Dan Ward is VP of revenue integrity at MethodCare, now part of ZirMed.
To better understand the fundamentals of predictive analytics — and why it has the potential to transform healthcare — it can be helpful to use Netflix as an illustrative example.
Let’s say, for example, you’re sitting around the house one rainy October Saturday and decide to view a few movies using Netflix’s streaming service. First you watched Field of Dreams then you decided, hey, this rain isn’t letting up any time soon, and that dog doesn’t want to go out in it any more than I do. So, after a brief backyard sojourn during which you and the dog confirmed that 38 degrees and rainy is in fact unpleasant — you reconvened your Netflixing and ended up watching Bull Durham, as well. Further, let us also assume that you enjoyed both movies and watched them all the way through.
As the credits rolled on Bull Durham, the critical question for Netflix was the same it always is: What would you enjoy watching next — specifically, what should Netflix recommend? Based upon the day’s viewing you may have a soft spot for baseball movies. Though it could just as easily be the case that you’re Kevin Costner’s biggest fan and the fact that you queued up two of his baseball movies was pure coincidence.
Given the uncertainty orbiting these pieces of information, maybe the best prediction would be Dances with Wolves, starring Kevin Costner. Or maybe the right pick would be Moneyball, the story of how the Oakland A’s leveraged data-driven, evidence-based sabermetrics to remain competitive against much more highly capitalized MLB teams. But what if neither Kevin Costner nor baseball is the most important correlation—what if the best predictor of whether you’ll like a film is simply whether it’s a sports movie from the late 80s?
As with all forms of predictive analytics, the question of what to recommend multiplies in complexity as overlapping variables (often in the form of unstructured data) are added and subsequently considered within algorithmic equations that power, in this case, Netflix’s recommendation engine. Further complicating the matter, it’s likely that you’re not the only person to have watched both of these films in close proximity and there are likely to be numerous “motivations” for such viewings across the population. It becomes apparent rather quickly the inherent challenge of something that seems, on the surface, as straightforward as a recommendation engine.
In healthcare we face these same kinds of challenges, just in a different form. The questions we ask are which gaps in care create the greatest risk for the patient, or which specific combinations of gaps in care correlate with readmissions—so that clinical outreach coordinators and other staff can prioritize whom to contact right away. We ask which types of claims are most likely to be under-coded or missing charges—so that organizations can make best use of finite resources like staff time and ensure the greatest positive impact on overall financial performance.
The recent DEA schedule change of hydrocodone prescription drugs has critical implications for prescribers, pharmacies and patients – not only for patients who are taking hydrocodone medications for chronic pain, but also for patients who experience new injuries that require short-term pain treatment.
The following scenario depicts how the hydrocodone schedule change can impact all of these stakeholders:
A patient goes to see her primary care physician because she twisted her knee in an exercise class and can barely walk. During the examination, the physician determines that the patient has torn her ACL and will need a referral to an orthopedic surgeon for further examination and treatment. In the meantime, however, the physician is going to prescribe the patient Vicodin, a common pain medication, which has recently been reclassified as a Class II drug under the DEA’s schedule change.
Sounds like a pretty common story, right? But as simple as this scenario sounds, there are multiple challenges that can arise when physicians don’t have the right tools to do their jobs efficiently.
The first potential problem has to do with the referral. The method a physician uses to refer patients to specialists matters – a lot. Paper-based referrals can cause a number of problems, from insufficient information provided to specialists, to lack of timely feedback to referring physicians, to inefficient referral tracking.
Electronic referral management through the use of electronic health records (EHR) solves potential issues with timeliness and tracking. But whom a physician selects to refer a patient to is also critical. In today’s value-based model of healthcare, careful selection and management of physician referrals is integral to improving patient outcomes and reducing healthcare costs. And one of the best ways to maximize physician referrals is to use an accurate physician directory, or database, that contains vital information like location, ZIP code detail, affiliations, areas of specialty, and organizational capabilities.
