By The TSquare Team on December 4, 2018 at 11:10 AM
A clinic’s revenue cycle can make or break the practice because it directly impacts the profitability of the clinic. “Central to any revenue integrity program should be the practice of perpetually re-evaluating and re-validating the fundamental principles behind every process and every system,” Erika Regulsky of Billing Paradise writes.
This means breaking down the revenue cycle into its fundamental parts to identify missed revenue opportunities and rebuild more efficient processes.
This is where business intelligence — so useful in the corporate world at creating efficiencies and identifying revenue opportunities — comes in.
Revenue Cycle Management and the Role BI Plays
Efficient management of your revenue cycle is central to your clinic’s profitability and your patient outcomes.
That said, a recent survey from Fibroblast found that nearly a quarter of healthcare executives don’t know how much revenue they are missing out on due to patient leakage. A tighter revenue cycle could solve this problem by ensuring referrals stay within the health system.
“To survive, today’s healthcare organizations must navigate both the fee-for-service and the value-based world,” the survey report says. “That means they need to grow revenues while demonstrating better value to payers and taking on more risk.”
Business intelligence is not just for Fortune 500 tech companies. Applied correctly, business intelligence tools can dramatically improve a clinic’s ability to manage its revenue cycles.
Specifically, business intelligence tools can break down the silos between a clinic’s departments. “When the billing department cannot effectively communicate with physicians, for example, it can take a long time to correct coding errors, which involves yet another department,” says a report from Tangible Solutions. “Integrated technology supports transparency and makes it easier for everyone to work effectively.”
This is one way that real data-driven intelligence can shore up revenue for medical clinics of nearly any size. In fact, strategic consulting firm Global Market Insights reports more and more clinics are recognizing the opportunities that BI creates for their bottom lines.
Below are three such examples.
1. Oklahoma State University Medical Center
One of the major challenges in revenue cycle management is the collections stage, or actually receiving payment from patients.
Oklahoma State University Medical Center has been able to leverage data intelligence to bring patient and payor collections to the next level. With the use of business intelligence tools, OSUMC has improved both the accuracy of billing and the cash flow of collections.
“We are better able to identify patient and payor responsibility upfront,” says OSUMC business office manager Barbara Mapp. “... This is huge from a customer service, productivity and reimbursement perspective.”
The approach? OSUMC used a business intelligence suite to estimate patient bills and verify coverage eligibility, allowing the clinic to reorganize its entire bill scheduling process. Collections at OSUMC has seen a seven-fold improvement since.
“With margins growing tighter, monitoring your contracts and communicating clearly and frequently with payers can make all the difference,” Bobbi Brown writes at Health Catalyst. This is precisely the role data took at OSUMC.
“Information is power,” says Dr. Luciano Prevedello, division chief of medical informatics at Ohio State University’s Medical Center. “There is a natural maturity level that happens around the analytical process.”
This maturity includes things like better risk management, quality improvements and the ability to anticipate change. Data can also help improve the maturity of the clinic as a whole, according to Dr. Prevedello, which can help shift the delivery model from a fee-for-service model to one of true value-based care.
2. Hutchinson Clinic in Kansas
In another example of data at work in a clinical setting, Hutchinson Clinic took a more foundational approach to building better analytics for their practice. The Kansas-based multi-specialty health group recently partnered with an outsourced data solution to revamp its revenue cycle management approach.
“Hutchinson Clinic maintains a culture of excellence by delivering the most advanced, timely and compassionate care possible,” says Michael Heck, CEO of Hutchinson Clinic. Heck adds that the new data-focused partnership will “facilitate growth and business performance that allows us to focus on care delivery, while reducing costs.”
The goal of the outsourced revenue cycle management system is to automate many of the clinic’s administrative functions using health plans, EHRs and a customized practice management system. The end result should be to improve productivity for existing staff, reduce costs for the clinic and increase revenue across the board.
These outcomes are to be realized via machine learning to create repeatable and automated processes based on Hutchinson Clinic’s existing (but up until now disparate) data systems. The partnership is in line with a recent report from Ernst & Young. Authors Dan Schoenholz, Keyuri Shah and Andrew Adams write that, in order to succeed, “health care providers will need to leverage modern, more integrated technologies, establish new partnerships and develop innovative solutions.”
This is that partnership at work.
3. UC San Diego Health System
Finally, Chris Nerney at Healthcare IT News reports how the UC San Diego Health System is improving revenue system performance with better data governance and integrity. The system assesses what is being collected on the front end, ensuring that the most important data is collected using information governance.
What does this mean in practice? “Incorrectly mapped fields not only can lead to gaps in care because providers are missing patient information, they can cost providers financially,” writes Nerney. “For example, if administrative staffers fail to map fields that define and consistently identify when a patient is scheduled to be readmitted, the hospital could face a readmission penalty.”
Cassi Birnbaum, director of health information management and revenue integrity at UC San Diego Health, says the main value of the data governance approach is that it avoids unwanted EHR gaps. Her system’s revenue cycle management processes work to integrate the most critical information for providers, which both improves patient care and maintains documentation integrity for payers and providers.
Connecting the Dots: Data and Revenue Cycle Management
At the heart of these revenue cycle upgrades is the data, which BI is built upon. With the right analytical tools in place, a business intelligence approach can drive your bottom-line profitability and improve the health of your practice.