What is Digital Health Technology?

Health Care Financial Consultant Digital Health

The importance of digital health technology

Digital health encompasses the use of various technologies such as such as mobile health (mHealth), health information technology, and telehealth to enhance to overall efficiency between doctors and patients across healthcare systems. The scope of digital health creates opportunities for physicians to gain a holistic view of their patients’ health and for patients to have greater access and ownership to their information.

The importance of digital health technology has increased over time, especially with the COVID-19 pandemic. In addition to increasing access to health information for both providers and patients, digital health also enhances patient-doctor relationships, increases patient disease prevention methods, and creates a shift toward value-based care.

What are the Benefits of Digital Health?

Better Patient-Doctor Relationships

Through digital health, patients can access information about their own health as well as have a stronger relationship with their provider. For example, many hospital systems have digital health portals where patients can message their providers and receive answers back relatively quickly, rather than needing to wait for their next appointment. With digital health portals, patients can also meet with their doctors via video chat, which is especially important during the COVID-19 pandemic. Providers can provide real time updates to their patients regarding lab work and testing all without the patient needing to come into the office.

Improves Access to Information

Using digital health technologies, patients can actively manage their own health and monitor any irregularities that they may experience. Through digital health, patients also have access to information related to the following:

  • Disease prevention
  • Physical therapy
  • Occupational therapy

Having such information at their fingertips allows patients to make more informed decisions about their health.

Promotes Lifestyle Changes Among Patients

The amount of education individuals have access to because of digital health is immense and can lead to lifestyle modifications for patients who may be at risk for common diseases, such as heart disease or diabetes. Physical and occupational therapy can also be achieved through digital health platforms which are paramount to a patient’s recovery.

What Impact Does Digital Health Have on Value-based Care?

Value-based care has been discussed frequently as an alternative to fee for service care. Through digital health technologies, the shift towards value-based care is now being made in the United States.

Value-based care creates a model where providers are rewarded for giving the highest quality care to patients rather than providing care at a lower standard which leads to readmission rates and complications. This type of approach can be used to expand a patient’s care management and ensure that the patient is not suffering because of a lack of quality providers.

Digital health allows for multidisciplinary care management that could be lacking in value-based care. Multidisciplinary care management consists of constant communication between providers, something that digital health has a crucial role in. Digital health technology paired with value-based care gives patients the opportunity to decide for themselves which providers are best equipped to handle their health.

What is the Future of Digital Health?

Digital health is still relatively new in the United States but with continued healthcare services moving towards a digital model, patients will be able to take their care into their own hands. This means that individuals across generations will be more educated about their health and will be able to make informed decisions regarding their own care. Advances in digital health are numerous and the United States will see many more in the future.

As the demand for digital health continues to grow throughout hospitals and healthcare systems, so does the challenges of finding a cost effective solution. At Pathstone Partners, our expert consultants specialize in providing information technology solutions for healthcare systems across several different markets.

From contract negotiations to software rationalization efforts, we take a comprehensive approach to improving outcomes and reducing inefficiencies for health systems. Contact us online to sit down with our experience consultants to learn about our healthcare consulting services how we can help with digital health technology.

 

Leveraging Healthcare Coding Supplier Relationships

Health Care Financial Consultant Medical Coding
All suppliers reduced their rates for all service lines of coding that more closely aligned with expectations.

A large academic medical center in the Midwest utilizes 4 different outsourced coding suppliers across the health system that did not have co-terminus contract renewal dates. Fees also differ across these suppliers for the same services at the same hospital locations. Though select suppliers proactively decreased rates upon contract renewal, rates still did not reflect the market. It is understandable that rates increase when a new International Classification of Diseases (ICD) is released given the learning curve and increased complexity, but it is expected that rates decrease over the years as coders learn and become more acquainted to the new ICD version.

Upon partnering with our healthcare technology consultants, the health system’s goals included improving standardization of current services, lowering the cost of coding services across the full system, and improving quality of service. Incumbent negotiations were conducted with all 4 suppliers to allow them to address the system’s goals.

