Blog   Tagged ‘healthcare’

EHRs: The Facts, Future and Financials

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To comply with Meaningful Use initiatives, more than 95 percent of hospitals have implemented some form of electronic health record (EHR) system since 2011. Some have spent hundreds of thousands of dollars to simply comply and put a system in place, while others have spent millions – even billions – to tailor a program unique to their needs.

The truth is EHRs are expensive to plan for, implement, train and maintain. And today, only a few years after installing new systems, nearly 38 percent of CIOs are already investing in optimization projects to improve or upgrade their current EHR programs, making this the biggest area of spending in healthcare IT.

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While EHR provides many answers and solutions, it presents many questions, as well.

  • What is the ROI for this massive technology upgrade?
  • How will EHRs really improve healthcare for doctors and patients?
  • What does the future of EHRs look like?

These questions and others are being considered and tested at hospitals around the country. Here are some of the more innovative practices and uses for EHRs that may help hospitals and executives plan for the road ahead and get the most out of their EHR investment.

Big Data

Gathering big data from a patient population is one thing. Deciphering and applying that data to solve real-world health issues is another. Hospitals that are successfully doing this are finding it is a game-changer for helping patients, the community and their care outcomes.


  • Identifying at-risk or high-risk patients to help reduce readmission rates: This data analysis looks at EHR information, zip codes and socioeconomic data to assign patients a risk score. This can also include monitoring patients with numerous chronic diseases (diabetes, heart failure, cholesterol, cancer, etc.) in real-time to help reduce hospitalizations and drive down the cost of care.
  • Clinical trial enrollment: Using big data could help patients enroll in clinical trials that will help improve quality of care and enhance outcomes. For patients, this helps match them to clinical trials and have access to safety monitoring during the treatment. For healthcare providers/researchers, this means having the data they need to find patients for trials and evaluate therapies.


A technology that has been talked about and hypothesized for decades is now at its tipping point and gaining the attention of healthcare executives across the industry. More than 83 percent of telemedicine executives who were surveyed in 2017 by the American Telemedicine Association said they are likely to invest in telehealth this year. And more importantly, they see patient-centered healthcare and EHR interoperability as top advancements they are most excited about.

Using EHR systems to treat patients with telehealth can reduce the cost of the care for both patients and providers. This technology allows doctors to stay more organized, save time, log into the patient’s record from anywhere, and prescribe medication in real time.


  • Remote patient monitoring for issues such as weight gain in at-risk heart patients. One of the biggest readmission rates for heart attack patients occurs when they start to gain weight. By using monitoring devices, doctors can receive weight readings every day allowing them to track patients’ health and have an idea of risk for readmission.
  • Doctors, hospitals and nurses are using telemedicine to treat children at school. This type of visit includes a nurse at school using a telehealth cart with video capabilities and high-tech ear, nose and throat scopes to communicate with a pediatric doctor or hospital staff for a remote patient visit. Parents can video in on the visit from work, allowing children to stay in school, parents to stay at work and nurses/doctors to best assess the child. It also allows children who do not have access to health care to see a doctor without going to the ER, further reducing overall healthcare costs for hospitals and patients.
  • Treating at-risk patients with numerous chronic conditions remotely with telehealth. Hospitals can track at-risk patients through their physiological data remotely with biometric sensors. This data can track everything from weight and heart rate to blood pressure and oxygen saturation. This information allows the team to provide remote support and communicate with patients at important times. The pilot program at Banner Health reduced hospitalizations by 45 percent ‡ and drove down the overall cost of care by 27 percent.

Patient Engagement

Enabling patients to access their own EHRs has shown great promise in helping them take control and engage in their overall wellbeing as well as helping providers prioritize patients’ concerns. The practice of allowing patients to collaborate on EHR notes and help set the agenda for their appointment has shown to improve communication between the patient and the provider, increase patient satisfaction, decrease visit times for doctors and optimize the appointment.


  • A University of Washington pilot study of patients setting agendas for their appointments found that most patients and clinicians felt it enhanced their relationships, and most said they would like to continue the practice. Also, patients who created their own agenda for the visit gave the doctor a more collaborative feeling and increased patient engagement – a key component of accountable care organizations and patient-centered medical homes under the Affordable Care Act.
  • An OpenNotes study found that by reviewing their medical records and clinician notes, patients could spot safety concerns (usually pertaining to medication errors or misreported pre-existing health conditions), and many of the flagged reports were turned into medical record revisions. The findings suggest that patients can help identify mistakes and are eager to have accurate medical records on file.

These are only a few examples of how EHRs are being implemented and used by providers and patients. The truth is that this technology is constantly morphing and evolving to help improve healthcare treatments and outcomes across the board. Clearly, there is an inherent need for healthcare executives, doctors and patients to find more valuable uses for EHRs to enhance patient care, improve outcomes and save costs.

Furthermore, what’s most critical to the evolving world of EHRs is that you have the right partners at the table to help educate, train and effectively adapt this technology to your unique needs. This includes your vendors, IT department, doctors, nurses and users.

Finally, the financial burden of improving and updating your EHR system will be a consistent line item for the foreseeable future. Knowing how to budget and prepare for those costs is vital to the financial success of your organization. And working with a banking partner who understands the complex world of healthcare finance is just as important.

Richard Ziegner is director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He can be reached at


Richard Ziegner is executive vice president and director of healthcare banking at UMB Bank where he is responsible for leading the bank’s efforts in the healthcare sector and providing capital and financial solutions to healthcare providers. He graduated from the University of Arizona in Tucson, Ariz. with a Bachelor of Science degree in finance and earned his Master of Business Administration degree from Northern Arizona University in Flagstaff, Ariz.

