SZO Oberwallis:
Intelligence Brief
Spitalzentrum Oberwallis — Brig & Visp
68,441 episodes · 2.3M billing events · CHF 33.2M · 2023–2024
February 2026
The Hospital at a Glance
Brig & Visp
70% outpatient / 30% inpatient — 47,587 ambulatory episodes · 20,839 stationary episodes
Two Sites, Two Economies
13,336 cases
Oncology: CHF 26.1M from one cost center.
High-value, low-volume. Drug pricing dominates.
55,105 cases
2.2× more rows at 1/9th the CHF.
High-volume ward consumables.
Brig = high-value oncology concentration · Visp = high-volume ward consumables
Nine Questions We Asked
- REVO Materials used but not billed?
- DUPL Same event billed twice?
- PHAN Billing for non-existent cases?
- STAL Catalogue out of date?
- COMA Costs on the wrong desk?
- COGA Controlled substances traceable?
- XILE Materials crossing sites untracked?
- GENO Overpaying for generics?
- IOIM More going in than coming out?
20 regular + 5 assessments
Revenue & Billing
Where money enters the system — and where it leaks out
Materials used but not billed
Duplicate and Phantom Billing
probe_duplicate_billing found 10,268 duplicates. probe_orphan_billing found 1,068 rows referencing non-existent cases. Same events often trigger both.
Why the Hypothesis Totals Don't Add Up
Gross sum across all hypotheses: ~CHF 376M. Real exposure is a fraction of that.
The probes identify overlapping symptoms of the same underlying issues.
The diagnosis system untangles which root causes drive which findings.
The 86% Pattern
This is DRG billing: ward consumables bundled into the case rate.
B-Onkologie: CHF 26.1M from One Cost Center
| Material | CHF |
|---|---|
| Keytruda (Pembrolizumab) | 4,350,000 |
| Darzalex (Daratumumab) | 1,800,000 |
| PRIVIGEN (Immunoglobulin) | 1,080,000 |
| Opdivo (Nivolumab) | 879,000 |
| Perjeta (Pertuzumab) | 668,000 |
| Ogivri (Trastuzumab) | 595,000 |
| Bavencio (Avelumab) | 557,000 |
| Imbruvica (Ibrutinib) | 557,000 |
CC 17405 (B-Onkologie ambulant) accounts for 79% of total hospital billing.
Oncology drug pricing dominates financial risk.
Revenue Cluster: What We Know
Stale case IDs persist in the billing system after case merges or cancellations. Delayed master data sync between clinical and billing systems.
The billing workflow gap diagnosis exists but did not trigger for SZO. Further investigation needed.
Catalogue & Pricing
Is the material master keeping up with reality?
963 Stale Articles, CHF 3.1M at Risk
| Material | CHF | Severity |
|---|---|---|
| Opdivo (Nivolumab) | 879,000 | high |
| Pelgraz (Pegfilgrastim) | 394,000 | high |
| Zejula (Niraparib) | 237,000 | medium |
| Ibrance (Palbociclib) | 220,000 | high |
| Imnovid 4mg (Pomalidomide) | 206,000 | high |
| Imnovid 3mg (Pomalidomide) | 118,000 | high |
Active billing against expired validity dates. Almost all oncology drugs.
The Price Gap
Below-Cost Billing
CHF 4.2M at risk
Materials sold below purchase price. PRIVIGEN (top-3 oncology drug) shows negative margin.
CHF 16.8M at risk
Billing amount lower than the hospital's own internal price list.
Combined: tens of thousands of events where the hospital sells below cost.
The Foundation
| Entity | Valid % | Invalid Rows | Impact |
|---|---|---|---|
| Cases | 100% | 0 | — |
| Materials | 73.7% | 17,250 | Zero-price cascade |
| Billing Events | 95.7% | ∼98K | Orphan material refs |
| Usage Events | 95.4% | ∼113K | Orphan material refs |
| Movements | 90.2% | ∼87K | Invalid locations |
| Suppliers | 100% | 0 | — |
| Article-Suppliers | 2.8% | ∼166K | Missing price/FK |
CHF 1.24M invisible to Gold-layer analytics.
Catalogue Cluster
Articles not reviewed or updated on schedule. Expired validity dates and missing standard prices accumulate over time.
Supplier agreements outdated for high-volume generics. Gap between procurement contracts and internal pricing not reconciled.
