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Solving revenue capture for POCUS - The importance of workflow management

by Gus Iversen, Editor in Chief | November 30, 2020

HCB News: We understand you implemented Synchronicity during the pandemic - how was that experience?
Dr. Hipskind: Any Informatics install can be painful. With Covid-19 and the onsite implementation moved to on-line implementation support from Sonosite. The day we went live, we went live with Synchronicity and turned off the old system. We had a few issues but worked through them. Great communication with Sonosite support. We are months post the go-live and still have very good support.

HCB News: I hear you speaking a lot about the difficulties of the old workflow system but I’m wondering where the decision came from to replace it. Were issues of QA and barriers to communication the most important pain points for the decision-makers?
Dr. Hipskind: Well in our case we had a product that was going to be sunsetted, so we had to decide whether to upgrade with that company or move to a different workflow system altogether. Compounding some of the drawbacks I’ve discussed, we had always had a difficult time getting the IT support we needed—the sense I got was that the customer assistance wasn’t all that sophisticated. Frustrations like those might not rise to the awareness level of hospital administration, although they would certainly pay attention to something that’s making care more difficult, or impeding our training mission. I think the most compelling reasons we shifted to Synchronicity was its potential impact on patient care, reimbursement capture, and overall revenue—in particular through the reduction of “phantom scans.”

HCB News: What are those?
Dr. Hipskind: Those are scans that are performed, and which often drive clinical decisions, but are never archived or sent out for reimbursement due to gaps in documentation.

While it’s hard to measure a negative, I’ve seen the percentage of phantom scans estimated at something near 80% at some sites, and for us in the ED here it was about 25% before we switched systems.

HCB News: What exactly does the new system do to help you improve that revenue capture?
Dr. Hipskind: Well unlike many hospitals, we have always billed for ultrasounds. But there’s also always been a huge barrier to that process because the documentation requirements are so complex. Why was the screen done? What was seen? Was the image stored, and can you prove it hits all these other data points to qualify for reimbursement? Without all of those data points, the chart will be incomplete and you’ll be ineligible for payment. And these aren’t something you can memorize and jot down for later; the key to reimbursement, we’ve learned, is to have as many as possible of those questions asked and answered at the bedside.

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