ED technology returns over $6 million in just two years

More accurate paperwork yields large increase

Greenville (SC) Hospital System University Medical Center has been able to achieve a return on investment (ROI) of more than $6 million in two years by using technology to more efficiently capture charges.

The ED PulseCheck (Picis; Wakefield, MA) helped the department increase billable charges and decrease denials with improved documentation, while saving considerable money through the elimination of paper and related products, says Susan Jarvis, RN, MSN, director of nursing in the ED at Greenville Memorial Hospital, which handles the vast majority (87,000 a year) of the system's emergency patients.

"We realized a $6.1 million ROI," says Jarvis, who says that the system went live in October 2004. Improved documentation and more accurate billing based on that documentation were the keys to this financial return, she says.

The hardware itself cost $250,000, because the department had not been automated at all, she says. "Then, we paid about $1.2 million for the software license and maintenance costs — some of which came out of the IT budget," Jarvis notes.

Charlene Ertzberger, system administrator for all four EDs in the Greenville Hospital system, says, "We were able to bill out $22 million more and netted $7 million," Ertzberger notes that the standard return on charges for EDs nationally is 30%. "We saw a reduction in scanning costs of $152,982, a savings of $17,000 in copy paper, and $14,238 for [paper] ED records," she says. In addition, the two full-time staff members who had been used to handle scanning duties were reassigned to other roles in medical records such as filing or sorting, she says.

The nursing and physician documentation modules, as well as a patient tracking system, have been in place since the first year, notes Ertzberger. More recently, she says, computerized physician order entry (CPOE) has been added.

Saving time and money

Prior to implementing the technology, the ED used a nonautomated method of documentation. "It was a template system," Jarvis explains. "The doctors would pull a template based on the patient's complaint, and the nurse would document and complete the charge sheet for supplies and so forth."

The system was "horrendous," says Ertzberger. "We had to get the charts together, separate the pages, bundle them up, and transport them by courier," she says. Next, a third-party coding company would have to read each page, try to decipher the handwriting, look at the charge sheet, and then determine what should be charged for, Ertzberger says.

"We often had lost charges from late billing," says Ertzberger, noting that her ED has only six days to 'drop' a bill, as required by her hospital's policy. "Over weekends there could be delays, and charges also had to be sent to different parts of the state," she explains.

Now, says Jarvis, all of that paperwork is automated. "If you document, for example, a Foley catheter insertion, the system will appropriately generate your charges," she says. The coders still looks at the charts and double-check them, but they do it online. "It is simply a verification process, instead of reading the entire chart and doing coding from that," Jarvis explains.

The nurses will document based on templates for different types of complaint: one for chest pain, one for laceration, etc., Ertzberger says. "Based on which boxes they select to document treatment, the system adds up different fees, such as supplies [and] professional and facility fees." As systems administrator, Ertzberger set up the different charges so they would be appropriately entered automatically as the documentation was completed.

The only way an error can occur, Ertzberger says, is if a staff member accidentally hits the wrong box, "But the [outsourced] medical coders still review the charts for accuracy," she says.

Ertzberger, who trained all department personnel, says the ED staff took to the system quite easily. "The nurses, physicians, and secretarial staff were all trained to do tracking, documentation, and order entry, which was broken up into stages [for the different applications]," she recalls.

Each group was trained separately. "Naturally, doctors and nurses received more training for documentation than the secretaries did," says Ertzberger, adding that the documentation course alone took two hours.

"As with any change, people were initially hesitant, but they became enthusiastic almost as soon as they started using it," she adds.

Now, says Jarvis, people complain when the system has to be shut down temporarily for monthly maintenance. "They feel lost without it," she says, despite the fact that some doctors think it takes a bit longer to document using the new system.

"There is a bit of a learning curve, as there will be with CPOE," she admits, "But I think that will yield an even bigger ROI."


For more information on automated billing and documentation, contact:

  • Charlene Ertzberger, System Administrator; Susan Jarvis, RN, MSN, Emergency Department Director of Nursing, Greenville Memorial Hospital, Greenville, SC. Phone: (864) 455-7000.

For more information on the ED PulseCheck system, contact:

  • Picis, Wakefield, MA. Phone: (781) 557-3000. Fax: (781) 557-3140. Web: www.picis.com.