Readers Write 11/19/08

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IT Projects Resulting in Savings (for $25,000 or Less)
By Southeast CIO

These are based on my personal (15 years) experience in hospital IT. Some of these may be a little dated.

Medicaid Eligibility Double Check Before Aged Receivables Go to Bad Debt Agency
Annual Savings: $50,000

Hospital sometimes help patients apply for Medicaid, usually after the patient receives treatment. The patient is usually placed into some type of Medicaid-applied status. When the application is approved or denied, the status is changed. Sometimes all that works and sometimes it does not. We created a batch process that identified any self pay/indigent patient/guarantor ready for bad debt and applied that information against the Medicaid Eligibility source/TPA. Even in these HIPAA-friendly days, a second check will find an organization money.

Resigned/Terminated Employee Automatic Dis-enrollment from Benefit Plans
Annual Savings: $20,000

The base HR package didn’t automatically term benefits. HR had to dis-enroll employees manually from programs. Sometimes that would not happen in a timely manner or a step was missed. The option is to either buy an expense add-on module or script the series of key strokes. Scripting can resolve this problem, eliminating part of an FTE and saving benefit dollars.

Intranet Application That Assigns Registrars To Patients/Rooms, Reduces Overtime
Annual Savings: $15,000

Some hospitals provide bedside registration, especially for maternity wards. Registrars were constantly on the phone or going back to the main office for their next assignment. We created a basic application for the Intranet that could be updated showing next assignment. Registrars could access that from their mobile laptops on carts and indicate when done. Overtime went down, registration productivity went up. We also used instant messaging for these employees (policy was no IM at that organization).

Fax Server to Retain Surgical Case Documents Faxed To/From Physician Offices
Annual Savings: $50,000

Faxing with MDs office always has its challenges. On occasion, surgical cases are delayed, increasing overtime and frustrating many involved. A fax server that retains inbound and outbound faxes eliminates a lot of headaches.

Microsoft License Discounts for Educational Organizations – Teaching Hospitals
Annual Savings: $12,000

Microsoft provides discounts for educational organizations. A 400-bed hospital usually provides some type of education to residents, etc. Even if it is on a small scale, it will sometimes help qualify.

Reduction in Hospital Bill (claim) Hold from 5 to 4 days
Annual Savings: $35,000

Most HIS systems are set to hold charges for X days after patient discharge. The point is to enable all charges to be entered, scrubbed, then dropped on a claim. When most HIS systems go in, to be careful, bill holds are sometimes set high. With good charging processes and focus, you can reduce these days. Interest earned on one day of charges billed and paid one day earlier adds up.

Small Revenue-Enhancing Projects: The Rule of the Year for 2009-2010
By AgedObserver

You’ve preached for a long time that our industry, in many cases, has adopted technology for the sake of technology, without examining the fundamental reasons of “why” and “what benefit” (CPOE is the best example). There have been countless multi-million dollar projects in the last 10 years where the end result has been average technology, combined with poor execution, resulting in lousy adoption and no demonstrable ROI. 

Instead of accelerating the entity, the attempted technology has slowed the organization’s progress, and in the hindsight of today’s economic environment, has placed provider organizations at risk because hundreds of millions of dollars poorly invested has escaped from their bank accounts.

Jim Collins identified some key aspects of how leading organizations use technology as an accelerator, thereby “avoiding fads and bandwagons yet becoming pioneers in the application of carefully selected technologies.”  Clayton Christensen talks about innovation needs, not for the sake of innovation, but to move the business forward in a steady, directed fashion.

In today’s environment, where capital for large technology projects is very scarce, it’s important that every project be aimed at providing additional revenue to the organization for work already being done, i.e., if you’re leaving money on the table because you don’t have the right technology (square peg/round hole or one-size-fits-all) and you can get a vendor to guarantee financial improvement, you have a winning solution. Large projects don’t work today because the manpower and up-front costs lead to extended (if any) return on investment for the purchaser.  

Small, focused, revenue-enhancing projects should be (my prediction is they will be) the rule-of-the-year for 2009/2010. The tie between the clinical activities and revenue is obvious, but so many technologies put a 10-foot wall between the two, or try to solve only one part of the two sided-puzzle, and hence don’t resolve true issues and put more money into provider’s hands.

The Future of Primary Care
By TornMD

The NEJM just had a roundtable on saving primary care, with big names in the field talking about the usual things: medical home, changing reimbursement, etc. Personally, I don’t see how anything but a drastic increase in salary will attract people to the field. I’m also not sure those are the people you want as your doctor.

Even though most EMR systems are targeted to internists, more technology is not going to change the everyday workings of a primary care provider. I did an informatics fellowship, so I’ve never practiced more than three sessions per week, always in an academic setting (with two sessions of supervising residents). Though I’ve found my patient care sessions very rewarding, there’s no way I could have managed a full week of it. Primary care is just not that intellectually satisfying.

As our department chair told us when I was finishing residency (2001), there’s no future in primary care. PAs and NPs can handle 95% of the cases we see (as evidenced by the excellent PAs I work with in our walk-in clinic). I often feel that dealing with lower back pain, URIs, and diabetes management is a waste of an MD.

The reward I get from primary care is probably what most people in private practice find the most frustrating. Being in an academic setting without productivity constraints, I have (a lot of ) time to spend with patients. The whole medical home concept — case management, explaining lab results, dealing with specialists — is a lot of what I do (especially since I speak Spanish and may be one of the only providers who can talk to patients without a translator). It’s also a lot of what patients appreciate. I often feel much more like a psychologist than a doctor; however, I don’t need an MD to do what the patients appreciate most –  listen.

There will always (I hope) be people who go into medicine because of the rewards of patient interaction, but the current system makes that less and less viable. Because of the lack of intellectual challenge in primary care, I believe the only way to attract the “best” is to couple it with research or teaching and to work where patients really need you. I was miserable during my private practice sessions when I saw well-insured patients for yearly checkups, STDs, or blackberry thumb. When I see Medicaid, non-English speaking patients for diabetes control or atypical chest pain, however, I feel that I’m actually contributing and fulfilling my role as a physician. Unfortunately, a Medicaid-focused private practice is not really financially sustainable.