Metrics That Matter for Your Revenue Cycle

In Arthur Conan Doyle’s novel, “A Study in Scarlett,” Sherlock Holmes says, “It is a capital mistake to theorize before one has data.” More than a century has passed since Doyle released his novel, but Holmes’ words still ring true.

The benefits of data are undeniable. With data, a company can hold itself accountable and align around key performance goals, repeat processes that benefit the organization and gauge weaknesses before the business is negatively impacted. Data’s value in home health care is no exception.

According to the Centers for Medicare & Medicaid Services (CMS), there are more than 10,000 Medicare-certified home health organization in the United States, and in 2019, there were more than 5 million beneficiaries. About 10,000 Americans a day have turned 65 since 2010. With challenges generated by the COVID-19 pandemic and a growing desire for people to receive care in the home, these numbers reflect the large and competitive market that homecare organizations operate in.

Within this competitive market, there is a demand for new, innovative solutions to speed and secure business profitability. Data analytics can deliver on this demand.

Revenue cycle management is a key to success in the home health care industry, and as organizations continue to navigate the pandemic’s aftereffects—along with new regulatory changes such as the Patient Driven Groupings Model—many are trying to re-establish a strong revenue cycle.

A strong revenue cycle gives organizations the ability to change, expand and grow for future success. However, it is important for businesses to understand that, among the many metrics that exist, some matter more in building a strong revenue cycle, and, ultimately, in providing better care. They include the following.

1. Patient-to-Clinician Ratio

Across the United States, clinicians are being tasked with caring for an increasing number of patients as the months tick by. At the same time, the demand for home health and personal care aides is anticipated to increase by about more than one third through 2026, according to the Bureau of Labor Statistics.

Inadequate staffing can slow down an organization’s revenue cycle or reduce revenue through Low Utilization Payment Adjustments. Therefore, supporting a balanced patient-to-clinician ratio is key to maintaining a steady revenue cycle and consistent cash flow.

2. Time to Initiation of Care

Timeliness of care is a key metric that can cause revenue cycle challenges for organizations. Providing a metric that covers the length of time from a patient’s admission to completion of the initial visit can expedite revenue generation. Many factors can cause untimely initiation of care, including inadequate staffing, ineffective operational policies or quality assurance backlogs. Not only does the timely initiation of care support a healthy revenue cycle, but studies have also shown that the timely initiation and provision of care correlates with better clinical outcomes.

Continued measurement and reporting of this metric is important for home health care organizations, not only because they should identify the rates at which they provide timely care and build upon them, but also because ensuring that care is provided in a timely manner will affect quality assurance and performance improvement measures and improve an organization’s Medicare Star Ratings.

3. Census by Payer Mix

We’ve covered how risks can be reduced with technology, and how the costs of implementing and using technology are improving every day. Now, let’s look at a few ideas about how technology enablement can help your agency increase revenue. Home health care organizations will want to ensure payer sources are diverse enough to provide payments in a timely manner as well as minimize the impact of payer reimbursement changes. All of this leads to a strong revenue cycle.

4. Days to Payment

Understanding the full revenue cycle will help identify changes to the cycle, predict cash flow and manage costs. Measuring from the initial admission date to the payment date will help organizations understand the revenue cycle by payer. Changes in this metric can identify operational issues, payer changes and scheduling opportunities to improve revenue cycles and cash flow. Understanding each payer’s revenue cycle is key to appropriate staffing, scheduling and predicting cash flow.

5. Rejection & Denial Management

Monitoring the percentage of claims that require additional time and resources to get paid is critical to protecting the revenue earned from the delivery of services. Opportunities to improve claim acceptance and avoid payment delays, reductions or eliminations can be identified by monitoring a denial percentage or a first-run rate, which quantifies the number of claims submitted and paid without additional efforts. Reviewing the types of rejections and denials to identify root causes can help adjust operational practices or alter the payer mix to minimize the impact on an organization’s revenue cycles.

The Power of Prediction

With a data set that is large and wide enough, organizations should be able to leverage the power of prediction. One of the key benefits of data analytics is being able to observe trends and pull from those observations to anticipate—or even influence—an outcome.

Rather than having a “wait-and-see” attitude, predicting outcomes and identifying changes in trends will help an organization refine future predictions and their operations.

In concert with foresight, repetition of a quality process is always a strong business strategy. However, replicating effective processes requires identifying practices that provide the best possible outcomes.

By leveraging data analytics, organizations can visualize and summarize key performance metrics and view historical trends in data. Then insights can be garnered and best practices can be developed to replicate processes and outcomes consistently. In the end, this provides improved patient outcomes and reduces costs.