Revenue Cycle Management: Analytics At The Crossroads

By Amanda Griffith, Contributing Writer

By using analytics technology to measure revenue metrics across facilities and physicians, Orlando Health avoided $22.7 million in bad debt write-offs.

In the past, the use of business analytics helped healthcare organizations improve financial performance, but their use was traditionally confined to analysts and other financial specialists. Today, healthcare’s decision makers have increasingly seen the value of having access to analytics solutions that give them actionable insight into the information they need — at both the right time and the right level of detail. Jose Rivera, CMPE, corporate director, Physician & Professional Services at Orlando Health, has experienced this evolution firsthand.

Orlando Health is a $2.1 billion, seven-hospital enterprise whose growth has presented significant organizational challenges. Since 2006, the Orlando Health Physician Group (OHPG) has grown from 70 to 500 employed physicians. Prior to being acquired, these practices had a wide variety of billing systems and revenue cycle processes in place. As a result, Orlando Health struggled with revenue cycle management efficiency and accuracy.

Combine Hospital And Physician Data On One Platform
Strengthening the organization operationally required getting all 500 physicians on the same page while promoting the most effective and cost-effective administrative practices. As a result, Rivera needed to understand each physician’s contribution while identifying a way to share information and workflows between the hospital and physician central business offices (CBOs).

“I’m a huge believer in the ideology that if you can’t measure it, you can’t manage it,” said Rivera, who manages the central business office and revenue cycle for all of Orlando Health’s employed doctors. “In doing so, there are so many variables in a revenue cycle, from patient scheduling to payment or denial. Our job is to make sure we generate a correct claim from each charge and then follow that claim through until it gets paid.”

The problem? Orlando Health didn’t have an enterprisewide analytics platform that gave the organization the ability to extract data out of the system in a manageable, easy-to-understand way. Within its practice management system, Orlando Health had an analytics tool but needed something enterprisewide. Rivera knew he needed a vendor that could help track and manage data inbounding from both hospital and physician CBO accounts receivable, but found there were few options.

“I’ve been involved in physician RCM for 20 years, and while things are getting better, most organizations have a silo in which the physician group doesn’t coordinate with the hospital and vice versa,” said Rivera. “Now that hospitals like Orlando Health have begun to acquire more and more physician groups, that has to change.”

Rivera knew he needed to find a way to integrate physician activities with the overall strategy of the healthcare organization, which he then needed to interpret to gain a clear understanding of how each physician’s performance supported the overall health system goals. After conducting his due diligence, Rivera and OHPG found an effective way to do both through an innovative approach that combines both hospital and physician data to create one common platform. This data can be merged to provide a complete picture of a physician’s revenue — from the practice to the hospital and vice versa.

Using Analytics To Make Better Business Decisions
The answer? VisiQuate, a company that offered Orlando Health proven SaaS solutions that could manage the volume, variety, and velocity of Big Data. Rivera liked that the app-like visualizations helped uncover hidden root causes, trends, and opportunities and could lead directly to real-world results for users at all levels.

“VisiQuate offered user-friendly analytics solutions that provided a dashboard effect with the ability to drill down and get into data that we can make business decisions on, quickly,” explained Rivera. “As an executive, I don’t always need to know what’s going right, but I want to know what’s going wrong, and I want a system to tell me that.”

Orlando Health has brought its hospital and physician practice revenue cycle systems into better balance using four sets of customized analytics from its vendor, including physician performance analytics, patient-pay analytics, revenue management analytics, and enterprise management analytics.

“We needed to create unified processes and guidelines to better serve our patients,” Rivera explained. “From a cost perspective, we’re saving money because we can marry hospital and CBO billing so Orlando Health now only pays for financial indicators once, not twice.”

Improve Revenue Capture, Avoid Bad Debt Write-Offs
Since 2010, when Orlando Health began using VisiQuate’s business analytics to improve revenue capture, the organization has achieved greater operational efficiencies and aligned performance with organizational goals. What’s more, Orlando Health’s physician enterprise has avoided approximately $22.7 million in bad debt write-offs each year, at least 62 percent of that amount directly attributed to its analytics platform.

“Common platforms, work files, and work lists are now possible because of the dashboards, functionality, and drilldown capabilities we have at our fingertips,” Rivera said. “Everyday alerts and better information tracking mean we can communicate better across the organization, and everyone knows how we are doing for the month.”

In addition, its leading indicators (ratio of conversation rate to final-billed, overall insurance verification of scheduled patients, collector productivity scores, charity-eligible workflow, and cross-system charity write-off flags) are no longer lagging. While lagging indicators do have their value, forward-facing and predictive analytics that present leading indicators and offer actionable workflows will be increasingly critical to remaining competitive in the evolving healthcare marketplace.

“If I look into the future, it’s easy to see that the revenue cycle is changing to a quality-focused world, and we’ll have to start marrying clinical and financial data,” offered Rivera. “We’re equipped to do that now.”

As a result of its revenue cycle analytics solution, Orlando Health has also reduced its prebilling hold times significantly in the five years since implementation, to the tune of a more than 30 percent reduction. Much of that is due to applications that grow with the organization’s changing needs while remaining easy to navigate and use. Rivera and his staff are now also able to reach a level of granularity where they can create individual score cards for each member of their teams, accurately tracking productivity levels over the course of any given month.

“It’s so important to take advantage of available data as much and as quickly as possible,” Rivera offers. “Changing the culture of our organization to be more data-driven has been the root of the successes we’ve had. Whereas before we couldn’t measure or manage data, now we can and are even able to use analytics to predict the future.”