Founded in 1973 to serve the residents of California’s North San Diego County, Tri City Emergency Medical Group has a long history of enhancing patient care through the development and use of state-of-the-art technology. Tri City’s forward-thinking emergency physicians were among the first in the nation to use bedside ultrasound to evaluate emergency patients, and more recently they developed a unique medical scribe program in which pre-med students assist with electronic record keeping and documentation.
Although the doctors’ attention is devoted to delivering excellent patient care, they recognize that if the medical group’s finances aren’t in order, their ability to continue serving patients is compromised. Therefore, they’ve charged their business office with employing the best people, processes and technology to optimize the revenue cycle and ensure the profitability of the practice.
Recession Brings Reimbursement Challenges
“The tough economy and changing California regulations have made it more and more difficult to collect payment in a timely manner,” explains Sue Kruger, Office Manager at Tri City. “Medicare and Medi-Cal pay only a fraction of the fee for emergency services, people who’ve lost their jobs and their health insurance oftentimes can’t pay for their care and private payers sometimes drag their heels.”
She notes that the group’s physicians treat an average of 6,000-7,000 patients a month. In terms of Tri City’s revenue:
- 27% comes from Medicare patients.
- 17-18% comes from Medi-Cal.
- A little over half comes from private insurers and self-pay accounts.
“Our employees have to work much harder to collect the same percentage of payment they did three or four years ago,” says Kruger. “If we didn’t have a paperless system, we’d absolutely have had to hire more staff.”
Integrating Content Management with Practice Management
After transitioning to a new practice management system—CPU’s MED/FM—in 2003, Tri City began thinking about how to get even more value out of that system. When CPU introduced an integration with Laserfiche enterprise content management (ECM), Tri City jumped on board.
“Handling paper was a big expense that slowed our staff down,” says Kruger. “Our doctors recognized that purchasing Laserfiche would pay off in terms of staff productivity.”
J.R. Juiliano, Tri City’s IT Manager, explains, “We scan everything that’s related to patient encounters into Laserfiche. This includes demographic information, dictations, EOBs and correspondence from insurance companies.”
He notes that the hospital sends information to the medical group via an FTP site. “In the past, we just printed everything onsite.”
This, of course, was problematic on many levels:
- It was expensive.
- It was difficult to store.
- It was tough to retrieve in a timely manner.
“We have to keep patient information for seven years,” says Juiliano. “We used to rent four storage units at a facility that’s ten miles away. We kept a year’s worth of records onsite in a big filing room, but somebody had to go over to the storage units at least once a week.”
Kruger adds, “Efficient medical billing depends on keeping people in their seats so they can be productive. Manual tasks like retrieving paper records just aren’t the best use of employees’ time.”
Today, Tri City automates the document capture, indexing and filing processes with the following tools:
- Laserfiche Snapshot converts the electronic documents from the hospital’s FTP site into TIFF images and processes them using Laserfiche Quick Fields, a high-volume document capture and processing tool that automatically extracts metadata from the documents and files them in the Laserfiche repository—no printing or scanning required.
- Laserfiche Quick Fields also scans and processes paper EOBs and correspondence from insurance companies. Using optical character recognition (OCR), Quick Fields converts the scanned images into editable and searchable text, extracts metadata and files the documents in the repository.
- Laserfiche Import Agent captures and processes electronic faxes.
Verifiers, coders and payment entry staff work with dual screens, so they’re able to view a document on one screen while performing data entry into MED/FM on the other. With the MED/FM integration, documents are automatically attached to the appropriate patient records in the practice management system. When employees type a number into a specific field in MED/FM, Laserfiche opens the corresponding document. This ensures that employees don’t have to launch Laserfiche or toggle between screens to retrieve the documents they require.
Kruger explains that the integration keeps her staff in their seats. “Laserfiche makes our staff so efficient that we haven’t had to hire more people. In fact, we haven’t even replaced everyone who’s left.”
Visibility = Productivity
Documents—whether scanned or electronically imported—are time-stamped when they enter the Laserfiche repository so that the management team can measure staff productivity. Kruger explains, “If something comes in at eleven but doesn’t get finished until 4:30 pm, I can go to the person and ask, ‘What were you doing for those five and a half hours?’”
Juiliano appreciates how easy it is to run and store reports in Laserfiche. With Laserfiche Audit Trail, a monitoring and reporting tool, Tri City can create summaries of all actions taken on a particular document or record, making it much easier to prove compliance with HIPAA. “We can see who changed what when, where and why,” he explains.
In terms of other types of reports, Juliano says, “We run a lot of reports—collections reports, month-end reports, weekly reports. Even if we don’t run the report in Laserfiche, we store it there, which makes it easy to access and compare historical data with present trends.”
Lisa Newland, Tri City’s Assistant Manager, notes that the group’s RAC audits have gone smoothly thanks to Laserfiche’s instant search-and-retrieval capabilities. “Being able to instantly pull the information the RAC auditors want to see makes life so much easier than digging through filing cabinets or storage boxes.”
All in all, says Kruger, “Laserfiche is a great product. I don’t know how we ever got along without it.”