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What if you didn’t have the grant money?

October 21, 2013

With today’s political climate, one thing is certain… there are a lot of uncertainties.  “Regime change” in the White House could result in unfavorable reductions in grant
funds, a movement towards fully Fee for Service (FFS) or Accountable Care Organization (ACO) billing models.  Life in the “encounter rate” world isn’t all that bad.  Regardless of which services you provide during a visit, or what outcomes they yielded, you get a flat rate of payment.  Everyone is looking to cut costs and excess spending, so it won’t be long before payers set their sights on the FQHC/RHC community.

Knowing all of this, can you answer some key questions that can tell you how well you might survive systemic changes in healthcare finance regulation?  There is no doubt that you have large amounts of information that may be difficult to get to and more importantly difficult to make sense of.  Your data is probably living in disparate systems where oversight and support is blurred at best.

  • Can you report on ‘average payment per service’ in an encounter rate world?
  • What would you have collected in a Fee for Service world for those same services?
  • Can you evaluate your cost per RVU by CPT code?

If you can determine how much each service costs you, and then see what payments you might yield for those services (under some alternate payment models), you can get an idea where you might stand in the absence of grant subsidies.   Having that data can give your organization direction as to which service centers are performing the worst financially, and you can focus your efforts.

Try a phased approach to analytics and reporting

You might be thinking, “I don’t have the time or expertise to do any analytics”. If that is the case, think about starting with a small subset of your reporting or a single
department.  Pick one pain point for your organization and try to gather as much data as you can.  Compile spreadsheets, run reports from the billing system, and talk to your vendor about custom queries.

Before you start, try this approach:

  1. Get out a piece of paper, and literally draw out the reports that you think you
    might need.
  2. Write down the goal of the report.  What do you
    hope to achieve with the data?
    1. Is your report “actionable”, or is it just more data to look at?
    2. Is it realistic and simple to understand?
    3. What does it measure?  Is it actually answering a question for you?
    4. Does it solve a problem
  3. Determine what “data elements” you would need to create those reports.
  4. Document the fields you want, a definition for each field and which system they
    originate from (this is called ‘building a spec’).
  5. Be willing to get more than one stream of data, and determine what you could use
    to string them all together.

Once you have a handle on the data, you can start to see how it all fits together.  You start to realize the relationships and dependencies between the data elements.  You have “scoped out” the reporting goals and you have “spec’d out” the data.

Where do I go from here?

The truth is that there are nerds out there like me who actually think analytics is fun.  Reach out to people in your industry using tools like LinkedIn, and Facebook.    (Be mindful of what you share, so that you don’t violate and HIPAA or HiTECH privacy regulations).   Check with your EHR/PM vendor.   Many of them have “community” portals and forums that you can use to connect with others.   If you have taken the steps above to “scope and spec” your data, people will find it really easy to help you.   You might find someone savvy with Microsoft Excel or Access can really chug through your data to give you the answers you need without having to implement large costly analytics systems.   Try to develop one or two key reports that demonstrate the value of analytics and reporting to your organization.   As others see your successes, they will want to be part of that.

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