What identification of victims of TWA Flight 800 taught the healthcare industry about medical records

Erika Grotto: Maintenance and transfer of medical records in times of disaster, today on HFMA’s Voices in Healthcare Finance podcast, sponsored by Fiserv.

Hello, and welcome to the podcast. I’m your host, Erika Grotto. On today’s episode, we’re continuing our discussion on disaster preparedness by zeroing in on medical records. Beth Friedman of Finn Partners shares the story of her own work after the crash of TWA Flight 800 in 1996. Later, I’ll be talking with Channing Monti and Janice Kocheran from Fiserv about the challenges of automated reconciliation. But first, let’s find out what’s happening in healthcare finance news. Here’s HFMA Senior Editor Nick Hut and HFMA Policy Director Shawn Stack.

Nick Hut: Hey, everyone. I’m hoping this segment doesn’t come across as too pessimistic in tone, but if it does, that’s because we’re talking about the financial state of hospitals about two-thirds of the way through the year 2022. Several high-profile reports of late have suggested that the recovery for hospitals this year has been shaky to say the least. Kaufman Hall’s monthly report as an example, found that margins for July were some of the worst we’ve seen during the pandemic and that this year is on track to be the worst of the pandemic in terms of hospital financial performance. So Shawn, what seems to be going on here?

Shawn Stack: So Nick, there’s a lot going on. The combination of lingering Covid challenges for hospitals, and not just new infection rates and new admissions put patients not being discharged or patients with comorbidities lingering in hospitals way longer than they have in the past. The shortages of nursing home beds or SNF beds to place patients safely into extended days for hospitals. It’s been very taxing for discharge planners and outlier payments for hospitals just aren’t there anymore. So those are some of the PHE impacts that hospitals are continuing to see, you know, long term.

Hut: Yeah, that’s some great data that you shared. Staffs are still not at full capacity, so hospitals have to keep paying contract rates, which have come down but not all the way down. Or they have to fill out their staffs by paying higher salaries to lure talent. You know, hospitals have added just under 50,000 jobs in the last three months, and that is expensive, especially these days.

Stack: Right, Nick, and some hospitals have decided, you know, they just can no longer afford to do that to keep the doors open. So they’re turning back on the services that they provide. Their max is a lot lower than it used to be providing certain services, because they just won’t have those happening, right?

Hut: Yeah, exactly. You know, in addition to the labor costs and the high costs of supplies and drugs, certain things that have been providing a financial cushion are diminishing, namely no more provider relief funding, and plus investment portfolios have had a very topsy-turvy performance in recent months. What are you seeing as far as balance sheet issues?

Stack: We’re seeing the low balance sheet issues echoing and beginning to threaten, although they have not shut down yet, a lot of community engagement and cuts, the potential of now looming cuts again to 340B that’s now being discussed really could hit community programs that hospitals are the biggest sponsors of—outreach, you know, mammogram buses, FQHCs, things that really impact those most vulnerable in our community are really at risk here of losing a lot of funding to these federal cuts. Physicians got a significant hair trim this year, although IPPS was the highest increase ever, it didn’t even come close to covering items that you just talked about, Nick. The increase in supplies and the increase in costs for these long stays. So I guess we are being pessimistic here, but it is very tough times for legacy providers who have really been there for our communities during this public health emergency. They’re really feeling it.

Hut: They sure are. And I think it’s worth mentioning that Fitch ratings recently reported that the outlook for the not-for-profit hospital sector over the remainder of 2022 and into ‘23 is “deteriorating” and that credit downgrades are likely to outpace upgrades during that span. I guess somewhat of a silver lining is that they do also see the pandemic reaching a point where hospitals can get back to a full slate of elective services while serving a reduced volume of Covid-19 cases. So we’ll see how some of these metrics evolve. Shawn, anything more—any advice how to ride out this storm?

