CSBI Sample Questions - HFMA
Fundamentally, analytics can be considered: A.Complex, as it integrates data from various sources B.Technically sophisticated and requiring specialized skill C.Work that simplifies data to amplify meaning D.The business driver
C. Work that simplifies data to amplify meaning Explanation: The objective of analysis is to understand meaning as it resides within data. The work is one of focusing on the relevant data to unlock meaning.
To make the assertion in favor of Business Intelligence, you have to gain the following: - An organizational picture of the type of work to be explored and understood (financial or operational; clinical or business process), - An appreciation for the work tasks undertaken in these functional arenas, - An awareness of whom the work is being performing the worked by (and the stakeholders beyond them), - An understanding of stakeholders' concerns, issues, and ability to influence, and - A plan to address these areas Note - There is a final step in the foundational groundwork that will help validate the assertion in favor of Business Intelligence: develop an understanding of the processes that produce or use data and information, along with data that is actually produced, as it is both process and the data produced by process activities that are the subject of analytics activity.
Analytics Assertion
- Volume demand for services—ED, / inpatient, / etc. - Labor hours needed next shift - Respiratory therapist full-time equivalents (FTEs) needed next March - Probability of ED being over capacity tomorrow - Number of medication pumps needed per month - Billings vs. collections over the next 30 days - Unit expenses per month for next quarter's flexible budget cycle
Predictive Analytics (Examples)
Sophisticated business intelligence and analytics are needed to facilitate proactive management of key performance indicators (KPIs). It is crucial in this process to: A.Develop a thorough understanding of the key performance metrics by consulting with stakeholders. B.Conduct an initial review of where needed data is located. C.Interview senior management regarding desired outcomes. D.Conduct a market analysis.
A. Develop a thorough understanding of the key performance metrics by consulting with stakeholders. Explanation: Understanding the performance metrics is crucial to focusing analytics work and structuring approaches. This initial step must include stakeholders. Without a stakeholder analysis, progress is unlikely.
An experiment provides what? A.Insight into true cause-and-effect by demonstrating what outcome occurs when a particular factor is manipulated B.A movement beyond the traditional realm of report-writing analysis and observational studies. C.Assurance that change is a non-factor D.Assurance that the improvement is just a random positive variation.
A. Insight into true cause-and-effect by demonstrating what outcome occurs when a particular factor is manipulated Explanation: In experiments, the focus is on carrying out specific orderly procedures to verify/refute/establish the validity of one or more thoughts (hypotheses) on what might happen in a given situation.
Predictive analytics refers to the skills, technologies, applications, and practices for exploration that answers the questions: a) What if a trend continues? b) What will happen next? (prediction) These can be generated continuously and/ or iteratively, as in performing "what if" scenarios.
Predictive Analytics (Simplified)
The first step in stakeholder analysis is identifying stakeholders. Who is involved? Consider your own department or area. Make the list as long as necessary. Here is a list presented as numbers for ease of viewing. This listing will be used throughout the presentation here.
Identify Stakeholders
Identify which options are key Power Decision attributes Select all answers that apply A. Expeditious B. Replicable - done in the same way, repeatedly C. Needed hours of operation D. Activity peaks and valleys
A, B
Identify which options are key Power Decision attributes. Select all answers that apply A. Targeted results B. Adaptable to differing circumstances C. Low cost D. Activity patterns
A, B
The following options are attributes surrounding databases and reporting applications. Select the correct options and select See Results. A. A decision-support function involving the framing and formatting of reports and relatively basic descriptive analytics, if any analytics at all B. Often is still performed in a team environment C. The output is typically of a simplistic, descriptive, and analytic nature providing quantities, comparisons, percentiles and maybe trend lines on graphs D. Work has been financially focused in nature
A, B, C, D
The following options are attributes surrounding databases and reporting applications. Select the correct options and select SUBMIT A. Insufficient to reveal the information needed for powerful decision-making B. Work has been patient focused in nature C. Often is still performed within the silos of individual process applications D. Provides all the information needed for powerful decision-making E. Work is typically based on performing recurring, routine reporting and analysis
A, C, E
Productivity is generally assessed by A.Benchmarking how many inputs are required B.Looking at the raw number of increased products and services offered C.Looking at the ratio of outputs to inputs D.Looking at market share
C. Looking at the ratio of outputs to inputs Explanation: Productivity is a focus on how much input is required for desired quality output.
Operations is the function that meets the demand for the product or service by the market. The set of decisions that comprise the operational function is well described in the work of Jay Heizer and Barry Render, authors of Operations Management (12th ed., Prentice Hall, 2020).
Operations
Which option is NOT a goal that should be kept in mind when displaying information in meaningful and usable ways to guide decision-making? A.Highlight the importance and meaning B.Use pictures C.More words, less graphics D.Less is more
C. More words, less graphics Explanation: Edward Tufte, the globally renowned leader in the visual display of information, outlines nine simple key points which include: showing the data, avoid distorting what the data has to say and encouraging the eye to compare different pieces of data.
