Using Data Analytics for Better Financial Outcomes
MetroHealth has also implemented an analytics tool designed to capture missing professional charges. When a physician generates a completed note for a hospital patient, the system automatically checks to be sure there are corresponding charges included in the file. If not, the completed note is flagged for further scrutiny.
"It allows us to investigate why there are no corresponding charges when there is a completed note. It lets us take proactive measures to identify the proper charges," Richmond says.
Through the use of this tool, MetroHealth saw a 5.2% increase in its inpatient professional charges per patient day between 2010 and 2012, he adds.
Estimating patient payments
Four months ago, MetroHealth began using data analytics to determine its patients' liability before performing a procedure.
"We purchased a third-party solution that allows us to estimate the patient's out-of-pocket responsibility," Richmond says. "As individuals are now having a higher cost-sharing portion, it is all about having an informed consumer. We all like to have an idea of what something is going to cost, and understanding the benefits that go along with the insurance you have can be very complex."
The tool uses an algorithm to generate the estimate based on MetroHealth's contracts with payers, its charge description master price for the procedure, the patient's insurance eligibility, and the anticipated service that is to be performed.
Armed with this information, MetroHealth calls patients who are scheduled for an appointment for which there will be a substantial out-of-pocket responsibility to inform them and to offer an opportunity to prepay.
"We have seen some success in securing payments from patients in advance of a procedure," Richmond says, noting that MetroHealth is now collecting about 15% of patient amounts prior to service. "It's a small amount, but it is still a success."
Balancing staff and patient volumes
Because workforce management is the largest cost center for healthcare providers, it's another key area where organizations can reap financial benefits from the use of data analytics.
HMA targeted its emergency department when it began looking for staffing efficiencies, Waller says.
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