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It was four years ago when the Dallas-Fort Worth Hospital Council (DFWHC) Foundation discovered that up to 25 percent of readmitted patients were not returning to their original health system for care, making it difficult to accurately predict and track readmission rates. This realization reinforced DFWHC Foundation’s decision to develop a regional enterprise master patient index, an immense database that allows hospitals to track readmissions and other patient information across a diverse North Texas market.
Today, 80 hospitals—including multiple health systems and acute care hospitals, as well as rehabilitation and psychiatric hospitals—participate in the DFWHC Foundation’s regional enterprise master patient index. Used in conjunction with other business intelligence tools, the patient index reviews claims data from participating hospitals. Hospital members can access the tool with a simple click, pulling up dashboards and benchmark reports. The patient index tracks more than 100 quality indicators for members, including healthcare-acquired conditions, readmissions, and other metrics.
Hospitals have used the index, which is designed to match and manage 8.5 million patient records, to help reduce readmissions by 20 percent across member facilities. Hospitals are also using the benchmark information to help guide other improvement efforts.
For example, one DFWHC hospital reduced its all payer 30-day acute myocardial infarction readmission rate from 12 percent to 9 percent and its 30-day pneumonia readmission rate from 16 percent to 12 percent. The hospital achieved these results by providing aggressive, upfront case management to patients who seemed likely to be readmitted, based on their demographic and clinical similarity to patients who had been frequently readmitted in the past.
Most healthcare leaders are familiar with the master patient index tools embedded within their organizations’ patient registration and IT systems. These tools allow providers to accurately link electronic health data to the right patient. Going a step further, an enterprise master patient index has the ability to sit on top of many IT solutions to link data across an entire enterprise. The DFWHC Foundation has taken yet another step, allowing patients to be identified and tracked between hospitals and health systems.
The tool enables members to easily access standardized data to measure value and quality improvement. Because of the index’s inter-facility tracking capabilities, quality indicators can be monitored more accurately and addressed accordingly. As part of the DFWHC Foundation member agreements, data is productively shared between competitors to help identify and spread best practices for quality improvement.
DFWHC addressed patient privacy and security concerns outlined in the HIPAA and HITECH Act in three ways. First DFWHC shared its reporting elements and structure with legal counsel that specialized in healthcare privacy and security regulations. Second, university researchers and faculty periodically verify the low probability of prohibited patient re-identification using the index. Third, the organization has integrated security measures in place to protect patient information for all services.
The DFWHC Foundation staff is now working to expand the regional enterprise master patient index to include long-term care facilities so members can better track patients across the continuum. In addition, they are currently in the process of building a physicians’ claims warehouse.
In addition to quality improvement and readmissions initiatives, DFWHC Foundation hospital members are now using the regional enterprise master patient index for other projects that support community health, research, and workforce initiatives.
Studies and research. Emory University?a participating DFWHC Foundation organization?is using the patient index to study connections between ozone levels and emergency department (ED) admission rates among patients with asthma and heart conditions. Likewise, the University of Texas Southwestern Medical Center is using data from the patient index to study long-term heart disease and outcomes.
Population health management and assessment. DFWHC Foundation members are now using outpatient data across the region to identify disease states in patient populations. They can measure how often inpatients and outpatients interact with a health system. For instance, the regional enterprise master patient index monitors ED visits, particularly for patients with multiple and chronic conditions, allowing providers to intervene before patients reach emergency status. This data can then be trended to determine whether clinical programs are effective from a population health perspective.
Tracking and trending ED use. Because 25-30 percent of North Texas patients are uninsured, many use the ED—rather than a primary care provider—for non-emergent conditions. DFWHC Foundation members are identifying non-emergent conditions and tracking “frequent flyers” to reduce unnecessary ED visits.
Blending clinical and administrative data. Twenty-six North Texas organizations performing cardiovascular surgeries have used the patient index to match patients between a clinical registry and claims warehouse. This allows organizations to see not only patients’ clinical attributes, but their encounters before and after surgery to conduct effective population studies.
A regional enterprise master patient index is most helpful in large metropolitan areas, states with many health systems like California, or regions spanning multiple states on the East Coast. Providers considering participation in a regional enterprise master patient index may consider the following tips:
Make it a collaborative effort. Technology is only an enabler. Participants must be willing to work together and committed to the idea that collaboration offers great gains in patient care rather than lost resources.