The illustration on the left proposes a way to think about and focus on the general interconnections of the three major organizational functions (shown by shape size) in the context of all healthcare provider organizations. Included are key organizational support functional areas - Decision Support, IT, and Human Resources. These areas are subsumed under general and administrative organizational tasks not addressed previously. This illustration is intended to be broadly directional, not prescriptive. Relative organizational positioning (reporting relationship and integration / interconnectedness) and the size of these functions certainly varies by organization interest, situation, and decision. In many healthcare provider organizations, Marketing might also be classified as a general and administrative task.
Recommended Focus
Stakeholders are individuals, groups, or institutions likely to be affected by (either negatively or positively) or who can themselves affect the outcome of an organization's efforts. Stakeholders are either involved in or impacted by the work. The stakeholder population can be broad, so narrowing the field to key stakeholders is a main objective. The four-step process is: 1) Identify Stakeholders 2) Stakeholders Profile 3) Stakeholders Relationships 4) Stakeholder Participation
Stakeholder Analysis
Sampling is a fundamental feature of experimental design in business analytics. The primary purpose of sampling is to: A.Make inferences about a larger population. B.Narrow the analysis activity. C.Limit generalizations. D.Simplify reporting categories
A. Make inferences about a larger population. Explanation: The population may be too large to test in its entirety. If so, a representative group or sample is needed. Sampling is a process for selecting smaller sets of data from a larger whole and making sure that the smaller sets are representative (maintains the fundamental characteristics) of the whole.
An essential skill that business intelligence professionals exercise in working with data selected for an analytics project is: A.Ongoing questioning of the data's relevance, accuracy, and completeness B.Confirming data is accurate C. Understanding how data systems operate D.Defining the limits of analysis based on data characteristics
A. Ongoing questioning of the data's relevance, accuracy, and completeness Explanation: If questioning of data does not arise naturally among data users, then a critical aspect of one's work is to make sure it does.
Utilization drivers currently support the fragmented, disconnected healthcare environment we experience today. An example of such utilization drivers is "preference-sensitive care." Preference-sensitive care is: A.Physician-centric B.Patient-centered and patient-driven C.Treatment protocols prescribed by payers D.The actual method for adjusting for risk across a population.
A. Physician-centric Explanation: Preference-sensitive care is where the course of care selection and frequency is driven in large measure by physician preference and opinion, which are driven by different incentives.
When exercising influence, which of the following is not likely to be available to a business intelligence consultant? A.Positional authority B.A budget for the analysis activity C.Access to all data sought for the analysis D.The ability to challenge business strategies
A. Positional authority Explanation: This requires direct authority over others, and business intelligence consultants don't generally hold this responsibility.
Disruptive innovation in health care is: A.The result of new business possibilities in the marketplace. B.The responsibility of executives to nurture strategies that may not initially seem to have much upside potential. C.The process of planning new market entrance strategies. D.The courting of new consumer markets.
A. The result of new business possibilities in the marketplace. Explanation: This is the correct answer. Disruptive innovation is an innovation that disrupts and replaces existing markets with ways of working or products previously not thought of as possible, but that are now possible due to new technology or another catalyst.
Business intelligence can produce a business perspective best characterized as: A.What happened; consider the future B.Understand and respect roots C.With appropriate tools, we can find what we need to know D.Operations are stronger when informed
A. What happened; consider the future Explanation: Business intelligence and analytics seek out the environmental dynamics at work (both internal and external) and the response processes, with the objective of identifying how to most appropriately move the business forward.
Predictive analysis refers to the skills, technologies, applications and practices for exploration that answer the question(s): A.What if a trend continues? What will happen next? B.When will a trend end? C.How will a trend end? D.How will a trend end and what should be done?
A. What if a trend continues? What will happen next? Explanation: Predictive analysis focuses on the dynamics currently in play and the likely consequences/results.
With the growing demand for greater value in healthcare, there should be corresponding focus on ways of achieving lower costs, better margins, and greater productivity. These will be discussed in turn and the ideas applied in the same measure as in both the financial and operational functional areas delineated at the outset of this section. By using activity-based costing (ABC) to understand their true costs, healthcare providers can avoid many potential pitfalls that can result from using traditional costing methods... Proactively managing profitability requires adopting advanced techniques, such as activity-based costing, to understand the true costs of services being provided, particularly before signing new or amended payer contracts. The writings of Robert Kaplan and Michael Porter of Harvard have led the field in promoting the idea that ABC methodology is an essential tool. It is essential for BI/analytics consultants to understand and be able to apply ABC costing, because they will be at the forefront of helping organizations adapt and change to this methodology.
ABC Costing
Data-rich -- - EHR, / Revenue Cycle, / DRG coding/ Information-intensive -- - EHR, and Revenue Cycle, / DRG /and ICD codes Asset-intensive -- OR and ED room use Labor-intensive -- Clock time vs. unit volume Dependent on speed and timing Dependent on consistency and control -- Patient access areas Dependent on distributed decision-making -- Population health management decisions across Medical Homes Cross-functional and cross-business in scope -- 30-day readmission Low average success rate -- Could be anywhere.