Stack: No, I do think it is going to be interesting to watch those metrics, Nick. I’m talking to a lot of our community and rural hospitals who, their days cash is almost diminished now. As funding and payments and costs have increased, it is a little bit challenging. So yeah, it’s going to be very interesting to see how this plays out.

Hut: Most definitely. Well, hey, thanks, everybody, and we’ll certainly be covering these trends for you every step of the way at hfma.org.

Grotto: I grew up in a small Pennsylvania town called Montoursville. You’ve probably never heard of it, although you might have watched the Little League World Series recently in the neighboring city of Williamsport. But in Montoursville itself, there’s not a lot going on, and the one thing that put it on the map is not a happy story.

On July 17, 1996, a group of 16 Montoursville High School students and 5 chaperones were among the 230 people aboard TWA Flight 800 when it exploded over the Atlantic Ocean. The effects of the crash on my friends, on my town, and on me, are significant and a story for another time. But here’s why I’m telling you about it. A few years ago, I learned that someone I knew through HFMA played a role in identifying the victims of the crash. Today, Beth Friedman works in PR as a senior partner at FINN Partners. Many of her clients are HFMA members, or work with members. She’s even helped us find some podcast guests. But her healthcare career began in medical records, and her role after the crash was gathering and organizing medical records for the victims. We got to talking recently about her experience that summer, and our conversation made me realize just how far the healthcare industry has come when it comes to medical records and what lessons can be taken for future disasters.

You and I know each other because of your experience in PR. You have helped out finding sources for articles and blog posts and podcasts for me and the other editors at HFMA. But you haven’t been a PR person for your entire career. Tell me a little bit about your professional background and how you ended up connected with the crash of TWA 800.

Beth Friedman: Wow. Of course, Erika. Thanks for having me on, and it’s a long story, but I’ll try and make it brief. So I started my career as a medical record coder and working in medical records. So that was the very beginning of my career. It was back in the 1980s when DRGs were first coming into play. So it was a time when health information management and coding’s impact on the revenue cycle was really evolving and changing rapidly. I worked in a hospital for a number of years, then I went to work in IT in healthcare. So I spent some years at McKesson Corporation and then decided to start my own public relations and thought leadership agency in healthcare. So that’s where you and I met.

Grotto: So back in 1996, were you still working in medical records?

Friedman: No, actually, at that point, I was working for—I believe I was working for McKesson at the time. And I just happened to be in New York when the crash happened. So my former father-in-law was a dentist—a forensic dentist—and he actually worked with the medical examiner of Suffolk County. I happened to be up in New York for work that week when the crash happened.

Grotto: So you’re in New York. You’re there for work, but you’re visiting. What happened after that?

Friedman: My former father-in-law gave us a ring and told us what happened. We found out about the crash, and we decided to stay in town and see what we could do to help. So I spent the next several weeks at the medical examiner’s office in Suffolk County on Long Island, New York, and my first experience was, as soon as I walked into what we called the “war room” –it was basically a room with a very large table where half a dozen of us, maybe a dozen people were gathering all the information sent in by the families. So you know, remember, Erika, this was back before we had all the lovely technology we have now. Before the internet and electronic sending of information was even a possibility. We were receiving packages every day, every minute, every hour of medical records, of dental records, of pictures, of tattoos, pictures of people’s tattoos. Any identifying information was being requested and sent, and so when I walked into that war room, the way they had it filed, or the way they had it set up was by type of document. So all of the dental records were in one area, all the medical records in another, all the pictures in another area. You know, with my medical record background and my HIM, I immediately—all I could think about was, we need a centralized patient record. If we’re going to be effective in trying to help the physicians and the medical examiner get answers to the families, we needed to centralize all the information. So I went right to work.

Grotto: What lessons did you take from that experience?

Friedman: You know, certainly, something everybody now in healthcare assumes is a given, right? The value of that centralized patient record. This was back when EHRs were just being discussed. I mean, certainly it was before meaningful use. And you know, we just really learned the importance of having all the patient information in one place. And you know, today, it’s just a given. Everybody assumes that. We have all of our EHRs and I think 100% of providers now have EHRs or EMRs. So it was one of the initial lessons of the value of where we ultimately arrived.

