The facility uses MedAssets’ Charge Capture Audit or CCA.net, which looks at the procedure being billed and then assesses whether all the other possible services have been billed. So, if a provider performed X procedure, then the provider also likely performed Y and Z. If those other procedures were performed but hadn’t been billed, then the facility can add those charges once documentation is reviewed and verified. Within the first 10 months of using this program, St. Vincent Health saved $3.4 million on 2 million claims.
The system also runs a risk segmentation analysis to determine a patient’s ability to pay after services have been rendered. Using software from Passport Health, staff can verify eligibility, benefit levels, and coverage; this has helped reduce denial rates. This allows St. Vincent to set up payment terms with the patient in advance of a procedure, as well as offer any discounts.
“The vast majority of patients want to pay their bills, but especially over the last couple of years, people just need assistance. By adding programs that are flexible and meet patient needs, we are also building a loyal customer,” Snow says.
While revenue cycle is the most obvious area to look for financial risk, analyzing clinical risks and making quality corrections can also garner financial savings. At the 2,000-bed Spectrum Health in Grand Rapids, MI, Joseph Fifer, vice president of hospital finance, and John Byrnes, MD, senior vice president of system quality, have been concentrating on reducing financial risks, and ultimately financial losses, through clinical quality improvements tied to staff salaries.
With seven hospitals, 16,000 employees, 1,500 physicians, and annual payroll and benefits amounting to $734 million in 2009, reining in risk and cost are challenging priorities. So, approximately eight years ago, the system took a look at its quality and safety program and decided it needed to be reinvigorated. “We set up quality measurements and we used an existing database for the quality reporting. We began reviewing the high-volume and high-cost medical procedures,” says Byrnes.