Guest post by Jeff Kaplan, chief strategy officer, ZirMed.
Jeff Kaplan
The 40,000 healthcare and healthcare IT professionals who gathered at the Sands Expo in Vegas brought a different vibe for HIMSS 2016. The halls buzzed with activity and an overall optimism that belied any of the potential causes for uncertainty—politics, a down stock market, increases in uncompensated care, the movement toward fee-for-value, or the staggering shift in patient responsibility.
For those who attended HIMSS 2015 in Chicago, the difference was visible in vendor messaging and audible in conversations during the conference. Among all attendees the optimism seemed well founded, grounded in reality. We all see significant opportunity to drive improvement in healthcare for our generation and generations to come. That’s why we came to HIMSS – we’ve placed our bets.
In that spirit, let’s talk about where healthcare is doubling down, where it’s hit a perfect blackjack, and which trends pushed as providers look for the next deal.
Double Down – Data Interoperability
Out of the gate at HIMSS 2016, there was increased focus and emphasis on the importance of data interoperability and integration. From booth signage to the increase in dedicated vendors to industry veterans evangelizing on the topic, you couldn’t miss the tells from all players—everyone wants to show they have a strong hand when it comes to interoperability. Epic’s Judy Faulkner made a play that Epic wasn’t just the leader of the interoperability movement – they were in fact the originator (see her interview with Healthcare IT Newshere).
Of course, wander off into other parts of the exhibition hall and it wasn’t long before you heard the all-too-familiar complaints about closed-system platforms – that they limit innovation by outside companies and technologists who can build applications to add additional value. In the era of Salesforce.com and other open platform successes, many HIMSS attendees spoke of their hope that companies like Cerner and Epic will follow suit.
Blackjack – Data Analytics
Over the last year vendors heard providers loud and clear – healthcare providers need hard ROI on any new initiatives, especially as many have EHR/HCIS sunk costs in the tens of millions of dollars. They need a sure thing—and the changes evident at HIMSS 2016 reflected that shift. Buzzwords like “Big Data” thankfully went to the wayside and were replaced with meaningful discussion around data analytics and data warehousing. Providers know they’ve amassed a wealth of clinical and financial data—now they’re looking for ways to increase the quality of patient care while driving down costs.
Guest post by Tom S. Lee, Ph.D., CEO and founder, SA Ignite.
Tom Lee
Those making the long trek to and through the annual, arduous health IT connection-fest known as HIMSS are undeniable siblings-in-arms. Each has their own list of “must learns” by which they measure the return on the foot blisters and hurried lunches.
This year, I brought my particular list of themes to track. Although the odds are great that I missed relevant crevices of the show, I believe I gathered a decent quorum of items to share here. You be the judge.
Theme 1: More Regulatory Guidance from CMS and HHS
The HHS, ONC and CMS brain trust spoke to packed rooms in an illuminating 24-hour span, which crossed multiple themes on my list. On the regulatory front, HHS Secretary Burwell, National Coordinator for HIT DeSalvo, and CMS Acting Administrator Slavitt, all made direct or indirect mention of the MACRA legislation and its constituent parts, the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs; e.g. Medicare accountable care organizations). MIPS and APMs together redefine how $250 billion per year in Medicare Part B payments will be paid to physicians in value-based, rather than fee-for-service-based, manners. The hub-bub around MIPS, in particular, stems from the fact that it can reward high-performing providers with incentives up to and even beyond 27 percent of Part B payments and penalize low-performing providers up to 9 percent, while also reporting their MIPS performance scores to consumers.
Although CMS was unable to confirm or deny many aspects of the CY2017 MIPS rule currently being drafted, I heard strong clues from CMS and its contractors confirming a Jan. 1, 2017, start of the first MIPS performance year. In addition, CMS officials publicly stated across multiple sessions that the draft CY2017 MIPS rule would be released “within a few months,” “in the spring,” and perhaps as soon as April.
