Plugging Revenue Leakage in Hospital Services using AI

Outpatient Services

Although majority of a hospital’s revenue comes from patient-admissions, the OP department acts as a funnel into In-Patient services. OP Services typically offer a range of diagnostic and imaging services to the patients, apart from in-house pharmacy in some cases.

45% of prescriptions have investigations advised on them with an average of 3.6 tests per prescription. A large 250-bedded hospital can have potential revenue of as much as INR 6 Million (60 Lakhs) in a month in the investigations prescribed.

The patient is generally free to get the investigation done at the hospital or somewhere outside. The “leakage” happens when the patient chooses to go out.

Identifying the Tests Advised

When it comes to identifying and estimating the potential revenue, the hurdles are quite amusing! Most of the doctors write prescriptions by hand – and the tests advised to individuals are simply not known to the hospital! Even if the prescription is scanned for records, it is a non-trivial task to automatically identify tests prescribed on it.

On the other extreme hand, there are a handful of doctors and hospitals that use electronic-entry for prescriptions. Here the problem is that of too much data! The hospital may know who needs what kind of services but the sheer volume of data may be too much for CRM and sales team to handle. Not every patient needs to be persuaded with a phone call or an attractive offer. A prioritized list of target-audience can drive operational (and cost) efficiencies while plugging the revenue leak.

AI to the Rescue

Given the variety of possible ways that prescriptions may be generated or captured, we have developed independent but compatible suite of AI based systems that address this problem and quite a few more.

Our digitization bot identifies diagnostic tests and investigations prescribed on paper-prescriptions. The leakage-analysis bot collates prescription data against OP services billing data to identify trends in leakage based on demographic factors such as age, gender, location, medical-specialty, doctor, etc. Finally, a ranking algorithm creates a prioritized list of customers on the CRM dashboard that can give the maximum ROI for CRM contact. Going a step further, our system can even predict out-of-pocket expenses for a patient – given his/her demographic and the doctor that he/she has come to visit!

The hospital also gets a condensed and actionable view of revenue-leakage. This helps them address the relevant operational or outreach issues. Because the whole dashboard is online, it is possible to track improvements in near real-time.