Hayes, makers of integrated compliance and revenue integrity platform for the nation’s premier healthcare organizations, announced that it has entered a strategic partnership with ThoughtSpot, the leader in search and AI-driven analytics, to develop solutions that empower healthcare organizations to proactively manage and mitigate revenue and compliance risks.
Hayes’ flagship revenue integrity software platform, MDaudit Enterprise, is a powerful, cloud-based risk monitoring solution used by the nation’s foremost academic medical centers, hospitals and physician groups.
MDaudit is an enterprise-class platform that enables organizations to efficiently monitor medical claims for billing and coding accuracy, ensuring compliance with government and commercial payer requirements and maximizing the attainable level of revenue.
The platform accelerates productivity for revenue cycle and compliance professionals by providing workflow automation, risk monitoring, built-in analytics and benchmarking capabilities – all in a single, integrated platform. In the market since 2003, MDaudit is currently used to audit one in eight providers in the U.S.
The partnership will focus on integrating healthcare billing, compliance and revenue integrity domain expertise from Hayes and ThoughtSpot’s search and AI-powered platform into a single, comprehensive enterprise solution.
As a data protection standards and development certification organization, HITRUST helps organizations safeguard sensitive data and manage IT risk across all industries and throughout the third-party supply chain. Since it was founded in 2007, the HITRUST Common Security Framework (CSF) has become the gold standard for compliance framework in the healthcare industry as it addresses the requirements of existing standards and regulations including HIPAA, PCI, COBIT, NIST, ISO, FTC, and state laws.
To become HITRUST certified, an organization must first complete a HITRUST CSF Readiness assessment to determine if the current alignment of its security and privacy controls relates to the requirements defined in the HITRUST CSF. The organization can then select a certified HITRUST CSF Assessor Firm that will perform several risk assessments, audits, and quality assurance procedures over the course of two to four months.
The HITRUST CSF has 19 different domains including healthcare data protection and privacy, endpoint protection, mobile device security, incident management, and disaster recovery. An organization will be scored on these assessments and must meet a minimum compliance level to become HITRUST certified.
Research has shown 97 percent of organizations that pursue a HITRUST Certified Security Framework certification rapidly improve their information security posture to meet certification and, most importantly, maintain their security posture. Furthermore, with a mature information protection program in place, organizations are less likely to suffer a breach and are more likely to be able to contain and minimize the impact of a breach, should one occur.
Organizations that implement a robust information security continuous monitoring (ISCM) program such as HITRUST to continually assess the state of their information security controls not only achieve higher levels of maturity, but also make better and more timely decisions.
By Frannie Raede, MPH, PhD, program manager, commercial development, Pillo Health.
In the U.S., 25% to 50% of all adults fail to take their prescribed medications on time, contributing to poor health outcomes, over-utilization of healthcare services, and significant cost increases. Failing to follow prescribed treatment regimens can have tragic consequences for patients and their families, and lead to complaints filed against pharmacists and physicians. One study estimates that medication non-adherence causes approximately 125,000 deaths and 10% of hospitalizations annually, and costs the U.S. healthcare system up to $289 billion each year.
Forgetfulness is the primary cause of non-adherence, but there are many other reasons why a patient doesn’t follow a treatment protocol, such as carelessness, fear, supply, cost, lack of information, or not understanding instructions.
Medication non-adherence is too costly to ignore, both in terms of the price to our healthcare system and the overall health and wellbeing of our nation. As the U.S. population ages, the problem will become more acute, with a greater number of older adults battling chronic diseases and conditions.
So, what can be done to reverse the trend?
Insufficient Information
Current adherence measurements do not paint a clear picture of medication habits, which can impact progress (or lack thereof) relayed between a patient and their provider.
The most frequently used measure of adherence is the Medication Possession Ratio (MPR), where an 80% MPR is considered passing. This is defined as the number of days in supply period, over the difference between the first and last fill dates. MPR ranges from 0 to 1, with 1 representing full adherence. The possession ratio is equal to the total day’s supply fill in a period, divided by the number of days in a period. This ratio is then multiplied by 100 to obtain the percentage of possession.
In theory, an 80% MPR means a patient is taking most of the medication they are prescribed during a certain time frame, but this measurement is not precise. The calculations are usually based on insurance claims data, and therefore do not account for the use of free samples or regimen changes. They also do not provide information beyond possession—for instance, if the medication was taken, if the correct dose was used, or if it was taken at the right time.
