For hospital CFOs today, maintaining a semblance of financial health is one of the top priorities. Raising revenue and cutting costs are the two main weapons in their arsenal to stave off fiscal despair, and over the past several years — since the American Recovery and Reinvestment Act of 2009 — health information technology has added a new line of costs to battle.
Certainly, health IT measures such as electronic health records, computerized physician order entry, meaningful use and others aim to modernize a somewhat antiquated healthcare system. However, these technology costs need to be handled. Karen Farrell, director of healthcare solutions at Nuance Healthcare, gives three of the most pressing health IT issues hospital CFOs have on their minds today.
1. Volume and complexity of health IT regulatory requirements. Government regulations have been churning out rapidly over the past several years, and many are tying Medicare payments to a hospital's quality and patient care (for example, value-based purchasing, hospital readmissions, etc.). Health IT is no different.
Starting in 2015 and beyond, Medicare-eligible hospitals, critical-access hospitals and professionals that do not successfully demonstrate meaningful use of EHRs will have a "payment adjustment" in their Medicare reimbursements — in other words, they will be penalized.
Ms. Farrell says these regulations are pressuring hospital CFOs to do more with less in their budgets, and each one could have a significant financial impact on federal reimbursement. Despite the omnipresent monkey on the back, hospital CFOs need to keep these regulations — especially those involving meaningful use — at the forefront of their minds because their organization's cash flows literally depend on them, she says.
2. ICD-10. ICD-10 is a complex issue. It will heavily impact revenue and coding — Ms. Farrell says ICD-10 complications could siphon away millions of dollars in revenue per month — but it also involves a tremendous switch in technology systems. Finance and health IT departments are intertwined on many issues, but perhaps none more than ICD-10.
HHS and CMS have proposed delaying the compliance date of ICD-10 from Oct. 1, 2013, to Oct. 1, 2014 — an extra year for hospitals and health systems to train coders and physicians and to implement the necessary software and standard operating procedures. "Everyone we talked to has a wry smile [about the delay]," Ms. Farrell says. "Here we go again. For those already preparing, it's just a bonus. For those who haven't started, this is a wake-up call. You should definitely start your preparation now."
If hospitals still have not started preparing for ICD-10, and even for those who are under way, Ms. Farrell says CFOs need to have a plan of attack to set ICD-10 up in stages. Rome wasn't built in a day — and ICD-10 won't be either — but now is the time to start evaluating all options for immediate ICD-10 transition. "CFOs need to start to understand what the potential impacts of ICD-10 are going to be on the organization and develop relationships with physician leadership, health information management leadership and CIOs," Ms. Farrell says. "They need to know what technologies are out there that can help them deal with the productivity and reimbursement-related challenges that are a potential reality if this transition isn't handled with care."
3. Lost productivity and physician documentation. For physicians used to the old paper systems, EHRs, CPOE and other IT initiatives might seem like a burden, and consequently there is a longer learning curve as well as lost productivity.
Ms. Farrell says a cure to not lose that productivity and associated revenue is, ironically, additional technology. Clinical language understanding technologies, like computer-assisted physician documentation, can analyze narrative text and help physicians document a more specific patient chart. "These technologies can improve document quality by analyzing clinical documentation, and when necessary, automating prompts for additional required details," Ms. Farrell says. "Smart use of technology and respect for the physician's thought process and workflow will go a long way toward adoption rather than asking physicians to completely change the way they enter their documentation."
CAPD can also positively impact clinical documentation improvement and coding teams because it could catch a problem before it's an actual problem. "CDI staff will send emails or walk the floors and ask physicians questions directly about required details retrospectively," Ms. Farrell says. "It's tough for physicians to remember what they were thinking about, and often queries go unanswered." Instead, EHR programs coupled with CAPD can initiate queries to physicians as they are working, leading to enhanced coding clarification, better quality records and reimbursement that more appropriately reflects the level of care provided.
Certainly, health IT measures such as electronic health records, computerized physician order entry, meaningful use and others aim to modernize a somewhat antiquated healthcare system. However, these technology costs need to be handled. Karen Farrell, director of healthcare solutions at Nuance Healthcare, gives three of the most pressing health IT issues hospital CFOs have on their minds today.
1. Volume and complexity of health IT regulatory requirements. Government regulations have been churning out rapidly over the past several years, and many are tying Medicare payments to a hospital's quality and patient care (for example, value-based purchasing, hospital readmissions, etc.). Health IT is no different.
Starting in 2015 and beyond, Medicare-eligible hospitals, critical-access hospitals and professionals that do not successfully demonstrate meaningful use of EHRs will have a "payment adjustment" in their Medicare reimbursements — in other words, they will be penalized.
Ms. Farrell says these regulations are pressuring hospital CFOs to do more with less in their budgets, and each one could have a significant financial impact on federal reimbursement. Despite the omnipresent monkey on the back, hospital CFOs need to keep these regulations — especially those involving meaningful use — at the forefront of their minds because their organization's cash flows literally depend on them, she says.
2. ICD-10. ICD-10 is a complex issue. It will heavily impact revenue and coding — Ms. Farrell says ICD-10 complications could siphon away millions of dollars in revenue per month — but it also involves a tremendous switch in technology systems. Finance and health IT departments are intertwined on many issues, but perhaps none more than ICD-10.
HHS and CMS have proposed delaying the compliance date of ICD-10 from Oct. 1, 2013, to Oct. 1, 2014 — an extra year for hospitals and health systems to train coders and physicians and to implement the necessary software and standard operating procedures. "Everyone we talked to has a wry smile [about the delay]," Ms. Farrell says. "Here we go again. For those already preparing, it's just a bonus. For those who haven't started, this is a wake-up call. You should definitely start your preparation now."
If hospitals still have not started preparing for ICD-10, and even for those who are under way, Ms. Farrell says CFOs need to have a plan of attack to set ICD-10 up in stages. Rome wasn't built in a day — and ICD-10 won't be either — but now is the time to start evaluating all options for immediate ICD-10 transition. "CFOs need to start to understand what the potential impacts of ICD-10 are going to be on the organization and develop relationships with physician leadership, health information management leadership and CIOs," Ms. Farrell says. "They need to know what technologies are out there that can help them deal with the productivity and reimbursement-related challenges that are a potential reality if this transition isn't handled with care."
3. Lost productivity and physician documentation. For physicians used to the old paper systems, EHRs, CPOE and other IT initiatives might seem like a burden, and consequently there is a longer learning curve as well as lost productivity.
Ms. Farrell says a cure to not lose that productivity and associated revenue is, ironically, additional technology. Clinical language understanding technologies, like computer-assisted physician documentation, can analyze narrative text and help physicians document a more specific patient chart. "These technologies can improve document quality by analyzing clinical documentation, and when necessary, automating prompts for additional required details," Ms. Farrell says. "Smart use of technology and respect for the physician's thought process and workflow will go a long way toward adoption rather than asking physicians to completely change the way they enter their documentation."
CAPD can also positively impact clinical documentation improvement and coding teams because it could catch a problem before it's an actual problem. "CDI staff will send emails or walk the floors and ask physicians questions directly about required details retrospectively," Ms. Farrell says. "It's tough for physicians to remember what they were thinking about, and often queries go unanswered." Instead, EHR programs coupled with CAPD can initiate queries to physicians as they are working, leading to enhanced coding clarification, better quality records and reimbursement that more appropriately reflects the level of care provided.
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