From HME Business – April 1, 2020
As HME providers expand their range of payers and revenue sources, they are learning to nimbly adapt to new market demands and make the most of new opportunities. To do that, they need to understand their businesses inside and out.
Fortunately, when providers pull back the curtain of their businesses, they are discovering they collect a lotof data. Thanks to today’s HME business and billing management software tools, providers are pooling oceans of information. The question is, how do they understand it and then act on it? Analytics tools are now helping providers do that.
PART OF A LARGER TREND
Over the past few years, providers have begun to truly study their businesses from a strategic standpoint. That’s not a surprise given that they are constantly chasing a broader range of funding sources and having to deal with constantly changing market, funding and regulatory dynamics.
At the same time, providers have really worked to ramp up their revenue cycle management game. Now, instead of simply making sure their billing operations are efficient, providers are using technology to manage and maximize each patient relationships’ potential revenue.
As a business practice and as a technology implementation, we’ve seen revenue cycle management “trickle down” from the larger scale healthcare organizations — hospitals, health groups, insurance carriers — into the realm of HME.
Similarly, we are now seeing the analytics tools and the practice of using analytics to study business performance and RCM performance, start to move from the larger facilities-based healthcare world into the HME world.
“The larger groups, the hospitals, the health systems are kind of the early adopters,” says Jason Dillon, national sales manager for HME and infusion at PlayMaker Health, which providers CRM and sales management tools for provides. “I think healthcare, in general, has always been that way. … And now I certainly feel like there is a shift in momentum at some of those mid-tier and smaller-tier [providers] at this point. … Gone are the days of just being able to maintain a business from a spreadsheet.”
Why? There’s a strategic imperative for providers to better understand their businesses.
“At this point, even the Ma and Pa organizations want to better understand what’s going on in their businesses; what’s coming in; what’s going out,” Dillon adds. “From day one, it’s really difficult to survive in a landscape that’s as competitive as the one we have at this point without knowing all of the intricate details of your business and what’s going on with it.”
EASY ACCESS TO INFORMATION
Perhaps the best phrase to define the impact of analytics in the business place is “strategic responsiveness.” HME providers collect lots of data using their billing and business management software, and they often have reporting tools, and of course, they can output data and analyze it using other software, but when a provider needs to understand and address a strategic business problem right away, analytics software tools can serve that information up faster than a drive-through burger joint.
“There are many different ways that you can track your business metrics,” says Fadi Haddad, the director of Business Analytics for HME software company Brightree LLC. Haddad notes that Brightree has built-in reports and gives its users an ad hoc reporting tool that lets them download the data that they need to study, and providers can use Excel reports to analyze that data and distribute that internally. The question is, is that process easy and responsive?
“I guess it depends on your definition of easy,” he explains. “Anybody can pull data into Excel; but, when it comes down to really modifying it and applying the appropriate logic to do it, that’s where I think some of the confusion or difficulty comes in. You really run into this scenario where you may pull something yourself, like maybe one person goes in and pulls a report on those outstanding sales order days, right? ‘I really, really want to know where do I stand here. How long has it taken me?; And then another person goes in, and they run the exact same type of report with the same metrics, but they use a slightly different logic, or they put an additional filter in there and come up to a totally different number — but yet it’s for the same key performance indicators.
“Now, as an organization, as a DME, the business is left wondering, ‘Well, which one is the right one for us to use?’” Haddad continues. “That’s where having an actual analytics platform comes in and can be used as a single source of truth. When somebody logs in within the DME, they can go in, and they can see, “Where are my outstanding sales order days? Where do they stand? Where are my aging accounts receivable? What’s going on with my denials?”
And, he explains that getting to the data doesn’t stop with knowing a high-level number. A provider will want to dive into the data behind that number.
“You need the ability to slice it down to the payer level, slice it down to the location level, even the user,” Haddad notes. “You want to make sure you’re always able to track and monitor each detail of your business and as deep as you want to go or as high as you want to go. And that’s really where that Advanced Analytics platform comes in.”