All suppliers recognized that there were other discussions being held with incumbents, so if they did not address the hospital’s goals, there was potential to lose the partnership. Multiple rounds of negotiations were conducted prior to selecting finalist(s) for the health system.

Conducting incumbent negotiations allowed for the health system to continue leveraging their historical relationship with each supplier. There are instances where coders have been with the health system for multiple years and developed a relationship with the providers.

All suppliers reduced their rates for all service lines of coding that more closely aligned with expectations, especially given that ICD-10 had been implemented for multiple years.

During COVID-19, there has been an extraordinary labor shortage for qualified coders. However, there was also less inpatient and outpatient volumes given the decreased non-necessary visits. Hospitals did see steady emergency department patient volumes, as many OP and IP coders shifted to ED coding.

Select suppliers also implemented tiered structures based on actual volumes. The higher the volume in the month reviewed, the lower the rate for services.

The Impact of Data Analytics in Healthcare

Health Care Financial Consultant Cost Reduction 02

Collecting and Organize Data

There is a wealth of information available that healthcare organizations can leverage to streamline efficiency and revolutionize patient care — thanks to an abundance of raw data. The key is to collect and organize this data into an easy-to-interpret format and leverage it to improve current processes and procedures.

In particular, studying healthcare data analytics helps facilities identify where they can cut costs to improve their bottom lines. Keep reading to learn more about the positive financial impact of implementing and studying data analytics in your healthcare organization.

What Is Data Analytics in Healthcare?

Data analytics in healthcare is the act of compiling, categorizing and interpreting previously disorganized data to learn from and use it to optimize a healthcare organization’s operations and services. In short, it’s studying data-derived insights to improve operational efficiency and patient care. The most notable uses of data analytics in healthcare include:

  • Forecasting real-time trends.
  • Automating processes and procedures.
  • Making data accessible and easier to understand.
  • Revolutionizing patient care.
  • Driving healthcare innovation.
  • Advancing medical research.

Studying data-derived intelligence is helpful for every aspect of running a patient-centered, profitable healthcare facility. For example, healthcare practitioners can use data to spot trends that could cause re-admissions or assist in disease prevention. Plus, analyzing data could surge a facility’s bottom line by streamlining its operational efforts, like anticipating supply or staffing needs.

The Different Types of Healthcare Data Analytics

To study data, healthcare organizations first need special software to collect it and systems to compile it into easy-to-digest information. It’s also helpful to understand the different kinds of data analytics. Depending on an organization’s goals or pain points, one type of data analytics might be more beneficial to gather and study than another.

There are four main types of healthcare data analytics organizations can leverage:
  • Descriptive: Descriptive analytics is historical data that organizations can analyze to decipher whether their current systems and practices are efficient.
  • Predictive: Predictive analytics uses forecasting techniques like predictive modeling to make educated guesses about what might happen.
  • Diagnostic: Diagnostic analytics aims to diagnose what happened and why — or the factors contributing to particular outcomes —  using historical data.
  • Prescriptive: Prescriptive analytics leverages machine learning and historical data to make predictions helpful for introducing optimal practices.
Ways Data Analytics Can Reduce Healthcare Costs

There are several ways utilizing data analytics improves patient care and boosts an organization’s bottom line. Keep reading to learn how data analytics reduces healthcare costs.

Accessible Medical Records

Going paperless with digital medical records or Electronic Healthcare Records (EHR) boasts significant cost savings for healthcare facilities. EHRs are also superb for collecting real-time clinical, administrative and diagnostic information healthcare professionals can use to anticipate a patient’s needs and further personalize their care.

For example, EHRs can prompt practitioners and administrative staff to schedule reminders and medication orders or note patient preferences and trigger warnings, thus improving the patient experience. Plus, an EHR helps streamline time-consuming clerical tasks, like data access and entry. It has the potential to reduce errors and make information accessible from multiple facilities.

