Justifying the Purchase of an AIMS System

1
Justifying the Purchase of an AIMS System

• Maria Galati, M.B.A.
• Vice Chair, Administration
• Department of Anesthesiology
• Mount Sinai Medical Center

2
Justifying the Purchase of an AIMS System

• Preparing a Justification
• What you should consider
• Qualitative and quantitative elements for
  convincing decision-makers

3
Perceptions The Use of Electronic Medical
Records (EMRs)

• Forty (40) of Internet users surveyed
• Assume physicians and hospitals used EMRs
• Industry observers estimate
• lt 10 of physicians and lt 20 of hospitals use
  EMRs
• Source MGMA, e-Connexion, Connecting for
  Health Survey, July, 2003
  

4
Justifying an AIMS System

• Do your homework
• Research the opportunities and threats
• Quantify where possible
• Convince the decision-makers
• Identify key stakeholders
• Institutional-wide (IT/MR/Hospital/Risk
  Mgmt./Physicians)
• Interface partners (Lab., OR, Admitting, MR,
  Bill. Vendor)
• Identify/involve project champions
• Know decision-maker priorities

5
Opportunities and Threats

• Implementing An AIMS requires
• Planning (selection, implementation, maintenance)
• A major capital investment (CON, capital budget)
• A change in organizational culture
• Champions w/support at all levels of the
  organization
• A learning curve
• A backup system

6
Convincing Decision-Makers

• Categories of justification
• I. Qualitative Elements (reflect your mission)
• Clinical Quality of Care
• Safety, accessibility, performance improvement
  tool
• Periop. Efficiency and Staff/Patient Satisfaction
  tool
• Academic Teaching Research
• Tool for tracking ACGME-related activity
• Residency training differentiator
• Data mining resource (Anesthesiology )

7
Convincing Decision-Makers

• Categories of justification
• I. Qualitative Elements
• Strategic
• IT Plan
• Philanthropy
• Competitive Advantage (Examples)
• Decentralization (QHN HC Info. Mgmt. Sys. Soc.
  Award)
• The LeapFrog Group Fortune 500 CEOs
• Computerized drug order entry standards
• Insurers responding with reimbursement bonuses
  (Empire BC/BS 3)
• Institute of Medicine Quality Report
• Recommends building information infrastructureto
  eliminate most handwritten clinical data.

8
Convincing Decision-Makers

• Categories of justification
• II. Quantifiable Elements
• Income production
• Cost avoidance
• Compliance
• Regulatory
• Billing
• Management Tool

9
AIMS Income Production

• Difficult to track a precise return on tech
  investments but investments paid for
  themselves. Dr. S. Safyer, Montefiore Chief
  Med. Officer
• Return on Investment (ROI )
• Income_________
  
• Book Value of Investment
• Source Crains NY Business, Few Hospitals Take
  Their Medicine, April 21, 2003

10
Income Production Billing Automation

• Income Opportunity
• Improved data capture
• Charge lag reduction
• Timely case capture
• Demographic interface

• Metrics (Manual Sys. Inefficiency)
• Missed revenues (costs) from
• Lag from DOS to bill generation
• Delayed/incomplete billing vouchers
• Insurance verification errors/labor costs

11
Income Production Billing Automation

• Income Opportunity
• Charge lag reduction
• Example 1 day reduction in charge lag
• 25m 4mo. Avg. GC
• 83 business days

• Metrics
• Average (GC) gross charge/day
• Gross collection
• 300,000 Avg.GC/day (45)
• 135,000/day
• one time revenue increment

12
Income Production Billing Automation

• Income Opportunity
• Improved data capture
• Revenue Capture
• Complete case capture
• Perioperative time span
• Concurrency avoidance
• Monitoring/modifier capture
• Informed managed care contract negotiation

• Metrics (Manual Sys. Inefficiency)
• Missed revenues (costs) from
• Reliance on provider input
• Missing billing vouchers
• Pre/post op work unit capture
• Non-synchronized clocks
• Provider diligence
• Bargaining mix trade-offs (bundling and caps on
  monitoring units)

13
AIMS Cost Avoidance

• Metrics Labor and Vendor costs
• Pt. demographics entry
• Manual record filing/collation
• Form printing costs
• Front-end processing
• Space/manual storage systems
• Microfilm/fiche/copy costs
• Confidential record disposal costs

• Opportunity
• Billing overhead reduction
• Record storage/retrieval
• NYS medical records law
• 6 yrs. gt discharge
• 3 yrs. gt pt. age of majority (18 Yrs.)
• 6 yrs. gt death
• Malpractice premium reduction?

14
AIMS Compliance Tool Regulatory

• Mandate
• HIPAA privacy stand. (4/03)
• Enforcement rules (interim 5/16/03)
• Civil penalties (25k/yr/req.)
• Criminal penalties (w/knowledge)
• JCAHO/State Health Depts.

• Opportunity
• Access on need to know basis
• Password security/auditing
• Record legibility
• Esig assures easy retrieval of legally
  reproduced form
• Instant anesthesia record updates/regulatory pop
  ups

15
AIMS Compliance Tool Billing

• Mandate
• Billing Compliance Audits
• P.A.T.H. compliance
• Medicare carrier audits

• Opportunity
• Physical presence documentation
• Consistent start/stop times
• Attestation statement
• Legibility
• Level of service support
• Efficient record access
• Esig

16
AIMS Management tool

• Opportunity
• Physician productivity
• OR efficiency
• Operating cost tracking

• Application
• Customized RVU system
• Physician compensation system
• Defensive benchmarking
• Perioperative time interval measures
• Drug/supply utilization by case/provider
• Drug/supply charge capture

17
Summary Justifying AIMS

• Implementing an AIMS requires a large financial
  outlay, careful planning, coalition building and
  ongoing TLC.
• Successful justifications consider an
  institution-wide view citing the qualitative and
  quantitative payback opportunities.