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Monday, February 10, 2014
  Clinical Accuracy Spoken Here  

Hospital Revenue Cycle: Let's Talk Money

Commercial Payers are under pressure by 5 forces:

  1. Economic downturn
  2. Changes in government regulations
  3. Quality and safety initiatives
  4. Increased consumerism
  5. Information technology
Although the impact is different for payers, they still face the very same issues as the hospital.

[Reference: Hospital Revenue Cycle, Module A, Industry Cash Flow]
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  Excellence in Case Mgmt  

Hospital Revenue Cycle: What is Predictive Modeling?

Commercial payers use predictive modeling extensively to price their premiums and to budget for hospital costs. Predictive modeling applies a statistical methodology to clinical and administrative data to forecast medical outcomes and costs for a given population.

Thanks to electronic data interchange and the standardization of data and tool sets, the cost of collecting and warehousing quality data is decreasing, allowing easier access to claims, prescription, demographic, utilization review, and a host of other clinical and assessment data.

Commercial payers can improve disease management and care management programs through predictive modeling and thus can improve health quality and control utilization.

[Reference: Hospital Revenue Cycle, Module A, Industry Cash Flow]
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  Improving Patient Care...  

Hospital Revenue Cycle: Avoidable Days

Potentially avoidable days (PAD) are days that could possibly have been avoided and are usually due to process or structural issues.

Hospitals are not a good place to be unnecessarily. The longer the patient remains in the hospital the greater the risk for HACs, we tie up beds that other patients could be waiting for and receive increased scrutiny from government payers.

The Joint Commission expects us to have good processes in place to enhance patient flow. Some issue caused the delay and many of the root causes are things that we do have control over.

[Reference: Hospital Revenue Cycle, Module B, Hospital Cash Flow]
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Tom RasmussenTom Rasmussen
Publisher
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