Payment reform based on knowledge gleaned from business intelligence and data analytics tools in hospitals and health systems is no longer optional. It's imperative. If you're not up to the task, start lobbying for additional resources now.
Healthcare finance executives are like the knife thrower's assistant who stands rigid while gleaming blades flicker past her head one after the other: declining Medicare reimbursements—phhhffft—falling inpatient volumes—phhhffft—rising expenses—phhhffft.
Each glinting blade threatens to draw blood. Or worse.
The shift from fee-for-service to a value-based payment structure is not only a potential implement of evisceration hurtling toward hospital finance and operations executives, it also means more work for healthcare IT execs.
That's because financial leaders "are trying to set up their organizations to move toward value-based purchasing and shared-risk arrangements… by using business intelligence tools and data analytics to be able to operate in that changing environment," says Healthcare Financial Management Association President Joe Fifer. He spoke with HealthLeaders in advance of the annual HFMA ANI conference in Las Vegas this week.
"93% of struggling hospitals with continuing negative operating margins confirm they have prioritized capital investments in over the next twelve months in coding, value-based support software, collections, and [revenue cycle management] outsourcing." — Black Book Rankings
But like strongmen straining under a stack of barbells, HIT execs are already struggling to stay on their feet as the weight of MU attestation, EHR implementation and ICD-10 implementation bears down on their quivering legs, backs, and arms.
CFOs realize that there is payment reform-related work that can't wait, and the good ones know that if their IT departments can't get the job done, the next best solution is to outsource it to a group that can.
Outsourcing brings its own headaches, as anyone who has ever paid the neighbor's kid to clear a snowy sidewalk knows. Your idea of "clear" and "sidewalk" and Skippy's may vary significantly.
But the decision to outsource an HIT project shouldn't come with any stigma.
IT leaders should embrace the help, headaches and all. In fact, CIOs and CTOs should lobby for outsourcing. Then they can ensure that the right partnerships are formed. [Vetting vendors and consultants carefully to weed out the Skippys of the world.]
In high-functioning organizations CIOs and CFOs work together to solve problems such as how to improve collections, reduce bad debt, and identify claims denials. Business intelligence and data analytics solutions, such as billing and revenue system implementations and upgrades are too important to be handled as just routine IT projects.
This is true regardless of an organization's size. Take physicians groups. If joining an accountable care organization is leadership's chosen path to fiscal health, then that means investing in an EHR system. The upfront costs can be daunting, even when eventual cost savings generated by the ACO are factored in.
Enter Farzad Mostashari. You'll recall his well-timed departure as National Coordinator for Health IT at the Department of Health and Human Services in 2013. Last week he announced the launch of Aledade, which offers primary care physicians services and technology needed to establish an ACO "with no upfront costs."
One of the company's goals is to "put primary care back in control of health care, with 21st century data analytics and technology tools," says Mostashari on the company's website. Specifically, Aledade offers:
- To assist with EHR optimization and workflow design
- To provide integrated data and technology platform
- Quality reporting (Meaningful Use, PQRS and ACO)
- Provider and practice performance benchmarking
Payment reform can't happen without IT, not even at the ACO level.
Whether you're in charge of a large health system's complex data analytics implementation solution or a relatively straightforward EHR system for a small physician's group, the task may feel monumentally challenging. It all depends on your budget, depth of staff, priorities, and deadlines.
If you're challenged, make the case for additional resources. The financial life of your organization—and the health of your own tender neck—may depend on it.