By Win Whitcomb, MD, chief medical officer, Remedy Partners.
Win Whitcomb
The Bundled Payments for Care Improvement (BPCI) Advanced initiative is a new advanced alternative payment model (APM) that will go live October 1, 2018. The successor to the 2013 BPCI program, BPCI Advanced is CMS’ most significant episodic payment reform proposal to date, indicating the government’s commitment to transitioning to paying for healthcare value rather than volume.
BPCI Advanced, a bundled payment model for Medicare fee-for-service beneficiaries, is a voluntary program in which acute-care hospitals and physician group practices may participate as “episode initiators.” As such, they will assume clinical and financial risk for patients during the episode. BPCI Advanced encompasses 32 bundles, or episodes, that include an inpatient hospitalization and the following 90-day period (save for three outpatient procedure bundles that include the procedure and 90-day follow-on period).
Applicants can choose one or more of the 32 bundles and then commit to participate with these bundles for the first five quarters of the program, at which time they can change their selected bundles. The bundled payment is carried out retrospectively where Part A and Part B claims are summed; if total payments are less than an episode initiator-specific target price, initiators keep the difference; if total payments exceed the target price, initiators must pay back overages. Performance on seven claims-based quality metrics impacts incentive payments. Episode initiators may go it alone or participate with a “convener,” which may provide services such as care-management technology, analytics and reporting, care-redesign expertise, access to post-acute provider networks, and financial risk sharing.
CMS recently distributed to applicants historical claims and target pricing data that contains Medicare Part A and B claims for each applicant, at the individual hospital-level, mapping to the 32 bundles and a target price for each bundle. Applicants can see total spending represented by all bundles and the total number of episodes. They can also see, in aggregate and for each bundle, major areas of spending during an episode, such as anchor hospitalization, readmissions, skilled nursing facilities, inpatient rehabilitation facilities, and spending tied to home health agency services, physician services, durable medical equipment, etc.
How to Succeed
Applicants should evaluate areas of high spending, high variation or both. Since BPCI Advanced is a pay-for-improvement program, applicants should select and prioritize bundles in which there is opportunity for improved performance over the baseline period (2014-2016).
Practices that improve care coordination will do well with BPCI Advanced. But keep in mind that BPCI Advanced episodes last for 90 days following anchor hospital discharge, so any readmissions occurring during this window will affect success. The best way to address this issue is to provide longer term follow-up with patients’ key physicians and other providers. One example of this is selecting the optimal discharge destination (e.g., to home without services, home with services, or post-acute facility) based on each patient’s profile. This can help improve the use of post-acute services, which account for substantial spending during an episode.
Ear, nose and throat (ENT) doctors handle a variety of cases and prescribe treatments based on what’s readily available. As technology continues to evolve and impacts the healthcare industry in not too subtle ways, ENT doctors will need to learn about new methods and approaches in their practice.
New innovations are paving the way towards more effective solutions to hearing loss. Sure enough, practitioners and healthcare providers are investing a great deal in technology as a means to satisfy new demands for better treatment plans. It’s only a matter of knowing which of these technologies can provide greater disruption in the field of ENT health.
With that being said, here are the most important technological trends ENT doctors will have to adopt.
The use of mobile apps
Mobile applications are becoming prevalent. This is made evident by the fact that nowadays there are apps for basically any purpose. Going beyond the field of financial services and education, there are now apps that cater towards specific medical needs.
For ENT doctors, apps are being developed to make it more efficient for practitioners to monitor, test, and adjust hearing aids for their patients. For instance, the ReSound app allows users to adjust the settings of their hearing aids using their mobile phones. The technology proves to be advantageous for older patients who want to address the deterioration of their hearing and lead a life with sound.
Popularity of cochlear implants
To address the long-term damages in the inner ear, ENT doctors rely on cochlear implants to restore hearing. Ever since they became a popular solution among hearing loss patients, cochlear implants have often been too expensive for many.
However, with recent innovations in ENT technology, these implants have become increasingly viable to patients. With that being said, the treatment is beginning to enjoy massive adoption by practitioners and health care providers. Moreover, it has become easier for patients to purchase accessories such as cochlear implant batteries from an increasing number of online stores that are selling to this market.
