Guest post by Dr. Talbot “Mac” McCormick, president and CEO, Eagle Telemedicine.
Dr. Talbot “Mac” McCormick
Looking back at 2017, we see some of the same significant trends that have been gaining momentum, along with a few newcomers. Together, these top-five trends will impact hospital medicine in 2018 in both traditional and unexpected ways.
Growth Despite Reimbursement Parity Confusion
The telemedicine industry’s growth continues rapidly despite the widespread confusion over reimbursement for telemed services from state to state. Why? Because most hospital leaders understand they face far more significant costs from the lack of proper physician and specialist coverage than they ever would by a less-than-optimal reimbursement rate for telehealth. A teleneurologist consult in the ED might be reimbursed at a lower rate than an in-person visit with an onsite neurologist, but keeping the stroke patient in the hospital could mean a $10,000 DRG reimbursement that the hospital would lose if the patient had to be shipped to a tertiary referral center for treatment. Which is the smarter investment? And more importantly, which scenario better serves the patient?
Expansion into New Types of Inpatient Settings
As micro-hospitals and long-term acute care hospitals (LTACHs) grow, they are looking for single-source providers of solutions, with one point of contact, one operating system, and one set of tools and processes. Telemedicine fits their models very well, helping them avoid contracting with a wide array of specialists to meet their patients’ needs. Micro-hospitals are already established in 19 states, and LTACHs are growing since a federal moratorium prohibiting their expansion expired on Sept. 30, 2017. Being able to access a variety of specialists via telemedicine, depending on the needs of patients on any day, is something these facilities need in order to fulfill their commitment to the communities they serve.
Increasing Use of Telemedicine in Metropolitan Hospitals
Rural hospitals have long been a sweet spot for telemedicine. The physician shortage is certainly more acute in rural areas as community hospitals struggle to recruit physicians, keep beds filled and, in many cases, stay solvent. Recently, however, more metropolitan hospitals have seen the advantage of telemedicine in two key areas. When cross-coverage calls are handled by telemedicine teams, it takes considerable pressure off night hospitalists who may already be overwhelmed with admissions, and yet their phones are ringing constantly with requests to respond to patient issues on the floor.
By the same token, telemedicine offers “surge protection,” providing assistance with patient admissions during ED bottlenecks, and cost-effective relief from hospitalist overload.
Virtual Partners for Solo Specialists
Individual specialists in pulmonology, cardiology, nephrology, and other areas might be on call with a local hospital 24/7/365, with no backup for nights, weekends, holidays, or vacations. Telemedicine specialists share coverage with these physicians—individuals and small practices alike—to help ease the demands on them. For example, a community hospital has a local cardiologist on call 15 days a month, and a telecardiology team on call the other 15 days of the month. This is just one real-life example we’ve seen as hospitals find new ways to meet the challenges of another trend that just keeps growing: physician burnout, coupled with a greater value placed on work-life balance than in generations past.
The revenue cycle management (RCM) process is one of the most vital parts of an efficient and functional healthcare entity. The vitality of this process to the healthcare industry as a whole cannot be understated, and it continues to grow with each passing year. In fact, it is predicted that the RCM market will reach more than $43 billion by 2022, underlining the increasing importance RCM has for healthcare providers. By offering the process by which healthcare providers receive reimbursement for their services from insurance providers, proper RCM can be the difference between sinking and swimming for healthcare facilities.
In understanding the facets that go into an effective RCM process, it’s important to note the key factors that successful RCM processes tend to share. These fundamentals all contribute toward creating an RCM process that brings the best results for healthcare facilities while minimizing their pain points and streamlining the experience for patients. Healthcare providers would do well to examine their RCM processes closely and determine whether or not these key fundamentals exist within their systems. If not, they may need to take a stark look at their processes and make significant changes if they are to have any hope of functioning at optimal efficacy.
For example, high accuracy is one of the most vital features of a successful RCM process. Without high accuracy, the data healthcare providers use to optimize their processes may be lacking, leaving them open to making serious errors in judgment. In turn, creating a domino effect that can have catastrophic effects on the rest of their RCM framework. Successful RCM processes also must incorporate a physician advisory module or component that can provide physicians with the resources from which they can navigate the regulatory environment with better success and ease. This can reduce obstacles that are encountered commonly with regards to legal requirements — in effect, streamlining the entire RCM process.
The below infographic from R1 RCM outlines these and the many other aspects that go into creating a successful RCM process for healthcare providers. Understanding these key components only becomes more important all the time. Meaning, there’s no excuse for not getting started on building a better RCM process today.
