Episode 6
Allison: Good morning, good afternoon, and good evening, and welcome to the Therapy Matters Podcast. Your one-stop resource for expert insights and advice on everything therapy and rehab. I’m your host, Allison Jones, and today I’m joined by Bill Sillar. Bill has over 17 years of experience in healthcare IT specializing in EMR and software solutions. He also comes from a family of healthcare providers and grew up in the clinic learning the family business, so he has a good deal of hands-on experience as well. Bill, we’re looking forward to tapping into that knowledge today. So thank you for joining me on the show.
Bill: It’s a privilege to be here. I appreciate you having me.
Allison: Excellent. So today, we’re going to focus on a big, important topic: business intelligence, or BI. Our audience is everyday practitioners, creating an overwhelming amount of data. In order to make smarter decisions, identify problems, and be profitable, they need methods and tools to turn that data into actionable insights. So, enter BI. But there are a lot of questions and maybe a little bit of confusion around what BI is, how it works, what the benefits are, the different categories, how to create a strategy, and does it make sense for their practice. A lot of things to unpack there. So, we’re going to try to make some sense of all of that today. Does that sound good?
Bill: It sounds really good, it really is an important topic to hear.
Allison: Great! Alright, so let’s dive in. So my first question, what is business intelligence? Give us a level set here. Tell us what it’s all about.
Bill: Allison, coming right out of the shoot, I love it. So, Allison, I’d like to pose this in a therapy-specific manner. Our therapy groups are facing lower reimbursements and higher overhead. We have to be careful not to make the wrong business decision, as it could set us back even more in today’s environment. It’s imperative that you take all the tools you have to make the right decision so you don’t impede your growth and keep your business thriving. So, to answer your question, what does business intelligence do? It takes the data you have available and enhances it to find different pieces that can show trends and potential problems. So it’s really popping out, Allison, an example that I utilize for millennials and Gen Xers is Where’s Waldo? Remember those books back in the day? They had huge double pictures, 24 by 24, with all these small people on them. And then you’d have to find Waldo in that book and that page. That’s what BI is doing, popping Waldo out of that page for you to find the data you need. You can catch potential problems early on. One of the other important things is if you’re getting data from a healthcare software system, it’s not just looking at flat data. The reports you get are usually daily or monthly, but BI puts algorithms and enhancements into the data so “Where’s Waldo” pops out and you can make better business decisions. Does that make sense?
Allison: It does, absolutely. And I love the analogy there of Where’s Waldo. I think that really helps bring it all together. So when therapy groups have used business data in different ways over the years, I think the traditional way we’ve looked at business intelligence was from a financial focus. We looked at financial data, payments, denial rates, and whatnot from a financial perspective. That’s the traditional way we’ve looked at it in the past. How can we use it to understand the financial health of their therapy practice? Maybe pulling the Where’s Waldo out of that data? Let’s dive into that a little bit deeper.