Effective time management
Even though medical technology has made it easier for doctors to manage their time, they still need to address long patient queues and maximize their activities to cover all cases in the waiting list. As always, time management has always been a complex problem being handled not only by practitioners, but hospitals as well.
In this sense, there is still a need to adopt better patient management systems. Luckily, there are productivity apps and workflow management software that can help doctors keep track of their patients and ensure optimum serviceability in their practice.
YourDoctors.Online provides patients direct access to the North American doctors. The company’s general physicians are available online to answer any general inquiry and experienced specialists for second opinions.
Elevator pitch:
We are like WebMD but with a personal touch. Connect with a personal doctor 24/7 to get personalized answers to your medical questions with an “opinion that matters.”
Founder story:
Nauman Jaffar
CEO Nauman Jaffar’s mother, aunt and boss were diagnosed with chronic diseases. Some survived due to on-time proper diagnosis while others were not that lucky. This motivated him to leave my corporate life and create a solution that connects global patients to world-class doctors. Our mission is to develop a social enterprise focused on preventing misdiagnosis and ensuring that excellent healthcare is a “click” away. We aspire to save one life at a time with medical “opinion that matters”.
Marketing/promotion strategy:
YourDoctors.Online is directly reaching out to consumers all across the world to connect patients with internet access to North American doctors get access to the best medical advice. We communicate through a variety of digital channels to not only stay top of mind but to gain awareness that getting the right medical advice is a few clicks away.
Market opportunity:
Our target audience and marketing focus is towards women from the ages between 20-35 and who for an online doctor service for their family.
Who are your competitors?
Because of the service YourDoctors.Online provides, we have no direct competitors. Companies, such as Best Doctors, 2nd.MD, do offer a similar service; however, instead of directly targeting companies and their employees, we directly going out to consumers. As a result, our patients are from 125 different countries.
How your company differentiates itself from the competition and what differentiates YourDoctors.Online?
With direct access to our customer, our competitive advantages is our brand value and our valued pricing for a medical second opinion. Since our market is international patient with various different affordability ranges, we provide our patients with access to doctors at affordable rates.
Business Model:
We have three different tiers of services such as 1) specialist who provide a medical second opinion for a premium price; 2) for our monthly members who get access to our auxiliary medical practitioners (i.e. psychologist, nutritionist, etc.); and 3) free access to our general physicians.
By Richard A. Royer, chief executive officer, Primaris.
Richard Royer
Back in the day – the late 1960s, when social norms and the face of America was rapidly changing – a familiar public service announcement began preceding the nightly news cast. “It’s 10 p.m. Do you know where your children are?”
Today, as the healthcare landscape changes rapidly with a seismic shift from the fee-for-service payment model to value-based care models, there’s a similar but new clarion call for quality healthcare: “It’s 2018. Do you know where your data is?”
Compliance with the increasingly complex alphabet soup of quality reporting and reimbursement rules – indeed, the fuel for the engine driving value-based car – is strongly dependent on data. The promising benefits of the age of digital health, from electronic health records (EHRs) to wearable technology and other bells and whistles, will occur only as the result of accurate, reliable, actionable data. Providers and healthcare systems that master the data and then use it to improve quality of care for better population health and at less cost will benefit from financial incentives. Those who do not connect their data to quality improvement will suffer the consequences.
As for the alphabet soup? For starters, we’re as familiar now with these acronyms as we are with our own birth dates: MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), which created the QPP (Quality Payment Program), which birthed MIPS (Merit-based Incentive Payment System).
The colorful acronyms are deeply rooted in data. As a result, understanding the data life cycle of quality reporting for MACRA and MIPS, along with myriad registries, core measures, and others, is crucial for both compliance and optimal reimbursement. There is a lot at stake. For example, the Hospital Readmissions Reduction Program (HRRP) is an example of a program that has changed how hospitals manage their patients. For the 2017 fiscal year, around half of the hospitals in the United States were dinged with readmission penalties. Those penalties resulted in hospitals losing an estimated $528 million for fiscal year 2017.
The key to achieving new financial incentives (with red-ink consequences increasingly in play) is data that is reliable, accurate and actionable. Now, more than ever, it is crucial to understand the data life cycle and how it affects healthcare organizations. The list below varies slightly in order and emphasis compared with other data life cycle charts.
