The not-for-profit Health Care Cost Institute recently published a report analyzing employer-sponsored insurance claims for the five ED procedure codes used to bill for ED visit facility fees. Over the seven-year timeframe of the study, the researchers reviewed more than 11.8 million procedure code claim lines per year, representing more than 4.7 million patients.  

During the study period, ED visit spending per person rose 98%, despite the overall ED use remaining the same. The average price of the facility fee claim was also up 98% over the same timeframe. A possible cause of the increase was a noticeable shift in the classification of severity of ED cases. For example, the number of cases receiving the most severe rating (a level 5 on a scale of 1-5) rose 38%, with the price of that code increasing 77%. At the same time, the use of the lowest-acuity code (level 1) fell 41%, although the price for that code grew 47%.  

Additionally, the average price of a facility fee claim in 2009 was $452, while in 2016, it was $894, a 98% increase. Again, all of these changes and increases occurred while overall use of ED remained the same. 

In response to these increases, insurance companies are taking drastic measures. For example, UnitedHealth Group instituted a new nationwide policy for more closely scrutinizing and adjusting facility claims for the most severe and costly ED visits for patients enrolled in its commercial and Medicare Advantage plans. National insurer Anthem took it one step further, denying coverage for visits to the ED that it determines were not for “true emergencies,” sparking an outcry from hospitals worried that this policy will ultimately harm patients and ED providers. 

The significant cost increases, along with the subsequent reactions by insurance companies, make it imperative for hospitals and EDs to review their operating statistics in more regular, shorter timeframes, ensuring that all staff fully understand and abide by standard operating procedures, especially when it comes to the acuity classifications. Identifying areas of concern or trends can help a hospitals adjust its training and procedures to ensure patients are receiving the more accurate classifications. 

Additionally, accurate recordkeeping can help ensure that all audits fully reflect the current needs of the ED, ensuring that the team is fully staffed so that nurses and physicians have the time and resources needed to accurately classify cases coming in their doors.  

An overall effort to reduce ED costs and increase efficiencies can give hospitals more of a buffer to adjust to changes implemented by insurance companies. New technologies, like bidirectional data-sharing software, make these tasks easier and more efficient for hospitals, allowing easier review of statistics along the full spectrum of care, from first response to discharge. Rather than having to dig through and analyze piles of paperwork, digital patient records and case notes are easily sorted and compiled, making reporting easier and more accurate. Hospitals and EMS agencies can share information between their two organizations to help improve patient care and outcomes, and increase efficiencies as well.   

As insurance companies begin to tighten their belts to battle the increasing ED costs, hospital providers can be prepared and mitigate the impact by keeping more accurate records and identifying areas where procedures can be improved – specifically in classification of cases – to ensure that they are always able to provide the best care to patients experiencing true emergencies. 

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The truth is that many of the aspects of SaaS lend themselves quite well to use in the health care and emergency response industry, thanks to increased reliability, easier access, and lower upfront costs.

What exactly is SaaS?

SaaS is a term used to describe any Web-based software tools and data storage solutions that can be accessed remotely from any device, anywhere. Technically, SaaS differs from the commonly used term, “The Cloud,” because the cloud is the virtual location itself where SaaS tools live –usually a collection of computers, servers, and databases connected to allow users to share their combined power. The other two well-known cloud services are infrastructure-as-a-service (IaaS) and platform-as-a-service (PaaS).

Before the growth of SaaS tools, you typically had to purchase and install new software for your business onsite, with hardware that you had to buy and maintain, and licenses that you had to purchase full-out (with additional 15-20% annual maintenance and support fees).

With SaaS, however, you now can typically buy a yearly membership and simply log in to existing user tools that the SaaS provider hosts and maintains remotely. This means the worry and cost of maintaining the hardware and software versions falls on the shoulders of the provider. Additionally, many SaaS providers spend more money to ensure a higher degree of data security than most small or medium organizations could afford themselves, making SaaS solutions more secure. Most SaaS vendors also undergo stringent security procedures and audits that regularly test their data centers’ levels of security.

