Providing access to information is the key to streamlining business office operations. Because they broaden access, document imaging, data marts, EDI and Web-enabled applications are winning a back-office following.
The Team Health division of MedPartners is a large hospital-based physician practice management company that provides 2,200 staff physicians to more than 260 hospitals and 55 radiology clinics.
Team Health bills for approximately six million patient encounters per year. It needed a better way to identify past due accounts, generate reports, access data to support managed care contract negotiations, and analyze contract reimbursement proposals.
Their technology solution: a data mart.
Meanwhile, administrators at Washington Hospital Center, an urban, 900-bed center with more than 400,000 outpatient and 40,000 inpatient visits a year, generated huge amounts of paper in its patient financial services operation. With increased complexity of billing, government regulations and managed care growth, the department couldn't keep up.
Their technology solution: imaging and workflow business management software.
For others, Web-enabled applications or electronic data interchange (EDI) are the solutions.
But the trait shared by today's most popular business office solutions -- and those projected to become popular in the near future -- is that they help provide easier, broader access to information.
Business office trends
Three trends are emerging as health care organizations seek to improve their business office operations with information technology, says Linus Diedling, vice president operations effectiveness, First Consulting Group, Tampa, Fla.:
* The billing function isn't just a back office, after-the-encounter issue. It has moved up front to a point early in the process as the decision is made to render service.
* Jobs are becoming less specialized and much more multi-skilled. Personnel no longer handle just billing, registration or scheduling, but instead are access care specialists or intake customer service representatives.
* Large entities are consolidating billing offices to gain greater efficiencies and streamline productivity.
All have implications for technology, according to Diedling.
A number of enabling technologies can be employed in the business office to help streamline operations, adds Ron Jones, vice president of southwestern region, First Consulting Group, Irving, Texas.
'The common denominator in all these technologies is they provide a way for an organization to collect, store and manage its information,' he says.
One technology Jones believes is at the forefront of streamlining business office operations is document imaging.
'Document imaging has the ability to revolutionize the way the patient accounting process operates,' he explains. 'It assists in billing and collecting in a more timely and accurate fashion. And, it helps increase customer satisfaction levels because of immediate access to information.'
Whether document imaging or another solution, technology will make or break health care, says Ed Bereski, senior vice president in charge of SmartLink Division, QuadraMed, Wyomissing, Pa.
'Currently, health care doesn't have the tools in place to manage information,' Bereski says. 'And the problem has gotten worse over the years as the amount of data needed to produce a claim, post it and analyze it has gone up exponentially. It used to be that you would need 65 data elements to collect a bill. Now you need 400-to-500 or more.
'Health care needs to play catch up when it comes to technology because we're about five years behind corporate America. Once we get beyond Y2K issues, much more emphasis will be placed on buying the tools needed to access and use information intelligently,' he continues. 'These tools, potentially, can save a facility millions of dollars.
'With Y2K issues at the forefront, health care organizations need to make sure they keep their current business processes going in the right direction,' Bereski adds. 'People are so panicked over Y2K, they're going to go bankrupt in the process. But, they'll have a great system in place. Simply put, they need to have money coming in the door. They need to turn their huge amounts of data into business intelligence. Until an organization has the technology in place, they won't be able to effectively compete.'
Despite Y2K and other obstacles, some health care organizations have found and are implementing solutions that are having a positive impact on their business office operations. Here are three examples.
St. Joseph Hospital: eliminating paper, automating manual work
As part of a proactive plan to head off increasing demands in its business office, St. Joseph Hospital -- a 121-year-old, 468-bed acute care hospital located in Lexington, Ky. -- decided to eliminate paper and automate manual processes.
'We were looking for a way to get out from under the mountain of paper that was threatening to consume us,' says Gary Ermers, CFO, St. Joseph Hospital.
The manual processes were very paper intensive and time consuming, according to Ermers.
This was a result of trying to reconcile remittances from insurance companies into proper patient accounts for posting, regeneration of UB92s and the work involved with pulling it up on paper, making corrections and refiling, not to mention the follow up work involved with resubmitting for collection.
'We wanted a system that would put information right at our fingertips,' says Ermers. 'We wanted to be able to answer questions from patients and insurance companies immediately and edit and resubmit bills online. Optical imaging seemed to be the answer.'
The hospital ultimately implemented a ChartMaxx Enterprise-wide Patient Record System from MedPlus. They are using Chart-Maxx to automate the billing process and as a document repository for patient financial records.
The system includes a feature that inputs all insurance and demographical information into the system during the registration process so it is immediately accessible to all users.
After conducting a needs assessment and deciding what they wanted out of the system, they contacted vendors and did an RFP.
The committee, made up of the CIO out of corporate headquarters, and staff from the business office and IS, narrowed their choices down to two. After site visits and meeting with key people, St. Joseph's chose MedPlus.
Simultaneous to installing the ChartMaxx solution, St. Joseph's was also converting its hospital information system to HBOC.
