EHR Interoperability Key to Revenue Cycle Management Success

EHR interoperability is needed to bring together clinical and financial data for revenue cycle management success now and in a patient-centered future.

The EHR system has become a staple of healthcare. Nearly all hospitals and office-based physicians have adopted the paperless charting system as of 2017, according to the Office of the National Coordinator for Health Information Technology (ONC).

EHR systems are designed to support the provider’s efforts to deliver better care to patients, resulting in improved patient outcomes and lower costs. Yet, the systems have not lived up to their potential when it comes to the latter goal.

Over 60 percent of hospitals and health systems are not realizing optimal value from their EHR systems, a recent survey of over 100 chief financial officers and revenue cycle executives found. More financial executives believe the challenges of EHR adoption equal or outweigh the revenue cycle performance benefits.

Health data exchange and EHR interoperability still pose a challenge for provider organizations using the EHR system to improve patient outcomes while supporting the bottom line. In a recent survey, 49 percent of acute care providers and 31 percent of post-acute care providers reported having very little ability to access or share patient data electronically. One-third of health systems also still struggle with interoperability, an earlier survey from Center for Connected Medicine found.

“We're still in the early stages of interoperability with EHR,” says Kevin Lenahan, senior vice president and chief financial and administrative officer at Atlantic Health System. But that isn’t stopping the six-hospital system in New Jersey from leveraging its technology to improve revenue cycle management and ultimately, the patient experience.

Overcoming interoperability challenges

Creating one chart for each patient is a top priority for Atlantic Health System, which has 4,800 affiliated physicians across 11 counties in New Jersey.

“One chart on a patient is essential,” Lenahan emphasizes. “A couple of years ago, we had a woman who had had five different EMR charts because we were on five different systems at that time. Now that woman has one chart, and that helps the patient and our physicians. The more we are aligned on one system, the more accurate the information is going to be.”

Getting every care site on the same EHR system allowed providers to view the most up-to-date information on their patients and communicate with other providers across the system digitally, which resulted in better, more satisfying care delivery.

However, the benefits of one EHR chart per patient could have been easily offset by a fragmented and complex patient financial experience, Lenahan stresses.

“Morristown Medical Center, which is one of our six hospitals, is the number one hospital in New Jersey for the second year in a row according to U.S. News & World Report,” he elaborates. “Our Cardiology program is in the top 50 in the United States according to U.S. News and World Report, as is our Orthopedics program.. We have also been a Fortune 100 Best Place to Work for 11 years in a row. Those are a lot of accolades and all well-deserved. But we need to make sure we provide our patients a consistent experience from the time they schedule an appointment, to their visit, and finally, how they pay their bill.”

Atlantic is focusing on creating one experience by consolidating the number of vendors it uses for revenue cycle management. The health system, for example, is a long-time partner of Zotec Partners (Zotec), a company that has consistently innovated medical billing and revenue cycle management since 1998.

Through the partnership, Atlantic uses Zotec’s platform to standardize medical billing across the system. The platform also uses a feed from the EHR system to bring the experience full circle.

“We are using the same database on there and updating the two systems with that,” Lenahan explains.

With Zotec’s interoperable system, Atlantic is providing easier access to patients so they can schedule appointments, update their insurance, and understand and pay their medical bills. These improvements are helping the health system create a cohesive patient experience, which for Atlantic, is the key to revenue cycle management success.

Improving the patient experience

Revenue cycle management has relied on clean claims, timely reimbursement, denial rates, and other traditional key performance indicators. However, high-deductible health plans and greater patient financial responsibility are changing how leaders see effective revenue cycle management.

In 2017, patient financial responsibility accounted for 88 percent more of a hospital’s revenues compared to 2012, a TransUnion Healthcare analysis revealed. And that percentage is likely to increase as patient out-of-pocket costs continue to rise.

The key to revenue cycle management system is accounting for the financial experience, in addition to the clinical experience.

“If we keep our eye on that and continue to maintain great quality, the finances will follow,” Lenahan says.

Atlantic is drawing on data from all areas of its system to improve the financial experience in order to boost patient satisfaction with the overall encounter. For example, the health system is using machine learning to understand what their patients pay out-of-pocket under hundreds of different plans. Digital integration and transformation are also top priorities next year for the health system, which is convening stakeholders from across departments to improve the digital experience systemwide.

But making these transformations a reality hinges on the right partner who is willing to look beyond the current interoperability and data challenges, Lenahan stresses.

“We're seeking partners who can look to the future and are always trying to determine how we can make the total experience better,” he says.

For Atlantic, Zotec is one of those partners.

“We don't want that financial portion to interfere with the quality of the care a patient receives,” states David Law, chief client officer at Zotec. “We constantly are working together on innovation, and it really does help to have a partner on the other side of the table to have that common goal.”

Using a combination of technology and innovation with the right partner, patients are coming back to Atlantic. The health system not only improved the number of unique lives touched by their providers, but also the number of times the patients come in for services. These metrics reflect the valuable patient experience the health system is providing, as they help to boost the bottom line.