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February 4 , 2008

Seeing Green — Streamlining the ROI Process Can Turn Headaches Into Revenue
By Kim M. Norton
For The Record
Vol. 20 No. 3 P. 10

Go inside three HIM departments that have realized the value of technology when it comes to fulfilling requests.

From the whirring of copy machines to the stacks of medical records waiting to be mailed, HIM managers are desperate for a better way to process release of information (ROI) requests. With electronic medical records (EMRs) becoming more prevalent and the Internet as commonplace as the water cooler, there is an advent of change sweeping through HIM departments across the country. ROI vendors—not copy services—are offering hospitals a more dynamic way of tackling their ROI process with the unexpected benefit of increased revenue.

Traditionally, the ROI process has been outsourced because of the administrative burden of sending out and tracking records, billing and collecting associated fees, and providing customer service. “It is unheard of to do it yourself. You won’t make any money, and the headaches it will create would far outweigh any revenue the department could potentially realize,” says Cecelia Owen, RHIA, manager of health information services and privacy officer at Halifax Regional Health System in South Boston, Va.

Although HIM departments handling the ROI process themselves may argue that they have better control over it, the administrative burden alone may be too much for one department. But vendors are revolutionizing ROI operations by sharing the processing functions and the responsibility of ensuring that the function is HIPAA compliant and customers are happy.

Here is a look at three hospitals of varying sizes that streamlined their ROI processes to such an extent that it affected the bottom line.

Henry Ford Health System
Detroit’s Henry Ford Health System has been a front runner in the race toward automation, having adopted the technology in the mid-1980s. “At [Henry Ford], we have system policies and procedures that have been in place for two decades, which have moved us into a paperless environment,” says Karen Schmidt, the organization’s director of medical record services and privacy and security information officer.

Because Henry Ford operates without paper records, Schmidt was distraught to walk into the HIM department and see staples strewn all over the floor, piles of reproduced paper records at every turn, and stacks of medical records waiting to be mailed. “I actually thought to myself, ‘Wait, we are a paperless institution and all I see is paper,’” she recalls. It was then that she realized there had to be a better way of handling ROI operations.

Henry Ford Hospital and Health Network, part of the hospital system, is mainly a closed medical staff, with the HIM department providing all medical record functions for the 900-bed hospital and its 1,000 physicians. The thought of bringing in other ROI systems to simplify the process seemed a daunting and unrealistic task. “I remembered MRO [an ROI vendor] from the San Diego AHIMA Convention. I was eager to hear what they could do for us, but I was not expecting much from the meeting I had agreed to. My expectations were so that I did not include others, such as the information technology staff, the other system HIM management staff, or the ROI supervisors in the initial meeting,” says Schmidt. Eventually, MRO was able to provide a turnkey operation to automate the HIM departments and eliminate the need for a copy service or reproducing paper.

Prior to signing on with MRO, the ROI process at Henry Ford involved the HIM staff locating the patient’s medical record on the EMR, printing it, and handing it to the copy service to distribute to requesters. “Not only were we printing the record for the copy service to send out, the copy service was also receiving full payment for the copies,” Schmidt says. “Although we received some reimbursement, it was hardly what we have come to expect with MRO.”

Henry Ford typically processes more than 60,000 requests for information per year. Previously, the HIM departments were averaging $5,000 reimbursement per month, producing approximately 2 million copies per year. Since automating the process, Henry Ford has purged its HIM departments of the copy machines and the copy service’s on-site staff. It has also increased its revenue to $30,000 per month while making zero copies. “What used to be a labor-intensive process both for our staff and the copy service has been erased,” says Erica Jordan, Henry Ford’s manager for record services.

Instead of printing off requests for medical records, the staff does everything electronically. “Once we identify the patient, we print off a label with the patient’s name and medical record number and electronically send the request over to MRO. From there, the HIM staff can identify the information, which is then sent quickly and directly from the EMR to MRO,” says Jordan. She adds that in addition to cutting down on copying, turnaround time and customer satisfaction have also improved.

“With our copy service, we were averaging seven to eight days, while with MRO we are realizing 4.5 days from the time the request is received to the time it is sent to the requester,” says Schmidt. As for customer service, MRO handles communication with the requester after receiving the initial request from Henry Ford. An acknowledgement of the request is immediately sent to the requester with a link to the MRO Web site, allowing customers to follow the request’s status. MRO is also able to work directly with third-party payers to allow auditors to view the medical records electronically in a safe and secure environment, according to Schmidt.

Overall, Henry Ford has been pleased with the benefits of the new system. “It is nice not to have to provide space and oversight for the vendor’s employees. The quality of support MRO provides is reassuring from a HIPAA and privacy standpoint in that their staff includes knowledgeable attorneys,” says Schmidt. She adds that the technology has standardized the process across the system and eliminated issues with duplicate requests, cut down on redundancies, improved customer service, and turned the HIM department into “somewhat of a revenue-generating one while proving to be painless and user friendly.”