Areas of Significance for Analytic Application
A powerful vehicle designed to encourage coordination of provider services: A.The Provider Services Coordination Agency (PSCA), a new healthcare regulatory body with the authority to institute penalties. B.Accountable Care Organizations (ACOs) C.Consumer Healthcare Boards (CHBs) D.Physician-Payer Relations Circles (PPRCs)
B. Accountable Care Organizations (ACOs) Explanation: ACOs can incentivize provider participants to coordinate all components across the continuum.
Select which option is NOT part of the iterative process of creative analytic thinking. A. Preparation B. Immersion C. Balance D. Incubation
B. Balance Explanation: BI/Analytics consultants will be asked to address situations like that in the following example. Although it is a simplified slice of the real thing, the example illustrates processes and areas needing attention to avoid turns in the wrong direction, or bad and possibly misleading results. It is an iterative process of creative analytic thinking/preparation/ immersion/incubation/insight that the BI/ Analytics consultant must engage.
"Supply-sensitive care" describes when healthcare service selection is determined by: A.The relationship of the cost of supplies and expected demand B.Capacity - the amount of resources available for use (and revenue) C.The discounting offered by payers on services D.Market position and brand recognition
B. Capacity - the amount of resources available for use (and revenue) Explanation: Healthcare decisions surrounding medical necessity are influenced by capacity, rather than by medical evidence or severity of illness. Decisions depend more on the beds available, clinics, CT scanners, physicians per capita, etc., than on what care the patient needs or wants.
An area of powerful leverage to develop performance improvements made possible by today's analytic tools is an enhanced ability to: A.Convince stakeholders of the need for changes. B.Conduct experiments on processes and the output of processes. C.Get the data "right." D.Warehouse extensive amounts of data amounts to build contingency plans.
B. Conduct experiments on processes and the output of processes. Explanation: In experiments, the focus is on carrying out specific orderly procedures to verify, /refute, and/or establish the validity of one or more thoughts (hypotheses) on what might happen in a given situation.
From the perspective of Decision Support (upper left in the diagram), what is the key lesson captured in the illustration? A. Decision support is concerned only with finance and supply chain operations. B. Decision support needs to discern cross-functional relationships, interconnectedness, and interdependencies when conducting analytics. C. There are areas such as general administration with which decision support will likely never be involved. D. Decision support needs massive resources
B. Decision support needs to discern cross-functional relationships, interconnectedness, and interdependencies when conducting analytics. Explanation: The processes and data (utilized and produced) are generally cross-functional and interconnected. Without this understanding, the full impact of any business analytics is limited.
The notion of "standardized work" is important to analytics for: A.Establishing viable, equitable, and legal employment policies B.Fully leveraging analytics for resource management and planning C.Structuring efficient data capture and usage D.Meeting government regulatory requirements
B. Fully leveraging analytics for resource management and planning Explanation: The concept of "standardized work" facilitates examination of processes, e.g., ABC costing, productivity, and optimized resource application (- labor, supplies, equipment).
The most important outcomes of business intelligence activities are: A.Effective resource deployment and cost effectiveness B.Increased decision-making capacity and performance improvements C.Performance improvement and process alignments D.Market understanding and products and services alignment
B. Increased decision-making capacity and performance improvements Explanation: The primary outcome and power of business intelligence is the ability to steer a course for the future. This ability is contingent upon strong decision-making capability and the capacity to adjust operations to improve performance.
Which of the following is part of the iterative process of creative analytic thinking. A.Ideation B.Insight C.Distribution D.Incapacitation
B. Insight Explanation: BI/Analytics consultants will be asked to address situations like that in the following example. Although it is a simplified slice of the real thing, the example illustrates processes and areas needing attention to avoid turns in the wrong direction, or bad and possibly misleading results. It is an iterative process of creative analytic thinking/preparation/ immersion/incubation/insight that the BI/ Analytics consultant must engage.
Descriptive analytics functions by: A.Providing a detailed narrative of current situations B.Summarizing and comparing patterns found in historic data C.Interviewing stakeholders to take the "organizational temperature" D.Employing the insights of industrial psychology to the business
B. Summarizing and comparing patterns found in historic data Explanation: Descriptive analytics seeks patterns in the data that may point to reasons for success or failure. Patterns in data then are described through the presentation of data in the form of tables and charts.
The implications of PHI in performing BI and analytics work center on: A.The ability to obtain permission to access the data. B.The capacity to always protect the confidentiality of the data. C.Manipulating data according to the HIMSS technology specs recommendations. D.Having all inferences and conclusions double-checked.
B. The capacity to always protect the confidentiality of the data. Explanation: One will have access to PHI data, and if deciding to use it must be sure it is used in a manner that always keeps it protected. One may decide not to use the data due to the requirements (e.g., maybe it is too difficult to protect, or using it is not worth the risk of a breach, so a workaround is just as effective). One must be clear on what PHI is and what it is not.