One of the largest barriers of delivering mental healthcare is the critical shortage of mental health professionals across the country, despite the significant prevalence and impact of mental health conditions. The National Alliance on Mental Illness and the National Institute of Mental Health report that 1 in 5 Americans live with a mental health condition and more than half of American adults with mental illness did not receive treatment in 2016. The U.S. Health Resources and Services Administration estimates an additional 70,000 mental healthcare providers are needed by 2025 to meet the expected growth in demand. In Chicago alone, patients may wait upwards of 10 months for a psychiatrist appointment.
Timely and quality behavioral healthcare is essential for improving patient mental health outcomes and increasing provider satisfaction. Telehealth is emerging as a viable approach to traditional on-site care methods, as it can rapidly improve the delivery of care by effectively addressing patient needs while reconciling the workforce gap. Specifically, telehealth can allow for immediate consultation (especially crucial in time-sensitive situations), increased treatment capacity and collaboration across the continuum of care, and improved outcomes (especially by allowing patients to receive care in the comfort of their own home).
Increased Access to Care In a given year, approximately one in 25 adults in the U.S. experiences a serious mental illness that substantially interferes with, or limits, one or more major life activities according to the National Institute of Mental Health. The American Journal of Psychiatry reported that untreated mental illness is estimated to cost approximately $100 billion annually in lost productivity.
Patients can benefit from providers who use video-based technology to conduct “virtual consults” when providing an initial diagnosis, as well as making recommendations for admission, treatment, transfer, or discharge. Additionally, for ongoing treatment, video offers patients a way to participate in ongoing care and support via “virtual visits” with mental healthcare providers. Convenient access to care can help patients who may avoid seeking initial mental healthcare and/or ongoing treatment as some patients may unfortunately avoid visiting a nearby mental health clinic or provider for a needed diagnosis if they are wary of public recognition and social disapproval. Patients might also not adhere to scheduled follow-up appointments if visits to these “known” mental health clinics in one’s community are required. With telehealth, patients can remain comfortably at home and confidentially receive the care they need.
Patient monitoring systems have long sounded off at the first sign of trouble, giving doctors and nurses the opportunity to divert their attention to the most serious medical situations. Generally, a series of alarms and chimes would sound off and give medical professionals an indication that a patient was having a medical emergency.
Today’s clinical alerting systems monitor much more than heart rate. In addition, they don’t just make sounds that can be heard by everyone within earshot. Clinical alerting systems are now more precise, with patient status indications being sent directly to the handheld communication devices carried by nurses and doctors. Here is a look into how patient monitoring systems have improved and the ways in which hospital workers are communicating more precisely.
Medical Alerts Issued Faster
In many emergency room settings, the steady sound of beeps, chimes, alarms and whistles goes off every other second. Some sounds indicate that everything is all right with a patient while others can give doctors and nurses legitimate cause for concern. Sometimes a critical care alarm can go unnoticed, especially if there is another emergency going on nearby. Newer clinical alerting systems have a smaller margin of error as they operate totally differently.
Direct Patient Emergency Warnings
The main nurse station at hospitals can be empty if there are multiple patients that need specialized care simultaneously. In other words, patient calls and even clinical alerts can go unnoticed if a healthcare center is operating on an outdated system. Beepers and pagers might help doctors on call to know when to go to the hospital, but more precise forms of communication are necessary for healthcare professionals who are working on the front lines. All it takes is the right setup for a healthcare provider to get information faster and in a more direct manner.
Reduced Emergency Care Response Times
When a patient in a hospital suddenly flatlines, medical professionals only have a few moments to turn the situation around to preserve life. While there may be several emergency care nurses in close proximity, they have to alert the doctor on call while working to save the patient who needs critical care. Modern patient monitoring and alert systems cut down on the amount of work that first responders must do to communicate. This has led to reduced response times as well as overall loss of life.
The reason why many hospitals or medical practices fail to integrate the EHR system effectively is that they have not gone for in-depth healthcare workflow analysis before implementing the EHR tool. Healthcare workflow analysis helps hospitals and medical centers to find out areas where health IT solutions can help in increasing the efficiency of performance.
It is important to design an EHR which smoothly fits into the workflow pattern of the medical establishment. The same EHR model does not work for every medical center. This is where healthcare workflow analysis techniques come in useful in designing the best EHR system for the medical facility.
