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.
- Benefits of rural health – “You have an opportunity to become a jack of all trades.”
- HIPAA compliance challenges
- Providing bandwidth for patients
- Being a “champion of MU”
- “We’re being asked to do as much as everyone else with fewer resources.”
- Rural health’s tight-knit community
- Mentor advice – “You’ve got to deal with the day-to-day”
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You have an opportunity to become a jack of all trades — you may get lucky enough to become master of some of them. You get exposed both on the clinical side and on the administrative side to things that you may not have seen otherwise.
A lot of the regulations and compliance guidelines that come out of Washington are very much directed toward the larger systems — but the same regulations and compliance issues fall on us, and we feel like we’re overlooked more often than not.
If you add in the payment penalties that could potentially be tied to something as simple as patient portal use, that 1 or 2 percent could be the difference between my door staying open, and us not having a hospital in Hugo, Colorado.
You’ve got to deal with day to day. You have to maintain that balance of making sure people are taken care of today, but you also have to be a fortune teller in some ways. You have to have your eye on the crystal ball.
Gamble: What do you feel are the biggest challenges and opportunities being in a rural health setting?
Yount: One of the big challenges you hear, which I alluded to before, is that it’s hard to find good staff. It’s hard to find people that are good at what they do who want to come out here and give up a lot of the amenities they have in more urban areas to provide care to patients. It also offers a great opportunity for people. If you’ve ever worked in a large healthcare organization, you find that a lot of the job skills are very siloed. You have your one area of focus, and you don’t delve outside of that area because the people sitting to the right and left of you are going to help you along those lines. And so if you do find someone who’s willing to come out to rural areas, you have an opportunity to become a jack of all trades — you may get lucky enough to become master of some of them. You get exposed both on the clinical side and on the administrative side to things that you may not have seen otherwise. It’s a challenge, but it’s also a good thing.
Funding is a huge problem. Our biggest payer is Medicare; two-thirds of our patients are Medicare, and another 15 or 20 percent are Medicaid. That doesn’t leave a lot of room for commercial insurances, but the way that Medicare pays my critical access hospital is different than it pays the University of Colorado Health System, which is located in Denver. The whole methodology is different. We have cost-based reimbursement, while they’re paid 100 percent on their volumes.
So funding is a huge problem. It’s not pay-for-performance hospitals that have had 86 closings in the last few years; it’s critical access hospitals, whether they’re getting gobbled up by larger health systems to maintain at least a footprint in the area, or shutting down. It runs the gamut, and that all funnels into the same place.
When someone comes to a rural area from an urban area, they have an opportunity to do more with the patient and to do more on the administrative side, but they also have to do more with less. And we have the same constraints that some of the larger organizations do. We’re a 24/7 facility. We also have the added benefit — or detriment, in some cases — of knowing who all of our patients are. I don’t provide healthcare to them; I’m the IT side of things. The way I help people is by facilitating that patient experience, but I know everybody who walks through the door. I’m usually on a first name basis with them. Whether I have good news or bad news, I know who you are, and I have to deliver that news just the same as I would if I didn’t know who you were. So it does add a layer of complexity.
HIPAA is also a big challenge of being in a rural organization. I’m ashamed to say that I’ve heard more conversations involving patient care in public areas than I probably should have. Because of the nature of how we provide care, it’s almost impossible to stop all of those interactions from happening. We’ve gotten a lot better, but it is just one of those challenges you don’t necessarily think about.
Then you have the logistic side of things — bandwidth, access to internet, etc. All of healthcare is done on a computer now, and so not always having reliable access to internet at my facility is a challenge. Also, some of our patients can’t get bandwidth in their homes. And so one of the initiatives we’re looking at right now is trying to find funding or programs available in our communities to help get that last mile of fiber or DSL for our patients. We’re trying to get that last mile so that they can have reliable bandwidth in their homes, which would enable them to take advantage of some of these services we’re talking about.
But I think if I had to put it into a nutshell, it’s that we’re being asked to do just as much as everyone else with an awful lot less resources. A lot of the regulations and compliance guidelines that come out of Washington are very much directed toward the larger systems — those are the organizations they have in mind, but the same regulations and compliance issues fall on us, and we feel like we’re overlooked more often than not. If we’re not looking out for ourselves, there’s nobody else looking out for us.
Gamble: Right. Along those lines, we’ve seen some changes to Meaningful Use stage 3 in terms of timelines and the requirements, but I imagine the way it was designed and carried out was very frustrating, especially for small hospitals.
Yount: I’m a champion of Meaningful Use. If nothing else, it got everyone using an electronic health record system. But those systems were rushed out. They were, at times, poorly designed. It was like the blind leading the blind. Meaningful Use Stage 1 was horrible. I feel like the Stage 2 modifications gave us an opportunity to correct some of those mistakes, but there were some political things that took place during the implementation of those two stages that changed that moving target, and changed some of the things that we, as healthcare organizations, had to achieve.
I believe that with the move to MIPS and MACRA, and more of the quality-based side of things on the physician side, I feel like we’re going to see a little bit more of a positive outcome than we did with Meaningful Use. There’s a lot of talk out there right now that Meaningful Use is dead. I wouldn’t necessarily say that it’s dead, but the regulations we’re talking about right now, I don’t feel are going to be in place when it comes time to do the attestation at the end of the year. I feel like it’s going to be different than what we’re talking about right now.