The primary outcome sought in providing healthcare from patient-centeredness is: A.Maximizing the effect of each individual service component. B.The greatest independence of the patient in a range of activities. C.Adequate funding for services provided. D.Opening up consumer choice.
B. The greatest independence of the patient in a range of activities Explanation: Arguably, the outcome sought allows the consumer the greatest independence in a full range of activities, especially those of daily living and autonomy in decision-making, across a full range of choices for living within the optimal, achievable quality of life.
Descriptive analytics is generated by querying, reporting, and online analytical processing (OLAP) tools and techniques that can help answer the questions: A.Who was responsible and when B.What happened and why C.What happened and what is likely to happen D.What happened and how can successes be repeated and/or failures corrected
B. What happened and why Explanation: Descriptive analysis seeks to describe patterns in past activity.
Clinical - Healthcare user satisfaction - HCAHPS - Evidence-based medicine pathways - 30-day readmission - Groupings based on DRGs, ICD, demographics - Risk management for hospital-acquired infections (HAIs), falls, decubitus ulcers, etc. - Benchmarks - external, internal
Business Functional Areas of Focus (CLINICAL)
Finance - Financial statements - ratios, as simple as cost per visit - Financial ratios - see HFMA's tables of Hospital Financial Statistics and Ratio Medians - Labor compensation and supply cost ratios - Key Performance Indicators - Benchmarks - external, / internal
Business Functional Areas of Focus (FINANCE)
Operations - Resource (labor, supplies, hard assets) utilization (assets such as equipment that may be fixed or moveable, rooms on care units, surgery, etc.) - Benchmarks - external, internal - Process and cap
Business Functional Areas of Focus (OPERATIONS)
Business intelligence and analytics must take into account all stakeholders. By "stakeholders" we mean: A.Funders of the analytics project(s). B.Budget-holders across the organization. C.All affected by or who can affect organizational efforts. D.Those responsible for applying analytics results.
C. All affected by or who can affect organizational efforts. Explanation: Analytics is about determining impact. Impact is appreciated as a dynamic set of drivers and corresponding results that occur in a complex system such as a hospital.
The BI / analytics consultant's work is moving beyond primarily data extraction, reporting, and simple descriptive analytic tasks to: A.Cutting edge programming B.Impact forecasting C.Assuming the role of an expert D.Active decision-maker
C. Assuming the role of an expert Explanation: BI/analytics consultants are increasingly being looked to for expertise on the best way to manipulate data to create powerful, actionable decision-making information.
The fundamental goal of business intelligence analytics is to: A.Obtain all pertinent data B.Check the veracity of the data selected C.Derive the one truth within the information that addresses the question D.Make the most appropriate decision
C. Derive the one truth within the information that addresses the question Explanation: The one truth enables better decision-making. Better decisions can be made when information has been discerned to be the correct information and it is not argued that other information and other decision possibilities are valid. A goal of "one truth" helps to focus attention.
Continuous, iterative exploration on individual aggregate situations (e.g., patient lengths of stay, resource management, revenue cycle acceleration, supply chain management) throughout a course of care over time that answers certain questions, what actions are needed, and what is the best that can happen, is known as: A.Descriptive analytics B.Predictive analytics C.Prescriptive analytics D.Iterative extrapolation
C. Prescriptive analytics Explanation: Prescriptive analytics uses the meaningful information derived from ongoing exploration and the probabilities identified to establish a course of reasonable action.
The purpose of a "medical home" is to: A.Keep all personal medical records in one location B.Foster long-term relationships with specific clinicians C.Provide healthcare users with a point of coordination across the continuum starting with prevention. D.Expedite billing by centralizing claim submission locations.
C. Provide healthcare users with a point of coordination across the continuum starting with prevention. Explanation: The coordination of care means that proper care and follow-up are delivered to the patient. This coordination is designed to achieve high-value outcomes by correcting the inefficiencies and high costs of disconnected health care.
Traditionally, the healthcare delivery continuum is structured as: A.Physician-dominated B.Patient-centric C.Provider services-centric D.Payer-and-fee-for-service-centric
C. Provider services-centric Explanation: The traditional healthcare perspective is "what services do we provide and where do we provide them?" This perspective has led to a system focused on acute-care treatment.
Predictive analysis is the practice of: A.Foretelling the future B.Establishing monitoring systems C.Providing probabilities of future outcomes based on what is known through existing data and select rules D.Determining frequency of past events to inform current-day business discussions
C. Providing probabilities of future outcomes based on what is known through existing data and select rules Explanation: Predictive analysis uses data to determine the probable future outcome of an event or the likelihood of a situation occurring.
Healthcare has entered a vast frontier. The frontier is characterized by _________________. A.Congressional involvement in the healthcare industry B.Physicians seeking more input from others on treatment modalities and plans. C.The availability of big data and the ability to use it in decision-making. D.The consumer revolution.
C. The availability of big data and the ability to use it in decision-making. Explanation: Computing power and capability, along with the analytic techniques that allow information to be collected and "unlocked,", have become an important consideration in healthcare management.
