By Jackie Birmingham, RN, MS, vice president, emeritus, of clinical leadership, Curaspan.
Jackie Birmingham
The Affordable Care Act calls for provider quality to be publicly reported and widely shared. As a result, the Centers for Medicare and Medicaid Services (CMS) extended star ratings to home health agencies (HHAs) on Home Health Compare (HHC) in 2015 to provide home health care beneficiaries with a summary quality measure in an accessible format.
By supporting consumer choice and encouraging provider quality improvement, public reporting will remain a pillar for improving healthcare quality. Currently, CMS reports 27 process, outcome and patient experience of care quality measures on the HHC website to equip patients and their families with the right tools to make choices about home healthcare.
Calculating the Two Types of Star Ratings
1) The Quality of Patient Care Star Rating – This rating probes nine specific evidence-based process and outcomes measures for each home health agency such as timely initiation of care, improvement in patients’ functional status and hospital readmissions. The measures are calculated into a composite score and star rating, which are typically calculated on a quarterly basis and include:
CMS rankings of all HHA providers reporting which is then divided into 10 ranked deciles for each measure.
Each HHA receives a score (.5 to 5) based on its ranked decile.
Each score is compared to a national agency average on that measure, and if there is a statistical difference, the score will be adjusted.
For each agency, adjusted scores are averaged to reach a composite score which are then translated into stars.
2) Patient Survey Star Ratings –These ratings incorporate the patient experience of care measures based on Home Health Care Consumer Assessment of Healthcare Providers and Systems (HHCAHPS). These surveys reflect patients’ views on a variety of issues including whether the staff checked patients’ prescriptions for side-effects and properly explained dosing instructions.
Guest post by Dr. Jennifer Yugo, chief scientist, Corvirtus.
Jennifer Yugo, PhD, SPHR
This is a time of tremendous growth and change in healthcare. As in any industry, growth sparks competition as patients have more and more providers from which to choose. From the supply side, this means increased competition for new, repeat, and referral patients. Simultaneously, providers are being pressed to reduce costs while improving the patient experience as they compete for market share.
Healthcare is becoming more competitive as patients have more choices and better information about their choices, especially through social media. To compete, providers have to focus on delivering quality service, a compelling patient experience, and – like competitors in retail – generate buzz.
Our research shows that a healthcare provider’s employees are the most significant contributor to delivering quality, being compelling, and generating buzz. The first component of this formula is ensuring you are hiring the right people. These are employees who perform, fit, and stay.
Pre-employment assessments are widely used across other industries as a key ingredient to quality. Healthcare is a final frontier where personality tests can be leveraged to improve individual and team performance, reduce costs, and most importantly, improve and differentiate patient care.
Sadly, healthcare positions are often viewed as “The Untouchables” where intuition and gut-instinct for hiring and management are used over evidence-based best practices. Following our intuition often results in hiring the wrong people – those who do not perform, are difficult to work with, and either quit or get fired.
Turnover is a huge component of costs and an obstacle to improving care, as well as the patient experience. With shortage of 68,000 primary care physicians predicted by 2025, consider the cost of turnover for one physician:
IT solutions are intended to making businesses more efficiently run and developed. In terms of medical practice, the business extends way beyond tending to patients only. Factors such as keeping both medical and billing record of patients, scheduling appointments that do not clash with each other, adhering to medical laws and regulations, and maintaining cross communication with patients as well as the support staff are central to smooth running of the medical practice.
The streamlining of these central factors among others constitutes “medical practice management” that is fueled and run consistently with the application of IT Solutions. These mainly include the usage of relevant software to help keep up with the daily operations; be it the medical activities or the administrative and support activities.
Some of the ways information technology solutions can help streamline your medical practice have been discussed in detail below.
Record Keeping
Higher the number of patients a medical practice tends to see, the trickier it is to keep up with the specific information and follow up instructions for them. IT solutions help manage the plethora of information ranging from medical record numbers to past medical prescriptions, medical tests history and health graph of specific patients. Employment of software such as the electronic health record help streamline these jobs, thereby making it easier to access detailed data regarding each patient.
Same goes for billing records. The best part about such software is their ability to converge different aspects of information about a patient at a single point, accessible through the patient’s medical record number prescribed by the practice.
Ask anyone involved in the world of clinical trials about the biggest trend facing the industry, undoubtedly they will say “BYOD.” The idea of allowing patients to use their own mobile devices to report data related to their trial participation isn’t necessarily a new one, but with more people using smartphones and tablets than ever before, it’s moved to the forefront of discussions about the best way to manage eCOA data collection.
Why BYOD Is Gaining Traction
On the surface, incorporating BYOD into eCOA seems like a perfect, and obvious, solution. Using dedicated applications on devices that they already own and are familiar with — and most likely have on them most of the time — they can enter data easily, and in real time. The benefits don’t end there, either.
