Jeff HeltonWhile preparing for a lesson on health information exchange in my health informatics course, I saw a disappointing statistic that gnaws at me to comment on. According to a recent Health Affairs article, more than one-third of hospitals in the United States do not participate in a health information exchange (HIE). Another statistic from McKinsey says only 50 percent of all hospitals are connected to an HIE. As with so many things in the management of healthcare organizations, there is sometimes value in not being the first adopter of new technology. However, organizations that take a conservative, “wait and see” approach could be denying themselves access to the benefit of valuable new technology. Considering the potential benefit of HIEs to healthcare providers, and hospitals in particular, this technology presents a potential opportunity for healthcare finance leaders to consider. 

One of the obvious benefits to me is in the management of Medicaid and uninsured patients in the emergency department (ED). If a patient has prior contact with a healthcare provider and is seen in the ED, the opportunity exists to get recent diagnostic testing results without having to incur the cost of duplicating existing work. If we partner with local safety net providers, the opportunity to reap shared cost savings seems pretty clear. Despite the best intentions of the Affordable Care Act, we will continue to deal with the problem of the uninsured and inadequate Medicaid reimbursement for the foreseeable future. I ask, “Why not invest in technology that would allow us the opportunity to mitigate some of that risk?”

A recent conversation with a fellow finance practitioner and HIE executive, Jim Langabeer of Greater Houston Healthconnect, yielded two great ideas that many healthcare finance leaders may not have considered when evaluating the value proposition of HIE. 

First, the risk of denials for readmissions continues to loom large in our revenue cycle. We invariably can identify patients who pose a potential readmission risk if we have seen those patients before within our health systems. But what if a patient has been seen for the same condition at another provider? HIE technology can allow us to see that prior contact, identify the potential risk, and intervene to minimize possible denials for preventable readmissions.

Second, HIE can be valuable to organizations operating under capitated payment as a result of participating in accountable care organizations because the technology can enable them to identify potential “leakage” of patients outside of the established delivery system. Lacking this ability, we often find ourselves with an end-of-period “surprise” in the form of claim chargebacks for out-of-network services. Wouldn’t it be valuable to identify such circumstances in real time and intervene before the cost exposure becomes problematic? At a minimum, I could see this capability being a boon to accounting staff who are struggling with estimating liability accruals for this sort of exposure. 

There’s an undeniable logic to the administrative inertia of waiting while the technology improves and affiliations in HIE shake out over the next couple of years. However, is the benefit of a “wait and see” approach truly greater than the potential benefit of HIEs to our organizations and communities? Here’s my question for finance executives: Who wants to step up and be a leader in this important industry initiative?

Jeffrey Helton, PhD, FHFMA, CMA, CFE, is assistant professor, Metropolitan State University of Denver, and a member of HFMA’s Colorado Chapter. 

Publication Date: Wednesday, December 11, 2013