Penn Highlands Healthcare is a nine-hospital system serving rural communities across northwestern and central Pennsylvania. Rural hospitals run lean, and during the COVID-19 pandemic the margin pressure was acute. Regard helped the system capture the complexity of the care it was already delivering — without adding a single step to its physicians' day.

Key results

• $3 million in additional annual revenue across 30 users, through more specific documentation
• 7% increase in CC/MCC capture rate
• 10% increase in case mix index
• 20% average reduction in time spent documenting
• Improved patient safety and more accurate risk adjustment
• Enhanced physician satisfaction and engagement through streamlined workflows

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About Penn Highlands Healthcare

Penn Highlands Healthcare provides innovative, high-quality, patient-centered care in rural communities across a multi-county area of northwestern and central Pennsylvania. The system employs more than 500 physicians, 300 advanced practice providers, and 4,000 non-clinical staff. It operates more than 400 inpatient beds, along with roughly 300 long-term beds, 50 personal care beds, and 40 independent living units.

The challenge

Penn Highlands faced three connected problems:

• Missed revenue from incomplete, nonspecific documentation
• Inefficient, retrospective processes that contributed to physician burnout
• An inability to accurately capture patient risk for both fee-for-service and value-based payments

"Rural hospitals run very lean," says Dr. Russell Cameron, Chief Medical Officer. "If you can help margins by improving the case mix index, this helps with revenue that keeps you afloat."

The system already had a workflow for reviewing diagnoses in the discharge summary and validating DRG assignment. But it ran retrospectively, which meant physicians were often answering queries days or even weeks after the patient had gone home.

"Doing this on the back end was painful because it created an odd workflow for the doctor," says Dr. Cameron.

That re-review took time and compounded a burnout problem the medical staff already felt. "All physicians hate to document," says Dr. Renee Allenbaugh, Medical Director of the hospitalist group. "That's not why we became physicians. We don't want to sit in front of the computer."

Shifting gears

In 2019, Regard approached Penn Highlands about piloting a technology that would integrate directly with the EHR and act as a clinical co-pilot, ensuring accurate and complete diagnoses upfront rather than after discharge.

"When I saw what it could do, I immediately saw the value," recalls Dr. Cameron.

Regard takes a deep dive into the medical record to surface important clinical information and support physicians in improving patient care. It also gives physicians tools to calculate patient risk and follow clinical best practices.

Building buy-in with superusers

Penn Highlands recruited two physician superusers for the three-month pilot — one who was tech-savvy, and one who was not.

"Having those superusers was incredibly important," says Dr. Allenbaugh. "When there are physicians who have already used it and felt good about it, it's easier to get others on board. When people saw the non-tech savvy physician could do it, they were more open-minded to it."

Regard stayed close throughout. "Regard was very involved in the physician training," says Dr. Cameron. "They came onsite to make sure it went well. They've also been very good about responding to us and quick to make modifications based on feedback they receive."

Dr. Allenbaugh saw the same thing. "Physicians who were initially hesitant to use Regard actually had a lot of good feedback for them, and they were responsive to that feedback," she says. "This dynamic was critical in terms of getting buy-in."

Results at the end of the pilot were favorable, and Penn Highlands rolled the technology out to its remaining hospitalists and residents. All hospitalists in the nine-hospital system now use it.

Gaining efficiencies

Before Regard, physicians lost time simply navigating the record. "Doctors usually needed to look through all parts of the record to make a diagnosis. Just toggling between the screens took time," says Dr. Cameron. "With Regard, all of that information is curated into a single view with hyperlinks to the original source."

Dr. Allenbaugh noticed the difference immediately in how long a progress note took. "I like the fact that there's a template and that I don't need to go in and out of the chart to get data."

She estimates Regard saves her roughly 10 minutes per patient, or one to two hours a day.

"Any time I can speed up the documentation and add quality, that's a win. That one- or two-hour difference means I can talk to a patient's family or go outside and get lunch with my coworkers. All of this makes my life as a physician more enjoyable." — Dr. Renee Allenbaugh

Physician feedback has been consistent. One physician reported better notes, a happier team, and hours saved per week. Another valued having standardized notes across colleagues.

Increasing patient safety

Regard helps physicians calculate patient risk so they can build effective treatment plans in less time, and it flags potential safety issues directly.

"I like the frequently used risk factors. Previously, we had to do this all by hand, so it's a huge time savings," says Dr. Allenbaugh.

One physician highlighted the automated ASCVD calculation: "Sometimes we don't have enough time to run a clinical calculator, but with Regard automating them we can now consistently deliver better care."

Another cited a direct catch — Regard flagged GI bleed patients still on aspirin.

Generating new revenue

Regard helps Penn Highlands physicians better capture diagnoses that affect both clinical care and reimbursement: CCs and MCCs that drive DRGs, and HCCs that affect risk-adjusted payments.

During a five-month pilot with 30 users, Regard identified a $3 million annual reimbursement increase — approximately $1,500 per encounter. The pilot excluded COVID-19 cases and included both control and test groups.

_{‍Scope: all Apogee Providers, inpatient encounters, Penn Highlands DuBois location. Pre-pilot 8/1/2020–11/30/2020; pilot 12/1/2020–4/30/2021. N = 2,542 patient accounts (1,268 pre-pilot, 1,274 pilot; 572 pilot cases analyzed by Regard).}

The control group is the part worth noting. CC/MCC capture fell 7% in the control arm over the same period while rising 7% in the test arm.

What happened next

Penn Highlands went on to validate the financial impact independently. As Dr. Allenbaugh told Healthcare IT News, the system ran its own internal study rather than relying on the vendor's figures — and measured a $7 million revenue increase, driven by a sustained 10% lift in case mix index.

The system has since scaled Regard across all of its hospitals and continues to extend it into new settings. Today, 95% of Penn Highlands physicians use the technology voluntarily. For more, see our conversation with Dr. Cameron recorded at HLTH.

Looking ahead

Penn Highlands plans to use Regard with its intensivists and eventually across its physician practices. "We own hundreds of practices," says Dr. Cameron. "Identifying the correct diagnoses in this setting is just as important — if not more important — than in the inpatient setting. This is what helps create an accurate risk adjustment score for patients."

Penn Highlands and Regard in the press

• EHR-integrated AI assistant boosts revenue by $7M at Penn Highlands — Healthcare IT News, January 2024
• A 'measurable' advantage: Why CMIOs from Mayo + 2 other systems are turning to AI — Becker's Hospital Review, May 2023
• Penn Highlands Healthcare expands AI diagnostics with software firm Regard — Becker's Hospital Review, October 2022

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