July 2018
In This Issue
From the Desk of the KAHCE President
Message from Your ACHE Regent - Spring 2018
Sponsorship Highlight - KaMMCO
Sponsored Students Reflect on ACHE 2018 Congress
Student/Early Careerist Spotlight
Advancing in ACHE - Part 2
4 Steps to Establishing Your Leadership Philosophy
Enhance Your Decision-Making Skills: 3 Tips
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Officers
President
Judy Corzine, FACHE
Stormont Vail Health
Topeka, KS


President Elect

Tony Thompson, FACHE
Allen County Regional Hospital
Iola, KS


Past President
Roger Masse, FACHE
Ellsworth County Medical Center
Ellsworth, KS


Treasurer

George M. Stover, FACHE
Hospital District #1 of Rice County
Lyons, KS

 

KHA Liaison
Ronald W. Marshall
Kansas Hospital Association
Topeka, KS


ACHE Regent
Patricia Sanders-Hall
High Road Coaching
Overland Park, KS

 

KAHCE Website
www.kahce.org
 


KAHCE LinkedIn
KAHCE Kansas Association of Health Care Executives

 

KAHCE Title Sponsors:

 



Sponsorship Highlight - KaMMCO

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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