Cost — One of the most significant cost centers for clinical trials, accounting for about a third of the costs of clinical trials, is reporting. More specifically, those costs are incurred in the provisioning of devices for study participants to use in reporting their data. With BYOD, those costs are reduced significantly.
Improved Engagement and Compliance — BYOD in clinical trials removes some of the learning curve inherent in providing devices to participants. Patients are already familiar with how to work their devices, and generally use them on a regular basis, which has the effect of increasing their engagement with the study, and more likely to record the data when and how they are supposed to. There’s no need to carry or learn about a second device, or go to any extra effort, which has the potential effect of improving the accuracy of study results.
Improved Access — Some experts argue that allowing patients to use their own devices for data collection can help increase access to clinical trials for patients living in remote areas. Currently, patients in those areas cannot participate in trials due to limited broadband, but reporting via cellular connections may open new opportunities.
Clearly, there are some significant benefits to using BYOD for clinical trials, and the potential for improved outcomes cannot be ignored. However, there are some concerns about BYOD in this capacity — concerns that have significantly affected adoption rates.
The current plight of America’s healthcare industry is not wholly unprecedented. In fact, it isn’t even unique.
Edgar T. Wilson
American education — higher education in particular — is going through a parallel period of turmoil and scrutiny. It is really uncanny how closely the two industries actually reflect one another. Consider:
Both are critical industries whose public/private status is up for constant debate
Both serve an essentially captive market: everyone needs education to succeed in the economy, and everyone, sooner or later, will require some form of healthcare
There has been a historical tendency for both to treat the people they serve as customers, rather than as students or patients. It is more than semantics: it is a reflection of an underlying philosophy that can potentially compromise the mission of each type of institution
Both are going through a crisis of accountability, in terms of what standards are used to measure their performance, and to whom they must answer for that performance
Both have been very slow to adopt modern technology, and as a result are going through a rapid, disruptive catch-up period
In the race to modernize and reconcile many of these conflicts of purpose and identity, it appears that higher education as a whole may be slightly ahead. Because of this relative lead on the healthcare industry, behavior within the American college and university system can act as a rough preview for the health sector. So, what do we see upon gazing into this crystal ball?
All for One?
A helpful place to direct this gaze is the recent ASU GSV Summit. The name alone reveals much about what is happening in higher education, and needs to happen in healthcare: Arizona State University, in the interest of promoting innovation, collaboration, and evolution in the higher education sector, joined forces with Global Silicon Valley’s family of companies to create their joint summit.
The summit began in 2009, seven years into the tenure of ASU president Michael Crow, who has become one of the leading voices and actors in higher education’s 21st century evolution. The summit is just one of the many strategic partnerships Crow has helped organize through ASU. Aligning the school with everything from technology startups supporting the development of ASU’s online degree programs, to the Mayo Clinic Medical School to offer future doctors transdisciplinary education in fields like business or engineering, Crow is expanding the reach of America’s largest public university by strategically sharing its resources.
In American medicine, there is a clear need for a similar attitude toward strategic partnerships and mission alignment, especially with technology companies and developers. This need is most acute in terms of EHR interoperability. Despite all the rhetoric, the old mentality of siloes, competition, and proprietary ownership prevail, and information remains immobile.
This symptom has implications that extend into every other facet of healthcare.
Patrick Soon-Shiong, billionaire, surgeon and incorrigible optimist, has set his sights on curing cancer. Much like the Precision Medicine Initiative, Soon-Shiong’s approach to this challenge is a matter of getting more, better data from as many partner institutions as possible.
“Cancer is really a rare disease,” he explains. “Because of the molecular signature, because of the heterogeneity, no single institution will have enough data about any [single] cancer. So you actually need to create a collaborative overarching global connected system.”
The end result — better medicine, better outcomes — is something common to the mission of every clinical organization, and ever caregiver practicing medicine. But the means — large scale collaboration, facilitated by transparency and a suspension of select elements of competition — are seldom realized in the current environment. Reconciling the ends and the means requires organizations to think bigger than themselves, and prioritize the sort of partnerships that bring new perspectives, larger pools of data, and creative solutions where they are desperately needed.
Founded in 2014, Modio Health is a cloud-based credentialing and career management solution for healthcare providers and organizations.
Elevator pitch
Modio Health makes physician career management easier. Replacing outdated and time consuming credentialing processes, expensive middlemen and pushy recruiters with a technology platform that serves both physicians and healthcare organizations. Our goal is to streamline hospital operations, from straightforward, cost-effective credentialing to transparent physician staffing.