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How health benefits might change in 2017 based on the election

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One of the most memorable achievements of the Obama administration is the Affordable Care Act (ACA). The bitter debates about this legislation that started long before its passage continue to this day—becoming a focal point of the 2016 presidential campaign. With the election still a few months away, it’s unclear exactly how healthcare and the ACA will be affected. What is clear, though, is that each candidate believes he or she has the right solution to fix America’s ailing healthcare system.
how benefits might change in 2017
Our Healthcare Services Chairman, Dennis Triplett, explores how each presidential candidate’s health care platform could impact employee benefits and businesses.

  • How we’re still feeling the Bern as Bernie Sanders continues to influence the Democratic health care conversation.
  • How might Hillary Clinton’s healthcare ideas play out?
  • Can Donald Trump repeal the ACA?
  • How might HSAs be affected?
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Of course, we recognize that as with all things political, anything could change.

Still feeling the Bern

Will we still feel the Bern of free healthcare? Bernie Sanders may not have won the Democratic Party nomination, but he has shaped and influenced the party’s platform on several key issues—including health care.

For him, the ACA isn’t good enough because 29 million Americans are still uninsured. And many who are insured can’t afford their deductibles.

The Sanders’ plan would have expanded Medicare to all Americans.

This has the benefit of separating health insurance from employment, which gives employees the freedom to change jobs or start their own business without the worry of losing health insurance.

He also suggests that it also would be a benefit to employers who no longer have the need to administer benefits plans and can focus more time and resources on running their core businesses.
Bernie Sanders
Leave no one behind

  • Medicare for all.
  • Separate health insurance from employment.
    • Employees can change jobs without fear of losing health insurance.
  • Employers can focus on running their businesses—not administering benefit plans.


  • Coverage for all Americans.
  • Relieves employers of a huge expense.


  • No out-of-pocket maximums on Medicare, and other coverage gaps.
  • Benefits become less of an employment differentiator.

How might Hillary Clinton’s policy ideas play out?

Clinton believes her more progressive approach on health care could help her with her base in the matchup against Trump. Her primary focus is on making the ACA work, and following President Obama’s lead she’s pledged to defend it against GOP efforts to repeal it.

  • Stay the course and make incremental changes
  • Make premiums more affordable and lessen out-of-pocket expenses.
  • $5,000 tax credit for families with out-of-pocket costs over 5 percent of their income.
  • Enhance premium tax credits.
  • Block or modify unreasonable health insurance premium rate increases.
  • Support new incentives to encourage all states to expand Medicaid.
  • Expand Medicaid in every state.
  • Invest in navigators, advertising and other consumer outreach.
  • Expand access to ACA exchange to families, regardless of immigration status.
  • Continues to support a “public option” to reduce costs and broaden the coverage choices.
  • Establish a federally run public option
  • Allow people to enroll in Medicare earlier, at age 55
  • Increase federal funding for community based health centers by $40 billion over the next decade.
  • Proposed a package of additional reforms.
  • Lower out-of-pocket costs, such as co-pays and deductibles.
  • Reduce the cost of prescription drugs.
  • Reward value and quality.
  • Expand access to rural Americans.
  • Provide women access to reproductive health care.

Can Trump repeal the ACA?

As just about everyone knows, Trump has branded himself as both the anti-establishment and the anti-ACA candidate. If elected, he promises his first order of business will be to ask Congress to immediately deliver a full repeal of Obamacare.

“No person should be required to buy insurance unless he or she wants to.”—Donald Trump

Trump’s plan:

  • Replace ACA with free market reforms to the health care industry that will broaden access and improve affordability and the quality of care.
  • Allow the sale of health insurance across state lines.
  • Tax credit for families that don’t have employer coverage.
  • Make health insurance premium payments tax deductible.
  • Establish high-risk insurance pools.
  • Work with states to review Medicaid options.
  • Provide block grants to states.
  • Incentivize states to remove fraud and waste from the system.
  • Raise the Medicare eligibility age from 65 to 67.
  • Price transparency and consumer tools.
  • Consumers could shop for health care like they do other products.
  • Allow cross-border prescription drug purchases.
  • Health savings accounts for all.
  • Tax-free contributions.
  • Appealing to younger people.
  • Account balance can be used by any family member without penalty.
  • Inheritable without a penalty.

Trump will most likely let Congress take the lead on these proposed reforms since healthcare is not one of his key platform issues.

Trump promises that his administration would require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals. Individuals would be able to shop for health care like they do other products so that they can find the best prices for procedures, exams or any other medical-related service. On a related note, the lack of price transparency has been one of the biggest challenges for people with HSAs.

Future of ACA

Unlikely to be replaced because of political obstacles and devastating effect on covered individuals but…

Despite the pre-election banter, my view is that it’s unlikely that the ACA will be going away any time soon.

As you’ve heard, the political obstacles associated with repeal are tremendous.

While I think full or total repeal is unlikely, change is inevitable regardless of whom our next President will be. So following the election, I think I would characterize the degree of probable change as mild to wild. Mild if we have a Democrat in the oval office to wild if we have a Republican. And that change will likely come in the President’s first 12-18 months in office as he or she puts their election mandate to the test. Change will be tempered by the Senatorial elections and we should keep our eyes on those races.  The House will likely remain in the Republican camp and the Speaker Ryan will have an influential role in how healthcare is reshaped in our country.


The content above represents the author’s personal views and not those of UMB Bank or UMB Financial.


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Dennis Triplett is chairman of UMB Healthcare Services. He has responsibility providing strategic direction and insights to the leadership team. Dennis has more than 29 years of experience in the banking industry. He currently serves as Chairman of American Health Insurance Plan’s (AHIP) HSA Leadership Council, Board Member and past Chairman of the Employer’s Council of Flexible Compensation (ECFC), and a Charter member of the American Bankers Association HSA Council.

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