Smooth, Efficient Supply Chains

Supply chain breakdowns result in lost time and revenue, but they also affect patient care. Organizations can use data analytics to assess and anticipate their supply needs. Doing so optimizes inventory management for a smoother and better patient experience.

For example, data analytics highlights trends like shipment delays and order-to-delivery time frames. Analyzing supply chain disruptions or issues reduces the likelihood of overspending and streamlines inventory management, resulting in smarter spending and prompt care.

Enhanced Security

Unfortunately, data breaches and fraud claims are all too common in healthcare. Cybercriminals are known to target healthcare organizations for sensitive information. Cyberattacks were especially prevalent during the COVID-19 pandemic when healthcare professionals felt overwhelmed and burnt out.

The effects of data breaches are exceptionally costly for hospitals and other healthcare practices. To tackle cyberattacks and data breaches head-on, healthcare facilities can study data analytics to analyze the status quo and identify unexpected changes. For example, pinpointing suspicious events like surges in network traffic might indicate fraudulent activity.

Staffing Needs

An understaffed healthcare facility affects professionals and their patients. Thus, it’s crucial that an organization can anticipate staffing needs — especially during seasons when staffing might naturally fluctuate, like the holidays or flu season.

However, it’s tricky to distinguish between overstaffing and understaffing. Overstaffing leads to overspending and understaffing negatively impacts patient care. Studying historical staffing data and seeing how the seasons and other commonplace events affect it helps organizations hire and schedule the appropriate number of staff members during times of critical need.

Learn to Use Healthcare Data Analytics to Improve Your Facility

Are you ready to use healthcare data analytics to improve your organization but don’t know where to begin? Consult our experts at Pathstone Partners! We’re a leading healthcare management consulting firm that collaborates with healthcare facilities to improve their financial and operational efficiency.

It’s our ultimate mission to empower practitioners to provide the best patient experience possible. Contact us today to learn more about how data analytics can transform the way you run your healthcare organization and provide patient care.

Minimizing Stakeholder Disruption in Office Supply Negotiations

Health Care Financial Consultant Office Supplies
The total financial impact in this category was $500K while maintaining variety for end users to be able to select items that meet their needs.

Pathstone partnered with a large healthcare system on the west coast to evaluate the full scope of Office Supplies & Related Product spend.  This process began with developing an understanding of the current state including vendor landscape, previous system efforts, and future goals.

This client had success selecting one primary vendor for most purchases and beginning to assess the types of purchases permitted through that vendor; however, we identified opportunity to revisit the items purchased to further negotiate pricing and refine the permitted purchase list.

Pathstone’s non-clinical purchased service consultants began identifying incremental opportunities by breaking spend into categories that may be purchased through an office supplies vendor: Ink & Toner, Paper, Office Supplies, and Other Related Products.

  • Ink & Toner: Ink & Toner may be covered under a relationship with a Managed Print Services provider, through a technology value added reseller, or a traditional office supplies vendor.  For Ink & Toner purchased through an office supplies vendor, we considered pursuing cost reduction on original equipment manufacturer (OEM) products, shifting volumes to remanufactured products, and shifting to high-capacity cartridges with higher page yields.
  • Paper: Paper also typically represents a large portion of spend in this category.  Pricing is typically influenced by external factors, such as the global supply chain.  Contracts may feature favorable fixed pricing on certain paper items, which presented standardization opportunities.
  • Office Supplies: The core of this category, health systems have a wide variety of office supply needs such as writing utensils, staplers, and binders. We evaluated average costs within each item type and set cost thresholds to eliminating the purchase of higher cost items while maintaining variety and choice for different end users.
  • Other Related Products: Other related products often available with office supplies vendors include furniture and breakroom supplies.  These categories were reviewed to determine if purchases are necessary or if other channels existed for more effective purchasing.

