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This is part two of the last podcast about why it is so hard to do analytics in healthcare finance. In the previous podcast, we talked about why more analytics isn’t done. Maybe, there are some other factors like culture in the business or the IT systems like practice management systems and billing systems. However, what we focused on in the last one was that there’s no alternative. If you want to get data, you can’t get it from the insurance companies. After all, they don’t want to give it to you because they know you’re going to use it against them. The only other place you can go to is the clearinghouses, and they’re a complete disaster.

Data is the business

Now, what doesn’t make any sense to me is that data is their fundamental business. I mean, they’re nothing but a hub-and-spoke business where they get data from insurance companies, they get data from providers, they send it on and forward it on to insurance companies, and they do all this in a structured data format. Even if they can’t output data tables, reports, and things like that, they sure as heck should be able to output the source files because they’re just handing off the package. 

Please give us the packages! Give us copies! I mean, it isn’t like they have to remake them. These aren’t physical objects. Just give us the 835 that you already have!

I’m going to relay some of the information about a harrowing experience with a recent clearinghouse. We referenced this a little bit in the last one. The client is a billing company. Further, the system is eClinicalWorks. We can’t get the denial information or all the transaction information we want out of eClinicalWorks because their reporting isn’t capable of doing that. So the only real option is to go to the clearinghouse. 

We went to a clearinghouse and said, “We want 835s. We don’t need 837s. Also, we don’t need charges, all that kind of stuff. We want 835s.” The short version is, they said, “Okay, go to the portal.” We’d already gone to the portal. We tried this. Go to the portal, download them. So we went, we tried, failed. It didn’t work.

The next part

Take two. We went back on another day, got on with their tech support, and had them try to walk us through step-by-step exactly how to get these out of the portal. The first thing they suggested was to go in and pull up a list of them, which we did. The first thing to note, they cap it at 100. So you cannot get more than 100 ERAs at a time. This is a considerable practice. What we want is tens of thousands, hundreds of thousands of ERAs. But we’re capped at 100 in a shot.

Forgetting even that for a second, let’s get the 100 and see if it works. So they took us through the steps. We went through to sort of like a payment section. Then, there was a list of all of these remittances, and we tried to check 100 of them and get them downloaded. That failed. We said, “Okay, let’s just try 10 and just see if we can get 10.” That failed. They told us to print them. We were listening to their tech support and doing what they were telling us to do. They said, “Print them.”

We can handle XML. We can handle all kinds of different data structures. It doesn’t even matter what it is as long as we can get them out of the system more than one at a time. Again, we can even do RPA to do this kind of stuff, but we’d instead get them in bulk rather than build something for this individual client.

Print, what?

They told us to print. In the back of my mind, I was thinking, “Yeah, this is not going to be successful.” But okay, we were supposed to print. The printing didn’t work. They said, “Go into the individual remittance,” and we said, “Well, we don’t want to print an individual remittance. We want all 100.” And they said, “Well, no, no, no! The 100 you selected will stay selected. So when you hit “Print,” you’ll get all of them.” 

So we went into the individual remittance. We tried to print. No, it said there was nothing selected. Not only not just the one, but nothing was decided. So we didn’t get a 100. We didn’t even get one. They determined that trying to print it was a failure. That didn’t work.

Back to square one

They decided to go back to the downloading option. We navigated back out to the list of remittances. Again, there are 100 of them, but we only selected 10 to see if we could get something. Once we reach 10, then we can go for 100. So they tried to suggest downloading again. We hit “Download.” It kind of went through some steps. It turned a little bit in the background, and eventually, it said success. Great! Fantastic! Success! 

We got 10 ERAs, but we didn’t see them. It didn’t pop up in the window. It didn’t download them to a local file location. Remember, we were in a browser in the portal, so it should prompt where you can download these two. But it didn’t. It said “Complete.” Like, complete to where? Where did they go? We checked the download folder on a local system. Nope, they were not downloaded there. Okay, so we asked them, “Where did they go?” And they said they didn’t know. We were thinking, “Well, isn’t this your system? Shouldn’t you know where they went?” And they said, “Hold on! We’ll get back to you.”