ANALYTICS IN ACTION: WECARE MEDICAL
Megan Brown is president of Ashland, Ky.-headquartered HME provider WeCare Medical LLC, which has 12 storefront locations that serve a broad range of patients in more than 100 counties across Kentucky, Ohio and West Virginia. WeCare was founded in 2004 and has seen considerable growth and expansion from the Ashland location since then.
Brown came on board as a Respiratory Therapist in 2011, working with patients served by WeCare’s Ashland, Portsmouth, and Charleston locations and gained a real stem-to-stern understanding of the business as it shot along its quick growth trajectory. Eventually, she was promoted to President and has since been working to identify and resolve issues around accounts receivable, outstanding sales orders, expiring CMNs. And in that undertaking, Analytics has played a considerable role, she says.
“About a year ago, I was helping the revenue cycle team,” Brown recalls. “I’d identified that we were having issues with our held AR. Our held AR, for those who are not as familiar, is basically anything that’s holding up revenue from coming in our doors. This could be CMNs, authorization, manual holds, from all the business that are reoccurring rentals. So I noticed that number was starting to increase.”
As WeCare did more business, the number continued to grow. So Brown reached out to its Brightree rep to see what could be done beyond the things she’d already tried to identify the problem within the organization that was causing the escalating held AR and then address it.
“Our rep told me that Brightree was working on a new program, and she’d referenced their analytics,” Brown says. “At the time, it wasn’t ready to be presented, but she reached out once it was ready. And you know, I’m just super thankful that we went that direction because we were able to take our held AR down by 57 percent.”
So, starting last June, WeCare started using analytics to analyze its departments and the responsibilities on each individual employee and assigned different workloads more evenly to where they could be successful in executing. Then it started using analytics to track its CMNs, which impacts its held Accounts Receivable.
“There’s a feature inside of our analytics that lets you review the CMNs that will expire soon,” Brown says. “They’re broken down in buckets. So you’ve got CMNs that are going to expire in three to seven days, and then eight to 14 days, and so on. We’ve actually taken our CMNs down 66 percent today, and that is directly thanks to analytics.
“Before analytics we were unable to see what was getting ready to expire without having to pull three and four reports, and merge them together.” She continues. “And it was just not efficient for our team to do. Moreover, after the reports had been merged together and altered so many times, you had to wonder if they were even accurate.”
WeCare derives its revenues from a pretty brand range of sources. Roughly 30 percent of its funding comes from Medicare, and the rest is diversified over sources, including commercial payers and Medicaid. So it takes work to ensure WeCare receives a steady flow of income. Moreover, like a lot of providers, WeCare has suffered the proverbial third week of the month lull that undermines that effort.
“I think every DME goes through this: you push information through the first two weeks of the month,” Brown explains. And then you taper off during week three. So then, Wednesday through Friday of the final week it’s ‘push-push-push-push-push.’ You’re pushing orders to the confirmation team so that they can release those claims to bill.”
That lag and then explosion of last-minute activity is not exactly an ideal situation for a provider trying to maintain steady cash flow.
“We were able to go into analytics and identify what our average revenue build was per location, and then, in turn, do spot checks throughout the day and throughout the week to make sure that we are staying on target to keep a steady flow of revenue,” Brown says. “If you don’t have steady revenue, it’s very difficult to run a successful budget, pay payroll, and keep expenses under control.”
Resupply is another important element of WeCare’s business that is benefiting from analytics, according to Brown.
“We take great pride in our resupply program,” she says. “It’s something that we feel we offer to the communities that we’re located in that the other DMEs don’t. We’ve been monitoring the average allowed amount per sales order that’s been created in the system, and I’m able with analytics to go in and look at an average allowed amount per sales order by employee.”
WeCare uses a blend of Brightree Connect to automate its patient outreach for resupply, as well as four callers to handle live calls as part of its resupply efforts.
