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Healthcare Practice Strategies - Winter 2015 - Using Utilization Data to Increase Reimbursement

Mar 15, 2015

In this era of accountable care, utilization data — which collectively reflects a provider's efficiency and, in turn, the value he or she can offer — is a critical way of conveying the value you bring to a payer or potential care-model partner (e.g., Accountable Care Organizations).

With the move to robust practice management software and Electronic Health Records, you probably have access to a treasure trove of data right at your fingertips. Here are some ways to put utilization data to work for you:

  • Start with the payer. Ask the payer to share how your practice compares to its peers in regard to cost drivers like hospital length of stay, pharmacy cost, ancillary cost, cost per patient and cost per particular diagnosis code.
  • Gather your internal data. If you haven't already, ask your EHR and practice management software vendor to show you how to aggregate operational, clinical and/or financial information in a single report, as well as perform data mining from your database.
  • Crunch the numbers. Compare your utilization data against national benchmarks, such as metrics from the American Health Care Association, federal government data sites, managed care organizations, independent practice associations, and the hospitals you use.
  • Share the data. If you can make the case that you are providing high-quality healthcare in the setting of efficient resource utilization, share your utilization data with payers to strengthen payer contracting.

Healthcare Practice Strategies - Winter 2015

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