Business Intelligence

Truven Health Analytics prides itself on, well, analyzing data. So when it came to picking this year’s top 15 hospitals, Truven analysts turned to crunching numbers. The winning health systems are those who showed higher survival rates and fewer errors at a lower overall treatment cost than any of the other health systems across the country. Overall mortality rates were 14.7 percent lower than non-winning peer group hospitals Complication rates were 15.1 percent lower ED wait times were 12.3 percent lower. The 15 health systems also lowered cost per episode by 5 percent, discharged patients from the hospital a half-day sooner than non-winners. Moreover, they showed y percent higher Patient Satisfaction Scores compared with the non-winning hospitals. The 2016 edition of 15 Top Health Systems evaluated 338 health systems and 2,912 member hospitals to identify the systems with the highest overall achievement on a balanced scorecard. Here are the winners: Large Health Systems (operating expense of more than $1.75 billion) Mayo Foundation – Rochester, Minn. Mercy – Chesterfield, Missouri Spectrum Health – Grand Rapids, Michigan Sutter Health – Sacramento, California Sutter Health Valley Division – Sacramento, California Medium Health Systems (operating expense between $750 million and $1.75 billion) Kettering Health Network – Dayton, Ohio Scripps Health – San Diego, California St. Luke's Health System – Boise, Idaho St. Vincent Health – Indianapolis TriHealth – Cincinnati, Ohio Small Health Systems (operating expense of less than $750 million) Asante – Medford, Oregon Lovelace Health System – Albuquerque, New Mexico MidMichigan Health – Midland, Michigan

With Google, IBM and Microsoft all setting sights squarely on healthcare, and analysts predicting 30 percent of providers will run cognitive analytics on patient data by 2018, the risk of investing too late may outweigh the risk of doing so too soon.

