For healthcare CFOs, finding opportunities to improve funding and prevent funding leakage is a serious challenge.
How do you ensure hospital funding reflects patient complexity? How can you better optimise resource allocation and funding?
As with any business decision, the answers depend on high-quality data insights.
A hospital generates huge amounts of data, which has the potential to support the analysis, planning, and delivery of optimised hospital funding and performance. The challenge for CFOs is how to access the high quality data and reporting required to make strategic decisions.
That’s where the Health Information Services (HIS) department comes in.
How HIS reporting and data can improve funding
HIS department manage all patient-related information and data. They code patient records, provide casemix and DRG data, audit coding, maintain data and reports, and much more. In short, the HIS department can be a goldmine of reporting and data for the CFO.
With access to a range of data and reports, the CFO can gain instant insights into the hospital budget’s health and the current funding situation – all of which can help them make evidence-based decisions to improve funding, maximise resource allocation, and, ultimately, optimise hospital performance.
Make better business decisions from better data quality
Making informed decisions relies on hospital CFOs being able to trust the quality of the HIS data. As we stated in the previous article, organisations lose an average of $12.9 million every year due to poor data quality. Furthermore, 40% of business objectives fail due to inaccurate data.
In the HIS department, data quality depends on the quality of coding.
Therefore, the work carried out by Health Information Managers (HIMs), clinical coders and coding auditors has a direct impact on how effectively the CFO can use HIS data to make decisions. After all, coding affects Activity Based Funding (ABF), which ultimately leads to better business outcomes.
There are three top causes of poor coding quality in HIS departments, as identified in our recent study:
- Incomplete clinical documentation
- Variations in coding standards interpretations
- Pressure caused by quota to HIMs and clinical coders
Our study also found these issues can be solved with the help of Health Information Technology (HIT), combined with efficient workflows, processes, and ongoing training.
Examples of HIS data to inform better funding
Some key examples of HIS data that can be used to improve funding include:
- National Weighted Activity Unit (NWAU) Achievement: Coding target vs Actual shows the CFO how many records are coded in a certain time, while Audit target vs Actual reveals how much funding was retrieved. Tracking outstanding NWAU/$ is also a good indicator of communication flow between clinicians and coders.
- Code Focus provides the NWAU/$ queries feature hospital teams need.
- Cost Data: As each episode is coded, Code Focus keeps a running total of ABF budget vs actual budget. So CFOs have real-time access to these figures to assess hospital performance, uncover funding that was unable to be determined at the time of coding.
- Average Length of Stay (ALOS): With insight into the average number of days a patient stays in the hospital, CFOs can assess resource utilisation, bed occupancy, and efficiency, which can lead to cost savings and increased capacity.
- Case Mix Index (CMI): Understanding the relative complexity of patients treated in the hospital is crucial for CFOs. For example, a higher CMI means CFOs can justify higher funding to manage the higher level of case complexity.
Why CFOs need real-time reporting from the HIS department
Hospitals are fast-paced environments, and new information can be quickly made available or suddenly required.
Real-time data and reporting enables immediate action, allowing hospital CFOs to proactively seize opportunities for better funding, prevent issues from escalating, or respond to resourcing needs.
However, when HIS departments are using multiple spreadsheets for coding allocations, coding audits, queries, CDI, etc., there is a high risk that by the time the data is extracted, it will be out of date. The burden of bringing together data from separate spreadsheets is time-consuming and labour intensive, meaning there will be a lag time from patient discharge. As such, CFOs can not make full use of the data to make timely decisions.
Code Focus helps solve this challenge by providing one unified and trusted source of data. A hospital using Code Focus said this:
“We went from 20 spreadsheets down to 0 thanks to Code Focus”
The cloud-based tool eliminates the need for multiple spreadsheets, instead putting all the data in one place, where human error is greatly reduced and managers can access real-time reporting easily, on demand.
For example, as each episode is coded, Code Focus keeps a running total of the ABF budget versus actual budget. With real-time access to these figures, CFOs can assess hospital performance and funding as it stands at any point of time and take corrective action immediately if necessary.
The coding auditing tool can help uncover funding that was unable to be determined at the time of coding, and it can also identify NWAU leakage as a result of coding errors or missing codes to ensure appropriate funding for all episodes.
The real-time reporting also enables CFOs to make insightful comparisons, such as comparing performance across sectors such as hospitals and campuses, or data from different specialties against the NWAU.
Code Focus also helps ensure high quality data through a real-time coder-auditor-coder feedback loop. It maintains a full history of every coding change and allows users to add comments to codes and detail their reasons for changes. Clinical coders can log in to access the feedback and apply their learnings, which drives a higher accuracy of coding and therefore more accurate funding.
No CFO can afford to ignore the advantages of HIS data and reporting to improve decision-making. However, the decisions are only as good as the data quality. When CFOs have access to high-quality real-time HIS data, they can have a clearer picture of the funding integrity of their hospitals and make informed decisions to improve funding, and ultimately, hospital performance.
CTA: Find out how Code Focus can help improve the quality of your HIS data, so you can make better business decisions.