Find the data
Capture the data
Normalize the data
Aggregate the data
Report the data
Understand the data
Act upon the data
One additional stage, which is a combination of several, is secure, manage and maintain the data.
Find the data. Where is it located? Paper charts? Electronic health records (EHRs)? Claims systems? Revenue cycle systems? And how many different EHRs are used by providers — from radiology to labs to primary care or specialists’ offices to others providing care? This step is even more crucial now as providers locate the sources of data required for quality and other reporting.
Capture the data. Some data will be available electronically, some can be acquired electronically, but some will require manual abstraction. If a provider, health system or accountable care organization (ACO) outsources that important work, it is imperative that the abstraction partner understand how to get into each EHR or paper-recording system.
And there is structured and unstructured data. A structured item in the EHR like a check box or treatment/diagnosis code can be captured electronically, but a qualitative clinician note must be abstracted manually. A patient presenting with frequent headaches will have details noted on a chart that might be digitally extracted, but the clinician’s note, “Patient was tense because of job situation,” requires manual retrieval.
Normalize the data. Normalization ensures the data can be more than a number or a note but meaningful data that can form the basis for action. One simple example of normalizing data is reconciling formats of the data. For example, a reconciling a form that lists patients’ last names first with a chart that lists the patients’ first name first. Are we abstracting data for “Doe, John O.” or “John O. Doe?” Different EHR and other systems will have different ways of recording that information.
Normalization ensures that information is used in the same way. The accuracy and reliability that results from normalization is of paramount importance. Normalization makes the information unambiguous.
Aggregate the data. This step is crucial for value-based care because it consolidates the data from individual patients to groups or pools of patients. For example, if there is a pool of 100,000 lives, we can list ages, diagnosis, tests, clinical protocols and outcomes for each patient. Aggregating the data is necessary before healthcare providers can analyze the overall impact and performance of the whole pool.
If a healthcare organization has quality and cost responsibilities for a pool of patients, they must be able to closely identify the patients that will affect the patient pool’s risks. Aggregation and analyzing provides that opportunity.
Leading CEOs will never say “wellness” is a top priority. Instead, they care about increasing revenue, providing great customer service or disrupting their market. Most see “an engaged workforce” as a path to these results. Even today’s successful “well-being” programs, which look nothing like their early predecessors (annual biometrics and flu shots, anyone?) are largely ignored by CEOs, and rarely connect to the purpose of the company.
Yes, many employers have embraced a more comprehensive whole-person approach to well-being, one that addresses emotional, physical, work and even financial well-being. But these alone can’t solve burnout.
These evolved “well-being” programs look beyond simple health outcomes and have a direct connection to improved employee well-being and critical business outcomes like employee engagement and reduced turnover.
For example, 88 percent of employees with higher well-being feel engaged at work, compared to 50 percent of employees with lower well-being. And 98 percent of employees with both higher well-being and a higher perception that their company supports their well-being say they want to be working at the same company in one year.
But even with this data at their fingertips, most C-suite leaders still find well-being too fluffy, hard-to-measure and irrelevant to their businesses. So, they have to look even more broadly. And the well-being industry needs to evolve and become relevant, or die.
When companies take a broader look at the results associated with an engaged and energized workforce, they’ll find real ROI within programs that were once seen as traditional wellness or well-being focused. ‘Engaged’ here doesn’t mean having well-being — it means a deep connection and sense of purpose at work that provides extra energy and commitment. And that’s what drives business results. Until employers combine well-being with employee engagement in their strategies, measurement approaches and programs, they will never solve employee burnout.
From on fire to burned out Because it sits at the intersection of something CEOs largely ignore — well-being — and something they pay attention to with increasing frequency — employee engagement — it’s not typically measured in one place. (Until now.) And you can only manage what you can measure.
Employee burnout is created by ongoing and intense job-related stress. This shows up in employees as exhaustion, cynicism and inefficacy, especially among the most talented and engaged employees.
Burnout is also associated with absenteeism, intention to leave the job and actual turnover. But for people who stay on the job, burnout leads to lower productivity, and decreased job satisfaction. Plus, it has negative impacts on team members. Burnout is often “contagious,” spreading toxicity across a team or spilling over into life outside of work. Cynical people just do worse work. It’s proven.
To burn out, an employee must be highly engaged and care deeply enough to get to the point of feeling burned out. Those at most risk for burnout are the top performing employees that employers can’t afford to lose.
