Post-ANI Reflections

Guest post by Tracy Currie, CEO of Capto.

Tracy Currie
Tracy Currie

HFMA ANI 2016 was a very interesting conference for me, which yielded some unexpected insights.  Throughout the conference and in conversations on the show floor, I heard a very strong emphasis on focusing on the consumer in healthcare. Provider organizations and the vendors that support them seem to have reached a kind of tipping point on consumerism. The once conventional wisdom that outcomes trump experiences, seems to be giving way to the realities of increasingly competitive healthcare markets. For me, this conversation was a prime example of a strange idiosyncrasy of the healthcare industry where we often shy away from talking about healthcare as a business and feel compelled to put every issue in the context of improving patient care.

I heard individuals at this year’s ANI reiterating the point that there is no data to support the idea that a better patient experience correlates with better outcomes. Healthcare leaders seem to be recognizing, though, that this fact is largely irrelevant, and does not justify negligence of the healthcare consumer experience. I heard an apt comparison to auto makers – who commands a financial commitment from their customers that can be similar to the cost of healthcare. Ford, Honda and BMW do not stop at making a safe and reliable vehicle, they work very hard to outdo their competitors in creating a complete shopping, purchasing, paying and owning experience that their customers will love. Quality care – like a safe, well running car – is clearly the most important thing, but it also just the start – the foundation for the much larger strategic play: creating a total consumer experience that attracts and retains great lifelong customers and their friends and families.

Clearly, in a world where healthcare organizations must compete for customers/patients /members, we have to take experience very seriously. Especially as organizations take on risk in managing the health of larger populations, a reputation for offering a great experience is going to be essential to attracting the right mix of patients and to engaging them in more effectively managing their own health and care. Fortunately for forward-thinking HCOs, emphasizing patient experience will set them apart from the rest of the pack in today’s market, as healthcare’s status quo for customer service is similar to that of a cable company, and a far cry from paragons like the Apples or Amazons of the world. So there is tremendous opportunity to seize and hold a competitive advantage by making healthcare brands attractive and part of a consumer identity that target customers want to be part of. The financial upside for a health system that can make being part of their community a source of pride and satisfaction for customers the way Harley Davidson has will be tremendous.

Interestingly, I found that this kind of frank business talk about and concepts like market share, customer retention and profitability, is not a comfortable thing, even at a healthcare finance conference. Healthcare leaders — be they physicians, CFOs or CEOs – do not feel safe outside of the boardroom in discussing their efforts to improve the bottom line, as necessary and natural as that is. It is an odd and anachronistic instinct we have in healthcare that is very out of sync with other industries, where we feel that we can only talk about the business of care in the context of providing better outcomes, improving access to care and reducing suffering. Even something like improving patient experience and creating happier patient populations, which should be universally commendable, requires gymnastic contortions of language to always be in the context of improving care rather than enhancing business performance.

One of the strongest impressions I came away from ANI with was that we need to give our industry permission to talk about the business of healthcare as a business, without shame or the need for double-talk. We must develop an acceptable language in which payers and providers can have business centric conversations to address these issues head on, rather than circumnavigating hard commercial conversations. The outdated idea that patient experience does not matter because it does not affect outcomes is a great example of how talking about the business of healthcare only in the context of providing great care can take even smart, sensible professionals down very counter-productive roads.

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Identity and Access Management in Healthcare: Automation, Security and Compliance

Guest post by Dean Wiech, managing director, Tools4ever.

Dean Wiech
Dean Wiech

Identity and access management (IAM) in healthcare continues to be a growing part of the industry. The management of identities, user accounts and access to both data and applications is a large task for hospitals and healthcare organizations. In the healthcare industry especially, the need to follow strict access and security rules and regulations exists, which makes IAM even more challenging. This need has led to newer solutions to meet the needs of healthcare organizations.

Here are the top four account management issues in healthcare that can be significantly improved:

Onboarding of Employees

The first issue that many healthcare organizations face is efficiently onboarding new clinicians and employees. For example, when a new doctor or nurse begins employment, they need their account created, and the correct access to the systems and applications they require in order to assist patients. The issue is, too often, new employees are waiting idle while all of their access and accounts are created.

