Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle

Transcription

1 A RelayHealth Case Study Gaining Actionable Insight into Financial Systems and Areas Impacting the Revenue Cycle Spartanburg Regional

2 2 Hospital systems across the country are looking to streamline their billing and collection processes to become more efficient and better compete in their markets. The challenge many face is how to turn the data that s already flowing through financial systems into actionable intelligence that can help hospital executives make important decisions. Putting the data into a usable form is one challenge; other hurdles include how to quickly drill down into the data to get the information needed to improve processes and how to compare performance against peer hospitals. Spartanburg Regional in South Carolina was facing many of these challenges when it chose to add RelayAnalytics Pulse to its RelayAssurance claims management system. Brian Earnest, Vice President of Revenue Cycle, says the addition of Pulse already is paying dividends through verification of the effectiveness of the system s billing practices Lack of ready insight into key performance indicators and comparison against peer institutions to validate Inability to gauge financial performance against peer performance levels or prompt corrective action. hospitals I can look at my key performance indicators, and then Difficulty to investigate billing anomalies compare them to other hospitals I select, hospitals that are similar to ours in size, scope, services and government structure, Earnest says. That s valuable intelligence that helps us understand where we are doing well, where there are opportunities for improvement and how to set strategic objectives. A first pass clean claim rate 16.65% higher than peers Daily snapshot of key performance indicators KPIs compared to customized list of peer health systems Ability to perform root cause analysis quickly

3 3 Spartanburg Regional Healthcare System (SRHS) has been serving the community more than 90 years, developing into an integrated healthcare system that provides care from birth to hospice. Featuring a full spectrum of services, SRHS is comprised of three hospitals Spartanburg Regional Medical Center, a 540-bed research and teaching hospital; Spartanburg Hospital for Restorative Care, a 97-bed long-term acute care hospital with a 25-bed skilled nursing facility; and Village Hospital, a 48-bed acute-care facility. In addition, SRHS is offers outpatient surgery centers, a multi-disciplinary physician group, hospice and home health services, and is home to Gibbs Cancer Center & Research Institute. With more than 5,600 associates and 500 physicians on medical staff, SRHS serves seven counties in North and South Carolina. In addition to providing more than $80 million in charity care annually, SRHS is ranked #1 in South Carolina for cardiac services by Healthgrades; the Gibbs Cancer Center & Research Institute received the Outstanding Achievement Award from the Commission on Cancer; and the American Nurses Association lists SRHS among the nation s top three percent of hospitals for excellence in nursing. Hospital System: Spartanburg Regional, Spartanburg, SC Solutions: RelayAssurance Plus, RelayAnalytics Pulse Beds: 588 licensed in two facilities, plus a 97-bed long-term, acute-care hospital Employees: More than 5,600 Medical Staff: More than 500 physicians

4 4 Brian Earnest certainly believed that Spartanburg Regional was holding its own against peer hospitals in terms of billing efficiency and other key performance indicators (KPI). However, actually getting and interpreting the data to validate this was a time-consuming and frustrating process before adopting RelayAnalytics Pulse. Earnest would pore through research from presentations he had attended that often contained out-of-date, standard benchmark information that might or might not be relevant to he and his peer hospitals. Another tactic would be to spend a morning with Healthcare Financial Management Association (HFMA) publications to try and find the data he was looking for. With RelayAnalytics Pulse, this information was immediately available, current and trustworthy. For example, Earnest explains he can say with certainty not only that Spartanburg Regional s first pass rate on claims is 84.82% but also that it compares favorably with the rate of peer hospitals he has selected. The first pass rate of those institutions is 68.17%. It takes us a little longer to get claims out the door following discharge, but it s paying dividends because our pass rate is better and claims are being paid quicker, Earnest says. Also when considering the workload and efficiency impact of denials, including rework and the appeals process, the small amount of extra time it takes to get the claim out clean the first time is worth it in staff productivity returns later. So while it may appear that we are behind on certain measures, we come out ahead on the metrics that I think are more important. We would not know this with any level of confidence without Pulse.

5 5 RelayAnalytics Pulse includes data from hundreds of hospitals that is updated daily and include historical views. The dashboard is highly customizable and quick views of key performance indicators can even be viewed on mobile devices. Earnest spent a little time during the go-live phase to set up parameters of peer hospitals, nonprofit facilities of 500 or more beds in urban settings with Level 1 trauma centers. Now he can look at a wide range of indicators at a glance, comparing Spartanburg Regional against similar hospitals or against benchmarks, drilling down into areas where he wants more information. This gives me a quick snapshot of trends I might not have been aware of, Earnest says. If denials spike, for example, I can see it immediately and drill down by payer or code to see what s going on. I like the green/yellow/ red indicators {exceeding, meeting or under-performing} that show our performance versus my peers so I know what my ratio is and see when it changes. In one instance, after noticing that the system s electronic fund transfer rate was slightly below the peer average, Earnest looked deeper into the data and noticed one payer wasn t using EFT. That quick fix brought the system back to a normal range. We choose Pulse because we have a long-standing relationship with RelayHealth, Earnest says. It easily integrated with the other products we have and uses the claims data already flowing through RelayAssurance. There was virtually no setup on our side to get it up and running.

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