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Hospital EHRs and Your Billing Services


(from the March/April issue of HBMA Billing by Ron Sterling)

For a wide range of reasons, many hospitals are actively promoting EHR products to their medical staff physicians. In some cases, hospitals offer specific products that they support and host. Alternatively, some hospitals promote one or more selected EHR tools on a preferred EHR vendor list.

Hospitals may offer subsidized use of these EHR products or pay a portion of the costs incurred by the physician practices. From the hospital perspective, practices that are strategically aligned with a hospital's computer strategy will enable more effective bidirectional exchanges of information and may thereby increase admissions from the participating practices. However, these hospital-driven EHR initiatives may not necessarily meet the EHR needs of every practice.

In order to protect the interests of your billing service clients, all hospital EHR offers should be carefully evaluated to verify that the products are in the best interests of your client. The following questions should be addressed:

  • Does the EHR product appropriately meet the needs of the practice? For example:
    • Practices have been offered EHRs from hospitals that did not include clinical content for their areas of medicine. Few practices have the expertise or time to develop clinical content, and even fewer practices can support independent clinical content.
    • Some hospitals offer EHR products that lack workflow or patient service tools needed by practices. Using an inappropriate EHR could increase both the costs and liability risks of your client's practice.

Hospital-based EHR products should be subject to the same level of analysis and review as other EHRs to assure your clients that they are appropriate and useful.

  • What support is the hospital offering for the EHR implementation effort? Many hospital EHR initiatives offer limited implementation and support services. In many cases, a hospital will not have sufficient resources to properly support a physician practice because the hospital staff is absorbed with the hospital's own EHR challenges. The resulting lack of appropriate resources and support could restrain progress and lead to problems for the practice. This does, however, create an opportunity for billing services to fill in the implementation and support gap to their clients.
  • What is the hospital's commitment to the EHR offer? Most hospital offers have defined time limits and exit clauses. For example, a number of hospital contracts offer the EHR for two years. In other situations, the hospital can stop offering the EHR service with 60 days notice. Both terms present unacceptable business risks to physician practices, which cannot undertake the expensive and complex effort to change EHRs based on hospital decisions. Practices also cannot afford free or inexpensive EHR solutions that may become very expensive when their two-year hospital subsidies are exhausted. Practices need to develop agreements that define the costs and include acceptable risks before agreeing to hospital-based EHR initiatives.
  • How can a practice separate their EHR use from the hospital's program? Many hospital initiatives are captive programs that include use of the hospital's licenses and hardware. For a wide range of reasons, the practice may need to pull out of the hospital program but continue use of the EHR. For example, the nexus of the practice's business may change to another hospital or the hospital may change their program. Unfortunately, not all EHR products can be split out and used separately by individual physician practices.

Along with EHR offerings, many practices are facing decisions about their billing services.

  • Can the billing service work with the hospital EHR product? Hospitals and some EHR vendors may not support interfaces with billing products. In theory, most EHR products support HL7 interfaces for demographics, appointments, and charges. However, because they want the billing service business for themselves, vendors are becoming more ambivalent about providing such interfaces.
  • If the practice changes billing systems, will they be able to continue to use their current billing service? Some billing services have successfully offered their billing and management services using the companion PMS product to hospital EHR systems.

For physician practices, hospital-based EHR systems do not necessarily present beneficial solutions and may include a number of substantial business risks that are not fully understood. Third party billing services can help their clients understand the issues associated with hospital-based EHR initiatives. Such efforts will both ensure that their clients' decisions to participate in these initiatives are appropriate for the practices and establish business relationships that their clients can depend on.

At the same time, billing services can establish a role for continuing to support their clients within their EHR strategies. That makes sense for the practices and preserves the reliability of their billing and collections strategies.

Ron Sterling (800-967-3028, publishes the popular EHR blog, and authored the HIMSS Book of the Year Award winning Keys to EMR/EHR Success. Ron is a frequent presenter on EHR issues for HBMA. © Sterling Solutions, 2011.

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