Don’t attempt to create a regional enterprise master patient index with a newly formed network. The initiative requires sophisticated knowledge, healthy collaboration, and a willingness to share sensitive information. Instead, work with an existing network of organizations. For example, more than a decade before implementing its patient index, the DFWHC Foundation forged partnerships with member organizations to support other healthcare initiatives, including patient medication management programs.
Obtain support from leadership as well as the community. To fully optimize a regional enterprise master patient index, the leaders of hospitals and health systems, universities, and health-related businesses must understand its value and the potential for innovation. For example, the DFWHC Foundation includes provider leadership and community members on its board, which has helped accelerate the impact of the regional enterprise master patient index data across the region.
Engage state leaders. State organizations such as the Texas Healthcare Information Collaborative and the Texas Institute of Healthcare Quality and Efficiency have a strong interest in the regional enterprise master patient index and its ability to improve healthcare quality and efficiency. The patient index presents opportunities to match data across registries and Medicaid that can lead to cost reductions and quality improvements. For example, by identifying specific populations that require health interventions, state agencies and healthcare providers can partner to help patients receive appropriate care.
Dedicate financial resources. Developing a regional enterprise master patient index requires a financial investment. Therefore, organizations should identify what they want to achieve, and then determine if the ROI is worthwhile.
For example, to participate in the North Texas patient index, providers must be a paying member of the Dallas-Fort Worth Hospital Council Foundation’s Information and Quality Services Center. Many facilities evaluate their use of the index by measuring their potential Medicare patient/program losses over a 30-day period and then determining the value of avoiding and reducing penalties by being able to accurately measure their readmissions on a regional, inter-system basis through the patient index.
An accepted belief in health care is “that which is documented is improved.” By establishing an effective regional enterprise master patient index, hospitals can maximize clinical and financial data to enhance quality care for patients across an entire geographical region. Through collaboration and dedication, establishing a regional enterprise master patient index is one way to bolster patient care while ensuring long-term financial viability.
Kristin Jenkins, JD, FACHE, is president of the Dallas¬–Fort Worth Hospital Council Foundation, Irving, Texas.
Grant Thornton: Facilitating EAM
Priority Advantage: Helping Organizations Optimize Their Medicare Advantage Plans
6 Patient Revenue Cycle Metrics You Should Be Tracking (and How to Improve Your Results)
Patient financial engagement is more challenging than ever – and more critical. With patient responsibility as a percentage of revenue on the rise, providers have seen their billing-related costs and accounts receivable levels increase. If increasing collection yield and reducing costs are a priority for your organization, the metrics outlined in this presentation will provide the framework you need to understand what’s working and what’s not, in order to guide your overall patient financial engagement initiatives and optimize results.
10 Ways to Reduce Patient Statement Volume (and Reduce Costs)
No two patients are the same. Each has a very personal healthcare experience, and each has distinct financial needs and preferences that have an impact on how, when and if they chose to pay their healthcare bill. It’s no longer effective to apply static billing techniques to solve the complex challenge of collecting balances from patients. The need to tailor financial conversations and payment options to individual needs and preferences is critical. This presentation provides 10 recommendations that will not only help you improve payment performance through a more tailored approach, but take control of rising collection costs.
Reduce Patient Balances Sent to Collection Agencies: Approaching New Problems with New Approaches
This white paper, written by Apex Vice President of Solutions and Services, Carrie Romandine, discusses the importance of patient segmentation and messaging specifically related to the patient revenue cycle. Applying strategic messaging that is tailored to each patient type will not only better educate consumers on payment options specific to their billing needs, but it will maximize the amount collected before sending to collections. Further, targeted messaging should be applied across all points of patient interaction (i.e. point of service, customer service, patient statements) and analyzed regularly for maximized results.
The Future of Online Patient Billing Portals
This white paper, written by Apex President Patrick Maurer, discusses methods to increase patient adoption of online payments. Providers are now seeking ways to incrementally collect more payments due from patients as well as speeding up the rate of collections. This white paper shows why patient-centric approaches to online payment portals are important complements to traditional provider-centric approaches.
