There are any number of indicators along the revenue cycle that warrant monitoring, she says, but as the technology has grown more sophisticated, executives in other areas of the hospital are using information scorecards to good measure. Following are snapshots of how several organizations are using dashboards.
Tracking Census Indicators
One year ago, Hartford (Conn.) Hospital put in dashboard technology from CareFx. Systems that feed it include the hospital's EHR, from Allscripts, and its financial system, from Siemens. "We had a shortage of real-time data in useable form," recalls Michael Lindberg, M.D., chairman of the department of medicine at the 700-bed teaching hospital.
Lindberg uses the dashboard to track data in three key areas.
The first is patient data, including a tabulation of patient length-of-stay and the percentage of early morning discharges. Another shows bed availability, the type of beds open, and the percentage of beds not available for patients, such as those being cleaned, or those in a room with an accompanying patient in isolation. A third scoreboard gives the readmission rate for patients brought back into the hospital less than 30 days since their last discharge.
Lindberg breaks down the data by individual groups of physicians. He creates a report each quarter for the hospitalists, which shows their average length-of-stay and readmission rates.
"We can take the high performers, see what looks to be effective for them, and model their behavior for others," he says. "Nursing managers also get the same information. They can see how their unit is performing compared to others. It sets up healthy competition."
The dashboard data helps Lindberg fulfill Joint Commission requirements for ongoing physician evaluations. He can identify trends and run comparisons over a several month period.
"We need to have a handle on what physicians are doing," he says. "Having a database to drill down to the individual physician goes a long way toward satisfying those requirements."
Purely financial data is not yet available on the CareFx dashboard. But Lindberg is lobbying to add such indicators as cost per hospitalization broken by physician and department. "We could show who might be an outlier for test ordering," he says.
Increasing Upfront Collections
Health First, a four-hospital delivery system based in Rockledge, Fla., uses an information dashboard, from McKesson, that aggregates data from multiple sources, including clinical, financial and administrative systems. For Michelle Fox, director of revenue operations and patient access, the dashboard has helped monitor registration activity and upfront collections from patients for co-pays and deductibles. The work occurs at the very front end of the revenue cycle, but the efficiencies show up on the bottom line.
One routine task Fox undertakes with the scorecard is a registration audit, which monitors the performance and productivity of more than 100 staff handling patient registration duties.
The scorecard shows-by registrar-a number of data sets, including the number of accounts worked and the average collections per registration.
The dashboard also weights registration activity, giving staff more credit for complete registrations that require assembling all information, as opposed to rolling over a file already started, Fox says. The dashboard pulls in data from Health First's scheduling system, from SCI, which handles pre-registration activities and does eligibility verification as well.
Fox underscores to the registrars the importance of collecting as much as possible from patients before service is rendered. "It sounds easy, but patients say they would rather be billed," Fox says. Delaying collections boosts the odds the bill may wind up as bad debt. "Health care is the last bill people want to pay," Fox says. Fox distributes a daily report to her staff showing what registrars have collected. "It creates competition," she says.
The strategy has worked for her. From fiscal 2009 to 2010, Health First boosted its point-of-service collections by 22 percent, or about $1.1 million. And from 2007 to 2008, collections jumped $2.2 million.
Monitoring Payer Delays
One of the challenges of monitoring the revenue cycle is the multitude of different payers typically in play. Legacy Health, a Portland, Ore.-based delivery system with five hospitals, works with more than 600 payers, says Terrie Handy, director of revenue cycle. It uses an enterprise dashboard, built by Huron Consulting, to help keep tabs on Legacy's primary payers. The dashboard, which draws data from the hospital's billing system, from Epic, shows the cash flow for 24 key payers, including Medicare, Medicaid, and larger commercial contracts. "It gives weekly, daily and monthly tallies for what dollars are flowing in," she says. In addition, the dashboard gives a projected figure for what the cash flow should be, so if there is a major discrepancy, Handy can investigate.
In one instance, the dashboard revealed a drop in payments from a Blues plan, which Handy raised during her monthly meeting with the payer. Turns out the payer had internal staffing issues, which was causing some claims processing delays. In another case, Handy learned that the local Medicaid payer had gone through a claims administration system conversion, and payments were delayed. But being able to present payers with objective data speeds delayed payments, she says. "Payers will dedicate their resources to processing the claims from the squeaky wheel providers," she says.
In addition, Legacy uses dashboards-part of the Epic system-to monitor both professional and hospital billing metrics. These dashboards show similar financial metrics, including A/R days, total charges, payments and adjustments. Legacy is working with Epic to improve the system's denial management reporting capabilities, including the ability to analyze denials by service line, adds Mary Kjemperud, vice president, revenue cycle.
