Authors:
- Mendy Koscinski, MSHCA, RHIA, CPCS, CPMSM, CPHQ, CPHRM, Privilege Content Consultant, VerityStream
- Angela Beardsley, BSBA-IT, CPMSM, CPCS, Consultant, VerityStream
We cannot think of a profession that necessitates having individuals with the innate ability to make well-informed and correct decisions more than that of Healthcare. This especially relates to those working in the field of Medical Staff Services and even more specifically within the areas of Credentialing, Enrollment, Privileging, Peer Review/Professional Practice Evaluation, Regulatory and Accreditation compliance, Medical Staff Governance, Bylaws, Rules & Regulations and Policies & Procedures development, and MSO/CVO Department (Administrative/Executive) Leadership. For a Medical Services Professional (MSP), having excellent analytical skills is crucial to making these decisions, not only to protect patients, but to transform the overall delivery of healthcare by improving the provision of care, treatment, and services.
To understand what analytical skills are, we must first examine what analysis means. According to Merriam Webster, the definition of analysis is:
- a detailed examination of anything complex in order to understand its nature or to determine its essential features; a thorough study doing a careful analysis of the problem; a statement of such an examination
- separation of a whole into its component parts.
Therefore, analytical skills are the skills required to perform an analysis (as defined above).
Analytical skills can be categorized into the following five (5) major types:
- Research – ability to investigate and collect data to learn more about the problem to be solved.
- Creativity – ability to be able to think strategically and outside of the box, to spot trends in the data and use in problem-solving, in order to reach an effective solution.
- Critical Thinking – ability to evaluate/interpret and deduce/dissect the information/data to identify the most significant pieces, and then addressing those pieces in order to reach an effective solution.
- Data Analysis – ability to go beyond just reading and understanding the data and identifying/highlighting trends/patterns for stakeholders/decision makers.
- Communication – ability to effectively communicate results of the findings and recommendations/solution to the problem - includes being sensitive to the problem, knowing who your audience is (stakeholders/decision makers), and the most appropriate method of communication (e.g., verbal vs. written).
Recognizing all the various analytical skills within each category and being able to acknowledge areas of strength and opportunities for improvement is essential to being a successful MSP, regardless of current position or title.
Consider the MSP and the various business processes where strong analytical skills would be important.
Credentialing
During the credentialing process, the MSP collects information to verify/confirm a providers’ credentials (education/training, board certification, current experience, etc.). When the MSP receives these verifications, the use of the analytical skill of data analysis is necessary to go beyond just reading and understanding the information received on the verifications and identify if there are any red flags that may need to be researched further. For example, if a providers’ NPDB is returned with a report of a large settlement that the provider did not report on their application, the MSP needs to have the critical thinking skills to be able to recognize this and take action on it. This would include an appropriate analysis, research to obtain additional information from the provider, and finally communication of the issue to the applicable medical staff leaders in the appropriate manner, taking into consideration the sensitivity and confidentiality of the issue.
Enrollment
Provider Enrollment is defined as the process used to establish eligibility to submit claims for governmental payers (Medicare, State Medicaid) and contracted commercial payers which includes the office locations the provider provides services to patients (beneficiaries). Provider Enrollment leaders are charged and often challenged to realize revenue sooner for their organization as well as decrease provider enrollment timeframes.
We interviewed Cheryl Cisneros, BSN, CPCS, CPMSM, Consultant Advisor, VerityStream and expert in Provider Enrollment, to find out how analytical skills play an important part in Provider Enrollment processes. Cheryl provided an example of the following business case scenario to demonstrate analytical skills at work:
An Enrollment Leader has been informed by their CFO that their organization of 3,000 employed providers has $15.0 million of claims on hold attributed to enrollment with dates of service approaching payer contract timely filing requirements. Failure to resolve will result in the organization having to write off the claims which is lost revenue. This is but one example of a business case scenario our Enrollment Leaders of today are charged to solve, diving into their toolbox of analytical skills for a solution. So, without delay, the Leader works in an organized and timely fashion and launches the following action plan:
- Step One: Research the claims that have been denied determining the cause(s). Divide and conquer. Recruit enrollment subject matter expert team members to join in the discovery. Schedule daily huddle to communicate updates.
