Rural hospitals are an integral part of our nation’s healthcare infrastructure, providing critical services – from primary to long-term care – for nearly 57 million Americans. Recent years have presented countless challenges for rural hospitals. Factors such as rising cost of care, increased competition, lower reimbursement rates, unbalanced payer populations, reduced patient volume, uncompensated care, increasing labor costs and increased regulation have constricted operating margins for rural hospitals.
These challenges require hospitals to focus on efficiency to survive. While most savings initiatives focus on revenue cycle and care partnerships, our experience working with hospitals has uncovered innovative approaches to reducing the administrative load of Health Information Management (HIM) departments. The following are five ideas rural hospitals should consider to reduce their Information Management expense.
Don’t keep physical records longer than required. Many rural hospitals keep physical records for too long because of the way they are organized. For example, medical charts are commonly stored alphabetically or by medical record number. Mixing records of varying retention extends the amount of time a given record set is stored. Generally, organizations don't have a file level inventory of the records they have, making it hard to find records when they are needed and almost impossible to keep up with retention. The complexity of retention laws makes the problem worse, as the risk of making a mistake is very high, so most HIM teams choose indefinite storage as a default retention period. Upfront discovery enables you to keep the most useful information and offload older records that are already eligible for destruction, lowering management cost, reducing risk, and improving compliance. Additionally, employee productivity is boosted, as maintaining legacy records systems often requires additional staff to support paper-driven processes. Optimizing retention can also help you reclaim valuable clinical space to generate revenue.
Ongoing costs associated with legacy record sets aren’t limited to paper form. Many hospitals have used more than one electronic medical record (EMR) system. As hospitals and their technology needs evolve, EMR and business software system upgrades are necessary. Legacy systems aren’t actively used going forward, but retention requirements and access needs for the legacy data remain. Maintaining old systems comes at the expense of software licenses, occupying costly and energy-consuming IT space, along with technical support staff. Cariend can extract data from proprietary systems for management by our HIPAA-compliant solution, eliminating the complexity of straddling multiple systems and reducing the expense of ongoing licensing and maintenance.
Retention laws in most states require medical records to be held for much longer than most are typically needed for effective continuity of care. Streamlining Release of Information (ROI) can both reduce expenses and improve outcomes. Offloading older, less frequently accessed records while keeping more recent records close at hand, is an effective way to balance compliance, costs, and patient care. In many cases, ROI services generate little to no revenue, as the ability to charge patients for records requests is limited by statute, and the cost of payroll, benefits, software, storage, and other overhead costs to run the program exceeds the revenue it generates. Outsourcing the older, less productive component of your records and associated ROI can significantly reduce your administrative load and costs, while maintaining patient care.
Scanning can become a black hole for payroll if not managed properly. Digitization is important to fully adopt your EMR, access records remotely, and eliminate delays in patient care due to misplaced charts or incomplete health information. However, the way you scan is important. First, you should consider what you scan, and when. By prioritizing files you need to access frequently or on an ongoing basis, you will reduce the labor required to clean up a backlog of paper. Using this strategic approach, you may find that some records will meet their retention before you even scan them, while other records may never be needed. These can be managed with a scan-on-demand process, in which you only incur the cost of scanning when you need the file. As you review your scanning strategy, review outsourced solutions. Workforce participation is at an all-time low, and labor shortages across industries, especially healthcare, are at an all-time high. Outsourcing can speed up the timeline to complete a scanning project and reduce your need for full-time employees once your conversion is complete.
Audit your use of in-house space and outside storage to manage both hardcopy records and the systems used to maintain electronic records. You can repurpose in-house storage space for revenue generating activities. Additionally, external space such as rented warehouses and storage units increases the risk of a breach and the cost for your staff to maintain and access the records. Often the facilities team bears the brunt of this management expense. By optimizing internal space and eliminating external storage, you can both reduce expenses and increase compliance.