MARGIN MANAGEMENT Beyond Documentation Maximizing the Performance of Your Mid-Cycle Hollie Freeman Senior Director Ben Koppenheffer Associate Director
2 Significant Investments, But to What End? ICD-10 Drove Significant Spending in People and Technology Physician Education Technology Investments: - Online Documentation Education Hospital Information Management Technology Investments: - Computer Assisted Coding Clinical Documentation Improvement Technology Investments: - CDI Workflow Tools Lacking Prioritization Unmeasured Outcomes Lack of Ongoing Monitoring
Net Revenue 3 Limited Insight into Total Opportunity Clinical Documentation Improvement $5.5 M Post-payment Takebacks $3.0 M Potential Revenue Potential Takebacks Actual Potential Inefficiencies of Current Structure Time Disparate Organizational Silos Scattered Data Sources Competing Priorities Lack of Visibility Into Bottom Line Impact
4 Lack of Benchmarks US Hospitals Your Hospital 2015 ICD-10 Conversion March 2017 CMS Benchmarks available You won t know how you stack up until it s too late Ongoing monitoring necessary
5 Best In Class Organizations Guided by Analytics Proactively identify areas of risk using performance metrics and create alerts to identify problems early Build an action plan that empowers teams to change behavior by prioritizing efforts and assigning accountability Monitor and leverage meaningful benchmarks to provide unique insights (i.e. where are the biggest risks) Create a common language about clinical behavior change to translate physician behavior into financial improvements Assign accountability and build action plan
6 Driving Significant Results through Prevention Maximize Reimbursement Prevent Revenue Leakage Operate Efficiently Bringing It All Together Improve CMI, CC/MCC Capture, and Unspecified Code Usage Clinical Documentation Risk Logic, Documentation Concepts Revenue Optimization Compass Decrease DNFC and Days A/R Mitigate Compliance Risk Monitor ICD-10 Performance
7 Proprietary Tools Provide Actionable Insight Documentation Concept Library Focus on Concepts, Not Codes Risk Target Library Identify Post-payment Takeback Risks Customized Benchmarks Identify Gaps and Target Improvements Used by 145 health systems and 500+ hospitals $18,031,962 Revenue projected through risk mitigation training at SCL Health 95% ICD-10 physician documentation compliance at Munson Health $3,100,000 Added reimbursement in first six months post-training at Mississippi Baptist
8 Four Steps Promote Continued Success 1 2 Create Physician Scorecards Focus on physicians with greatest opportunity Track data monthly Conduct DNFC Analysis Ensure CDI is not compromising cash flows CMI increase should not mean an increase in DNFC 3 4 Define your 10-10-10 Determine top 10 service lines, codes, and physicians with greatest opportunity Identify where to focus efforts going forward Review Midcycle Denials Dashboard Track top drivers of midcycle denials monthly Parse denials by root cause and course correct as needed
9 Beyond Technology: Three Pillars Drive Lasting Change Connect Advise Educate Cohort of Peers Members collaborate on midcycle issues to share best practices for revenue optimization and maximize documentation, coding processes Dedicated Advisor Your dedicated advisor teaches, advises and connects your team, so you know how to make the most of the technology at your fingertips Financial Leadership Council The Advisory Board s research engine for hospital and health system finance leaders provides strategy and best practices, diagnostic tools and benchmarks 2014 The Advisory Board Company advisory.com
Case Study 10 Rapid Reimbursement Growth from Dedicated Effort West Virginia United Health System 90 days Find Opportunities Specialties Improve Documentation Generate Returns Additional Reimbursement From CMI Increase Codes Concepts Laterality Encounter Updated query forms Documentation tip sheets Pocket guides Posters in physician lounges $130K $178K $308 K Camden Clark UHC Total
Case Study 11 Multi-pronged Attack Decreases Audit Risk Community Medical Center Expanding Scope of Audit Defense Sustained Returns over Four Years Impact Risk Prevention Activities Dollars at Risk of RAC Audit 1 $16.3M $16.0M $13.1M $9.8M Risk Exposure Analysis Audit Workflow Audit tracking Appeals Risk stratification Opportunity identification Physician education Audit prevention Time Year 1 Year 2 Year 3 Year 4 Audit Letters Received 487 314 283 73 Year 1 Year 2 Year 3 Year 4 1 Risk determined using Revenue Optimization Compass audit monitoring functionality