Guest post by Jonathan A. Handler, MD, FACEP and chief medical information officer for M*Modal.
The U.S. Government officially recognizes that filling out paperwork is expensive. The most costly paperwork requires us to measure and report information – like our yearly income. If you have ever filled out a government form, you may have noticed that it provides an estimated cost to complete.
For example, the simplest “EZ” income tax form will cost each taxpayer an average of four hours and $40 (http://goo.gl/C6ra — page 41). This is a result of the Paperwork Reduction Act, which requires the government to reduce the paperwork burden on the public and publish the estimated cost of completing each form. However, the Paperwork Reduction Act may have a loophole, because it seems to be limited to government documents.
The government creates a tremendous documentation burden on healthcare providers that appears to fall outside the scope of the Act. In 2014, new government requirements will increase that workload dramatically even as reimbursement drops. Since we do not have consensus on how to address these changes without sacrificing patient care, I believe a key trend in 2014 will be “Managing the Cost of Measuring Care.”
Clinicians are already at the breaking point in the time they spend on documentation and care measurement. This year, regulations demand more than ever. The move to ICD-10 significantly increases the cost of choosing the right billing code because ICD-10 is more complex and about eight times bigger than ICD-9. Stage 2 of the government’s meaningful use program requires clinicians to record more patient information in structured form, to report clinical quality measures, to perform medication reconciliation, and much more. The Two-Midnight rule requires physicians to anticipate when an admitted patient will need to stay in the hospital longer than “two midnights” and justify that in writing.
Healthcare organizations today are pursuing a wide range of health IT initiatives in the hopes of reducing costs, improving efficiencies and, most importantly, enhancing patient care. While a great deal of attention is being paid to high-profile health IT topics, such as electronic health records (EHRs) and health information exchange (HIE), there are basic aspects of the workflow at healthcare organizations that can also play a key role in driving healthcare efficiencies. One of these is the patient discharge experience.
How well patients are communicated with upon discharge is a leading threat to a healthcare organization’s top-line revenue, as well as an endangerment to the patient experience. With Medicare/Medicaid regulations now making it difficult to collect revenue for a patient’s second visit for the same problem within 30 days, special attention needs to be paid to how well healthcare organizations are preparing the patient when they walk out the hospital door—and at home following their release. Patients need to be able to understand their at-home instructions for post-visit care so they don’t have to return to the healthcare facility for more treatment or instructions, which will negatively impact the hospital’s revenue and the patient experience.
Creating a more effective discharge experience for patients requires providing clear, easy to read discharge instructions. Accomplishing this is not always a simple task given that the instructions typically are compiled from a large set of data feeds, gathered from multiple treating physicians and need to be provided in a language that the patient can understand. Health IT can play a critical role in overcoming these hurdles.
Similarly, healthcare organizations will benefit from considering the archival system in place. It is important to have an archival process that will enable the organization to prove that discharge instructions were complete and comprehensive. This will avoid the potential for losing Medicare/Medicaid reimbursements in the event of an audit. Not having the ability to easily retrieve all relevant records exposes the healthcare organization to avoidable revenue loss.
Guest post by Brian White, founder of Competitive Solutions.
Should every physician practice adopt electronic health records? Maybe not. When evaluating the transition to an EHR system, it is critical to consider the long-term efficiency of the practice. Simply put, EHR adoption will not yield operational improvements for every practice.
While many practices using EHRs increase the overall throughput of the business and enhance profitability, others struggle with adoption of the new technology – slowing operations and creating significant financial losses. Many practices repeatedly change vendors or abandon the EHR entirely after significant investment. Making the right decision for your individual practice and navigating the pitfalls of EHR implementation can be difficult and time-consuming. Maximize your potential for success by undertaking a strategic evaluation that includes the following considerations.
If your practice has not adopted EHR, is now the time to do so?
1. What are the operational benefits/detriments of adoption?
a. Will EHR allow the practice to see more patients? Or, will it cause the practice to see fewer patients?
b. Will EHR require additional labor in the day-to-day function of treating patients? (In most cases, the answer to this question will be yes.)
c. Will EHR provide the ability to track trends in patient status, statistical data or ease of access that will be more efficient and/or clinically beneficial?
In the new healthcare ecosystem that is increasingly migrating to cyberspace, who can healthcare consumers rely on? Who in the healthcare service supply chain will prevail? Who will be the next Amazon or Yelp? Chances are it will be the organization that can deliver and mediate a centralized consumer experience – connecting healthcare consumers not only with care and treatment options, but also with pharmacists, labs, therapists, clinics, wellness coaches and other resources along the care chain.
More today than ever before as the care conundrum continues, fewer and fewer crave office visits, hospital stays or trying to reach physicians by phone. When we’re well, we see no reason to visit a physician. When we’re sick we increasingly wait until we’re sicker. And when we’re somewhere in between, we avoid calling because we know we’ll be put on hold. If there were a better way to consume healthcare, most of us would likely take it.
Interestingly, within this conundrum lies an opportunity for the myriad of healthcare players – from payers and providers at one end of the supply chain to wellness tacticians, retailers and mobile tool providers at the other end – to create a sustainable dialogue with healthcare consumers.
According to a recent survey conducted by Purdue Healthcare Advisors, a nonprofit healthcare consulting organization, hospital executives are reluctant to implement ACOs — 46 percent — and they have no plans to implement an Accountable Care Organization (ACO)-like model in the near future.