In a new report, the Limeade Institute determined that burnout emerges when a highly engaged employee begins to have low well-being. Sadly, this is often a result of work pressure and lack of support from the employer.
“You have to be on fire in order to burn out,” said Dr. Hamill, lead researcher and Chief Science Officer of the Limeade Institute. “While both disengaged and burned out employees are at high risk for turnover, burnout is not the same as disengagement. If an employee isn’t feeling the energy or commitment from being engaged at work, then they’re most likely disengaged — not suffering from burnout.”
The Limeade Institute found employers are actively driving out top talent by causing the burnout and leaving it up to employees to deal with alone. The most common causes of burnout are not individual, but rather organizational; think work overload, role ambiguity, lack of feedback, lack of support and a perceived lack of fairness.
Burnout is acutely rampant in healthcare, particularly among caregivers. According to research from the Mayo Clinic, more than half of physicians report one or more symptoms of burnout. Similar research found the prevalence of burnout among nurses is as high as 70 percent and as high as 50 percent for physicians, nurse practitioners and physician assistants. And Stanford Medicine research highlights that it costs them between $250,000 and almost $1 million every time they need to replace a physician. They estimate physician burnout costs at least $7.75 million a year. Keeping just a dozen physicians from burning out is worth millions to just one hospital.
The world is a big place. However, since the introduction of the internet, the world just seems to get progressively smaller because of our ability to communicate with people who are leagues away. We are able to share information to a vast audience without any delay. And with the budding concept of “the internet of things”, it’s not a far-fetched idea that we should soon find that we’re able to control devices over an internet connection.
While the ability to share information has always been our strongest trait as a species, a lot of specialists, especially in the medical field, are severely limited by one thing — distance. Despite our ability to share information, we cannot completely transfer skill and experience from one person to another. Skilled doctors are sought all over the world because they carry something that they cannot simply transfer over the internet — their skill. There are many things that simply cannot be taught, such as how to maintain a steady hand during complex procedures or how to remain composed during a high-risk medical operation.
This was exactly the problem that the Da Vinci Medical robot was meant to address, and since its introduction in 2000, it has done exactly that. Because of this technological development, distance was no longer an issue when it came to providing skilled medical assistance. Because of the Da Vinci Medical Robot, skilled physicians were able to conduct complex and risky procedures despite being miles away from the actual patient.
Other times, instead of being able to emulate the movements of a doctor who’s miles away, robots can also serve to assist the doctor. This is the case with the first dental surgical robot, Yomi. This robot, unlike the Da Vinci Medical robot, is designed to help dentists perform procedures more accurately.
Yomi is a robot that was built by Neocis, a company that hails from Miami, Florida. It was recently approved for production by the FDA. The robot is programmed to plan out dental procedures based on the results of a patient’s CT scan results. Apart from this, the robot is also able to guide the drill as the dentist performs the procedure.
As the healthcare industry is strongly focused on efficient workflow, mobile apps are what can help doctors and patients interact on the go. According to a survey, 90 percent of medical institutions already use or plan to use mobile apps for patient treatment and/or internal management. With the growing number of hospitals that start to launch mobile apps, there has increased a need to shift away from the one-app-fits-all model to systems that serve to accomplish specific tasks. Urgent care clinics are the first in line to try enhance the efficiency of their work by turning to mobile applications.
To provide preventive care to more patients, most healthcare systems have created retail and urgent care clinics for people to visit and arrange an appointment on the same day. While retail centers provide mostly basic services, for instance, chronic conditions treatment, urgent care clinics deal with more serious cases. Also, such clinics typically have labs and offer X-Ray services. That’s why it is very important to provide these medical centers with appropriate software that will serve the overarching goal – effective patient treatment. So why not use a mobile app to improve the entire workflow? Let’s weigh up all the pros and cons.
Benefits and drawbacks of custom mobile apps for urgent care
If you plan to get a custom mobile app for an urgent care center, thoroughly consider finances, time and energy that you are going to invest in the project. If an app is developed to serve doctors, then all the risks are worth taking. Apps for smartphones and tablets speed up urgent care delivery and help doctors find the fastest solution in code blue situations.
