Calvert Health, an 80-bed hospital in rural Maryland, required physician advisory services to enhance their utilization management process. The goal was to optimize regulatory compliance, clinical documentation, and revenue protection.
Challenge
Calvert Health, a small non-profit hospital, underwent significant change in a three-year period, including new processes, management, and staff. Through the changes, operational efficiencies and departmental initiatives fell to the wayside. The new leadership team escalated the needs of the department and through a departmental review by Harmony, we uncovered missed opportunities in their utilization management and documentation practices.
Hospital leadership understood the current documentation and undefined escalation process left them exposed to potential financial and legal issues. If not addressed, they could continue to miss significant monetary opportunities – vital to the financial health of a small hospital. They needed an outside, unbiased solution.
Solution
Calvert Health partnered with Harmony Healthcare for exploratory and consultative conversations about their current obstacles and desired state. Through these collaborative discussions, Harmony developed an in-depth understanding of the initiatives, challenges, and identification of departmental goals.
During the evaluation and analysis, Harmony met with the teams working behind the scenes. One physician was juggling an immense workload; he handled all escalated questions from the clinical and non-clinical staff, in addition to his typical patient workload and leading committees. Harmony tailored a customized solution for physician advisory services that included on demand peer-to-peer review, custom reference templates, and physician education.
Results
In partnership with Harmony, Calvert Health has improved policies and procedures and streamlined processes, allowing their team to focus on other initiatives. The single physician, previously handling all escalations, now spends that time treating patients and leading advisory committees. In the first months, Harmony’s team attained 58% peer-to-peer (P2P) overturn rate, equating to about $100,000 in revenue protection.
The success of the Physician Advisory Program has led to other engagements throughout the organization, including clinical documentation integrity support.
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