Here are some steps that need to be followed during the healthcare workflow analysis in order to implement the EHR system perfectly:
Mapping of processes
This is the first thing that needs to be done while carrying out healthcare workflow analysis. The core processes that usually take place with regard to individual patients and which need to be analyzed in detail are as follows:
Scheduling: When a person first approaches a medical center, an appointment is fixed. The medical center receives multiple appointment requests every day and all these appointments need to be properly recorded in schedule calendars. Fact sheets are prepared to record the number of patients that the medical center receives during a particular time period. The scheduling process also includes alerts. Both the patient and the doctor should receive alerts about the upcoming appointment in order to be ready for it.
Patient visit: When the patient comes to the appointment, the doctor conducts a medical evaluation. The general checkup is followed by a psych evaluation. After the evaluation process is over, the doctor carries out the diagnosis process. Every step needs to be recorded so that progress notes can be made and the doctor can charge the patient accordingly.
Patient admission: After the diagnosis process is over; the patient gets admitted into the medical facility on the recommendation of the doctor. The enrollment process requires the signing of various forms so that the medical facility gets all the details about the patient.
Treatment process: Once the patient is admitted into the facility, the doctor makes a treatment plan. Either individual therapy or group therapy is provided along with medication management so that the patient can recover as soon as possible.
Discharge from the hospital: When the treatment process comes to an end, the patient is discharged on the date suggested by the doctor. A discharge plan is made and lots of reports are generated in order to record the treatment process of the patient in detail.
Guest post by Steve Wilson, vice president of product management and marketing, Accusoft.
Steve Wilson
It’s no surprise that the healthcare industry is one of the most highly-regulated industries in the United States. Therefore, maintaining compliance is no easy feat. Paperwork and documentation often hinder the productivity of even the most advanced healthcare facilities. Fortunately, with the digital revolution, a majority of these inefficiencies can be solved with document automation.
More healthcare companies are utilizing the software to help ensure compliance, reduce risk and focus on providing better patient care. It does so by providing facilities with the ability to set up digital checklists with due dates, reminders for task completion, and more. Whether it’s used in daily operations or staff and patient-related work, document automation makes the process simple. Here’s how:
Daily Operations
With all that goes on in a single healthcare facility, there are certain details that can often be overlooked or forgotten. Daily operational tasks, such as completing vendor contracts and purchase orders, keep the facility running – yet the Journal of Contract Management report found that more than 70 percent of companies lose or misplace 10 percent or more of signed contracts.
A modern workflow software manages these important recurring documents and contracts with an automated process. Furthermore, with electronic signatures, repeating or bulk documents, such as facilities requests, can also be signed. Easing the burden of daily operations helps to significantly free up valuable time to focus on providing the best patient care.
Staff Operations
Better patient care begins with better staff operations. Document automation provides a centralized location to keep all important templates — from physician agreements and credential documents to time sheets and other organizational forms. Instead of relying on hard copies of documents, which are susceptible to damage or misplacement, everything is digital. No matter the size or complexity of the staff, as healthcare facility staff sizes can range from 42 to more than 11,000, digital processes help maintain compliance by ensuring credentials and certifications are standardized and up-to-date.
Patient Operations
Patient care is the driving force behind the massive growth of the healthcare industry. While nearly all facilities offer good care, the most distinguished are recognized for their outstanding commitment to offering the best care. When facilities and operations are efficient and compliant, health staff can focus their attention on providing that care, instead of managing paperwork and processes. Workflow software can easily set periodic reminders to inspect and maintain emergency generators, eyewash stations and fire extinguishers to ensure they are always in working order in case of emergency.
New applications of telehealth that enhance existing provider-to-provider communications are revealing a new way for healthcare organizations to ensure patient care remains in-network. As hospital M&A activity accelerates and organizations strive to glean the most value from their investments in technology and human resources, telehealth is recognized for its role in keeping communications and care in-network.
Telehealth is increasingly being leveraged to offer providers immediate in-network specialist expertise and to reduce ad hoc out-of-network referrals. These kinds of applications make the in-network choice convenient for providers and patients while driving increased patient engagement and more integrated care across the broader care team.
Providers are seeing that telehealth applications can be complementary – instead of disruptive – to their workflows and provide them with a new approach to practicing medicine via technology.
Immediate Communications with Colleagues
Video-based technology can help providers optimize their current workflows by facilitating faster and more flexible consults with on-demand access to in-network specialists. A provider’s network of experts can be built into the technology, which enables a provider to immediately reach the designated, first available specialist for answers. Instead of wasting valuable seconds and minutes looking for the names and contact information for specialists, providers can use telehealth to expedite provider-to-provider interactions which accomplish the critical objectives of doing what is both right and timely for the patient’s situation.