The total financial impact in this category was $500K. Qualitative benefits included enabling better control and visibility of purchases while maintaining variety for end users to be able to select items that meet their needs.

  • Ink & Toner: Achieved $200K value by shifting remanufactured ink to OEM to maintain increased discounts and moving eligible toners to high-capacity cartridges.
  • Paper: Achieved $30K value by shifting volumes to paper that was contracted at a flat, competitive rate.
  • Office Supplies: Developed a price capping methodology to drive $270K, or 13% value across all office supply purchases.
  • Other Related Products: Identified targeted categories to restrict purchasing within the client portal; further evaluation of alternative products available to quantify value.

The Importance of Information Technology in Healthcare

Health Care Financial Consultant Technology

What is Healthcare IT?

Information technology (IT) plays an important role in the modern world, impacting many industries such as the banking industry and tech industry. Not as widely recognized is the importance of IT in the healthcare industry.

Before delving into the importance of information technology to healthcare, it is necessary to understand what exactly IT refers to in this space. Most commonly, healthcare information technology employs the exchange of health-related data via electronic systems involving the use of digital technology to record, assess, and distribute patient related-data.

Why is IT Important in the Healthcare Industry

The importance of information technology in healthcare is demonstrated when its effective use leads to improvements which medical care providers can bestow upon their patients. Medical care often involves the analysis and decision making of multiple specialists, payors, and the patient and readily available and accessible information is crucial to help inform the patient’s best treatment plan and increase overall efficiency of the health system. It is often difficult to share, access, and maintain consistent information across the many sectors and stakeholders present in medical care. Thus, minimizing the demonstrated gaps of information that present themselves in healthcare financial is where information technology proves instrumental to the industry.

That said, improvements to medical care are limited by the quantity and quality of the information that healthcare providers have on their patients. Insufficient medical information can lead to medical errors that may potentially affect the medical and wellness of patients, payors, and healthcare providers. For example, adverse drug reactions can be linked to insufficient access to medical information and cause over 350,000 hospitalizations and 1.3 million emergency room visits every year in the United States. Therefore, by assisting the delivery of accurate and accessible patient information, supporting shared decision making, establishing networks of social support for patients, and enhancing treatment compliance tracking, IT drastically improves the quality of care provided to patients and avoids the unnecessary costs of medical errors and information gathering.

The Benefits of Establishing a Healthcare IT Infrastructure

IT plays a role in medical data collection and research. By providing researchers with patient data, the development of new treatment options and clinical studies can be conducted.  Additionally, IT eliminates unnecessary processes, such as physical test result interactions and information gathering interchanges using software such as MyChart.

IT also facilitates healthcare providers in the process of remaining compliant with increasingly complex regulatory policies and federal programs. An example is the 340-B Drug Pricing Program, where covered entities must maintain certain statuses and coverage statistics to qualify patients for reduced drug prices. With the development of platforms such as RxStrategies, hospitals and hospital networks can adhere to the strict regulations, minimize the costs of doing so, and maximize the benefit from such programs.

In conclusion, IT has impacted the healthcare industry across the multiple layers and institutions involved in the industry. Patients have benefited from improved medical care, physicians have been able to make better informed decisions, payors have been able to better track their beneficiaries, hospitals have been able to reduce unnecessary costs, and regulatory powers have been able to ensure complex regulation are complied. As information technology continues to develop, so will healthcare.

What is Revenue Cycle Management (RCM) In Healthcare?

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It is extremely important for RCM in healthcare to run smoothly

Healthcare Revenue Cycle Management (RCM) is the financial process that organizations use to manage the administrative and clinical functions associated with different steps of patient care from start to finish. The process starts when a patient schedules a visit for medical services and finishes when all claims and patient payments have been collected. In summary, revenue cycle management in healthcare serves as the strategy for streamlining processes, ensuring steady collections, and making healthcare providers financially viable.