Theme 2: The Rising Importance of the Back-Office Impacts of Value-Based Programs
Over the last nine months, it wasn’t clear how Medicare’s Chronic Care Management (CCM) program was playing out in the field. CCM rewards primary care providers with a monthly per patient fee for delivering a set of high-quality, chronic care services to patients both within and outside the clinic. The dollars netted by a practice can be substantial, even eclipsing the incentives earned from complying with meaningful use over the last several years. However, the front-office and back-office tasks needed to support a successful CCM program can be substantial. Whereas after walking 80 percent of the main exhibit hall floor I saw no CCM vendors, I saw in the first-time-exhibitor hall several companies out of ~40 exhibiting focused exclusively on offering outsourced CCM program delivery services. Maybe the CCM model and market are starting to take root.
When I remodeled my house a few years ago, I hired a contractor, and negotiated a bundled payment for the entire job. The fees I paid to the contractor covered project management costs as well as the costs of independent subcontractors assembled do the work, such as carpentry, dry-wall, electrical and painting. The contractor stood to make a nice profit if they efficiently managed the work of their subcontractors. On the other hand, he could lose his shirt if there were unmanaged rework and cost overruns.
Bundled payments are still relatively rare in healthcare. If a patient has knee replacement surgery, each provider – the surgeon, anesthesiologist, hospital, rehab facility and home health agency are paid separately. The patient is often left to serve as their own general contractor, without any one provider responsible for the cost and quality of episode. As a result, there can be significant variations in episode cost and clinical outcomes for the same procedure.
CMS has been experimenting with voluntary bundled payment demonstration projects for about five years. In 2011, CMS launched the Acute Care Episode (ACE) program with a handful of healthcare systems. In 2013, CMS began the Bundled Payment Care Initiative (BPCI) with over a hundred participating hospitals. The bundled payment programs included different conditions, procedures and episode durations. However, they all worked in a similar way: CMS combined a bundle of health care services that had been previously paid as separate components. A bundled payment price was set, representing the average historical episode cost, less a withheld amount (typically around 3 percent). A general contractor (AKA “convener”) was assigned responsibility for the total cost and quality of the episode of care. After five years of voluntary experimentation, the concept of bundled payments is about to go big.
In April 2016, CMS will require 800 hospitals that are located in one of 67 geographic regions to be conveners for Comprehensive Care for Joint Replacement (CJR) surgeries – mostly elective hip and knee replacements. The bundle payment will include the costs of the hospital stay along with all related costs within 90 days of the hospital discharge. Each of the providers involved in the surgery and post-discharge care will continue to bill Medicare as before, but the hospital will now be financially responsible for all of the costs. If the bundled costs are below the target price, the hospital will receive a bonus that they may share (or not) with the other providers participating in the care episode. However, if costs are above the target, the hospital is responsible for paying the difference to CMS.
Guest post by Jeff Lin, senior vice president of product management, InstaMed.
Jeff Lin
The amount a patient must now pay before a health plan covers any portion of the balance has increased 67 percent in five years, according to the Kaiser Family Foundation. This surge in patient responsibility is driven primarily by enrollment in high-deductible health plans which require patients to pay towards a certain minimum balance before the plan benefits begin. According to HealthPocket, deductibles are expected to increase 8 percent to $6,480 for a family plan, further increasing patient balances.
Despite this growing trend, many patients leave their visit without any expectation that they will receive a bill or a discussion about how to make a payment. Therefore, it should come as no surprise that providers can expect to collect only 50 percent to 70 percent of a patient balance after a visit (McKinsey and Company). As patients’ out-of-pocket expenses continue to grow, healthcare providers of all sizes will need to focus on improving the payment experience to ensure patient collections and the future of their organization.
Make Healthcare Payments Simple Providers can look to best practices from other industries to guarantee their revenue while making it simple for patients to pay their responsibility. Just like reserving a hotel room, providers can require that all patients present a payment method before the time of service to ensure the responsibility is automatically paid with low staff intervention. Patients are familiar with this process from their experiences in other industries and often prefer automated, simple payments. Providers can leverage innovative payment technology to securely automate payment collection with saved payment methods.
Add Healthcare Payments to Household Bills Nearly 70 percent of patients surveyed said they pay their non-healthcare bills such as cable or utility bills online or through a bank bill portal, according to the 2014 Trends in Healthcare Payments Annual Report. This demonstrates that patients prefer to make payments through convenient payment channels. However, these payment channels are simply not always available in the healthcare industry. To enhance the payment experience, providers can easily allow patients to pay online or through a website where they are already accustomed to visiting and paying bills. For instance, many health plans offer member portals,which enable patients to manage claims and view benefit amounts. By enabling patients to make online payments to all of their providers through these member portals, providers will receive a payment as soon as the claim is adjudicated – all without ever sending a statement or making a phone call.
