Imagine Blog

Jennifer Kroken

Jennifer Kroken

Jennifer Kroken is a Practice Solutions Consultant for ImagineSoftware with 27 years of industry experience. She is a frequent contributor to several national radiology publications and received her MBA from Upper Iowa University.

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Using Healthcare Business Analytics to Power Your Practice

2019 is underway and promises to maintain the breakneck pace of change in healthcare. With the flurry of activity, it is more important than ever to maintain a clear vision of what is happening in your practice so you can make sound decisions with greater impact.

It's hard to believe a mere 15 years ago, we were managing in the rearview mirror—waiting until month end reports to find something had gone wrong or identify the beginnings of a potential disaster. Thankfully those days are over. We are living in an exciting age where administrators now have more access to data than ever before. We have rapidly moved from having static daily snapshots of data to a dynamic real-time, multi-dimensional view of your practice's healthcare business analytics.

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Thanks to Business Intelligence (BI), data provided by billing systems are more granular than ever—but how do we use this to our advantage?

It's easy to be overwhelmed upon first review of business intelligence and analytics for healthcare organizations—there’s a lot of data being measured with some falling into “mission critical” and some “nice to know”. The following are some tips to use your BI to your advantage, while not making data analysis a full-time job.


Use Daily Snapshots to Your Advantage

By now, you most likely have a baseline for a normally operating practice. If not, here are some consistencies to keep track of:

  • Average daily charges - For hospital-based practices it is normally best to exclude weekend activity so you know what a "normal Monday" should be
  • Average daily payments
  • Average trasactions - Coding, payment posting

These are typical "danger zones" where despite all our technological advances, we can quickly succumb to operational failures in billing basics.

With these snapshots, you now have a baseline for a few useful applications of business analytics in your healthcare practice. For example, having identified a category where the numbers are lower than expected, you can drill down to a coder or payment poster to find they are behind in their work or discover a site of service that may be experiencing download issues. At that point, the manager can quickly deploy necessary resources to correct the issue.  Without a reference point, it will be difficult to make sense of the numbers and impossible to take corrective action promptly.


Approach Healthcare Business Analytics with a Question in Mind

Unquestionably, the most common concern of physician centers on revenue is "why is it down? The best way to answer that question is with focus. Is a particular payer the culprit? Are payments grossly out of line for one site of service from one month to the next?

Be careful not to get too bogged down in isolated numbers, since trends are more informative when defining the problem. Look for abnormalities in the data from one month to the next and then utilize the BI to drill down from there.

For instance: if upon a visual review of your BI, you find Blue Cross appears to be the issue, drilling down into payment data may show that payment posting is a couple of days behind and that alone could answer the question.  However, if the answer does not appear to be that simple, further investigation may reveal the issue lies in problems with the clearinghouse or directly from the payer.

But if everything on the top-level review appears normal, this is where BI can assist in pinpointing the source of the problem. With multiple drill-downs available, you can narrow the focus all the way down to a singular provider who may have been overlooked for a credentialing renewal.

The bottom line is to approach the data with focus, or you can spend hours of time looking at interesting, but not particularly helpful, numbers.


Let BI Be Your Guide

For the experienced BI user (who is less overwhelmed when viewing high volumes of data), allowing BI to ask the question for you could be your approach. Dashboard visuals can be particularly useful in this instance, with BI highlighting danger zones and you can take it from there. Typically, there will be a category that is noticeably “down” based on the graphs and you can often click your way to your answer.

However, allowing the BI to guide you to your issue takes a little more doing than it might first appear. If you have one coder whose productivity recently ground to a halt, there are usually operational questions to be answered (rather than a lazy employee) so take a cautious first pass of the data since the answer may not be obvious on the initial review.

The Perils of Up-To-The-Minute DataThere are far more pros than cons when working with a BI to analyze your practice. However, one area of caution is a question that every administrator has received from a doctor at some point in their career (and if you haven’t…it’s coming):

"What are we being paid for 'X' procedure?"

What should be an easy answer proves to be incredibly difficult. If your BI is counting every payment as a transaction, then make sure you are combining primary/secondary/patient payments to answer this question.  You may have had a batch of secondary payments posted yesterday which could report you are currently receiving ~$8.00 for a CT scan. Be careful not to jump the gun in providing a quick answer and instead, make sure the answer makes sense.

The BI can potentially come in with a career save when it shows you one major payer somehow paid from a new (incorrect) fee schedule and now you really are getting paid $8.00 for a CT. In that case, BI is now your new best friend. Armed with documentation, you can approach the payer for quick resolution and that is something the administrator of 2019 can appreciate.


Conclusion

Understanding that every keystroke and download becomes a data point is both exciting and potentially overwhelming. The BI is a powerful tool in understanding and perfecting your practice. Use caution when reviewing the data because more data is just that: data. Understanding is a separate issue—beating your employees over the head with productivity numbers alone is indeed an approach, but the detail as to why the numbers fluctuate almost always involves an operational issue. Healthcare business analytics provide you up to the minute information, but the basics of a sound operation still…and always will…apply.

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