'Getting information from the mainframe into the imaging system was a bear, says Ermers. 'We had 20 years of customization to our mainframe which made it more complex to go through the interface engine. MedPlus worked it out and met our needs.'
The new system has saved St. Joseph's an incredible amount of time and money, says Dorothy Zimmerman, director of the hospital's business office.
'It provides us with immediate access to information so we don't have to take the time to look for it. This has allowed us to work with our increased patient load without adding to our staff of 52.1 FTEs. In fact, we're getting along with two less FTEs,' she says.
'We've actually absorbed the growth,' agrees Ermers, 'without adding more staff. In fact, staffing has been under budget for the last two years which has resulted in savings of approximately $100,000.'
He adds that with the new system in place, 'We've been more productive, even without a full staff to complement it.'
When a patient comes into St. Joseph Hospital, all the pertinent ADT information is scanned into the system and a record is created on the mainframe so authorized personnel have immediate access to it online. The record is then sent over an interface to the system and a file is created.
'Now, if a patient or insurance company calls, we can answer the question immediately. So we're better able to handle customer service issues,' says Zimmerman. 'And, if a change needs to be made to a UB92 form, we can make it and send out a new bill promptly. Our elderly mainframe could not do that.'
The learning curve on the new system was not long, according to Zimmerman.
'Formal training only took one and a half hours,' she says. 'After that, on-the-job training made us proficient.'
'The business office isn't always a fun place to work because you're always fighting for your money,' says Zimmerman. 'So, getting people excited about new technology makes for a much nicer place to work. My employees are happier now, which makes a lot of difference.'
'I am extremely satisfied with the immediate access to information the system provides. It has helped increase the productivity of the billing staff and the satisfaction of patients and insurance companies,' says Ermers. 'And I'm happy because expenses are coming in below what we budgeted and we can attribute that partially to the MedPlus system.'
Team Health: A data mart helps track A/R, reporting and analysis
The Team Health division of MedPartners is one of the nation's largest hospital-based physician practice management companies.
Headquartered in Knoxville, Tenn. and Fort Lauderdale, Fla., the company contracts with 260 hospitals and 55 radiology clinics across the country to provide staffing and management. Approximately 2,200 physicians work under Team Health contracts.
Although they bill for approximately six million patient encounters per year, they also faced challenges with identification of past due accounts; report generation; accessing data to support managed care contract negotiations; and, analysis of contract reimbursement proposals.
Team Health chose QuadraMed's SmartLink Data Mart solution to handle reporting needs that its IDX legacy system cannot handle.
It cost about $75,000 for hardware, software and licenses to bring up Team Health's billing operations centers in Plantation, Fla. and Akron, Ohio. Two other centers, in Pleasanton, Calif. and Knoxville, Tenn., will go live next year.
Information in the database is updated weekly through an electronic download from the host system.
The data mart houses all billing information, charges, CPT codes, ICD-9 codes, patient demographics, insurance and payment information. It provides quicker access to information than queries sent to the legacy system and allows for more activity on the server than is available on the host system.
Identifying individual accounts was difficult with the legacy system; some receivables could fall through the cracks, according to Randy Aguiar, senior vice president of systems integration and accounts receivable management, Team Health, Plantation, Fla.
'With six million or so records on the system, it's a real bear to do sorts,' he says.
There also were problems running account queries directly on the host information system.
'It could take up to an hour to identify lost dollars,' says Aguiar.
With the new data mart, $5,000 still active from June 1997 can be identified and a report generated in five minutes. 'We have picked up a lot of time,' he says.
Likewise, the old system presented several obstacles to generating color, graphical reports for executives, based on CPT, ICD-9 codes, and other clinical data contained in the billing system, as well as reports to support accounts receivable and management.
Reports pulled from the legacy system would take hours of formatting. The process would have to be repeated for each report for each facility. It took days to run the volume of reports requested.
Yet another challenge was capturing data to support managed care contract negotiations and analyze contract reimbursement proposals.
'We need information such as which CPT codes are used most often in different departments for different insurance companies, so we know what the implications will be,' says Aguiar. What might take us one to two hours with the legacy system can now be done in less than 10 minutes.
But the biggest benefit of the system, according to Aguiar, is that it has made hard dollars easier to collect.
'Outstanding A/R days have been decreased by three to four,' he says. 'Years ago you threw claims against the wall and 80 percent would stick and 20 percent required follow up. Today 10 percent stick and 90 percent don't pay and require follow up. It's definitely a different ball game today,' Aguiar continues.
He says that the SmartLink data mart helps because it is easy to use and delivers information quickly and in a format that he can use.
'And, we've only tapped about 40-to-60 percent of its capability,' he says. 'So the future looks even brighter.'
Washington Hospital Center: trading paper for digital images
'In this age of electronics, we were still in the mode of huge amounts of paper,' says Cecilia Moore, assistant vice president of patient financial services, Washington Hospital Center, Washington, D.C.
'The complexity of billing, with increasing government regulations and managed care growth, was really affecting my department,' she says. 'We could no longer deal with all the paper we needed to keep up with. We were less than productive and it was costing me a lot of money to manage the paper and the process.'