The cycle continues

They put us on hold, went away for like 10 or 15 minutes, came back, and said, “Okay, they went to the billing system.” And we were like, “Wait, wait, wait! What do you mean?” And they said, “Yeah, well, we sent them to eClinicalWorks.” And we said, “Well, no, no, no, no. eClinicalWorks already has them.” And they said, “Well, you should get them out of eClinicalWorks.” We said, “No, no, no, no. I don’t think you understand. 

Remember the conversation we had a half-hour ago, which was, we’re talking to you because eClinicalWorks cannot provide us the data that we want. We want to get the raw system files. We want to get the 835s, and that’s why we’re talking to you.” And they said, “Oh, okay.” And I was thinking, “Didn’t we talk about this, like a little while ago? Wasn’t this the entire purpose of the conversation?” But it seemed like to them this was a new concept. So they said, “Oh, okay! Well, hold on.” They went away, 15 minutes. More technical support. They said, “We’re going to escalate.”

Prioritizing the right issues

They went in to escalate. They came back, they said, “Okay,” and they had us do something again. We downloaded them again. The same thing happened. They repeated the same thing where they said, “Okay, well, they’ve got sent over to eClinicalWorks.” I said, “Yes, I know that. They’re already being sent to eClinicalWorks. That happened before we ever started this conversation. It also happened yesterday and the day before. 

They’re constantly being sent over to eClinicalWorks. We want them ourselves.” And I explained all again, “We’re trying to do data warehousing and analytics for this billing company. We need the data pulled out, so we can run all of it because you can’t analyze it in eClinicalWorks.” And they said, “Ah, okay. Okay, great! Hold on! We’ll escalate technical support.”

They put me on hold, and went away again. Another 15 minutes. They put us on hold because there was more than one on the call. They went away for 10 or 15 minutes, came back, and said, “Okay, they’re being sent to eClinicalWorks.” And I thought, “Oh, my God! It’s like Groundhog Day. Wait, what? But we want them.” And they said, “Yeah, but you can’t download them.” We said, “Okay, but you have them, right?” “Yes, but we sent them to eClinicalWorks.” “Great, but you still have them somewhere. Can’t we get those?” 

Now we were an hour into this tech phone support. We were having the same conversation that we’ve had several other times in that same call, in the same call.

Oh, I just saw a coyote. Beautiful! Okay, squirrel. There was a coyote across the road. I’ve got windshield time. I’m in the mountains in California. Okay.

Seeking answers

They said, “We don’t know if we can get them because they’re being sent to eClinicalWorks.” I said, “Yes, we know that. We established that a few times already in the course of this conversation. We want them.” And they said, “Okay, well, we’re going to have to escalate the tech support.” And I was tearing my hair out, going facepalm, “Oh, didn’t you say that? Wasn’t that the last thing that you did? I mean, what was technical support doing for the last 15 minutes in this last shot that I was on hold? What were they doing?” 

And I didn’t get a good answer. And eventually, they came back and said, “We’ll get back to you.” And I said, “Okay, well, are you going to call us back: this afternoon or tomorrow? When will we get an answer to how we get these files?” And the answer was, “If you don’t hear from us in a week, contact us back.”

What’s the point of this story?

Why am I sharing all of this? First of all, our system is so screwed up. It is so hard to get the raw data to be able to analyze that. Why? Well, even if you have an organization that wants to do analysis, even if you have the right resources internally or even if you have the desire, the goal, the culture to be a data-driven organization, God save you from actually being able to get the data ever to be able to accomplish your goals. Holy moly! I mean, it is incredible to me. I don’t understand how these folks function. I mean, the clearinghouses, the IT systems, the practice management systems, the billing systems. It’s astounding to me. It is mind-boggling. I don’t get it.

It also means that there’s an opportunity. We are figuring all of this out. If you want your data, if you want it out, and you want to have answers, we will make sure there’s a way to do that. That’s our mission. Moreover, this shouldn’t be that hard. Everybody should have access to their data. Maybe, some laws support this. I know HIPAA and other things like that are supposed to be reinforcing these kinds of things. But the reality is, it isn’t true. 

Final thought

Nobody has access to all of the data. We’re going to figure all of this out from every clearinghouse. And from every IT system. Also, from everything so that you can answer all of these questions without spending hundreds of thousands of dollars or millions of dollars on a massive IT implementation. This, I think, is another reason why it is so hard in our industry to do analytics, but we will solve it.