Professionalism in developing and utilizing business intelligence carried a special obligation. This special obligation is: A.To protect all private healthcare information (PHI). B.To provide only the data requested in the reporting form requested. C.To teach and lead others in the power of the tools. D.To be knowledgeable about upcoming technology innovations.
C. To teach and lead others in the power of the tools. Explanation: The special obligation is an ethical one: to use the specialized knowledge and expertise to add value by teaching and leading others in the power of the tools and seeking out new questions, directions, and ways to leverage organizational data and information.
What is the fundamental purpose of engaging in business analytics? A.To create accurate intelligence about competitive factors B.To protect the organization's cash position C.To understand what is happening and determine how best to move forward D.To assess organizational products and services viability
C. To understand what is happening and determine how best to move forward Explanation: The heart of analytics utilization is knowing what is occurring, internally and externally, to the organization. Once these realities are grasped, attention can then be turned to how to respond moving forward.
As early as 2003, hfm magazine presented an article about clinicians' (nursing, physical therapy, respiratory therapy, clinical laboratory sciences, social work) interest in gaining an understanding of the financial and "business" aspects of the organizational work. Indeed, 80% of survey respondents strongly indicated the importance of this knowledge for successful career performance and the future of health care. A total of 69% of mid-level and lower participants indicated a need to understand financial statements.1 The outcome of this survey specifically, and of other subsequent writings, was to illuminate the need for clinicians to understand organizational expense related to cost, cost allocations, variance, trending, and the like in providing care - and the financial professional's key role in this process.2
Clinicians' Interest in Understanding the Business Aspect
Consumers have played a role in the creation and maintenance of a flawed and disconnected healthcare delivery system through one specific reality: A.Consumers generally don't take good care of their health. B.Consumers engage actively in competitive shopping for services. C.Consumers are resistant to "sticker shock" i.e., prices are a secondary concern. D.Consumers are disconnected from the impact of their economic decisions.
D. Consumers are disconnected from the impact of their economic decisions. Explanation: This is the correct answer. It's a problem when consumers of anything are disconnected from the economics of their decisions. Limited cost for consuming the resources predisposes the consumer to always prefer more. Providers see opportunity-potential markets and become reluctant to integrate or connect.
Which option is NOT a key clinical informatics goal? A.Improve patient care B.Build information and communication systems C.Improve clinical information systems and improve knowledge management D.Determine coverage by predicted volume
D. Determine coverage by predicted volume Explanation: Coverage now can be determined by predicted volume, and the workload by time of day, day of week and day of year based on severity. This is an example of achieving better decisions by doing a better job in relation to all of the Power Decision attributes.
Following the foundational work of understanding the type of work done in different functional areas, learning who the stakeholders are and what their concerns and issues are, and developing a plan to address stakeholder concerns, the next step in business analytics is to: A.Examine the market environment. B.Begin identifying the type(s) of data required to conduct analysis. C.Conduct research of similar past concerns to identify potential starting points. D.Develop an understanding of the processes and data that will be involved in analysis.
D. Develop an understanding of the processes and data that will be involved in analysis. Explanation: One must develop an understanding of the processes that produce or use data and information, along with an understanding of the actual data, as it is both process activity and data produced by process activities that are the subject of analytics activity.
Business intelligence consultants employ knowledge, expertise, and communications competency to pursue the primary goal of: A.Helping the organization discover process flaws. B.Identifying appropriate resources for existing capabilities. C.Preserving successes. D.Identifying opportunities to move forward.
D. Identifying opportunities to move forward. Explanation: The primary goal of business intelligence consulting is to provide the knowledge and understanding for the organization to move forward. The primary goal is , developing an actionable future
Prescriptive analysis is an emergent area that uses hybrid data to: A.Predict what will happen B.Diagnosis problems C.Correct misapplication of descriptive analysis D.Indicate what should be done
D. Indicate what should be done Explanation: Predictive analysis uses hybrid data (which might include historical, real-time, internal or external, structured or unstructured, and others) with business rules and mathematical models to indicate what should be done.
What is the significance of the list of six leadership styles: authoritative, affiliative, democratic, coaching, coercive, and pacesetting? A.It identifies preferred types of leadership styles in priority order. B.It identifies the leadership styles appropriate and not appropriate to today's business environment. C.It is a roadmap to leadership development as an executive. D.It shows how to exercise influence and stimulate action in different circumstances.
D. It shows how to exercise influence and stimulate action in different circumstances. Explanation: Leadership at heart is about influencing and stimulating action. All of the above styles are integrated in a strong leader.
In the application of business intelligence and analytics, organizations are encouraged to shift their focus from finance to: A.Supply chain B.Productivity C.The "patient experience" D.Operations
D. Operations Explanation: Business intelligence, while employing analytics to "break things down," is a whole-system, operations-focused activity. Operations is where the billable work is done, and the preponderance of the cost lies.
