Data insights support healthy outcomes
KPMG helped a children's hospital identify opportunities for significant cost savings and revenue enhancement.
Client
A pediatric specialty hospital
Sector
Healthcare
Project
Data management for revenue cycle efficiency
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Client challenge
This pediatric specialty hospital provides coordinated care in a state-of-the-art environment designed entirely for kids, with a dedication to excellent patient outcomes. When the hospital became a freestanding facility after it divested from its parent company, it faced a set of challenges that were new to its leadership. Streamlining administration and operations became a priority. But without the IT and data expertise of larger organizations, the hospital did not have enough internal clinical, operational, and financial data to produce insights for prioritization of its work. As a result, leadership was unable to determine whether its decisions and interventions were performing as it had predicted. What’s more, it did not have insights into cost savings around length of stay, claims denial, and re-admissions necessary to ensure consistent outcomes for its patients.
Hospital leadership engaged KPMG to help them overcome these challenges, leveraging our healthcare industry knowledge, experience with data and analytics, as well as specific tools such as the KPMG Clinical Insight data tool. The goal: turn data into insights that can help streamline operations, improve cash flow, and support healthy outcomes for their patients.
Among other insights, KPMG analysis of the hospital's data revealed that improving clinical documentation processes would reduce claim denials and lead to a potential $14 million in revenue.
Approach
One of the core value propositions offered by KPMG is our ability to turn data into insights and valuable outcomes for our clients, even those who come to us with sparse internal datasets. Our KPMG Lighthouse Center of Data, Analytics, and AI is well positioned with powerful platforms that produce a clear and sustained competitive advantage.
We began to work with the hospital shortly after it spun off from its larger parent organization. Our team was able to work with the client’s incomplete data and, by applying industry leading practices to cleanse and standardize it, extract information from its systems. With industry benchmark data added into the mix, we were able to perform a proper analysis of key clinical areas—notably, length of stay and re-admission.
Visibility into the hospital’s operations gave leaders the ability to see where improvements could be made and value created—opportunities that emerged from deep digs into the data. Now, the client can uncover multiple root causes for the same problem. Business leaders and medical professionals can analyze a specific procedure, department by department, to optimize processes. Providing better information and focused postoperation guidance for a new mother, for example, can reduce the occurrence of complications and, hence, re-admissions.
The specialized nature of the medical conditions and procedures at a pediatric facility meant that we had to reconfigure our algorithms to address the client’s unique needs. This is a feature of the KPMG approach:
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It can be customized to address client-specific challenges.
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In this instance, we modified the diagnostic-related groups (DRG) aspect of our algorithms to account for pediatric conditions and medical procedures. Another discovery brought an opportunity to improve revenue efficiency.
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Our analysis found a large number of claim denials related to inadequate clinical documentation, an insight that represents a significant opportunity to improve top-line results.
Benefits to client
Our team’s experience in data and analytics, combined with our deep industry and domain knowledge in the healthcare space, enabled us to build a composite approach around the client’s data in combination with industry and benchmark data. We identified key opportunities, including:
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A length-of-stay (LOS) reduction opportunity driving a potential cost savings of $6.7 million.
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A $14 million revenue opportunity with the improvement of clinical documentation processes, reducing claim denials.
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The discovery of inadequate documentation led to a significant opportunity to improve top-line results.
KPMG insights
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We have the capability and experience to work with specialized clinical care data
Our clinical care insights platform can be configured to address the specific needs of clients in the clinical care space. In this instance, given the client’s specialized focus on pediatrics, we modified our algorithms to accommodate and interpret pediatric DRG data, enabling an extensive look into the client’s complex operations and care environments.
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We can work with sparse or incomplete data to produce valuable outcomes
The majority of hospitals simply do not have the salient in-house resources to manage data through its entire lifecycle or the experience to manage a cloud environment. As a trusted advisor to hospitals, we run our analytics on an industry-compliant cloud platform with the power to run millions of records, extracting insights that can have a significant positive impact on revenue.
Meet our team
Debarshi Datta
Director Advisory, Digital Lighthouse, KPMG US
Debarshi Datta
Director Advisory, Digital Lighthouse, KPMG US