By Shawn Yates, director of product management, Ontario Systems.
Shawn Yates
Impossible projects, crazy deadlines and short staffing present a bigger challenge than their own resolution: They draw focus away from important revenue cycle functions that maintain positive margins. Caring for the patient is, of course, the healthcare provider’s core mission. Healthcare’s financial operations help to achieve that mission.
Those involved in the revenue cycle process grasp the value efficiency and agent productivity can bring to an organization.
Reduced cost, greater performance, and the capacity to work through more patient accounts are the direct benefit, and those goals tie directly to financial performance and the core mission of outstanding patient care. Workflow, data analytics, reporting and performance dashboards are just a few of the tools you use to get to that point.
When working with new technology, having a resource to leverage from an outsourcing perspective can be very beneficial. Providers who outsource do so because they know their health system functions more efficiently when they can focus on what they do best.
What are the specific reasons that make outsourcing a particularly attractive investment right now? Three factors contribute:
It’s difficult to stay up-to-date on today’s technology. Whether it’s a smart phone, a smart appliance, or a smart digital assistant like Alexa, new features critical to your process come and go at a rapid pace. Leveraging technology outsourcing resources helps healthcare providers digest this information easier and implement solutions faster.
Siloed information means common, effective practices are shared less freely. Mergers, acquisitions, and other forms of consolidation make it difficult to reconcile the most effective practices that different parts of a health system use. A good managed services team focused on your technology can bring all that information together, which means more harmonious operation not only within your team, but in concert with others.
Increasing productivity is the key to financial success. Fully-leveraging new technology can be the key to managing talent, setting goals, and ultimately improving productivity, while using expert resources in a technology outsourcing capacity can help you bring in new features quicker. Together, these practices lead to faster returns on investment as providers today are faced with reduced reimbursements.
That was the subject line of the message from Lantern, a behavioral health startup whose app and coaching services I had used for a while. Lantern’s letter stated it is shuttering its business on August 1, helpfully offering to continue the coaching services for a limited period and pointing to other resources for those who relied on its services for six years since it started. News reports say Lantern is laying off 25 employees after failing to find a buyer for the company.
Firstly, I want to say this to the folks at Lantern: I’m sad we have to say goodbye. Although I had ceased to use the app a while back, I had developed a relationship with my personal behavioral coach who checked in with me regularly to see how I was doing with my meditation practice, often prodding me with a gentle nudge when I missed reporting on my sessions. I had the benefit of several conversations with my coach who was helpful, understanding and skilled at her work. Despite my short relationship with Lantern, I felt a positive impact on my well-being through regular meditation and mindfulness.
I came to know about Lantern back in December 2016 when I shared a stage as a speaker at an industry event with one of their executives. Back then, behavioral health was getting recognized as a $280 billion problem, which I wrote about after the Senate Health Committee announced the Mental Health Reform Act. Behavioral health is a complicated and expensive issue in U.S healthcare, which consulting firm McKinsey estimated affected 20 percent of the U.S population and was significantly underfunded in terms of treatment infrastructure.
In late 2016, there were more than 200 behavioral health startups, all of whom were responding to a brewing mental health crisis, and a favorable legislative and funding environment. Lantern was one of the highly visible ones, raising $17 million in series A money from marquee names, such as UPMC, Stanford University and Mayfield Ventures. The opioid epidemic and the exacerbation of related mental health issues was about to explode into public consciousness. Health insurance companies, faced with increasing costs for mental health and substance abuse, had started taking an interest in these startups. High profile partnerships were announced, such as the one between Highmark BCBS and Quartet. For a while, behavioral health seemed like a sure shot.
So what went wrong?
I’m sure the folks at Lantern and their VCs are pondering the question hard. However, back when I wrote about it, the signs of trouble were already visible. The Lantern executive I met at the time indicated that the lack of a reimbursement model for behavioral health was a huge challenge for growth. In healthcare, as we know, following the money is a prerequisite for success. The Department of Health and Human Services (HHS) had thrown $44.5 million at the problem, a drop in the ocean relative to the size of the problem.
Even for those who had access to funding, finding and recruiting trained clinicians with experience in behavioral health was a massive challenge.
Many startups, looking to stay outside the purview of regulation, tried to sidestep the FDA and go straight to employers and consumers (an expensive mistake that many failed digital health startups have learned the hard way).
Eventually, these problems had to come to a head. Lantern’s sad demise, brought about by a lack of ability to scale, and a lack of interest from the same insurance companies who were bullish on the sector two years ago, tells us that a business model with no revenue model has limited chances of success.
Is behavioral health dead then? Perhaps not. Many new telehealth companies, such as Teladoc, now offer behavioral health services. The CMS’s new rule to boost telehealth payments could be a shot in the arm that revives the fortunes of struggling behavioral health startups.
Patient satisfaction surveys are growing in popularity among healthcare organizations as the United States health system continues its transition to value-based care. A well-designed and distributed survey can help you discover hidden issues or gems in your organization’s care system. It can also provide useful insights on whether you’re meeting patient expectations.
If done right, your patient satisfaction survey can be a key player in building a satisfying and cohesive experience for patients. It can help you identify which aspects of care — facility appearance, provider approachability, cost, convenience, etc. — are most important to patients so you can plan improvements accordingly.
There’s just one catch: convincing patients to complete your surveys can be tough. You’ll need to up your game if you want to gather substantial feedback. To get the most out of your patient satisfaction surveys, follow these four tips:
Provide a Compelling “Why”
Even if your patient satisfaction survey takes only five minutes to complete, you’re still asking busy people to willingly give up their time. If you don’t want to be ignored, you need to give patients a good reason to spare five minutes.
In the communication accompanying your survey, let patients know you care about their experience at your facility and want their journey to be as frictionless as possible. Tell them their feedback plays a vital role in improving quality of care for all patients. Make it clear that you want to provide a best-in-class environment and service.
Keep Surveys Brief
If possible, it’s best to keep your surveys concise and simple. The longer and more complex a survey is, the less likely people are to participate. Also, if the survey is short and easy-to-understand, you’ll typically get better (and more clear) feedback from patients.
A top goal should be to ask patient satisfaction survey questions that elicit useful responses. This means keeping questions short and to the point. If a question is lengthy or focuses on more than one aspect of the patient experience, the patients’ answers may be confusing.
Avoid Paper Surveys
Although the healthcare industry is a bit behind on the digital revolution, patients are not. They expect the ease and convenience of completing surveys and other healthcare paperwork on their mobile devices. Thus, a paper survey will be met with disdain.
An online survey is user-friendly and much easier to manage than a paper survey. Patients can complete the survey whenever it is convenient for them, and all submitted data is housed in an organized database for easy analysis.
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.