These measurements often assume that patients are taking their medications correctly just because they picked them up from the pharmacy. To provide optimal care, healthcare providers need to better understand their patients’ medication behaviors so they can track progress and intervene when necessary, especially in cases where it’s essential a medication is taken correctly to protect a patient’s health.
With the fourth technological revolution in full swing, more and more digital innovations are changing the world we live in. From having virtual assistants on our devices to directly transforming computer designs to objects through 3D printing, it’s safe to say that these emerging technologies have made many aspects of our lives more efficient.
This is why it’s imperative for healthcare professionals today to utilize technology to improve their practice and enhance patient experiences. Not only will it help treat patients more effectively, but it will also help streamline the numerous services in the healthcare system. With this in mind, here are technological advancements that could positively shape the state of healthcare and the patient experience:
Wearable technology
Wearable technology first came to prominence in the healthcare industry with the development of fitness trackers. These are smart devices that are incorporated into clothing or worn as an accessory, which help patients proactively monitor their health by informing them of their heart rate, blood pressure, and physical activity statistics. Now, the data collected by wearables is becoming much more advanced, as a new design can even help detect breast cancer.
For many patients, visiting the hospital or their doctor’s clinic can be a double-edged sword. Although seeing their physicians helps keep their health in-check, some people find their visits to be a hassle, as commuting or simply moving around can be a tiring and costly activity for them. Thankfully, through virtual healthcare innovations, patients don’t have to experience such inconveniences.
Anesthesia billing can be tremendously complicated. Small errors can result in delays and a failure to collect. To improve revenue cycles, we’ve compiled some key ideas that will make an impact on your billing and collections.
#1: How is the charge established?
There are a number of factors that can affect anesthesia billings, but the process can be broken down to a relatively simple formula. Charges are established by adding base units, time units, and modifiers, and then multiplying by your fee per unit. In other words:
(Base Unit + Time Units + Modifiers) x Fee Per Unit = Charge Amount
#2: Accurate Start and Stop Times
The industry follows Medicare’s definition for anesthesia billing start and stop times. Anesthesia billing start and stop times are based on the continual presence of an anesthesia provider. It is critically important to record accurate start and stop times. Do not round your time, and never guess when the start or stop time was.
#3: Understanding Billing Modifiers
Billing modifiers can have a big impact on your charge amounts. There are a number of modifiers that come into play including physical status, medical direction, anesthetic type, and add-on codes. These modifiers can affect your charge amounts in a variety of ways so it’s important to understand each modifier and the role they play in billing.
#4: Documentation is critical
Accurate documentation is the difference between success and failure in generating cashflow. You can have the best systems available, but if the information that you feed into the system is inaccurate or incomplete, your billings and collections will suffer. Pay close attention to your start and stop times and record them accurately. Keep up with the billing modifiers that we discussed in #3. If you log these accurately, your revenue cycle management is set up for success.
This report describes examples of electronic health record (EHR) related burden, as well as strategies and recommendations that HHS and other stakeholders can use to help clinicians focus their attention on patients rather than paperwork, when they use health information technology (health IT).
“Usable, interoperable health IT is essential to a healthcare system that puts the patient at the center, like President Trump has promised,” said HHS Secretary Alex Azar. “We received feedback from hundreds of organizations and healthcare providers on this new burden-reduction strategy, and the input made clear that there are plenty of steps still necessary to make IT more usable for providers and maximize the promise of electronic health records.”
The development of the report, required under the 21st Century Cures Act, was led by the HHS Office of the National Coordinator for Health Information Technology (ONC) in conjunction with the Centers for Medicare & Medicaid Services (CMS). The initial draft, issued in November 2018, represented HHS’s assessment and response to feedback heard from a wide variety of health IT stakeholders, from practicing clinicians to health IT developers.
The report released today reflects additional input from the more than 200 comments submitted in response to the draft strategy and recommendations. The report outlines three primary goals and offers recommendations to:
Reduce the effort and time required to record information in EHRs for health care providers when they are seeing patients;
Reduce the effort and time required to meet regulatory reporting requirements for clinicians, hospitals, and health care organizations; and
Improve the functionality and intuitiveness (ease of use) of EHRs.
“The strategy we are releasing today takes a hard look at ways that the federal government and stakeholders can work together to reduce the administrative and technological burdens experienced by healthcare providers,” said Don Rucker, M.D., national coordinator for health IT. “Patients will benefit from these efforts because their physicians will spend more time focused on them instead of their keyboards.”
