Making an Impact on TNC DNR Establishment Billing

The LCHD Environmental Health Specialist began the QI project by assembling a QI team. The QI team consisted of health department nursing staff, clerical staff, and environmental health staff. Once the team was assembled, the AIM statement was discussed, the purpose of the project was reviewed and the timeline for the project was established. The team then used the fishbone diagram and brainstorming to discover reasons that the fee was being paid late by many establishments. Through this process it was identified that: bills were going out later than desired by staff, the fee was nominal and establishment may not deem as necessary, staff is very busy during that time of year to track billing, and there is no penalty for not paying the fee. In turn these contributing factors caused revenue lost to the Health Department Agent Status program and impacted the fiscal sustainability of the program. During the QI process it was determined that each TNC establishment would be billed 2 times for the service. The bills would be spaced 30 days apart. A late fee of $30.00 would be implemented for establishments that did not pay their bill after the second bill. This change was approved by the Board of Health, added to policy and fee schedule. A notice also went out to all TNC establishments notifying them of the change. During the process it was decided that environmental health staff versus clerical staff would bill once per month at the same time every month for TNC establishments. This would help ensure that all bills were going out in a timely fashion. A database was created to track dates of first bills, second bills, late fees and when bills were paid. This process made the communication between the program assistant who was receiving the payments and environmental health staff who were billing establishments consistent. The program assistant would track payments and enter all payments into the database in real time. The database was much more effective in tracking all the data needed than previous methods used. The 2017 billing year was considered a pilot year to track whether or not the above-mentioned changes that were implemented changed the outcome of bills being paid on time.

Primary source for measuring the impact of this project was through an internal Excel spreadsheet used to measure status of billing.