Juno Health: In your article, you highlight that disconnected EHRs and manual billing processes are a major source of revenue leakage for rural hospitals. From what you've seen in the field, what specific capabilities should rural hospital leaders be looking for in an EHR to ensure RCM is truly embedded — not just bolted on — to their clinical workflows?
Dr. Michael Zappa: The EHR should be able to integrate all the service lines of a facility from inpatient to outpatient to diagnostics. Building on that foundation, its RCM function should capture most charges automatically.
JH: You make a compelling case that clinicians shouldn't be responsible for managing billing activities. Can you walk us through what that looks like in practice when an EHR has the right automation built in? What does that workflow transformation mean for both the clinical staff and the hospital's bottom line?
MZ: Clinician’s want to care for patients, not be pulled away from the bedside with tasks such as duplicative charting just to get codes and procedures entered into another part of the EHR or separate RCM solution.
Done right, clinician’s should simply order what a patient needs, document the care given and the patient’s response, and results of diagnostic tests should populate directly into the record. A clinician should never even think about charge capture, the system should know what was done and link the proper charges.
For the hospital, this automation will be a big shot in the arm, boosting revenue quickly – automation assures that hospitals get paid for what they do. By eliminating the human element of relying on the busy clinician to do just one more thing, missed charges will become a distant memory.
JH: You discuss how siloed work queues and the burden of self-scheduling drive patients to seek care elsewhere. How important is the EHR's role in proactively keeping patients within a rural hospital's network, and what should a well-configured EHR be doing automatically to prevent that leakage?
MZ: Patients assume they will receive quality care; they will make their decision about where they receive it by how easily they can access it, and how timely and clear the communication is. For example, if a patient is simply given a phone number to call to set up an outpatient scan, they might delay calling, they might call and get put on hold or asked to leave a message, or they may get an appointment a few weeks out.
Each of these potential outcomes increase the probability of the patient not getting the test they need or getting it done at a system that has honed its efficiency better than the one in which they started care. If the EHR processes the physician’s order and it immediately gets prioritized in the scheduler’s work queue, and that scheduler calls the patient to offer them appointment options soon after they were seen, the patient gets timely, safe care and stays with the system.
JH: Rural hospitals often lack the IT staff, financial runway, and time to manage complex technology rollouts. What does a realistic and responsible EHR implementation look like for a rural facility — and what should hospital leaders watch out for when evaluating vendors who may be promising more than they can deliver?
MZ: EHR implementation is so significant that it can be career defining for leaders as well as a key factor that tips the scale of the balance sheet. Rural hospitals must be even more careful in their analysis and selection of a new EHR vendor given their often limited margins and reserves.
Elements critical for success include:
An out of the box solution that has best practice workflows ready to deploy
Up front pricing that includes the customizations that are mission critical
Maintenance and modifications that can be easily handled by the hospital’s current IT staff
Automated charge capture
RCM that is 100% tested and deployed day 1
Advanced integration solutions that make the facility easy to access and prevents patient and service line leakage
Critical points with vendor selection:
Remember, if something sounds too good to be true, it’s probably not true
A vendor’s performance with implementation will be just as good as their ability to meet deadlines prior to go live
Do not bet on an integration with a bolt on product; search for a solution that meets the system’s needs inherently
Check references
JH: You open the article by noting that federal Medicaid cuts will disproportionately impact rural hospitals. Given that financial backdrop, how do you respond to administrators who feel they can't afford to invest in a new or upgraded EHR right now? Is there a way to frame the ROI conversation that makes the case for acting sooner rather than later?
MZ: If a hospital has an outdated EHR that doesn’t integrate its services, doesn’t automatically capture charges, is lacking a modern RCM program, cannot streamline follow-ups or referrals, and has not capitalized on AI to attract and retain clinicians, it can’t afford NOT to invest in a new EHR.
It is analogous to the ability to afford college or professional school – many people cannot afford it outright. However, if they do not invest that money in the pursuit of higher education now, that virtually eliminates any possibility of earning a higher income in the future. The obvious choice most people make is to find a way – loans, grants, scholarships, a part-time job, etc.
Looking for a better way to manage your hospitals revenue, billing, and reimbursement? Contact Juno Health and one of our healthcare experts will be happy to show you how we can help.