“I can go in and target those employees and work with them to see if they are educating the patients like they need to,” Brown says. “You know, talking about the importance of changing their filters every month and getting their scripted pressures because they’ve not actually changed their cushion. So we’ve seen that go from $96 up to $105 per sales order created by an employee.”
Another element of its business that WeCare uses analytics to monitor, assess and address is the outstanding unbilled business. Analytics help the provider understand how much and why, and then determine ways to decrease it.
“Because it’s the first thing that you see in terms of money value when you click on the Brightree summary page, we started taking a look at what are we leaving on the table each month,” Brown explains adding there was a gap between new business and delivered log of business that was getting into the hundreds of thousands of dollars. WeCare understood some of the reasons why that was happening, but not all of them.
“That’s because we don’t bill or confirm a sales order to release until we have all documentation that’s needed to complete that file,” she says. “With some insurances, you can bill, but in the event you get an audit, you need to have the documentation. Well, we don’t chance that; we make sure that we have all documentation prior to letting that claim go out the door. So, we started monitoring that month after month and by diving into each location easily within analytics to examine, well, let’s hypothetically say our Ashland has $100,000 sitting outstanding. What kind of impacts can we make?
“You can drill into that in analytics to see what work is in progress,” Brown continues. “Who are the majority of the sales orders assigned to? So then our response can be more targeted to the employee that has a higher volume of sales orders sitting, instead of the old, ‘well let’s just work on Ashland as a whole’ and throwing darts at a moving dartboard.”
Applications of analytics such as this help WeCare ensure it closes out at the end of the month that whatever business we have obtained for that month; that it collects all of the documentation required; and that it bills that business before the close of the month. The ultimate goal is to make business turn on a dime.
“I think at the end of the day, our goal is to get that process tightened up so that everything is done within a three-day turnaround,” Brown says.
KNOWING MORE ABOUT YOUR MARKET
Analytics isn’t just about understanding your own business but understanding the market and how your business stacks up against other players.
For example, as new providers and investors look at the attractive demographics of post-acute healthcare, competition is increasing almost daily in the HME environment, PlayMaker’s Dillon notes.
“Whether you’ve been in business for 20 years and have some sort of that word-of-mouth customer base built up, or you’re in day two from just getting your licensure and being able to offer different products or therapies, I think it’s important to know who’s doing what and who’s not doing what in order to identify and develop your niche.”
So PlayMaker Health aims to provide analytic tools that help providers see how they fit into the competitive landscape, and how well they are reaching the market.
“Even where you don’t have a relationship established, we can absolutely show you some of those, for lack of a better term, ‘performances’ in your area: who’s referring, how often, and, if you’re not getting any other referrals, where those referrals are going,” Dillon explains. “And again, you can spin that off multiple times. We can show you things like payer mix, and what percentage of a physician’s practice is coming against different payer sources and so on.”
The result is that the provider is using analytics not to optimize its operational performance, but its sales and market performance. Analytics are being used to grow the business.
“There’s a component of our platform that helps you identify and evaluate, really, those existing relationships,” Dillon explains. “For example, you may have a relationship with a physician, and he or she tells you, ‘Hey, you’re getting 100 percent of my business.’ Well, when you use our data, you find out that they might be only sending you 50 percent or 75 percent of referrals; there’s business being left on the table.
“Then there’s what I consider the ‘green space,’” he continues. “Those are relationships that you don’t have, and a lot of times, you might not even know that they exist. There could be a physician three blocks over from you that’s currently referring out in the top 10 percentile of physicians nationwide relative to the products you support — and you don’t even know their name! So it’s both the leading and the lagging indicators that we are tracking with our software and data.”
And toggling back to operational performance, Brightree’s Haddad says that his company’s Advanced Analytics gives providers the ability to use broader data benchmarking against the market. Instead of looking at just their data, they’re comparing performance to anonymized data collected across the system’s user base.
