I enter any reporting assignment that hits on health care finance with a certain amount of trepidation. The revenue cycle in this industry defies description. There are dozens of steps from the time service is rendered to the day—often weeks later—when the reimbursement check hits the provider’s bank account. Merely understanding Medicare and other health plan payment rules can chew up vast resources before a claim even leaves the building. Then once it does, there are the ever present intermediaries—the claims clearinghouses. And getting payers to talk about what happens to claims once they hit their front door is not easy. Rare indeed is the source who can lay claim to understanding the entire revenue cycle process (where no two paths seem to be the same).
But I do know this much: health care organizations are facing financial challenges unlike any they have seen before. It’s in part fueled by the recession and the rise in uninsured. For many, more people are showing up for services with little or no ability to pay. The tightening financial picture begs for easy-to-use tools for administrators to understand how their departments are faring in the grand scheme of things. These managers may not see the entire revenue cycle, but they do understand their role in it.
Continuum Health Partners, a four-hospital delivery system centered in New York, is working on such a tool. I spoke recently with Jill Embler, the assistant vice president of financial planning at Continuum, as part of my reporting for a forthcoming feature article on business intelligence. Jill patiently walked me through the variety of reports—80 or so total—her department churns out. The health system depends on a financial information system that is laden with data. The financial information is extremely useful, but the financial information system is extremely opaque—writing queries to the mainframe system is difficult. “You need to know some programming; it’s ugly,” she said.
Jill’s department has been charged with pulling information from the system, then providing reports to various administrators. Last year, Continuum turned to a vendor partner, Dimensional Insight, to create a BI overlay to make it easier to access the data. The dashboard has already streamlined operations, freeing up time for Jill and her crew to analyze data, not merely produce reports. “We do some analytics now,” she said. “But we don’t have time to see actual trends or do deep-dive analysis. Understanding what the data means is where we want to focus.”
The BI dashboard will be a self-service tool, one enabling department heads to track their own financial metrics without relying on others to produce and disseminate the reports. And intricate reports these are—LOS by payer, LOS by DRG, LOS by physician, profitability, and others. Building these dashboards is not a simple task—reporting my story, I encountered many a hospital which is outsourcing the effort.
But one common theme emerges—without some data analytics tool in place, without an easy way to consolidate information from a number of different databases, providers will be hard-pressed to sustain their organizations. “If you don’t have a BI tool, you won’t be able to keep up,” Jill said. “There is so much pressure to decrease cost and uphold quality. The challenge is to get that information out there to make a difference. We would need an army of people to produce reports at the pace people request them.”
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