In the integrated model, physician orders from the clinic or for outpatient services such as lab would draw on data from a master patient index, which includes insurance and demographic information. The system connects to payers, who in turn verify electronically if a given test is covered. "If it appears a test isn't covered, we can show the patient they may be responsible," Santangelo says. An all-electronic transaction would reduce the cost of the department offering the affected service, he adds. Processing orders that originate in paper requires rekeying. Ordering tests electronically "may add a little more cost to the practice but lowers the cost on the back-end and more importantly it reduces the chance of errors," he says. Currently many orders are billed without a preliminary diagnosis, a missing piece of information the integrated order entry/billing system would catch.
The first step is to deploy the orders system in the practices of the employed physicians. After that project, Susquehanna will bring on affiliated physician offices. The system, Santangelo says, will have to be user-friendly for the physicians and their staff. "The connection would be a great patient satisfier," he says. "Every time there is a mismatch between their condition and what the lab test is, it won't be paid. It is a great patient dis-satisfier. Payers tell the patient they have to get the diagnosis changed by their doctor to pay. It happens more than we want it to."
Santangelos's envisioned set-up would preclude problems down the line with payers. "Bills should be going to payers electronically, with electronic payment coming through, no manual touching-that is the way it is supposed to work. When you get a rejection from payers, somebody has to make phone calls and send e-mails. I can't lower the cost of billing if I'm chasing down rejections."
The CFO's other dream item is what he calls a "registration scorecard." The data analytics tool would assess the performance of his registration staff, offering insights into the accuracy of data being input and how much manual intervention is later required as the data feeds into the revenue cycle. Santangelo says a few bolt-on tools exist that might work, but he's unsure how well any of them would perform.
Name: Harry Greenspun, M.D.
Title: Senior Advisor Health Care Transformation and Technology
Organization: Deloitte Center for Health Solutions, Washington, D.C.
Wish List Item: Innovation, Insight
When the topic swings to innovative technology, Harry Greenspun brims with enthusiasm. "This is the most exciting time in health care in 30 years," he says. "There is an alignment of incentives, tremendous innovation and a lot of great thinking brought to the industry."
There's also a missing piece that Greenspun says would spur adoption. "CIOs need a clearer view into the innovation community," he says. "They are asked to provide mobile devices, telemedicine and consumer connectivity. There is a huge world of innovation they could tap into. But it's impossible to track what is available. It's difficult to vet a company [providing needed technology] and understand their viability. Do these companies offer a real product? Keeping tabs on that is very challenging and takes more time than CIOs have to spend."
Greenspun says member associations and other organizations in the industry could do a better job of facilitating vendor introductions and offering a way to assess products.
"The industry needs to ask CIOs: what issue are you trying to solve?"
Common Wish: Regulatory Stability
While CIOs have many particular needs for their operations, they share one overarching concern. They'd like better clarity, if not outright relief, from an ever-growing list of federal regulations governing their operations. A better sense of "regulatory certainty" is tops on the holiday list for Michael Krouse, senior vice president and CIO at Ohio Health, a 17-hospital delivery system based in Columbus. The regulations in play include ICD-10 (postponed to 2014), meaningful use (under fire from certain Republicans), and ACO payment models (reinforced in the federal health reform legislation). "We are working hard and fast and will try to be compliant with all the regulations," Krouse says. "But we would hate to find ourselves in a position after doing all that work that it doesn't matter anymore."
The ICD-10 deadline, which CMS once asserted was set in stone for 2013 deadline (then subsequently shifted to 2014), is a moving target for many CIOs-and some experts contend that the federal government has lost credibility on its pronouncements about the regulation as a result. Many CIOs looked at the most recent postponement of ICD-10 with a mixture of relief and dismay-relief in that a resource-draining project had been delayed, but dismay in trying to regroup yet another effort around compliance.
For Chuck Christian, CIO at Good Samaritan Hospital in Vincennes, Ind., ICD-10 and meaningful use Stage 2 are "on a collision course." Reporting deadlines for meaningful use and ICD-10's go-live converge in October 2014, a timeline which Christian says will be very challenging for smaller hospitals to fulfill. "The timing of the programs is like juggling running chainsaws," the CIO says, adding that Stage 2 ups the ante on quality reporting requirements. "I wish that we had done ICD-10 a long time ago and had it in place before meaningful use came about," he says.
Christian describes an industry in conflict over ICD-10. "There are competing agendas," he points out. "AHIMA [the American Health Information Management Association] says 'let's get it done,' while others say 'slow down, we're not ready.' The question is: who do you listen to?" Christian says that last summer's delay on ICD-10 helped his hospital, and he predicts Good Samaritan will be prepared on schedule. "Payers are the ones that will struggle," Christian says. "They have more customized systems." Thus, some claims may be rejected, or stalled, he says, echoing a common industry concern. "If you can't bill with the appropriate coding, or the coding is wrong, it will negatively impact reimbursement. Just because we can produce the transactions doesn't mean someone else can process and adjudicate them. We will need to be able to monitor and audit that. A lot of things are hanging in the balance."