Data-Driven Clinical Documentation Improvement Program Increases Revenue and Improves Accuracy of Risk Adjusted Quality Metrics

Allina Health, an integrated delivery system throughout Minnesota and western Wisconsin, has long understood the value of clinical documentation improvement (CDI), and its growing importance in recent years. With the implementation of ICD-10, the specificity needed for accurate coding has increased, and reimbursement shifts have occurred as well, creating sizeable payment disparity for some clinical conditions. Leaders at Allina wanted to understand where their CDI program would have the greatest return on investment. However, data from the EHR was not sufficient to inform their strategy. CDI specialists still lacked the ability to perform a comprehensive assessment of the accuracy of clinical documentation, and were unable to confidently target improvement efforts in areas that would generate the greatest return on investment. To take a more data-driven approach, team members leveraged the Health Catalyst Analytics Platform, including their Late-Binding™ Data Warehouse and broad suite of analytics applications to develop a CDI analytics application. With the application, the team identified opportunities and thoroughly vetted them, before collaborating with physicians and service line leaders to educate providers on documentation improvements.

They achieved the following results:

  • 12.1 percent improvement in CV surgical cardiology CC/MCC capture rate.
  • 6.3 percent increase in medical cardiology CC/MCC capture rate.
  • Increased accuracy in publically reported risk adjusted quality metrics
  • Revenue capture improvement across the system – resulting in millions of dollars of additional reimbursements.
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Mission Health Receives 100 Percent of At-Risk Dollars in Payer Incentive Program

Since 2004, the US healthcare system has annually ranked last relative to 10 other developed nations in quality, access, efficiency, equity, and health outcomes. In an effort to improve the quality of care and patient outcomes in the U.S., the Center for Medicare and Medicaid (CMS) launched a series of quality incentive programs designed to generate a shift from volume to value-based reimbursement.  The health insurance industry soon followed their lead, and started writing contracts with hospitals in which a percentage of payment was based on performance on selected quality metrics.

Faced with the challenge of reporting on numerous incentive programs with differing expectations, Mission Health leveraged their enterprise data warehouse to aggregate the data needed to track the quality measures. With millions of dollars on the line with one particular payer, Mission developed an analytics application to monitor performance on the metrics in that contract.  The application was used to analyze whether performance feedback and workflow changes would lead to improved performance on the metrics, thus ensuring that they would maximize reimbursement, while improving care for patients.

Results:

  • Achieved 100 percent of all at risk dollars.
  • 100 percent of the ambulatory metric targets were exceeded, some by as much as 19 percent.
  • All five hospitals exceeded targets for 80 percent or more of their inpatient metrics.
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Nurse-Driven Protocol Optimizes Management of Post Op Afib While Reducing LOS and Costs

Post Operative Atrial Fibrillation occurs in up to 30 percent of all patients after cardiac surgery. This serious complication increases the length of the patient’s hospital stay, and is associated with a twofold increase in the incidence of cerebral infarction and an increased risk of 30-day mortality. Timely and consistent management of Post Op Afib can prevent significant complications and help prevent death. To standardize such an approach to managing Post Op Afib, Allina Health’s Minneapolis Heart Institute created a physician committee to raise consensus on and develop a protocol for Post Op Afib management.

The committee ultimately created a nurse-driven protocol and decision support algorithm linked to the health system’s electronic health record (EHR). Additionally, it uses analytics, supported by Health Catalyst’s Late-Binding™ Enterprise Data Warehouse (EDW), to track physician ordering rate, patient outcomes, and cost. This combination of people, processes, and analytics tools has made a significant difference for Allina and its patients.

  • Two-day reduction in ICU LOS.
  • 5.9 percentage point reduction in ICU readmission rate.
  • $1.5 million savings.
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Data-Driven Approach to Improving Cardiovascular Care and Operations Leads to $75M in Improvements

Health spending in the United States is greater than the gross domestic product of most nations, and the costs for cardiovascular disease (CVD) and stroke care alone total $193.1 billion. CVD accounts for approximately one out of every three deaths in the U.S. and contributes to the shorter life expectancy of Americans. Thirty-five percent of CVD related deaths occur before the age of 75 years, and 19 percent before the age of 65.

