How hospitals can make big data pay big

Opportunities abound for hospitals and health systems
By Donna S. Charles
10:38 AM

Hospital executives are faced with numerous challenges related to healthcare reform in general and the Affordable Care Act  in particular. Strategic decisions about how to address these challenges will significantly impact not only the financial and clinical performance of hospitals, but the perception of executive leadership itself.

Even though optimizing workflows and other processes are the main avenues available to executives to address these issues, it’s critical to understand the role that advanced information technology has in bringing these efforts to fruition.

Reduced payments to hospitals for avoidable readmissions began in 2012 under the ACA’s Hospital Readmissions Reductions Program, and the program is expanding in future years by increasing the level of payment reductions and expanding the scope of illnesses covered.

[See also: Health IT not keeping pace with big data.]

By 2015, under the ACA’s Hospital Readmissions Reductions Program, a penalty of up to 3 percent of regular reimbursements will be levied against hospitals that have had too many patient readmissions within 30 days of discharge for conditions such as heart attack, heart failure and pneumonia.

Compounding these factors are estimates from the American Heart Association that the number of people in the U.S. with heart failure could rise 46 percent, from 5 million in 2012 to 8 million in 2030, while the costs required to treat the condition could rise from $31 billion to $71 billion over the same timeframe.

Big data software applications represent the single most effective solution to addressing the myriad cost pressures facing hospitals, including the reduction of avoidable hospital readmissions. With each passing year, these technology investment decisions will become increasingly pivotal as a variety of cost pressures continue to rise.

Cost/benefit analysis will help reduce risks
While payment reductions constitute a significant financial risk for hospitals, there are additional risks related to the Centers for Medicare & Medicaid Services publicly reporting hospitals’ 30-day readmission rates and other healthcare quality measures online at “Hospital Compare” and other venues. As healthcare consumers and employers become increasingly aware of the available date, they will begin to more readily use that information to make decisions about where and how to engage service providers for healthcare.

However, all of these developments provide great opportunities for hospitals and health systems; not only to maximize payment capture from CMS, but also to bolster hospital marketing programs that promote achievements in key quality measures. With the right strategy for health information technology, hospitals and health systems can reduce avoidable readmissions, avoid reimbursement adjustments, and gain new market leadership in the healthcare reform environment.

Much of the raw data resources needed to achieve these goals are currently available in-house, however: 1) the data is often contained within non-integrated systems, and 2) hospitals and health systems lack the software applications needed to transform this data into actionable clinical information and business intelligence.

[See also: Without sharing, big data is nothing.]

An overarching strategic plan that breaks down these “silos” of non-integrated data and then applies effective “big data” applications is the key to achieving a superior return on investment in these technology implementations. When correctly implemented, hospital administrators, as well as physicians and other clinicians, benefit from “dashboard” views of key data, scorecards, and other easy-to-use displays that deliver meaningful information that’s at the fingertips whenever and wherever it’s needed.

Improving the decision making process
Big data applications are driving a revolution in healthcare because they quickly transform mountains of unused data into quickly available, actionable intelligence, which improves decision-making in areas such as: hospital discharge planning, disease management, quality improvement, performance reporting, as well as many other aspects of hospital and health system operations. For example, effective analytics solutions can not only predict readmission rates for patient populations and individual patients, but also facilitate efficient resource planning and scheduling tasks.

Technology is transforming the healthcare industry in ways that parallel every other industry on the planet. The leaders and the laggards within the healthcare industry are now being defined by how adroitly they are able to use technology to achieve real gains in clinical quality and business efficiency.
Beyond the technology, however, it’s critical to engage all of the non-IT stakeholders in the hospital every step of the way. As a result, your technology implementation will benefit from ongoing support and valuable internal advice from an interdisciplinary team of administrators, physicians, nurses and business staff.

Donna S. Charles is the principal consultant of Oron Healthcare Group, which enables healthcare organizations to improve financial and clinical results through the effective use of health information technology and related process improvements.