Specifically, ONC and CMS looked at four key areas and offered strategies to address each area:
Clinical documentation
Health IT usability (or ease of use of health IT tools and systems)
Federal health IT and EHR reporting requirements
Public health reporting (including coordination with prescription drug reporting programs and electronic prescribing of controlled substances).
Seema Verma
“The taxpayers made a massive investment in EHRs with the expectation that it would solve the many issues that plagued paper-bound health records,” said CMS Administrator Seema Verma. “Unfortunately – as this report shows – in all too many cases, the cure has been worse than the disease. Twenty years into the 21st century, it’s unacceptable that the application of Health IT still struggles to provide ready access to medical records – access that might mean the difference between life and death. The report’s recommendations provide valuable guidance on how to minimize EHR burden as we seek to fulfill the promise of an interoperable health system.”
The report explains that different types of administrative burden can affect different healthcare providers, but is focused on those healthcare providers that are directly involved in delivery of patient care. Those may include physicians, nurses, and other clinical staff; practice managers and other administrators immediately engaged in the management of care delivery; and care delivery institutions, such as hospitals.
Verizon and Emory Healthcare have entered into a strategic partnership to develop and test 5G Ultra Wideband-enabled use cases that could transform the healthcare industry. As part of the partnership, Verizon lit up the Emory Healthcare Innovation Hub (EHIH) with 5G Ultra Wideband service, making it the nation’s first 5G healthcare innovation lab.
EHIH is a healthcare advancement and commercialization program committed to improving the patient care and provider experience. EHIH does this by leveraging the 11TEN Innovation Partners’ “demand driven innovation” approach to solving the most pressing problems facing health care. Verizon will collaborate with Emory Healthcare and its nine Innovation Hub partners, including founding partner Sharecare, to help spur the development of healthcare solutions powered by 5G.
The massive bandwidth, super-fast speeds and ultra-low latency of Verizon’s 5G Ultra Wideband network have the potential to help redefine patient care with real-time data analytics, giving researchers the ability to explore solutions such as connected ambulances, remote physical therapy and next-generation medical imaging.
EHIH will be able to test how 5G could enhance augmented and virtual reality (AR/VR) applications for medical training, enable telemedicine and remote patient monitoring, and provide point of care diagnostic and imaging systems from the ambulance to the ER.
Tami Erwin
“The potential of Verizon 5G Ultra Wideband combined with mobile edge computing to transform healthcare is limitless,” said Tami Erwin, CEO of Verizon Business Group. “Which is why Verizon is partnering with Emory to explore the 5G future of patient care. With 5G, doctors should be able to do things like create holographic 3D anatomical renderings that can be studied from every angle and even projected onto the body in the OR to help guide surgery.”
“The healthcare industry, driven by value-based care and increased consumerization, is set for a paradigm shift that will put a much greater focus on connectivity and access to data,” said Scott D. Boden, MD, Vice President for Business Innovation for Emory Healthcare. “Across every facet of healthcare, from care innovation to reimbursement model transformation to decentralization of care, speed to data is critical to the digital evolution of health,”
This engagement is part of Verizon’s broader strategy to partner with customers, startups, universities and large enterprises to explore how 5G can disrupt and transform nearly every industry. Verizon operates five 5G Labs in the U.S. and one 5G Lab in London that specialize in developing 5G uses cases in industries ranging from health care to public safety to entertainment. While this is the first 5G lab Verizon has set up on-premises for a customer, it will be part of an ongoing initiative to co-develop 5G-related use cases to help customers transform their industries.
In addition to providing EHIH with 5G, Verizon will offer network and security services, project management, professional consulting services and managed infrastructure and sit on the Emory Hub Executive Advisory Board.
The ribbon cutting for the new 5G healthcare innovation lab takes place Friday February 28th from 10a-12p ET at One Glenlake Parkway, NE, Atlanta, GA. If you’re interested in attending and speaking to Verizon and Emory executives on site please contact the below Verizon spokesperson.
Nuance Communications, Inc announced the general availability and accelerated delivery of the Nuance Dragon Ambient eXperience (DAX) solution, an ambient clinical intelligence (ACI) solution for a wide array of medical specialties. Working in tandem with electronic health record (EHR) systems, the Nuance DAX solution revolutionizes the physician-patient experience by securely capturing and contextualizing physician-patient conversations and powering the exam room of the future where clinical documentation writes itself.
