Hospices Leverage Business Intelligence to Speed Revenue Cycles

Hospices are adopting business intelligence tactics to guide strategic decisions. Some are finding that these methods, often technology-enabled, can help them maximize revenue and lower costs, according to health care consultants at New York-based accounting firm Freed Maxick. 

“Business intelligence” is defined as the processes and technology a company uses to collect and analyze data produced from their activities. To implement this effectively, hospices need insight into all the processes that impact their revenue cycle, according to Maureen Lehsten, principal at Freed Maxick.

“One of the highest priorities is managing revenue cycles to care for the patients,” Lehsten said. “They need to eliminate pebbles in the stream and make sure they don’t have a boulder in the cash flow, reducing the time from the patient coming in and cash coming in.”

Lehsten made these remarks in a virtual session at the National Hospice and Palliative Care Organization’s Leadership & Advocacy Conference. 

From a cost and revenue cycle perspective, harnessing data that the organization already captures can improve cash flow, Dan Gerena, principal of the business intelligence practice at Freed Maxick, said at the conference.

Payroll and electronic medical record systems, for instance, can paint a picture of where the money flows. From the cost of providing patient care through receiving payment for it, the data captured can tell a broader story of a hospice’s value proposition, Gerena indicated.

This level of attention to back office and clinical operations will be necessary to succeed in a value-based payment landscape, according to Lehsten.

Value-based care is expected to loom larger in hospice reimbursement in the long term. Among the first steps is the hospice component of the value-based insurance design (VBID) demonstration, known as the Medicare Advantage (MA) hospice carve-in. The program has entered its second year.

Some hospices are also seeking participation in ACO Realizing Equity, Access, and Community Health (REACH), which replaced the Global and Professional Direct Contracting (GPDC) models.

Providers need to prepare for these changes by examining cash flow data to understand their costs and optimize the revenue cycle process, Lehsten indicated. This is of particular concern when working in Medicare Advantage in which payment arrangements are often more complex than the traditional fee-for-service model.

“The carve-in is a major disruptor for all hospice providers. Are there areas that you need to dive into a little further to respond very proactively to what you’re seeing in real time?” Lehsten said. “The revenue cycle process allows visualization to change behaviors across the organization, improve cash acceleration, reduce denials and identify where those claims are getting held up early on in the cycle.”

Careful data analysis can inform hospices’ efforts to build efficiency and lower costs in anticipation of payment reductions that typically occur within Medicare Advantage.

“The way to become more nimble as an organization is really to have visibility in those metrics that drive quality and cost,” said Gerena. “[It’s] changing the paradigm from a static analysis and working with data in real time to understand where the opportunities are. It’s [telling] a story about really aligning data to how you are a low-cost provider.”