According to a recent survey conducted by Purdue Healthcare Advisors, a nonprofit healthcare consulting organization, hospital executives are reluctant to implement ACOs — 46 percent — and they have no plans to implement an Accountable Care Organization (ACO)-like model in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
“This survey has identified a significant need for advocacy and education to support hospitals and help them survive the wave of changes brought on by the Affordable Care Act,” said Mary Anne Sloan, director of Purdue Healthcare Advisors. “Hospital executives are charged with enhancing patient care and managing margins with a shrinking workforce and diminishing patient volumes.”
Hospital executives find ACOs to be unstable and financially risky
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future (46 percent) cited the following reasons:
According to a new report from AMN Healthcare, a healthcare staffing firm, 78 percent of hospital executives believe there is a shortage of physicians nationwide, 66 percent believe there is a shortage of nurses, and 50 percent believe there is a shortage of advanced practitioners. The survey also indicates that the vacancy rate for physicians at hospitals approaches 18 percent, while the vacancy rate for nurses is 17 percent, considerably higher than when AMN Healthcare conducted a similar survey in 2009.
“Change in healthcare is a continuous evolution, but the one constant is people,” said AMN president Susan Salka. “No matter what models of care are in place, it takes physicians, nurses and other clinicians to provide quality patient care, and the fact is we simply do not have enough of them.”
AMN Healthcare’s 2013 Clinical Workforce Survey asked hospital executives nationwide to comment on clinical staffing trends affecting their facilities. More than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 24 percent of hospital executives who rated staffing these professionals as a high priority in AMN Healthcare’s 2009 workforce survey.
Over the past year, economic pressure and regulatory changes have increased scrutiny around areas of inefficiency within the healthcare industry. With new policies like the Affordable Care Act creating the need to improve patient outcomes and prevention, 2014 will be the year for much needed efficiency upgrades across the board at hospitals. And with mounting pressure to cut costs amidst anticipated physician and other major shortages, new and innovative ways to leverage technology will be called upon to usher in changes for the healthcare industry.
The business of care will continue to be a major area of focus for hospitals in 2014. Preventable, adverse events because of medical errors cost the healthcare industry more than $29 billion in 2013 and have led to between 50,000 to 100,000 deaths each year. Healthcare professionals and hospitals cannot afford to continue accepting medical errors as balance sheet losses, which are not only jeopardizing profitability, but patient care. To save money and improve patient care at the same time, hospitals will look to learn from technology being used successfully by other industries in 2014 to enhance real-time analysis and, thereby, prevention and outcomes.
Guest post by Greg Link, co-author with Stephen M. R. Covey of the national bestseller Smart Trust: The Defining Skill that Transforms Managers into Leaders.
As the name implies, patient satisfaction scores are nothing more than a measure of a patient’s healthcare experience. Like customers in any other industry, healthcare patients expect good, old-fashioned, caring customer service and to have their expectations met. Unfortunately, due largely to the extreme complexity of the healthcare experience, patients have historically lowered their expectations and defined extraordinary service as merely having their health issue ultimately resolved. That’s like ignoring all of the service aspects of a hotel stay as long as you slept through the night.
Now, in response to the Affordable Care Act, which links hospitals’ government reimbursement payments to how well they score in the Hospital Consumer Assessment (HCAHPS) on patient care, hospitals across the country are scrambling to improve their scores.
Stephen M.R. Covey
“The reality is, hospitals can’t talk themselves out of a problem they behaved themselves into,” Stephen M. R. Covey said, author of The Speed of Trust and Smart Trust.
Covey suggests that the patient experience is not a campaign or a department; it is a function of a high-trust culture generated by good, old-fashioned, common-sense behaviors demonstrated by all stakeholders. These behaviors are common to trusted people and organizations throughout history – behaviors like listening first, clarifying expectations, talking straight, creating transparency, extending trust, and demonstrating respect. One compelling example of a remarkable extension of trust is the Cleveland Clinic, where they are so transparent they give patients online access to their own charts and medical records, including doctors’ notes.
Guest post by Ken Perez, senior vice president and director of healthcare policy, MedeAnalytics, Inc.
Chase scenes—usually involving cars, motorcycles or speedboats—are an adrenaline-producing staple of the Bourne movies, which are some of my favorites. In these scenes, one party, the villain, pursues another party, the hero. The chased tries to evade the chaser by choosing a circuitous, complex route, and often, some sort of distraction or unexpected intervention—such as a train or crowd—prevents the chaser from catching the chased.
Implementing the Affordable Care Act (ACA) can be likened to a long, long chase scene in which significant segments of the public are being asked to chase after the law, i.e., comply with it. But the ACA’s route has certainly been circuitous and complex, and there have been numerous distractions that may ultimately leave some of the populace in the dust of ignorance and nonparticipation.
