Outsourcing and HIM Issues Pros Cons Don Asmonga

Outsourcing and HIM Issues, Pros & Cons Don Asmonga Director, Government Relations April 16, 2004

Who Am I? • • • Donald D. Asmonga, MBA Director, Government Relations With AHIMA since February 7, 1994 Capitol Hill Veteran Policy & Government Relations Team: – Dan Rode, VP of Policy of Government Relations – Sue Prophet, Director of Coding Policy & Compliance – Jean Schlichting, Senior P&GR Coordinator

Who Is AHIMA? • • • Founded in 1928 Health Information Management (HIM) Professionals 47, 000+ members nationwide 52 Component State Associations 8 credentials (CCA, CCS-P, CHS, CHPS, RHIT, RHIA) Directors, managers, privacy officers, coders, educators and more… e. HIM Over 230 HIM & HIT programs nationwide WWW. AHIMA. ORG

Outsourcing What is it? • Functions performed by personnel or staff not in the employ of the service provider Examples: • Medical transcription • Coding & clinical evaluation • Claims processing • Editing • Adjudication • Call centers • Data storage • Other data processing tasks

Outsourcing Background Information: • Nearly half of all transcription is outsourced to specialized vendors. • From 1998 -2003: IT software and services spending grew from $2. 5 billion to $10 billion (ITAA, ES, the Impact of Offshore IT Software and Services Outsourcing on the U. S. economy and the IT Industry, March 2004) • $20 billion market for US medical transcription--$40 million to India. (. 2%) • 30% of Medical Transcription Industry Alliance (MTIA) members have international operations. (www. mtia. com) • Dept. of Labor projects that 97, 000 new health information technicians will be needed by 2010.

Outsourcing Background Problems: • University of California at San Francisco Hospital – Sub-sub contractor in Pakistan threatened to post confidential files on web unless paid. (was paid) • Only one incident in millions of patients in California • Heartland Information Services – Extortion attempt by employees in Bangalore, India. Reveal confidential information unless provided cash payment. (caught, arrested & awaiting trial)

Outsourcing (Con) Primary Concerns: • Privacy – Overseas access to US protected health information. Entities beyond the reach of HIPAA • Economics – Loss of US jobs and businesses • Technology – Ease of transfer of information

Outsourcing (Pro) Why Outsourcing is Necessary: • Not enough qualified transcriptionists. Demand has increased dramatically. – More information required – Electronic health records • Demand for quicker turnaround times. From 48 hours in years past to 4 -6 hours, or shorter. Why? – Improve patient care/reduce medical errors – Tightening of standards of accreditors and regulators – Desire to deter malpractice litigation

Outsourcing (Pro) • Prompt payment and pressure from payers – More detailed documentation – More transcribed documentation: ER reports, clinic notes, daily progress notes, physician office records, etc… • Cost Reduction – Cheaper rates per line

Outsourcing Outlying Issues: • Privacy – How do we reach those not covered by HIPAA? • Workforce – Workforce development & training needs to be addressed to meet current and future demands – Any law that restricts outsourcing MUST make provisions for workforce training • Time – Turnaround time: speed of processing

Outsourcing Outlying Issues: • Information and Communication Technology (ICT) – New technologies enhance security: technology, strong policies, training and monitoring – Adoption of ICT to increase quality, safety , and cost effectiveness. Examples • Electronic health records • Voice recognition technology • Artificial Intelligence engines to scan text documents and assign billing codes • Direct entry of data by clinicians via templates – Technology will change professions • e. HIM

Outsourcing Outlying Issues: – Questions? • How fast can we have these technologies? • How fast can the industry facilitate an assimilate these technologies? • Adoption of ICD-10 will assist and enhance ICT. • Foreign markets don’t want to lose business – Addressing problems

Outsourcing Helpful Tips: • All parties adhere to confidentiality, privacy and security laws • Establish and abide by clearly defined protocols for handling, processing, storing, and transferring information. Also call for audits and audit trails of information • Follow recognized best practices and accepted standards

Helpful tips: • Require fair and equitable training and reimbursement of qualified labor hired to perform the outsourced tasks • Overseas outplacement training should address language and cultural barriers • Contracts should call for an immediate disclosure of any violation or legal or contractual obligations along with immediate corrective measures • All for a termination clause to be invoked if protocols are breached

Questions? Don. Asmonga@ahima. org www. ahima. org