Walking with Dashboards: Current and Future Practices for Management and Board Level Compliance Dashboards

Transcription

1 Walking with Dashboards: Current and Future Practices for Management and Board Level Compliance Dashboards HCCA New England Regional Conference September 7, Presenters: Kate Connelly Kelly Sauders Agenda Selecting the right metrics to achieve your goals and drive continuous improvement Pros and cons of qualitative vs. quantitative reporting Achieving a balance between static and variable measures Practical examples of Dashboard reports Note: Data presented to in Dashboard examples is fictional and is intended for illustration purposes only. HCCA New England Regional Conference, September 7,.

2 Selecting the Right Metrics to Achieve Your Goals and Drive Continuous Improvement Selecting the Right Metrics: Define Your Audience Questions to consider: Board-level Management-level Internal External HCCA New England Regional Conference, September 7,.

3 Selecting the Right Metrics: Define Your Goals Questions to consider: Infrastructure vs. Risk (or both)? Actionable vs. Informational Items Prioritized vs. Total Universe Follow Up on Previously Identified Issues to Drive Improvement and Measure Progress 4 HCCA New England Regional Conference, September 7,. Goal: Continuous Improvement Example # 5 HCCA New England Regional Conference, September 7,.

4 Goal: Continuous Improvement - Example # Source Entity Engagement Internal JKL Self-administered Drug Billing Date of Initial Reporting February, 9 Risk Status Moderate Internal DEF Crediting of Laboratory Testing January 9, High Internal ABC Interventional Cardiology Coding April 9, High Internal ABC Dialysis Charge Capture May, Moderate Internal GHI Vendor Purchasing/Conflicts Disclosure Process May, High External DEF Short Stay Discharges October, High 4 External JKL Hemophilia Clotting Factors Biling November 9, High 4 Internal DEF PQRI Reporting for Orthopaedics January 9, Low External ABC Partial Hospitalization Program Documentation and Billing January, Moderate 6 KEY Corrective Actions Implemented Corrective Actions Implementation In Process- On Track Corrective Actions Implementation In Process- Overall On Track, One or Moderate/Low Risk Items Behind Schedule 4 Corrective Actions Implementation In Process- One or More High Risk Behind Schedule 5 Corrective Actions Implementation In Process- Not Started HCCA New England Regional Conference, September 7,. Selecting the Right Metrics: Continuously Reassess Incorporate feedback into the development of your dashboard reporting It is unlikely that everyone agree on any one approach Re-evaluate the report on a periodic basis to determine if it captures the need of your organization and the needs of the audience 7 HCCA New England Regional Conference, September 7,. 4

5 Qualitative vs. Quantitative Reporting Pros and Cons Qualitative vs. Quantitative reporting Quantitative Pros Provides a basis for comparison Is easily tracked/ trended Cons Depends upon common definitions/ interpretations of standards Focus on outcomes/scores can detract from overall message Application of quantitative measures to assess compliance efficacy has yet to be successfully demonstrated Qualitative Provides capability to factor risk and efficacy of underlying processes into the results Analysis can be completed more efficiently / less resource intensive Getting everyone on the same page in terms of what is important can be a challenge Results are subjective Objective measurement of progress is difficult 9 HCCA New England Regional Conference, September 7,. 5

6 Example: 7 Elements (Quantitative) Corporate-Wide 7 Elements ABC GHI JKL DEF MNO PQR Compliance Oversight Policies & Procedures Average Communication Training & Education Auditing and Monitoring Response to Deficiencies Enforcement HCCA New England Regional Conference, September 7,. Example: OIG Risk Area (Quantitative) Billing Trend Summary: Outpatient Payments Greater Than $5k Number of Cases by Service by Entity per Quarter Data Timeline: Q(7//-9//) Q(//-//) Q(//-//) Device A Device B Drug A Drug B Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q ABC DEF GHI JKL MNO PR HCCA New England Regional Conference, September 7,. 6

7 Example: Enterprise Risk Management Reporting (Qualitative) Enterprise-wide risk assessment Sample Heat Map What are our risks Risk Glossary HCCA New England Regional Conference, September 7,. Achieving a Balance Static vs. Variable Reporting 7

8 Static and Variable measures Goal: Achieve a balance between static measures to track progress over time and variable measures to accommodate external environmental changes. Capture progress while not getting stuck in the past Consider a combination approach: 7 elements / Infrastructure: STATIC Assessment of Specific Risks: VARIABLE TIP: Continually reassess usefulness of reporting elements 4 HCCA New England Regional Conference, September 7,. Example: The changing risk profile Risks are fluid and can often change over time. So too can the risk profile of an organization change, as reflected in the example below. Prior Year Red Risks Physician Financial Relationships Red Risks Short Stay Admissions NEW Revenue Cycle: Front End Revenue Cycle: Back End Medicare / Medicaid Funding Joint Ventures / Mergers Physician Billing Credit Balances Quality of Care RAC Readiness / Preparedness Readmissions NEW Alliances - Physician and Other Partnerships Medicare / Medicaid Funding Quality Metrics Reporting NEW Physician Billing External Regulatory Audits NEW Financial Margins Clinical Documentation and Coding Legend NEW = New risk this year = Risk ranked higher this year = Risk ranked lower this year 5 HCCA New England Regional Conference, September 7,. 8

9 Practical Examples of Dashboard Reports Additional Practical Examples of Real Dashboards Tracking OIG Compliance Audit Risk Areas Short Stay Admissions/PEPPER Privacy/Security Dashboard 7 HCCA New England Regional Conference, September 7,. 9

10 OIG Compliance Focus: Inpatient Outlier Payments Billing Trend Summary: Inpatient Outlier Payments Number of Cases by Entity per Quarter Q (July-Sept ) Q (Oct-Dec ) Q (Jan-March ) ABC DEF GHI JKL MNO PQR 8 HCCA New England Regional Conference, September 7,. OIG Compliance Focus: Inpatient Payments > Charges Billing Trend Summary: Inpatient Payments Greater Than Charges Number of Cases by Entity per Quarter Q (July-Sept. ) Q (Oct-Dec ) Q (Jan-March ) ABC DEF GHI JKL MNO PQR 9 HCCA New England Regional Conference, September 7,.

11 OIG Compliance Focus: Medicare Short Stays (- days) HCCA New England Regional Conference, September 7,. Compliance Focus: Readmissions *Sample MedeAnalytics Report HCCA New England Regional Conference, September 7,.

12 HCCA New England Regional Conference, September 7,. Speaker Contact Information Kate Connelly, CPA, MBA Director, Compliance Coding/Billing and Audit Partners HealthCare Charlestown, MA Phone: (67) Kelly J. Sauders, CPA, MBA Partner Deloitte & Touche LLP New York, NY Phone: (58) HCCA New England Regional Conference, September 7,.