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How an integrated EHR can simplify practice operations, RCM

Integrated EHR offerings with revenue cycle management (RCM) technology and AI features can help streamline operations for independent physician practices.

In an evolving healthcare landscape, it has become increasingly challenging for private practices to maintain independence. However, an integrated EHR offering can make all the difference, according to Paul Brient, executive vice president and chief product officer at EHR vendor athenahealth.

"It's increasingly difficult to be an independent practice," Brient said during an interview. "The world has gotten a heck of a lot more complex."

Indeed, over 100,000 physicians have left private practice and become employees since 2019, according to a study sponsored by the Physicians Advocacy Institute.

Much of the complexity that healthcare practices face lies within revenue cycle management (RCM), according to Brient. While reimbursement has always been a complex aspect of healthcare, practices are looking to adopt new payment models as the shift to value-based care continues.

Value-based care ties reimbursement to the quality of care provided, compared to the traditional fee-for-service model, which pays providers for the number of services performed.

Integrated RCM services

Staying abreast of new reimbursement models and submitting claims with the proper documentation is a complex process that requires RCM expertise, which can pose challenges for independent providers.

"Independent practices are not massive health systems where they can hire professional people to build an entire revenue cycle operation," said Brient. "They're small practices and they have one or two people that are trying to do this stuff, and there's turnover and there's complexity."

An integrated EHR and RCM solution can help simplify reimbursement so independent practices can focus on care delivery.

Brient emphasized that the athenahealth EHR has built-in revenue cycle services to help simplify reimbursement processes, including back-end claims processing and RCM.

Reports show independent practices have found value in the integrated EHR offering. Earlier this year, athenahealth earned the 2024 Best of KLAS Overall Physician Practice Vendor award, which KLAS awards to vendors with ambulatory EHR and practice management systems ranked in multiple-size groups for independent practices.

"Our mission is to help these independent practices thrive, and we do it by curing that complexity," said Brient.

"Just like physicians cure patients, we cure the complexity problem and make it so that the physicians can focus on delivering care, which is what they went to medical school and chose the profession to do, not deal with all the complex regulations on how to get paid and how to stay compliant," he emphasized.

Recently, the vendor launched a service supporting the Medicare Chronic Care Management program. This value-based care model encourages practices to provide care management services to at-risk patients.

"It's very hard if you're a three-doctor practice to hire care managers with the specialization they need," said Brient. "You just don't have the scale to do it."

However, the emerging service from athenahealth provides practices with care managers.

"The patients have someone to talk to in their care manager, so when they come into the office, they're much better informed," said Brient. "It allows the physician to spend the time on any course corrections, not talking about what they talked about last time."

EHR optimization

In addition to its RCM services, the vendor is integrating AI and machine learning into its software to automate administrative tasks and give providers more time to deliver patient-centered care.

For instance, the vendor uses AI to deduplicate medicine histories that it receives from Surescripts and other health information networks.

Previously, staff would sort through patient medication histories to remove old prescriptions and decipher which medications were current. However, AI can quickly find the most current medication information and present it to the provider.

"It's not rocket science, but computers have a hard time doing that," Brient said. "AI does it really well."

The vendor is also using AI to automate front-office tasks like insurance card capture. Instead of manually typing in the patient's health insurance information from their insurance card and selecting the correct insurance package, front-office staff can scan the card, and the computer will choose the correct insurance package.

Brient said the vendor will also soon offer ambient documentation services, which will allow providers to automate draft clinical documentation.

"The computer will listen to the physician and the patient talk about the visit, and then the computer will generate a note and, in some cases, code the encounter and actually provide orders," said Brient.

"It is all about focusing on that user experience, trying to make it as delightful as possible, and really allow the physician to focus on the patient," Brient emphasized.

Enhanced interoperability

To eliminate information overload, athenahealth is also focusing on optimizing EHR workflows.

"In the last craze of interoperability, it was all about getting data from one place to the next, but what it did is it put a whole bunch of burden on the providers to then reconcile the information," said Brient.

According to a 2024 survey from athenahealth conducted by The Harris Poll, 63% of physicians indicate that EHR information overload adds to their stress levels.

"If you go to the hospital and you're sick, your medical record is long," said Brient. "If you then go see your primary care doctor, they do not care about your blood sugar every four hours on day three of your seven-day hospital stay. It's just irrelevant."

By using AI to reconcile data from various sources, athenahealth gives providers control over which information the EHR adds to patient records. Providers can control which data is brought into patient charts from outside networks, helping to avoid information overload.

"If there's a special circumstance where they need to know what your blood sugar was on day three, they can click a button and see the whole thing," Brient pointed out. "We think it's the logical step in interoperability, and we're super proud of it."

Hannah Nelson has been covering news related to health information technology and health data interoperability since 2020.

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