RCM’s Role in EHR Interoperability Key to Health System Success

September 15, 2020

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. In fact, 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.

Many health systems across the nation are still in the early stages of interoperability with EHR. But that isn’t stopping healthcare organizations like Atlantic Health System (Atlantic), a six-hospital system in New Jersey, from leveraging its technology to improve revenue cycle management and ultimately, the patient experience.

Overcoming interoperability challenges

Atlantic is focusing on creating one experience by consolidating the number of vendors it uses for revenue cycle management. For example, the health system 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, essentially using the same database on there and updating the two systems with that.

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.

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, for instance, let’s say a patient has five different EMR charts because the organization was on five different systems at one time. With Zotec’s interoperable system, the patient can now have one chart, which helps the patient and the physicians. The more an organization is aligned on one system, the more accurate the information is going to be.

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

However, the benefits of one EHR chart per patient may not be as beneficial with a fragmented and complex patient financial experience in place. Making sure patients have a consistent experience from the time they schedule an appointment, to their visit, and how they pay their bill is also critical to an organization’s 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. Organizations that keep an eye on that and continue to maintain great quality will have finances that follow.

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.

Zotec Partners is one that looks to the future and always tries to determine the best way to make the total experience better, never allowing the financial portion to interfere with the quality of the care a patient receives. As healthcare organizations seek to partner with an RCM provider, it’s important that they work together on innovation and share common goals.

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.

By David J. Law, Chief Client Officer with Zotec Partners

Published in RevCycleIntelligence, August 2020