For the health care industry, Kim Hollingsworth describes information dashboards as "a wave everybody is jumping on." By aggregating information form disparate sources, the dashboard provides a convenient tool to spot performance trends and curb small problems before they become big ones, says Hollingsworth, partner, revenue management, at IMA Consulting.
There are any number of indicators along the revenue cycle that warrant monitoring, she says, but as the technology has grown more sophisticated, executives in other areas of the hospital are using information scorecards to good measure. Following are snapshots of how several organizations are using dashboards.
Tracking Census Indicators
One year ago, Hartford (Conn.) Hospital put in dashboard technology from CareFx. Systems that feed it include the hospital's EHR, from Allscripts, and its financial system, from Siemens. "We had a shortage of real-time data in useable form," recalls Michael Lindberg, M.D., chairman of the department of medicine at the 700-bed teaching hospital.
Lindberg uses the dashboard to track data in three key areas.
The first is patient data, including a tabulation of patient length-of-stay and the percentage of early morning discharges. Another shows bed availability, the type of beds open, and the percentage of beds not available for patients, such as those being cleaned, or those in a room with an accompanying patient in isolation. A third scoreboard gives the readmission rate for patients brought back into the hospital less than 30 days since their last discharge.
Lindberg breaks down the data by individual groups of physicians. He creates a report each quarter for the hospitalists, which shows their average length-of-stay and readmission rates.
"We can take the high performers, see what looks to be effective for them, and model their behavior for others," he says. "Nursing managers also get the same information. They can see how their unit is performing compared to others. It sets up healthy competition."
The dashboard data helps Lindberg fulfill Joint Commission requirements for ongoing physician evaluations. He can identify trends and run comparisons over a several month period.
"We need to have a handle on what physicians are doing," he says. "Having a database to drill down to the individual physician goes a long way toward satisfying those requirements."
Purely financial data is not yet available on the CareFx dashboard. But Lindberg is lobbying to add such indicators as cost per hospitalization broken by physician and department. "We could show who might be an outlier for test ordering," he says.
Increasing Upfront Collections
Health First, a four-hospital delivery system based in Rockledge, Fla., uses an information dashboard, from McKesson, that aggregates data from multiple sources, including clinical, financial and administrative systems.
For Michelle Fox, director of revenue operations and patient access, the dashboard has helped monitor registration activity and upfront collections from patients for co-pays and deductibles. The work occurs at the very front end of the revenue cycle, but the efficiencies show up on the bottom line.
One routine task Fox undertakes with the scorecard is a registration audit, which monitors the performance and productivity of more than 100 staff handling patient registration duties.
The scorecard shows-by registrar-a number of data sets, including the number of accounts worked and the average collections per registration.
The dashboard also weights registration activity, giving staff more credit for complete registrations that require assembling all information, as opposed to rolling over a file already started, Fox says. The dashboard pulls in data from Health First's scheduling system, from SCI, which handles pre-registration activities and does eligibility verification as well.
Fox underscores to the registrars the importance of collecting as much as possible from patients before service is rendered. "It sounds easy, but patients say they would rather be billed," Fox says. Delaying collections boosts the odds the bill may wind up as bad debt. "Health care is the last bill people want to pay," Fox says. Fox distributes a daily report to her staff showing what registrars have collected. "It creates competition," she says.
The strategy has worked for her. From fiscal 2009 to 2010, Health First boosted its point-of-service collections by 22 percent, or about $1.1 million. And from 2007 to 2008, collections jumped $2.2 million.
Monitoring Payer Delays
One of the challenges of monitoring the revenue cycle is the multitude of different payers typically in play. Legacy Health, a Portland, Ore.-based delivery system with five hospitals, works with more than 600 payers, says Terrie Handy, director of revenue cycle. It uses an enterprise dashboard, built by Huron Consulting, to help keep tabs on Legacy's primary payers. The dashboard, which draws data from the hospital's billing system, from Epic, shows the cash flow for 24 key payers, including Medicare, Medicaid, and larger commercial contracts.
"It gives weekly, daily and monthly tallies for what dollars are flowing in," she says. In addition, the dashboard gives a projected figure for what the cash flow should be, so if there is a major discrepancy, Handy can investigate.
In one instance, the dashboard revealed a drop in payments from a Blues plan, which Handy raised during her monthly meeting with the payer. Turns out the payer had internal staffing issues, which was causing some claims processing delays. In another case, Handy learned that the local Medicaid payer had gone through a claims administration system conversion, and payments were delayed. But being able to present payers with objective data speeds delayed payments, she says. "Payers will dedicate their resources to processing the claims from the squeaky wheel providers," she says.
In addition, Legacy uses dashboards-part of the Epic system-to monitor both professional and hospital billing metrics. These dashboards show similar financial metrics, including A/R days, total charges, payments and adjustments. Legacy is working with Epic to improve the system's denial management reporting capabilities, including the ability to analyze denials by service line, adds Mary Kjemperud, vice president, revenue cycle.
Working denials is one of the keys to revenue cycle management. And at Concord (N.H.) Hospital, an information scorecard has proven to be a valuable tool in the effort. For the last two years, the 250-bed hospital has used a Web-based denials management scorecard from McKesson, that works in conjunction with the software vendor's Relay Health claims clearinghouse.
The dashboard aggregates claims status, showing data on the 14 payers that constitute the vast majority of Concord's claims, explains Tom Antinerella, director of patient access.
Denials files can be returned shortly after a claim batch is sent to Relay, and sometimes Antinerella spots problems on the payer side that the plan didn't even know about. "They can have information system issues and we're the first ones to tell them," he says.