Allina Health is a large integrated healthcare delivery network operating in Minnesota and western Wisconsin that includes three large cardiac centers. Due to the prevalence and mortality rate of CVD, leaders at Allina Health recognized that they needed to focus on cardiovascular health in order to truly impact the population health and patient outcomes of the communities they serve.

By leveraging real-time data from its enterprise data warehouse (EDW), Allina Health effectively identified and addressed clinical practice variation and operational issues affecting cardiovascular care and costs. In doing so, the health system realized more than $75 million in performance enhancement savings and revenue increase over a four-year period by focusing on supply chain, lab test and blood utilization, clinical practice changes and clinical documentation improvement.

 

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A Service Line Approach Improves Women’s Health at UPMC

By the age of 60, more than one-third of women in the United States have had a hysterectomy. Healthcare systems across the country are recognizing that a women’s health service line offers a pathway to improving care and decreasing cost for these patients. Having accurate activity-based costing information is necessary to uncover opportunities for clinical practice improvement and cost reduction.

The University of Pittsburgh Medical Center (UPMC) made the decision to organize Women’s Health as a service line across the entire health system. UPMC fortified this approach with strong and collaborative leadership, an enterprise data warehouse, and an activity-based cost management system. The results:

  • 20 percent reduction in inpatient length of stay for hysterectomies (over a three-year time period)
  • 34 percent reduction in open hysterectomies
  • 28.3 percent reduction in 30-day readmissions for hysterectomies

These results were obtained during a time when this clinical service saw a 25 percent improvement in its contribution margin.

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Service Lines and Activity-Based Costing Reveal True Cost of Care for UPMC

Between 2007 and 2014, U.S. healthcare costs per capita increased by almost 25 percent. The way in which health systems are typically organized, managed, and budgeted (as departments and units within separate hospitals) works against them when they attempt to improve population health and decrease costs. The University of Pittsburgh Medical Center (UPMC), a large health system with more than 20 hospitals and 500 clinics, was keenly aware of this challenge as it embarked on population health and value-based care initiatives that spanned the entire organization.

The health system determined that it needed to break down the virtual walls between care centers and standardize service lines across the enterprise. By extension, this organizational change mandated the need for activity-based costing in healthcare that would deliver the insight necessary to run a service line effectively. UPMC organized six service lines within the health system, each spearheaded by clinical, operational, and financial leadership. Each service line uses the health system’s innovative, data-driven activity-based costing methodology to understand the true cost of care.

Notable, measurable results of UPMC’s service lines and activity-based costing methodology to date include:

  • $42 million of cost reduction opportunities (approximately 2 percent of targeted service line cost)
  • $5 million in supplies savings
  • Transparency toward identification of contribution margin variation for specific procedures
  • Up to 97 percent improvement in time to access information
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How to Reduce Clinical Variation and Improve Outcomes While Demonstrating a Positive ROI

Clinical variation can be frustrating for patients and their families, often leaving the impression that healthcare team members are not on the same page and don’t agree on the plan for the patient’s diagnosis or treatment. It is also costly—the Institute of Medicine estimates that $265 billion (30 percent) of healthcare spending is waste that directly results from clinical variation.

To reduce unwanted variation, Texas Children’s Hospital invested considerable resources to develop clinical standards tools, including evidence-based order sets; however, demonstrating the effectiveness and utilization of those guidelines, pathways, and order sets had been daunting. To that end, Texas Children’s deployed an analytics platform from Health Catalyst to aggregate and analyze the data needed to perform both of these critical functions.