Payment Portals Can Improve Self-Pay Collections and Support Meaningful Use
Increased electronic engagement between healthcare providers and patients provides significant opportunities for improving revenue cycle metrics and encouraging patients to access EHRs. This article, written by Apex Founder and CEO Brian Kueppers, explores a number of strategies to create synergy between patient billing, online payment portals and electronic health record (EHR) software to realize a high ROI in speed to payment, patient satisfaction and portal adoption for meaningful use.
Large Health System Drives 10% UP (Patient Payments) and 10% DOWN (Billing-related Costs)
Faced with a rising tide of bad debt, a large Southeastern healthcare system was seeing a sharp decline in net patient revenues. The need to improve collections was dire. By integrating critical tools and processes, the health system was able to increase online payments and improve its financial position. Taking a holistic approach increased overall collection yield by 10% while costs came down because the number of statements sent to patients fell by 10%, which equated to a $1.3M annualized improvement in patient cash over a six-month period. This case study explains how.
ICD-10: Managing Performance
With the ICD10 deadline quickly approaching and daily responsibilities not slowing down, final preparations for October 1 require strategic prioritization and laser focus.
Clarity Drives Collections
Read how Gwinnett Medical Center provides clear connections to financial information, offers multiple payment options for patients, and gives onsite staff the ability to collect payments at multiple points throughout the care process.
Orlando Health Gains Insight into Denials, Reduces A/R Days with RelayAnalytics Acuity
Read how Orlando Health was able to perform deeper dives into claims data to help the health system see claim rejections more quickly–even on the front end–and reduce A/R days.
Revenue Cycle Payment Clarity
To maintain fiscal fitness and boost patient satisfaction and loyalty, healthcare providers need visibility into when and how much they will be paid–by whom–and the ability to better navigate obstacles to payment. They need payment clarity. This whitepaper illuminates this concept that is winning fans at forward-thinking hospitals.
Streamlining the Patient Billing Process
Financial services staff are always looking for ways to improve the verification, billing and collections processes, and Munson Healthcare is no different. Read about how they streamlined the billing process to produce cleaner bills on the front end and helped financial services staff collect more than $1 million in additional upfront annual revenue in one year.
Wallace Thomson Hospital Automates to Maximize Limited Resources
Effective revenue cycle management can be a challenge for any hospital, but for smaller providers it is even tougher. Read how Wallace Thomson identified unreimbursed procedures, streamlined claims management, and improved its ability to determine charity eligibility.
7 Steps for Building and Funding Sustainability Projects
Before launching an energy-efficiency initiative, it’s important to build a solid business case and understand the funding options and potential incentives that are available. Healthcare leaders should consider taking the steps outlined in the whitepaper to ease the process of gaining approval, piloting, implementing, and supporting sustainability projects. You will find that investing in sustainability and energy efficiency helps hospitals add cash to their bottom line. Discover how hospitals and health systems have various options for funding energy-efficient and renewable-energy initiatives, depending on their current financial structure and strategy.
Key Capital Considerations for Mergers and Acquisitions
Health care is a dynamic mergers and acquisitions market with numerous hospitals and health systems contemplating or pursuing formal arrangements with other entities. These relationships often pose a strategic benefit, such as enhancing competencies across the continuum, facilitating economies of scale, or giving the participants a competitive advantage in a crowded market. Underpinning any profitable acquisition is a robust capital planning strategy that ensures an organization reserves sufficient funds and efficiently onboards partners that advance the enterprise mission and values.
Key Capital Considerations for Mergers and Acquisitions
The success of healthcare mergers, acquisitions, and other affiliations is predicated in part on available capital, and the need for and sources of funding are considerations present throughout the partnering process, from choosing a partner to evaluating an arrangement’s capital needs to selecting an integration model to finding the right money source to finance the deal. This whitepaper offers several strategies that health system leaders have used to assess and manage capital needs for their growing networks.
Trend Watch: Providers adapt as value-based care moves from hype to reality
Announcements from several commercial payers and the Centers for Medicare and Medicaid Services (CMS) early in 2015 around increased efforts to form value-based contracts with providers seemed to point to an impending rise in risk-based contracting. Rather than wait for disruption from the outside in, health care providers are now making inroads on collaborating with payers on various risk-based contracting models to increase the value of health care from within.