By streamlining and automating the account management processes, this issue can be improved. Automating the process allows administrators to easily enter new employee’s information into a source system, such as the HRM system and check off which systems the employee needs access to and accounts in; and the new accounts are automatically created.

Changes to Accounts

Next, there is the issue of movement or changes to an employee account throughout their employment. Often, clinicians need to contact their manager to ask for permission for a change to or additional access, who then in turn needs to contact IT or HR to have the change carried out.

IAM software with workflow management capabilities has evolved to assist with this situation. A web portal with workflow can be set up so that employees can easily request changes to their account and then have it securely carried out.

As an example, a nurse moves to a different unit, or floor, and needs access to a different set of data or applications. A nurse can easily request the access through a portal and the request is automatically sent to the correct people for approval. Once the approval is given, the change automatically is made. If the request needs multiple levels of approval, it will move to the next person in line. In addition, all of these changes are logged so that the healthcare organization knows exactly what changes are made, when they were made and who approved them.

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The DaaS Model Is a Good Fit for the Healthcare Industry

Guest post by Brent Whitfield, CEO, DCG Technical Solutions, Inc.

Brent Whitfield
Brent Whitfield

The healthcare industry deals with tight IT budgets and highly confidential records that require premium security, which is why desktop as a service (DaaS) is an appropriate solution. This technology allows you to focus more on your healthcare business than IT, which in the long run, cuts costs. Here are various other reasons why desktop as a service may be the right solution for your healthcare operation.

Virtual Desktops and the Cloud

When you use desktop as a service you are operating on a “virtual desktop” powered by a cloud provider. It connects everyone in your organization through one platform. Employees can then bring their own laptops or other devices to access data or communicate with other team members. This system potentially means you no longer need IT to maintain every physical desktop and server in an in-house infrastructure.

Instead of updating security on every company computer, the cloud provider handles security updates, which tend to prevent breaches better than a locally managed system, especially those that are HIPAA-compliant.

Healthcare Collaboration

Because of the growing complex nature of the healthcare industry, professionals from various specialties within the field are working together, creating a more collaborative culture. That’s another good reason to use virtual desktops, which allow for easy collaboration between even distant facilities in real time.

This team effort requires strong, decisive leadership so that staffing, ethics and communication are high quality. If this essential foundation is in place combined with desktop as a service, the result is enormous synergism for dealing with committee issues such as interdisciplinary programs, charters and training programs. Another reason for collaboration is that it helps expedite services, which can help save lives.

Strength of DaaS Security

Since all healthcare facilities must comply with strict HIPAA regulations, which require robust security to protect patient privacy, cloud solutions are becoming increasingly more appropriate than trying to run all systems on in-house architecture. As long as you make sure your cloud provider is HIPAA-compliant, you won’t have to worry much about constant security updates or data backups since the cloud provider will do that for you.

In recent years, healthcare data breaches have affected more than 30 million patients. But that was often a result of thieves stealing laptops were confidential information was stored. It raises the question: would you rather store data on multiple devices that can potentially be stolen, or in a safe cloud-based haven where only users with passwords gain access?

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How to Boost Your Salary In Health IT Sales

Guest post by Robyn Melhuish, communications manager, MedReps.com.

Robyn Melhuish
Robyn Melhuish

A few years ago, medical sales professionals who sold health IT and software products earned the top salaries in the field. While these professionals still earn high salaries, the 2016 MedReps Salary Survey by MedReps.com, a job board for medical sales representatives, found that they are no longer the top earners in medical sales — with an average total compensation of $149,985. This is a drop of $19,896 from 2015 and a drop of $22,906 from 2014.

While salaries for health IT sales professionals have dropped, most are still happy with their salaries. Among survey respondents, 78 percent said they were somewhat or very satisfied with their overall job, similar to the 75 percent who said they were somewhat or very satisfied with their income. Yet, more money clearly means higher job satisfaction — those who said they are very satisfied with their income earn an average of $177,319 compared with $100,903 among those who are very unsatisfied.

