Mount Sinai Medical Center's Latest Surgical Tool: Data Mining

You might say data mining tools have helped Mount Sinai Medical Center uncover a small gold mine.

Using business intelligence tools, Mount Sinai discovered $4.5 million in uncollected revenue owed to the New York City hospital by insurers and others. These new "rebilling opportunities" have so far resulted in Mount Sinai collecting $2.5 million in revenue over the last year from insurers who underpaid patient bills based on their contractual obligations and other factors, said David Fuld, the medical center's director of IT.

"Good information is often trapped in legacy systems," said Fuld. "Our patient accounting system has millions of pieces of information. At the end of the day, you need someone to take action, but to take action you need to get that information to the person who needs it. The dashboard does that."

Information Builders WebFocus BI tools help Mount Sinai accounts receivables personnel "slice and dice" patient accounting and other data from subsets of the medical center's Oracle data warehouse, said Fuld. Through an IB "management dashboard," accounts receivable personnel can more easily query specific information, such as bills underpaid by $5,000, helping identify opportunities for rebilling. "Before they'd get a stack of papers on their desk to sort through," he said.

About 300 Mount Sinai executives and managers have had access to the hospital's management dashboard for a variety of reporting needs for several years. But about 18 months ago, Mount Sinai began making the Information Builders dashboard available via a Web portal to accounts receivable managers so that they could conduct these payment variance queries.

This functionality helped managers identify lists of billing that had been underpaid by insurers. For instance, based on contracts between Mount Sinai and insurers, an insurer could be obligated to fully pay for a patient's hip replacement surgery, minus the patient's co-pays and deductibles. However, the queries uncovered situations of underpayments, such as insurers paying for the surgical procedures and drugs needed during an operation, but not for the artificial hip prosthetics.

Those are the sorts of high-ticket items that can really add up for hospitals like Mount Sinai when insurers and others fail to pay them, said Fuld. Each year, Mount Sinai bills for about 55,000 in-patient admissions and 600,000 outpatient visits and generates operating revenue in excess of $1 billion, he said.

Now that Mount Sinai has analyzed and rebilled those previously "closed accounts," the hospital will continue to use the BI tools to hunt for other as-yet-undiscovered revenue or cost savings opportunities, Fuld said.

"Hospitals are under tremendous pressure," Fuld said. "Organizations need to examine opportunities to utilize technology to save money and boost revenue."

This story was modified on Oct. 30 to correct the name of Information Builders.