Prisma Health Recoups $12 Million in Lost Revenue

PRISMA Health and Versalus Health teamed up during one of the most challenging times to streamline Utilization Management, ensure compliance, and recoup lost revenue

Tackling these issues that most organizations postponed due to the pandemic was no easy feat and required thoughtful strategy with buy-in from the team. It was both the vision and “get it done” attitude of PRISMA Health’s EVP and CFO, Michael Burke, which launched a successful Utilization Management partnership with Versalus when resources were already thin and taking on new projects seemed an impossible task. Michael rallied his team and leadership with a steadfast commitment to seeing quick and measurable improvements.

What prompted PRISMA to update its Utilization Management program?

MICHAEL BURKE:  The most obvious and immediate need was to address the high number of patients in observation status for multiple nights. This number was alarmingly high. I saw the need to reduce the long observation rate and partnered with Versalus to enhance our existing program and establish new protocols consistent with CMS 2-Midnight Rule. Statusing patients appropriately was the first corrective action towards reducing inappropriate long observation and short inpatient stays. This resulted in enhanced compliance and improved cash flow.

“Versalus Health under-promised and over-delivered as it relates to my expectations regarding this project. The Versalus team continues to do that in spades through great teamwork and ensuring significant buy-in from our team to get the job done. ”
-Michael Burke, EVP and CFO Prisma Health

What improvements in efficiency, compliance, and revenue integrity were you expecting to see?

BURKE: Of course, the hope was to ensure appropriate admission status (reduce inappropriate long stay Sponsored Material observations and short stay inpatients) and make the process more efficient. The CMS 2-Midnight Rule has been confusing. Working with Versalus to educate staff and physicians and improve work processes helped us correct course quickly placing patients in the right hospital admission status.

Since the Versalus program is much more efficient than our previous process, we immediately saw a reduction in the time patients spent in observation status. Versalus Health under-promised and over-delivered as it relates to my expectations regarding this project. The Versalus team continues to do that in spades through great teamwork and ensuring significant buy-in from our team to get the job done.

How were you able to prioritize the initiation of this new program during a time when most were delaying initiatives due to pandemic-related issues?

BURKE: There is never a great time to institute a substantial change. Pre pandemic, we had planned for two large system implementations. Covid added significant stress on staff and resources, but we were committed to pushing forward with those initiatives and also revamping our Utilization Review program. The Covid-19 pandemic was a war, and we attacked it as such. The guys that hit the ground on D-Day did not stop because the cliffs were too high—they saw it as a challenge to overcome and went full force. That is the attitude we had. It was another test of will, but the PRISMA physicians, care givers, and leadership team kept a laser focus on operating our corporate service business as usual and hitting our targets for go live.

 

“The Versalus Health partnership resulted in our patients being placed in the correct status. Subsequently, we reduced inappropriate short inpatients stays, and inappropriate long observation stays which resulted in a positive financial impact of $12 Million in just over 4 months, so the program is working very well.”
-Michael Burke, EVP and CFO Prisma Health

 

What results did you achieve? What recommendations do you have for others considering a change?

BURKE: The Versalus Health partnership resulted in our patients being placed in the correct status. Subsequently, we reduced inappropriate short inpatients stays and inappropriate long observation stays which resulted in a positive financial impact of $12 Million in just over 4 months, so the program is working very well. The next step is expanding the approach to all payors.

Covid has been challenging to say the least. We saw the impact of the virus up close and personal. You learn from things like this. You can’t leave money on the table even during times of crisis. Pulling together and making it happen by focusing on the big picture is the only way to get there. Versalus Health is a great company. Facing this test was made a bit easier by partnering with them. I would also say if we could do this during the height of a pandemic, anyone can.

 

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