Benefits of SaaS and Cloud Technology for First Responders

Today a wide range of SaaS-based software tools are available for first responders, and offer benefits such as:

Improved Communication Between Providers:

Hospitals and EMS agencies are increasingly moving to the use of electronic patient care records (ePCRs) to make patient’s information easier to access, more accurate, and more streamlined throughout the care spectrum. A record can be started by an EMS agency and handed off in the emergency department, then on to nursing and physicians. This not only saves time for all providers, but helps ensure everyone is operating on the most updated information.

Additionally, other software tools allow hospitals to more easily share patient outcome data back with EMS agencies, allowing them to close the loop and provide real-world learning opportunities that help improve pre-hospital care. EMTs can see if their impressions were accurate, what they missed, and even see ways to improve procedures.

More Accurate Properties and Inspection:

Software tools with built-in inspection checklists can help improve community safety by ensuring your property and inspection records are more complete and updated, and easily accessible when needed. Progressive forms built into your inspection software can identify any mistakes or omissions as the form is completed, while scheduling functionality allows the inspector to schedule any follow-up appointments on site.

Additionally, access to digital reference libraries can make inspections more efficient as well. Once recorded, your digital inspection records stored via SaaS can be accessed for a wide range of uses, including during incident response. Your teams can access floor plans, photos, locations of hazardous materials, and even driveway and parking information to help create a more effective response plan.

More Informed Dispatch and First Impressions:

For fire departments, the use of SaaS makes it possible to deploy your software tools to your busses and fire engines, better equipping your team out in the field. With remote access to various reference databases and fire codes, it’s easier than ever to ensure impressions are as accurate as possible. Additionally, built in features like drop-down terminology menus and progressive forms that alert the user to mistakes, your ePCRs are more likely to arrive at the hospital complete and ready to be handed off with the patient.

Easier Analytics and Reporting:

Clean, robust data is key in decision-making, reporting, and planning. Being able to easily access and cross-reference data for your department or agency helps you not only paint an accurate picture of your operations, but is helpful in budget planning, QI projects, and even public relations campaigns. Additionally, you most likely need to report regularly to a collection of state and national organizations; digital data stored securely in SaaS help ensure you are always ready to report when needed. Finally, many grant applications require data giving insight into your organization over months or even years. Being able to easily collect and process this information with analytics software makes your agency operations more efficient and transparent.

More Efficient Billing and Patient Follow-Up:

Whether you are tracking patient billing or ensuring that care coordinators contacting patients post-discharge have all the pertinent information, a robust digital record keeping system that is easily accessible helps ensure more efficient and productive work. The ability to access complete patient information creates more productive communications and cuts down on the paper work for your staff. Digital records also help reduce human error, as some fields can be automatically ported over from documents like incident reports. Additionally, reliable, easy-to-use records systems help expedite reimbursements for your agency.

Optimized Personnel Management:

From ensuring your employees’ vaccinations are up-to-date to managing continuing education and training hours, software tools can save you hours of work. With an increased focus on addressing PTSD as well as exposure to hazardous materials and viruses, employers can find practical ways to improve the health and well-being of their employees by setting alerts on specific conditions and incidents. Digital, SaaS-based software for personnel management built specifically for first responders can alert you on a wide range of needed personnel follow-up actions, increasing safety and ensuring compliance.

As the world becomes more digitally connected and technology-based, it makes sense that the recording and maintenance of the massive amounts of data involved in heath care follow the same path. Thanks to SaaS solutions, this future is becoming more affordable and efficient for all providers at every point along the care spectrum.

To learn more about software tools designed specifically for EMS and for Fire Response, visit eso.com.

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As a result, technology leaders are investing more time and brain power into developing new tools that help close the gap between patient care and the provider’s view of the big picture, leveraging data sources that continue to grow at an exponential rate. Today’s “smart” products are prolific in the private sector – from watches that record a person’s health habits, to voice-activated digital assistants in the home that can deliver a wide range of information at a moment’s notice.  

