Data and analytics are at the heart of every healthcare organization, from deciding how to best contact patients to identifying ways to decrease bad debt and improve revenue. Experts Fran Eviston-Ball, CEO at Summit Radiology, Oliver DiLivio, Director of Finance at Integrative Emergency Services, and Tom Cavanaugh, VP of Product Management at Zotec Partners, provide their insight on how they use data to drive decision-making in their everyday lives.
How do you utilize data to run your business?
Fran: If you can’t measure it, you can’t manage it. We understood how the radiologists worked and optimized their efficiency, but when we started looking at the revenue side, we weren’t measuring things like collections and payor contracts. If practitioners are educated on the front end, it helps with collections and fewer denials on the back end. This allows our board to be well-education decision makers.
Oliver: We use data to create an accurate forecast of revenue for a whole year in advance. We leverage the analytics from the revenue cycle side of the business to model and track budgets. This level of fidelity also allows us to detect anomalies and drive solutions.
How are we using machine learning and AI at Zotec to help our providers optimize revenue?
Tom: For charges that require manual intervention, we use AI to guide them into the right place to be worked appropriately. We also have technology solutions such as ZiTCH. We understand the role that high-deductible plans play today and utilize a claim-holding strategy to avoid these plans so that when we file, these claims are fully adjudicated by the payors, reducing bad debt.
How do you use data to build trust?
Fran: The revenue cycle is the lifeline of any healthcare organization. Where there is transparency, we can build trust. We give our decision-makers access to information and ask them to question it, allowing us all to be nimble in our decision-making. Therefore, as each decision is made, it builds trust both internally and externally.
How do you leverage transparency within your organization?
Oliver: We have a lot of providers that are on productivity-based pay models. Having confidence and transparency in the work being performed and the RVUs being generated has settled many questions and eliminated uncertainty. It has made us quicker to action, built trust with our provider leaders and employees, and maximized revenue by finding areas to target.
How can we use data and analytics to help practices thrive in a constantly changing environment?
Tom: The RVU rule comes out every year, so one thing we supply is the RVU Impact Analysis to provide custom financial guidance to each of our clients. There are a lot of other changes coming in 2023, so we are focused on supporting our clients with the data they need to execute their processes going forward.
What are some of the top data metrics that you focus on at your practice?
Fran: Charges are essential to make sure everything is consistent. It’s easy to be transparent by looking in CZAR to ensure no hospital partners have made changes, and we can quickly make sure that all our collections match up as well.
Oliver: We spend a tremendous amount of time looking at the back-end data that comes from the charge liquidation report in CZAR and using that with other denial information. We go by the payor to track common denial trends and find deviations from that.
Can you provide a real-life story of using data to make a quick decision?
Fran: One of our healthcare partners has had a relationship with us for decades, but they do not always provide the information we need to ensure our collections and denials are on track. With the data transparency from Zotec, we can quickly find anomalies and go back to our client and ask if there have been any changes. In the past, it would have taken us 6 to 8 months to catch something like this.
How have you used data to find scalable opportunities?
Oliver: One of the data points we like to look at, especially with our emergency medicine groups, is RVUs per patient they are generating. You may find providers with substantial variances within the same group, and you can learn how documentation is performed by each provider. This helps ensure that your providers and your practice are genuinely getting compensated for their performance.
How can data and analytics help practices provide a more compassionate patient experience?
Tom: Everyone has different preferences, so we use data and analytics to determine how to best contact patients to provide them with their bills and walk them through the process. We also use data and analytics to know the correct information and what to say to the patient to alleviate stress. We then use patient feedback to learn and change the process going forward.
How do you use data to support patients with their healthcare financial experience?
Oliver: When we looked across many of our emergency department groups, we noticed a higher propensity to pay and higher average payments from self-pay patients when the charge master was lower. When we apply our uninsured discount, we are doing sensitivity analysis and trying to find a sweet spot that improves patient experience while also increasing revenue.
How do you use data to validate performance?
Fran: We partnered with Zotec a few months before the COVID-19 pandemic. We weren’t sure how we were going to navigate the pandemic. Partnering with Zotec and having transparency helped us analyze how we were staffing our physicians and how our patients’ situations were impacted to ensure it was a good experience from everyone’s perspective.
What are some strategies to keep data safe?
Tom: Make sure monitoring is set up around all the infrastructure you are responsible for to track the data going in and out and catch any possible anomalies. A lot of data breaches come from user access points. Therefore, utilize two-factor authentication. For reports that provide patient health information, such as the charge liquidation report, we use encryption to ensure data security.
What type of data do you hope to get in the future?
Oliver: One of the things we are most focused on is ensuring appropriate payment. A piece of that is the No Surprises Act which allows us to have options in how we want to pursue recoveries on accounts. Another big piece of this process is the qualified payment amount, and I think greater transparency in how insurers calculate this is where I hope we can get some more clarity.
Tom: We want to really drive improvement with patient satisfaction as well as in online reputation management. We really want to make the end-to-end process wholly transparent and satisfying to provider groups and patients.
For further information, Fran Eviston-Ball can be reached at firstname.lastname@example.org. Oliver DiLivio can be reached at email@example.com. And Tom Cavanaugh can be reached at firstname.lastname@example.org.Watch Now