CDP Clinic in Sisseton, South Dakota. Credit: cdphealth.com
That rural hospitals are struggling isn't exactly a secret. More than 80 rural facilities have closed since 2010, and recent research from iVantage Health Analytics found that 41 percent of them are operating at a negative margin. Some of these hospitals are surviving by partnering with larger regional health systems. Some are changing their care delivery models entirely.
But others have found success simply by overhauling their electronic health records.
The functionality of many EMR systems is patchwork in nature, making it cumbersome for small staffs to handle things like billing and meeting meaningful use requirements. Fewer workers tackle more complex tasks, which makes it a struggle to operate in the black.
Make the EMR system simplified and more automated, however, and now these rural hospitals have got a fighting chance.
That's been the experience at Rawlins County Health Center in Atwood, Kansas. Sharon Cox, Rawlins' CEO,, and Destiny Schroeder, its information systems director, decided a more automated approach would help improve the hospital's financial outlook, and so far, they've been right.
"We were running a couple of different systems that weren't integrated, and this was an opportunity to do that," said Cox. "One of the things you have to do in a hospital that's small and with very few resources is you have to use technology to leverage resources, because we don't have the staff or the expertise."
There are different ways to streamline and automate an EHR system. Since wallets were light, Rawlins partnered with athenahealth to make the required overhaul. The turnaround was pretty dramatic, and put into stark contrast some of the deficiencies of Rawlin's old legacy system.
"A big part of that was meaningful use and being able to meet meaningful use requirements," said Schroeder. "That changes year to year, it seems, are there are more requirements that need to be done for that. With the legacy system we had, not all of our meaningful use data could be collected within one system. We had several different systems we had to go through that was kind of piecemeal ... even to do day-to-day tasks. We've seen a huge difference with that. That's made it a much easier process."
"Small and rural hospitals see this as a foundational element to success in the future," said Cox. "So many of those hospitals were looking at such dire circumstances, and how they were going to survive in the future."
One of the big things this has accomplished has been to take administrative tasks off providers' plates -- something that becomes especially important when staffing and resources are limited.
Rawlins has seen a huge change in its workflow -- take charge entry, for example. Before the switch, the staff had to wait until the day-end close to enter those charges, and so they wouldn't be seen in the account until the next day. Now, for the people in medical records, they can see all of the changes and see where they have results. That makes for a quicker workflow process; they can close the visit and drop a claim, whereas before it might have been strung out over several days.
Coteau des Prairies, a 25-bed acute care community hospital in South Dakota, has turned its financial picture around following a similar approach. For CEO Michael Coyle, the desire to streamline EHR stemmed in part from a lack of technical expertise on the part of the hospital's small staff.
"We don't have gurus here -- we're too rural," said Coyle. "Whenever something went down, it seemed to take forever to fix. We're a very busy hospital. The longer we're down, the longer it takes to catch up. Burnout happens."
A streamlined, automated EHR has helped staff avoid that burnout, and has made operations at the hospital much more efficient. That's been reflected in Coteau des Prairies' bottom line, which has improved substantially. That's no small feat: The hospital has a high Medicaid population and sits close to a Native American reservation, with 60 percent of the overall population comprised of Native Americans.
"We meet with our client representatives every Friday and we go through what we need to be profitable," said Coyle. "We've seen huge financial changes, probably upwards of seven figures. It will be close to a seven-figure turnaround by the end of the year. We're doing front-end collections better than we ever have before. We're not missing charges like we were in the past. And when the patient's ready to go, the chart's done, so you can print out a summary and take everything with you."
Coyle said automated EHR systems are a requirement for survival in the rural healthcare market these days, at least for those facilities who are resistant to partnering with a larger health system. Further necessitating this shift is a rapidly changing healthcare system marked by uncertainty in Washington in regards to reform and how care is delivered -- and paid for -- in the future.
"Anytime you put the federal government into healthcare, it makes it more complicated," said Coyle. "Just the little things, like the 340B program going away. That's a huge revenue source for us. That's how we pay for a lot of our charity care. And you've got to incentivize your providers. If they have to create a chart and they're not creating (relative value units), they're not making money. With all the changes that are coming, the technology we use needs to be functional, and it needs to respond to what the government is asking us to do."
The numbers don't lie. Since implementing the approach, Coteau des Prairies has seen a 20 percent reduction in cost, and a 20 percent increase in revenue -- a 40 percent swing overall.