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Challenges and opportunities in data analytics

Challenges and opportunities in data analytics

Healthcare organizations have become mass gatherers of data. But without sophisticated analytics, integrated IT tools, and processes to mine that data, they may not be able to take advantage of it.

The 33 leaders who gathered for the HealthLeaders Media Revenue Cycle Exchange, held March 23?25 at the Fairmont Grand Del Mar in San Diego, discussed some of the challenges and opportunities they’ve identified within their organizations around data analytics, as well as the tools that help them maintain an effective revenue cycle.

 

Let the data do the talking

Popular wisdom says culture starts at the top?but data is another important catalyst for change. The ongoing managed Medicaid expansion is requiring organizations to collect more prior authorizations and precertifications, presenting a challenge for revenue cycle leaders. Changing the culture of the organization is often key to handling that challenge, and one way to make the change is through data, says Jane Berkebile, MA, CPAM, system vice president of revenue cycle for OhioHealth in Columbus.

One significant challenge for OhioHealth is educating physicians about the increased need for preauthorizations under managed Medicaid. In the past, many of these patient accounts were written off as charity care. However, Berkebile’s organization now needs to focus on the administrative requirements around Medicaid.

Educating OhioHealth’s 343 physician practices, as well as the employed specialists and primary care physicians, by showing them the importance of preauthorizations, has represented a change in culture.

"For communication with our physicians, clinicians, and administration, the best tool we have is to show them in the data what’s really happening," says Berkebile. Her organization’s data analytics team drills down to the information that impacts each department. Departments usually see the gross charge number and think they are doing well, she says.

However, if a department is not getting appropriate authorizations, it may not actually be getting paid that amount. Berkebile finds physicians in particular react positively to seeing data.

"If you show them the data and don’t preach to them, and let them discover the problem, you can get more positive reactions from the physician community," she says. Following the data trail can also help you avoid pitfalls, such as relying on anecdotes that may hide the actual problem.

"The tyranny of the anecdote will not be allowed in this organization," says Doug Robison, performance improvement leader for John Muir Health in Walnut Creek, California. "You have to back it up with data."

 

Turn data into information

Even data only goes so far?it needs to be turned into information, says Russ Weaver, vice president of revenue cycle/finance for Adventist Health System in Burleson, Texas, relating advice he once received.

"You will be more successful if you figure out how to turn data into information. When you’re given something, ask, ‘What does this tell me?’ "

It is important to get back to the root cause and have a sufficient level of detail to address change. As part of the transition to the Cerner Patient Accounting product, Adventist has taken the opportunity to review its processes and reporting. As part of this, Weaver is careful to avoid relying on anecdotal information.

"You can’t go to the director of patient accounts and say you think his or her department is doing something wrong without having meaningful data to back it up," he says.

Sometimes what seems like a data problem is really something else, so it’s important not to lose sight of the basics, such as whether your organization is collecting required data on the front end, according to Doug Brandt, CPA, associate chief financial officer for Truman Medical Centers in Kansas City, Missouri.

"We’re focused on capturing the data items that need to be captured. There is always some low-hanging fruit, so identify and fix that first, then move to the harder-to-fix items," he says.

For example, it is important for revenue cycle leaders to look at the root cause of things such as denials. Even if you are measuring all the right things, if something is not happening at the front end (for example, the registration department is not verifying the patient insurance), you are going to get denials. UnityPoint Health in Des Moines, Iowa, is using data to get to the root cause of denials.

"We’re using data to drive that change by having the service providers focus on getting it correct at the beginning, versus always having to do it on the back end," says Renee Rasmussen, CPA, MBA, FHFMA, vice president of revenue cycle for UnityPoint Health.

 

Ensure ‘clean’ data

Organizations that can’t trust their data might run into problems with data standardization. Alternatively, organizations can fall into the trap of having too much data, but not enough accountability. The first step to ensuring clean data is to assemble a group of stakeholders to determine what data is necessary and where it will come from, says Tammy Thomlison, chief revenue cycle officer for the University of Mississippi Medical Center in Jackson.

Her organization has set up a team to look at the data warehouse generated by Epic and agree, organizationwide, where they will pull data from.

"As an organization, we had to decide where we would pull certain information from the data warehouse, so that when we’re pulling reports we all get the same results," says Thomlison. Her team also uses the Qlik software to provide reporting options on top of the data warehouse. Having data in multiple systems and managing various interpretations of that data is a challenge for many organizations.

Systems must also ensure the data is clean once they have it, says Don Shaw, vice president of revenue cycle for Baton Rouge (Louisiana) General Medical Center. "Once you start pulling information, you find that sometimes you have surprises that you have to fix."

Revenue cycle leadership must hold itself to the same accountability standards it hopes to see from other departments. Data transparency is one way to increase collaboration and trust between the revenue cycle and clinical departments.

"I think it goes back to making sure our data is as accurate as possible. If other departments find differences or errors, we acknowledge that and go back and make those adjustments," says Rasmussen.

 

Measure the right things

The University of Chicago Medicine focuses more on internal benchmarks than external.

"Your benchmark is what you did last week. Now do better than that," says Charlie Brown, MBA, vice president of revenue cycle for The University of Chicago Medicine. "To really set those individual targets, you’ve got to measure against your own internal performance."

UnityPoint also focuses on internal benchmarks, but supplements them with HFMA’s MAP App, says Rasmussen. "We look at the key performance indicator of net revenue yield for our nine regions to really compare different areas."

The most important thing is to set your own benchmarks and targets, adds Berkebile. "By looking at your data and seeing where you are, you see the opportunities and continually set targets to improve your own data. We don’t try to match somebody else’s number?we continually work on improving our own performance."

Organizations need to avoid the pitfall of measuring the wrong things or being so inundated with data that they can’t make a decision.

"There are an endless number of things we can measure, and you don’t want to be playing a game of whack-a-mole where every time something pops up, you hit it and then another thing pops up," says Brandt. "It’s important to find the balance and identify where we need to drill and what we need to focus on."

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