Ease the Burden of Deductibles High deductibles can result in large balances for a single patient visit which can make it difficult for a patient to pay their total balance at one time. Automated, customized payment plans can help patients pay down these large balances over time without relying on paper statements, staff follow-up calls and manual payment posting.
As a best practice, these plans should enable providers to automatically collect payments in a secure and compliant way with automated notifications and receipts to the patients.
Guest post by Jeff Goldsmith, vice president of marketing, Revolve Robotics.
Jeff Goldsmith
We will never return to the days of house calls and family doctors who knew you from birth. However, thanks to advances in mobile and digital technology we are well on our way to a new golden age in medicine, one that will offer near instant access to electronically delivered healthcare from humans, anywhere, any time. The groundwork has already been set – there have been more than one billion tablets produced by the tech industry (one for every seven humans), so we certainly have enough screens to get a caregiver’s face in front of every patient.
So, what’s the next step? An understanding and commitment to using this technology to give everyone access to care, whether they are an aging boomer, someone living in a rural area without enough specialists, or a very sick kid who can’t travel because of their treatment regime.
This isn’t science fiction – robotic technology and tablets are already being combined in schools, in homes and in hospitals to better patient experiences. For example, a public elementary school in Round Rock, Texas recently accommodated a student receiving chemo in Philadelphia by using a telepresence robot to put her back “in” the classroom. The technology allowed her to look around the room, interact with fellow students and ask questions as if she were there in person – all for under $1,000.
The ROI of this type of set-up for schools is impossible to calculate nationwide, but the benefits are massive. Not only does the child benefit, so do their classmates who learn about inclusion, the school which evolves its technology, and the community because it gains one more educated human being. More than 40,000 children undergo treatment for cancer each year in the US – imagine giving each of them this opportunity.
Guest post by Chris Strammiello, vice president global alliances and strategic marketing, Nuance Communications.
Chris Strammiello
Every healthcare IT professional is already thinking about mobility and security in general, but not all consider their relation to document management. A single piece of paper could contain immeasurable amounts of sensitive data and even protected health information (PHI) that, if somehow found in the wrong hands, could present major HIPAA violations. So, how will document imaging impact healthcare technology?
The Mobile Game-Changer
As healthcare organizations transition their processes from paper to electronic workflows, mobile device use will increase. From patient registration to discharge and beyond, mobile technology simplifies patient communication via e-prescriptions, online scheduling and automated appointment reminders.
Productivity-enhancing capabilities like barcode scanners, e-forms and e-signatures also benefit practitioners by improving on-the-ground access to clinical documents and reducing manual document handling. Plus, mobile devices can curb printing costs through the implementation of pull printing, which holds a print job on a server until the user authenticates its release at the output. Ultimately, for the patient, all of these advantages translate into more time for quality interactions with their doctor; for the hospital, significantly streamlined processes and lower costs.
We also expect to see an increased use for mobile devices in medical instrumentation. Take, for example, the advancements brought to speech therapy with the utilization of a tablet’s microphone during a session. Previously, patient testing would have been done with a much larger and more complex device that would produce less data about the quality, pitch and frequency of the voice. Not only are mobile devices simplifying day-to-day workflow within the healthcare industry, but they will also revolutionize the actual healthcare practice.
Smarter, Simpler and Even Spoken Security
Alas, as with all technological advancements, security remains an essential question mark. Unfortunately, the smartphones, tablets, laptops and even multifunction printers (MFPs) that increase access to patient information are also some of the biggest security vulnerabilities in EHR implementations. In fact, theft or loss of portable and unencrypted devices is the leading source of reported HIPAA data breaches and fines. Even further, as the U.S. Department of Health and Human Services now defines office copiers and printers to be actual workstations, IT professionals must secure them in the same way they do computers.