Yuma Regional Medical Center case study
Yuma Regional Medical Center (YRMC) is a not-for-profit hospital serving a population of roughly 200,000 in Yuma and the surrounding communities.
Before becoming a ZirMed client, Yuma was attempting to manually monitor hundreds of thousands of charges which led to significant charge capture leakage. Learn how Yuma & ZirMed worked together to address underlying collections issues at the front end, thus increasing Yuma’s overall bottom line.
Reforming with a New 50-Bed Acute Care Facility
Kindred Hospital Rehabilitation Services works with partners to audit the market and the facility’s role in that market to identify opportunities for improvement. This approach leads to successes; Kindred’s clinical rehab and management expertise complements our partners’ strengths. Every facility and challenge is unique, and requires a full objective analysis.
5-Minute Briefing on Revenue Integrity Through HIM WhitePaper Hospitals FS
As the critical link between patient care and reimbursement, health information enables more complete and accurate revenue capture. This 5-Minute White Paper Briefing shares how to achieve cost-effective revenue integrity by your optimizing HIM systems.
5-Minute Briefing on Accelerating Cash Flow Through HIM WhitePaper Hospitals FS
Speedier cash flow starts with better CDI and coding. This 5-Minute White Paper Briefing explains how providers can improve vital measures of technical and business performance to accelerate cash flow.
5-Minute Briefing on Reducing the Cost of RCM WhitePaper Hospitals FS
Qualified coders are getting harder to come by, and even the most seasoned professional can struggle with the complexity of ICD-10. This 5-Minute White Paper Briefing explains how partnerships can help improve coding and other key RCM operations potentially at a cost savings.
Providers Focus Too Much On Revenue Cycle Management
The point of managing your revenue cycle isn’t just to improve revenue and cash flow. It’s to do those things effectively by consistently following best practices— while spending as little time, money, and energy on them as possible.
Lucille Packard Children’s Hospital Stanford Case Study
How Lucile Packard Children’s Hospital Stanford increased payments received within 45 days by 20% and reduced paper submission claims by 70% by using ZirMed solutions.
Using Predictive Modeling To Detect Meaningful Correlations Across Claims Denials Data
The reasons claims are denied are so varied that managing denials can feel like chasing a thousand different tails. This situation is not surprising given that a hypothetical denial rate of just 5 percent translates to tens of thousands of denied claims per year for large hospitals—where real‐world denial rates often range from 12 to 22 percent. Read about how predictive modeling can detect meaningful correlations across claims denials data.
ZOLL and Emergency Mobile Health Care Case Study
Emergency Mobile Health Care (EMHC) was founded to be and remains an exclusively locally owned and operated emergency medical service organization; today EMHC serves a population of more than a million people in and around Memphis, answering 75,000 calls each year.
Maximizing Medicare Reimbursements White Paper
Since the Physician Quality Reporting Initiative (PQRI) introduction, CMS has paid more than $100 million in bonus payments to participants. However, these bonuses ended in 2015; providers who successfully meet the reporting requirements in 2016 will avoid the 2% negative payment adjustment in 2018, so now is the time to act! Included in this whitepaper are implications of increasing patient responsibility, collections best practices, and collections and internal control solutions.
Denials Deconstructed: Getting Your Claims Paid
Getting paid what your physician deserves—that’s the goal of every biller. Yet even for the best billers, achieving that success can be elusive when denials stand in the way of success, presenting challenges at every turn. Denials aren’t going away, but you can learn techniques to manage and even prevent them.Join practice management expert Elizabeth W. Woodcock, MBA, FACMPE, CPC, to: Discover methods to translate denial data into business intelligence to improve your bottom line, determine staff productivity benchmarks for billers, and recognize common mistakes in denial management.
Automation and Operational Improvement Drive Sustainable Results
Physician practices must improve organizational efficiency to compete in this era of reduced reimbursement and escalating administrative costs.
Revenue Cycle Management Resolves Migration Implementation Issues
Many healthcare organizations are pursuing next-generation health information systems solutions. Learn more about Navigant's work with University of Michigan Health System.
Partnering For Success – Provider Achieves Strength in Stability
The proper implementation of healthcare information technology systems is crucial to an organization’s financial health.
