Hospitals have recently become great at storytelling – amassing large tracts of data to decipher what happened with a patient’s history and uncover the reason for their symptoms. The problem is the story stops there, in the past. Instead of forecasting our future, we are stuck compiling facts and figures to tell us how we got here, not how to get there.
Real-time business analytics, in its raw form, can be a great transparency tool to push outliers, or costly circumstances, to the top attention of the leadership team. Since much of healthcare is going to automated, protocol-driven workflows in the clinical setting, we have to imitate the approach on the operations side of the shop and eliminate the manual processes are managed through inefficient approaches, due to the absence of real-time analytics.
A good example is the use of real-time data mining for surgery cases in an operating room concerning charges and expenses. Currently, at the end of a case the staff has to enter the charges for a specific case and patient after consumption has occurred. Using analytics, we can build history and a behavior profile showing what it should look like each time the doctor performs a case. These analytics include things like chargeable hours spent in the OR, supply costs, and staffing usage.
Let’s say for example we are talking about an outpatient vascular procedure. The charges for this procedure are typically $20,000 and the reimbursement is typically $6,000. The person who normally enters the charges for the OR is on vacation and someone else must fill in who normally doesn’t perform this task. Instead of capturing all of the correct information, three implantable grafts, at $1,000 each never make it into the charges because the invoice stickers were thrown away at the end of the case, instead of being attached to the operating room summary. So instead of booking $20,000 in charges, the charges are only $8,000 and the reimbursement is only $2,000. That translates to $3,000 in paid expenses and $4,000 in missed reimbursement for each case. At 8 cases a week, it quickly adds up ($1.65 M in missed cash plus $1.2 M in non-recouped expenses).
Without analytics to identify these issues in real time, it may be 45 days before we realize we’re also missing $4,000 in cash/case. You may be successful in appealing later IF you catch the error, but in the meantime you are without vital reimbursement for your hospital. With over 300,000-400,000 patients per year, the chance of catching these outliers is unlikely. Effective analytics point this out and prevent it on the front end by showing us the expected results in real-time.
This example is replicated all across the continuum within a healthcare facility by alerting folks to potentially financially disastrous circumstances. Healthcare is a system analogous with a giant pile of sand that we need to move from one side of the room to the other. For years we’ve been using tweezers to perform this task; analytics gives us a shovel. Don’t be afraid to use it.
CFO & Chief of Strategy
Ensemble Health Partners