Healthcare Business Analytics Services

MBA eliminates the labor-intensive, error-prone, confusing RBRVS manual look-up and associated data entry and aggregation required by many RVU calculators. All conventional RBRVS procedure codes are included. Calculations are customized to client’s specifications by RVU Reference Year, Location of Service, Modifier Weights, and Standardized or Regionally-Adjusted Costs. Results can be delivered in a variety of reporting and data formats to meet client’s needs. For further illustration, see the Example which provides a summary table representing Component and Total Regionally-Adjusted RVUs by Provider based upon more than 175,000 medical services produced by a multi-provider group.

Find out how RVUs can benefit your business.

RBRVS RVUs are generally considered to be the “gold standard” metrics representing medical services production resources. Standardized components represent the contributions of provider effort (Work), overhead resources (Practice) and risk (Liability), which together sum to represent all combined resources (Total) involved in the production of medical services. RVUs represent superior production metrics because they are free from the biases inherent in financial production measures (e.g., differences related to payer mix, collections, reimbursement or billing conventions), and RVUs are more sensitive that simple activity volume measures (e.g., patient visits, deliveries, or surgeries). Frequently services are delivered by collaborating providers, which may not be recognized in reimbursement-based production metrics. See the attached Collaborative Production Analysis which represents provider production efforts (Work) with appropriate recognition of collaboration among providers. Additionally, federal regulations recognize the use of RVUs as a potential safe harbor regarding production components of provider compensation and bonus plans.

Activity-Based Cost Analysis calculates actual medical services production costs by procedure.  The specific knowledge of medical services production costs has important implications in numerous areas, such as payer fee schedule negotiations, cost center analysis and service production strategies. Once costs are known, vague problems often become clear, divisions frequently dissolve into consensus, the course of action becomes clear and better business decisions are made.  

Would your business decisions change if you knew exactly your profit, or loss, for each payer? MBA believes that the specific knowledge about payers’ margins affects not only your decisions regarding that payer, but also strategically affects many other business decisions. Payer margins, good and bad, are some of the most important determinants of future business success. If you don’t know your margins, many decisions are simply experienced management guesses. 

Payer Profit Analysis combines the knowledge of actual payer services production costs and related payer reimbursements (either actual or allowable). Knowledge about payer margins is both operationally and strategically important:  First, the specific knowledge of a payer’s margin affects both immediate and longer-term aspects of your provider-payer business relationship that should not be ignored; Second, knowledge of payers’ margins creates a risk awareness of potential impact, positive and negative, on current and future cash flows;Third, potential payer fee schedule renegotiation opportunities are identified and quantified. Empowered with the knowledge created from Payer Profit Analysis, MBA can guide you through the payer fee schedule negotiations process.

MBA offers two approaches to efficiency measurement, depending upon client interests and data availability:  RVU-based metrics and multi-attribute mathematical programming.  RVU values represent the best standardized measures of provider, overhead and liability production inputs, and provide denominators for easily-produced cost and revenue  metrics such as Provider Cost per Work RVU, Overhead Cost per Practice RVU or Collections per Total RVU.  These metrics can provide useful internal and external bench-marking measures.  Mathematical programming allows the comparative evaluation of multiple services production units and yields exact determination of each unit’s relative efficiency, but also identifies opportunities for improving efficiencies. MBA can support your interest in either of these methodologies.

MBA’s analyses offer ideal contributions to annual strategic planning activities.  Our tables, graphs and reports provide a clear, empirical introduction to the discussion important topics such as productivity, cost management and profitability.  In fact, one organization spontaneously brought their prior year documents to the current year’s meeting so that they could compare personal and group performance across years! Our standard strategic planning collection includes about 24 documents:  If you have special strategic planning needs, MBA can provide custom data management and analysis using IBM’s SPSS application.  

The principal determinants of business decisions, such as activity volume, production, costs, and margins, are concisely presented in a dashboard. Metrics are updated following each data analysis, with drill-down and trending capabilities based upon client’s submissions, regional and national benchmarks. Custom metrics can be created to uniquely respond to your organization’s information needs and interests.