- Step Two: Complete a data analysis of the results to determine trends. As a leader you determine with the collected data that there are gaps in the initial non-delegated payer enrollments for commercial and Medicare. Utilize the data results to create your baseline metrics report created by the Enrollment Data Analyst – Claims on Hold by Payer by reason.
- Step Three: Create a plan to implement process improvements to eliminate gaps. Communicate and engage the enrollment team and billing services to solve for solution(s).
- Step Four: Implement improvements, continue to complete data analysis and communicate metrics monthly to enrollment team, billing services and leadership.
In this business case scenario, the Enrollment Leader successfully decreased the claims on hold to $500,000 in six (6) months and sustained for the entire year. The Enrollment Leader and the team members contributed to the solution as the leader optimized their analytical skills tools - research, creativity, critical thinking, data analysis and communication.
Privileging
During the Privileging process, a provider requests the patient care services and/or procedures they wish to perform. Along with their request for privileges, the provider must provide documentation of competency for the requested privileges and the MSP must also obtain the appropriate verifications. It's not just a matter of this supporting documentation being received by the MSO, but the MSP must also analyze the information received, to determine if the provider meets the training/experience and/or volume criteria or requirements for the privilege(s) requested. Prior to forwarding the privilege request to Physician Leaders for review/recommendation, the MSP must audit this information to determine if there is anything that needs to be flagged for the Physician Leaders to be made aware of, in regard to the provider possibly not meeting the privileging criteria and/or any adverse information that has been received.
The analytical skill of data analysis is critical for the MSP during the privileging process. The MSP must have the ability to go beyond just reading and understanding the information that was received; they must be able to identify and highlight any information that would be significant for the decision makers to be aware of. At times, the information that is received may require the use of the MSPs critical thinking skills and ability to perform the appropriate research. As an example, a verification may have been received in regard to a providers’ privileges at another hospital which indicates something like “all investigations regarding this provider have been closed” (as was in the case of Christopher Duntsch, aka “Dr. Death”). The MSP needs to have the appropriate critical thinking skills to interpret this to mean that at some point there was a significant issue that led to an investigation, and that this needs to be researched further before privileges are granted. This might include the MSP informing the appropriate Physician Leader(s) immediately, so that they can personally reach out to a Physician Leader at the hospital from which the verification was received, to ask some additional questions and try to obtain some additional information, before making a privileging recommendation.
Communication is another important analytical skill for the MSP to possess when it comes to the privileging process. The MSP must have the ability to effectively communicate the results of their data analysis to the decision makers; this includes knowing how to handle any sensitive information and also knowing what the most appropriate method of communication with the decision maker is. The communication method could vary across the different Physician Leaders that the MSP works with, so it is important for the MSP to develop good rapports with all of their Physician Leaders, so that they know what method of communication for is preferable for each.
Peer Review/Professional Practice Evaluation
As the gatekeepers of Patient Safety, many MSPs facilitate the Peer Review/Professional Practice Evaluation process, which involves activities that measure, evaluate, and help to improve the performance of providers within a health care organization. Many analytical skills come into play for MSPs when gathering and reviewing the data that contributes to a providers’ quality assessment process. The first analytical skill used by the MSP during this process is research. The MSP must do the research to know which performance indicators are meaningful and measurable for each specialty within their organization.
Next, the MSP must know the appropriate communication method for presenting the indicators to their Medical Staff leaders for review and approval. Once the indicators are approved and implemented and data is being collected on providers, the MSP must use the analytical skills of creativity, critical thinking, and data analysis to go beyond just reading and understanding the quality data, in order to determine if there are any fallouts/triggers (as compared to the providers’ peers or any other organizational targets) and/or trends/patterns that need to be flagged for their Medical Staff leaders/decision makers to review, possibly for further action such as a case review or focused review. Again, the MSP must be cognizant of the appropriate communication method for relaying this sensitive and confidential information to their Medical Staff leaders, so that it remains protected under the Peer Review process.