With all this in mind, both physical and technical safeguards must and will be improved in the near future, starting with the embrace of solutions that provide two-factor authentication. Commonly used in financial services, two-factor authentication combines a password with something you know, like the answer to “What is your mother’s maiden name?,” or something you have, like a fingerprint. We can expect such biometrics, including voice commands, being more commonly used as a second authentication factor in the near future. Long gone are the days of scanning your ID card to credential a print release – users will simply speak to the printer to verify who they are.
The healthcare industry remains at a crossroads as providers and healthcare IT professionals confront a rapidly changing business and regulatory landscape. With factors like rising patient cost obligations, growing payer complexity, and the inevitable shift to a value-based payment environment weighing on them, medical practices nationwide are in search of new IT solutions to support them. The rapid pace of cloud adoption across all sectors is a prominent example. The market for cloud solutions is one of the fastest growing areas within healthcare, but it’s not solely a private sector phenomenon; the federal government’s cloud-first strategy finally gained traction in 2015, prompting a FCW analyst to predict accelerating momentum for federal cloud initiatives over the next three to five years.
One of the strongest factors driving cloud momentum among medical practices today remains security concerns: with growing IT complexity increasing security risks, cloud options remain an attractive plug-and-play alternative to on-site servers that allows healthcare providers to minimize vulnerabilities. But modern cloud solutions also allow providers to maximize practice management capabilities and offer faster time to value. And, with features like pay-as-you-go pricing, cloud solutions don’t require a big upfront investment, making them a popular choice with budget-conscious healthcare organizations.
Another key factor driving practice adoption of modern, cloud-based solutions is the need more efficient workflows to support effective patient billing. The patient share of healthcare costs is growing rapidly in the US. According to a Kaiser Family Foundation report, out-of-pocket costs have grown three times as fast as overall healthcare costs. And, the average deductible has skyrocketed from $584 in 2006 to $1,318 in 2015. Practices need solutions that can help them implement controls and analytics as patients become responsible for a greater share of costs.
As a result of these and other factors, cloud technology now plays a pivotal role in healthcare, and cloud-based healthcare IT solutions are becoming increasingly important in helping practice successfully navigate this new environment. So what’s in store for 2016? Here are some healthcare IT trends to watch:
A more modern, intuitive software experience: The consumerization of healthcare IT has begun in earnest, and that means practices are looking for design-centered products that deliver intuitive solutions. Cloud-based healthcare IT solutions that move beyond Web 1.0 to provide a consumer-focused user experience (UX) will be the clear winners.
Even with electronic decision-support technology and responsive, knowledge-based medical software built into modern electronic health care record (EHR) systems, it is critical for physicians and clinicians to recognize the primary focus is still treating the patient. In an effort to survive escalating costs of care and declining reimbursements, modern health care delivery models shifted from a patient-centric care model toward a financially motivated business model.
With the push toward value-based reimbursements and rigorous quality measurement reporting mandates, hospitals and medical organizations today must balance the need to remain financially solvent with improving patient outcomes and experiences throughout the health care journey.
Business Process Outsourcing: Revenue Cycle Management (RCM) and Value-Based Care
End-to-end RCM in the healthcare industry explores cost per transaction beyond salaries and benefit packages. Administrators examine productivity volumes, idle time, workforce utilization ratios and patient flow as key factors that directly influence revenue potential.
Business process outsourcing (BPO) has gained popularity in recent years as a way for hospitals and practices to control operating costs without compromising patient care or satisfaction levels. It is a win-win proposition for all stakeholders. The RCM software and services market, which includes BPO, now garners more than $12 million, annually. There are many reasons to consider BPO, including streamlining internal efficiency, expediting third-party payer reimbursements, and reducing data entry errors that stifle cash flow and frustrate consumers.
Analytics, Document Management and BPO
Improving document management is critical. Leading technology enables collecting vast amounts of data, data that can be used to improve patient outcomes, and financial performance. However, data is only valuable if it can be rapidly accessed, analyzed, organized and converted into actionable information. Digital Documents, which is a company that provides outsourced document management services, says document processing services essentially convert information to digital assets.
Those assets may translate into higher profit margins. One study showed hospitals that outsourced most of their RCM operations in 2014 saw an average revenue increase of 5 percent to slightly more than 6 percent. Revenue increases are expected to continue to grow over the next few years, especially in the health IT outsourcing area, which according to Reportstack should see an annual compounded growth rate of almost 9 percent through 2019.