Halifax Regional Health System
When Halifax Regional, a 192-bed, 100-physician hospital, upgraded its record system to include an EMR in early 2006, its ROI vendor became outdated. In looking to automate the ROI process, the health system had to take into account its large number of nonbillable ROI per year.

Halifax Regional processes approximately 3,000 ROI requests annually, with roughly 75% of those being nonbillable. With the remaining 25% still needing to be contracted out, Owen expected it to be easier with an EMR in place but not that it would also be a moneymaker.

“Our customer service has improved significantly, our turnaround time has improved, and we are actually generating revenue by using HealthPort [formerly known as Smart Document Solutions],” says Owen. The previous vendor charged Halifax Regional a monthly fee for use of a HIPAA log, but the EMR and HealthPort’s software have eliminated that cost. “While not a huge savings, every little bit helps,” Owen says.

In addition to making paper records obsolete, automating the ROI process allowed Halifax Regional to realize a $12,000 profit and eliminate on-site vendor employees, freeing up precious space. Another benefit is the improved account receivables in patient financial services (PFS). “PFS is now able to access records for nonbillable ROI requests to process claims and to respond to additional information requests from payers, which saves the HIM staff time in not having to process these requests for PFS, which ultimately expedites payment of these accounts,” says Owen.

“Overall, our experience has been very positive, and we would not do it any other way. In moving to an EMR, [Halifax Regional] saw the benefit in switching ROI vendors, and for us this particular model has made our department profitable,” Owen adds.

Medical University of South Carolina
Unlike Henry Ford and Halifax Regional, the Medical University of South Carolina Medical Center automated its ROI process while maintaining on-site personnel. Nevertheless, its agreement with Universata, a health information exchange company, has paid dividends through improved customer service, more knowledgeable employees, and updated technology.

With approximately 1,800 ROI processed per month, Susan Pletcher, RN, MPA, CHAM, director of health information and patient access services at the medical center, a 709-bed teaching hospital in Charleston, S.C., and her staff “were looking to become more electronic because we knew that the technology was there for improvement,” she explains. The previous vendor had three employees and a supervisor on site, and the turnaround times for requests were anywhere from 28 to 32 days, with a few reaching 60 to 90 days. “There were times when requests were urgent, and we needed to pull in our staff to accommodate the requests,” Pletcher says.

With the process automated, the turnaround time for requests is down to three days despite having the same number of on-site employees. “A lot of our success with Universata has come from their technology and their perspective on how ROI should be processed,” says Pletcher. With their previous vendor, the medical center’s staff would scan in patient records in an attempt to automate. However, when a request for records was received, they would have to print off the scanned record for it to be sent out in paper form by certified mail.

Now, the paper trail has been eliminated and the entire process is electronic. Pletcher says the new technology pays due diligence to patient privacy and HIPAA concerns. “It is a great relief to know that the work is being done in a timely and efficient manner that is costing us about the same,” she says.

Consider the Possibilities
Evidence suggests that HIM departments can break even or increase revenue by automating the ROI process. Although the HIM professionals interviewed for this article say there is a learning curve associated with the technology, it was not enough to deter them from recommending the move to automation.

They point out that it’s important not to be intimidated by the lack of an EMR or the size of your hospital. “You have to open your mind to change,” Jordan says. “You have to stretch just a little and consider that automation just might work for you and your department because it really works.”

— Kim M. Norton is a New Jersey-based freelance writer specializing in healthcare-related topics for various trade and consumer publications. She can be contacted at kim_norton1@hotmail.com.

ROI processing models
There are numerous release of information (ROI) vendors out there. The size of an organization and the number of ROI processed could dictate how one structures its request process, but there are options when it comes to streamlining, say experts.

Vendors can offer one model, several, or variations on all depending on a healthcare organization’s needs. Insiders say among the possibilities HIM managers can choose from are the following:

• the shared services model, a system that evenly divides responsibilities and profits between the provider and the vendor;

• the traditional model, in which for every billable image the vendor sends out, the hospital receives one free;

• the pure technology licensing model, a do-it-yourself plan in which the hospital pays for the technology and all expenses associated with sending out the ROI but keeps all ROI fees received; and

• the hybrid model, which can be any combination of the three.

According to industry experts, streamlining the ROI process doesn’t need be a headache. Cutting down on administrative burdens by contracting all or a portion of the responsibility or simply updating software can mean a significant difference in the bottom line. Hospital size need not be a concern either, as each vendor has a model that can and will work to streamline an antiquated processing system.