Regulatory and Accreditation Compliance, Medical Staff Governance, Bylaws, Rules & Regulations, and Policies & Procedures Development
In order to ensure and maintain compliance state and federal regulations, accreditation standards, medical staff bylaws, rules and regulations, and organizational policies and procedures, the MSP (especially one new to an organization) must first utilize the analytical skills of research, critical thinking, and data analysis. It is important for the MSP to perform ongoing research, be keenly aware of, and have an in-depth knowledge of the applicable regulations, standards, bylaws and rules and regulation provisions, and policies and procedures which govern the care, treatment, and services provided throughout the organization.
Once the MSP understands how the organization is structured (infrastructure), including executive, administrative, and medical staff leadership, clinical programs, departments, and other operational components, the skills of critical thinking and data analysis must be used to compare and crosswalk regulatory, accreditation and governance documents to identify any areas of non-compliance or misalignment with goals and objectives. When there are additions or revisions indicated, the MSP must be able to effectively communicate with organizational executive and medical staff leadership the findings and recommendations, including the relevant background information and the potential impacts on the organization.
MSO/CVO Department (Administrative/Executive) Leadership
MSPs in administrative or executive leadership positions are responsible for a multitude of high level organizational and operational functions that require the application of strong analytical skills.
- Developing and operating a department budget is complex and often involves collaboration with many stakeholders across a health care organization. The MSP must be knowledgeable of organizational goals, short-term and long-term objectives and targets, and the influence they will have on decisions that impact not only the department’s budget, but also the budgets of other departments. This is especially important if there is a shared contract for services, such as software/program components. For example, the MSO might be financially responsible for the Credentialing and Privileging component and the Quality Department financially responsible for the Professional Practice Evaluation component.
Critical thinking is often required to determine appropriate resource allocations of any contributing or collaborating departments, the resources necessary to support both current and future operations, including any new programs or services to be offered, and the potential for any capital expenditures. Researching and analyzing prior budget data, especially where performance is above and/or below projected targets, can provide an understanding of where opportunities exist and allows development of a more accurate forecast for the future. Additionally, these skills are necessary to perform ongoing and consistent monitoring of expenditures to identify variances and to develop effective mitigation strategies. - While the way we monitor and analyze staff performance and productivity within the MSO/CVO has evolved over the past eighteen months, due to the pandemic, the necessity to keep staff connected, engaged and motivated remains. In the modern workplace era where many MSPs are now working from home, the MSO/CVO leader must utilize analytical skills to ensure the department continues to function at a high level. Whether it is performing ongoing data analysis and research to optimize processes, the use of technology, or workflows, to using creativity and effective communication strategies to support and encourage team collaboration and well-being, applying the analytical skill of critical thinking to develop strategies and find innovative yet logical solutions to complex problems, especially in the remote workplace environment, is essential to keeping the department and the team aligned with operational and organizational goals and objectives.
It is important for the MSP to understand which types of analytical skills are imperative for the processes they facilitate and tasks they perform; and also, to know where their strengths and weaknesses are in regard to analytical skills. If you are unsure of where you stand in regard to analytical skills, there is a fun quiz we found, which can help you assesses overall how analytical you are: Quiz to determine overall how analytical you are
Also, consider the things the MSP can do to improve their analytical skills:
- Active Approaches:
- Work out Math Problems
- Play Brain Games
- Join a debate or reading club
- Passive Techniques:
- Increase your knowledge base
- Take time to think about things
- Expand your World view
- Search for connections
- Pay attention to detail
- Ask yourself questions about why things are the way they are
- Putting your analytical skills to work:
- Take on new responsibilities
- Challenge yourself with little things
- Instruct others on Analytical thinking
In conclusion, analytical skills are the traits and abilities that allow an individual to collect, investigate, organize, and analyze information; and to visualize, problem-solve, and make decisions. Using our analytical skills is the method by which we find solutions to various identified problems, investigate to determine relevant facts, find logical solutions, make concrete decisions, and deploy action plans. These solutions may be reached by straightforward, methodical approaches, or through more innovative techniques, but both ways require analytical skills.