One can’t blame the public. The ACA is complex, multidimensional in scope, and it features a lengthy, multi-year rollout. A product of two enormous pieces of legislation—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act—the ACA totalled, before consolidation, over 2,400 pages and contained more than 450 sections.
Guest post by Dr. Jeff Livingston, board certified obstetrician and gynecologist, MacArthur OBGYN.
Recently on The Daily Show, a very interesting topic was covered — the lack of interoperability of electronic health records. This was a huge surprise to me as one would not expect the Comedy Central to cover a topic frequently discussed only by health information technology policy wonks.
During the satirical editorial, John Stewart lambasted the fact that the electronic health records from the VA system are unable to communicate with the electronic health records of the Department of Defense. He pointed out the illogic of having two large departments in the United States government having two different systems that cannot exchange information with each other.
Guest post by Rick Little, vice president of Client Services, MedAptus.
Revenue cycle management. Right now you’re probably thinking this term sounds like some fancy business school jargon, so why should you care about it? Isn’t that an accounting issue? What does it have to do with healthcare IT?
Well, a lot actually. Applying health IT resources to revenue cycle management processes is a must-do now as the Affordable Care Act, Meaningful Use and the looming ICD-10 transition swing into full gear. In fact, now more than ever, technology solutions are needed to drive correct coding and billing compliance for an optimized revenue cycle. Without it, your organization will struggle into 2014 and beyond.
Here’s a quick look at how charge capture and management software helped The University of Texas MD Anderson Cancer Center prepare technologically and financially for all that the ACA, ICD-10 and other initiatives may bring.
More than eight years ago MD Anderson identified electronic charge capture as a technology capable of providing financial, administrative, and compliance improvements. MD Anderson Cancer Center is part of the University of Texas system and located in the heart of the Texas Medical Center. One of the largest employers in Houston, MD Anderson has more than 18,000 employees including more than 1,400 physicians, and served nearly 110,000 patients in 2011.
Back in 2004, when the organization identified improving its revenue cycle management as an initiative, here are some of the challenges it faced:
A huge sprawling campus
An in-house developed Electronic Health Record (EHR)
Old legacy systems for scheduling and billing
Limited use of order entry
Beyond automating and streamlining physician charge capture processes, MD Anderson also required its chosen software solution to integrate with its EHR, link together numerous legacy systems and drive reconciliation improvements across its many clinical areas.
MD Anderson began using charge capture and management technology from Boston-based MedAptus with 50 physicians piloting the company’s mobile Professional Charge Capture (Pro) in early 2005. After initial pilot results that demonstrated improved revenue and decreased charge lag, MD Anderson implemented MedAptus’ use across its entire enterprise. Today, more than 1,300 clinicians utilize Pro for their professional charge capture and management.
Since MD Anderson began using charge capture technology, many improvements have evolved out of their implementation. These include:
EHR Charge Entry
A vital component of the charge capture deployment at MD Anderson is integration with the hospital’s proprietary EHR, Clinic Station. Working together, MD Anderson and MedAptus created an interface directly within the EHR allowing providers to easily complete charging and charting tasks via a single sign-on and with the preservation of patient context between the two systems. This real-time, simultaneous entry has reduced errors, improved compliance, decreased time-to-billing and driven personal efficiencies.
Inpatient consultation charges
As MD Anderson evaluated areas for improvement within its revenue cycle processes, inpatient consultation charges stood out as an area for review. To improve capture here, a new interface from the consult scheduling system capable of creating consult visits within MedAptus was implemented. As a result, consult charge opportunities can now be consistently capitalized on by providers and MD Anderson is able to reconcile for anything that may have been missed for appropriate follow-up.
In looking for help with charge reconciliation, MD Anderson needed a solution that provided support staff with full transparency of activity. In general, this staff consists of those tasked with reconciliation and those responsible for charge accuracy (typically coders). Regardless of organizational role, using MedAptus, staff are able to view the number of charges expected, submitted and missing at the provider, specialty and location level. They can also view the status of submitted charges as they are worked and approved by the coder group. Coders leverage the almost one million rules embedded within the MedAptus application which include Medicare edits, NCDs and LCDs as well as MedAptus proprietary and custom rules.
Once charges have been submitted for back-office review, the MedAptus configuration at MD Anderson allows charges to be “stamped” with specific data elements that are important to financial reporting across the MD Anderson enterprise. Prior to MedAptus, administrative staff needed to manually designate fields such as billing areas or revenue centers. Charge management automation has led to better staff productivity and increased accuracy of revenue reporting around this task.
Given all of the areas along the revenue cycle that charge capture and management technology can impact … still wondering why enhancing revenue cycle management processes is an IT challenge?
Rick Little is responsible for the implementation of software products and ongoing customer support services at MedAptus, including the implementation of MedAptus’ software solution at The University of Texas MD Anderson Cancer Center.