The three key large-scale mistakes in business analytics are: A.Sampling errors, errant analytics applications, and loss of focus. B.Unsubstantiated inferences from samples to larger populations, undetected data "noise,", and loss of focus. C.Difficulty in isolating and explaining patterns in the data, ignoring the processes under the data, and the fallacy of "explaining everything one detects." D.Sophistication compensating for a lack of data, difficulty finding and explaining patterns in the data, and equating correlation with causation.
D. Sophistication compensating for a lack of data, difficulty finding and explaining patterns in the data, and equating correlation with causation. Explanation: The key point is that as business intelligence/analytic work increases and there is pressure to move more quickly, one needs to move cautiously and thoughtfully. In an attempt to explore everything, one often detects randomness or "noise" in the system that is mistakenly thought to be meaningful. These three large-scale mistakes destroy the credibility of an analysis.
This diagram is a graphic representation of what? A.Proposed legislative reorganization of healthcare B.Healthcare payers' risk continuum C.Physician, guidance on appropriate treatment modalities D.The traditional healthcare services continuum
D. The traditional healthcare services continuum Explanation: Healthcare delivery is performed within the context of a continuum that meets the needs of individuals' health conditions. Displayed here are possible opportunities for healthcare services across the general continuum of consumer health conditions. A shift is occurring today whereby emphasis is moving toward the front end of the continuum (wellness and prevention) and away from strict acute care focus.
Any business organization, including a healthcare provider organization, is structured as three main functional areas: operations, marketing, and finance. Why is it important to understand this basic structure for business intelligence/analytics? A.This structure provides a handy means of comparing organizations. B.This structure properly focuses business intelligence into operations and provides the boundaries of business intelligence activity. C.This structure provides direction for simplifying business analytics. D.This structure encourages a holistic, systemic framework for business analytics.
D. This structure encourages a holistic, systemic framework for business analytics. Explanation: Analytics addresses the dynamics and realities of interacting domains and requires a systemic view for context and accuracy of findings. The key idea is focus -- recognition that organizational attention must be paid to all three functional areas creates focus needed for sustainable success.
In the chart is an example of a high-level, chronologically laid out set of elements comprising a revenue cycle process (again, generally descriptive, not exhaustive or prescriptive). This type of chart reveals process elements, could allude to (or point to possible questions about) process speed based on the number of steps, and should signal dependencies. It also would allow one to gain a basic understanding about the work performed and the data outputs from this work; the use of data, one step to the next, and who is using it; and IT system location of the data generated in a step. For example, the Scheduling data would be in an ADT system, while the Utilization Management, Cash Posting, and Denial Management information would be found elsewhere.
Data Available and Its Use
The highest and last detail level presented is understanding interdependent activity. This is crucial to interpreting what and why activity happens the way it is observed yet does not seemingly make sense on first observation. This situation is common in clinical care. It is especially crucial to improving resource scheduling in clinical and non-clinical settings. A common clinical example is depicted here. In this case, resources are applied to perform needed procedures and other work. These resources are dependent on another department's volume, in relation to the totality of the ED cases in a period of time, and the resources are applied taking into account possible bottlenecks or timing issues in the preceding service areas.
Dependent Demand
Descriptive analytics provides a look at, and possibly an understanding of, past performance. This understanding is unlocked from the historical data by summarizing and comparing or mining for patterns. The patterns then may point to the reasons for success or failure. Patterns in data then are described through the presentation of data in the form of tables and charts. Almost all management reporting falls under descriptive analytics. It is the predominant analytic type in use, mostly because it has been used for many years and does not require extensive computational power to yield significant results. Summarizations and comparisons are most often made by means of the following with readily available tools, such as Excel. - percentiles - frequency distributions and standard deviations - scatter plotting - trend lines
Descriptive Analytics
- Count of healthcare users - inpatient admissions - Cost per adjusted discharge - Children and adolescents with non-urgent health issues in the ED during primary care provider's office hours. - Average length of stay (LOS ) - Days of average LOS above 3 - Median days in accounts receivable (AR) - Time measure of door-to-administration of TPA (physician-administered stroke medication that must be given within first three hours from onset). To describe the situation, use all of the following: a) Range of minutes b) Mean minutes c) Median minutes d) Standard deviation in number of minutes - Number of cases miscoded - Number of miscoded cases per shift - Days cash on hand vs. target - Labor compensation ratio - Inpatient census per hour per unit - 30-day readmits - HCAHPS score
Descriptive Analytics (Examples)
Descriptive analytics is generated by querying, reporting, and online analytical processing (OLAP) tools and techniques that can help answer the questions about: a) What happened (through general reporting) b) Why is this happening (by showing patterns or trends) Data (information) is presented in terms of: - Quantities - Frequencies - Locations - Classifications - Combinations - Comparisons - Trends
Descriptive Analytics (Simplified)
An organization must have a financing function to ensure that monetary resources are available to conduct operations. Accounting is only one component of the financing function, although it is often the most notable and a critical element of planning and performance monitoring. Here is a list of responsibilities that are part of the finance function. -Financial administration, direction and control -Treasury functions -Financial planning, budgeting and reporting -Revenue cycle - Patient accounts, billing (coding), and accounts receivable, etc. -Accounts payable -Salaries and payroll -Contract negotiation and management - insurance, vendors, etc. -Financial regulatory compliance -Maintenance of accurate and auditable financial records -Accurate and efficient transaction processing -Leadership of the organization's VBP and population health projects -Supply chain management functions (some organizations) -Information technology management (some organizations)
Finance
At the same time, the need exists for financial and IT professionals involved in gathering and understanding the data, to "walk a mile in the clinician's shoes," indicating that communication with clinicians in the clinician's workspace and understanding their work and issues is essential in moving forward in the environment of integrated work.
