While the regulations and pricey updates tied to electronic health records have long been causing struggles for smaller rural hospitals, the advent of cloud-based EHRs is changing that.
In some cases, rural providers say the investment in a cloud-based EHR not only saved their organizations from closing their doors, but it yielded financial gains and a new wave of quality and patient satisfaction improvements.
Lost Rivers Medical Center in Arco, Idaho, a 14-bed critical access hospital faced a financial crisis four years ago, prompting the hiring of CEO Brad Huerta to right the ship. At the time, they were $3.5 million into bankruptcy and meaningful use was only months away. They had about $7000 in the bank, and were still managing records on paper, meaning they had a pressing need for an EHR they could barely afford.
"We were down to counting pennies and shaking out the couch cushions to make payroll so we couldn't make the mistake of unsuccessfully attesting for meaningful use stage one."
With no servers to buy, and no need to hire IT staff to maintain them, a cloud-based solution was an affordable way to quickly modernize their operation and bring them successfully through stage one attestation. It's a model that works for small or struggling hospitals with limited resources Huerta said, and meaningful use compliance was just the beginning.
The reimbursement from attestation enabled the hospital to make improvements to the facility and hire some key personnel. With only three or four billers and coders on staff, the help of extra oversight provided on the back-end meant more billing and coding errors were caught and claims rejections plummeted.
Huerta said their cash on hand from first quarter 2016 to end of first quarter 2017 grew by more than 120 percent while days in accounts receivable dropped from over 100 days to 52.
The transformation may seem dramatic, but Huerta said when you have an integrated system with one patient record that instantly updates when information is entered anywhere in the system by any provider, clinical mistakes go down. There is no double ordering of tests, no duplicating care or misdiagnosing. The record is up to date the second info is entered.
"Mistakes go down and quality goes up. Certainly, physician satisfaction definitely goes way up. It's a lot easier to chart from your tablet than having to go back to the doctors' lounge."
Patient costs also go down because mistakes like unneeded tests diminish, and outcomes improved thanks to better accuracy of patient information and corresponding care decisions, Huerta said.
The cost of a cloud-based system depends on what it will entail, including for hospitals, which can include revenue cycle and billing services. Hospitals pay a monthly charge amounting to a percentage of net collections. However, facilities don't have to pay for new interfaces, updates, training or other add-ons that often price small rural healthcare facilities out of the installed EHR systems.
Whether it is a platform from athenahealth, which Lost Rivers chose, or some other vendor, Huerta now says he'd require that any hospital he ever works in adopt a cloud-based EHR.
"Our survivability is assured. I have no doubt we will be here next year and 10 years from now. We're actually starting construction on a surgery center, we're expanding our hospital. We've given out merit increases and cost of living increases. We are very financially sound at this point."
Other cloud-based EHRs include CareCloud, Kareo, Practice Fusion, Aprima, AdvancedMD, NueMD, and Health Fusion MediTouch.
Frank Beaman, CEO of Faith Community Hospital in Jacksboro, Texas, said 2017 will mark the first fiscal year for the hospital operating under one software system, after navigating the hospital through a similar financial disaster.
Six years ago when Beaman first stepped in as CEO, the safety-net hospital was six to 12 months from closing, and the hospital had a million-dollar EHR system that no one knew how to operate. They also hadn't billed anyone in 120 days.
"We were the poster child for how dysfunctional the HITECH legislation was implemented. We went through four systems in five years, with two lawsuits and continued conversion after conversion. It was chaos."
The problem wasn't just the EHR, it was internal, Beaman said. A culture of apathy had developed, and some employees just didn't want to embrace change and help save the hospital.The negativity didn't end there. Beaman said the community had recently voted against a bond to rebuild the hospital despite significant issues like asbestos and mold. Beaman said community members didn't like the hospital and had no confidence in their services. Rebuilding the trust and the bond with them would also be crucial to their survival.
"It was truly a fork in the road. Either be one more casualty in the state of Texas or get back in, tighten up our bootstraps and jump in to see if we can save it."
They too signed on with cloud-based EHR operator athenahealth and saw their AR days plummet from 160 to 180 down to the thirties. At their low point, Beaman said they had no more than 30 days cash on hand. Now he said that number is more like 110, and they're building up cash reserves as well.
Beaman also said paying for upgrades was a burden, something they had to do with other EHR vendors. With their cloud-based system, they've saved money and are paying a percentage of their net collections.
They are now in newly built hospital with 17 beds and a separate maternity ward.
In addition to the financial gains that have come with greater efficiency and accuracy in their revenue cycle, the community has come back to them thanks to fewer mistakes and better care. The shift in attitude shows through the results of their patient satisfaction survey. When a patient is discharged from the emergency room, they fill out an electronic survey. If there's a negative outcome, an email is sent to executives.
"Patients can get a phone call before they leave the parking lot," Beaman said.
With an ER volume of roughly 350 patients a month, their satisfaction rate is over 98 percent.
Both Beaman and Huerta hailed the operational simplicity of cloud-based EHRs as a selling point for rurals. When you're struggling just to keep your doors open and recruit doctors, building a server network and an IT department just isn't in the cards. With the cloud, you don't need to. If you can find one that will tailor its scope and capabilities to your needs, that saves money too.