Integrating Care Standardization with Healthcare Revenue Cycle Excellence

RevCycleIntelligence.com reported that St. Luke’s Health System, one of 15 top health systems in 2017, was named as a top health system by Truven Health Analytics and IBM Watson Health based on care standardization!

And how does this relate to revenue cycle? 

“When you standardize your processes and you perform consistently, we have seen fewer of those occurrences that ultimately add extra cost without value, such as readmissions, longer lengths of stay, and more complications,” Bart Hill, MD, Vice President and Chief Quality Officer  at St. Luke.

Using Medicare data from 2014 and 2015, Truven Health Analytics and IBM Watson Health reported that each awarded health system reduced healthcare costs while improving the following care quality measures:

• 17.5 percent shorter wait times in the emergency department

• 13.4 percent fewer in-hospital deaths

• 8.5 percent fewer complications

• 10.2 percent shorter lengths of stay

St. Luke’s Health System has seven hospitals to manage, and each of them has their own “culture” and methodology. The challenge was to prevent variation and make operations, methodologies, and treatment consistent across all facilities. Care standardization allows health systems to better track and improve costly adverse healthcare events for patient populations with high-risk conditions, such as sepsis, heart failure, stroke, and pneumonia.

“By standardizing it, you reduce the variation in care and you can track and measure lengths of stay, readmissions, complications, and all the things that contribute to excessive and non-value-adding costs,” Hill said.

This upfront quality process ultimately reduces exceptions and denied claims in payment cycle. Additional improvements can refine this process further. Take for example denied claims. Many denial management processes do not incorporate denial information from EOBs/EOPs. By extracting this information for both posting automation and analysis, providers can basically create a closed looped system without missing data, and better metrics for continual improvements!