Grotto: It’s grim when the best thing a family can hope for is identification of a body, but the good thing that came out of this was that all of the victims eventually were identified.

Friedman: Yes. Absolutely. And I will tell you, the team that was there, that was our sole purpose. We would be so happy and thrilled. Like you said, unfortunately, it was for a sad reason, but it gave us such joy that we could get that answer back to that family. And we could close a case, basically.

Grotto: So on the last episode of the podcast, we talked about the continuity of patient care in times of disasters and the importance of having records in the right place and easily accessible. But what are the other takeaways here today for healthcare organizations when we’re talking about things happening that don’t affect your organization necessarily but do affect your patients? When you might have another entity calling and needing something from you.

Friedman: Yeah, absolutely. You know, this TWA crash was what they consider or what they classify a mass disaster. Hospitals prepare for this. Provider organizations prepare for it. Communities prepare for it. So certainly one of the lessons learned and one of the things we talked about on the last episode was the data and the patient information and having that when disasters do occur. This summer, it’s hurricane season. We’re right in the middle of hurricane season. I think we’ve been pretty lucky so far this year in ’22, but you never know. So it’s all about the continuity of care of that patient during a disaster, because the patient’s care needs to continue, but the place, the clinic they used to go to, the physician’s office, even the hospital in some cases, Erika, might be closed down. They might not be able to give the patient that care. So think of a standup clinic, think of emergency workers that are trying to help perhaps a kidney failure patient, renal failure patient that needs dialysis. Perhaps a diabetic that needs medications that, his or her home is gone, the medication cabinet’s gone, the pharmacy’s closed. So all these types of scenarios exist and during a disaster, this type of day-to-day care that we think of as very routine becomes critically urgent.

Grotto: Are there things to think about when communicating with patients about these things as well? I mean, you know, in the case of an air disaster, you were not dealing with living patients, but certainly were with families. But then, you know, if you have something like a natural disaster and a patient needing medication as you talked about, are there things that you need to communicate with your patients?

Friedman: Absolutely. I believe that the patient engagement family communications community. Think about this, because these type of disasters affect an entire community and sometimes communities across state lines, right? So these types of communication plans need to be part of your disaster recovery or your disaster preparedness I should say, program. I believe September is Disaster Preparedness Month, so I think it’s timely that we’re talking about this. There are lots of best practices and policies and procedures out there and hospitals should be—your listeners, our listeners, should be very familiar with this already—but think about how are you going to communicate with your patients, your families, your other caregivers, right, the providers your entire community when perhaps the electricity is out or perhaps phone lines are down. Really thinking about using mobile communications during disasters, I’m sure, is best practice in all these scenarios.

Grotto: TWA 800 was an unprecedented event at the time. We hadn’t seen anything like it before, but the unprecedented events are the things we need to be most ready for, I think. So what do you think are the final takeaways here, Beth?

Friedman: Yeah, absolutely right. And you know, it seems like we’re seeing more unprecedented natural disaster events these days, right? I would say the most important thing is being prepared. So when it came to the plane crash, my father-in-law was part of New York Metro’s mass disaster team. They had drills. They had practices. I even think I volunteered once to be a patient during a mass disaster. It was a regular thing. It happened all the time. Lots of different clinicians involved, lots of stakeholders, lots of emergency services, whether it was the ambulances or the hospitals. A lot of people involved and practicing a drill, doing a drill just in case something like TWA 800 happened. So in addition to those type of community efforts with mass disaster preparedness, I believe hospitals and health systems should also be prepared. And that includes tapping into some of those best practices, policies and procedures I mentioned on the interview today. Know that it’s about continuity of care and recognize those community partnerships you need to have in place ahead of time. The need for information sharing and exchange and how are we going to do that during a disaster, and as you mentioned, finally, the communication with your community, your patients, your providers and your families.