Financial and IT Professionals' Interest in Understanding the Clinician's Space.
BI analytics work enables these viewpoints: - Hindsight - Feedback through descriptive analytics about where one has been. - Foresight - Looking ahead to avoid problems and to chart a path toward greater success. This latter perspective is critical for future work in any industry. Foresight, enabled by predictive and prescriptive analytics, provides a needed understanding about what is likely to happen and what actions might be best to engage and navigate in the fast-changing environment.
Hindsight / Foresight
The illustrations on the left depict the general interconnections of each of the three major organizational functions discussed on the previous page in the context of the delivery segments serving healthcare users -- healthcare provider organizations (using the classic division of provider types). The size of each shape in the illustrations depicts both the relative historical focus on that function as related to analytics and the particular organizational focus on each function of "the business."
Historical Focus
A multidisciplinary professional practice involves professionals in clinical practice, clinical administration, financial specialties, and revenue cycle—patient access, insurance, claims management, etc. These areas are the key roles involved in performing the work tasks within the functional areas discussed previously. Emerging with particular prominence in this mix are clinical informaticists and BI/analytics professionals. The question is—what is needed for these wide-ranging fields of expertise to work together to meet the requirements of value- and quality-based reimbursement?
Key Functional Roles
Marketing provides the market interface function that is focused on understanding what the marketplace overtly seeks, anticipating shifts, and ensuring a strong marketplace presence. The commonly known 4 P's of Marketing are (product, price, place (i.e., distribution channel), and promotion. The key idea here is focus. Sustainable success is a result of focus created by recognizing that organizational attention must be paid to all three functions. Analytics engaged in relation to a function is a proxy for organizational emphasis and focus. Health care is no different.
Marketing
All segments of the healthcare delivery system (discussed in the first course of this curriculum) need to focus on these three basic functions as the foundation of what they do. Each segment produces outputs, has financing needs, and should pay attention to the marketplace served. However, for a variety of reasons (which are beyond the scope of this course), healthcare providers often show insufficient focus on the three functions. As is the case in any industry, engaging analytics that unlock information within each function is needed to propel the organization forward regardless of segment. With the information that is revealed, performance can be improved across functions. So, in health care, at what or where do we look?
Performance Across Functions
The discussion of player relationships and changes occurring in the business of providing healthcare services is not meant to be exhaustive. A large number of stakeholders and stakeholder interests are involved in the key business functions that dominate in health care—operations and finance. Therefore, the BI/Analytics consultant must perform a thorough stakeholder analysis to ensure that all players and viewpoints are appropriately considered when determining analytics projects, in particular: those that are forward-looking or predictive. those asking new, previously unimagined, or perceived as impossible-to-tackle questions; or those calling into question items or processes long taken for granted. In the next section, we'll look at a process and framework for stakeholder analysis.
Players in the Healthcare Services
The practice of relating what you do know to what you do not know, provides better information that is valuable at the point when a decision is needed. Here, probabilities are applied to historical data in combination with rules, algorithms, and possibly external data (using benchmarks) to determine the probable outcome of an event or likelihood of a situation occurring. Meaning can be ascribed by: - Indicating the probability of occurrence - pointing out possible actions to address the patterns - indicating possible consequences of action or inaction In sum,— one can turn uncertainty (what one does not know) into usable probability—that is, take action based on the likelihood of occurrence. Predictive analytics are variously presented as numbers, scores, or percentages, depending on the use of the information - for example, checking a credit score before a costly elective-procedure admission, or the number of labor hours needed on Tuesday.
Predictive Analytics
Prescriptive analytics is a very new and still-emerging area that uses hybrid data (which might include: historical, real-time, internal or external, structured or unstructured, and others) along with business rules and mathematical models to indicate what should be done. The models may or may not include a predictive component, and thus, prescriptive analytics is not necessarily predictive. Decision paths or options can be presented or decision implications illustrated using a "what if" analysis. As with predictive analytics, output can be continuously generated and updated to take advantage of new and better information as it becomes available.
Prescriptive Analytics
- One less RN needed next shift - Order 200 surgical kit packs #2328 for use over next six months with delivery schedule of X. - Always review any case with codes 12345A for coding errors - Accounts payable schedule - Services needed per specific admit type XXX to avoid 30-day readmit - Inpatient transport to imaging on Mondays first shift at 3 FTEs - Increase flex budget for 3 North unit by 3.5% These would be the result of calculations performed using the methodologies described rather than "rule of thumb," estimations or guesses after looking at descriptive information.
