H. Jackson Brown, Jr., the American author who wrote Life’s Little Instruction Book, contends that “nothing is more expensive than a missed opportunity.” It’s an observation that healthcare leaders should take heed of – as there appears to be ample opportunity to improve clinical care, operations and the overall bottom-line in this era of big data.
Indeed, as the volume of data coming into the healthcare industry has grown exponentially in recent years, so has the call to make something of it. The challenge for healthcare organizations is to ensure that they are capitalizing on all the opportunity that is inherent in this deluge of data.
However, simply having this data isn’t enough. Ambulatory surgery centers (ASCs) need to convert the data into something actionable. By doing this, ASCs can dramatically change how they run their centers; thereby improving cash flow and increasing overall net worth.
Seeing the opportunity in data
The first step is to understand the specific ways that data can be utilized to improve the performance of your ASC. Generally, the data will reveal areas of opportunity for your ASC to strengthen its processes. By evaluating the information, you can devise a list of action steps for your team to implement.
Consider the following ways that data can help your ASC:
Develop and fine tune a strategic plan. An analysis of data could help your surgery center identify the initiatives that can help your organization become more successful. For example, an analysis of industry trends could reveal that cutting-edge procedures such as spinal fusions – procedures that previously were only performed in hospitals – have become viable for ASCs and could specifically help your center expand its offerings.
Optimize utilization. Insights gleaned from data can also reveal exactly how your surgery center procedures should be optimized on a day-to-day basis. The analysis could reveal which procedures bolster the bottom-line. Factors to consider include the total reimbursement for a procedure, the time and staff involved in such a procedure, the technology, equipment and infrastructure costs involved in such procedures, the costs of the relevant implants, among other costs. Thus, while higher reimbursing procedures may on its face appear to be more financially beneficial, an ASC needs to analyze all of the above factors to determine the most efficient, effective and profitable approach to operating the ASC.
Improve surgical outcomes. As clinical data is captured and analyzed, care managers can be notified of patients who are not doing well. Physicians can then refine their care based on verified best practices. As such, your center can continually improve outcomes, making it possible to succeed under value-based arrangements.
Negotiate optimal managed care contracts for surgeons. Data is critical to making a compelling case to payers that reimbursement for your ASC should be increased. For example, it is invaluable to have information about your surgeons’ educational backgrounds, detailed outcomes data that illustrates the quality of care they deliver, readmissions rates, the costs involved in performing the procedures, as well as how much the same procedures would cost a payer if performed at a hospital. When armed with this information, you will be well on your way to obtaining highly favorable managed care contracts for your ASC.
Market your ASC to consumers. You can more successfully market your ASC to consumers by backing up claims about the quality of your surgeons with outcomes data. For example, if your surgeons are providing top-tier care, patients will want to have their procedures conducted at your facility, instead of in the hospital or at a competitor’s outpatient center.
Optimize revenue cycle functions. Data can help your ASC maximize its net revenue while remaining fully compliant. The data will help fine-tune various components of the revenue cycle including managed care contracts, coding and claims, payment posting, accounts receivable management and patient accounts. For example, the following are a few of the operational and financial key performance indicators that an ASC should track as they provide the exact actionable intelligence necessary to run a successful facility:
• Net revenue per case
• Total clinical hours per case
• Medical supply costs per case
• Inventory turnover
• Total cases per number of operating rooms
• Trended cash collections
• Net collection ratio
• Point of service cash collections
• Days to bill
• Days to pay, by payer
• Denial rate
• Shifts in payer, specialty or procedure mix
• Days in A/R
• A/R > 90 days
• Bad debt write-off percent
Overcoming challenges
Leveraging big data to improve performance requires overcoming a variety of potential challenges. To start, your ASC should optimize the use of its practice management systems (and EHR, if it utilizes one). These solutions must have all the relevant fields built into them. For example, your systems should include functionality that tracks the cost of supplies and labor. In addition, you need to have the right technology infrastructure in place in order to maximize efficiency, avoid disruptions due to downtime, and also to avoid cybersecurity attacks on your patients’ private health information.
In addition, the right analytics tools can help to extract data in a presentable fashion. To accomplish this, you need to customize your analytics tool in a manner that makes it possible to track relevant metrics and tell a story in a meaningful way that clearly shows where opportunities lie.
Finally, your ASC must have the right people in place who can take meaningful action when coding, managed care contracting, accounts receivable management, utilization or other opportunities are identified. For instance, you need managed care contract experts to address contract issues and operational experts to address operational issues. What’s more, medical directors, administrators and board members need to address strategic issues on an ongoing basis.
By addressing these challenges and enabling your organization to truly take advantage of big data, your ASC can ensure that it is not falling into the missed opportunities trap. Instead, you can experience the satisfaction that comes with using big data to empower your ASC to succeed.