With RCM in healthcare, the goal is to discover any possible problems in the revenue cycle and solve them before they become a bigger issue. It is extremely important for RCM in healthcare to run smoothly to keep your entire system working properly.

How Does the Revenue Management Process Cycle (RCM) Work in Healthcare?

There are seven main steps in the revenue management cycle for healthcare. These include:

  • Patient eligibility check and insurance authorization
  • Medical coding and billing
  • Claims creation, validation, and submission
  • Error/denial check and correction
  • Statement to patient (EOB and/or bill)
  • Payment collection from patient
  • Continuing data analysis
Why is Revenue Cycle Management (RCM) Important for Healthcare Providers?

While healthcare providers are largely focused on the quality of patient care, there remains a level of concern regarding reimbursement and collections. The process from initial delivery to full payment is complex and implementing effective RCM is essential for to minimize the number of errors, increase the likelihood of payment, avoid aging accounts receivable, and improve overall profitability in health systems. Often there is a significant delay between services and payment collection, making it difficult to see the exact view of cost, spend, and revenue.

Managing revenue is essential for any business and focusing on improving the revenue cycle plays an important role in increasing claims efficiency while reconciling costs against revenues to optimize cash flow. In addition, the healthcare revenue cycle process houses important patient information and data leaks could have substantial legal ramifications. Ultimately, the goal of revenue cycle management in the healthcare industry is to develop a process that helps organizations get paid the full amount for services as quickly as possible by identifying points of friction and resolving them.

Benefits of Focusing on the Revenue Cycle in Your Health System

There are many benefits to efficiently managing your revenue cycle such as improved patient satisfaction, maximized monetary benefit, reduced administrative burden, and simplified processes.

  • Improved Patient Satisfaction: Revenue Cycle Management (RCM) enhances the patients’ experience with the entire hospital billing process through increased transparency in cost of service, added support throughout entire care process, and minimized number of forms for tracking patient data.
  • Reduced Administrative Burden: Revenue cycle management in healthcare serves as the entity for streamlining the processes. Outsourcing and automating the revenue cycle alleviates the administrative burden of the providers, allowing for a greater focus on delivering quality care to patients.
  • Maximized Monetary Benefit: “According to a report from Sage Growth Partners, more than a third of health systems have faced more than $10 million in bad debt annually. The situation is worsening due to unpaid bills and every year up to $125 billion is lost in unpaid and underpaid claims”. Effectively implementing RCM results in lower denial rates, which leads to increased cash flow and faster speed to payment. The process brings accuracy to the system and leaves little room for errors during insurance verification, coding, and claims processing, in turn maximizing collections.
  • Simplified Processes: Successfully managing your revenue cycle drives efficiencies through workflow automation, which improves scheduling processes, coding and billing, and payment processing. Removing the complexities in the workflow leads to improved operational efficiency of the providers, ensuring they meet their revenue targets.

How to Improve Clinical Documentation in Healthcare

Health Care Financial Consultant Clinical documentation

What is Clinical Documentation Improvement (CDI) in Healthcare?

Clinical documentation improvement (CDI) aims to represent a patient’s clinical status into coded data. This data is then used for medical research, quality reporting, financial reimbursement, public health data, and disease tracking/trending. By enhancing clinical documentation, medical data collection, reporting, and digital health technology, hospitals will improve their cost efficiency, thus maximizing their revenue and increasing productivity in their organization.

Why Are Clinical Documentation Improvements Important?

With the increasing complexity of medicine and healthcare, there is great importance of capturing data accurately for further analysis. Physicians spend about six hours per day performing data entry into patient records, which includes clinical documentation. These administrative tasks detract providers from focusing on patient care, which is what they are trained on. Physician education typically doesn’t include payer rules for clinical documentation, or other factors that influence a hospital’s revenue.

Moreover, physicians typically don’t prioritize improvements in clinical documentation, and consider it to take away time from providing patient care. The implementation of physician advisors, or clinically experienced professionals, can act as a bridge between healthcare providers and other staff to support clinical documentation improvements.

