Standardized decreased observation time after outpatient interventional procedures - impact on 90 day emergency room visits, admission rates and clinic visits

Abstract

Materials and Methods: Sensitivity and scenario analyses were overlaid on an existing validated modeling tool in Excel. Sensitivity analysis calculates revenue fluctuation related to dynamic adjustment of discrete variables such as patient and provider mix. In scenario analysis, we project three possible scenarios -Optimistic, Base, Cautious -by changing multiple variables simultaneously. Base case assumes the status quo. Optimistic case projects modest gains in level of care, provider mix, documentation, and collection rates, while the Cautious case projects unfavorable trends. Results: Sensitivity analysis demonstrates that significant gains in hypothetical revenue can be attained specifically by increasing patient volume, attending physician instead of advanced practitioner staffing of visits, physician compliance with billing, and institutional collection rate. The Base case scenario projects $1.7M in charges with $293K in hypothetical revenues. The Optimistic case assumes modest gains in provider mix (30% increase in attending staffing for complex patients), increased attending compliance with documentation (50% increase), and a 5% gain in collection rate, resulting in $2.2M in charges with $483K in revenues. The Cautious case assumes shrinking patient volume (15% decrease in volume), lower acuity of care (25% decrease in high level visits), poor provider mix (i.e. 10% decrease in attending staffing), no improvement in documentation, and a 5% reduction in collection rate, resulting in $1.3M in charges and $188K in revenues. Conclusion: Strategic application of widely used corporate financial modeling can identify key opportunities to maximize revenue from an IR inpatient service. Sensitivity and scenario analyses demonstrate a wide range of potential revenues that may be achieved by an inpatient IR clinical service. Close attention and active management of key variables may result in significant implications for the financial health of an IR division.