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Avoiding Financial Losses After EMR Implementation

Posted on April 3, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

While hospitals buy EMRs to improve their operations – both clinically and financially – too often they take a hit before they work out the kinks in their installation.  In fact, healthcare institutions often end up losing up to 5 percent of their gross revenue after EMRs are implemented, according to consultant Erick McKesson.

One typical story comes from Maine Medical Center, which found that patient charges weren’t appearing after its $150 million Epic installation in 2012. These billing errors were one of the reasons the medical center posted a $13.4 million loss in the first six months after the installation, hospital executives reported.

But according to McKesson, managing consultant with Navigant, it’s possible to overcome these problems. In an article for Becker’s Hospital Review, he tells the story of a group of health systems which worked together to avoid such losses. The group worked together to identify the most valuable software features that flagged mischarges or reporting errors. They then identified the five charge program “edits” which had the largest financial impact.

Areas the cooperating health systems considered the most important included:

* Administrative codes

The health systems noted that incorrect administrative codes lead to lagging revenue. That’s particularly the case when there are different codes for the same procedure. Hospitals need to be sure that clinicians use the higher code if appropriate, which can be helped by the right technological fixes.

* Anesthesia

It’s important to monitor your charges when there are two distinct aspects of a single procedure that are charged separately, particularly with anesthesia services. If your audit system flags the absence of the added codes, it can recapture a substantial level of missing revenue.

* CT

Seeing to it that radiology charges are automatically reviewed can ensure that appropriate levels of revenue are generated. For example, in the case of CT exams, it’s important to see that charges are assessed for both the exam and if needed, the use of a contrast agent.

* Emergency Department

It’s not unusual for ED physicians to undercode high-acuity patients. But it’s important to address this issue, as undercoding can result in significant financial consequences.  Not only that, in addition to generating financial losses, undercoding can create problems with performance-based reimbursement contracts. If patients are depicted as less acute than they actually are, payors may expect better outcomes than the patients are likely to have. And that can lead to lower revenue or even significant financial penalties.

* Infusions

Auditing infusion charges can be very helpful in capturing added revenues, given that they are one of the most frequent charges in healthcare. Infusion codes are very complex, including the need to track start and stop times, difficult rules regarding what charges are appropriate during infusions and issues related to “carve out periods.” Auditing systems can help clinicians comply with requirements, including simple-to-create functions which automatically flag missing stop times.

As readers will doubtless know, getting competing health systems to engage in “coopetition” can be tough, even if it helps them improve their operations. But given the need to combat post-EMR lags in revenue, maybe more of them will risk it in the future.

Thoughts On Hospital Telecommunications Infrastructure

Posted on August 31, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Given the prevalence of broadband telecom networks in place today, hospital IT leaders may feel secure – that their networks can handle whatever demands are thrown at them. But given the progress of new health IT initiatives and data use, they still might face bandwidth problems. And as healthcare technical architect Lanny Hart notes in a piece for SearchHealthIT, the networks need to accommodate new security demands as well.

These days, he notes healthcare networks must carry not only more-established data and voice data, but also growing volumes of EMR traffic. Not only that, hospital IT execs need to plan for connected device traffic and patient/visitor access to Wi-Fi, along with protecting the network from increasingly sophisticated data thieves hungry for health data.

So what’s a healthcare CIO to do when thinking about building out hospital telecommunications infrastructure?  Here’s some of Hart’s suggestions:

  • When building your network, keep cybersecurity at the top of your priorities, whether you handle it at the network layer or on applications layered over the network.
  • Use an efficient network topology. At most, create a hub-and-spoke design rather than a daisy chain of linked sub-networks and switches.
  • Avoid establishing a single point of failure for networks. Use two separate runs of fiber or cable from the network’s edge switches to ensure redundancy and increase uptime.
  • Use virtual local area networks for PACS and for separate hospital departments.
  • Segment access to your virtual networks – including your guest Wi-Fi service – allowing only authorized users to access individual networks.
  • Build as much wireless network connectivity into new hospital construction, and blend wireless and wired networks when you upgrade networks in older buildings.
  • When planning network infrastructure, bear in mind that hospital networks can’t be completely wireless yet, because big hardware devices like CT scans and MRIs can’t run off of wireless connections.
  • Bigger hospitals that use real-time location services should factor that traffic in when planning network capacity.

In addition to all of these considerations, I’d argue that hospital network planners need to keep a close eye on changes in network usage that affect where demand is going. For example, consider the ongoing shift from desktop computers to mobile devices use of cellular networks have on network bandwidth requirements.

If physicians and other clinical staffers are using cell connections to roam, they’re probably transferring large files and perhaps using video as well. (Of course, their video use is likely to increase as telemedicine rollouts move ahead.)

If you’re paying for those connections, why not evaluate whether there’s ways you could save by extending Internet connectivity? After all, closing gaps in your wireless network could both improve your clinicians’ mobile experience and help you understand how they work. It never hurts to know where the data is headed!