Get the E-newsletter
some finance and clinical executives, information governance (IG) may come off
as a somewhat academic concept that is better suited for the legal, health
information management (HIM), and IT wonks in their organizations. Yet leaders across
the enterprise have much to gain by optimizing information in the same way they
strive to enhance patient safety or improve quality—with a systematic framework
of policies and procedures that are continually reinforced and updated so they
become part of the culture, says Robert Smallwood, IGP, managing director of
the Institute for Information Governance.
IG programs provide a coordinated approach to help organizations optimize the
value of their information assets while reducing privacy and security risks and
ensuring legal and regulatory compliance.
information governance is about knowing what your information holdings are,
where they are stored, and governing them properly based on their level of
sensitivity or confidentiality,” says Smallwood, who has authored several IG
the general business sector, IG has been largely viewed as a strategy to cull
unnecessary and duplicate files that bloat an organization’s storage footprint.
In health care, IG offers several benefits that are particularly useful as
organizations move toward value-based payment. For example, IG helps generate
cleaner data that can be used to streamline service delivery, reduce costs, and
spur innovation, Smallwood says. After a merger, IG can help the restructured organization
get a better handle on information assets that are widely diffused across the
also can help promote organizational alignment and foster collaboration among traditionally
siloed functions such as quality and the revenue cycle. “One of the aims of
information governance programs is to leverage information as an asset across
the organization,” Smallwood says. Ideally, IG programs should foster
information sharing that promotes improvements in overall population health as
well as the financial health of the hospital, health system, or health plan.
many healthcare organizations entered 2018 with more-mature IG programs than
they had just 12 months ago, hospitals, in particular, still lag behind other
sectors in their level of IG maturity. A 2017 survey of primarily provider
organizations by the American Health Information Management Association (AHIMA)
found that the top three barriers to making progress with IG are awareness and
understanding of the concept, budgeting/funding issues, and communication/cooperation
across silos (click on the exhibit below).
all stakeholders within an organization on board—and determining who is in
charge—can be a major challenge, says Melissa Martin, who spent 18 years as
associate vice president of privacy and HIM and chief privacy and HIM officer
for West Virginia University Medicine, Morgantown, W.V.
have to get past whether this is owned by HIM or IT or business analytics and
bring those groups together so you can move forward with information
governance,” says Martin, who is also a past president and chair of AHIMA.
recommends not getting caught up in the term information governance but instead focusing on developing the
framework around security, privacy, records management, and data integrity in
general. “It’s already occurring in some organizations, but successful
information governance programs pull it all together and break down the silos
between different entities and departments in their organization,” she says.
the same time that WVU Medicine was preparing to roll out a shared electronic health
record to all of its hospitals, Martin and her team developed an
enterprise-wide IG steering committee with leaders from HIM, IT, business
analytics, hospital billing, physician billing, and other areas. But the
initiative picked up even more momentum when the committee engaged clinicians
in efforts to bring quality reporting under the IG umbrella. Working together,
leaders at WVU Medicine created policies and procedures on data quality and
storage, records retention, privacy and security, and other areas.
her role as assistant vice president for the new WVU Heart and Vascular
Institute, Martin (pictured at right) continues to apply her IG acumen. “It became pretty clear
when I stepped into this role that we still had plenty of work to do on
information governance,” she says. For example, creating the new service line
meant pulling together the data from two academic departments—not just on the
main campus but from sister hospitals as well. Collection and integration of information
from disparate sources was essential to help service line leaders, business
analysts, and the finance team create financial pro formas to determine which
heart services to offer where, as well as how to price them.
Medicine’s enterprise-wide IG framework has continued to be helpful as the
service line has grown. “We’ve had a number of acquisitions over the past year,
and without the ability to pull together that information from those areas, it
would have been difficult to get approval from our board to acquire practices
or develop clinics in certain rural areas, which is extremely important to our
overall mission,” Martin says.
hospitals have been slow to embrace IG, health plans tend to be further along
on the IG journey, says Matt McClelland, a member of the Information Governance
Initiative’s advisory board and former manager of the information governance
office at Blue Cross Blue Shield of North Carolina, where he oversaw
traditional records management, file analytics, e-discovery, and other areas.
of the main benefits of IG is the ability to comply with external regulatory
pressures, whether those are audits or litigation,” McClelland says. “When
you’re dealing with large amounts of unstructured data, a robust information
governance program allows you to know what you have, know where it is, and know
the relevance to any kind of investigation, litigation, or audit and provide
that in a timely manner.”
health plans also embrace IG because such programs can help protect their
organizations against security threats, including breaches that occur at providers
and other business partners. “By reducing your footprint through good
information governance practices—such as only keeping what you need to keep and
only sharing certain information with partners—you can build walls around what
needs to have walls,” says McClelland, who works with health plans that have varying
levels of IG maturity in his current role as a principal consultant with
also can help health plans and other organizations minimize information like
files and emails that need to be migrated to other platforms, and thus help to
contain costs. “Most organizations are dealing with at least hundreds of
terabytes of unstructured data that is on network shared drives and email, and
most of that has not been managed very well,” McClelland says. This includes
redundant, outdated, and trivial information, also known as ROT. For this
reason, most organizations embarking on IG should use a file analytics tool
that will scan content like emails, slide decks, and Word documents that have unstructured
data (e.g., text, numbers, videos) to determine its age, its key users, and
whether it is duplicated elsewhere in the organization.
his 10 years working on IG at Blue Cross Blue Shield of North Carolina, McClelland
developed what he believes is a four-step process for moving forward that
applies to hospitals as well as health plans.
