Speaker 1: Hi, I'm Lisa Miller, the CEO of iHealthcare. We're going to talk today about the cost impact and the relationship reimbursements to cost. So what I want to talk with you about today is how we achieve cost savings for our clients. And our approach is a little bit different than others in the marketplace. We like to look at cost and the relationship of cost to reimbursement. And so, in order to give you an example, I'm going to specifically talk today about spine and a little bit about how we identify cost savings opportunities, but we also map those costs, as you will see right here, understanding your true cost impact to your actual reimbursement and how we dive down into every DRG, how we look into the analysis by physician, by payer, and even by revenue code, and that's how we're able to uncover a tremendous amount of cost savings by looking at that whole continuum, that holistic view of what does an item cost and how does that cost map to actual reimbursement. So I just want to, for today's purposes, I want to talk today about the OR. The OR is your largest opportunity for profitability and revenue, but it's also your biggest driver of cost. And so, we're going to talk about spine implant cases, and specifically, these are DRGs 459, 460, 471, 472, 473. It's lumbar and cervical fusion cases. And those cases have the high-cost implants, the rods and the screws and the biologics that are used on those cases. So what's unique about our approach is that we'll look at your costs for your implants. So you may have numerous spine vendors, numerous biologic vendors, and different physicians utilizing different ways and different approaches. So we still will look at analyzing your costs by component, costs by biologic, and we'll benchmark that cost to national best practices, you know, based on, you know, your hospital of your size, your utilization, market share, we'll do all that same analysis. But the difference that we do it by healthcare is we also request additional information and we tie that information back to reimbursement. So what we like to get, and we want to make it very simple because sometimes when hospitals are looking at DRG analysis, they kind of get, you know, buried with all the information and it's very difficult to put all the information together and then present the data. And so we want to make things very simple. So what we ask for, what we look for for our data is claims data, actual billed data for your last 12 months of spend. So your last 12 months of cases, right, for these DRGs. And so when we get that information, we want the detailed revenue codes. And specifically what we're looking for in mapping the cases to cost are REV code 272s and REV code 278s. So REV code 278s are the actual implants and the REV code 272 are supply costs. And those two revenue codes, we want to understand the relationship of that, those costs to your actual reimbursement. So what I want to talk in more detail about is all profitability analysis starts with understanding your true costs, then mapping to actual reimbursement, connecting that to your systems, processes, item master, charge master, then to your managed care agreements. And that's how you uncover opportunities for cost improvement, for utilization improvement, and process improvement. So there's a lot to cover. And so I'm going to go through a little bit of a 30,000 foot view. But certainly after this video, I would love to have the opportunity to talk with you individually and really be able to customize our discussion based on your own needs. And for the purpose of this educational video, I just want to go from a 30,000 foot view and explain how we look at cost mapping to reimbursement and what some of our results have been. So as I was saying before, as we look at benchmarking your pricing, we also look at getting that build patient data or claims data. And so when we get the details, we're able then to understand a couple of things. We're able to understand what's it costing the hospital for, let's say, a lumbar pedicle screw case. And what are the costs? What are the actual reimbursement by payer? And are there other opportunities that are being missed? And I'll give you an example. From the claims data information, we're able to find out sometimes that there are items missing that aren't on the charge master or items not on the item master. And we're able to see on that claims data that there were a couple of components that should have been billed. What we're also able to see is, and many times, is if you've got managed care agreements, and sometimes there are carve-outs and carve-outs that have been updated, that those carve-outs haven't been maximized or optimized. And so there's ways that the hospital can derive more reimbursement. But because of the way the managed care agreement states those costs need to be reimbursed, they're a little bit out of the typical norm of just sending a bill in. They have to, an invoice has to be sent in or there's another process. But we always like to map these cases even to the managed care language so we understand what the reimbursement is. The other opportunity we see when we're digging down into the data and we're mapping cost to reimbursement, sometimes we see charity care cases. And so those charity care cases, while we're renegotiating new pricing for the implants, we're able to add charity care cases into the contract. But without seeing your reimbursement data, we can't add those cases or understand that kind of impact. And one additional item is because the charge capture process tends to be very manual in the OR, we're able to understand systems and processes. And those systems and processes, are there room for improvement? Are there ways to ensure charge capture? Are there ways to ensure that the rev codes are being billed the way they should be under the right revenue code? And so when we do our analysis, we're able to say, OK, that cost impact by reimbursement and driving it down to every single layer gives a different viewpoint. And we're able to make a presentation to say to the physicians, the clinical staff, and then to the vendors, this is where the price points need to be. Because our reimbursement and our own structure doesn't allow for these implants to be above this certain price point. The last item is really being able to say this is a whole continuum, right? Cost impact reimbursement. So it's very important as you're looking at cost reduction initiatives that you map to reimbursement because there's going to be other opportunities to maximize your reimbursement. So I just want to recap and go over some of the opportunities that we do find when we perform this kind of analysis. So we find cost savings opportunities from the benchmarking. We also find cost savings opportunities because we know that implant cost should be 30% or less of the total cost as compared to the reimbursement. So if implant costs are 30% more than the total cost of reimbursement, then we know there's opportunity. So we like to use that ratio. The third opportunity we uncover are issues with reimbursement, and those could vary too. Some of those implants are not on the, they weren't billed. There are issues with same-day cases, and so we're finding this quite a bit now where some of these spine cases are same-day procedures, and they're being billed or being reimbursed at a different or lower rate, and it's good for the hospital to be aware of those cases. We also find charity care cases that could be included in the new agreements with the vendor, and we're finding opportunities where the markup is wrong and the hospital markup is not, it wasn't performed right, the percentage wasn't right to the implants. And we're also finding opportunities that similar items were picked in charge capture but not the right item, and again, it doesn't reflect what was accurately used in the case. So when we look at this from a holistic perspective, your cost to reimbursement, there's so many opportunities that we uncover as opposed to just looking at a cost savings initiative from a pricing perspective. We're looking from this perspective as it comes all the way full circle to what the hospital actually gets paid. I hope you've enjoyed the video training that I just went through. As I said, it was a 30,000-foot view, but a different perspective on how we look at cost savings. I welcome you to reach out to me at lmiller at vihealthcare.com, and I would love to have a discussion about your cost savings initiatives and how VI can work with you. Thank you.