Guest post by Tatsiana Levdikova, copywriter, Effective Soft.
Tatsiana Levdikova
Hospital managers want to be sure that hospital staff constantly improve their skills and share relevant information with their colleagues. Automated solutions cannot become a substitute for a discussion where healthcare professionals can exchange their knowledge and share their ideas, but routine tasks can be arranged in the form of a workflow portal.
Usage of such a portal has a number of advantages:
It will help employees to save their time;
It will enable hospital managers to assign different access privileges to users, thus restricting access to medical data;
The portal can automatically create and send out reports like the ones covering employee performance.
This portal can be used to create its own medical knowledge base for the hospital.
A hospital is a place where like-minded people work and spend much time together. Not to lag behind other healthcare professionals, hospital staff must keep abreast of the latest trends and developments in medicine. However, being extremely busy during their working hours, the personnel has not time to discuss medical trends and developments on the fly: according to the National Center for Health Statistics the mean wait time in U.S. emergency departments increased 25 percent, from 46.5 minutes to 58.1 minutes from 2003 through 2009.
A hospital communication portal seems to be the right choice in this case. However, it should be noted that developers of custom hospital software and such portals in particular must pay close attention to the specifics a medical organization has.
The portal will enable the personnel to share valuable medical information, such as aspects of people, companies, news and other things of interest in a convenient, efficient, and fast way. Besides, it is important to give users an ability to comment.
Users would have their own profiles enabling them to connect directly with each other. The profiles could also include basic information on departments where users work, room numbers, working hours, specializations, and more.
Capabilities of the portal could be extended further by adding elements of social networks by making it possible for users to upload videos and images, tagging other users to them, etc. A general chat or forum could also be launched. All in all, the portal could become an important part of the HRM reporting system and assist hospital managers in managing sources and personnel.
Such a portal has the potential to become much more than a communication tool. It could become an effective hospital automation tool:
Guest post by Dave Willsey, CEO and co-founder, Integrify.
David Willsey
Data security is a top concern of every healthcare provider today. And for good reason. A recent news story from The Wall Street Journal reported that healthcare is “frequently cited as one of the industries most exposed to cyberattack due to large networks with numerous access points and vulnerable, legacy computer systems.”
If there is an industry more vulnerable to hackers today than healthcare organizations, you’d have to search far and wide to find it. Healthcare hacking is a growing problem. It is a trend that will not change course anytime soon.
Unfortunately, hospitals and other providers present a target rich environment for criminals and malicious hackers. And, to make matters worse, a recent study by researchers at three leading universities concluded that additional threats are coming from within “the house” as clinicians and other staff are taking shortcuts and finding workarounds to security measures in an attempt to deliver better patient care.
The federal government response to this growing threat is two-fold: mandatory reporting of data breaches and financial penalties that sting when violations of protected health information occur.
When it comes to reporting and ensuring continuous improvement to guard against future risk to data security, the number-one best practice today is a well-conceived, executable and automated incident response plan (IRP).
The good news is seven-in-ten providers have an IRP in place. The not-so-good-news is most of those plans are based on manual, labor intensive, error-prone processes. What’s needed to step-up the game for healthcare providers is an automated IRP workflow process. Automation is the only way to protect your data as the threat continues to evolve in the future.
Secure data and information is the chief reason to automate IRP workflow. But ROI is another major business driver to invest in automation. Here’s why – you’ll get quick payback from more accurate information about threats and breaches sooner in the process before they get out of hand; your teams will be able to execute with rapid response times that lead to fast resolution when compared to manual processes; and, finally, automation will bring your leadership team and other key stakeholders a unique capability to apply analytics and intelligence to support and measure continuous improvement in critical processes against future threats.
Automated IRP can provide all users with a simple incident reporting tool across the healthcare ecosystem – if a doctor or nurse or someone in the pharmacy formulary, for example, notices a potential security issue, that user can immediately trigger an automated IRP process. This action would notify the front line responder teams who can then escalate a response if needed.