Grotto: Yeah, I think that’s a great summary of our conversation. I think there are a lot of things that healthcare organizations can be thinking about here. So Beth, thank you so much for sharing these thoughts with me today on this podcast. And more importantly, thank you for all the work you did to bring my classmates home to their families.

Friedman: You know what, Erika? You and I have talked about this topic many times and our mutual experiences during TWA 800 crash. I appreciate being on the call today. Hopefully our mutual lessons learned can help others.

Grotto: If account reconciliation is part of your job, you’re familiar with the big challenges: large volumes of data, multiple channels and reconciliation types, and quite possibly, inefficiencies in your processes. Today’s sponsor, Fiserv, has some strategies to meet those challenges. I recently spoke with Channing Monti with Fiserv’s financial risk management solutions division, and Janice Kocheran, a product manager with Fiserv, about what healthcare providers can do to maximize efficiency and improve performance.

In your experience, what are healthcare organizations really looking for when it comes to financial management and reconciliation automation in healthcare?

Channing Monti: A lot of the organizations I speak with, they’re very focused in bringing the business challenges to us that can be summarized in collective groups. They’re looking at ways to handle and manage large sets of data, both from internal/external sources. They’re coming from multiple channels from a payment perspective, and then obviously, presenting multiple recon types that are going to need to be considered and also taken into consideration for fraud and other activities to ensure that they’re reducing their financial risk and exposure. They’re looking to see how they can automate with multiple front-end and back-end processes, some of which may be creating manual processes to get data out of these systems. They’re looking for automation and operational efficiencies related to detail level transaction matching where things are manually intensive, where there’s large sets of volume as I mentioned before. They’re looking at continuous cost reductions at the same time how they can also standardize processes as they look to grow and expand their business and operational models, and again, as I also mentioned, they’re looking to control their financial risk and exposure and also promote auditability and system integration, going back to the standardization example. So those are the collective themes that we typically hear as organizations present their financial management challenges to us in areas where they’re looking to automate, specifically around reconciliation.

Janice Kocheran: Having a centralized hub to bring all of those integration points together helps with managing all the different payment types and the tenders and the clients. And as organizations grow, the centralized, standardized hub helps with that.

Grotto: I’m curious what your thoughts are on this. Do you think that healthcare organizations are prepared for—Channing, you mentioned the process piece of it—do you find that they’re prepared for the process piece behind everything else they want to do?

Monti: In some cases they are, and in some cases, they will adamantly admit that they may seem prepared but ultimately they’re not. Growth that we’ve seen over the last couple of years due to a lot of different things we all are aware of has caused organizations to rethink their strategies as new payment methods are presented and organizations are expected to allow their clients and patients to leverage and utilize things like Apple Pay and PayPal, things like that that are mobile device oriented. And at the point of sale, they want to be able to exercise these options to use these cardless and contactless payment types, which creates another process or processor relationship for a lot of these organizations. A lot of times, people will throw bodies at managing new processes as a way to accommodate the introduction of these new options. However, it keeps them less efficient and less operationally effective in the back office, so again, they want to be able to standardize processes so that if they bring in a new processor, a new payment type, a new system, a new relationship, a new banking relationship for example, it’s just a matter of taking what’s been standardized, applying that to the new process, if you will, and then being able to modify it and tweak it accordingly based on this new relationship that’s been established.

Grotto: Healthcare providers are dealing with multiple payment channels and types, banking relationships, growth goals. How are they dealing with all of these things?

Monti: A lot of them, the way they’re dealing with it, as I mentioned earlier, they’re adding tasks to staff members they currently have as they work rapidly, trying to assist them with automation. You know, a lot of these organizations, especially in the healthcare space and the hospital network space, a lot of organizations are looking to expand their relationships—bring more hospitals into their coverage area or coverage models. And when they do that, they’re opening up—as you mentioned—they’re opening up opportunities, obviously, for multiple banking relationships. So you want to be able to nimbly move through that integration, and having individuals take on new tasks in a temporary manner are somewhat acceptable, but if you don’t have a good path forward on how you can assist with that automation and making those processes more efficient, it’s a challenge.

