Advanced Analytics Can Help Optimize Staffing and Better Manage the Impact of Psychiatric Visits and Claim Denials
Emergency departments (EDs) are a hospital’s gateway to admissions and therefore a significant source of revenue, but they’re facing challenges including reimbursement pressure, increasing regulations, and competition from urgent care centers.
EDs are responding by better matching resource assignments to demand and deploying less costly resources where appropriate. They’re also integrating advanced performance analytics into their operational reviews and conversations with hospital administration. Here are three trends we’ll be seeing in 2019, which will impact emergency medicine and continue to transform the health care landscape.
1. Physician and Nurse Shortage Driving Up Compensation
The shortage of physicians and nurse practitioners has been driving up compensation, according to one recent report. With a projected shortage of up to 120,000 physicians by 2030 and baby boomers aging, staffing shortages should be expected.
By integrating an advanced performance analytics application, hospital EDs can optimize staff scheduling to match historical variability in daily and hourly volumes and arrivals, as well as patient types, acuity, and a staff productivity index. Inadequate staffing levels can negatively affect performance metrics, and impact patient length of stay and the number of patients who leave without being seen (while having too much staff increases costs).
d2i’s advanced data analytics can help provide insight into how best to improve performance metrics by aligning physician hours with historical factors that can impact performance to optimize productivity.
2. Psychiatric Visits in the ED Continue Rising
Understanding the timing and demand for mental health services in the ED is more crucial than ever as ED visits for psychiatric complaints are becoming commonplace. The long-term inpatient care options are dwindling and more and more patients end up in EDs with mental health needs. This is happening across patients of all acuity levels, from those presenting with suicidal thoughts and psychosis, to those experiencing the three most common complaints: depression, anxiety, and stress.
Because of the complexity of psychiatric treatment, some EDs have been introducing mixed service-delivery models. To deliver proper psychiatric care despite a challenging environment, EDs need to understand mental health service demand in order to reduce crowding and improve outcomes through a variety of means. Those include telepsychiatry and using data analytics to understand the impact behavioral health patients have on ED crowding. Analytics can help identify where and when additional resources should be applied to reduce patient walkouts and improve patient satisfaction.
3. Major Payers Denying ED Visits
With several major insurance companies denying ED visit claims after a diagnosis is made, and the American College of Emergency Physicians pushing back, EDs should seek to work with payers to manage frequent users of its services into alternative, lower-cost care settings.
d2i considers post-diagnosis claim denial an unfair practice because it suggests that patients can properly diagnose themselves or risk a huge hospital bill. By making it a financial decision, it could put lives at risk. The same data the payers are using to justify denials could be used by payers to identify patients who historically use the ED for nonemergent issues in order to educate their members and connect them to other treatment options. Utilization review is especially crucial in this arena, and advanced analytics can help EDs prevent denials and support successful appeals.
4. Need for Actionable Data
Overall, one thing is clear (this also came up during our focus group at ACEP18): There’s an urgent need for actionable data. Just because you have data in your EHR or data warehouse doesn’t mean it’s working for you. Relevant, actionable data is an absolute must in order for an ED to drive important improvements in efficiency, quality, revenue optimization, and patient satisfaction.