Analytics for Compliance:A Case Study of Deployment
Barbara J. PiascikSr. Vice President/Chief Compliance Officer
St. Vincent Catholic Medical Centers
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Topics of Discussion
� Introduction to St. Vincent Catholic Medical Centers
� Preparing the data
� Workflow and process improvement
� Sample results
� Risk assessment
� Measuring success
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St. Vincent Catholic Medical Centers
� Services as a major healthcare resource for the New York Metropolitan area
� Anchored by St. Vincent’s Hospital Manhattan in Greenwich Village 440-bed acute care hospital
� Facilities also include:
– Behavioral health hospital
– Skilled Nursing/Hospice Facilities
– Home Health Care agency
– physician practices with multiple outpatient services
– An ambulance company
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New York Experience
� NYS Office of Medicaid Inspector General – has developed tools and extensive staff to use
data for review, potential audits and program improvements
� 1300 published audits over the last 18 months
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St. Vincent Position and Strategy
� Need for improved visibility into our data
� Manual processes were inefficient
� Reacting to the data rather than being ahead of the data
� Decision made to implement data analytics
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Healthcare Analytics
� Definition: A rapidly evolving field of healthcare business solutions that make extensive use of data, statistical
and qualitative analysis, explanatory and predictive modeling.
� If you don’t review your own data somebody else will be looking.
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Who is looking at your data?
� OIG
� MIC
� OMIG
� RAC
� Quality organizations
� Your patients
� Commercial payers
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Data Mining – What is it and what do we do with it??
� Definition: The process of extracting patterns from data.
� Track & Trend
� Equal Results
•Slice & Dice
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Data Friend or Foe???Warning
� Too much vs too little
� Dangers:
– Privacy
– Encryption
– Accuracy
– No plan
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Convert to Usable Format
� Home grown report writer or database
� Known tools like Access or Crystal
� Bolt on system
� Enterprise analytics
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Data, Data Everywhere
� How to begin
– Inventory of current systems
– Inventory of current reports
– Implementation team of stakeholders
– Ultimate purpose of data
� Determine what to measure
� “Single Source of Truth” across organization
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Gathering the Data
� How to get information into system for analysis
� Convert information into useable format
� Verify that data is accurate and complete
� Automate as much as possible
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AccuracyMission Critical
� Data must be trusted to be:
– Correct
– Complete
– Current
– Old stuff
� How much is too much??
� How old is usable?
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Warning – WarningBe Careful What You Ask For
� Too much information can destroy a project
� What are my key metrics to measure?
� Targets for my key metrics?
� How often – daily, weekly, monthly?
� Is there time to review data timely?
� Can it promote an action?
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Workflows
� Who needs the information?
� Is the process manual – as user wants to see
it or automatic?
� If it is automatic, is there accountability for review?
� If data shows problem – what happens??
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Success!!!
� SVCMC’s Patient Access Department
� Analyze and right “rules” for our organization
� Data sent daily for previous day
� Each day report of errors sent to various supervisors
� Sorted by registrar
� Current policy all must be corrected within 24 hours
� Clean bill rate from 78% to 99% in just 6 months
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Sample Graphs
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Looking Good!!!
� Sophistication of presentation
� Board of Directors
� Senior Management
� Who needs details
� Quick highlights of negative trends
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Challenges
� Lots and lots of internal systems
� Internal resources
� Lots of trial and error
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Did what you fix work??
� Monitoring
– Dashboards and key performance metrics
– Efficiency tools, i.e. targets and automatic alerts
– Allows for accurate monitoring of corrective action
– Timely fixes
� Process improvement
� Managing performance
� Measuring success
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Risk Assessment
� How do you find where your risks are hiding?
� Rules engine (100s of RAC rules alone)
� Benchmarking to standards (PEPPER, MEDPAR)
� Trend analysis
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New Ideas
� Review of potential audits out there
� New service – is it successful?
� Old service – still needed?
� Government workplans
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Operational Uses
� Some uses of analytics– Top 10 tests done
– Top 10 most expensive tests
– Wait times
– Geographical analysis
– Identify risk target areas prior to an audit (RAC/MIC) and
proactively change HIM/coding/billing practices
– Understand the financial impact of dollars at risk across a portfolio
of accounts
– Identify root causes (coding and documentation) of compliance
risk
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Risk vs Reward
� Problems revealed
� Action needed
� Potential self-disclosure
� Able to find a problem quickly
� Allows for quick review of multiple risks
� Consistent data
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ImplementationWorth its Weight in Gold
� Do your research – not all analytics systems are the
same
� Partnering with the system vendor
� Usable information
� Good results require:
– Time
– Energy
– Resources
– Good IT tools
– Purpose in mind
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Changes, Changes, Changes
� Learn it – it changes
� How quickly do you know
� How timely do you find out
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In Summary
� Good channels of internal communication
� Measuring the right data
� Workflow aligned for action
� Proactive analyses
� Ongoing monitoring of data
� Assessing success
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Thank You
� Contact information
– Barbara J. Piascik
– 212-356-4538
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Questions
Enjoy the rest of the conference!!!
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