Crunch time: new generation of financial information systems makes crunching numbers—accessing data to make smart decisions—faster and easier

Health Management Technology, March, 2005 by Richard R. Rogoski

In what seems like only a few short years, financial information systems (FIS) have evolved from simple, back-office support systems into fully integrated solutions that can handle everything from payroll to accounts receivable and revenue cycle management. But such increased functionality would not be possible without the ability to combine disparate databases into a single source of financial information that can be mined at multiple levels.

The importance of data mining quickly became apparent to corporate executives at Scripps Health in San Diego, who had been working with six separate databases before upgrading to a newer version of Sunrise Access Manager/Patient Financial Manager from Boca Raton, Fla.-based Eclipsys Corp. Scripps Health currently operates five acute care facilities totaling nearly 1,400 beds, two medical groups with 14 outpatient clinics, a home health agency and a health plan.

Drill-down Dynamics

Today, yearly revenues average $1.35 billion, which is a big turnaround from a few years ago when Scripps Health posted operating losses in 2000 and 2001 totaling approximately $26 million and $22 million and respectively.

In an effort to bolster their bottom line, Scripps Health devised a number of key strategies, not the least of which was drastically changing their methods of billing and reimbursement. "A couple of years ago we moved away from capitated risk to fee-for-service risk," says David Cohn, vice president of patient financial services. Additionally, since each hospital had been running its own Eclipsys FIS, the organization made the decision to upgrade these 13-year-old systems by installing an enterprisewide FIS.

With the HIPAA deadline looming, Scripps Health had only six months to install and test the new system. In July 2003, they rolled out version 11.3, which was not only HIPAA-compliant, but was also the vendor's "multientity" product. This enabled the organization to merge multiple databases into one central database that now resides on the mainframe. "Prior to that, each hospital was operating in its own silo," says Cohn.

That presented problems of both access and efficiency, says Paula Pochodowicz, senior support analyst for information services. "Patient registration lives at the corporate level, but then there is an entity level." In the single-silo version, the user had to login to one entity, then logout before logging in to another facility's database.

While those on the enterprise level have access to information on the enterprise level, and those on the hospital level can see hospital-level information, users in the central business office who have the proper clearance can now access entity-level information via a common network--without having to go through a number of time-consuming steps.

Mollie Drake, corporate director of access management, notes that the new system also has an ad hoc report-writing feature, "but you can also run reports based on whatever level you want to drill down to." The system also makes it possible to write alerts. Currently, Scripps Health has alerts set up only for "bad debt and bad address," she says.

An added benefit of having a central database and drill-down capability is the ability to track and evaluate claims denials, says Cohn. "Each payer has different ways of letting us know about zero pays or denials. Now we can monitor them in a centralized way."

Escape From Written Queries

Still, having all this data readily available doesn't necessarily mean that all the information will be there when the user wants to analyze it. Keith Eggert, corporate director of patient financial services at Orlando Regional Healthcare (ORH) in Florida, found this to be the case. "Typically, with financial queries, we can spend 80 percent of our time trying to get our hands on all the data, and then spend 20 percent of our time analyzing it," he says.

Comprised of seven acute care facilities serving more than 640,000 Central Florida residents per year, ORH had already invested a considerable amount of time and money in aggregating its disparate data systems by adopting best-of-breed and best-of-practice strategies, including the installation of QuadraMed Affinity and streamlining its revenue cycle processes. However, while six hospitals are wholly owned and have their data in one database, the seventh hospital is a separate corporation that has its own database, Eggert says.

This, in itself, can present a major challenge for any enterprise, but it became even more problematic for ORH when it was necessary to extract key elements of financial data from all seven hospitals for analysis. Suppose, Eggert says, "I'm looking for all managed care accounts over 90 days that were admitted through the emergency room. That's a refined population." Likewise, "When you get into denials of claims which have X error, you want to find out if there are other accounts with the same error.

"Typically, we would have to pool the accounts, then have queries written to identify a problem," he continues. "Maybe those queries wouldn't work, so we would have to have other queries written."