Another matter is getting a mobile app to serve patients. The urgent care market focuses quite narrowly on doctor-on-demand apps for patients. Moreover, most patients turn to urgent care less than 2 times a year. So is the effort justified? Apps may be installed when needed and removed if not needed any more. That’s why it seems reasonable to download an app from the App Store or use a website to get the updated patient information.
What is the best solution for urgent care providers
Though custom mobile apps for urgent care centers may be optional, there is always a strong need in other software. Clinics demand healthcare management information systems (HMIS), custom imaging and visualization apps, patient administration systems, electronic health record (EHR) systems and other medical software to improve patient outcomes and meet the needs of a certain clinic and its staff. Healthcare policy management software can aid the facility in its short- and long-term management goals while considering the stringent regulations and healthcare standards.
McKinley County, New Mexico, is the namesake of the assassinated 25 U.S. President William McKinley. Many locals, particularly those Native Americans of Navajo decent living on reservations, have also been the victim of assassination, but in character in addition to physical attacks. Three decades ago Gallup, New Mexico, which borders on the Navajo Reservation, was known as “Drunk Town, USA.”
For many years Northwest New Mexico’s Gallup ranked number one nationally in the number of alcohol-related deaths. This reputation also killed many resident’s spirits, contributing to addiction, joblessness and homelessness, further highlighting the need for behavioral health care in this region. Native American youth have the highest rates of alcoholism of any racial group in the country, according to the National Institutes of Health.
McKinley County Is One of Poorest in U.S.
There are many stories like this. Addiction’s partner is the adjunct poverty of McKinley County, one of the poorest counties in the U.S. In Gallup there is a large population of Navajo and Na’nizhoozhi Indians. It is the most populous city in the county with 22,670 residents and is situated between Albuquerque and Flagstaff with 61 percent living below the federal poverty line and unemployment at 8.4 percent.
The Indian Health Service (IHS), an operating division within the U.S. Department of Health and Human Services (HHS) is the principal federal health care provider for Indians. Its mission is to raise their health status to the highest possible level. However, there are still issues such as the life expectancy for Indians being approximately 4.5 years less than the general population of the United States, 73.7 years versus 78.1 years.
Data from a 2014 National Emergency Department Inventory survey also showed that only 85% of the 34 IHS respondents had continuous physician coverage. Of these 34 sites surveyed, only four sites utilized telemedicine while a median of just 13 percent of physicians were board certified in emergency medicine. Another behavioral health related disease afflicting the territory is diabetes. In 2016, diabetes was the sixth leading cause of death for New Mexicans and the seventh leading cause in the U.S.
RMCHCS Hospital Fights Addiction with Behavioral Health Apps
Despite the drumbeat of bad news and discouraging statistics, organizations such as Gallup’s Na’ Nihzhoozhi Center Inc.’s (NCI) has 26,000 admissions every year and is the nation’s busiest treatment center with many repeat customers. The detox center was the result of an effort 30 years ago which began when more than 5,000 people marched from Gallup to Santa Fe to demand assistance from state lawmakers and received a $400,000 for a study to build a detoxification center. The hospital then received two-million-dollar ongoing yearly federal grant out of which NCI was born.
The leader of that effort in the ’80s and ’90s was David Conejo who returned in 2014 as the CEO of Rehoboth McKinley Christian Health Care Services (RMCHCS) where he leads the fight against addiction with traditional tactics, but also behavioral healthcare innovations that have captured the attention of the healthcare industry.
Turing the Tables on Addiction
When he became CEO of RMCHS a few years ago, he took a financially failing hospital and turned it around with the help of William Kiefer, Ph. D who is the hospital’s chief operating officer. Recognizing the root cause of the region’s health problem was addiction, Conejo revitalized a former rehab building on the hospital’s grounds and with some fundraising he launched the Behavioral Health Treatment Center.
The center is operated by Ophelia Reeder, a long-time healthcare advocate for the Navajo Nation and a board member of the Gallup Indian Medical Center. Bill Camorata, a former addict, is the behavioral special projects director. He opened “Bill’s Place,” an outdoor facility where he and hospital volunteers treated the homeless with meals, clothing and medical triage as part of Gallup’s Immediate Action Group that he founded and serves as president. The center has treated more than 200 addicted residents since the center opened in 2015 and has a staff of 30 who manage resident’s case work, provide behavioral health services and are certified in peer support.