Bill: Absolutely. And you make a great point. Just kind of a little bit of history when we’re talking about business intelligence and looking at it from a health care lens, it’s always looking at the financials first. And if you think about where business intelligence just kind of started in general, it was really on the financial side and even outside of if we’re talking about banking and stocks and things, that’s where a lot of that business intelligence and the analytics really has its foundation in health care since it was already adopted in other industries. That was the first spot – how can we look at all of our organization, all of our different locations, and how can we have a financial roll up on these locations? And then from a billing perspective, how can we make sure that we’re billing as efficiently as possible? Again, in the previous question you asked, we talked about how reimbursements are lower and the overhead is higher. So you can’t just look at it from a financial side of things. Now just because of all these different challenges that organizations have. So what we’ve seen business intelligence change into is we’re looking at it from 360 degrees. So not just looking at it from a financial, not just from a billing standpoint, but we’re also looking at how we gain top line revenue. So how are those patients coming into our offices? So taking a look at referral sources and being able to monitor, is this provider that is referring it to us? Are they keeping on track with what they’ve done in the past or are they falling off? So if you have a marketing department, you might be able to really dial in that marketing effort. Also, we’re looking at this digital revolution that we’re in right now. So the way that patients engage on the front end with their health care providers is different. Being able to have business intelligence will be able to really solidify your strategy from a digital marketing perspective to ensure that you’re getting all of those patients coming into your offices from that digital landscape. So, that’s from a top line revenue and patient gain perspective, that’s one of the things that’s really critical: seeing where your patients come from and how quickly you can get them from referral into your office. So, you can identify what part of that cycle you are missing out on. Are you even touching those patients? If you’re getting them as prospects, are you able to get them into the door, make an appointment, and get that done? From a top line revenue and patient gain perspective, that’s really exciting. But after we get that patient in the door and we’re looking at the information from a registration and business intelligence perspective, everything can kind of get messy. So, if we’re not doing a great job of onboarding that patient, maybe we’re missing case information or demographic information, business intelligence can tell you that you’re at this location and you are always missing this type of information. And, on the back end, you’re getting denied claims. MGM says that every time you have a denied claim, it’s $25; every touch you have to make to a claim is $25 and it’s hitting your bottom line. So, you want to make sure you are hitting all of those aspects for a 360-degree view – there is money in each one of those parts. You also want to make sure from a clinical perspective that your providers have a full schedule, but you don’t want to make them overworked. Provider burnout is another burden therapy groups have right now, so this is another way you can monitor that and make sure you have one provider getting an ample amount of workload instead of burning out. There are great benefits that you get with business intelligence that can solve so many problems therapy groups encounter on a day-to-day basis.
Allison: That’s fantastic. So you talked about the intake process and the clinical process. What about patient experience or patient outcomes can BI be used to improve those aspects?
Bill: Absolutely. In a number of different ways. So one of the things is you can send a patient a survey and a very common one is NPS. I don’t know if the listeners are familiar with Net Promoter Score. That’s what NPS stands for. Everybody’s probably encountered them and it’s one question: How likely on a scale of 1 to 10 are you to recommend this service or good to a friend or family member? Based on the score that person gives, they fall into three categories: Detractor, Neutral, or Promoter. Those are the folks you want to find your nines and tens. Those are the folks you really want to get behind. What I’ve seen with business intelligence, those that get behind NPS, I’ve really seen benefits of those putting that into business intelligence because then you can find out based on the reason why the patient came in, you can categorize their NPS. So if I had a person come in for a shoulder, if I had them come in for a knee, I can see what the NPS scores are based on those different things and I can see by location. So if I have one location that’s doing a great job with shoulders for this age group, that might be a marketing ploy I’m going to try to get out there and really capture the market, or it’s a way we can improve ourselves. If we’re not doing a great job, we can make sure we do some improvement.
Allison: This is great information. So how else can BI be leveraged? Can you use it to reduce no-show rates? Cancellation rates?
Bill: Absolutely. That’s a great one that you mentioned there. So you can definitely use it to reduce your no show rates and cancellation rates. If we’re looking at business intelligence, it’s all about looking at patterns. Trying to identify what is the common cause. For example, if we’re looking at different age brackets or locations, we might need to put in a different policy at one location because we’re finding a higher cancellation rate there versus another location. Being able to identify those patterns is gold because it will improve the bottom line. We’ll have fewer patients canceling. And any time we have a patient cancel it’s a provider just sitting there, wasting time. That’s the last thing we need when we have a shortage of therapy providers, we want to make sure everyone is working and providing care.
Allison: But it can also be used to look at the performance of your therapists too, so it can help you identify your top performing therapists.
Bill: Absolutely.
Allison: So who’s producing the most? You can look at that from a performance perspective in terms of rewarding them with bonuses or pay increases, stuff like that. This ensures that you’re retaining staff and preventing burnout and turnover, especially now when staff are so critical. You want to make sure that you’re retaining and keeping those folks happy.