Kocheran: To add to that, banking organizations have specific standard types of files. So moving in and out of and adding banking relationships and adding payment types, if you build out those standard automated processes, transactions can be added without even having to make a lot of changes. They flow in as you add them.

Grotto: Thank you so much for providing these insights today. Channing and Janice, I appreciate you joining me today.

Monti: Great. Thank you for your time. Appreciate it.

Kocheran: Thank you so much. You have a great day.

Grotto: Frontier Reconciliation from Fiserv is a proven automated reconciliation solution that streamlines processes and pulls in data from any source, including electronic health records (EHR) such as Epic. It helps comply with regulations while increasing efficiency and reducing costs. Frontier Reconciliation forms a complete account reconciliation picture across your healthcare organization, making exceptions instantly visible and reducing manual interventions. It supports growth while freeing up staff time to focus on patient satisfaction. Fiserv currently supports large healthcare organizations across North America. Fiserv is a global leader in payments and financial technology, serving thousands of financial institutions, government agencies, corporations and millions of businesses worldwide. www.fiserv.com

Voices in Healthcare Finance is a production of the Healthcare Financial Management Association and written and hosted by me, Erika Grotto. Sound editing is by Linda Chandler. Brad Dennison is the director of content strategy. Our president and CEO is Joe Fifer. Special thanks to our sponsor this week, FiServ. We always want to hear what you think of our podcast, so please leave us a rating or review in your preferred podcast app, and hit subscribe while you’re there. If you’d like to talk with our team directly, you can reach out at [email protected].

It was by chance that Beth Friedman was in New York in July 1996 when TWA Flight 800 crashed into the Atlantic Ocean after taking off from John F. Kennedy Airport. It was a favor to her father-in-law at the time, a forensic dentist, that she extended her stay to help organize the crash victims’ medical records for identification purposes. And it was by careful and methodical organization of medical records that the team successfully sent all 230 victims home to their families.

Recently, Friedman, who now works in PR as a partner at FINN Partners, joined the “Voices in Healthcare Finance” podcast to share what she took from the experience and what it means to healthcare organizations today.

Centralized medical records

The use of electronic health records today is a given, Friedman said. But in 1996, the idea of a centralized medical record was just starting to be discussed. And the way the team initially organized the records they’d gathered for the crash victims was by type — dental records in one place, medical in another, photos in a third, etc. Friedman, whose career began in medical records, convinced the team to organize by person, which allowed them to work more quickly and efficiently.

“We really learned the importance of having all the patient information in one place,” she said. “It was for a sad reason, but it gave us such joy that we could get that answer back to that family.”

Lessons for future disasters

The crash of TWA 800 was unprecedented at the time, but it’s also the type of thing that communities, hospitals and individual leaders need to prepare for, Friedman said. In the case of the crash, the medical records were not for living patients, but they were necessary to get swift answers for the families. In the case of a natural disaster or other circumstance where continuity of care is at risk, it’s critical to ensure any healthcare organization treating a patient has ready access to their information.

“Think of a standup clinic, think of emergency workers who are trying to help perhaps a kidney failure patient, renal failure patient who needs dialysis,” she said. “These types of scenarios exist and during a disaster, this type of day-to-day care that we think of as very routine becomes critically urgent.”

Rehearsal also can be a useful part of preparedness, Friedman said.

“My father-in-law was part of New York Metro’s mass disaster team,” she said. “They had drills. They had practices. It was a regular thing.”

Tapping into best practices, policies and procedures to create and rehearse a comprehensive plan can make all the difference when disaster strikes, she said.

“Know that it’s about continuity of care, and recognize those community partnerships you need to have in place ahead of time,” she said.