When you look at some of the more basic challenges of Meaningful Use, like the patient portal, for example, while our population is getting much more ingrained in using digital technology, we still have a very large percentage of our population who don’t own a computer, who don’t have access to internet, and then some people who just don’t care. With the simpler guidelines, a very large percentage of your patients not only have a portal, but they have to use it. How are you going to hold me accountable and penalize me for something that is 100 percent outside of my control? It’s counterintuitive, and those penalties that are going to start coming into play this year, when we do our Stage 3 attestation. If we don’t achieve it, we’re going to start seeing those payment reductions in 2020. We’re a cost-based reimbursement facility, so if you add in the payment penalties that could potentially be tied to something as simple as patient portal use, that 1 or 2 percent could be the difference between my door staying open, and us not having a hospital in Hugo, Colorado.
I don’t think it was a very thoughtful implementation. A lot of my colleagues refer to it as meaningless use, but at the core, it did get everybody using an electronic health record. Now we’re all trying to dig ourselves out of how haphazardly it was put together, but I think it was something that had to happen. It could have been done better, and it still could be done better, but I am an advocate of the program.
Gamble: I think that’s a good way to look at it, and it’s an honest way to look at it. Now, in your previous role, you were with Colorado Rural Health Center. I imagine that experience really helped prepare you for this role.
Yount: Sure. And actually, prior to going to Rural Health Center, I was an IT director at two other critical access hospitals — one in Kansas and the other in Colorado. I was very familiar with the challenges that those particular facilities were dealing with. When I came onboard, Rural Health Center had started an initiative to roll out IT services to rural healthcare organizations across the state, including hospitals and clinics. One of the things that astounded me — and it shouldn’t have, but it was due to my lack of experience at the time — was that the challenges at the two facilities were the same ones impacting every hospital I had stepped into. There may have been a small variation on the challenge or there may have been a slightly different situation, but the overall theme was identical. We probably could have just swapped logos on the facilities and walked in, and it would have been the exact same experience. It was an eye-opening opportunity, and it was a fantastic way to increase my own personal network.
The Rural Health Center is doing some fantastic things. Colorado was fortunate to have an independent State Office of Rural Health. They aren’t tied to an education system, a government entity, or the state themselves. They are truly independent. They’re doing some fantastic things, especially with quality. And they’re leading an effort in data aggregation and informatics that a lot of the other state offices haven’t even began to touch yet, just because they can’t. They’re hamstrung in what they’re able to do through their larger affiliations.
Gamble: Right. One thing I’ve noticed in speaking with people at rural health organizations is that there is a bond. Others who are at similar organizations know the unique challenges. Have you found that there’s a network among CIOs or directors at rural health organizations?
Yount: Absolutely. It’s a small family. Actually, I became familiar with you through Mike Archuleta, one of my colleagues down at Mt. San Rafael Hospital in Trinidad. Mike and I have been working together for quite some time. We are a very tight knit community, and I would say I’ve got mentors across the spectrum. I was fortunate enough at my first hospital to work under an IT director who was very knowledgeable, very compassionate, and very driven. He taught me the right way to approach things, and it’s actually where I take adage that I can learn anything from anybody, it doesn’t matter who they are. Everybody out there does something better than me. It’s just figuring out what that is and appreciating them for who they are and what they have to teach you.
But in terms of my own peers, I’m reaching out to my colleagues probably on a weekly basis. Any time a challenge comes up, I’ll reach out to them to figure out how they’ve tackled it. If some bit of information comes across my desk that I think may be beneficial to them, I absolutely share it. Phishing emails, malware, and CryptoLocker are all things that have unfortunately become very prevalent in healthcare. Any time we encounter an email that may potentially be a threat, I forward a copy of that to my peers to say, ‘hey, I just want you to know we saw this. Be aware of it and be ready to show your end users,’ and they do the same for me.
In terms of my own mentors, one of my first was actually my first chief financial officer. He knew nothing about IT, but appreciated the fact that without it, you can’t have healthcare. His name is Jason McCormick. He’s brilliant. He taught me an awful lot about patience; about trying to see the big picture and not getting caught up in the weeds of things. I’d say that’s probably the thing I’ve been able to take most from him — you’ve got to deal with day to day. You have to maintain that balance of making sure people are taken care of today, but you also have to be a fortune teller in some ways. You have to have your eye on the crystal ball, while also standing in front of a mirror so you can see where you’re coming from.
I’ve been pretty fortunate in my career to have worked work with intelligent and capable people, and I’ve tried to incorporate at least some of the best things from everywhere I’ve gone. Whether I’ve done it right or not, who knows.
Gamble: It goes back to what you said how everyone can teach you something. It seems like a really good philosophy to have.
Yount: I’d like to think so.
Gamble: All right. Well, that covers what I wanted to talk about. I really appreciate you giving so much of your time for this.
Yount: Of course. Thank you for being interested. We’re often overlooked, and publications like yours absolutely help to shine the spotlight on rural health, which is what we need. We need attention.
Gamble: Absolutely. Thanks again, and have a great day.
Yount: Thank you, Kate.