Luckily, it’s not just the products you sell that impact salaries in the industry — experience, job title, education, and more have an effect on pay, the report found. That means you can increase your salary if you feel you should be making more. Here are a few ways you can take home more money:

Move to management

Selling products that earn more money may sound like a good idea, but it may not be the best move. Although medical sales professionals who sell health IT and software products no longer make top dollar, they are still among the top earners in the industry. Only biotech sales professionals, surgical sales professionals, and capital equipment and durable medical equipment sales professionals earn more.

Even though there is more money to be made, selling new products is challenging. Instead, stick with what you know to gain more experience and move up to higher positions. After all, the more experience you have, the more money you make — those with 20 or more years of experience earn the highest average medical sales salary at $165,735. What’s more, sales directors and sales vice presidents report the highest salaries in medical sales, an average of $209,082.

Instead of starting all over again with a new product specialty, work toward gaining a management position with the experience you have. Talk to your supervisor about leadership opportunities, learn what you need to do to move up, take development classes, or volunteer to take on more responsibilities.

While the money may look greener on the other side, your experience is valuable, and sticking with health IT and software will pay off in the long run.

Hit the road

While traveling may decrease your work-life balance, it could increase your paycheck. In our survey, medical sales professionals who travel 50 percent of the time earn $167,061, on average. On the flip side, those who don’t travel at all for work earn significantly less — an average of $125,344.

Take the initiative and take on more travel. Let your manager know you’re interested in and willing to travel more. Volunteer to visit new territories and reach new clients.

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The Magnitude of Medical Errors

Guest post Ken Perez, vice president of healthcare policy, Omnicell.

Ken Perez
Ken Perez

On May 3, BMJ (formerly the British Medical Journal) published an analysis of prior research on medical errors by a team led by Dr. Martin Makary, a professor of surgery at Johns Hopkins University School of Medicine. Startlingly, the analysis concluded that more than 250,000 Americans die annually and nearly 700 perish daily from medical errors. Based on the Centers for Disease Control and Prevention’s (CDC’s) official list of the top causes of death, that figure would place medical errors as the third leading cause of death, behind only heart disease and cancer, which each took about 600,000 lives in 2014, and ahead of respiratory disease, which caused over 147,000 deaths.

The kind of medical mistakes that can be fatal range from surgical complications that go unrecognized to errors regarding the doses or types of medications administered to patients.

The Johns Hopkins analysis received widespread media coverage, with the New York Times, NBC News, NPR, Time, U.S. News & World Report and the Washington Post, among others, all reporting the study’s findings.

This is certainly not the first time that medical errors have attracted the attention of the mainstream media.

The Institute of Medicine’s landmark report, To Err is Human: Building a Safer Health System, released in November 1999, concluded that 44,000 to 98,000 Americans died each year because of preventable mistakes in hospitals. Moreover, the report estimated the annual costs of medical errors at $17 billion to $29 billion.

It was estimated that more than 100 million Americans were aware of the general conclusions of the IOM report, thanks to ample media coverage, which conveyed the idea that medical errors were more prevalent and costly than previously thought. Despite all the publicity about medical errors as a result of the IOM report, it would appear that the U.S. healthcare system is not any safer more than 16 years later.

No one knows the precise toll of medical errors, largely because the coding system used by CDC to record death certificate data does not capture items such as communication breakdowns, diagnostic errors, and poor judgment, all of which can cost lives.

In terms of the economic cost of medical errors, a study sponsored by the Society for Actuaries and conducted by Milliman in 2010 concluded that medical errors in 2008 cost the United States $19.5 billion—$17 billion (87 percent) of which was directly associated with added medical costs (inpatient care, ancillary services, prescription drug services, and outpatient care). The remainder was due to increased mortality rates and days of lost productivity from missed work, based on short-term disability claims.

Adjusting for the increase in the U.S. population from 2008 to 2016, the current year’s cost of medical errors is estimated at $20.8 billion. Continue Reading

Motivated Attackers Will Find a Way Into Any Given Network

Guest post by David Thompson, senior director, product management, LightCyber.

David Thompson
David Thompson

Healthcare organizations are stuck between being an ever increasing target of a data breach and generally having less security resources than a comparable enterprise. It’s a classic situation of needing more with less, with all of the urgency of a full-scale crisis.