Structural & Operational
Cost centers, cross-site flows, and the I/O gap
Costs on the Wrong Desk
148 actual CC mismatches + 66,720 producteur mismatches.
Root cause: CC master data drift (data_quality, 85%) — CC assignments drifting after organisational restructuring.
Materials Crossing Sites Untracked
Root cause: Cross-site routing error (process_failure, 90% confidence — highest of all diagnoses).
Transfer orders not closed before billing.
The Hypothesis We Could Not Test
is_controlled_substance: 0% populated in OPALE export.is_generic: 0% populated. MIGEL codes: 0% populated.This hypothesis cannot be evaluated from current data.
Not disproven — untestable. Resolving this requires enriching the OPALE export or connecting to a reference database.
Two Supply Chains
TRANSFER
coeff ≈ 1.0
Direct
no transfer
transfer-only
Overall I/O coefficient: 0.47 — but this is not a single number. It's three populations.
Three Populations
The Actionable Gap
Both-present materials, min 100 transfers
| Segment | Materials | % | CHF Delta |
|---|---|---|---|
| Under-recorded (< 0.80) | 731 | 67.5% | 3,000,000 |
| Balanced (0.80 – 1.20) | 273 | 25.2% | 1,000,000 |
| Over-recorded (> 1.20) | 79 | 7.3% | 615,000 |
Total actionable delta: CHF 4.6M.
Root cause: Inventory process gap (process_failure, 85%) — disconnect between ward receipt and patient-level documentation.
The Full Picture
Verdicts, assessments, and what comes next
8 of 9 Confirmed
| Code | Hypothesis | Status | Findings | Score |
|---|---|---|---|---|
| REVO | Revenue leakage | Confirmed | 109,740 | 0.67 |
| DUPL | Duplicate billing | Confirmed | 77,005 | 0.67 |
| PHAN | Phantom cases | Confirmed | 78,073 | 1.00 |
| STAL | Stale catalogue | Confirmed | 10,397 | 1.00 |
| COMA | CC misallocation | Confirmed | 138,635 | 1.00 |
| XILE | Cross-site leakage | Confirmed | 138,487 | 1.00 |
| GENO | Overpriced generics | Confirmed | 22,043 | 1.00 |
| IOIM | I/O imbalance | Confirmed | 12,400 | 1.00 |
| COGA | Controlled substance gap | Not observed | 8,421 | 0.53 |
CHF values overlap — same events trigger multiple hypotheses.
Five Assessment Scorecards
1,922 medium
6,215 low
881 medium
7,436 low
2,302 medium
64,420 low
2,061 medium
5,880 low
6,661 medium
48,249 low
Six Root Causes
| # | Root Cause | Category | Conf. | Hypothesis |
|---|---|---|---|---|
| 1 | Cross-site routing error | process_failure | 90% | XILE |
| 2 | Catalogue maintenance lag | process_failure | 85% | STAL |
| 3 | Procurement pricing mismatch | structural | 85% | GENO |
| 4 | Orphan case data entry | data_quality | 85% | PHAN |
| 5 | CC master data drift | data_quality | 85% | COMA |
| 6 | Inventory process gap | process_failure | 85% | IOIM |
Six Things in 90 Days
- 1 Quarterly catalogue review — 963 stale oncology articles with expired validity. Procurement + Pharmacy.
- 2 CC master data reconciliation — 5-digit vs 4-digit mapping against current org chart. Finance, 1 week.
- 3 Top-20 negative margin materials — Cross-reference against supplier contracts. Procurement.
- 4 Billing interface audit — Check for duplicate transmission and orphan case IDs. IT.
- 5 Cross-site transfer workflow — Verify transfer orders close before billing. Logistics.
- 6 Ward scanning pilot — 5 high-value materials with I/O < 0.5 on one ward. Nursing + IT.
What We Need From You
- Controlled substance flags — is_controlled, is_generic, MIGEL codes. Enriched export or reference database.
- Procedure data — 0 rows in current export. Required for implant traceability and DRG analysis.
- Org chart — For cost center master data verification and restructuring timeline.
- Supplier contract terms — For negative-margin audit and procurement renegotiation.
The analytics pipeline is ready — the fields exist, they just need to be populated.
From Data
to Decisions
25 probes · 9 hypotheses · 5 assessments · 6 diagnoses
Every finding is traceable. Every number is queryable.
Every root cause has a recommendation.
nuMetrix — February 2026