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Without Margin, How Sustainable is Mission?

To serve communities with emergency and service lines is only sustainable with profitable care. Margin provides for maintaining quality health systems, providers and staff. So, margin must be managed and defended. To do this requires looking at the right information, at the right time. What is the logical control point for gaining clarity and accountability across clinical and financial aspects of care? Hint: This vantage point for clarity is found in the point where clinical and financial data merge. Remember, the charge shows clinical information that spans diagnosis to procedure, inpatient or outpatient, and whether drugs, tests, surgery or other interventions were required. This makes the chargemaster the logical control point for gaining clarity and actionable information to manage across the clinical and financial aspects of care. The viewpoint from the chargemaster is the key to accountability for effective, profitable strategic management. Every hospital has a chargemaster (CDM) – whether it is actively managed or not. A well-managed chargemaster enables validation of clinical and financial information to ensure that it is current, correct and complete. This validation is important since an error submitted in a claim to a payor causes all kinds of additional headaches. These added burdens range from costly denials, to audit management and even legal battles about payment and compliance. Also, even across silos, collaboration and communication can happen readily around the process of ensuring that bills are correct by way of validating that information is current via the chargemaster. Why would a hospital not want to validate that their information is current, complete and accurate? Ensuring accuracy in procedural data is vital to both the quality drive and to correct billing for all services provided. The charge is central to this, and with bundled payment the charges become the basis for measuring cost-per-patient and cost-per-patient-type. To disperse payments to the range of providers in a risk-sharing organization, accurate charging is vital to be able to pinpoint each party’s portion of care. As the main source for the valuable procedural data with the checks and balances that an affordable healthcare system requires, the charge-level of procedural data is the best vantage point.  From this viewpoint, managers can ensure accuracy is maintained, understood, and analyzed – across the health system, and its disparate systems that include the electronic health record. This is vital in order that clinicians can make real improvements to quality of care and that healthcare may be sustainable in the highest and best form. What are your views on ensuring accuracy across diverse departments and in electronic records? We’d love to hear more from you. Read more in Brian Workinger’s article “Front-Line Perspectives on Price Transparency and Estimation” in the September issue of hfm. And, on the HFMA blog. Follow Brian on Twitter @RIJourney.