Same-database marriages

May 22, 2014

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What are the pros and cons of maintaining a common or shared, if not connected, database across all facilities within a network or system that weds revenue cycle’s chargemaster with supply chain’s item master file? No rift here.

Better patient care, reduction in duplication of tests and procedures, reduction in wasted time gathering same information for all parties involved in billing/collections.

– Patrick DeAngelo, Vice President, Technology and Process, McKesson Business Performance Services

Supply items and fulfillment/replenishment, along with cost savings are not realized when synchronization is lacking between the CDM and IMF.

– John Dragovits, Senior Vice President and General Manager, Revenue Cycle, Allscripts Healthcare Solutions Inc., Chicago

PRO: A common database will demand the standardization, that all item names, descriptions, pricing changes and coding updates therefore can be maintained easily and automatically across facilities. Consistent naming and accurate and current codes are fundamental to any revenue integrity goals as it provides extra measure of capturing revenue and preventing overcharges, which could lead to compliance risk.

CON: It requires a resource commitment to link the item master to the chargemaster. It can overburden internal resources if you are not leveraging a tool to facilitate the process. Time and effort needs to be spent up front to get everything set up correctly at the right level of detail. There could be supply items in the item master that are represented in the chargemaster are too generic resulting in lost revenue when multiple items that have a wide cost variance roll up under the same charge code. It’s important to be as specific as possible in the implementation process to avoid inadvertently losing lots of dollars later.

– Amy Amick, President, Revenue Cycle Management Segment, MedAssets Inc., Alpharetta, GA

There are both pros and cons to establishing this type of connection, and these will vary by each organization and the types of services provided.

Some of the pros are: Current data in a clean and consistent format across the organization, improved user experience in searching for an entry, improved timing of billing and reimbursement and improved vendor pricing data and contracts.

Several cons to this are: Determining ownership of review and maintenance of the files, the resources of time and staff required to complete the initial connection and obtaining buy- in from all stakeholders within the organization.

– Karen England, Revenue Cycle Consultant, Ingenious Med, Atlanta

PROS: Clinicians will have a much better idea of resource utilization. And having a complete connection will give them a uniform way to view and manage the cost per unit of care. 

CONS: The systems not only have very different functions, but they also change somewhat illogically and in a rapid way. As a result, maintaining synchronization and accuracy of data is difficult and can be expensive.

 – Jeffrey Rose, M.D., CMIO, TriZetto Corp., Denver

Integrating systems can add a great deal of efficiency but those linkages doesn’t operate in a vacuum. Tightly coupling two systems without a full analysis of the revenue cycle can remove – without replacing – checks and balances in the human linkages between two systems. [For instance] if you capture the wrong data at the front end, it becomes faster and easier for the wrong data to flow out the back end. 

– Patrick Campbell, Product Manager, MedAptus Inc., Raleigh, NC

Optimized revenue cycle and supply chain requires standardization and the leveraging of the system scale. By connecting the databases across the system, this process becomes easier and gives the organization increased financial transparency. The negative is that the hospitals with unique expense infrastructure may lose their charging flexibility.

– Robert Magnuson, Principal Advisor, Impact Advisors LLC, Naperville, IL

Regarding maintaining a shared database across all facilities in a network of system, there are several key factors to consider:

PROS: Standardized approach for charge capture and identification of gaps in charge integrity, streamlined processes, resource efficiencies, clinical data initiatives, effectiveness of reimbursement strategies. 

CONS: Lack of resource allotment for oversight of the end-to-end process, reliance on technology that may not provide the necessary data integrity management.

– Kathy Schwartz, Product Manager, Craneware Inc., Atlanta

PROS: The data governance approach to “Big Data” will be a game changer in the future. Focusing on CDM and IMF is no longer viewed as standalone back office activities. Common, connected data across the CDM, IMF, EHR and data warehouses are a common goal for providers. As we move from payment by episode to population health, integrated data will lead to an enhanced, increasingly beneficial focus on quality. 

UPMC has taken data that traditionally resides in separate information systems and combined it under a new enterprise data warehouse. The cost management group has used this information to establish cost per procedure down to the SKU level. Coding was changed to more accurately connect the supply cost to charge coding creating a seamless flow of information to the EMR.

Under this new foundational architecture, UPMC researchers were able to electronically integrate – for the first time ever – clinical and genomic information on 140 patients previously treated for breast cancer. Traditionally, these data have resided in separate information systems, making it difficult, if not impossible, to integrate and analyze dozens of variables.

CONS: Provider resources are stretched to the limit implementing meaningful use, ICD-10, value-based purchasing, etc. Developing and maintaining the discipline and the resources to address base systems of the CDM and IMF can be challenging. Many systems may not be ready to consider past coding or charging strategies or be willing to adopt a more disciplined master data management process to ensure consistent and complete item level data that can be connected across the continuum of care throughout all of the related applications from contracting, to billing and ultimately to the patient electronic health record. The focus of cost, quality and outcomes will require more collaboration with supply chain, clinicians, physicians and revenue cycle as we transform the delivery models to match the new payment models. Having all of these stakeholders committed to the transformation can be challenging.

– Mary Beth Lang, ScD, Vice President, Healthcare Pharmacy and Supply Chain Management Commercial Services, University of Pittsburgh Medical Center (UPMC)

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