Mount Sinai Medical Center in Good Shape With WebFOCUS

With a new business intelligence platform from Information Builders, Mount Sinai Medical Center has improved patient care while meeting cost and performance goals.

New BI System Delivers Important Cost and Patient-Care Metrics to Doctors and Administrators

Ongoing debates about healthcare reform have revealed the need for greater transparency, accountability, and performance among providers such as Mount Sinai Medical Center. In response, the 1,200-bed facility on Manhattan's Upper East Side has rolled out a business intelligence (BI) and performance management environment that helps physicians deliver high-quality care while adhering to institution-wide cost and performance standards. Technology from Information Builders is making it possible.

IT personnel at Mount Sinai are no strangers to the power of enterprise reporting. For years, they have depended on Information Builders WebFOCUS to provide critical business intelligence via financial and operational reports. Today, the organization is in the process of standardizing on WebFOCUS for all of its reporting needs, with new BI dashboards and self-service analytic applications at the front lines.

Mount Sinai's primary BI application supports an outpatient group of 1,000 physicians known as Faculty Practice Associates (FPA). Dubbed the FPA Dashboard, it provides information about growth, productivity, and revenue-cycle metrics along with sophisticated analytic tools. Physicians and administrators use the dashboard to run their practices more productively, and managers use it to align operational objectives with corporate strategy.

"Business intelligence technology plays a crucial role for any hospital trying to meet financial and quality of care objectives," says the director of enterprise reporting at Mount Sinai Medical Center.

To make significant changes at a hospital, physicians and medical staff are the most important people to engage, since they have the largest impact on overall care as well as on a hospital's profitability. That's why Mount Sinai makes the dashboard and associated analytics available to all FPA physicians. The directo believes this wide distribution has allowed for greater inclusion of physicians in the business of clinical practice and will enhance performance. "If the physicians are not supporting the goals of the organization, the organization will not be successful," he says.

Over time, Malamed believes the FPA Dashboard will also help Mount Sinai uncover the root causes of issues and instigate targeted improvement initiatives. Increased transparency will enforce greater accountability among the medical staff.

"Without implementing a comprehensive framework for managing performance there is no easy way to incorporate operational effectiveness and efficiency into the institution's overall goals," he adds.

Identifying the metrics and indicators that guide the organization is the first step. Next, that data must be presented to users, so they can be held accountable. "A hospital needs to be run like a business," says the director. "And like any business, it needs to be efficient."

For example, if charges fall off unexpectedly from one month to the next with no changes in provider availability or volume, a division manager might use the dashboard to verify that everybody is submitting their charges correctly.

A Prescription for Accountability

Administrators, financial personnel, practice managers, and care providers all use the FPA Dashboard to run metrics, combine reports, and create custom reports based on specific parameters. For example, about 265 people in Mount Sinai's department of medicine are using it to monitor an incentive plan based on work relative value units (RVUs) – a productivity metric established by the American Medical Association.

"Thanks to the dashboard, providers have more data on hand to make decisions about their practices," notes Dominique Archer, FPA business manager for the hospital's department of medicine. "They can drill down to service locations, payer mixes, population of ambulatory visits, and many other variables."

Some physicians use the tool to set goals and monitor progress on a monthly basis. Ultimately, Archer believes these exercises positively impact the quality of patient care. "It allows us to see what types of services are being requested in each division, so we can schedule the optimum number of staff," she explains, citing one example.

To create the FPA Dashboard, Mount Sinai involved various constituencies, from programmers and information specialists to physicians and business users. Led by Phong Bui, the business owner for the project, each group identified the most valuable key performance indicators (KPIs) and the report formats that would be most useful to their users.

As a senior developer with expertise in reporting, Julie Zhu took point on the project. Her team spent about three months in the first phase of the development cycle: gathering information from IDX Group applications and building a reporting database.

"Many people were accustomed to waiting a week for reports," Zhu says. "Now, using a standard Web browser, they can view pertinent information whenever they want, and display or analyze data in easy-to-read bar graphs."

Today approximately 1,000 healthcare professionals have access to the FPA application, including 70 administrators.

"The FPA Dashboard saves an enormous amount of time tracking down information," Bui says. "They can immediately recognize problems and address them, or drill down to find out why certain conditions exist. For example, if payments are lower than normal within a certain department, a manager might ascertain that work productivity units are low because there are new doctors in that department."

Other departments are expressing interest in deploying similar WebFOCUS environments to help them with management strategies, research projects, clinical activities, teaching loads, and other information-intensive activities.

The finance group uses WebFOCUS Active Reports to slice and dice information, roll it up, filter it into specific cost centers, and create charts. Active Reports include a pre-selected payload of data to help recipients pinpoint issues and track trends. Another new WebFOCUS project involves working with clinicians to identify important clinical metrics. "We want to make that information available internally, so we know what is going on within the hospital," the director of enterprise reporting says. "But we also want to share that data with the public to show that we are proud of our reputation and accountable for the quality of our care."

According to the director, Mount Sinai plans to create other Active Reports to help the institution develop a holistic view of performance across the enterprise. "We've gotten our arms around some key financial measures," he says. "Now we plan to expand to clinical and operational measures so we can analyze recurring costs and pinpoint cause-and-effect relationships."

A Healthy Return on BI Investments

Mount Sinai is also using WebFOCUS to make it easier for hospital administrators and billing personnel to analyze charges. The medical center recently identified more than $5 million in missed charges, rebilled for them, and recouped close to $3 million in a single year from insurers who underpaid patient bills based on their contractual obligations.

The BI tools help accounts receivable personnel analyze patient accounting data from an Oracle data warehouse, which stores information about closed accounts. Using the dashboard, these employees can identify opportunities for rebilling. For example, an insurer might be obligated to pay for a patient's appendectomy, minus co-pays and deductibles. However, an AR auditor might discover that the insurers paid for the surgical procedure but not the associated drugs or postoperative care.

The ROI from investigating these previously closed accounts can be substantial. Each year, Mount Sinai bills for about 55,000 in-patient admissions and 600,000 outpatient visits, generating operating revenue in excess of $1 billion. The director of enterprise reporting says the hospital will continue to use the BI tools to hunt for undiscovered revenue or cost savings opportunities throughout the enterprise. "At a hospital the size of Mount Sinai, there are tens of thousands of unique charges," he says. "It can be like finding needles in a haystack. WebFOCUS makes that process easier."

The hospital hopes it will soon be able to use Information Builders Integrated Health Intelligence (iHi) application suite, as well as the Performance Management Framework (PMF) for Healthcare, which includes a predefined data model to streamline the creation of metrics, scorecards, dashboards, and roles. These vertical BI applications link high-level strategy maps to quality-of-care objectives to facilitate tracking metrics such as length of stay, HIM-coding quality, readmits, and insurance denials.

PMF for Healthcare will enrich the performance management environment. iHi will provide a detailed data model down to the patient level to formulate more granular metrics. What's Mount Sinai's goal? "To help us obtain the important balance of quality of patient care, safety, and satisfaction with our labor, resource, and financial objectives," the director answers.

"Information Builders has been terrific in sharing their time and expertise with us," he adds. "They have been very open and available throughout this project. We have a great relationship going forward into future endeavors. Their technology is making a qualitative difference in the way we carry out our business."