Summary: A three-pronged approach to organizational analysis consists of clinical analysis, operational analysis and financial analysis. Find out how these approaches link together to provide holistic results.
In order to achieve optimal results and maximize profitability for a healthcare organization, a three-pronged approach to organizational analysis is necessary. As a starting point, it is critical to determine where your organization is in terms of key metrics. This can be achieved through an in-depth SWOT analysis which consists of determining your organization’s strengths, weaknesses, opportunities and threats.
Healthcare, in particular, is a complex industry laden with constantly changing legislation. Remaining profitable and competitive under such circumstances can be challenging. A three-pronged approach to organizational analysis includes operational, clinical, and financial analyses to be performed in conjunction with one another to maximize revenue, reduce costs, and improve the quality of healthcare.
Healthcare Reform has brought about many changes in regard to how organizations function from a financial perspective. New payment methods have been introduced such as bundled payments, Managed Care Organizations, and Accountable Care Organizations. Reimbursement has been reduced through Medicare. Medicaid is in the process of massive expansion. Changes are occurring in coding such as transitioning to ICD-10 from ICD-9. E&M coding has become a new buzz word, ensuring that coding reflects the proper level of care both provided and allowed. Contract negotiations are becoming critical to make sure the best possible rates are obtained. Denial management and revenue cycle are certainly areas to concentrate upon to ensure maximum profitability.
From an operational perspective, how do you stack up against your competition? What are your step-by-step processes? How can additional efficiencies be achieved? How are you complying with healthcare reform requirements? Have you performed a gap analysis to make sure all reform processes are in place? Have you looked at your organization from a risk perspective? What about insourcing versus outsourcing opportunities? Do you have areas which would benefit from one versus the other? When is the last time you reviewed your policies and procedures? Are they written clearly and concisely? Are they all still relevant? Are others needed? From an information technology and infrastructure perspective, where do you stand? Is the right information available to the right people in the right format? Is the information pertinent, relevant, accurate, and valid?
The clinical focus has shifted to improved quality and reduced costs. What are you doing to reduce your readmissions rates? Are you prepared to face the penalties if your rates are deemed to be too high? Reimbursement is shifting from volume to value and from quantity to quality. Have you made this shift throughout your entire organization? Patient satisfaction is a key component and used as a key performance indicator. Customers have the choice to utilize any provider they so choose and are becoming quite astute in comparing patient satisfaction scores to make an educated selection. Excellent customer service has now become the norm. The “wow” effect has become standard. What are you doing to “wow” your customers? Clinical pathways are becoming prevalent. Have you standardized and publicized your clinical pathways? Are there areas in which processes can become more efficient and/or streamlined? Have you reviewed your utilization management plans to make sure they are optimized? Have you performed an analysis on length of stay by payer source to ensure maximum reimbursement?
Putting it all Together
Each of the three prongs can certainly be analyzed separately and at different time intervals, but the key to maximizing profitability, sustainability, and viability is to analyze your organization from top to bottom from operational, financial, and clinical perspectives. Your desired outcomes will be achieved and in many instances exceeded through establishing and monitoring short, intermediate, and long-term strategic goals and expectations.