Effective incident response planning addresses three key areas – people, process and data. With people, it’s very important that the roles of each person handling patient data are well identified and this would include all clinical staff, billing and administrative personnel, insurance agents, IT personnel, outside vendors, contractors, and others.
Guest post by John Squire, president and COO, Amazing Charts.
John Squire
Why do so many small medical practices give up a significant portion of their earnings to outside billers? Depending on its geographic location, volume of billing, and other factors, a practice will pay an average of seven percent of its total revenue to a biller, which could be the difference between profit or loss, maybe even success or failure.
In many cases, the reasons given are that no one in the office has experience with medical billing and the physician doesn’t believe a small staff can handle the added burden of work. But if you dig a little deeper, these assumptions are often wrong.
As a developer of electronic health record (EHR) and practice management (PM) software for small practices, my company hears a lot about billing directly from physicians and staff. We’ve learned exactly who does the billing and how they do it once a practice starts using a PM system for the very first time.
In one case, a medical assistant was able to learn everything he needed to know about billing from the PM product training alone. That’s because the physician specializes in podiatry, so the practice uses a limited set of billing codes. With a relatively light patient workload, this Medical Assistant has more than enough time to handle billing functions during normal office hours.
At another practice, when a gynecologist questioned her staff, she learned that her receptionist was eager to start doing something else, preferably from home so she could care for young children. The receptionist became certified in medical coding at a local community college on her own time, and now uses the PM system remotely and visits the office once a week every few weeks.
In a third practice we know, the pediatrician himself shares the work of billing with two of his part-time staffers, who welcomed the extra hours of pay. One staffer had knowledge of billing from a past job, while another was eager to learn. They all handle billing together as a team, so there’s no burden on any single person.
Guest post by Susmit Pal, healthcare strategist, Healthcare & Life Sciences, Dell EMC
Susmit Pal
Aging populations and the rising incidence of chronic disease consume a disproportionate amount of healthcare resources. In the United States, about 75 percent of healthcare dollars go to chronic disease care and two out of every three Medicare recipients suffer from at least two chronic diseases.[1] The pressure for relief will grow as the population ages with approximately 10,000 new patients estimated to enroll in Medicare every day for the next 15 years.[2] The current demand for resources for chronic disease care combined with the imminent spike in Medicare enrollment beg for achievable solutions and strategies that address costs, care quality and outcomes in the short term.
Enter the Internet of Things (IoT), also referred to as the Internet of Medical Things (IoMT) within the healthcare industry. IoT is something that most are well-familiar with, but for the sake of clarity, we define it here as the purposeful connection of intelligent sensors, devices, and software to computer networking systems using Bluetooth, Wi-Fi, RFID or M2M wireless technology in order to promote an inter-functionality that serves a greater purpose. In healthcare, that greater purpose is the achievement of less costly and more information-driven and efficient patient care. Think wearable devices and wireless pill bottles, nanotechnology and ingestibles, and network-enabled medical devices like stethoscopes that can transmit cardiac data directly into a patient’s electronic health record (EHR).
The Impact on Chronic Disease Management IoT shows great promise in helping to improve the health of patients with chronic conditions. Combinations of remote monitoring, analytics and mobile platforms have repeatedly cut re-admissions of high risk patients with congestive heart failure (CHF) by more than half.[3] Evermore affordable and easier-to-use devices, such as wireless scales and heart rate and blood pressure monitors are improving overall wellness for the chronically ill. In fact, some researchers estimate that the value of improved health in patients with chronic disease using remote monitoring could amount to $1.1 trillion per year by 2025.[4]
At the consumer level, the rapid increase in the type and variety of personal mobile fitness trackers like Fitbit®, and online fitness applications for consumers demonstrates comfort with IoT to monitor physical health. Their very existence has created an avenue for patients to become more accustomed to tracking and managing their health online. In response, healthcare organizations are beginning to incorporate them into their consumer engagement strategies, while payers are starting to offer discounts and incentives tied to wellness management.