Product/service description
The Modio platform is home to thousands of healthcare providers, as well as many larger healthcare organizations and practices. By integrating with government agencies, public databases, and private sources, Modio has built a centralized practitioner database, called the Unified Provider Record, for healthcare providers and their affiliated organizations. Case studies show that the Modio platform decreases both provider credentialing time and the associated costs, reducing administrative burdens and eliminating lapsed licensure.
Origin story/founder story
Modio Health was born from the firsthand experiences of our team of doctors. Our founders had all been stung by the inefficiencies they encountered in their years of practicing medicine. The hassle of credentialing, the constant, nagging contact from recruiters, and high fees for licensing and job placements encouraged them to create a solution to these pain points. After heading a successful EHR implementation business in the early 2010s, they left their full-time jobs to get Modio off the ground. With the help of a Bay Area network of technology and production experts, and their own connections with healthcare providers, our founders launched Modio in July of 2015. Modio immediately gained traction with large ASCs, medical groups, and hospitals. Just nine months after its initial launch, Modio is already an integral part of many healthcare practices.
Marketing/promotion strategy
Our marketing strategy is heavily based on our extensive network of providers. Whether that’s our in-house team of physicians, or providers whom we’ve helped to get credentialed or find jobs, our network is constantly building up through referrals and simple word-of-mouth communication. We also promote the Modio name through targeted media, conferences, and mail campaigns.
Market opportunity (in your particular space—numbers, competitors, etc. are helpful)
Modio offers a scalable solution for healthcare management in a chaotic landscape. Few platforms aim for the level of comprehensivity that we do; Modio is the only service that combines credentialing services, an open job marketplace, and practice management all in one. In an industry that wastes more than $200 billion dollars every year in hospital administration costs, our efficient, inexpensive system is the first step to solving the problem.
Hardly a day goes by without some new revelation of a US IT mess that seems like an endless round of the old radio show joke contest, “Can You Top This”, except increasingly the joke is on us. From nuclear weapons updated with floppy disks to needless medical deaths, many of which are still caused by preventable interoperability communication errors as has been the case for decades.
According to a report released to Congress, the Government Accountability Office (GAO) has found that the US government last year spent 75 percent of its technology budget to maintain aging computers where floppy disks are still used, including one system for US nuclear forces that is more than 50 years old. In a previous GAO report, the news is equally alarming as it impacts the healthcare of millions of American’s and could be the smoking gun in a study from the British Medical Journal citing medical errors as the third leading cause of death in the United States, after heart disease and cancer.
The GAO interoperability report, requested by Congressional leaders, reported on the status of efforts to develop infrastructure that could lead to nationwide interoperability of health information. The report described a variety of efforts being undertaken to facilitate interoperability, but most of the efforts remain “works in progress.” Moreover, in its report, the GAO identified five barriers to interoperability.
Insufficiencies in health data standards
Variation in state privacy rules
Difficulty in accurately matching all the right records to the right patient
The costs involved in achieving the goals
The need for governance and trust among entities to facilitate sharing health information
CMS Pushing for “Plug and Play” Interoperability Tools that Already Exist
Meanwhile in a meeting with the Massachusetts Medical Society, Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services’ (CMS) acknowledges in the CMS interoperability effort “we are not sending a man to the moon.”
“We are actually expecting (healthcare) technology to do the things that it already does for us every day. So there must be other reasons why technology and information aren’t flowing in ways that match patient care,” Slavitt stated. “Partly, I believe some of the reasons are actually due to bad business practices. But, I think some of the technology will improve through the better use of standards and compliance. And I think we’ll make significant progress through the implementation of API’s in the next version of (Electronic Health Records) EHR’s which will spur innovation by allowing for plug and play capability. The private sector has to essentially change or evolve their business practices so that they don’t subvert this intent. If you are a customer of a piece of technology that doesn’t do what you want, it’s time to raise your voice.”
He claims that CMS has “very few higher priorities” other than interoperability. It is also interesting that two different government entities point their fingers at interoperability yet “plug and play” API solutions have been available through middleware integration for years, the same ones that are successfully used in the retail, banking and hospitality industries. As a sign of growing healthcare middleware popularity, Black Book Research, recently named the top ten middleware providers as Zoeticx, HealthMark, Arcadia Healthcare Solutions, Extension Healthcare, Solace Systems, Oracle, Catavolt, Microsoft, SAP and Kidozen.
Medical Errors Third Leading Cause of Death in US
The British Medical Journal recently reported that medical error is the third leading cause of death in the United States, after heart disease and cancer. As such, medical errors should be a top priority for research and resources, say authors Martin Makary, MD, MPH, professor of surgery, and research fellow Michael Daniel, from Johns Hopkins University School of Medicine. However, accurate, transparent information about errors is not captured on death certificates which are the documents the Center for Disease Control and Prevention (CDC) uses for ranking causes of death and setting health priorities. Death certificates depend on International Classification of Diseases (ICD) codes for cause of death, but causes such as human and EHR errors are not recorded on them.