The debate rages on, despite the Department of Health and Human Services (HHS) issuing a rule finalizing Oct. 1, 2015, as the final date for ICD-10 implementation. Why? Because they said there would be absolutely no more delays last year. And the year before that. It’s kind of like a parent who doesn’t follow through with consequences in childrearing. If the child gets away with it once, they’re going to try again. I predict rages against the machine until midnight on Sept. 30, 2015.
The Delay
I was in the field, one day into a two-day boot camp, in Connecticut. UConn had just made it into the Final Four, and the hotel bar was filled with revelers watching ESPN. I was in my hotel room, on the phone with my husband because the hotel didn’t have C-Span. He gave me a blow-by-blow count of the votes required until the SGR “doc fix” bill would pass because, at the last minute, the bill had been revised to include language affecting ICD-10 implementation.
If it passed, doctors’ reimbursements would not be cut by 24 percent, but ICD-10 would be delayed by at least a year. My husband is a surgeon, so we had a stake on both sides of the fence … or aisle, I suppose. Of course, it passed — it always passes. But what did that mean for all the people I’d taught in the past months, and what would that mean for the class I had to face the next morning, smack dab in the middle of their training? I expected to see my class members just as disheartened as I was and worried about the energy level of the second training day.
It turns out I didn’t even need to bring cookies. Nobody was disappointed. In fact, there seemed to be a collective sigh of relief. And these were the people I thought were ahead of the curve on implementation.
So, I took a poll:
Did they think people not ready for ICD-10 in 2014 would be ready in 2015?
No.
Did they think people who were almost ready would spend the year getting extra-ready?
NueMD, provider of cloud-based medical practice management software for small practices, in partnership with Porter Research and the Daniel Brown Law Group, surveyed practices and business associates about HIPAA compliance and how small practices and billing companies are coping. The survey of about 1,200 healthcare professionals, conducted during October 2014, found medical practices and billing companies are struggling to comply with regulations under the Health Insurance Portability and Accountability Act.
“Understanding HIPAA can be difficult for practices and billing companies, especially if they’re already scrambling to keep up with changes like ICD-10 and meaningful use,” said Caleb Clarke, sales and marketing director at NueMD, in a statement. “With audits looming, we wanted to get a sense of where the industry stands and provide resources to help those who may be struggling.”
NueMD surveyed practices and billing companies in all 50 states; most of the practices were small and made up of one to three providers.
In a nutshell, the survey found that:
66 percent of respondents were unaware of HIPAA audits (a staggering number)
35 percent of respondents said their business has conducted a HIPAA-required risk analysis
34 percent of owners, managers and practice administrators reported that they were “very confident” that their electronic devices that contain PHI were HIPAA compliant
24 percent of managers, owners and practice administrators at medical practices reported that they’ve evaluated all of their business associate agreements
56 percent of office staff and (non-owner) care providers at practices said they’ve received HIPAA training in the last year
HIPAA is one of the primary and most comprehensive government regulations that affect the daily activities of each healthcare organization every day.
Signed into law in 1996, the law outlines policies to protect sensitive patient data and penalties for those who don’t comply. Recent updates under the HITECH act introduced several changes that affect the responsibilities and liabilities of covered entities and business associates.
Enforcement of breaches is occurring at a more rapid pace. HITECH extended certain HIPAA security and privacy requirements and set the stage for greater enforcement, including:
Widening the scope of the law, requiring health information exchanges to be business associates of healthcare entities, and applied HIPAA privacy and security requirements directly to the HIEs.
Greater penalties for noncompliance.
Redirecting civil monetary penalties back into enforcement activities instead of into the general fund. This provides additional funds for future enforcement and incentivizes proactive enforcement activities.
Adding breach notification requirements to entities that operate personal health records or otherwise maintain personal health information for purposes other than healthcare delivery or payment.
Opening the way for enforcement by states’ attorneys general.
Also, the HITECH Act incentivizes a more aggressive pursuit of HIPAA, which means it’s more likely that healthcare organizations will now be audited more regularly.