Gain the authority to do the work. IG requires an executive champion to
drive the program forward as well as a director or vice president to run the
day-to-day operations and align the program to the goals of the organization. Some
organizations also are creating a chief information governance officer role,
although such titles are not common in health care. In other organizations, the
CIO, HIM director, privacy director, or another leader might take on the key
Develop the foundational components
of the program. These
components include retention schedules and electronically stored information (ESI)
maps, which depict the flow of information in an organization. Other key pieces
include standards, policies, data and records inventories, disaster recovery
plans, and educational programs for staff.
Create goals and targets. McClelland recommends establishing
roadmaps that span one, three, and five years. “Be reasonable about what you
can and cannot achieve,” he says.
Execute on the plan but be patient. Recognize that an IG program is
constantly evolving and does not have to achieve everything at once. Leaders
might choose one particular area of focus, such as regulatory or privacy, at
sure where to start? Experts offer the following advice to leaders who are interested
in developing enterprise-wide IG programs.
Assess your organization’s IG
maturity. Both Martin
and McClelland suggest looking at AHIMA’s IG Adoption Model (IGAM). In
December, the Office of the National Coordinator for Health Information
Technology (ONC) released a patient demographic data-quality framework that
endorsed the model, which includes 10 organizational competencies such as IG
structure, strategic alignment, and data governance (view a PDF of the model).
Smallwood believes the IGAM is a useful tool but
also points to the IG Process Maturity Model (IGPMM) from the Compliance,
Governance and Oversight Council (CGOC). The IGPMM was originally developed in
2012 and rates organizations on 22 key IG processes. It was updated in 2017 to
include an emphasis on legal, privacy, information security, and cloud security
issues. “Perhaps the best approach is a hybrid one, combining relevant aspects
of both maturity models to customize the assessment for a particular
organization’s needs and IG program goals,” Smallwood says.
Determine what resources you need.
leaders may perceive that funding is a barrier to developing IG programs, a
basic IG framework does not require a major investment and often can leverage
internal resources, Martin says. Cross-functional partnerships also can help
leaders make the most of limited funds and staff to advance IG, McClelland
Give clinicians a reason to
Poor IG across a
physician practice, hospital, and affiliated post-acute provider can lead to
inconsistent data quality in an organization and may affect the quality of
care. Clinical leaders may be more likely to get involved if they understand
that IG programs can help them deliver better care, McClelland says.
Engage human resources in
developing a formal kickoff as well as continued training. Consider launching an IG program
with an enterprise-wide security awareness or privacy training event, Smallwood
says. Ongoing staff education might include monthly IG tips presented in an
employee newsletter or brief quizzes on issues like privacy and security.
Use metrics to audit your IG program’s success. An IG
project to promote cleaner data to reduce medical errors might aim for a 5 or
10 percent reduction after 12 months, Smallwood says. Another project under the
IG program umbrella might be to clean up shared drives and major information
stores to eliminate ROT and reduce the storage footprint, setting a goal to at
least stop or slow the growth of electronic storage costs—or, more
aggressively, to cut costs by 10 to 15 percent.
IG is underutilized in health care, that trend is shifting as more
organizations begin to recognize the benefits, experts say. As adoption of IG
programs grows, leaders should not get overwhelmed in their early efforts to
manage information more strategically across the enterprise.
a project and just get started,” Martin says. “Then you will see that framework
really come to life.”
Ramos Hegwer is a
freelance writer and editor based in Lake Bluff, Ill.
for this article: Melissa
RHIA, CCS, CHTS-IM, assistant vice president, WVU Heart and Vascular Institute,
Morgantown, W.V.; Matt
consultant, Doculabs, Inc., Raleigh, N.C.; Robert
managing director, Institute for Information Governance, San Diego.
Cedar: Reimagining the Patient Financial Experience
Cedar’s CEO and co-founder tackles the topic of patient payment and the importance of having an innovative patient financial management system.
TRIMEDX: Moving Healthcare Providers Toward Mature Clinical Asset Management
This article includes a discussion by TRIMEDX leaders about the best ways to mature a clinical asset management program.
HealthTrust: Optimizing Purchased Services
Andrew Motz, assistant vice president, supply chain consulting at HealthTrust, discusses the value of a data-driven approach when procuring purchased services.
Change Healthcare: Accelerating Revenue Cycle Transformation
Jason Williams, vice president for strategy and business analytics, Change Healthcare, discusses the importance of technology and technology-enabled services in reinventing the revenue cycle.
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.