Prescriptive Analytics (Examples)
Continuous, iterative exploration of individual situations throughout a course of care, or larger groups or sets over time, answers the questions: a) What actions are needed? b) What is the best that can happen? For example, "Turning Hospital Data into Dollars," in the February 2010 hfm magazine, laid out examples related to answering these questions. One related to charge coding demonstrated the use of predictive modeling to indicate specific action to be undertaken, or not. The case "demonstrates the scale and comprehensiveness of predictive analytics. The model detected, with greater than 90 percent probability, 18 accounts as missing a charge for an implantable joint device. In this example, the model analyzed all similar procedures for the previous 12 months and identified, with a 93.6 percent probability, accounts that, if the four conditions were performed in conjunction, should have the artificial joint charge on the bill." Review action was called for and taken in all cases. Others were left alone.
Prescriptive Analytics (Simplified)
The high-level starting point for understanding some processes may be readily available. Maybe your organization has diagrammed the broad process elements, or flow-charted one or more processes, or even value stream-mapped segments. Processes readily discoverable on the internet dealing with the revenue cycle, budgeting and planning, and capital/financial planning. All of these processes are found in a variety of detail and levels of complexity. Process mapping and flow charting are essential to understanding the way an organization works and then how to analyze the work performed. There are many charting/mapping applications that can take you through the steps and process. Some organizations may have performance improvement offices that can offer expertise in process mapping and flow charting. Recommended Exercise: Develop a Revenue Cycle diagram and/or flow chart.
Process Mapping and Flowcharting
When considering productivity, one is simply looking at output vs. the application of resources. Productivity = output/input
Productivity
The last step of stakeholder analysis is analyzing stakeholder participation. When starting to think about stakeholder participation level and method, you can use this chart to document the level of attention one might expect currently if nothing is done and the desired attention based on findings taken during previous steps.
Stakeholder Participation
Given all the information to this point, one now makes and pegs stakeholders by a suitable participation type and selects a strategy or method, such as leading or co-leading some segment of the work or personal visits to receive consultative advice. Participation Methods Participation methods might include any one of the following (or more): Workshops Questionnaires Interviews Role plays Brainstorming DiscussionsOpen-endedWorld CaféSmall group Surveys Newsletters Briefings
Stakeholder Participation (cont)
The second step in stakeholder analysis is analyzing stakeholders' profiles. While perfection is not expected, general observation and simple questioning should reveal directionally correct useful information The location of stakeholders on the chart below helps make rankings on this profile page.
Stakeholders Profile
The third step in stakeholder analysis is analyzing stakeholder relationships. Drawing a picture such as this about the stakeholders involved in your item of focus renders an important understanding of the relationships between and among stakeholders -- dependencies, interconnections, power positions, etc. This information is very useful when thinking about later process steps related to priorities and participation.
Stakeholders Relationships
Standard Work is a powerful Lean tool. Standardized is not necessarily "identical" and "absolute." Processes and tasks should be standardized for the sake of quality, safety, and cost. As the standardized approach is improved, the new way becomes the baseline for further improvements, and then the cycle repeats. Improving standardized work never ends. Standardized work consists of three elements: - The rate at which work is to be performed in a process to meet workload. - The work sequence in which one performs tasks within at the rate determined above. - The standard supplies, equipment, etc., required to keep the services rendered or process operating smoothly.
Standard Work
If one's organization does not have such charts available, it is advisable to create them over time for multiple reasons: a) the points made previously that allow application of analytic thinking, b) they are needed to understand "standard work," which is required to fully leverage analytics for resource management and planning activities (e.g., activity-based costing, productivity, and optimized resource application - that is, labor, supplies, and equipment), c) viewing processes from the vantage point of such charts helps in discerning the significant KPIs from the many that are possible.
The Need For Process Charts
What is not often written, yet must be a commitment of professionals, relates to the social exchange one makes. The exchange is an obligation incurred for a grant given. The Grant: being allowed the time, resources, latitude, and respect for your opinion when you present information that points to a new direction. The Obligation: to do more than what the basic tenets are—more than using acquired knowledge and skills only to build requested reports or analyses, perform a checklist of tasks, or provide decision support. The obligation (and part of one's accountability) is to use one's specialized knowledge and expertise to add value by: -Teaching and leading others in the power of business intelligence tools, and -Seeking out new questions, directions, and ways to leverage organizational data and information.
This accountability and obligation is recognized in the HFMA code of ethics, which asks that members foster excellence by keeping abreast of pertinent issues and promote a greater understanding of financial issues by others in the healthcare field and the public.
Organizations in pursuit of any marketplace objectives must rely on three main functions for sustainable existence: operations, finance, and marketing. It is necessary to start at this level to establish, as the basis of further analysis, the fundamental importance and interconnection of each function.
Three Main Functions: 1) Operations 2) Finance 3) Marketing
