The following is a guest article by Kaitlyn Nelson, Director of Strategic Account at Stoltenberg Consulting

Healthcare in the U.S. relies heavily on federal support, generally in the form of Medicaid and Medicare reimbursements for services or federal grants to fund community health centers. In fact, the federal government sponsors nearly 32% of total health spending in the United States. In this environment, healthcare organizations across the country closely monitor potential changes in funding to assess impacts on patient care delivery, reimbursements, staffing strain, and future investments in technology and support.

Recent legislation has heightened awareness, leading to a significant number of pivots in the way healthcare organizations and community health centers are approaching how they deliver care, leverage EHR systems to help maximize reimbursements, and re-prioritize health IT initiatives.

Using EHR Systems as a Tool to Help Ensure the Highest Reimbursement

There is a great deal of power in a well-optimized EHR system, built around proper workflows and good training for staff and providers. And with today’s AI features built into leading EHR systems, accurate and efficient coding has never been easier. That’s a great first step, but there are even more ways that healthcare organizations are leveraging their EHR systems to their financial advantage in today’s era of funding cuts.

One area relates to care delivery, in identifying multi-specialty providers who can code to the highest allowable level for various services delivered during a patient encounter. This requires optimizing the EHR system in a way that facilitates accurate coding by multi-specialty providers, as well as training those providers on proper coding procedures. AI functionality can help to ensure accurate and complete coding to ensure that all services delivered are entered and under-coding is avoided.

Another initiative by healthcare organizations relates to the tight integration of their EHR system with their revenue cycle management system. This integration helps to ensure processes are in place for first-time clean claims, prompt and accurate denials management, and collection of revenue for all services provided. It’s imperative that no dollars are left uncollected and that reimbursements flow into the practice as quickly as possible. Solid revenue cycle management can make this happen.

Re-Prioritization for Health IT Initiatives

Earlier this year, healthcare organizations began to pause large-scale IT and operational initiatives. Many organizations have placed projects ranging from new HR systems to clinical workflow optimizations on hold. However, they recognize that IT progress cannot come to a halt, and that strategic projects are necessary to ensure care quality, operational efficiency, and organizational financial well-being. Therefore, many healthcare organizations are taking on smaller, short-term initiatives. This approach allows for incremental progress in a way that is sensitive to budget conditions and can be prioritized to make positive impacts in short sprints. Short-term initiatives may include optimization (specifically for workflow improvement and standardization), as well as revenue cycle performance improvement, and automation implementation to boost operational efficiency and reduce staff burden.

Re-prioritizing health IT initiatives involves several strategic considerations, including:

• Will the investment result in maximizing allowable reimbursements and collections?
• Are there efficiencies and automations that can fill the gap caused by staff reductions?
• What tools are already in place that can be optimized, or shelved, based on ROI?

A Shift in IT Staffing

Today, a reliance on fractional and part-time support, as well as solid partnerships, can help a healthcare organization continue progress in its IT journey. Specialists in various areas of health IT, as well as consultants who can support the planning and implementation process for these initiatives, are filling the gap as hiring freezes and reductions of in-house IT teams take place.

The great news is that there is a strong talent pool of consultants and fractional IT professionals who have a high level of skill and experience to support healthcare organizations — without internal overhead. Good partners have deep insight into what’s working for others, can implement industry best practices, offer flexible terms, and serve as collaborators to develop and execute a strategic plan to maximize short-term gains.

A Focus on Provider and Staff Burnout

Federal funding drives not only innovation, but also basic staffing required for operations and delivery of patient care. It is critical for healthcare organizations to actively monitor providers and staff for signs of burnout and put measures in place quickly to address it. One way to accomplish this lies in the organization’s EHR system — ensuring all are coached, so they can feel efficient and confident in their system utilization. Satisfaction with an EHR system is a key factor that contributes to a provider’s job satisfaction. Investments to make this a reality will deliver ROI for provider retention.

In addition to training, easy access to IT support teams is crucial for providers’ ability to maximize time with patients and focus on quality care. When providers are confident in EHR use, feel supported, and can receive issue resolution quickly, their clinical documentation is likely to be more complete and accurate. Proper documentation and coding helps ensure that all regulatory, compliance, and reimbursement requirements are being met, maximizing potential payments.

In periods of uncertainty, it’s important to remember that there are strategic priorities that will help healthcare organizations continue to progress toward their goals. Creative IT solutions to longstanding industry challenges may allow healthcare organizations to rethink their approaches to care delivery and operations, along with how they integrate technology to remain resilient in an ever-changing landscape. 

About Kaitlyn Nelson

As Director of Strategic Accounts for Stoltenberg Consulting – a Med Tech Solutions company –Kaitlyn provides client hospitals with staffing and operational alignment, along with flexible resource allocation. With extensive EHR vendor knowledge, industry market understanding, and firsthand analyst experience, she understands hospital needs. Having successfully led hospitals and health systems through many legacy support, managed services, help desk, and go-live engagements, she delivers project oversight to ensure project alignment, end-user satisfaction, and EHR system ROI across its full lifecycle.