For a number of reasons, more and more hospital groups are enhancing their services by acquiring physician practices, both inside and outside their traditional areas. But along with the opportunity to provide more services to more people, there are major challenges. Especially when it comes to integrating the multiple sets of incomplete data used by the different groups.
Fortunately, integrating Big Data from multiple incompatible sources is one of the things we do best. So we have created an analytics solution that gets every physician on the same page. It features a revenue cycle data mining platform that calculates the total contribution margin for every employed physician. The platform contains data from the revenue management systems, costing and other key systems of record. So it can compile the professional revenue for a hospital stay and compare it with the corresponding hospital practice performance based on admission and discharge dates. The net result? Clients can measure revenue across the entire system as it relates to each physician. This knowledge has led to improved financial, operational, and even clinical performance.
In a typical hybrid practice group, different physicians will use different therapies to treat the same Dx code. With this solution, providers can gain new insights into which treatments lead to the best outcomes, then standardize those treatments across the practice, creating better patient outcomes, higher patient satisfaction, and improved revenue. That is just one example. Here are other ways our analytics lead to improved outcomes.
Advanced predictive capabilities make it easy to understand which patients are more likely to cancel, and for what reason. By understanding this, CBO staff can proactively reach out to no-shows with multiple reminders. Physicians and the enterprise both use their time more productively.
No matter how large the group, management can highlight each individual physician’s performance at a glance. Looking more closely, it’s easy to monitor several important KPIs, such as Total Net Revenue, Insured Charges, and Work RVUs, then drill into any of them to know even more. Additionally, built-in filters allow you to focus your analysis on a region, a specialty, a practice, or even an individual physician.
Because physician performance and hospital performance have always been measured by completely disparate data sets, it has never been possible to get a holistic view of each physician’s actual contribution to the success of the enterprise. But with this solution, this vital information is now easily available. The physician’s professional charges can be matched to the same patient’s hospital data in a combined, side-by-side view to show the whole picture.
Too many issues with claims are created long before the physician submits the bill. When screened by a business rules engine, many of these issues can be resolved upstream in the revenue cycle, instead of turning into time-consuming, costly denials. By aggressively fixing errors at the source, a great deal of unnecessary effort is eliminated. To put it another way, clean claims = faster payment.