How Health Information Management can be used for Cost Containment

Health information management (HIM) has changed significantly in the 23 years that I have been an HIM professional; however, one constant has been characterizations of HIM departments as cost drains to hospital operating expenses. HIM departments require a team of well-trained and knowledgeable HIM professionals to ensure accurate coding, analysis of legal medical records, reviews of clinical documents, document imaging, and release of medical records. HIM professionals also must engage professional learning to understand the highly regulated and fast-changing healthcare delivery space. A fully-staffed, well-trained, and knowledgeable HIM team contributes to the effectiveness of HIM departments and hospital operations but also comes at a cost often criticized by healthcare leaders. Nevertheless, I argue HIM departments are not cost drains but are tools for healthcare cost containment. 

Healthcare systems are overwhelmed with administrative burdens caused by ineffective and inefficient tools and the lack of the HIM departments. HIM departments could help healthcare providers and leaders maximize hospital operating expenses as implementing effective HIM processes can help to improve the quality of care while simultaneously reducing healthcare costs. For example, HIM departments ensure healthcare providers can supply accurate, prompt, and complete patient information. With this information, healthcare providers can make highly informed treatment decisions, reducing the likelihood of errors, duplicative testing, and treatments. Specifically, HIM departments can contribute to improved care and healthcare cost containment by: 

Improving coding accuracy: Accurate coding of patient information can ensure proper reimbursement rates and highlight fraud or abuse. HIM professionals can train healthcare providers on accurate coding procedures and medical necessity requirements to ensure proper documentation and minimize denials. 

Minimizing duplication: Electronic health records (EHRs) and health information exchange (HIE) systems allow healthcare providers to access a patient’s medical history, treatments, and test results quickly and easily across continuum of care. This can help reduce the need for duplicative testing and treatments, saving time and money.

Encouraging preventative care: HIM systems can be used to show patients’ risk factors for illnesses and diseases, enabling providers to take earlier preventative measures. The overall maintenance of these preventative measures can aid with early identification of these tests based upon known social determinants, saving time and costs associated with more aggressive treatment measures down the line.

Analyzing treatment outcomes: EHRs can be used to assess treatment outcomes and show patterns, trends, and best practices. Providers and policy makers can use these insights to show the most effective and efficient treatments, leading to improved patient outcomes and reduced costs.

Thus, with the support of HIM departments, patients and healthcare providers could experience healthcare cost containment. 

A collaboration between HIM departments and healthcare providers result in improved denials remediation, interoperability, health maintenance of high-risk patients, and better use of data. Such collaboration could be extremely beneficial to enhancing organizational re-negotiation presence for renewal of payer contracts. HIM departments are a much-needed healthcare resource and important departments in the overall understanding of healthcare costs. The time is now for healthcare leaders to support HIM department-healthcare provider collaboration and switch the narrative of HIM departments from cost drains to cost saving.