Moore says she tried microfiche as an alternative to paper records, but keeping up with it was a monumental task.
She says she knew there had to be a better way. It turned out to be a partnership with Vredenburg. The company had not worked with health care organizations, but did have experience doing imaging with the Pentagon. Moore was confident they could handle the paper processing demands of a large organization.
Washington Hospital Center, a 900-bed urban center with more than 400,000 outpatient and 40,000 inpatient visits a year, implemented Vredenburg's Electronic Business Office (EBO) solution to help solve the problems.
EBO is an imaging and workflow business management software solution, tailored specifically to address health care needs. Vredenburg used the HighView software development environment -- HighView Pro -- to build the inpatient module of the Washington Hospital Center's EBO.
'We started with admissions,' says Moore. 'When a patient is admitted all the pertinent documents, including insurance cards, photo identification, admissions referrals and insurance verifications forms, are captured and stored electronically. Because of government requirements, we still keep paper documents. But we hope a time will come soon when we'll eliminate paper completely.'
Using HL-7 compliant structures implemented with an Oracle relational database, patient information is organized by episode of care. This lets personnel retrieve documents according to date, name, social security number, payment source or service date.
Additionally, responding to requests from payors and insurance companies is more efficient because accurate information about each episode of care is already organized and stored in the system. And, requests can be handled on the same day they come in, lowering the number of days it takes the hospital to receive payment.
'Immediate access to this information has improved productivity tremendously,' says Moore. 'Before my staff would have to go to a file room to find the information and that alone might take a day depending on how well it was filed. Because we can now access the information real time I was able to reduce my staff by three.'
Washington Hospital Center recently finished implementing the remittance/explanation of benefits module, the second piece of the EBO. It will enable them to define whether they were paid appropriately or if they are owed additional money, Moore says.
'Before we had to order information from the file rooms so we could bill secondary insurance companies. This was extremely unproductive and costly. And, often times, we would lose our secondary payments because we weren't timely or couldn't find the information. We just couldn't handle the volume of information needed.'
Washington Hospital Center expects to implement EBO outpatient and correspondence modules.
The approximate cost of Vredenburg's EBO entry package, with a 15-seat license, integration and set up, a year's maintenance and underlying third-party software is $150,000, not including hardware.
'My staff is really excited because of the ease of this system,' says Moore. 'And we've realized tremendous savings, though not documented yet, because of the reduction in microfiche costs, productivity improvements, increased customer satisfaction and improving collections substantially.'
RELATED ARTICLE: The business office of the future: in search of the EDI 'Holy Grail,' Web technologies and the universal desktop
The experts agree: Technology is the answer to streamlining operations. Beyond the current technologies being used, there are others that have definite promise as we move into the next century.
'Electronic data interchange (EDI) is kind of like the Holy Grail,' says Ron Jones, vice president of southwestern region, First Consulting Group, Irving, Texas. 'Ultimately, with EDI there would be little need for document imaging in the business office. Many vendors have EDI solutions. The problem is there is no standardization, and that is what we need. Once we get there, we'll have everything we need. But I don't see that happening. If it did, that would be like solving world peace.'
'We're seeing more carriers mandating that information be communicated electronically,' says Jon Blake, patient accounts specialist, MedPlus, Inc., Mobile, Ala. 'This is good for the hospital because, if their EDI system can handle it, they can receive initial and secondary payments much more quickly. The problem, once again, is standardization.'
Web technologies is another area that is causing some excitement in the health care arena.
'Web access will be a common way to view documents in the near future,' says Taylor Walsh, healthcare business area manager, Vredenburg, Reston, Va. 'There is still a gigantic privacy/security issue in the world, but we'll make inroads gradually as these issues become less of a concern.
'The entire health care enterprise is one large-externet,' Walsh continues. 'With Web technologies, we'll all be able to share information which will have implications in all areas of the health care enterprise.'
To add another level of efficiency, Walsh sees barcoding becoming more prevalent, also.
'Barcoding will make indexing a lot easier because the system will automatically read the form and put it into the correct folder, without human intervention.'
Roger Allison, president of The Pathway Group, Vienna, Va., thinks the universal desktop or stepping stone technologies will be the solutions we'll be seeing in the near future.
'Access to information is really the issue,' Allison says. 'As health care organizations convert to enterprise-wide systems and computerized patient records, the universal desktop gives a common look and feel at the front end of legacy systems, so quick access to information is available.'
SystemSource, Ridgeland, Miss., offers a universal desktop technology. 'Our product ties disparate systems together so information can be easily' accessed. They have one common look and feel, regardless of what system is being used,' says Jeff Lamb, president, SystemSource.
'It is similar to a Web browser in that it can be accessed from anywhere in the world. And it's written in Java so it is compliant with lots of platforms.
We're also addressing the ability to have a single sign on to view whatever information is needed,' he continues. 'This would give the business office the ability to access all kinds of information from different systems.'
Kris Straub is an Atlanta writer specializing in technology issues.
