You can show Kirk Hintz the money, or show him the data, but what he really wants to see is the variance. Formerly an options trader in Naples, Fla., with some practice administration experience, Hintz assumed the position of CEO for Nashville-based Radiology Alliance two years ago.
“Reports have to take data and turn them into information quickly, without the need for substantial analysis,” Hintz says. “A report needs to be configured in a way to readily identify significant variant.”
With 42 full-time equivalent radiologists, one outpatient imaging center, and 11 hospital clients, Radiology Alliance employs 60 FTEs, 29 of which are engaged in an increasingly rare in-house billing operation. When Hintz arrived in 2012, healthcare was in the midst of the transition to version 5010 of the standard electronic Health Insurance Portability and Accountability Act transaction regulations, and the practice had not dropped charges in nearly 90 days.
“The financial system at that time was in a complete shambles,” Hintz recalls. “Reporting was abysmal, and the system did not function. That was when we made the transition from our previous vendor to Fuji Financials, and implemented a conversion process for the RIS as well.”
A smooth electronic interface
While Hintz has not yet arrived in financial-system paradise, the situation has improved considerably. The practice has made considerable progress in tracking productivity, although the process is labor-intensive. Significant efficiencies, however, have been gained in the ability to electronically interface our patient billing system with the facilities the practice serves.
Today, for instance, the practice has bifurcated its payment process, so that all self-pay payments go to a separate lock box. An electronic file is generated by the practice’s bank and sent directly to Radiology Alliance and uploaded into its system.
“What used to take four hours of a payment poster’s time, now takes 45 minutes to work exceptions,” Hintz reports. “It was that type of upgraded interface-ability and connectivity that we wanted to move to, and there are a lot of those type of features built into the platform.”
The entire transaction creates an electronic file that is remitted to Radiology Alliance: The patient sends payment via check or credit with the statement to the remit address; it arrives at the specified lockbox; the remit address goes to Baltimore; Baltimore opens the check, stamps it for deposit only, enters the scan code on the statement and sends it to Radiology Alliance’s bank.
“We just upload that information from the bank on a daily basis,” Hintz explains. “We see that, yes, Mr. Smith made the payment. We pull up his account, see that he had that charge outstanding, we accept it, and it posts to his account. Before, we would have had to enter in all of that information manually. It saved us about four hours a day, and that’s just one example.”
An eye on RVUs
Time is money, so Hintz also has focused on building out the practice’s ability to track physician productivity by RVUs, an activity that involves downloading data from the hospital system’s patient portal and manual manipulation. “It is a very resource-intensive process that we go through because it is an important part of our reporting structure,” he says.
Hintz noted that physicians experienced the Hawthorne effect—whereby just the knowledge that productivity is being monitored results in behavior modification—in describing the impact of RVU sharing in a pool of highly intelligent and competitive radiologists who characteristically exceled in school. “We publish the data, it’s not anonymized and the group saw an automatic increase in productivity,” he says. “An email goes out with everybody’s productivity from the previous day.”
Radiology Alliance also uses the RVU data to assess the amount and intensity of the work at a particular location for staffing purposes. “For example, if we see an influx of studies requiring a certain subspecialty, then we need to make sure that we have available in our system, somewhere, the subspecialist to read those studies,” he says.
An advantage of having an in-house billing department is the ability to deploy resources where they will have the greatest impact; collections is one of those areas, Hintz says. “The advantage is that I can control the backend, and we can go as hard as we want after the last dollar,” he says. “We pride ourselves on the collection effort that goes into the work that we do.”
A two-faced database
Nonetheless, reporting has been challenging and is a primary target for improvement. When the practice converted to the new system, which is built on the radiology billing software from Imagine Software, Charlotte, N.C., Hintz insisted on retaining the old data. Unfortunately, to prevent data contamination, it was necessary to create two databases.
Hintz expects to resolve that problem with a recently acquired roll-up software product from Targit, which will enable the practice to consolidate the pre-conversion and post-conversion databases into one data set for reporting. Finally, Hintz will have the larger dataset he sought for trend analysis, the precursor to variance.
“For example, subtle shifts in modalities (by location), shifts in self-pays, trends and shifts in denials by payors: Those are all things you can’t pick up on in a given month unless you have a baseline of previous months to compare to,” he says. “That’s what we are after.”
With the database problem in hand, the practice recently hired Melissa Ray as director of practice management, to help refine its reporting capability. Ray previously managed a billing operations center for a major billing vendor; her primary charge is to build variances into most reports. “That is what drives a valuable report,” Hintz says. “Month to month, month compared to prior year, year over prior year, we want to see trends. We have to establish trends in order to detect variances, and we need two or three years of information. The longer the line for history, the greater the degree of accuracy for projections.”
Adds Ray: “Take Payer denials: Having the data is one thing, but trending is what’s important. The look of the reports and graphing is good, but we’re focusing on the comparative value and not just the volume.”
Reports would be much more helpful, Hintz says, if they captured and identified a trend. “If we really want to go to the next degree, we will generate reports with alerts when numbers come in over or under a certain variance for certain metrics,” Hintz says. “For example, if our denial rate increases 10 percent, an alert would be generated and we would be able to hone in on that.”
In the coming months, Hintz will deploy Synapse RIS from FUJIFILM Medical Systems, Stamford, Conn., in a tight integration with its financial system and its Synapse PACS. Further anticipated efficiencies include automatic patient demographic updates: When a client uses the Fuji RIS system to enter patient demographic information, a demographic file will auto-populate on the billing system.
Hintz lobbied Fujifilm to configure the RIS to capture the copious demographic data required by state agencies of independent diagnostic testing facilities. “The government requests this data, and it is very difficult to get to,” Hintz says. “The new RIS is going to start generating fields and capturing that data, so it will generate reports, facilitating that process substantially.”
Still some distance from paradise, Hintz praised his software provider for its ability to listen to its clients. “They listen and care more for their customers than other companies that I have encountered,” he says. “When we make suggestions, they are constantly listening and looking for ways to improve their product. That’s the kind of strategic partner you really want for the long term.”
Cheryl Proval is editor of Radinformatics.