Now it’s not uncommon to see the same organization suffer its second or third data breach, and patience (patients too) are wearing thin. At the same time, we know that many organizations have intruders that are lingering and have stayed hidden for a year or more. It’s possible the cybercriminals are using an undiscovered foothold in one organization to get to another within the same health or provider network.

Almost without exception, healthcare organizations of all sizes seem helpless to be able to stop a data breach. Stopping a breach means different things to different people, and that is part of the problem. A good portion of the industry is still focused on completely keeping an intruder from getting into their network. This is a fool’s errand and simply not achievable. Motivated attackers will find a way into any given network. Some professional vulnerability contractors will guarantee that they can break in to your network within two days. There are far too many ways for an attacker to get in, particularly through an employee account or computer.

So, you can’t keep a network intruder out, but you can try to detect their presence as quickly as possible. Almost all healthcare organizations currently lack this capability, but some newer solutions and procedures are showing great promise in making the speedy detection of a network attacker a reality. The good news is that these approaches might only require an hour or two of personnel time each day—and sometimes quite a bit less than that—so it is well within the means of a small healthcare IT group that wears multiple hats and is always pulled thin.

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How HIT Employee Expectations Are Changing and What You Need to Do to Hold Onto Your Best Employees

Guest post by Ben Weber, managing director, Greythorn.

Ben Weber
Ben Weber

The pace of life has changed over the last few decades, and it’s changed absolutely everything. Now, we expect communication to be instantaneous by email and text. We expect delivery to be two-day (and free), thanks to Amazon. And increasingly, expectations about work and careers have changed as well. The time spent at a single organization has been condensed, going from 40 years down to three, five or sometimes even less. Most people anticipate working for multiple companies over the course of their career, not to mention some may have multiple careers in the course of their working lives. Either way, this is a costly trend for employers.

That’s one reason we here at Greythorn conduct an annual survey of healthcare IT professionals: so we can understand what’s motivating them to stay, or seek out new employment. Have a look at some of our key findings and consider what this may mean for you and your team/organization. Perhaps there’s a nugget or two within that may help you ensure you’re doing everything you can to retain your top talent.

Motivation #1: A higher salary

It should come as no surprise that a higher salary can tempt someone away, even from a job they love. What might surprise you, however, is how many of your employees expect their salary to increase right now in their current roles: a full 87 percent of survey respondents said they expect at least a 3 percent increase in the next 12 months. If this expectation isn’t managed or met, the odds are good that you may start seeing some of your best employees begin to grumble.

According to our research, job security is no longer a top motivator for healthcare IT professionals. In our last survey, it slid from the top three—where it’s remained for several years—to number six. Meanwhile, 71 percent of the full-time employees who participated in our research said they’d consider joining the uncertain world of consulting—mainly, because the money’s superior. They’ve accepted that in consulting, job security is rare, and are choosing to embrace that higher degree of risk to capitalize on their earning potential.

So what can you do? Besides the obvious and often less feasible option of increasing everyone’s salary, you can provide transparency to your staff.  Ensure they understand what’s expected of them and are accountable for delivering on your key objectives. Provide documentation to support a salary review and/or a guaranteed raise based on meeting those objectives.  Explain some of the  obscured issues going on within your hospital or health system, which may make a raise unattainable (for now), and/or why the annual bonus was potentially smaller than what they’d hoped for. Although they may be disappointed with the news you’re sharing, you’ll further a trusted relationship—and their loyalty—with your honesty.

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Expanded Funding for HIE Connectivity

Guest post by Joe Cernik, vice president business development, eMedApps.

CMS and ONC recently announced an initiative (read: funding) to connect a variety of providers to health information exchanges, expanding the list of eligible providers to include long-term care, behavioral health and substance abuse treatment providers. Meant to increase the sustainability of HIEs and support improved access to the right patient data at the right time, the increased funding supports categories of providers that have been slow to adopt HIE technology.

The intent of increased funding for HIEs translates to better, more comprehensive access to patient data, improved patient care and reduced costs.