Building a Clinically-Integrated Network
As value-based payment models evolve, providers are challenged to maintain superior clinical outcomes while controlling costs.
Winning in the Post-Acute Marketplace
Read more about factors contributing to the changes in the post-acute marketplace and what it means for manufacturers, physicians, clinicians, patients, and post-acute facilities as they anticipate the transition to the second curve.
Building A Common Vision with Employed Physicians
HSG helped the physicians and executives of St. Claire Regional in Morehead, Kentucky, define their shared vision for how the group would evolve over the next decade. As well as, develop the strategic and operational priorities which refocused and accelerated the group’s evolution.
Practice Performance Improvement
The client was a nine-hospital health system with 14 clinics serving communities in a multi-state market with very limited access to care, poor economic conditions, high unemployment, and a heavy Medicare/Medicaid/uninsured payer mix. In most of these communities, the system was the sole source of care.
Though the clinics were of substantial size (they employed 98 physicians) and comprised of multiple specialists, the physicians functioned as individuals and the practices lacked any real group culture.
Clinical Integration Without Spending a Fortune
Clinical integration can be expensive, but it doesn’t have to be, as this four-step road map for developing a CIN proves. Does it have to cost millions to initiate a clinical integration strategy?
Contrary to popular belief, we have clients who have generated substantial shared savings and a significant ROI over time, without massive investments. Yes, some financial capital is required for resources the CIN providers can’t bring to the table themselves. But the size of that investment can be miniscule relative to the value it produces: improved outcomes and documentation for payers.
Adding Value to Physician Compensation
Today’s concerns about physician compensation are the result of the changing healthcare environment. The transition to value is slow, but finally becoming a reality. Proactive hospitals want to ensure that provider incentives are properly aligned with ever-increasing value-based demands.
This report focuses on the three big questions HSG receives about adding value to physician compensation; Why are organizations redesigning their provider compensation plans? What elements and parameters must be part of successful compensation plans? How are organizations implementing compensation changes?
Effective Revenue Cycle Management in Your Network
Revenue Cycle Management has become an even more complex issue with declining reimbursements, implementation of Electronic Health Records, evolving local carrier determinations (LCD), and payer credentialing [The emphasis on healthcare fraud, abuse and compliance has increased the importance of accuracy of data reporting and claims filing).
The efficiency of a medical practice’s billing operations has critical impact on the financial performance. In many cases, patient billings are the primary revenue source that pays staff salaries, provider compensation and overhead operating cost. Inefficiencies or inaccurate billing will contribute to operating losses.
Succeeding in Value-Based Care
This publication identifies and outlines the necessary characteristics of a fully-functioning clinically integrated network (CIN). What it doesn’t do is detail how hospitals and providers can participate in the value-based care environment during the development process.
One common misconception is that the CIN can’t do anything significant until it has obtained the FTC’s “clinically integrated” stamp of approval. While the network must satisfy the FTC’s definition of clinical integration before single signature contracting for FFS rates and contracts can legally start, hospitals and providers can enjoy three key benefits during the development process.
Therapy: Benefits at All Levels of Care
Nearly half of all Medicare beneficiaries treated in the hospital will need post-acute care services after discharge. For these patients, a stay in an inpatient rehabilitation facility, skilled nursing facility or other post-acute care setting comes between hospital and home.
Does Your Budgeting Process Lack Accountability?
With the proper process, tools, and feedback mechanisms in place, budgeting can be a valuable exercise for organizations while helping hold organizational leaders accountable. Having a proper monthly variance review process is one of the most critical factors in creating a more efficient and accurate budget. Monthly variance reporting puts parameters around what is to be expected during the upcoming budget entry process.
Cost Accounting: the Key to Cost Management and Profitability
Managing the cost of patient care is the top strategic priority of most hospital CFOs today. As healthcare shifts to more data-driven decision making, having clear visibility into key volume, cost and profitability measures across clinical service lines is becoming increasingly important for both long-range and tactical planning activities. In turn, the cost accounting function in healthcare provider organizations is becoming an increasingly important and strategic function. This whitepaper includes five strategies for efficient and accurate cost accounting and service line analytics and keys to overcoming the associated challenges.