Bill: And Allison, you bring up a great point. When we’re looking at outcomes and trying to make sure that there are a bunch of different things there, we’re looking at the outcome of that patient coming in and how well they did with the therapy provided. However, everybody is having difficulties negotiating with insurance payers at this point. It would be great if you had data that would show and compare to other benchmarks from a national standard or other set. We’ve also seen folks have been able to negotiate better payer contracts because they’ve done better with outcomes. When we flip to value based care, business intelligence is going to be a big tool. We want to understand when that patient is going through care, what is the outcome? Do they have to come back for care after their initial appointments, and if so, have they re-injured or something like that? Those are the types of things that you want to understand from business intelligence, so you can calculate reimbursements and make sure you’re getting better as an organization from an outcomes perspective. There’s a lot of different uses. When we look at the future of healthcare, it makes sense to dive deep into business intelligence, rather than making decisions with your gut. Your competition is going to be using these tools, so you really want to make sure you’re utilizing all the technology out there to make the best decisions, because if you make the wrong decision, it can set you back and some organizations can’t afford that.
Allison: So, that leads me to my next question. When we talk about leveraging business intelligence, is this something that every therapy practice should be taking advantage of, or is this something more appropriate for larger practices?
Bill: There’s really not a size where you should be looking at this. This is a one size fits all model that should be for business intelligence, especially groups that want to grow that practice. If you’re looking to add more locations, business intelligence is definitely the way to go. If you don’t want to grow more locations but you want to improve your bottom line, business intelligence is the way to go. So it’s out there for everybody. You don’t need to be a gigantic practice, or looking to grow into 1700 different locations. If you’re looking to improve that bottom line, I would recommend that to everybody.
Allison: So how do you do it, how do you get started?
Bill: A really good question. So, if you’re looking to get into business intelligence, there are a couple of ways you can do that. First, ask yourself what types of data you’re looking to go after. To get a 360-degree view you’ll have to do a quick inventory of the different systems and where your data is located. For example, electronic medical records, billing system, CRM system, payroll system. Identify all of those different systems to identify the types of reports and things that will improve your bottom line. Does that make sense?
Allison: It does.
Bill: What’s really nice is that it sounds technical, but in today’s day and age, what a lot of these providers have done is they’ve tried to make it as easy as possible. It’s a lot more attainable to go up and learn about data, analytics, and business intelligence. I mentioned at the top of the session that my family is in healthcare: they’re providers, so I’ve got to love it. My mom is learning SQL reporting right now in an effort to get better at this. She got a book from the library, like SQL for Dummies, but I think that’s really overkill. You don’t need to be a SQL expert. A lot of these tools are drag and drop. What I’ve seen out of Power BI, Tableau, Yellowfin, and a lot of these technologies. It’s drag-and-drop technology that you don’t need to be a coding expert for. You just have to understand what you’re trying to build and what your end product should be. If you have an idea of what you want to see, you can figure it out by dragging, dropping, plugging, and playing with it. Additionally, there are a lot of great resources available. For example, if you sign up with a number of these different vendors, they have universities which can walk you through all of that stuff—not brick-and-mortar universities, but Tableau universities and Yellowfin universities.
Allison: Now, do they have health care specific dashboards and reports that are sort of pre-made that make it even easier to sort of plug and play it?
Bill: Absolutely. So we’ve found that many organizations are trying to cater to the healthcare industry. It’s a huge industry, so we want to make sure there’s content available. I’d recommend you take a look at the vendor you’re using. Do an inventory of the data sets you have, and then also of the business intelligence tool. See what type of content they have. Don’t recreate the wheel–if something can be manipulated slightly, that’s the way to go. And then as you become comfortable with the tool, you can start creating your own reports. Start small and bite off only as much as you can chew. Once you’re comfortable, then you can go wild with business intelligence.
