Healthcare providers need to keep their eye on the right patients as they look for ways to boost revenue and reduce risk.

Paul Cerrato, Contributor

July 1, 2014

3 Min Read
(Source: <a href="" target="_blank">Ragesoss</a>)

Ever since the Centers for Medicare and Medicaid Services (CMS) decided to penalize hospitals financially for avoidable readmission of patients within 30 days of their discharge, health systems have been coming up with inventive ways to keep patients out of the hospital while also trying to bring in more revenue.

Most of these approaches make sense. They've created population health management programs that analyze patient data to spot those at high risk for readmission, for instance, and then offer preventive measures to those patients. They've created care-coordination systems to make sure discharged patients arrive safely at their next destination, whether it be their home, a rehabilitation unit, or a nursing facility. Most hospitals have also redoubled their efforts to educate patients at discharge so that they understand how to take their medications and see the value of making follow-up appointments with their primary care physicians.

But some healthcare providers are going too far in their attempt to maintain a healthy revenue stream while trying to absorb the CMS penalties or reduce the risk of incurring them. A recent New York Times article points out that some providers are using the services of data analytics vendor MedSeek, which "offers services intended to help hospitals 'virtually influence' the behavior of current and would-be patients." The vendor helps healthcare providers refine their marketing by analyzing metrics such as age, sex, race, income, culture, religious beliefs, and family status. The goal: Help providers "scientifically identify well-insured prospects."

[A better approach, or a privacy violation? Big Data Helps Insurer Pinpoint At-Risk Patients.]

The Times quotes a blog post from Bill Andrae, a MedSeek VP, that suggests providers should reach out to "all high-value men and women" to notify "profitable individuals 18 and older" about their services, and to urge them to schedule screening procedures and appointments. (MedSeek has since taken down the post.)

There are at least two problems with this tactic: First, as clinicians cater to the worried well, they'll spend fewer resources on sicker, less affluent patients who really need the added attention. Second, it's going to result in a lot of unnecessary, expensive tests that offer very little return on investment -- at least for patients.

The list of unnecessary, even potentially dangerous screening procedures continues to grow. Experts now say that PSA screening to detect men at risk of prostate cancer doesn't work. Several oncology researchers also question the value of mammography screening for women in certain age groups. And recently, 17 medical specialty societies identified 90 tests that aren't worth the cost.

Obviously healthcare providers need to find ways to offset diminished reimbursements, but persuading gullible patients to waste their or their insurer's money on useless procedures isn't the answer.

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About the Author(s)

Paul Cerrato


Paul Cerrato has worked as a healthcare editor and writer for 30 years, including for InformationWeek Healthcare, Contemporary OBGYN, RN magazine and Advancing OBGYN, published by the Yale University School of Medicine. He has been extensively published in business and medical literature, including Business and Health and the Journal of the American Medical Association. He has also lectured at Columbia University's College of Physicians and Surgeons and Westchester Medical Center.

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