IoT is also helping to spur on some rather exciting new technological advancements in chronic disease management. Connected wheelchairs, for instance, are enabling people with disabilities to engage with care providers on a whole new level, communicating health alerts to care teams and repair notices to manufacturers. A group from the University of Missouri is spearheading a development project to utilize home monitoring sensors in an effort to prevent falls among the elderly by providing alerts to the patient when there is a fall risk, while Dell Healthcare is working with hospitals to leverage the use of tablets with integrated card readers to enable remote healthcare for home-based treatments.
There exists an even greater potential for IoT to impact chronic disease management at a population-level when combined with data analytics. For instance, Health Net Connect (HNC) has initiated a population diabetic management program with the intent to improve clinical outcomes and healthcare savings for diabetes, one of the deadliest and most costly of chronic diseases—and the results are impressive. They captured vitals and blood work from study participants over a 6-month period to measure the impact that routine teleconferencing and patient monitoring had on outcome. Patients in the program showed a significant decrease in key biomarkers, including 9.5 percent lower HB A1C and 35 percent decrease in LDL. To put that into perspective, for every 1 percent drop in HB A1C they estimate an $8,600 annual savings, and for every 1 percent decrease in LDL there is a 1 percent decrease in coronary heart disease, which costs on average a million dollars over a lifetime. HNC is continuing this program, noting that “this project has, and currently is demonstrating return on investment with cost savings, improved access for program members to their physician, improved clinical outcomes, and improved knowledge by program members on their disease condition.”[5]
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
Abhinav Shashank
Currently, one of the most discussed topics in the healthcare industry is MACRA; a complex 962-page document that is supposed to redesign the entire healthcare industry. Know all about MACRA in six questions.
What is MACRA?
MACRA stands for Medicare Access and CHIP Reauthorization Act. It’ll repeal the current Sustainable Growth Rate (SGR) Formula and extend CHIP for two more years. Extending CHIP for two more years (in total four years now) will help tens of millions of kids in retaining their insurance.
SGR was introduced in 1997, as a method to curb the Medicare expenditures. Under SGR the physician payments were cut if the overall expenditure was above the benchmark. This payment cut system turned out to be a major reason for significant losses incurred by physicians. Fearing payment cuts, many physicians started denying services to Medicare beneficiaries.
In 2015, “Doc Fix” or MACRA was proposed, which as the name suggests fixed the unprecedented payment cuts. If it weren’t for “Doc Fix,” physicians would have faced 21 percent payment cuts in 2015.
The Notice for Proposed Rulemaking (NPRM) was issued on Apr. 27, 2016, and the final rule will come in November. MACRA’s full implementation will begin from 1st January 2017.
What will MACRA change/replace?
The idea behind implementing MACRA is to create something that works and is enduring. MACRA would bring changes through its unified framework called “Quality Payment Program,” which has been further divided into Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APMs).
All those who will be eligible for MIPS are called Eligible Clinicians. The term has expanded from “Eligible Provider” to “Eligible Clinicians.” It will include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and groups of such clinicians. This expansion has increased the number of people who will receive payments from Medicare. CMS might expand to Medicare part B after two years, which will include therapists, clinical social workers, clinical psychologists.
To keep health information flexible and user-centric, and bring all these changes with better care opportunities, MIPS will evaluate eligible clinicians on four measures namely: Quality Category to replace PQRS; resource use category to replace value-based modifier; Advanced Care Information (ACI) to replace meaningful use; Clinical Practice Improvement Activities (CPIA).
How will the four categories measure the performance?
