In today’s complex healthcare environment, pushing any initiative forward isn’t merely complex. In fact, it’s like “hitting a moving target with a bow and arrow from 1,000 yards away — while blindfolded,” says Patrick Yount. But no matter how big (or small) the task, the key is to ask the right questions and talk to the right people. And for the past year and a half, that’s precisely what he’s been doing as CIO at Lincoln Community Hospital, where his goals are to move to a single EHR platform, improve the patient experience, and shore up the revenue cycle process.
In this interview, Yount talks about how his plans to tackle these lofty goals, all while dealing with the challenges that come with being a rural health facility. He’ll discuss his strategy in selecting a vendor, the “fantastic opportunity” Lincoln has to become a leader in behavioral health, the approach he took as the organization’s first CIO, and why, despite its faults, he’s still a champion of Meaningful Use.
- “Redefining positions” to avoid staff cuts
- Identifying “data bottlenecks” in the claims process
- Revenue cycle — “It starts the moment someone walks in the door.”
- Two sides of patient experience
- Portal functionality as a key factor in EHR selection
- Behavioral health teleservices — “It’s very exciting”
- Setting up stations to make the dialogue “a little easier”
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The goal is to retain as many staff members as possible. If we can avoid hiring additional staff, that would be a bonus for sure, but it doesn’t necessarily factor in the decision as to which vendor to choose. It shouldn’t.
Now that we’ve got a lot of our data consolidated into one area, it’s trying to identify those bottlenecks that would otherwise keep us from being able to move forward. We had to learn what we didn’t know, and now that we know what we’re looking for, it’s trying to decide what to do with those pieces of data.
One of our big factors in deciding on an electronic health record is how well does the patient portal work? How functional is it for your patients? What type of return can they get by using the portal?
There’s a stigma that’s associated with mental health issues. And so, the fact that they can click on a button on their phone or pull up their laptop and actually have a face-to-face visit with a provider that nobody is aware of, that has to help make the dialogue a little bit easier.
Gamble: I guess as you get further along in the implementation phase, that’s when decisions will have to be made as to whether you need to bring in additional people, and how exactly that’s going to happen.
Yount: Yes. I think given our workflows, given our volumes, and given what the vendors that we’re interacting with now are telling us, we should be able to get through the implementation without additional staff. One of the things I’m always leery of when working with EHR vendors is when they promise you, ‘if you implement our system, you’re actually going to be able to cut staff, because we’ll be able to do a lot of this work for you, or our system will eliminate some of these workflows.’ I have yet to see that actually come to fruition.
And honestly, it doesn’t even factor into the decision. We are the largest employer in our respective community, and cutting staff is not part of the business model. We want to redefine those positions and make us more efficient, more patient-facing, and more service-oriented, versus back in workflow and data entry. But the goal is to retain as many staff members as possible. If we can avoid hiring additional staff, that would be a bonus for sure, but it doesn’t necessarily factor in the decision as to which vendor to choose. It shouldn’t, anyway.
Gamble: Right. You also mentioned revenue cycle as a priority. What’s your strategy there?
Yount: When I was asked to come in and start working on the revenue cycle side of things, it was my first real foray into healthcare billing. The first year was like drinking from a fire hose. I received probably as many emails from Medicare and Medicaid on a daily basis than I do from my own internal staff talking about billing updates and common problems you have with getting claims paid. The State of Colorado recently went through a contractor change with Medicaid, and there were a whole host of challenges that we, as well as other facilities, were going through as a result of this transition. Thankfully, the State has been kind enough to work with us and some of the other rural hospitals to get those challenges resolved, but in terms of learning and trying to adjust to the way revenue cycle is supposed to work, having some of those other outward pressures only complicated things.
My big focus was trying to take us from having a higher than average turnaround time on getting claims paid, and getting the turnaround time on payments down as much as possible, along with increasing our day’s cash on hand, and trying to integrate a lot of the disparate data that was coming through some of our systems. Those were my big focuses. Those have changed over the past year. Our facility has gotten much more efficient on getting bills off the door, getting payment followed up on.
Now that we’ve got a lot of our data consolidated into one area, it’s trying to identify those bottlenecks that would otherwise keep us from being able to move forward. We had to learn what we didn’t know, and now that we know what we’re looking for, it’s trying to decide what to do with those pieces of data that we’re now getting our hands on.