Since implementing the dashboard, Concord has had a substantial decrease in the number of billing write-offs that originated with missing or inaccurate information. Antinerella circulates a report generated from the dashboard to the registrars responsible for the accounts, who then take corrective action.
"The registrars get the account numbers, do the forensics, and figure out what they did wrong," he says. "There is no punitive element. The report is just meant as feedback."
This past July, Concord wrote off $180,000-compared with $490,000 in write-offs in July 2009. Granting departments access to the dashboard has paid off as well, as certain areas, such as radiology and cardiology, saw improvements in their denial rate due to internal errors that were corrected.
Using the scorecard, Antinerella can crunch claims data by department, or by payer. The billing and follow-up departments are organized by payer, so the scorecard gives them insight into their particular areas of responsibilities, he adds.
"If you show people the impact of their actions on the life cycle of a claim, you get changes in behavior," he says.
Tracking Medication Expenses
Based in Arlington, Texas, Northstar Anesthesia contracts with 42 hospitals in six states. It uses an information dashboard, from Shareable Ink, that monitors the productivity and quality performance of the 460 physicians and nurses it dispatches to assignments. The platform uses digital pens, which doctors use to document anesthesia care on special forms designed to capture both discrete data and image files, says Brian Woods, M.D., who serves as chief medical officer at Northstar.
The discrete data fields generate billing data, which is exported to a billing service. The system also collects aggregate data-22 metrics in all-which Woods reviews through a secure Web site. He analyzes performance from the regional level down to the individual.
For example, the system shows turnover time between patients, a key indicator of anesthesia productivity. It also reveals the expenses generated by each physician, so if one provider generates considerably more medication expense than another on a similar case, Woods will intervene.
Northstar opens up the scorecard to providers so they can see how they stack up against their peers. And the group also gives hospitals access. After a procedure, the hospital pharmacist uses the system to perform medication reconciliation, checking the physician report against the drug tray returned after the procedure. Pharmacists might note that the physicians did not check off every drug used, and can note the error. It's important for the anesthesiologists to be as cost-effective as possible, Woods says, even though the hospital bears the expenses of the drugs used. "The hospital is the ultimate financier of anesthesia services," he says. "We don't have a job if they can't keep their doors open."
Northstar also uses the dashboard to track its compliance with core measure reporting for CMS. If the practice hits certain measures, such as administering antibiotics within 60 minutes of incision, it qualifies for a 2 percent return on total annual Medicare billing. That translates to a potential bonus of upward of half a million dollars annually, so it pays to uphold quality measures, Woods says. "Physicians have never been held accountable," he says. "They've done, spent and charged whatever they want. In today's marketplace, physicians have to be held accountable for performance. It is a tough conversation to have, but with objective data, you can do it."
Reducing A/R Days
Two information dashboards are in play at Excel Eye Center, Provo, Utah. One is provided by Navicure, the vision care group practice's claims clearinghouse, and the other by NextGen, the group's EHR/practice management system vendor.
The Navicure dashboard displays data on the total number of claims submitted, rejections, claims pending, and claims paid. It's been in place since the Eye Center-which has nine ophthalmologists and three optometrists-switched to Navicure in 2008.
Using the dashboard, Brittney Wachter, business manager, can drill down to individual claims and correct errors-sometimes before the clearinghouse even dispatches the claim to the payer.
That's because Navicure has built in "edits," or cautionary alerts pertaining to certain data fields that would stop a claim from proceeding. "When you click in, you know right where to go," she says. "A message tells the error. It could be the wrong patient ID or wrong date of birth, any number of small things."
Since switching to Navicure, the practice has reduced its average days in A/R from 45 to 29, Wachter says. The dashboard has figured in that reduction, given its capacity to portray claims needing additional work.
The NextGen dashboard, which Wachter uses less frequently, gives a provider-by-provider breakdown of patient volume, and also reveals appointments in the pipeline for Excel's five sites.
Tracking patient flow like that lets Wachter know the group is on target for meeting monthly goals. The NextGen dashboard includes a built-in tasking system that Wachter and her crew use when working certain accounts. Billing staff use the system to keep tabs on outstanding patient balances, with embedded notes about when to make follow-up calls. "The point is to not have a bunch of sticky notes on your desk," Wachter says. "We can do it right from the computer."
Cutting Supply Chain Waste
When it comes to data management, Drex Deford is a big believer in graphical representations.
"A picture is worth 1,000 lines in a spreadsheet," he says. Deford is the CIO at Seattle Children's Hospital, a facility that is attempting to gives its employees the capacity to create data visualization tools. One year ago, Seattle began using dashboard creation software from Tableau.
The software enables staff to pull data from multiple sources, including their own personal spreadsheets, and import it into a dashboard, which can then be shared across the organization or replicated as needed. The package enables the creation of many types of charts, including bar, pie, scattergram and Gantt charts, a type of multi-faceted project management timeline.
Children's supply chain management department used the Tableau tool as part of an effort to streamline the purchasing and distribution of supplies, says Ted Corbett, director of knowledge management. The dashboard revealed which products were being used and how quickly. By keeping inventories at appropriate levels, the hospital was able to avoid costly special orders, and more importantly, free up valuable clinician time from tracking down needed supplies, adds Deford.
The "demand flow" system is based on industrial techniques pioneered by Toyota, he says. In sum, the hospital reduced its annual supply chain costs by about $3 million, Corbett says.
Deford's own IT department uses the system to track its ongoing projects. The timelines give him a sense of what everyone's working on, and he can analyze staff activity by various factors, such as area of hospital or executive sponsor. "It helps me manage the number of hours people are working on any one project," he says. "It helps determine priorities."
This story originally appeared on Health Data Management.
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