Allison: This is some great advice and just a caveat here, we are not promoting or supporting any of the vendors that we’re mentioning here today.
Bill: No, I’m just referencing them as examples.
Allison: I think one of the other questions here is, you know, we talked a lot about, and I think you alluded to it a little bit, how all the different data points in the data sources you’re pulling in come together. You might be pulling in data from your EMR or CRM. Is it all pulled in through the buy solution? Do you need a strong technical background to make that happen?
Bill: So great question, Allison. And again, the way I would start off is to try to start slow. So if you’re doing an inventory of all your data resources—your EMR data, billing data, financials—what’s the critical one that has most of the information you need? I would start there first. Try pulling that into a business intelligence tool. Once you have it in your business intelligence tool, you’ll have to understand, because this is a tricky point, how to get these different systems to play well in the sandbox together. Most systems have some sort of data export—a CSV file or some other file that you can export—and then upload that into a business intelligence tool. So, at the very least, you can do it in a more manual fashion with an export and then an upload. That would work out fine. But then, if you want it to be a little more automated, you can utilize APIs to connect a system to your business intelligence tool so that the information is running back and forth. We’ve come up with two ways of doing it: an extract, transfer, and load process or an extract, load, and transfer process. So ETL or ELT sounds delicious, but you can do either one of these processes to get that information into a business intelligence. Not to get too technical, it’s really just making sure that in that process, when we talked about it earlier, we said that there can be enrichment of the data where algorithms and other things come into play in the ETL process. It’s not so much in the extract process, but in the transfer and transform of the ETL process where those algorithms are coming in and the enrichment of data occurs. Then, it gets loaded into your business intelligence tool. That’s a little bit of the process behind it.
Allison: Okay perfect, so the million dollar question here, I think that everybody probably has on their mind, this sounds expensive. So, when you’re thinking about it, we have listeners across the spectrum here. We have small practices up to large practices, and everybody’s concerned with financial commitments. So, when you hear it I think people automatically assume this is going to be an investment. Is it a major investment?
Bill: Well, what I would say is that business intelligence, whatever the investment is going to be, it will pay off in the ROI that you’re going to receive. If I could give you a way to spot problems before they become chronic issues, I would pay a lot of money for that. To be able to see into the future, in order to be proactive rather than reactive, there’s a lot to consider. You have to think of all the downtime with your employees, the rising overhead. How could you get more reimbursement? So there’s such a heavy reliance on this that I would be willing to pay a hefty penny for those types of things. Now, what I’ve found, and it’s different for everyone, is that a business intelligence system will always prove out as the right way to go from an ROI perspective, based on the cost. It’s really pennies on the dollar when you want to invest in a business intelligence tool.
Allison: Excellent, I always say don’t don’t trip over dollars to pick up pennies.
Bill: That’s right, it’s a good one.
Allison: Final question. What are some main takeaways for our listeners today?
Bill: Great, great one. So some main takeaways for our listeners are that you really want to understand the whole power behind business intelligence. If you’re not utilizing a business intelligence tool today, it will make you proactive as opposed to being reactive. The big power behind business intelligence is being able to spot problems quickly, like we were talking about with Where’s Waldo – you get to spot Waldo in about 3 seconds. Compared to two years in the past, business intelligence is much more approachable.When we talk about vendors, they’ve really tried to open this up so that it’s not just people with computer science degrees who can do this. They’ve tried to make it as drag-and-drop as possible. And when you look at your organization, it’s not just from a financial lens, but every different lens that business intelligence can be harnessed. This way you can take the data, chop it up, filter it, and click down into the source of all the different things, so you can get to the crux of every issue.
Allison: That’s awesome, thank you so much, Bill. We are out of time but I want to thank you for joining us today. Thank you to the audience for tuning in to the Therapy Matters podcast, your one stop resource for expert insights and advice on everything, therapy and rehab. We look forward to seeing you on the next episode, thank you.
Bill: Thank you.
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