June has finally arrived, and with it always come preparations for the annual HFMA ANI conference and a corresponding flurry of press releases related to the state of healthcare finance. I’m particularly interested in the ways in which technology is helping providers to cut costs and provide better care, so my digital “ears” perked up when Jared Krawczyk, a Statistician at Fi-Med Management (and the man behind its Twitter handle), alerted me in 140 characters to the release of its REVEAL/md™ proactive compliance software that, according to the company’ press release, “allows users to instantly identify audit risk exposure and revenue potential within their medical groups regardless of their size.”
Now I’ll admit, I’ve never found compliance, RACS or analytics to be particularly creative endeavors, but I do realize the important role they all play in keeping healthcare running smoothly. This particular press release, which mentions all three, stood out to me for two reasons: the fact that the new software is the first of its kind, and that it promises a “unique experience that will make you forget that you are using a statistical tool.” Certainly an intriguing concept, so I decided to follow up with Jared to see just how this new first works.
Why introduce REVEAL/md now? How has healthcare reform created a market for this type of solution?
JK: “Healthcare reform is helping fuel the need of this product because both the government and commercial payers have identified the amount of money that is billed in error every year and have put forward a major effort to audit providers in the attempt to recoup these dollars that have been paid incorrectly.
“Getting paid quickly, accurately and with no strings attached in today’s healthcare environment is difficult. The typical medical group compliance team is charged with monitoring and improving the documentation, coding and billing activity of hundreds of physicians and coders at multiple locations, paid under dozens of fee schedules. The typical plan calls for reviewing a handful of randomly selected charts for each physician – several thousand charts for a large medical group - in the hope of finding some clues that lead to actionable insights. This may take most of the year (or much of the compliance budget), leaving insufficient time for education and improvement. Such plans may meet industry standards, but the odds of effecting lasting change are poor. In the end, innocent mistakes lead to recoupment of revenue; the consequence of repeated mistakes can be much more severe.
“With REVEAL/md, the client is reviewing 100 percent of the activity of 100 percent of your physicians every month, making statistically-valid comparisons of each physician’s patterns with peers in a national database to identify true outliers and pinpoint areas of concern across more than 45 key indicators, and estimating the financial consequence (i.e., recoupment potential) of audit by third-party payers. The analysis can be completed in about 15 minutes each month, leaving the compliance team free for education and improvement. No more random chart audits searching for needles in haystacks; you’re immediately on top of the high-risk areas with focused reviews, heading straight for actionable insights, with plenty of time (and budget) for education and improvement.”
How did you come up with 45 known risk indicators? Why is that the magic number?
“Our risk indicators have been developed to mimic auditors’ (both government and commercial payer) claim identification methodology when it comes to complex audit reviews, mainly E/M level of service analysis and other outpatient procedural issues. We currently analyze 45 because these are the hottest targets in today’s environment. These will expand and adapt based on changes in the audit entities focus.”
The PR mentions that you’ve created a “unique experience that will make you forget that you are using a statistical tool,” which seems to reinforce the focus the industry is now putting on user experience/user-centric design. How did user experience (UX) play into the tool’s development?
“The UX of our tool took the highest priority; our development cycle works in reverse compared to traditional standards. We strictly focus on the customer experience first and then work back into the technology to suit those needs, not the other way around.
“Our development team has a unique characteristic; we all actually have worked consulting for medical groups in regards to complex compliance analysis. This gives us a valuable perspective of not just “thinking” we know what the client needs are, but actually knowing what they experience and the restrictions/difficulties they run into on a daily basis because we have been in those situations ourselves. This allows us not only to build tools for our clients but, essentially, we are building tools that we love using.
“The unique experience that is described is a fundamental change in the way analytics and business intelligence is viewed today. We see ourselves putting a creative spin on analytics that makes our customers actually excited to use our tool - it’s not just another thing to add to their endless list of tasks for a given day. It’s an artistic approach that will not only help our users by providing meaningful insight, but also enhance how they communicate problems and opportunities to the rest of their organization, who typically are not directly familiar with the complexities of compliance.”
So there you have it. Healthcare IT – even in the world of finance and analytics – can be creative. Now, if developers could just figure out a way to make it fun, too. Gamification shouldn’t just be for mobile health, you know.
Jennifer Dennard is Social Marketing Director for Atlanta-based Billian's HealthDATA, Porter Research and HITR.com.