It makes sense, then, to investigate how similar smart technologies and analytics can be implemented in healthcare, looking at ways to make procedures and practices more effective and efficient by leveraging the large amount of patient-centric data floating around. This available info, however, can be overwhelming, pouring in from countless different data sources. To be made useful, it must be augmented and combined into easy-to-process views that can help drive decisions through powerful analytics tools. 

The availability of healthcare data –and the proper tools to process, analyze, and share it – can improve efficiencies and patient experience throughout the healthcare spectrum. The future for both patients and providers promises to be significantly more seamless and efficient. For example: 

• More Efficient Patient Records: Hospitals face no shortage of data and patient records. From admission to discharge, then on into billing, pages and pages of a paper trail have historically followed a patient throughout his or her journey. Today, electronic patient care records (ePCRs) – built and maintained with Electronic Health Record (EHR) software – are gaining momentum, making it easier for providers to access, update, and share important patient information. 
• Data, Starting with First Responders: Thanks to mobile technology and open platforms, ePCRs can essentially be started by the first responder, who can gather basic information as well as first impression from the incident. Customizable digital forms can be created to be specific for the most common or time-sensitive health conditions – such as stroke assessment – to ensure that the most important questions are answered and recorded at each and every call. 
• Easier Hand-off at the Emergency Department: In the rush of the arrival at the emergency department, digital (and more complete) patient records reduce the hand-off time from EMS to hospital staff, allowing all teams to operate more efficiently and focus of the job of assisting the patient, rather than having to be brought up to speed or completing the same questions again. Physicians can easily pull up all information on the patient, rather than having to call down to the records department for paper copies. This lightens the workload across the spectrum. 
• More Efficient Shift Changes: In the same way, nursing staff – who research shows are chronically overworked – can spend less time at shift change, knowing that all data in the ECPR is updated and reflective of a full-patient history. This allows the new shift to jump into action right away, and the outgoing shift to leave on time, promoting better rest between shifts and increased safety on the commute home. 
• Lightened Workload on Records Staff: In the past, hospital record staff faced a seemingly endless mountain of paper records that had to be reviewed, inputted, and saved. By utilizing ePCRs, this workload is greatly reduced, increasing efficiencies and staff satisfaction, even reducing the number of stress-related sick days taken by staff. Records that are already in a digital format, and that can be easily reviewed and updated, allow employees to focus on new initiatives and improving the workflow across the records and billings process. 
• Better Patient Follow Up: Once a patient is discharged, their health journey is obviously not over. A major cause of concern for healthcare providers (and cost for insurance companies) is readmissions. Today, many insurance companies employ specialists (often nurses) who contact recently discharged patients to ensure they understand all facets of post-hospital care, from their medications to their follow-up appointments. By leveraging healthcare analytics tools that aggregate population information for a specific geographic location, the follow-up specialist can obtain a better understanding of the socio-economic factors any given patient may be facing that could complicate his or her recovery. This demographic information can lead to a more informed conversation, and awareness of red flags. 
• More Communication Between Providers for Improvement: New record-sharing software tools allow hospitals to share back information with first responders and EMS teams to evaluate performance and identify areas for possible improvement. The opportunity to openly communicate and review cases and statistics promises to not only improve efficiencies, but patient outcomes as well. This sharing of information may very well help identify new assessment criteria for various diseases and help first responders gather information earlier in the process that providers down the line may urgently need. This data can also help ensure proper state and municipal funding for Fire Departments and EMS agencies who must complete audits and reviews on a regular basis. 
• Improved Identification of Areas for Future Healthcare Growth: From analyzing the number of providers in a geographic location, to seeing what the most common ailments or risk factors are in a city or county, healthcare data can help providers understand the best and most needed areas for growth. For example, a specific city may see a high number of age-related diseases or conditions due to the average age of its population. This knowledge can help hospitals not only staff their facilities correctly, but can help healthcare providers identify locations where their specific services may be most in need. 

The bottom line is that the data is there, and only promises to keep increasing. By investing time and money into the proper tools, healthcare providers can harness the power of this available information to achieve the Triple Aim and improve all facets of healthcare. 

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