would always be known and prompt action would be taken by the concerned person.

It has been observed that the TPA department maintains a database of patient only up to
the final approval obtained during discharge. No database is mentioned regarding final
settlement. Only when accounts department demands, then only the final settlement receipt
is searched in the files. Hence it is necessary to maintain and update such a database. It
would also help in speedy refund of security deposit to the patient.

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Project 3

Studying
And
Calculating
Turn Around Time
(TAT)
For
OPD patients

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PROCESS
The Out Patient Department (OPD) handles the patient who come for pre and post-surgery
consultation. An appointment is given to such patients according to their and Doctor’s
convenience. During this process the patients meets the Doctor who usually advises the
patient to carry out certain tests to diagnose the illness. After a particular illness is
diagnosed, the Doctor suggest a line of treatment and the patient is admitted according to
his convenience. In the same way after discharge, a patient is supposed to visit the Doctor
for post-surgery consultation. This complete process is handled by the OPD department in
consultation with the Doctor and the CROs.

PROCESS FLOW
Whenever the patient enters the hospital, he first visits the reception desk and meets the
concerned CRO. The CRO has an appointment sheet which has details of all the patients
who have appointments on that day and their timings. The CRO is then supposed to contact
the concerned Doctor. If the Doctor is free, the patient is sent in the consulting room. After
the patient has meet the doctor and done some tests as prescribed by the Doctor, he is asked
to pay the bill while leaving the hospital.

TIME ANALYSIS
In order to capture turnaround time, the process was observed. Time was noted for each
patient while meeting the CRO. The time at which the patient enters the consultation room
to meet the Doctor was captured from the OPD register which is maintained at the nursing
station. The checkout time for the patient was noted down from the bill.

The sample size of the data is 30. After analysis of the data, following results were
obtained.

Mean

Waiting time 00:31

Total time 00:58

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OBSERVATIONS AND CONCLUSION

It was observed that most of the delay happened because of late arrival of Doctor. Doctors
arrived late because of any previous commitments or because of being on IPD round. Also
there were delays because of consultation process getting extended for a particular patient
and hence the next patient had to wait for a longer time. Sometimes delay also takes place
due to late arrival of patient.

In order to avoid delays, the doctors must decide a standard appointment time which they
would take for every patient at different levels of treatment. Usually first consultation is
longer as compared to post discharge follow up. Hence while scheduling appointments the
CROs would be able to properly schedule the appointments according to the standard time
suggested by the doctors.

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References
 Currae Specialty Hospital, a Patni Enterprise http://www.currae.com/specialty/

 A time motion study in the OPD clinic of a rural hospital of West Bengal, IOSR
Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-
ISSN: 2279-0861.Volume 13, Issue 7 Ver. II (July. 2014), PP 34-37

 A time-motion study of opd services at a state level ayurvedic hospital to reduce

the opd congestion, Research Article International Ayurvedic Medical Journal
ISSN:2320 5091

 Bhargo L, Mishra A, Agarwal AK. Time-motion study to know: Efficiency and

effectiveness of clinical care is essential to hospital function?. Indian J Community
Med 2014;39:254-5

 Chattopadhyay A, Ghosh R, Maji S, Ray TG, Lahiri SK. A time motion study in
the immunization clinic of a tertiary care hospital of Kolkata, West Bengal. Indian
J Community Med 2012;37:30

 Re-engineering the Hospital Discharge: An Example of a Multifaceted Process

Evaluation David Anthony, VK Chetty, Anand Kartha, Kathleen McKenna, Maria
Rizzo DePaoli, Brian Jack

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