Robert Wood Johnson University Hospital (RWJUH) in New Brunswick, NJ, has an integrated view of its finances and operations with Allscripts EPSiTM. The organization recovered $4.5 million in underpayments its first two years of using EPSi’s Product Line Analysis Contract Modeling tool. You can read more in a recent case study.
Prior to implementing the Allscripts EPSi modules Cost Manager, Product Line Analyst and Enterprise Management Dashboard in September 2011, RWJUH had limited financial and patient data reporting capabilities.
Before EPSi “There was always a level of skepticism with our reports back then,” said RWJUH senior financial analyst, Michael Piagentini. “Is that the true fully-loaded cost for that service? It was hard to know for sure.” This uncertainty was particularly difficult when RWJUH negotiated contacts with payers.
Contract modeling saves the day at the negotiating table
Contract negotiations between healthcare providers and payers are complex. It’s important for both sides to get the facts straight.
Piagentini shared an example of how important it is to have quick, accurate information during these discussions:
We were in negotiations with a major payer recently. One of the leaders representing RWJ stepped out of the meeting to double-check something. He said that the payer believed our admissions were way up and we weren’t doing necessary observations – that we were admitting “everybody.”
With EPSi we’re able to check those assumptions. In just a couple of minutes, I handed him a report that showed we were trending a 20% incremental increase in observations year-over-year for that payer. He returned to the meeting with real data.
Not only does the Product Line Analyst module help with fast, easy reports. According to Brandon Drucker, finance process improvement associate at RWJUH, “Contract modeling enables us to see different scenarios next to each other. We can negotiate what brings the best benefit to Robert Wood Johnson, while being fair to payers.”
Bringing more efficiencies to light
With EPSi, RWJUH better understands the total costs of providing care, can more easily recover lost revenue, and will be better prepared to negotiate fair contracts with payers. All of these abilities help ensure financial health for the organization.
“When you go through an implementation this grand, and get new information this granular, you notice opportunities throughout the organization,” said Piagentini.
Using EPSi, RWJUH is recovering underpayments from missing charges, incorrect codes, stop-loss corrections, bundling charges and more. These learnings are particularly helpful as the organization makes sweeping changes to its Charge Description Master (CDM), the list of what the organization charges for services.
Editor’s Note: KLAS named Allscripts EPSi solution as Category Leader: Decision Support for the eighth consecutive year. Read more in a recent news release. (We updated this note on Feb. 5, 2014 to reflect the correct award name and we updated the post on Feb. 18 to correct a quote attribution.)