According to the World Health Organization (WHO), 117 countries code their mortality statistics using the ICD system. The authors call for better reporting to help capture the scale of the problem and create strategies for reducing it. “Top-ranked causes of death as reported by the CDC form our country’s research funding and public health priorities,” says Makary in a press release. “Right now, cancer and heart disease get a ton of attention, but since medical errors don’t appear on the list, the problem doesn’t get the funding and attention it deserves. It boils down to people dying from the care that they receive rather than the disease for which they are seeking care.”
The Root Cause of Many Patient Errors
Better coding and reporting is a no-brainer and should be required to get to the bottom of the errors so they can be identified and resolved. However, in addition to not reporting the causes of death, there are other roadblocks leading to this frighteningly sad statistic such as lack of EHR interoperability. Unfortunately, the vast majority of medical devices, EHRs and other healthcare IT components lack interoperability, meaning a built-in or integrated platform that can exchange information across vendors, settings, and device types.
Various systems and equipment are typically purchased from different manufacturers. Each comes with its own proprietary interface technology like the days before the client and server ever met. Moreover, hospitals often must invest in separate systems to pull together all these disparate pieces of technology to feed data from bedside devices to EHR systems, data warehouses, and other applications that aid in clinical decision making, research and analytics. Many bedside devices, especially older ones, don’t even connect and require manual reading and data entry.
Healthcare providers are sometimes forced to mentally take notes on various pieces of information to draw conclusions. This is time consuming and error-prone. This cognitive load, especially in high stress situations, increases the risk of error such as accessing information on the wrong patient, performing the wrong action or placing the wrong order. Because information can be entered into various areas of the EHR, the possibility of duplicating or omitting information arises. Through the EHR, physicians can often be presented with a list of documentation located in different folders that can be many computer screens long and information can be missed.
The nation’s largest health systems employ thousands of people dedicated to dealing with “non-interoperability.” The abundance of proprietary protocols and interfaces that restrict healthcare data exchange takes a huge toll on productivity. In addition to EHR’s physical inability, tactics such as data blocking and hospital IT contracts that prevent data sharing by EHR vendors are also used to prevent interoperability. Healthcare overall has experienced negative productivity in this area over the past decade.
Vice President Joe Biden recently took the stage at Health Datapalooza in Washington, D.C. to discuss where healthcare technology currently stands, and he didn’t hold back. Among other things, he chastised the industry for poor health IT system interoperability and the resulting difficulties it causes providers and patients. “We have to ask ourselves, why are we not progressing more rapidly?” Biden lamented.
Biden’s criticism is only the latest high-profile commentary about the unfulfilled promise of information technology in healthcare. AMA leaders and individual physicians have been grousing about it for years. We’ve seen technology increase efficiency, reduce costs and improve productivity in every other industry – but why not healthcare?
Ironically, seven years after the passage of the HITECH Act of 2009, doctors are less productive than they were before, and IT is the culprit. Rather than enabling a better, more streamlined workflow, IT has become a burden.
The drag that IT is placing on healthcare providers is a principal reason why U.S. Health and Human Services (HHS) Secretary Sylvia Burwell announced with great fanfare at the HIMSS16 conference an “interoperability pledge,” which vendors and providers alike are encouraged to take. Its purpose in part is “to help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.”
This call resonates because the promise of better healthcare through technology has been broken. Technology has changed the way we communicate, the way we shop, the way we watch TV, the way we drive, and the way we interact with our homes. As an industry, healthcare is lagging way behind. The consequences are drastic. In order for us to deliver the kind of holistic care that will truly improve people’s health, it’s time not only to talk about the potential, but to make it a reality for users and providers across the healthcare continuum.
Here’s the reality: we have today what 10 years ago was called a supercomputer in front of physicians – a device that knows virtually everything about the patient – but it isn’t helping out in ways that we take for granted in our everyday lives when we shop online, use Google Maps or order an Uber.
Ask anyone involved in the world of clinical trials about the biggest trend facing the industry, undoubtedly they will say “BYOD.” The idea of allowing patients to use their own mobile devices to report data related to their trial participation isn’t necessarily a new one, but with more people using smartphones and tablets than ever before, it’s moved to the forefront of discussions about the best way to manage eCOA data collection.
Modio Health makes physician career management easier. Replacing outdated and time consuming credentialing processes, expensive middlemen and pushy recruiters with a technology platform that serves both physicians and healthcare organizations. Our goal is to streamline hospital operations, from straightforward, cost-effective credentialing to transparent physician staffing.