Quality Category: Instead of reporting on nine measures, Clinicians will have the choice to pick speciality-specific measures. They can choose six measures to report to CMS that suits them the best reflecting their practice. But one of these measures must be an outcome measure or a high-priority measure and one must be a cross-cutting measure. Clinicians can also choose to report a specialty measure. Clinicians can report through Claims, Electronic Health Record (EHR), Clinical Registry, Qualified, Clinical Data Registry (QCDR) or Group practice reporting web portal.
For the year one, quality category will have 50 percent weight in the performance scoring procedure.
Resource Use: Clinicians are not required to report for this, CMS will calculate these measures based on claims and “availability of sufficient volume.” To account for the differences among specialties, CMS has proposed to add 41 episode-based measures. These episode groups have potential to provide more actionable insights on measure resource use than the various cost measures.
For the year one, resource use category will have 10 percent weight in the performance scoring procedure.
Advancing Care Information: Clinicians can report on the measures that suit their practices the best and reflect how the EHR technology is being used for daily needs, with particular emphasis on the interoperability and information exchange. The performance score does not use threshold and allows physicians to receive partial credits on measures.
For the year one, advancing care information category will have 25 percent weight in the performance scoring procedure.
Clinical Practice Improvement Activities: In this category, clinicians would be rewarded for activities that improves overall care delivery such as care coordination, beneficiary engagement, and patient safety. Clinicians can choose practices’ goal from a list of 90 plus activities. This category does not require a full year reporting. CPIA activities need to be performed for at least 90 days during the performance period.
For the year one, CPIA Category will have 15 percent weight in the performance scoring procedure.
Like retail and education before it, a major shift is underway in the healthcare industry that is putting power back in consumers’ hands. Similar to how retail outlets are delivering custom experiences based on consumer preferences, or how there is more attention to individual needs in the classroom, patients are able to play a more active role in their healthcare administration and decision-making than ever before. This means participating in a shared decision-making model with physicians, seeing their needs and preferences reflected in the course of their treatment, and easier access to their medical data, made readily available to both the patient and his or her medical team.
This article will explore the phenomenon that is PCC, a paradigm shift changing the healthcare industry at its core. So much so, PCC is driving adoption of three technology related trends that are in line with its principles. They include: telemedicine, cloud computing and mHealth.
Patient Centered Care and 2016 Healthcare IT Trends
Telehealth
While many assumed in-facility care would remain the norm after house calls faded from popularity decades ago, that may not be the case. Increasingly, telemedicine — or remote consultations, diagnoses, and treatment performed by medical professionals — is becoming a standard practice in the healthcare industry.
For example, the below ad from Anthem BlueCross and LiveHealth Online was released by one of the nation’s largest insurance agencies promoting remote consultations states the “doctor is always in” and sessions are “quick and easy with no appointments and no driving.”
In line with the principles of PCC, telehealth promises greater access to care for patients who don’t live in close proximity to a healthcare facility. For the greater population, telehealth offers convenience and the comfort of care delivered in a patient’s natural environment. Administering care in a patient’s environment instead of a traditional healthcare setting can also facilitate better care in some cases. Fierce Healthcare provides the example of blood pressure screening – taking a patient’s blood pressure in a natural setting, like their home or workplace, may more accurately reflect their blood pressure on a daily basis.
Telehealth and the benefits this practice offers to patients are perfectly in line with the patient-centric approach favored today. In light of this, it wouldn’t be surprising if telemedicine adoption continues to rise in the coming years, along with the demand for technology that can facilitate remote care.
In the age of the digital hospital and the connected patient, security will likely improve the less it depends on providers.
Everything from HIPAA to patient engagement treats physicians as the white hot sun of the healthcare universe, holding everything together and keeping it all in stable orbit. They are accountable for health outcomes, for patient satisfaction, for guiding patients to online portals, and for coordinating with care teams to keep data secure — even as mobility and EHR dominance complicates every node in the connectivity chain. All this digital chaos brings more diminished security.