“You can look at your own trend, and say, ‘I grew by 10 percent overall year over year,’” he says. “Hey, that’s great, but wouldn’t it be great to know what the industry average is? What if the industry is actually growing at 30 percent?
“Outsourcing lets us see broad benchmarks (obviously, we would never share provider-specific information), study them in an aggregate fashion, and say, ‘Hey, the industry, in general, is sitting at X. We’re sitting at Y. What can we do to make you better?’” He continues. “Having that visibility is key. It’s not something you’re going to be able to get if you’re just building it yourself because you’re limited to your own data.”
So how do providers get started with Analytics? It is possible to implement analytics on your own, but not easy, according to Brightree’s Haddad.
“If you do this yourself, you need to get the data for one,” he says. “Depending on how you want to do that, and the level of sophistication you want to go with your analytics platform, it could be something as minimal as having an analyst or two on staff running those ad hoc reports and then creating your own set of reports through a series of ad hocs and pivots and via lookups and all those wonderful things.”
More sophisticated options would be for the provider to set up its own data warehouse, which would entail server costs, software licensing costs, data migration costs, acquiring additional market data, and then hiring a business analyst, a database administrator, and, depending on the level of sophistication, perhaps a data scientists given that analytics can involve artificial intelligence. Did I neglect to mention the attendant data security that would be involved in all these considerations? (If you’re not blanching at this scenario, you likely have more budget and bravery than most HME businesses.)
On the other hand, with outsourcing, providers can tap into an existing analytics system that sits in a secure, cloud-based environment.
“You log in, it’s a secure environment, you look at the data, you see what you need, and you start taking action,” Haddad says. “It’s not just looking at the data, but it’s pulling that actionable insight from it.
“Another huge benefit to outsourcing is the ability to set an alert,” he adds. “We want to find ways to be proactive; we don’t want to be reactive. With a tool that’s already fully developed like Advanced Analytics, you can set these types of pulse alerts so that, let’s say, you are looking at your denials ratio or the outstanding sales orders or your net revenue collection. You can easily go through and set a threshold to stay within a range for those outstanding sales orders. If it’s anything higher than that, you’re going to get an email notification. You can’t really do that with Excel.”
PlayMaker’s Dillon adds that providers should look for an analytics vendor that will work to understand their business so as to minimize the disruption of implementation.
“I think it’s important to find [an analytics] provider that offers a full service solution from A to Z and really impacts your business flow, or your resources minimally, if at all,” he explains. “And what I mean by that is you as a business don’t typically have a lot of time or resource to dedicate to a secondary, or a third, or fourth maybe software or data project. And so it’s important for you to find someone that can handle that as a standalone.
Additionally, that vendor should also provide the training that ensure the entire business uses the available analytics tools to their fullest potential, Dillon adds.
“Make sure that you are going to be trained on it, not only from the initial kind of kickoff, but all the way through you actually utilizing and implementing the data and strategy in the field,” he explains. “Don’t stop at someone that gives you literally one particular point of view in terms of the data.
“I think it’s important, especially in today’s ever-changing environment, that you focus on a solution and a provider that gives you kind of the comprehensive view,” Dillon continues. “Find a solution that gives you all the angles, not just where you want to go, but where you’ve been and where you are. I think when you have kind of those three angles in terms of the business, it really does give you the opportunity to lay out a dynamic strategy and figure out how to go win.”
From Brown’s perspective, a key lesson that WeCare learned in its analytics implementation is that analytics helps providers get in front of the trends before they become problems.
“I think the biggest thing is in our industry and with today’s time,” she says. “I think that all DMEs need to become less reactive and be more proactive. And in order to be able to do that, you’ve got to be able to look at all of these performance indicators daily, weekly, monthly, monitor the trends that are happening inside all aspects of your business. It’s not just direct operations, but internally in your revenue cycle piece. You know, that’s where the biggest impact can be made. … It’s changed our culture.”