What is the return on investment (ROI) for participating in a health information exchange (HIE)?

Simply stated, ROI measures the benefit (or return) an investment generates in relation to the cost of the investment. The HIE ROI answer is different for each organization.

While the ROI calculation can be framed in financial performance terms – if it costs XX to participate in the HIE, what is the dollar return to a practice or facility?

ROI value can also mean increased productivity and efficiency, minimal disruption to workflow, and improvements in care. Or, for a facility, ROI can mean improvement in risk adjustment scores and quality metrics.

 

 

Physicians – let’s talk about your ROI from HIE participation!

  • Patient records are up-to-date;
  • Lab work and medications are current;
  • Increased efficiency for physician and staff.

Your office may save 15 minutes per patient per day which means one additional patient may be seen daily.

This benefit compared to the HIE investment costs may potentially realize a gain of $1.30 for every $1.00 invested in Year 1. In Year 2 and thereafter, the practice may realize a gain of $9.00 for every $1.00 invested.

SHINE can help you do the math to see what gains might be achieved for your practice!

SHINE provides physicians with the tools to:

  • Utilize patient panel and population health analytics in a meaningful way;
  • Effectively transition to a value-based payment model; and
  • Support efforts to meet requirements for MIPS/APMs.

 

Hospitals – let’s talk about your ROI from HIE participation!

Better care. Access to more complete, longitudinal patient data in the HIE results in better clinical assessment and care planning because:
  • Patient records are up-to-date
  • Problem list complete
  • Lab work, vitals and medications current

Improved revenue. The opportunity to capture significantly richer clinical documentation enables coding that more accurately reflects severity of patients’ conditions, which can result in improved revenue through higher case mix index (CMI) and risk adjustment scores (RAF).

By including HIE data, one medium-sized PPS hospital recently participated in a retrospective study which demonstrated the potential for an average CMI increase of .44 though better coding, which would have represented an increase of $90,000 in MS-DRG payments annually. That same hospital could also have documented a 75% RAF increase for its Medicare Advantage patients, resulting in significantly higher revenue. The potential financial benefits far outweigh the cost of HIE participation.

Patient ROI

Physicians can be influential when it comes to a patient’s healthcare data and encouraging them to securely access their information to improve health outcomes. SHINE participating physicians, hospitals, and other healthcare-related entities, can share patients’ health information through a secure, electronic health information network.

The Physician/Patient Relationship ROI

SHINE provides tools to enhance the physician/patient relationship:

  • Access patient information in a timely, secure manner to improve patient visits;
  • Improve care coordination and patient safety;
  • Increase physician/patient communication.

 

SHINE participation gives your patients a simple and secure place to find all of their health records in one place, any time. It’s called myMOHealtheRecords.

Go to myMOHealtheRecords

 

Frequently Asked Questions?

It is the ratio of the benefit derived from an investment versus the cost of an investment. It can relate solely to financial benefits, or can be viewed in terms of intangible benefits.

ROI is a key performance indicator often used to determine the benefit of an expenditure. It is useful for measuring success over time and taking the guess work out of future business decisions.

When physicians access HIE data they access a patient’s longitudinal history, and may review medical appointments or incidents the patient has experienced in other clinics or hospitals, study all medications prescribed to the patient, and learn the patient’s results from lab tests or x-rays. This level of increased information, found in one place, may lead to enhanced patient encounters, more effective coordination of care, efficiencies in workflow and productivity for the physician and the staff, and cost savings in staff time and expensive medical tests and labs. Time saved by the physician and staff may allow the scheduling of additional patients in a day or in a work week.

For example: 15 minutes saved in gathering 1 patient’s medical information = 15 minutes that could be utilized in scheduling one additional patient a day. $50 (1 additional appt. per day) x 5 days x 40 weeks = $10,000 annually. In a 3-physician practice, the amount is $30,000 in annual revenue.

HIE fees for a small practice are approximately $3,000 annually with an initial $10,000 EMR integration expense to establish the necessary interfaces. Doing the math means in the first year, the practice could realize $17,000 ($30,000 annual revenue increase minus $13,000 HIE investment) or a ROI of $1.30 for every $1.00 invested. In year two, $30,000 annual revenue increase minus $3,000 annual HIE fee = $27,000 realized increase, or $9.00 for every $1.00 invested.

ROI for a hospital is more complicated to determine. Through the HIE, the facility utilizes longitudinal patient data to deliver better care, so patient records are up-to-date and the problem list more complete, and the patient’s lab work and medications are complete and current.

The opportunity to capture significantly richer clinical documentation enables coding that more accurately reflects the severity of patients’ conditions, which can result in improved revenue through higher case mix index (CMI) and risk adjustment scores (RAF).

By including HIE data, one medium-sized PPS hospital recently participated in a retrospective study which demonstrated the potential for an average CMI increase of .44 though better coding, which would have represented an increase of $90,000 in MS-DRG payments annually. That same hospital could also have documented a 75% RAF increase for its Medicare Advantage patients, resulting in significantly higher revenue. The potential financial benefits far outweigh the cost of HIE participation.

To receive more information regarding the exchange of health information in Missouri please contact Jonathan Smith 844.424.4370 or email jsmith@shineofmissouri.com.

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