Only as Strong as the Weakest Link
Every business out there has learned — usually the hard way, or by watching someone else learn the hard way — that whatever the security infrastructure, users are the weakest link. More devices means more users, and more connectivity and data-sharing means more weak spots all along the chain. By design, the EHR system adds vulnerability to healthcare data security through a long chain of users.
Patients don’t have a systemic, accountable role in all of this. Our whole approach fosters passivity on the part of the patient and paternalistic assumptions on the parts of caregivers and policymakers. We give tacit acknowledgement of this imbalance whenever malpractice law or tort reform is mentioned — and promptly left behind in the face of other, patient-exculpatory programs and initiatives.
Patients are a part of this. Clearly they are invested in their own security — the costs of health data breaches contribute to the rising costs of care, besides exposing personal financial and medical information that can carry its own universe of costs.
Patients are implicated, but they must also be accountable for security in the new high tech healthcare system.
An Old Problem with New Importance
Getting patients included in the evolution and delivery of healthcare requires engagement. The same goes for digital security. The ethical and financial dilemmas of the security situation is an expensive distraction for administrators and caregivers, but it is a learning opportunity that could empower patients. A new emphasis on digital security and privacy could be the start of a cascade of engagement with further questions of use and responsibility for outcomes.
Already, patients are key players in making telemedicine effective. Access is on the shoulders of the patients, and utilization depends on their technical literacy. The incentives–time and money savings, improved access to care–are powerful, but come with the obligation to learn the platform through which remote care is delivered. Utilizing any telehealth solutions requires patients to think about what information they want to share, whether they trust the new platform, communicating effectively with their provider, and gaining confidence for the new medium.
This same model can be applied more broadly to EHRs, and the patient role in the digital healthcare system.
Guest post by Ken Perez, VP of healthcare policy, Omnicell, Inc.
Ken Perez
Quality expert W. Edwards Deming was famous for many concepts, including the Deming Wheel or Deming Cycle, more formally known as the PDSA (Plan-Do-Study-Act) Cycle. It is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a product or process.
The Centers for Medicare and Medicaid Services’ August 25 release of 2015 quality and financial performance results for Medicare accountable care organizations (ACOs) reflected the application of the PDSA Cycle by the participating organizations as well as CMS in its continued development and refining of its ACO programs.
At a high level, in 2015, the 404 reporting ACOs—392 in the Medicare Shared Savings Program (MSSP) and 12 in the Pioneer ACO Model—achieved $466 million in savings. A bit more than half of the ACOs (210 or 52 percent) held costs below their benchmark, and slightly less than a third (125 or 31 percent) generated savings above a minimum savings rate (MSR) and met quality performance standards, thus meriting shared savings.
As is common with most statistics and especially any material news coming out of Washington, D.C. nowadays, there were widely divergent interpretations of these results.
On the cheery side, CMS chief medical officer Patrick Conway, M.D., rhapsodized, “Accountable Care Organization initiatives in Medicare continue to grow and achieve positive results in providing better care and health outcomes while spending taxpayer dollars more wisely.”
In contrast, Clif Gaus, CEO of the National Association of ACOs, in an email message to FierceHealthcare, struck a negative tone in his appraisal of the results, sharing that his organization “was disappointed not to find stronger financial results that reflect the extensive financial and personal contributions invested by ACOs” and he also said that CMS and Congress must “take swift and decisive action to solidify the foundation of the Medicare ACO program.”
Despite these obviously divergent views, certainly neither Conway nor Gaus would disagree with the idea that the ability to learn is a critical success factor in ACO performance.
A deeper analysis of the data bears this out. As noted by CMS, more-experienced ACOs were more likely to generate savings above their MSR. In performance year 2015, 42 percent of ACOs that started in 2012 generated savings above their MSR. This compares with 37 percent for ACOs starting in 2013, 22 percent for 2014 starters, and 21 percent for 2015 starters.
The value of learning from experience was also reflected in the quality results. MSSP ACOs that reported quality measures in both 2014 and 2015 improved on 84 percent of the measures common to both years.