Results:

  • $2,401 reduction in cost per patient with order set utilization, and an 8.4-day difference in average length of stay (LOS).
  • $15 million reduction in total direct variable costs in Fiscal Year 2015, $32 million anticipated reduction in Fiscal Year 2016 at the current order set usage rate, and a potential $64 million annual reduction with a hypothetical 80 percent order set usage rate.
  • 1,629 percent return on investment (ROI).
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How One Hospital Took the Pain Out of Getting Paid

A hospital’s core mission is to provide the best care possible. To continue to do so, however, hospitals must be paid promptly. Discharged not final billed (DNFB) cases—where bills remain incomplete due to coding or documentation gaps—represent an ongoing challenge for hospitals around the country.

Thibodaux Regional Medical Center, like other hospitals, faces a myriad of new government regulations that have made hospital bill collection efforts more onerous. Its leaders recognized their inadequate manual DNFB process left hospital staff overburdened and put at risk the necessary cash flow to best serve patients.

The hospital automated and streamlined this process to relieve the burden on physicians, provide an integrated view of data, optimize visibility and workflow, and reduce the need to “downcode” reimbursements due to missing documentation. The hospital leveraged analytics to provide actionable feedback to continuously improve the process.

Thibodaux has already achieved significant improvements to cash flow and operational efficiency:

  • 44.4 percent improvement in delinquency rate
  • 8.2 days reduction in A/R days
  • 70.5 percent decrease in the number of billhold accounts outstanding
  • 50 percent decrease in physician portion of DNFB dollars
  • 97 percent improvement in operational efficiency
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Calculating the ROI of Diabetes Care Improvement

Texas Children’s Hospital has dedicated itself not only to successfully improving diabetes mellitus (DM) outcomes, but also to developing a framework for measuring the ROI of its performance improvement efforts. Texas Children’s tackled its DM initiative with a combination of technology investments and new organizational models, including an enterprise data warehouse (EDW) and analytics platform, a clinical care process team model for improving the quality and cost of care, and a diabetic care unit (DCU) staffed by a highly specialized, highly trained group of providers. Health system leaders also worked with the business school at Rice University to develop a model for measuring ROI that focused on easily quantifiable drivers. The results of this effort include substantially improved quality of care for DM patients, an increase in net revenue by a projected $232,000 annually, and an estimated ROI of 53 percent.

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Allina Health’s Dedication to Quality Improvement Delivers On the Triple Aim

Improving clinical outcomes is good for patients and good for health systems. In fact, Allina Health’s focus on data-driven outcomes improvement realized a total financial improvement of $125 million in a single year.

Allina embraced the mandate of achieving the Triple Aim: improving the quality and cost of care, as well as the patient experience. To achieve this goal, Allina’s leaders recognized that they would need to realign their strategies, organizational structures, and management practices. Confident that data would help the health system improve the quality of patient care and reduce costs, they implemented a data-driven performance improvement strategy.

The results are astounding. This strategy has achieved financial improvements for the health system of $100+ million per year, four years running, while also advancing Allina Health’s Triple Aim goals of improved clinical outcomes and a better patient experience through dozens of improvement initiatives.

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How Allina Saved $13 Million By Optimizing LOS

Like most large healthcare systems throughout the country, Allina Health’s financial health improves dramatically by optimizing inpatient care for the patients it serves.

Allina recognized optimizing length of stay (LOS) was one of the key drivers of its inpatient financial performance and developed the technical infrastructure and analytic capabilities to understand LOS performance by the minute and not the day; adjust LOS to account for patient acuity and compare performance to national benchmarks; make LOS data available to clinicians across the organization in near real-time; and estimate the financial impact of LOS opportunities to enable targeted interventions for improvement.

