Business Intelligence Packs A Punch With Payors
Improvement of commercial-payor contracts can result in significant revenue gains and better contracts for medical groups, with radiology practices among them. Successfully negotiating such deals, however—and optimizing them to include financial dividends—necessitates that actionable business intelligence be brought to the bargaining table.
Douglas G. Smith, managing partner of Barrington Lakes Group, LLC, Barrington, Illinois, says that this rings true no matter what a practice's size and geographic scope are. He cites as examples the case of two radiology groups, both of which achieved favorable payor-contract-negotiation outcomes powered, in part, by analytics. Practice A is entirely hospital based, employs approximately 60 radiologists, and maintains a broad geographic presence across multiple sites of service. Practice B has a staff of 28 radiologists who provide service at three hospitals, as well as at several freestanding imaging centers. It also operates its own outside read service.
Both practice A and practice B wanted to engage their payors in meaningful dialogue that would lead to favorable contract negotiations. Smith notes, "The first step was to come to an understanding of payors' main objective—namely, decreasing their imaging outlays by reducing unnecessary and unwarranted utilization of advanced procedures, without compromising the quality of patient care."
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The Road to Actionable Information:Q & A with Robert J. Kebbekus
Radiology practices interface with many disparate information systems that produce data, but generating meaningful reports that pull information from all of those systems—PACS, RIS, billing, and reporting—is too cumbersome to be done with any regularity. As payors begin to link reimbursement to outcomes and episodes of care replace individual medical transactions, the need for an analytics platform that can extract appropriate data points from multiple systems that validate care to support reimbursement became quite clear to partners William G. Pickart (who owned a medical-billing company and had extensive experience running companies in other industries), and Robert J. Kebbekus and Timothy D. Dyer, seasoned financial-services and former bank executives. This realization led Pickart, Kebbekus, and Dyer to form Integrated Medical Partners (IMP), Milwaukee, Wisconsin, where
they serve, respectively, as CEO, President/COO, and EVP/CFO.
Consisting of a portfolio of several synergistic service businesses involving practice-information systems, the company strives to provide practice leaders with complete, deliverable, accessible, and, most significantly, actionable information to help them become more efficient, without negatively influencing patient care. Kebbekus says, "We saw that there was an information gap in health care. Clinical and financial data were sitting on multiple, disparate systems, creating a silo effect. We knew that we couldn't just rely on the common data points used by most billing companies to drive our business and that of our clients. Rather, we felt it imperative to invest in a robust analytics platform and highly trained client-service personnel in order to properly translate data into actionable, concise information."
RadAnalytics recently sat down with Kebbekus to explore the workings of IMP, as well as the imperatives for radiology practices on the analytics front
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Data-driven Strategy Delivers Relief From Pain of Reimbursement Cuts
Reimbursement reductions—most recently, the 2011 Medicare Physician Fee Schedule cuts—have had a significant impact on the radiology arena, with many practices and imaging-center companies taking sizeable hits to their bottom lines or being forced to close their doors. Some entities, however, refuse merely to accept the negative impact of government reimbursement cuts. Rather, they are harnessing analytics to assess—proactively—the effects of such purse-string tightening on their revenue streams and earnings, as well as to formulate new strategic initiatives aimed at compensating for the shortfall.
 Center for Diagnostic Imaging (CDI), Minneapolis, Minnesota, ranks in this group. Tom Tomlinson, COO, says, "Imaging providers can react to cuts—and other challenges, for that matter—by laying off staff to meet financial targets, but that only creates stress and impedes the caliber of service to patients. We have long thought it far better to assess and analyze data at a granular level to see how reimbursement reductions and other factors will affect us, and to base our approach to handling them on actionable information, rather than hearsay."
CDI currently owns and operates 59 imaging centers in 10 states; its roster of affiliate radiologists includes approximately 200 to 225 individual practitioners. Over the past few years, Tomlinson notes, its leaders have consistently mined the database to determine how (and to what degree) anticipated cuts will affect not just the business in general, but revenues generated per individual CPT® code. These projections are based on a combination of variables, including (but not limited to) reimbursement-percentage figures released prior to the execution of cuts, proprietary historical-utilization data, and practice-expense data.
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ABC Hospital Emergency Department
Many a RIS can generate a report that identifies the source of referrals by referring physician. As shown in this analysis of the hypothetical ABC Hospital's emergency department, however, Integrated Medical Partners has the ability to plumb multiple data silos to assign referrals by physician and procedure. Subsequent reports reveal macroscale referral patterns that, going forward, support strategic initiatives.
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Cost Management and Patient Satisfaction Affect Practice Success
Organizations deemed better-performing medical practices by the Medical Group Management Association's Performance and Practices of Successful Medical Groups: 2010 Report Based on 2009 Data excelled in profitability/cost management, productivity/capacity/staffing, accounts receivable/collections, and patient satisfaction. With the exception of multispecialty practices, these groups also incurred higher IT operating expenses than their lesser-performing counterparts and reported a lower ratio of bad debt to fee-for-service activity per FTE physician.
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Electronic Health Records Gain Ground in 2010; More RAC Audits in 2011 Forecast
The accelerated uptake of electronic health records, the widespread use of smart phones by practitioners, and dramatic advances in telemedicine are among the 2010 health-care trends cited in a new industry report from staffing company Jackson & Coker (Alpharetta, Georgia). Among its forecasts for 2011 are more audits by recovery-audit contractors, ever-deeper Medicare and Medicaid cuts, and fierce competition among hospitals.
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