Innovated by Nuance and Microsoft, the Nuance DAX solution is built on decades of healthcare experience, in-depth research investments in conversational AI, and enterprise-focused cloud services. Nuance DAX leverages and extends the proven power of Nuance Dragon Medical, already relied upon by more than 500,000 physicians globally, with the latest advancements in ambient sensing technology and AI to create a fully voice-enabled and ambient exam room environment.
As part of a multi-year joint development effort, Microsoft has come together with Nuance to enrich Nuance DAX’s capabilities with AI and cloud capabilities from Microsoft, including the ambient intelligence technology, EmpowerMD, which will come to market as part of the Nuance DAX solution.
The accelerated delivery of the Nuance DAX solution is driven by the healthcare industry’s need to mitigate what the World Medical Association is calling a “pandemic of physician burnout,” with 51 percent of physicians reporting frequent or constant feelings of burnout caused by a staggering administrative workload of electronic paperwork to document patient care and which is required for insurance coverage, financial reimbursement, and medicolegal liability protection.
Burnout is a serious barrier to improving the cost and availability of healthcare services. A recent study published by the Annals of Internal Medicine reported that physician turnover and reduced clinical hours are attributable to burnout costs of $4.6 billion, or about $7,600 per physician, in the United States each year.
“It is essential to develop technology that empowers clinicians so that they can get back to doing what they trained for and love. It is equally important that we return to patients their doctors’ undivided attention,” said Joe Petro, CTO, Nuance. “Our development of Nuance DAX began with a deep understanding of how doctors need and want to work. We’ve delivered an unobtrusive solution that is as present and available as the light in the exam room – and already producing meaningful results for clinicians and their patients.”
Novant Health, Rush University Medical Center, and SSM Health are among the many leading healthcare organizations that have chosen the Nuance DAX solution to improve the physician and patient experience. Organizations of varying sizes such as Nebraska Medicine are already realizing increased efficiency and patient throughput, higher satisfaction scores, and reduced provider burnout after using Nuance DAX. Provider satisfaction scores for clinical documentation increased approximately 88 percent, and patient consent rates exceeded 90 percent, within only two weeks of using Nuance DAX.
SSM Health, a Catholic non-profit integrated health system serving communities throughout the Midwest, plans to pilot this technology in some of its specialty clinics in St. Louis, Mo., Oklahoma, and Wisconsin, beginning in March. “With the Nuance Dragon Ambient eXperience solution, our providers can spend more time with their patients and less time on administrative tasks,” said Ann Cappellari, MD, Vice President and Chief Medical Information Officer, SSM Health. “This helps providers and patients communicate more clearly and build stronger relationships. That results in better care, which is everyone’s goal.”
Said Greg Moore, corporate VP, Health Technology and Alliances, Microsoft, “As AI continues to improve, we expect it will empower our health system partners to turn their observations into actions — to reduce risk, flag concerns, and even help guide clinicians to the most effective care plans. By working together with Nuance, and applying the power of Azure and Azure AI, we aim to positively transform the day-to-day life of front-line care providers – ultimately empowering them to provide optimal health for their patients.”
The Nuance DAX solution is built on Microsoft Azure, a highly secure HITRUST CSF certified platform, compliant with the HITECH Act, and that has implemented the physical, technical, and administrative safeguards required by HIPAA. The Nuance DAX solution is now available for an array of medical specialties and includes:
• Ambient device: A purpose-built ambient device with a highly optimized microphone array, large interactive display, integrated biometrics, and multi-sensory capabilities, capable of reliably capturing a multi-party conversation within an exam room setting.
• Ambient documentation: An automated clinical documentation solution powered by deep-learning-based AI and certified through a quality review process.
• Ambient skills: A growing list of integrated Dragon virtual assistant capabilities through a hands-free access point that will enable care teams to complete tasks in real-time within their EHR and other third-party applications.
By Frannie Raede, MPH, PhD, program manager, commercial development, 
As part of the ongoing efforts to strengthen the relationship between patients and their doctors, the U.S. Department of Health and Human Services (HHS) issued the 
Verizon and Emory Healthcare have entered into a strategic partnership to develop and test 5G Ultra Wideband-enabled use cases that could transform the healthcare industry. As part of the partnership, Verizon lit up the Emory Healthcare Innovation Hub (EHIH) with 5G Ultra Wideband service, making it the nation’s first 5G healthcare innovation lab.
Nuance Communications, Inc