Rangely District Hospital in Rangely, Colorado, was struggling to show progress toward quality measures with limited reporting tools. It was at risk of missing out on revenue from Medicaid and Medicare.

THE PROBLEM

The hospital was losing valuable physician and staff time making up for missing functionality. It had inefficient and time-consuming processes for securing authorizations. And it was financially burdened with unexpected add-on costs.

“As a critical access hospital that primarily services Medicaid- and Medicare-eligible patients in rural Colorado, our financial health is strongly linked to performance on quality measures,” said Bernie Rice, chief compliance officer at Rangely District Hospital. “But our former IT services were making it harder, not easier, to report out on our performance, which put our ability to collect full payment in jeopardy.”

Clinicians and staff also were losing time fixing problems caused by lack of functionality, and EHR vendor Meditech’s business model was adding to the hospital’s financial stress, rather than reducing it, Rice said. Because of missing functionality, caregivers and staff were losing time; for example, payer rules were not automatically updated so staff had to read payer bulletins and manually update billing rules in the systems, he added.

“Rangely staff also had to manually change how dictionaries were built and update our chargemaster with the correct codes,” he explained. “This made it harder to ensure claims were submitted correctly the first time, report out on performance, or fulfill the large volume of audit requests we received.”

Further, contacting Meditech’s support teams created more problems as their tech support teams were very hard to work with and didn’t seem to be subject matter experts, Rice said. The hospital also faced additional financial stresses through add-on fees, including fees for updates, he added.

PROPOSAL

Rangely District Hospital turned to EHR vendor athenahealth to help with generating necessary reports, cleaning up the claims submission process, and lowering operational costs, with the ultimate aim of meeting state and federal quality requirements.

MARKETPLACE

There are a great many EHRs on the market today, each with varying degrees of functionality, including reporting abilities. EHR vendors include Allscripts, Cerner, eClinicalWorks, Epic, Greenway Health, Netsmart and NextGen Healthcare.

MEETING THE CHALLENGE

After implementing athenaOne for Hospitals and Health Systems, the hospital generated reports it needed, streamlined its claims submission process, reduced operational costs, all allowing staff to focus on things that mattered most, Rice said.

“We’ve already made progress toward meeting state and federal quality requirements,” Rice said. “The new services also helped us to efficiently prepare and submit claims, which contributed to a 53 percent increase in baseline cash collections.”

athenahealth’s Billings Rules Engine tracks changes to over 40 million payer rules and uses that information to identify errors before the hospital submits claims, Rice explained. Days in accounts receivable have gone down 15 percent.

“We’re eliminating costs and probably saving somewhere around $300,000 to $500,000 a year, and not spending a lot of time thinking about where we’re going to find $100,000 for the next interface,” Rice said.

The staff doesn’t have to dedicate large amounts of time to manually calling to get prior authorizations, Rice added. Those people, in turn, are a lot happier, he said.

RESULTS

In addition to the aforementioned benefits, easier reporting enables staff to respond quickly to audit requests from state, federal and other organizations, Rice said.

There has been a 53 percent increase in cash collections over baseline since go-live, a 15 percent decrease in days in accounts receivable, assistance from time-saving tools that automatically track changes to payer rules, authorization management services that free up staff to take on high-value work, and reduced operating costs with transparent pricing that includes upgrades and interfaces, Rice detailed.

ADVICE FOR OTHERS

“You have to look for more of a partnership opportunity,” Rice said, “rather than a vendor contract.”