Using Dashboards to Drive Better Performance
Baptist Health saved an estimated $200,000 a year from just one change driven by its new dashboards.
The decision support team at Baptist Health, Little Rock, Ark., has implemented a new process combined with a self-service reporting tool to help service line leaders monitor their financial performance—and make quick decisions when needed.
“Our organization looks at our service line managers as catalysts for change,” says Brock Holman, director of managed care and decision support for Baptist Health, which is Arkansas’ largest not-for-profit healthcare delivery network. “We believe we should arm them with data and allow them to be responsible for their performance.”
At the same time, providing service line leaders with the ability to access self-service dashboards frees the decision support team to work on broader, systemwide initiatives, such as population health management. Baptist Health has one system-level CFO, but there are no hospital-level CFOs or dedicated financial analysts. The organization’s seven-member decision support team is responsible for operational accounting, labor management, contract management, forecasting, cost accounting, decision support, and ad hoc financial reporting.
“We have adopted a self-service approach to dashboards because of the scope of the work that we do and the limited number of analysts that we have in the organization,” Holman says. “We had to develop tools that users could drive themselves.”
A Self-Service Model
Up until last year, dashboard reporting was a mostly manual process that Holman’s team managed on an ad hoc basis. Before they adopted a new decision support platform, they had relied on a homegrown system using Structured Query Language (SQL) that pulled data from their electronic health record. A basic business intelligence tool only allowed analysts to develop “flat” reports that did not allow for much detail or customization. As a result, analysts spent a lot of time fielding and responding to new report requests each time a new need arose.
Turnaround time was another issue, says Andrew Covington, manager of decision support. “The bottleneck would sometimes be on us because we had to prioritize what we could do,” he says. At the same time, the decision support team was reluctant to say no to leaders who were engaged in critical performance improvement efforts.
Fortunately, the addition of self-reporting capabilities has created more capacity for Holman’s team to take on more work. Now users can access self-service dashboards for service line, profitability, and utilization reporting.
Service Line Dashboards
One example is the development of the “charge-based” service line report that the decision support team created for its newest hospital in Conway, Ark. The team needed a way to monitor volumes without having to wait for patients to be discharged/coded. “We developed service-line logic that groups patients based on the charges that have posted to their accounts, regardless of discharge/coded status,” Covington says. “It provides the service line leaders with more timely data, so they do not have to wait until the end of the month.”
The decision support team also has developed summary and detailed profitability dashboards that service line leaders can use to identify potential opportunities for the revenue cycle, cost savings, and costing methodology refinement.
For example, incorrectly coded charges in the revenue cycle can present substantial opportunities. Leaders used the tool to identify why some outpatient procedures had both a net loss and a negative direct margin. They determined that some implants were being incorrectly charged as non-implants, resulting in missed implant-specific payment. “There was a disconnect between the service line people and the revenue cycle people,” Covington says.
The profitability dashboards are used to identify trends in the following areas.
Payer mix. Service line leaders also can use the reports to identify payer mix and collection issues that can affect the revenue cycle, such as denials. When reviewing the neurosurgery service line, the team identified three cases for which the hospital received no payments because they were denied by Medicare. They also found some instances in which the hospital was repeatedly missing a charge for inpatient obstetrics cases. “We were missing out on reimbursement because of that,” Holman says.
Utilization. Regarding cost savings opportunities, service line leaders can use the profitability reports to identify physician variation in utilization, as well as length of stay and contract negotiation issues.
RVUs. In terms of costing methodology, service line leaders can use the reports to help identify opportunities to update RVUs. They also might find accounting issues that can create erroneous results. For example, revenue and/or expenses posting to the incorrect cost center, resulting in a disconnected relationship.
The decision support team also developed utilization dashboards that can assist leaders in identifying differences between facilities and physicians when similar services are performed.
For example, users can focus on inpatient medical supplies to identify opportunities to standardize costs and increase margins. Specifically, they can identify average supply cost per physician by DRG and identify variation.
For example, when reviewing the utilization of spinal implants, the neurosurgery service line leader met with physicians to discuss the data. The physicians were receptive and identified at least one opportunity to reduce variation in supply use. In fact, they were surprised to learn that one item cost twice as much as another and agreed to standardize to the less expensive item. As a result of this one change, they will save an estimated $200,000 a year.
Before rolling out the tool to the entire organization, Holman and Covington tested the new reporting process with a small user group. Today, hundreds of users across the organization utilize the decision support tool to access self-service dashboards.
Covington and Holman offer the following advice for CFOs and other finance leaders who want to leverage dashboards to improve organizational performance.
Market the initiative across the organization. “The CFO needs to sell the process and tell the organization that they have to transition to a new way of getting information and having conversations,” Holman says.
Give the decision support team and vendor adequate time to roll out the tool properly. “The CFO needs to be able to provide the resources to support this type of implementation and allow some other responsibilities to be put on hold,” Holman says.
Ensure clean data from day one. “Data issues can be the biggest holdup in a process like this,” Covington says. “Be skeptical about any data element you have and test it for completeness and reasonableness.”
Holman agrees. “No one expects the data to be perfect,” he says. “But it will kill a conversation [with an operational leader] if you can’t stand behind the data. We can have tools but credibility is really our best asset.”
Train service line managers on using the new tool. Although leaders at Baptist Health have not rolled out a formal training curriculum on the decision support tool for service line managers, Covington provides one-on-one training or group presentations on the tool. “We target people who we know are engaged,” he says.
Let service line leaders set the agenda for improving performance. “Our organization is large but not so large that we do not know the physicians who are likely to drive change,” Holman says. “If we find something in the reports, we will ask [service line leaders] about it. But we want these activities to be operations driven, not finance driven. It’s a better conversation whenever operations drives this.”
Looking Ahead to Episodic Performance
Holman says his decision support team is working with key leaders in Baptist Health’s physician organization to determine how they are going to approach episodic-based performance down the road, such as through a cardiac bundle. One of their goals is to build the functionality across the organization that will be needed to help leaders monitor their clinical and financial indicators.
“Our concern is that if you can’t marry up your claims data with your cost data, you may never be able to drive the kind of change that you need to,” Holman says. “[With the decision support tool,] we can make better strategy decisions.”
Interviewed for this article:
Brock Holman is director of managed care and decision support, Baptist Health, Little Rock, Ark., and is a member of HFMA’s Arkansas Chapter.
Andrew Covington is manager of decision support, Baptist Health, and is a member of HFMA’s Arkansas Chapter.
This article is based in part on a presentation at the 2016 Strata Decision Summit in October in Chicago.