For example, a provider may be examining a patient and realize that the patient’s condition requires specialist expertise. With telehealth, the provider can immediately reach out to an in-network specialist. The specialist accepts the virtual consult request, from anywhere and on any device. During the virtual consult, the specialist can evaluate the patient and communicate the appropriate next steps. All stakeholders – the provider, the specialist, and the patient – benefit from the immediacy, efficiency, and effectiveness of a virtual consult conducted in real time.
The broader healthcare organization (whether a medical practice, a hospital, or a health system) will benefit from an increase in in-network referrals. By leveraging the organization’s network to drive better patient outcomes faster, providers can deliver lasting value for the healthcare organization and enhance its overall reputation.
Increased Patient Engagement
Technology can also help providers optimize their current follow-up processes and easily check in with patients after a hospital stay or outpatient procedure. Providers can use telehealth to offer patients appropriate follow-up care at their own home via video. This allows providers (or providers’ in-network resources) to reach out to patients based on those patients’ preferred contact methods (e.g., email or text) and languages (e.g., Spanish, German, etc.) to remind them of their upcoming video visits. The result is increased patient engagement in their ongoing treatment plan. Travel time, related transportation expenses and appointment no-shows are minimized due to this efficient method of follow-up care.
For example, a provider can facilitate a virtual visit with a patient to ensure understanding and adherence. During a virtual visit, the provider (or related in-network care team members) can evaluate the patient’s progress, answer questions in real time, provide patient education, and re-emphasize the treatment plan – all while the patient stays comfortably at home and the provider remains conveniently in the office. All stakeholders – the provider, the care management team members, and the patient – benefit from timely conversations which can drive better adherence and overall outcomes.
James Smith is a blogger with Centra Care, an urgent care center in Tampa.
Healthcare services from across the world are teaming to create better facilities for patients. This is leading to the better and faster provision of seamless patient care with fewer medical errors and improved quality of healthcare while allowing for lower costs.
Accountable organizations are increasingly turning information technology to deliver quality care to patients while ensuring that an unnecessary duplication of services is avoided. Collaboration is key to getting the maximum effectiveness from IT led healthcare solutions, for all stakeholders involved.
Health IT has made it possible for healthcare providers to better accomplish stellar patient care through the safe use of health information while also sharing them confidently.
The evolving protected and private electronic health records are making health information available electronically as and when needed. The result is significant improvements in the quality of care. IT collaborations also help reduce the distances between care providers and patients, improving workflow and services delivered.
Here are the latest IT related collaborations in the world of healthcare.
Medtronic and American Well
Announced in October 2017, this collaboration seeks to bring about an exciting new revolution in telehealth and the way it is used to facilitate chronic, comorbid patients.
Together the companies will provide patient with reliable access to American Well’s telemedicine solutions, using the video-enabled platforms provided by the Medtronic Care Management Services. Information gathered from these remote patient monitoring systems will also be given to clinicians registered with the American Well service.
All in all, this IT led collaboration aims to enhance patient access to healthcare, and clinicians’ access to relevant information easier.
CVS Health and Epic
This exciting new initiative has a very ambitious goal. When CVS Health collaborates with Epic’s Healthy Planet services, the result is prescribers with more power. The collaboration aims to get access to information and analytics that will give prescribers additional resources to find lower cost drugs for their patients.
The resulting platform also aims to gain valuable information and insights into dispensing patterns and medication observance.
The definitive goal of this collaboration, however, is a lot more versatile. It will enable prescribing healthcare providers to find cheaper alternative medication and figure out if the patient’s insurance covers it. Also, pharmacists will get better information regarding medicines so they can make better-informed decisions regarding patient care plans.
Allscripts and Zocdoc
Another exciting new IT-related collaboration in the field of healthcare happened between the scheduling software maker Allscripts and Zocdoc the online scheduling platform for healthcare providers and clinicians.
The API based integration is making it possible for patients to book appointments online with their preferred physicians. The services are available to new and existing practices that are using Allscripts or Zocdoc.
The result will hopefully lead to maximum effectiveness of the physician’s time. It will also improve the efficiency of the office staff while also improving access to healthcare, creating a more connected and streamlined experience for patients.
Patient monitoring systems have long sounded off at the first sign of trouble, giving doctors and nurses the opportunity to divert their attention to the most serious medical situations. Generally, a series of alarms and chimes would sound off and give medical professionals an indication that a patient was having a medical emergency.