Health spending continued to grow at a slow rate last year the Office of the Actuary (OACT) at the Centers for Medicare & Medicaid Services (CMS) reported today. In 2013, health spending grew at 3.6 percent and total national health expenditures in the United States reached $2.9 trillion, or $9,255 per person. The annual OACT report showed health spending continued a pattern of low growth—between 3.6 percent and 4.1– percent for five consecutive years.
The recent low rates of national health spending growth coincide with modest growth in Gross Domestic Product (GDP), which averaged 3.9 percent per year since the end of the severe economic recession in 2010. As a result, the share of the economy devoted to health remained unchanged over this period at 17.4 percent.
“This report is another piece of evidence that our efforts to reform the health care delivery system are working,” said CMS Administrator Marilyn Tavenner. “To keep this momentum going, we are continuing our efforts to shift toward paying for care in ways that reward providers who achieve better outcomes and lower costs.”
Total national health spending slowed from 4.1 percent growth in 2012 to 3.6 percent in 2013. The report attributes the 0.5 percentage point slowdown in health care spending growth to slower growth in private health insurance, Medicare, and investment in medical structures and equipment spending. However, faster growth in Medicaid spending helped to partially offset the slowdown.
Other findings from the report:
Medicare spending, which represented 20 percent of national health spending in 2013, grew 3.4 percent to $585.7 billion, a slowdown from growth of 4.0 percent in 2012. This slowdown was primarily caused by a deceleration in Medicare enrollment growth, as well as net impacts from the Affordable Care Act and sequestration. Per-enrollee Medicare spending grew at about the same rate as 2012, increasing just 0.2 percent in 2013.
Spending on private health insurance premiums (a 33 percent share of total health care spending) reached $961.7 billion in 2013, and increased 2.8 percent, slower than the 4.0 percent growth in 2012. The slower rate of growth reflected low enrollment growth in private health insurance plans, the continued shift of enrollees to high-deductible health plans and other benefit design changes, low underlying medical benefit trends, and the impacts of the Affordable Care Act.
Medicaid spending grew 6.1 percent in 2013 to $449.4 billion, an acceleration from 4.0 percent growth in 2012. Faster Medicaid growth in 2013 was driven in part by increases in provider reimbursement rates, some states’ expanding benefits, and early Medicaid expansion.
Out-of-pocket spending (which includes direct consumer payments such as copayments, deductibles, spending by the insured on services not covered by insurance, and spending by those without health insurance) grew 3.2 percent in 2013 to $339.4 billion, slightly slower than annual growth of 3.6 percent in both 2011 and 2012.
Among health care goods and services, slower growth in spending for hospital care and physician and clinical services contributed to slower growth in national health care spending in 2013. However, faster spending growth for retail prescription drugs in 2013 partially offset the overall slowdown.
Hospital spending increased 4.3 percent to $936.9 billion in 2013 compared to 5.7 percent growth in 2012. The lower growth in 2013 was influenced by slower growth in both price and non-price factors (which include the use and intensity of services). Growth in private health insurance and Medicare hospital spending decelerated in 2013 compared to 2012.
Spending for physician and clinical services increased 3.8 percent in 2013 to $586.7 billion, from 4.5 percent growth in 2012. Slower price growth in 2013 was the main cause of the slowdown, as prices grew less than 0.1 percent. Growth in spending from private health insurance and Medicare, the two largest payers of physician and clinical services, experienced slower spending growth in 2013, while Medicaid growth accelerated as a result of temporary increases in payments to primary care physicians.
Retail prescription drug spending accelerated in 2013, growing 2.5 percent to $271.1 billion, compared to 0.5 percent growth in 2012. Faster growth in 2013 resulted from price increases for brand-name and specialty drugs, increased spending on new medicines, and increased utilization.
In 2013, households accounted for the largest share of spending (28 percent), followed by the federal government (26 percent), private businesses (21 percent), and state and local governments (17 percent).
In any industry passwords can be a hassle to manage, but perhaps this is no more true than healthcare. Password strategies are put in place to keep data secure, including patient’s information, but they often cause headaches for clinicians. And since every minute matters in the clinical setting, any process that takes longer than necessary can become a major problem when patient outcomes hang in the balance.
