Healthcare Performance Metrics - A detailed Analysis

Introduction & Challenge Objective:

This project was done as part of the "Maven Hospital Challenge" and I was tasked with playing the role of an Analytics Consultant for Massachusetts General Hospital.

I’ve been asked to build a high-level KPI report for the executive team, based on a subset of patient records. The purpose of the report is to give stakeholders visibility into the hospital’s recent performance and answer a few key questions. The CEO has also asked to summarize any insights that can be derived from the data.

About the Dataset:

Synthetic data on ~1k patients of Massachussets General Hospital from 2011-2022, including information on patient demographics, insurance coverage, and medical encounters & procedures.

Point to note: We have data only until Feb 2022 and hence any decline in trend or serious assumptions for the year 2022 should not be made as it will give false results on comparison.

Tools Used:

Power BI

Data Preparation & Modelling:

The data was pretty much clean but it required little changes.

Data Analysis and Visualization:

Dashboard Designing - I went on to create 3 pages, one to display the KPI overview (also answering the very important questions) and the other 2 pages that shows the in-depth analysis.

Insights & Analysis:

KPIs:

Total Encounters - 28K

Total Patients - 974

Total Readmitted Patients - 769

Average Length of stay (In hours) - 7.25

Average Cost per Visit - $3.64K

Procedures covered by Insurance - 14K

Amount covered by Insurance - $31.1M

1. How Have Total Patients and Readmissions Changed Over the Years?

There has been a fluctuating trend in both total patients and readmissions. The admissions / readmissions peaked in 2014 and later stabilized. But there has been a rise around 2020 and 2021 (maybe the pandemic era).

2. How Many Procedures Are Covered by Insurance Annually?

The number of procedures covered by insurance peaked around**** 2014 and 2021 reflecting the total admissions as discussed earlier.

3. Which Encounter Classes Have the Most Insurance Coverage?

Ambulatory encounters receive the highest insurance coverage at 13 million dollars, followed by wellness and outpatient classes at 4 million dollars each. This indicates that ambulatory care is a significant part of the hospital's insured services.

4. What is the Average Length of Stay for Each Encounter Class?

Inpatient encounters have the longest average stay at 37 hours, significantly higher than other encounter classes. This can help the hospital focus on inpatient care management.

5. What is the Average Cost per Visit Each Year?

The average cost per visit shows considerable fluctuations, with peaks around 2012, 2015, 2017 and 2020, and also a notable decrease in 2021. This can reflect changes in treatment costs, operational efficiency, or patient care strategies.

6. Age and Gender Distribution of Patients

The majority of patients are aged 70+, with 542 patients in this age group. The gender distribution within this age group shows a higher number of females (285) compared to males (257). The age groups 41-50, 51-60, 61-70, and 31-40 have relatively fewer patients, with a nearly equal distribution.

7. Gender and Ethnicity Distribution of Patients

The gender distribution is almost equal, with 494 females (50.72%) and 480 males (49.28%). Ethnicity-wise, non-Hispanic patients form the majority with 783 patients (80.39%), while Hispanic patients account for 191 patients (19.61%).

8. What are the Most Common Patient Diagnoses?

The most common diagnosis is "Encounter for problem" (4.3K), followed by "Urgent care clinic" (3.6K), "Encounter for check-up" (3.0K). A significant portion of hospital visits is for general problems, urgent care, and check-ups.

9. What are the Most Common Procedures Performed?

The top procedures are "Assessment of health and social care" (4.6K), "Hospice care regimen" (4.1K), "Depression screening" (3.6K), "Depression screening using patient" (3.6K), and "Assessment of substance use" (2.9K). Mental health services, hospice care, and substance use assessments are among the most common procedures. This highlights the need for robust mental health services.

10. Which Procedures Have the Highest Costs?

The highest cost procedure is "Electrical cardioversion" ($36M), followed by "Auscultation of the fetal heart" ($6M), "Evaluation of uterine fundal height" ($6M), "Combined chemotherapy and radiation" ($5M), and "Colonoscopy" ($5M). So basically heart and cancer-related procedures cost more.

11. What are the Most Common Encounter Classes?

The most common encounter class is "Ambulatory" (12.5K), followed by "Outpatient" (6.3K), "Urgent care" (3.7K). The high number of ambulatory and outpatient encounters indicates a need for strong outpatient services and facilities.

12. What is the Average Time to Readmission Each Year?

The average time to readmission has shown significant fluctuation over the years with a sharp decline in 2014.

13. How Does the Length of Stay (LOS) Compare for Readmitted and Non-Readmitted Patients?

The consistently higher LOS for non-readmitted patients suggests these patients have more complex health issues or require more extensive care during their stay. The relatively stable and lower LOS for readmitted patients implies that readmissions are managed efficiently, possibly with effective follow-up care or quicker treatment protocols.

14. How Have Patient Numbers and Insurance Coverage Amounts Changed Over the Years?

Patient numbers and insurance coverage amounts have fluctuated over the years. Patient numbers peaked around 2014, while insurance coverage has been relatively stable with slight variations.

15. What is the Trend of Total Costs Over the Years?

Total costs peaked at 12M in 2014 and have generally remained high with minor fluctuations.

16. What Are the Common Reasons for Readmissions?

The most common reason for readmissions is "Encounter for problem" (3.6K), followed by "Urgent care clinic" (2.8K)

17. What is the Average Cost by Encounter Class?

Inpatient encounters have the highest average cost at $7.8K, followed by urgent care ($6.4K), and emergency ($4.6K). The high costs associated with inpatient and urgent care encounters highlight the need for efficient resource allocation and cost management strategies in these areas.

18. Which Payers Cover the Most Costs?

Medicare covers the highest costs at $19.2M, followed by Medicaid ($8.4M), Blue Cross ($2.0M), Dual Eligible ($2.0M), and other payers covering lesser amounts.

Recommendations:

Elderly Care: Focus on special care for elderly patients and the necessary resources as most of them are above 70 (Senior Citizens)

Ethnicity-basedTrain hospital staff in culturally competent care practices to better serve the diverse patient population. Ensuring language services for non-English speaking works better.

Focus on reducing Readmissions: Implement targeted strategies to address the common reasons for readmissions, such as enhancing follow-up care, and post-discharge support.

Enhancing mental health services, given the high frequency of mental health screenings and hospice care procedures.

Resource Allocation: Allocate resources effectively to support outpatient and ambulatory services, which handle the majority of encounters.

Cost Management: Analyze high-cost encounter classes (inpatient and urgent care) to identify areas for cost optimization. Consider strategies to manage resource utilization. Monitor and review high-cost procedures regularly to find cost-saving opportunities.

Enhance Insurance Processes: Ensure that the hospital's billing and reimbursement processes are efficient to maximize insurance coverage and reduce denied claims. Strengthen relationships with major payers like Medicare and Medicaid. (to negotiate better terms)

Conclusion:

This project was a great experience in terms of learning how to analyze the Hospital's performance and focussing on key points to show first and later show the in-depth analysis.