Did Covid light your fire or put it out? I’ve seen three reactions from family and friends so far: Fight, flight, or freeze. Could the same be true with the leaders of our healthcare organizations? Some hospitals are seeing great progress right now. They identify the gaps quickly and work to repair the breakpoints that affect revenue and patient safety. They’ve improved processes with Covid as a catalyst. We’re in an environment right now that is moving incredibly fast but let’s be real, a great number of healthcare organizations are just getting by. Covid has delayed process improvement initiatives and the data breakpoints are multiplying by the day. Today, I’d like to talk to you about the healthcare industry’s response to the Covid era, and the revenue and patient safety data gaps that cost the industry millions of dollars every year.
Revenue integrity does indeed rely on the accuracy and alignment of the item master (IM) and the chargemaster (CDM). But here’s the real rub, a great amount of supply spend (especially right now) happens outside of the item master, and as such, it is subject to manual processes. Without a robust data source, what are the chances the organization can gather the information needed to process that order without error or better yet, file a claim within 72 hours? Take a peek at the rejected claims and the dollar amount per year reported by U.S hospitals in your spare time. It’s public information and it seems that hospitals have accepted the data gaps as the state of healthcare.
So why do hospitals continue to lose revenue due to bad or missing information? It’s easy to say there is no reliable source for good information, but that’s not true. We hear the typical hospital has data issues impacting almost 30% of the charges in a case. This is a major breakpoint. Having an on-demand data source to manage the item master and chargemaster should be a top priority of course but hospitals also need a source of truth that allows them to tap into unbiased industry data. And that source must have all the necessary procure to pay data attributes required to transact with. Purchasing doesn’t have time to chase this information down and more often than not, they haven’t been given the right tools.
Right now, hospitals need to know every manufacturer in the market making a specific product or product category. We can’t make clinical functional equivalents this hard. Hospitals are still dealing with backorders and distribution disruptions daily and they can’t be confined to working with only the companies their distributors and GPO’s are contracted with. Driven by Covid, all that non-file/non-contract data must be populated with all the necessary data attributes to support the procure-to-pay processes as well. If a hospital doesn’t have a reliable source for industry content, the data breakpoints are growing by the day.
For example, many U.S hospitals don’t have recall information on demand and before the order is sent to their distributor or manufacturer. If a hospital doesn’t know that an item is on recall before the PO is sent, then they are buying recalled products and as a consumer, I don’t want to be admitted to that hospital. Every organization needs checks and balances in place to understand what is on recall and to stop the purchasing staff from ordering the product before it hits the shelves. Not only is it inefficient from an operational perspective, but it also places both the patient and organization at risk. Real-time recall information is proactively available today. This is something we have to fight for, and we cannot let Covid delay our efforts.
After 22 years of working with senior leadership in the healthcare supply chain, I’m certain that executive personalities and internal politics play a pivotal role in a hospital’s revenue and patient safety performance. Many organizations fear being exposed when exposing the breakpoints within. It’s easier to say that’s the state of the healthcare industry, but is that true? Can we accept that now or do we fight with everything we have to change it? I understand that Covid has brought about fatigue in healthcare organizations across the country, but now is the time to address the data gaps tactically.
When Covid began, I froze. I’ll admit it. No move was better than the wrong move I thought. But then the fight in me bubbled to the surface and I realized that I can make a difference. And it’s time to get real about the data breakpoints and what it’s really costing healthcare.
How people react to adversity varies greatly. It doesn’t matter if it’s inherent or taught, people can evolve from flight or freeze to fight (with the right guidance). If we’ve learned anything from the last two years, it’s that the supply chain acts as the veins of a healthcare organization. The truth fears no question, so measure everything, get real about the data gaps and forget the politics within that prevent you from shedding light on the things that cost your organization. It’s everyone’s responsibility to repair the breakpoints that affect patient safety, revenue performance, and process improvement. An organization’s ability to do all that is reliant on the people they hire and what they prioritize. My hope is that the Covid-era will push supply chain executives to better understand data and how to leverage it because we need them to fight for patient safety, process improvement, and revenue performance right now, more than ever.
About the Author
Lee Ann McWhorter is the Vice President of Business Development at Meperia. Her primary goals are to reduce data error, reduce cost and improve patient safety in the healthcare industry. Lee Ann has worked with the founders of Meperia for over 16 years and understands the breakpoints in the healthcare supply chain and the need for unbiased, quality data moving forward. For more information about Meperia please reach out to lmcwhorter@meperia.com.