Since providers often need to access their own systems, as well as patient data and treatment history quickly, to assist patients, something as simple as getting locked out of systems or forgetting credentials to accounts is time consumer and tedious to overcome. Contacting the helpdesk and waiting to get passwords reset wastes what little time caregivers have to with patients. Simplifying password resets can give critical time back to caregivers and support staff in the care setting.
Easier said than done, of course. Many healthcare organizations resist implementing any type of password solution because they don’t want to bombard clinicians with yet another new technology. One of the major reasons being that they assume the implementation and training time are lengthy and because they’re currently bogged down by a variety of other pressing issues, such as meaningful use and preparing for the transition to ICD-10 in October 2015.
Also, because healthcare organizations must abide by strict rules and regulations, implementing password solutions can sometimes be an issue. In addition, healthcare’s leaders need to ensure that any new technologies implemented follow these regulations.
An Easy Solution to Password Reset Issues
Several leading healthcare organizations have opted to use self-service password reset solutions to easily solve their password reset issues. Just as banking websites allow consumers to reset their passwords, end users can easily reset their passwords after correctly answering security questions that they previously provided answers to. Clinicians simply click the “forgot my password” button and can easily reset their password from anywhere at any time. This allows clinicians to proactively solve the problem without have to contact another department for help.
The handling and sharing of medical records is a critical and sensitive issue, and one that affects millions of providers, patients and payers every day. According to the Center for Disease Control and Prevention, Americans alone make more than a billion visits to doctors’ offices, clinics and hospitals annually, so one can only imagine how often medical records exchange hands between patients, physicians, specialists, healthcare organizations and their staff.
Test results, images, medical and billing history and other related information continue to be mailed, faxed and—more commonly—emailed between interested parties. Email is the most popular of these options because it combines the wide accessibility of snail mail with the immediacy of fax transmission. But email as a means of sharing sensitive healthcare data lacks in three critical areas: security, regulatory compliance and working with large files.
Security, privacy and protection
Gaps in email security should have doctors and patients sweating bullets any time they attach medical information to an email and hover their cursor over the “send” button.
The overarching problem lies in the encryption, or lack thereof. Like CDs and popular online sharing services, medical records transmitted via email are generally unencrypted. This is the case not only in transit, but also when they sit on the servers of the email providers. Thus, sensitive medical information lies vulnerable at all times.
Exchanging records by email means exposing patients’ personal information and their entire medical histories to a nefarious underworld of hackers seeking to exploit such information. It may include the most personal and private information, from social security numbers to diagnoses for chronic illnesses. Should information get in the wrong hands, there’s no predicting the extent and impact of the consequences.
Guest post by Dr. Christopher Ray, chief technology officer of Medical Information Records, creator of AnesthesiaOS, a cloud-based EHR solution for anesthesiologists and winner of Dell’s “Advancing Medicine” Healthcare Innovation Challenge.
Mobility and Bring Your Own Device (BYOD) strategies are transforming all aspects of healthcare by enabling physicians, nurses and medical staff to improve the delivery of care while enhancing patient outcomes and safety.
The upsides are impressive: Fast, responsive, agile solutions that streamline healthcare workflows and harness big data to deliver smarter care and more personalized medicine. By enabling providers to use preferred devices and mobile cloud software, mobility can help transcend how electronic medical records (EMR) are captured, accessed and viewed.
When it comes to mobility and BYOD in healthcare, however, security and compliance must go hand-in-hand. In creating AnesthesiaOS, a fully mobile anesthesia information management system (AIMS), we focused on providing greater efficiency in practice management while ensuring the highest levels of safety and integrity for protected health information (PHI).
To that end, creating, achieving and maintaining compliance with both patient privacy and healthcare standards was accomplished by leveraging the following set of comprehensive best practices:
Protect, Identify and Confirm All Regulated Data
The biggest challenge healthcare organizations face today is preventing information from ending up in the wrong hands. Since protecting information is an overarching goal, it’s crucial to identify all regulated data that will be generated on, accessed from, stored on or transmitted by a mobile or BYO device.