Gamble: You also mentioned improving the patient experience. Can you talk about what you’re doing there? I imagine that this is an area where it really factors in being a rural facility where patients have to travel a long way to get care.
Yount: Yes. Actually, in terms of patient experience, I’ll go back to the revenue cycle part of the discussion, and point out that most people think of revenue cycle as getting a bill out the door and getting payments. The revenue cycle process actually starts the moment somebody walks into the front door of the facility and the person at the front desk says, ‘hello.’ Every person that touches the patient, and the patient record, along the process is now part of revenue cycle.
In terms of improving the patient’s experience, there’s two sides to that. There’s improving the patient experience for the ones who are able to come to our facility, and then there’s improving the patient experience for those patients that may not have the means to come in and be seen by a healthcare provider.
A couple of other things that we’re rolling out this year are online bill pay, and a cleaner statement process. One of our big factors in deciding on an electronic health record is how well does the patient portal work? How functional is it for your patients? What type of return can they get by using the portal?
A lot of the excuses — and I have no other better word for this—I’ve heard in the past from rural facilities is, ‘our patients don’t want that. Our patients want to pick up the phone and talk to somebody. They don’t want to get on their computer or their smartphones to own their own health record.’ I used to believe that. But over the past six months, I’ve seen such a huge change in the adoption of mobile devices by some of the population that has traditionally been overlooked as being too antiquated to want to use these form factors. My mother was probably the most vehement person I know about not using a smartphone. One day I got her one and enrolled her in a patient portal. She lives in Kansas, and she spends almost as much time looking at her health record as she does playing Candy Crush now, because it’s something she can do. She’s engaged with her providers. And so, it’s really trying to look at how easy we can make you the steward of your own record. That is probably one of the most heavily weighted metrics we’re looking at as we make our overall decision.
Another area where our facility is unique is because we are located along I-70, we have a huge population of patients come to us who are traveling through the area. And so I want to choose an electronic health record that has the ability to share and exchange information between systems agnostically, so that if someone who is driving to Denver to go skiing has a medical emergency, we’re able to get information from their record from all of the other places that they’ve gone to, and be able to share the information that we acquire as part of their visit with us. We want to make sure we can get that out to their providers, and have them interact with that data as quickly as possible.
One of the big initiatives we’re moving forward with — and we’re actually a frontrunner in this area — is in starting to roll out behavioral health telehealth services. It’s very exciting. We were awarded a USDA grant about four months ago to implement a telehealth solution. It’s the first grant of its nature that was awarded in the State of Colorado. We feel incredibly fortunate to be the recipient of the grant, and we’re in very early stages of deciding how we’re going to roll this out.
We’ve found that the low-hanging fruit, and probably the area of greatest need — and that’s how we’re tackling this; what’s the fire right in front of me that needs my attention — is behavioral health. It’s a fantastic opportunity for us. We’re in the process of setting up telehealth stations at four other hospitals across our area that don’t have their own behavioral health services in-house as a way to start providing those services to their patients. We want to bundle the telehealth service with a community paramedicine program that would allow our paramedics and our transportation services to go to the patient’s home and get the telehealth equipment set up in their homes, so that they can start to interact with their primary care physicians — not only at our facility, but with other primary care specialists who may be located in Denver, Boulder, and some of the more populous areas. This way, they don’t necessarily have to drive into the city. It’s a pretty big initiative that we’re very pleased to be spearheading.
Gamble: It’s one of those areas that doesn’t get quite enough attention. There is such a shortage of behavioral health specialists, especially in certain areas, and it can be so difficulty for patients to even get an appointment in the first place.
Yount: Think about it from the patient’s perspective — the ones that are able to travel. In our community right now, we have a mental health clinic, but if John Smith drives down to go see his behavioral health therapist, I know what his vehicle looks like, and so does Mary, who lives right up the street. There’s a stigma that’s associated with mental health issues. And so, the fact that they can click on a button on their phone or pull up their laptop and actually have a face-to-face visit with a provider that nobody is aware of, that has to help make the dialogue a little bit easier as opposed to visiting a therapist and having to stand out in front of the clinic waiting for all the cars to drive by so you can get out of our truck and leave without anybody seeing. It’s the logistical and the personal side of that too, let alone the reimbursement, the staffing, and the challenges that come with dealing with patients who have mental health issues.
We feel like it’s going to be a win for everyone, and it’s something that’s long, long overdue. The funding and the reimbursement are now starting to align with the human aspect of this discussion. It’s very exciting, and again, long overdue.