Revenue cycle management has gone from being a "back office" function to an "end-to-end" system that begins at patient intake or even before, claims specialists say. Advanced technologies, in tandem with improved workflows and better data have resulted in RCM systems that encompass the entire healthcare enterprise. With the right automation tools and revenue cycle support, experts say healthcare providers should be able to improve their cash flows by collecting patient payments up front, determining precise eligibilities and filing clean claims to payers. With the fee-for-service business model changing to prospective payment and value-based care, healthcare organizations are undergoing a cultural shift that dramatically alters their approaches to patient intake, eligibility verification and claims processing. These are issues that providers will have to understand and adjust to accordingly, says Jose' Rivera, vice president of physician solutions development at Santa Rosa, Calif.-based Visiquate. "Fee-for-service is going away and bundled payments will come to fruition," he said. "We will see a resurgence of capitation because it puts the risk back on the provider. Organizations were able to overcome ICD-10, but as the model moves toward quality I think we'll see another resurgence of value proposition payer mixes." As a result, Rivera believes it will be a lot more difficult to get paid. Meeting the challenge means physicians must become educated on tracking quality metrics and reporting them to payers, he says. "This is a formidable task because different payers with different contracts all want slightly different quality metrics," Rivera said. "It's a big question mark in the back of my mind." Emphasizing intake RCM specialists agree that patient intake is a critical part of the revenue cycle process and that if they aren't emphasizing it, they need to do so immediately. Collecting patient deductibles, co-payments and eligibility authorizations is paramount for boosting the organization's cash flow as well as for ensuring clean claims, Rivera said. "That is the front line – they need to capture that information correctly and guide it to the right places," he said. "When it comes to authorizations, we are still in a prehistoric environment where a payer has to be called on the phone and it's a half-hour wait to get the authorization. This process definitely needs to be upgraded." Patient registration is undergoing dramatic change, with intake clerks "being asked to do more and more," says Colleen Wood, vice president for the Eastern U.S. at Jacksonville, Fla.-based Availity. RCM technology at the point of intake should be leveraging technology for patient data capture as well as having credit and debit card readers for upfront payments, she said. And while some providers – especially physicians – have been reluctant to ask for payment upfront, collecting deductibles and co-payments at intake fosters cash flow while informing patients of their obligations. "As patients, they should want to know how much it will cost," she said. "This is an opportunity for them to ask about costs and manage their dollars, which they couldn't do previously." Receiving deductibles and co-payments not only improves cash flow, it also creates a more comprehensive patient profile, Wood said. "It goes deeper than just getting deductibles and co-insurance," she said. "It is the total dollar for the patient and provider experience. Deductibles are part of the equation, but the challenge is that there is a ton of data about patients being eligible for services, but also the benefit level each payer covers and how it is going to be covered. Providers need to realize they need to get the total dollar and understanding of the benefit level for every patient, whether it is in the physician or hospital setting." Illuminating the buckets Although the emphasis is on intake, the back end of the revenue cycle continues to be as vital as always and clean claims remain the key to prompt payment. Still, there are stumbling blocks in the claims filing system, says Jay Deady, CEO of Greenwood Village, Colo.-based Recondo. "On the back end, we need to identify the buckets and reasons why claims aren't adjudicated cleanly," he said. "When we illuminate those buckets, patient ineligibility and lack of authorization are still the main reasons for denials." Electronic data interchange transactions with payers is still the standard for eligibility and authorization data, but Deady's research shows that the information can be wrong up to 25 percent of the time. On the whole, however, the process has improved immensely in the past few years, he said. "We're getting more information earlier, getting more information cleared earlier and more is being done earlier," he said. Many moving parts While the end-to-end revenue cycle system has become more automated, there are "still a lot of moving parts" within the process, noted Mike Nissenbaum, CEO of Dallas-based billing contractor Aprima. "There are so many changes just on what is covered and how much will be paid," he said. "There are constant changes in plans and the payers can modify formularies and delay them up to six months. That is very stressful. If we don't pay attention to all these rules changes, our clients suffer." 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Healthcare analytics company Decision Resources Group is growing its healthcare data trove in a big way, adding claims and electronic health record data for its new Real World Evidence repository, or RWE. DRG touts the fact that RWE, meant to offering its clients better patient insights and help them do longitudinal analytics, covers 90 percent of the U.S. healthcare system The company did not release the cost of the data acquired. Brigham Hyde, senior vice president of analytics and chief data officer at DRG, said the amount of data it now has available for licensing to its clients – all of it de-identified – far surpasses that offered by Truven and other data companies. "We have four times as many patients as Truven has and six times as many claims, and we have EHR detail," Hyde said. IBM announced February 18 it would purchase analytics company Truven, adding a massive repository of data to its Watson Health Cloud. [Also: IBM Watson buying Truven Health Analytics for $2.6 billion] DRG is expanding its expertise to offer its clients more complete and dynamic analyses in the following areas: health economics and outcomes research, epidemiology validation, patient-level forecasting and market sizing, patient-level compliance and real-time network influence. The RWE data asset comes from multiple data providers in the U.S. and includes patient, healthcare professional and payer-level analysis. "As healthcare continues its shift from volume to value, DRG's RWE repository enables academic grade analysis of the cost centers of healthcare in the U.S., as well as the behaviors and outcomes of treatment and coverage decisions," Hyde said. The repository covers 240 million unique U.S. patients with more than five years of historical data, and has 3.2 billion medical and pharmacy claims, enabling closer analysis of cost and outcomes data, according to DRG. Hyde said DRG would leverage its nearly 400 analysts worldwide to provide customers with disease specific insights. For example, the repository has strong coverage of Type 2 diabetes, along with payment details, lab values and clinical progress of patients. DRG also is using the RWE repository to make available custom and interactive analytic dashboards and analytics to enable clients to answer important business questions quickly. In a separate announcement today, DRG said the board of directors appointed Jonathan Sandler CEO. Sandler also serves as DRG chairman of the board.

Big screens in every hospital unit show quality and safety indicators for doctors, nurses, patients and family members. Children’s has reduced urinary tract infections while improving medication safety and time to treatment.

The hospital that gained notoriety earlier this year for paying criminals $17,000 in ransomware attack is now set to build a new emergency department and campus beautification work. 

The aim is to save $25 million annually and Health Catalyst’s profits are directly tied to MultiCare meeting that goal.

Advanced analytics and machine learning technologies are critical to pinpointing problems in large datasets that could be losing providers money. That’s why some organizations are investigating every single denied claim to better understand trends. 

A Navy Seal-like analytics team at the University of Michigan Health System eliminated 10,000 hours of work and recovered $3 million in RAC money. Here’s how an experimental, try-and-fail approach helped them do it.

Caleb Anderson says changing payment models are likely to make hospital executives rethink revenue cycles, and consider outsourcing services to Cerner or one of its competitors, including athenahealth, eClinicalWorks, NextGen, Conifer and others.