Allina leveraged its enterprise data warehouse (EDW) and analytics platform and optimized LOS, yielding the following results in the first two years of its improvement efforts:

  • 26,000+ inpatient days saved
  • $13.4 million in direct operating expenses saved
  • Hospital capacity (bed availability) created for 5,000+ admissions
  • Avoided adverse patient events and reduced the total cost of care
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Understanding the Market Trends and Business Drivers of a Complex Healthcare Organization

As a Pioneer ACO, Partners HealthCare knew that understanding the healthcare business drivers of hospital volume and other strategic business trends was critical to its success. To increase this understanding, Partners recognized that it needed an advanced population health management analytics application that addressed strategic questions, could be deployed quickly, and would enable users to engage with the application to contribute toward real improvement. By emphasizing strategic questions rather than the technology solution itself, adopting Agile development methodologies, and working with stakeholders to drive adoption, Partners has developed an effective analytics platform that consists of an enterprise data warehouse (EDW) and advanced population health analytics applications. These efforts have resulted in an increase of up to 75 percent in operational efficiency, strategic questions answered up to 10 times faster, and perhaps most importantly, a cultural transformation where data helps drive strategy.

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How Hospital Financial Transparency Drives Operational and Bottom Line Improvements

In an era of steadily declining operating margins, hospitals are seeking ways to increase their profitability. Learn how one hospital system integrated financial and operational data in near real-time, giving their leaders visibility into how their decisions are impacting the bottom line. Leadership is now making more informed decisions and they are addressing problems as they arise. Budgets are consistently being managed close to target and variances for each cost center are readily explained with drill-down capabilities into the general ledger. A significant manual effort associated with over 1,000 cost center spreadsheets has been eliminated and the organization has saved $12 million in labor savings.

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Improving Healthcare Provider Productivity with Advanced Analytics

Improving provider productivity to enhance access to care and positively impact the bottom line is one of the most important tasks facing healthcare organization today. Historically the approach to evaluating provider productivity was complicated, time-consuming and inconsistent. This left providers struggling to effectively manage in their areas of responsibility. Learn how section chiefs, providers and operational leaders at one healthcare organization now have access to near real-time data, a single source of truth, and national benchmarks that enable them to optimize productivity—which resulted in their ability to see more patients and increase revenue per clinical FTE, contributing $20M in organizational savings.

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Revenue Cycle Management: Analytic Driven Insights and Efficiencies

To run efficiently and use the money they earn to improve the health of a community, healthcare institutions must manage their revenue cycle well. Crystal Run Healthcare, one of the fastest growing multi-specialty group practices in the country, anda physician-led accountable care organization (ACO), is committed to ensuring that the dollars it earns serve its patient population and are not wasted on inefficient processes. To that end, Crystal Run recognized that to minimize manual reporting and make quick, well-informed decisions related to revenue cycle management, they needed to employ analytics. With the implementation of an advanced analytics application, on top of their EDW platform, this ACO now accesses data up to 99% more quickly, has reduced staff time to identify variance root causes by 97%, and is actively identifying financial management improvement opportunities.

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Healthcare Revenue Cycle: How to Improve Data Timeliness and Reduce Manual Work

With cash flows declining, margins tightening and bad debt increasing, it’s more important than ever for healthcare organizations to maintain their bottom line. Efficient, effective revenue cycle management that ensures timely payment is one key to an organization’s financial health. Learn how this healthcare system: a) improved their data timeliness, b) realized an estimated $380K in annual operational savings, and c) reduced manual work.

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How to Increase Professional Billing Charge Capture with Healthcare Analytics

The demand on hospital coders continues to rise – and even more so with the ICD-10 rollout. At the same time, health systems want to make sure professional billing charge captures are accurate. Learn how North Memorial Health System leveraged their hospital enterprise data warehouse – and the Health Catalyst Professional Billing Module – to: a) increase the number of provider notes with sufficient clinical data for billing, b) increase their monthly net income and c) improve their hospital coding staff productivity by 25%.

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Hospital Revenue Cycle Management: 5 Ways to Improve

Besides improving your information systems and educating your staff on the ins and outs of managing revenue, there are many more opportunities for improvement. Here are five suggestions to help health systems improve their revenue cycle management: 1. trend and benchmark your healthcare data; 2. use an enterprise data warehouse to mine your healthcare data; 3. constantly ask frontline staff for suggestions; 4. monitor all payer contracts; and 5. maintain convenient and caring touch points with patients.

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