GHX has developed two new services to help providers improve charge capture on implantables
Implantable medical devices are expensive. So is failing to charge patients for them, or failing to take advantage of your hard-fought contract pricing. Healthcare providers are losing billions of dollars a year due to a lack of automation and process efficiency surrounding implantables, according to GHX. But the Louisville, Colo.-based company believes it has a solution.
Today’s process of acquiring implants is in need of improvement, says Derek Smith, GHX chief commercial officer. Too often, the sales rep in the OR hands the surgeon an implant, but the OR lacks the time or information resources to determine whether that implant is on contract. Furthermore, because the hospital’s information systems – for scheduling, OR, billing, etc. – fail to connect with each other, charges may not find their way to the chargemaster, or the wrong charge may appear. “There are times when a provider may not capture everything that is implanted in the patient,” says Smith. “When that happens, they miss the opportunity to bill for it.
“There’s a lot of discrepancy, which drives a significant amount of waste. Not to mention the labor related to tracking down that waste.”
Manufacturers feel the effects of inefficiencies as well. “They lack demand sensing or demand signals,” says Smith, meaning suppliers often lack a heads-up on what implant the surgeon needs, and when. Because of that, suppliers typically overstock their inventory; the sales rep is under increased stress on the day of the procedure, trying to anticipate what’s needed; and invoice inaccuracies may result.
Two new services from GHX – Case Xpert(sm) and Order Intelligence(sm) – are designed to help providers improve charge capture on implantables; increase their level of on-contract spending; decrease contract overpayment due to an increase in real-time pricing; access early-pay discounts; and reduce documentation errors, case-to-bill cycle time and time spent on dispute resolution. Vendors, meanwhile, can benefit from a reduced procedure-to-payment cycle; increased inventory turns and a reduction in wasted and expired products; and reduced logistics costs due to a visible demand signal.
Offered as a software-as-a-service application, Case Xpert is designed to capture and share data from case creation to product usage, while validating that the device is on contract. The result is more accurate billing, purchasing and inventory tracking, according to GHX. The system also provides the ability to transport orders for physician-preference items via the GHX Exchange, and automate the review and validation of the information on the order.
Its capabilities include:
- Case scheduling, designed to give early demand signals to manufacturers on caseload and requirements through the hospital’s existing scheduling system. A notification is routed to the manufacturer’s sales representative to alert them to cases and product needs.
- Case preparation, offering provider and manufacturer a single view into case information. (GHX says Case Xpert partitions information so it can be viewed only by those who are authorized to do so.) As the procedure date approaches, providers can view the information that manufacturer sales representatives have entered to help ensure items are correct. The item selection is synchronized with data from the vendor catalog and the item master.
- Usage capture and documentation, which allows the provider to scan the item and have it recorded in the provider’s system and visible to the manufacturer’s sales representative. Case Xpert stores data and communicates it to the provider’s materials management information system and billing systems once it’s been approved.
Order Intelligence, meanwhile, takes information from Case Xpert and enables providers to process consigned orders, route those orders to manufacturers and sales reps, and park incomplete orders for management and further data review.
At the recent GHX Healthcare Supply Chain Summit in Las Vegas, the company demonstrated in an operating room setup how Case Xpert and Order Intelligence works. Days or weeks prior to the procedure, the hospital notifies the vendor what implant will be needed. On the day of surgery, the rep brings in the implant and scans it; the circulating nurse does the same. The system ensures that everything matches – lot, serial number, expiration date, contract status, etc. As the procedure unfolds, the circulating nurse and vendor corroborate what has been implanted and what has not. When the procedure is finished, that information flows to the hospital’s billing system.
GHX believes that it can be the conduit between manufacturer and provider to facilitate the efficient utilization of physician-preference items, says Smith. “We make sure we’re connecting [manufacturer and provider], and creating visibility to both parties.”
The problem: Providers lose billions of dollars each year due to a lack of efficiency in tracking implantables through their system.
How it impacts providers: The OR may lack the time or resources to determine whether an implant they are using is on contract. Or there is a failure to properly connect the hospital’s information systems, such as scheduling and billing, with each other.
How it impacts manufacturers: Inefficient tracking means suppliers lack demand signals. They could overstock inventory and put increased stress on the sales rep in anticipating what’s needed and when.