From a recent CMS blog post: ‘The great promise of technology is to bring information to our fingertips, connect us to one another, improve our productivity, and create a platform for the next generation of innovations. Technology, when widely distributed and available, enables providers to improve patient care by distributing information and best practices leading to better experiences of care for individuals in the health care system.” *

What does expanded funding for HIE connectivity mean for patients and providers?

One organization making the most of the initiative is the Massachusetts League of Community Health Centers, the statewide primary care association representing and serving the needs of the state’s 49 community health centers (CHCs). This organization partnered with eMedApps (infographic author below), to define a programmatic approach to onboarding CHCs to the IHE and extending the value of the funding increase.

Ellen Hafer, MTS, MBA executive vice president and chief operating officer for the Massachusetts League of Community Health Centers, shared her insight and experience connecting disparate providers to the Mass HiWay: “Health information exchange is critical as I envision it for quality of care in the short run now as well as the long run. Much of those benefits revolve around connecting disparate aspects of the care continuum at the community-health level. Community Health Centers (CHCs) are often independent organizations who serve as primary care providers, social support agencies and economic engines transforming their communities, one patient at a time. Many offer integrated care, but it’s across the spectrum of clinical specialties like behavioral health or oral health and not necessarily the full complexity of medical specialties. The information connection to behavioral health and substance abuse treatment in high risk populations extends the care continuum where it’s needed.”

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Recent Updates Give Home Health Agencies the Star Treatment

By Jackie Birmingham, RN, MS, vice president, emeritus, of clinical leadership, Curaspan.

Jackie Birmingham
Jackie Birmingham

The Affordable Care Act calls for provider quality to be publicly reported and widely shared. As a result, the Centers for Medicare and Medicaid Services (CMS) extended star ratings to home health agencies (HHAs) on Home Health Compare (HHC) in 2015 to provide home health care beneficiaries with a summary quality measure in an accessible format.

By supporting consumer choice and encouraging provider quality improvement, public reporting will remain a pillar for improving healthcare quality. Currently, CMS reports 27 process, outcome and patient experience of care quality measures on the HHC website to equip patients and their families with the right tools to make choices about home healthcare.

Calculating the Two Types of Star Ratings

1) The Quality of Patient Care Star Rating – This rating probes nine specific evidence-based process and outcomes measures for each home health agency such as timely initiation of care, improvement in patients’ functional status and hospital readmissions.  The measures are calculated into a composite score and star rating, which are typically calculated on a quarterly basis and include:

2) Patient Survey Star Ratings –These ratings incorporate the patient experience of care measures based on Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). These surveys reflect patients’ views on a variety of issues including whether the staff checked patients’ prescriptions for side-effects and properly explained dosing instructions.

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The Final Frontier: Reduce Turnover and Differentiate Your Patient Experience

Guest post by Dr. Jennifer Yugo, chief scientist, Corvirtus.

Jennifer Yugo, PhD, SPHR
Jennifer Yugo, PhD, SPHR

This is a time of tremendous growth and change in healthcare. As in any industry, growth sparks competition as patients have more and more providers from which to choose. From the supply side, this means increased competition for new, repeat, and referral patients. Simultaneously, providers are being pressed to reduce costs while improving the patient experience as they compete for market share.

Healthcare is becoming more competitive as patients have more choices and better information about their choices, especially through social media. To compete, providers have to focus on delivering quality service, a compelling patient experience, and – like competitors in retail – generate buzz.

Our research shows that a healthcare provider’s employees are the most significant contributor to delivering quality, being compelling, and generating buzz. The first component of this formula is ensuring you are hiring the right people. These are employees who perform, fit, and stay.

Pre-employment assessments are widely used across other industries as a key ingredient to quality. Healthcare is a final frontier where personality tests can be leveraged to improve individual and team performance, reduce costs, and most importantly, improve and differentiate patient care.

Sadly, healthcare positions are often viewed as “The Untouchables” where intuition and gut-instinct for hiring and management are used over evidence-based best practices. Following our intuition often results in hiring the wrong people – those who do not perform, are difficult to work with, and either quit or get fired.

Turnover is a huge component of costs and an obstacle to improving care, as well as the patient experience. With shortage of 68,000 primary care physicians predicted by 2025, consider the cost of turnover for one physician:

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