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Return on Investment for Health
Information Exchange Participation
What is the return on investment (ROI) for
participating in a health information exchange (HIE)? As the Executive Director of one of the most
successful HIEs in the nation, I am often asked this question, and there are
several ways to define ROI.
Simply stated, ROI measures the benefit
(or return) an investment will generate in relation to the cost of the
investment. So, if it costs X to participate in the HIE, what is the financial
return to the facility?
While the ROI calculation for some is
framed in strictly financial performance terms, for others it can mean
increased productivity and efficiency, minimal disruption to workflow, and
improvements in care. Inherently, the HIE ROI is puzzling because the answer is
different for each organization. So, why should a healthcare organization pay
to provide clinical data to an HIE?
This is the “chicken or the egg”
question of which comes first. In order for an HIE to have a significant ROI
for its members, a certain level of participation by healthcare providers has
to occur. One doctor or hospital participating singularly in an HIE does not create
much HIE ROI value. However, when all of the healthcare providers in a
community, region, or state participate in a HIE, the ROI is noticeably
impacted.
The ROI is different for hospitals. For
a PPS hospital with diagnosis related groupings (MS-DRGs), the additional information
provided by the HIE may significantly increase the hospital’s case mix index
(CMI).
A recent hospital study revealed patients
receiving care at a small hospital visited 10 other healthcare facilities in
the calendar year reviewed. Analysis of the hospital’s problem list (after
de-duplication) indicated only 25% of the total problems found in the HIE were
present in the hospital EHR and billing. This finding significantly impacts
the hospital’s bottom line. Overall the inclusion of the HIE data resulted in a
227% increase in potential ICD-10 codes over what was available in the
hospital’s EHR, with an average CMI increase of .44 and an annual increase in
MS-DRG payments of $90,000.
If this same hospital also participated
in some form of alternative payment model (APM) the ROI example could be even
greater. In most APMs, patient risk scores and the associated payments are
based on the complexity of a patient’s health conditions. Each patient is
assigned a risk score. This score is based on the problem list for the patient
that is included in the billing submitted to the payer. If the problem list is
incomplete and reflects only 25% of the total problems patients have been
diagnosed with, then the hospital may receive a significantly lower level of
reimbursement.
Finally, the ROI for patients cannot be
evaluated through the same financial performance lens the provider community
applies. If the available HIE data saves a patient’s life, either by informing
care or preventing a medical error, it may be impossible to calculate ROI, even
though the benefit returned has immense value. This is the core patient safety
imperative delivered by HIEs across the nation.
KHIN recognizes this obligation to
patients, and takes it a step further by offering a free personal health record
to all Kansas patients through myKSHealtheRecords. The personal health record
is connected to the HIE which allows patients to have simple and secure access
to all of their health information in one location. In addition, there is ROI
for patients in the value of time and money saved when eliminating duplicative
testing and the re-creation of patient history for providers.
KHIN is a physician-led health information network offering a suite of
health information technology tools to help Kansas healthcare and healthcare
professionals CONNECT. ANALYZE. TRANSFORM. Visit www.khinonline.org or call
877.520.5446 to learn more.
Laura McCrary, Ed.D
Executive Director, Kansas Health Information Network
Senior Vice President, KAMMCO
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