With millions of reimbursement dollars at stake, hospitals find big returns in “Big Data”
By quietly capturing the data that matters, and showing hospitals how to make it actionable, RealTime Medicare Data (RTMD) is pointing the way on how to make the U.S. healthcare system more efficient and effective.
“A hospital cannot guarantee its future relevance simply because it exists today,” said RTMD Founder and CEO Gina McWilliams. “That’s the blessing and the curse of Big Data; it can bring operational vulnerabilities into rather harsh light.”
Whether the 5,723* hospitals across the country want to examine those vulnerabilities or not, the Centers for Medicare and Medicaid Services (CMS) continues to force the issue.
And in the era of healthcare transparency, with billions of annual Medicare claim reimbursements at stake, it’s a fact that hospital administrators cannot ignore.
The savviest among them are already tracking the healthcare movements of the Medicare beneficiary population in their service areas.
They know where these patients are going for treatment, and which treatments are taking place at which facility.
They know which DRGs earn them the most, and which DRGs cost them the most. They also know that when it comes to point of care, all physicians are not created equal.
“The business of operating a hospital is much leaner today,” said McWilliams. “Hospital leaders can ill afford the financial repercussions that can come with hiring an underperforming provider.”
This spans everything from outlier statistics in average length of stay by procedure and mortality rates, to the frequency with which a certain physician’s patients are readmitted.
Relative to where they were just five years ago, healthcare reimbursement dollars are scarce. For those serving Medicare beneficiaries, these dollars are only earned after intensive paperwork and procedural adherence satisfy a meticulous set of criteria as mandated by CMS.
Those that wish to stay in the game have turned to RTMD, asking for an independent report card of their performance.
It is not Big Data for Big Data’s sake.
“With our information, providers are finally able to see themselves the way CMS sees them,” said McWilliams. “It is about uncovering what you do not know.”
“There is no rubberstamping what we do here,” she added. “And I think that is our secret sauce. Many of the hospitals with whom I’ve worked get the wisdom of value-based care versus fee-for-service. But to understand it conceptually and to implement it successfully, taking into account the nuances of a particular hospital’s service area, its business lines, and its staff infrastructure, are two very different things. That’s where we excel.”