Profitability Concerns Rank High in Emergency Medicine

Advanced performance analytics that can integrate deep EHR and RCM data can help drive ED profitability.

The profitability of emergency departments is affected by a number of factors, including missed billing for services provided, coding errors, ED staffing mix and levels, and so on. These challenges are being overcome by advanced performance analytics which integrate EHR, clinical, and operational data -- as well as billing data -- to improve ED profitability.

Emergency Medicine's role in the future of health care is changing, along with government regulations. In an increasingly complex environment, EDs face competitive and budgetary pressures to meet high demand for unscheduled acute care.

According to a study from the University of Maryland School of Medicine, 48% of all health care occurs within the ED. Due in part to a lack of effective prevention, and inpatient and outpatient resources, EDs are being used for non-emergency cases. This leads to overcrowding which adversely affects revenue cycles and creates other challenges.

To improve performance across domains -- including quality of patient care, service delivery, risk mitigation, and profitability -- EDs need timely access to data that will inform decision-making and enable performance improvement.

Availability of Data in EDs

In 2018, d2i conducted a benchmarking study to compare the availability of information in EDs and how it might impact four areas:

• Operations
• Clinical Outcomes
• Finance
• Patient Satisfaction

Among the 151 companies participating in the study, ED physician leadership ranked staffing optimization as their biggest challenge. Patient satisfaction was also a very important measure for health care administrators.

While 96% of respondents said their HCO had a process improvement program in place, the study also revealed that using analytics and data was time-consuming and often limited to spreadsheets and static reports. Many of those surveyed didn't realize that more robust analysis was available. Although most respondents were interested in staffing and scheduling optimization to reduce costs and increase capacity, they didn't have access to the necessary tools and data.

Responses also indicated that profitability was affected by incomplete documentation, inconsistent E&M codes, and missed billing for services. An inability to integrate claims and EHR data could lead to breakdowns in the revenue cycle.

Identifying Missed Opportunities

d2i's analytics solutions provide our clients with information and insight to make sure that opportunities for improvement aren’t overlooked. Working with data gleaned from more than 20 million ED visits, we've helped our clients identify some of them:

• Potential Training Opportunities: We have found that 95% or more of non-behavioral health patients who were admitted to the hospital should code and bill at an E&M Level 5 or higher. Our analytics can help identify exceptions and provide medical leadership the information necessary to review these cases and ensure providers are trained in accurate documentation.
• Missing Attestations That Lower Reimbursement: Some payers and states require direct notes by the attending physician for certain types of treatment. Our suite of analytics can identify treatment events that may be missing required documentation, helping EDs avoid down-coding or a reduction in payment. Such events include critical care for more than 31 minutes of hands-on treatment, co-signing of APP/NP charts for shared and supervised visits, fracture reductions, and radiology interpretations by the attending physician.
• Anomalies in Coding Patterns: We calculate an average of E&M coding by both provider and group which reflects acuity of cases, quality of provider documentation, and/or accuracy of coding by the RCM vendor. This allows for quick and easy identification of outliers.

While most RCM vendors offer a comprehensive set of reports for billing-related metrics, d2i enhances reporting by integrating this information into our business intelligence platform and adding one-click filtering and enhanced drill capability.

The availability of more data and new business imperatives are more important than ever to health care systems that must provide feedback to multiple stakeholders. Performance improvement initiatives require that data be aggregated, harmonized, and analyzed from many perspectives. Purpose-built performance analytics can curate data for performance and process optimization, giving insight into the impact that various metrics have across domains.

Brian Sweeney is the Director of Client Success at d2i, a cloud-based health care analytics solution that helps organizations stay viable in today’s complex health care landscape.