Giving GA Hospitals Healthcare Cost Data to Lowering Spending

May 14, 2018 - With claims reimbursement rates falling and competition among healthcare organizations intensifying, hospitals are calling on their providers to increase efficiency and reduce healthcare costs for each admission.

So, what do providers need to accomplish the monumental task of providing care at greater efficiency and lower costs?

For the Georgia Hospital Association, it is healthcare cost data, explained Bill Wylie, the Senior Vice President of the association’s shared services arm, the George Hospital Health Services (GHHS).

“Our hospitals are not getting paid more, at least not on a per-case basis,” he recently told RevCycleIntelligence.com. “Anything that we could do to bring some more transparency to costs would be really strong for our member hospitals. More information is always better for both the caregivers as well as the patients.”

But merely dumping a plethora of healthcare cost and quality data into a provider’s hands was not the route Wylie aimed to take. He emphasized how providers should be able to access healthcare cost data that helps them choose the most appropriate and affordable care pathway for each patient, not tell them the how to practice medicine.

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“What hospitals have found throughout the years through trying to integrate and employ physicians is that employment doesn't always mean alignment,” he said. “Physicians want to practice autonomously, and they need information that they can use to help inform physicians and caregivers on alternatives that may provide the same efficacy of treatment but perhaps at a lower cost.”

However, that information should not force providers to take the most cost-efficient care pathway. Healthcare cost data should present low-cost options for providers to consider in a convenient way.

“There are always reasons why a lower cost alternative may not be the best path of care for the patient,” he said. “But it's better to at least know that that path exists versus just going with what you've done for previous patients.”

With this goal in mind, GHHS partnered with IllumiCare to offer GHA hospitals access to a data analytics tool that provides not only actual care costs but also human cost data in the EHR system. The information shows up as a ribbon in the patient’s electronic health record and displays real-time hospitals costs of medications, lab tests, and imaging procedures.

The ribbon also displays human cost information. For example, the data analytics tool measures radiation exposure based on the number of tests a patient has undergone or will undergo. Then, the tool tells providers the associated cancer risk with that exposure level.

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This human cost function also helps to improve care coordination and unnecessary test utilization, Wylie added.

“It provides information on the amount of lab work that's been done, whether that may or may not be needed at that particular junction,” he said. “It helps keep track of tests since there could be three or four doctors working on a particular patient at that time and maybe they're not coordinating. The tool would help coordinate that. Do you need that full lab workup because it's already been done by another physician?”

Giving providers additional information on top of actual care costs could be key to actually realizing cost savings. A 2017 University of Pennsylvania analysis found that just giving providers cost information in the EHR system did not result in fewer laboratory tests or lower healthcare costs.

Researchers explained that the healthcare cost data lacked context. The information needed to be better targeted or framed by clinical scenario to be truly effective at reducing costs and unnecessary testing.

Wylie aimed to contextualize healthcare cost data and seamlessly integrate the information into provider workflows. The ribbon of information achieves both.

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“It pops it up and hovers over the EMR so the physician has the opportunity to look at that information,” he remarked. “Then, they can make informed judgments from that. There is no requirement for a physician to document why they chose a more expensive or less expensive treatment or continued with a particular care path. It's just another information tool that is not obtrusive in the physician workflow that just allows them to make more informed decisions and take care of those patients.”

GHHS is still in the beginning stages of implementing the healthcare cost data analytics tool at member hospitals, but the GHA subsidiary expects to achieve similar cost savings as those realized by the Texas Hospital Association.

Member hospitals in Texas saved $112 to $202 in direct costs per inpatient admission after giving providers access to healthcare cost data in 2016, IllumiCare reported. A pilot involving 55 providers in Texas also generated $430,444 in savings in just 71 days.

Wylie hopes to bring that same value to Georgia, which has a similar healthcare landscape.

“There's a lot of similarities between Georgia and Texas from the standpoint of our membership,” he explained. “They have more hospitals than we do. But they have large safety net hospitals in Dallas and we have large safety net hospitals in Atlanta and Savannah that look very similar. Hopefully, we can experience some of those same successes here.”

Putting meaningful healthcare cost data into provider hands should also benefit the value-based care transition for hospitals in Georgia, he added.

“Every hospital is trying to find a great value, whether that's in delivery systems or cost containment. Value-based care crosses over both,” he said. “Nobody is getting paid more per DRG. This solution could allow us to contain some costs, reduce unnecessary tests, and improve the patient safety aspect of advanced radiology.”

“Then hopefully this could create some margins that hospitals can then use to put back into some of those other services that we know are money losers and allow them to sustain those services that are needed in the community that they may not be able to sustain otherwise.”

In addition to hospital savings, Wylie expects patients to also see their healthcare costs drop.

“It can help lower the cost for the patient. If a physician takes a lower cost pathway and the patient has a high deductible, it can lower those costs,” he said. “It would lower the interactions that they may have to have with that physician or the hospital, in general, and lead to fewer lab sticks, fewer interruptions, fewer times down to radiology and imaging.”

Lower patient costs stemming from more and better data access for providers should result in higher patient satisfaction scores, too.

“It allows the patient to lower their stress level and focus on healing rather than focus on the mechanics of their care plan,” he pointed out. “It takes out some of those different issues that may occur. Any time you can reduce the number of negative interactions with a patient, even those that are required and necessary, it ultimately provides a better experience for the patient overall.”

As hospitals continue to give providers the tools and data they need to decrease costs, GHHS expects their partnership to ultimately achieve the Triple Aim.

“Any time we can provide something that can help hospitals operate more efficiently, take better care of the patient, and have higher patient satisfaction is a homerun for us.”