By Taylor Smith, VP Business Development
A recent conversation with a hospital IT leader underscored a shift many organizations are experiencing. The question was not whether inpatient optimization has value. The question was more strategic:
“Why should my team invest time and resources into implementing this now?”
Today’s IT leaders are balancing cybersecurity threats, EHR optimization, data governance, infrastructure modernization, and a growing portfolio of enterprise initiatives. Every project must demonstrate measurable value and alignment to organizational priorities.
Patient Status Accuracy Has Become a Real-Time Enterprise Risk
Hospitals are under increasing pressure to make accurate patient status determinations in real time, not retrospectively. Payer scrutiny is intensifying. Denial activity is rising. Margins remain constrained. The window to support medical necessity and defensible documentation is measured in hours, not days.
Even highly effective Utilization Review (UR) teams face structural limitations:
- Volumes fluctuate daily
- Staffing varies by shift and service line
- Nights, weekends, and holidays create unavoidable coverage gaps
- Manual workflows depend heavily on individual availability and experience
The outcome is not a reflection of effort or competence. It reflects the system design. Without consistent, real-time identification, opportunities are missed, and risk accumulates.
Financial and Operational Impact
When leaders evaluate inpatient statuses through a global lens, the implications become clear:
- A typical missed inpatient conversion represents approximately $6,500* in lost net revenue.
- *The 6,500 figure represents the average payment differential between Observation and Inpatient status, based on client claims data for 2025.
- Missing just one patient per day can equate to approximately $2.4M annually.
- **$6,500 x 365 = $2,372,500
- Late conversions materially increase denial exposure and downstream administrative burden.
- Manual processes create inconsistency even within strong teams.
This is not simply a revenue cycle challenge. It is an organizational risk management issue.
How Tech-Enabled Automation Changes the Equation
At Brundage Group, we view automation not as “another system,” but as an operational standard. Our tech-enabled approach to UM is designed to create consistency, visibility, and reliability across patient status workflows.
Certus Radar™, Brundage Group’s proprietary automation and utilization management solution, is purpose-built to continuously analyze clinical and operational data to identify inpatient-appropriate cases early in the stay. Rather than relying on manual chart review, Certus Radar functions as an always-on layer of intelligence across the organization.
Certus Radar consistently surfaces high-value cases in real time, allowing organizations to gain a level of operational reliability that manual processes cannot achieve alone. Opportunities are identified regardless of staffing levels, shift coverage, or timing.
A well-designed, tech-enabled approach enables:
- Consistent identification of high-impact cases
- Earlier intervention, while documentation remains clinically defensible
- Reduced dependency on perfect staffing conditions
- Operational coverage that effectively extends 365 days per year
This is not about replacing clinical expertise. It is about ensuring clinical expertise is applied to the right cases at the right time.
What We Observe After Implementation Is Often the Most Revealing
A common trend occurs after organizations deploy Certus Radar alongside external Physician Advisor support.
Across organizations, total inpatient upgrades often increase, even when overall conversion rates eventually normalize. The conclusion is straightforward: the opportunity existed all along. It was not surfaced consistently.
Technology does not just create opportunities. It provides visibility into what was previously hidden by workflow constraints and variability.
Benefits Extend Beyond Securing Earned Revenue
The value is not limited to financial performance.
By automating routine case identification, UR and clinical teams gain capacity to focus on:
- Strategic collaboration with physicians
- Stronger documentation integrity
- Improved discharge planning and throughput
- Reduced manual chart-mining and administrative burden
The downstream effect is improved operational performance, more substantial clinical alignment, and a more maintainable workload for highly skilled teams.
Strategic Implication for IT and Executive Leadership
This is not about asking IT to do more. It is about enabling IT to play a central role in protecting global performance.
Tech-enabled status determinations, powered by Certus Radar, support executive priorities:
- Securing earned revenue
- Reducing compliance and denial risk
- Strengthening clinical and operational alignment
- Creating consistency where variability currently introduces exposure
Brundage Group is physician-led, tech-enabled, and results-driven. We combine clinical expertise, advanced analytics, and proprietary technology to help hospitals strengthen performance without placing additional strain on already limited resources.
As organizations evaluate priorities, inpatient optimization is increasingly less a discretionary enhancement and more a foundational capability for sustainable performance.
Ready to reduce risk, strengthen patient status accuracy, and capture missed opportunities?
Learn how our tech-enabled solutions can support your organization’s priorities.
