Employing better data analytics can help rural hospitals stay competitive despite their unique financial limitations.
Rural hospitals are closing at an alarming rate for a wide range of reasons, from an aging workforce caring for an aging community, to tightening budgets mixed with lower reimbursement rates from those who rely on public assistance. As the health care industry moves toward the value-based care model, smaller, rural hospitals can benefit more than ever from using better data analytics to stay open, keep costs down, and, simply, keep saving lives.
One unsettling trend, growing increasingly evident in the past few years, is the rate of closures for rural hospitals nationwide. A study from Chartis Group and iVantage Health Analytics found that between 2010 and 2016, 80 rural hospitals closed their doors. About 41 percent of rural hospitals faced negative operating margins in 2016.
At many rural HCOs, volume is low, perhaps 20 to 30 visits per day, with only one or two providers. Many cases are non-emergent, particularly because of the lack of primary care providers in many rural areas. Even with such a low volume — or precisely because of it — rural hospitals must streamline care as much as possible
The Biggest Challenges Facing Rural Hospitals
Community challenges, government policies, and changing demographics are among the main reasons why rural hospitals are struggling financially. They’re also under pressure due to the nationwide push toward value-based care, and their numerous demographic and staffing challenges are driving costs up. Some of the challenges are specific to rural and smaller HCOs. Others, like the aging population and a projected lack of physicians, are issues they share with larger health care systems.
Compared to hospitals in urban, more densely populated areas, key challenges include:
- A high rate of socioeconomically disadvantaged patients
- A high rate of uninsured patients and patients with public insurers (Medicaid, etc.)
- Lower claim reimbursement rates
- More patients seeking care outside rural areas
- Lower rates of employer-sponsored health coverage due to lower employment rates overall
- A shortage of primary care providers
- A disproportionately high number of patients from sectors including seniors, military veterans, pediatrics, and behavioral health patients
Staying Competitive and Profitable
To keep their doors open and their practices strong and profitable, rural HCOs can do a number of things within their day-to-day workflow as well as the framework of their financials, compliance, and protocol adherence requirements. These include taking a close look at their highest-level issues, including lack of interoperability, rising patient-care costs, and less-than-desirable clinical outcomes, as well as clinical quality metrics and patient care.
While data analytics can undoubtedly make a big impact on larger-scale HCOs — from addressing long ED wait times to reducing claim denials — there’s definitely room to improve management of smaller rural hospitals. These HCOs need the best possible tools for health care data analytics. A smaller HCO serves a smaller patient population, so different target benchmarks and workflows apply. Streamlining workflow processes like billing and reporting can help tremendously — both to keep rural HCOs operational, and their patients out of emergency departments (EDs).
Smaller size could mean a potentially bigger impact on providing life-saving care. One way that data analytics can benefit smaller HCOs is through reductions in revenue leakage (for example, through missed charges and suboptimal coding).
Data analytics can be used to manage resource and facility use by integrating components such as risk management, hospital utilization, and quality assurance into in one performance management process. Because non-covered, duplicate, and incorrect coding seem to be a particular issue, better monitoring of claims via utilization review is especially important because it can reveal improper reimbursement.
The Performance Analytic Application from d2i can help rural HCOs improve coding practices, monitor resource utilization, and reduce practice variability.
Contact d2i to learn how we can help you obtain better, more actionable data, or schedule a 30-minute demo to learn how we can help your organization maximize its resources, keep costs down, and improve quality of care.