With the advanced IT systems available today, healthcare organizations are transforming data from a series of abstract numbers into palpable business strategies.

Given that healthcare has become an intensely competitive environment, highly refined data represents the edge providers need to stay ahead of declining reimbursement, increasingly convoluted regulations and escalating costs. Borne-out returns on investment from generating, extracting, synthesizing and using raw data are being widely touted across the provider spectrum.

No wonder, then, that free-standing radiology centers are among those benefiting the most from data mining system capabilities. Squarely in the path of Medicare fee reductions and competing for business with acute care facilities, organizations like St. Louis-based Metro Imaging are depending on salient data management for guidance.

Many uses for data mining

“We use it to either reduce costs or increase revenues,” said CFO Christine Keefe, who uses Merge eMed's Fusion RIS. “There are a number of categories we use; among them is a practice analysis tool that allows us to analyze trends in our referring physician base. It tells us who is sending patients, the types of patients they are sending and for what reason. This helps us sharpen our marketing focus.”

Metro Imaging operates five centers in the greater St. Louis area and seven staff radiologists interpret about 100,000 studies per year. Because personnel is the organization’s highest cost, Keefe uses the RIS system to coordinate scheduling, manage workflow and measure employee productivity.

“It allows me to determine where our staff is best used,” she said. “I can even out the workload across the five sites.”

More power to providers

Merge eMed president Bob White says the company's FUSION RIS solution is designed to help providers unlock their data.

“They are sitting on a ton of information and they need to learn how to use it,” he said. “It’s no longer just about getting data, it’s about getting timely, relevant data. Our system lets providers view their operations holistically, giving them the ability to use data mining for practice analysis and to identify inefficiencies in real time.”

Data mining is also empowering providers in contract negotiations with payers. Minneapolis-based Allina Health System is an 11-hospital network, and finance manager Dawn Massmann, who is responsible for forging managed care agreements with insurers, says the IMACS Workbench product gives her bargaining leverage.

“We’re mining all our patient bills so we can review each payer’s activity, break it down into service lines and model our contract negotiations with that payer,” said Massmann, whose department processes approximately 1 million claims per year.

“The system is re- markably accurate, so that as we negotiate, especially with methodology changes, we can communicate with them in the same language.”

IMACS’ data mining and business analytics tools give Massmann the ability to challenge a payer’s proposed reimbursement cut by demonstrating its impact — something providers haven’t previously done to any convincing degree.

“We can now show the payer how a proposal may not have the expected results,” she said. “We can model it to show how changing a methodology can have the opposite effect.”

Leveling the field

To be sure, data mining systems “have leveled the playing field” for providers who — without ready access to data — have had no other option than to acquiesce to payer demands, said Gary Chew, senior managed care division analyst at Hillcrest in Tulsa, Okla., part of the Ardent Health System.

“Since the early ‘90s, the power has been tilted toward the payers,” he said. “Data mining systems help keep them honest. It also helps us make more refined decisions when we used to shoot from the hip. Expertise management has come to the revenue side.”

Chew says before implementing the IMACS system, he spent half his time verifying that managed care models worked properly. Now, he said, he is more involved with analysis, studying the impact of charge master increases and reimbursement changes.

“I get a lot of questions and I now have the opportunity to find answers,” he said. “I don’t think I’ve gotten a question that I haven’t been able to answer.”

A clinical tool

Physician clinics are also hampered by chronic go-rounds with payers, though their source of contention is with rejected claims. In response, a data mining system can serve as a quality control vehicle for billing staff to ensure that claims are tidy and timely, said Frank Marshall, COO for Irving, Texas-based MedSynergies.

“It’s pretty simple — a claim can only be paid, denied or given no response,” he said. “We’ve developed metrics that show where the process is broken and gives them actionable information to optimize their revenue cycle. They can review the claims process from the front end to payment.”