What Are the Challenges of CDI?

While implementing CDI can improve hospital revenue and efficiency, you should account for potential pitfalls. When creating a CDI program, consider the following:

  • Technology issues: Some outdated technology may make communication and reporting more challenging. While implementing a CDI plan, there may be necessary technology updates as well.
  • Conflicting information: Some client intake charts may have duplicate or conflicting data with their patient records. CDI can help remove and prevent unnecessary reporting.
  • Physician engagement: After the CDI system implementation, physicians must comply with new standards and communicate as necessary.

While you may face these challenges, the overall impact on patient well-being makes CDI necessary for many individual healthcare practices. As employees address the individual challenges, they’ll create a trickle effect that enhances all aspects of the hospital system.

Benefits of Clinical Documentation Improvements

There are several benefits to implementing clinical documentation improvement within your health system. The main advantages of CDI include:

  • Reduced Claim Denials: Insurance companies can deny a patient’s request for healthcare coverage due to ineligibility, lack of detail, late submission, missing information, and more. With enhancements in clinical documentation, claims will be thoroughly completed on time, which reduces the chances of a patient’s claim being denied.
  • Lower Physician Queries: Improved clinical documentation will also decrease physician queries, by ensuring the Current Procedural Terminology (CPT) and Classification of Diseases (ICD) codes are precise based on physician notes.
  • Improves Communication: Lastly, CDI strengthens communication not only for the patient and provider, but for everyone who accesses the patient’s charts, specifically billing companies. Clinical documentation improvement keeps both the healthcare provider and billing company on the same page regarding the patient’s healthcare, so they will better care for the patient. Payers continue to push for CDI and accurate clinical data not only to tie financial reimbursement to value, but to consequently improve care quality overall.

A 2016 Black Book Market Research survey found that nearly 90% of hospitals that implemented CDI earned at least $1.5M more in healthcare revenue and claims reimbursement, showing a clear benefit for hospital revenue.

Improved Documentation and Performance

CDI also advances patient care. When a patient’s record is accurate detailed, healthcare professionals can create more personalized treatment plans. Better documentation not only improves patient care, but also provider performance. The Heritage Valley Health System in Pennsylvania found that better CDI reduced their predicted mortality by 27%, showing clear and tangible benefits. With better clinical documentation, healthcare providers can more easily identify and correct gaps in care. This comprehensive data allows providers to catch a potential complication before it arises, therefore improving patient safety and shortening hospital stays.

Different Types of CDI Metrics

Knowing which key healthcare metrics to look for will help you understand how your system works and where to make adjustments. If you want to analyze trends and gaps, Pathstone Partners will assist as you interpret and visualize the data.

Review Rate

The review rate accounts for how many documents the CDI team reviews in a given time. This metric helps administrative staff measure productivity within any organization. You can break this number down by timeframe and assign quantitative goals to each CDI team member.

Query Rate

The query rate is the number of queries per the number of reviews. This number helps leaders notice how their team handles documentation and manages communications.

Response Rate

This rate represents how often staff is responding to queries. You can see which groups are struggling to respond and offer guidance and education to improve this rate.

Response Time

Your response time is how long it takes physicians to respond to queries once they receive them. You might consider setting a standard response time goal across all teams. Reaching this goal will improve communication and ensure patient needs are met quickly.

Case Mix Index (CMI)

The CMI is the average relative weight of all diagnosis-related groups (DRGs) within a hospital. This number determines how sick patients are at any hospital and helps staff calculate payments to meet demand. You should monitor this number monthly and compare it to similar institutions with the same services.

Need Help With Clinical Documentation Improvement?

As a leading healthcare management consulting firm, Pathstone Partners can help with CDI in any facility. We work with your team and offer strategies and software that improve performance across the board.

Whether you want to implement a new CDI program or refresh your policies, we can find a custom solution for your facility. Contact us today to learn more about our CDI consulting capabilities!