The Query: Insights on Breakthrough Government Performance

Business Intelligence Helps Reform the Healthcare Industry

In the last decade, our use of technology to analyze massive amounts of data has improved dramatically through the use of business intelligence (BI). With BI, it is possible to do many things that couldn’t have been done with analytical tools a decade ago. For example, in the healthcare industry, BI can be and has been used to give healthcare executives and lawmakers insight into how to decrease healthcare debt, to prevent disease, and to decode the human genome in a week, rather than in the previous time frame of ten years (The Economist, Data, Data Everywhere“).

Recently, a new investigative series used business intelligence to put pressure on a hospital system that has been aggressively billing Medicaid for numerous rare medical conditions.  Steven Doig, a precision journalist working for California Watch, a project of the Center for Investigative Reporting, wrote over 120 SAS programs that analyzed 51 million patient records. With these programs, Doig noticed a pattern with a California-based hospital chain. The hospital was routinely billing Medicare for rare medical conditions to boost its bottom line. For example, states an article from MediaBistro, “out of 468 cases of “autonomic nerve disorder” reported in California in 2010, 360 were reported by Prime Hospitals — 90 times more often than the average hospital. The reason? Medicare reimbursement for “autonomic nerve disorder” is $5,500 more than the reimbursement for what is more commonly catalogued as a “fainting spell”.

“This kind of evidence would be impossible to gather from a warehouse full of file drawers filled with millions of pieces of paper; finding the telltale patterns in a mountain of documents is beyond the human attention span. But in this age of electronic public records, seasoned reporters who know how to use powerful computer tools can see not only the trees, but the whole forest. As an investigative reporter, it’s wonderful to use such tools to uncover problems that otherwise might remain hidden. But as a taxpayer, I often wish government agencies would be doing the same kind of analysis.” said Doig.

Click here to read more fascinating facts about healthcare BI and Doid’s work.

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