Conducted in October 2013 among 206 hospital executives at a director level and above, the survey also reveals that executives are struggling with finding solutions for lower reimbursements and increased costs, while still maintaining an acceptable level of quality care.
“This survey has identified a significant need for advocacy and education to support hospitals and help them survive the wave of changes brought on by the Affordable Care Act,” said Mary Anne Sloan, director of Purdue Healthcare Advisors. “Hospital executives are charged with enhancing patient care and managing margins with a shrinking workforce and diminishing patient volumes.”
Hospital executives find ACOs to be unstable and financially risky
Executives are waiting for ACO models that are more stable and mature to avoid having to reinvest funds to implement changes or updates, according to the survey. The executives who do not have plans to implement an ACO model in the future (46 percent) cited the following reasons:
According to a new report from AMN Healthcare, a healthcare staffing firm, 78 percent of hospital executives believe there is a shortage of physicians nationwide, 66 percent believe there is a shortage of nurses, and 50 percent believe there is a shortage of advanced practitioners. The survey also indicates that the vacancy rate for physicians at hospitals approaches 18 percent, while the vacancy rate for nurses is 17 percent, considerably higher than when AMN Healthcare conducted a similar survey in 2009.
“Change in healthcare is a continuous evolution, but the one constant is people,” said AMN president Susan Salka. “No matter what models of care are in place, it takes physicians, nurses and other clinicians to provide quality patient care, and the fact is we simply do not have enough of them.”
AMN Healthcare’s 2013 Clinical Workforce Survey asked hospital executives nationwide to comment on clinical staffing trends affecting their facilities. More than 70 percent rated the staffing of physicians, nurses, nurse practitioners and physician assistants as a high priority in 2013, compared to only 24 percent of hospital executives who rated staffing these professionals as a high priority in AMN Healthcare’s 2009 workforce survey.
Guest post by Jonathan Zimmerman vice president and general manager, Clinical Business Solutions, GE Healthcare IT.
With key deadlines looming, 2014 will be a critical year for the healthcare industry, one marked by important industry milestones and advances. As ICD-10 implementation and meaningful use Stage 2 attestation approach, many are saying we have reached healthcare’s tipping point – where first of its kind opportunities for collaboration and innovation intersect with challenging regulatory standards and population health demands. In order to better facilitate these updates and solve potential market challenges, healthcare providers will need to blend innovative technological solutions with current operational systems.
As the industry evolves, we anticipate three key opportunities for 2014.
#1: Smarter Collaborations
New industry partnerships and alliances are being created to collectively address standardization and implementation. Healthcare IT organizations are working to adopt common standards and protocols to provide sustainable, cost-effective, trusted access to patient data. Payers and providers are coming together to ensure healthcare providers are setup up for success. Regulatory agencies, manufacturers and providers are working diligently to approve more devices, streamline communications and update payment codes in time for ICD-10 implementation. We are also seeing CIOs/CTOs work closer than ever before with physicians in order to reap the benefits of incentive driven initiatives like meaningful use Stage 2.
Guest post by Scott Parker, senior marketing analyst, CureMD.
Healthcare needs to be efficient in delivering care to the patient. What if iPad and iPhone apps provide the services healthcare professionals need? Wouldn’t that be a dream come true? The mobile healthcare market is talk of the town in healthcare circuits. The amazing thing is, mostly mobile EHRs are free. Soon to be launched CureMD’s app Avalon will be free too. It is free because you only pay for the services you use.
Medical history on fingertips: Healthcare professionals only dreamt about a day, when the ease of access in terms of patient data could take a step further, and somehow make them get off their boring computer screens. All of patient’s data is just a few taps away with mobile EHR. Providers can access an up-to-date list of current and past diagnoses of the patient; along with list of medications the patient has been formally prescribed.
Empowering patients: Mobile EHRs are not just for care providers. They are for patients as well. Patients can use mobile EHR to view their test results along with clinical summaries of their visit to the practice. They can keep track of their vaccinations, making it convenient for the providers and staff to arrange an appointment. If providers are able to empower patients through mobile EHR they are essentially empowering themselves.
Accurate sharing of patient information: Mobile EHRs provides a coordinated system of care through its function of interoperability. It allows for secure exchange of data among multiple providers, practices and healthcare facilities in real-time. This will provide a better support structure for informed clinical decisions. All in all, it reduces manual medical errors caused by humans trying to provide information through lethargic channels.
Given the spirit of #mHealth13, I thought the following infographic was appropriate: mHealth stas: mobile apps, devices and solutions. Created by xcube labs, a mobile apps developer, it details the current use of mobile apps in healthcare by patients. Since mobile health, #mHealth, is now more than a $1.3 billion industry and it’s expected to grow to more than $20 billion by 2018, according to mhealthshare.
Not surprising, the use of smartphones is the most prominent device of physicians in the care setting, and an estimated 62 percent of physicians using tablets. Likewise, 72 percent of nurses and other caregivers are using smartphones in the care setting.
From a patient perspective, almost every person in the US – 247 million – have downloaded a healthcare app for their personal use, and there are more than 40,000 apps available for use by patients.
The sector is clearly burgeoning. For example, Becker’s Hospital Review recently reported that the vast majority of clinicians use mobile devices in their day-to-day practice. About four in five clinicians currently use smartphones every day, a rate which will increase to nine in the 10 next years.
Additionally, more than half of physicians use tablets daily. “Half of clinicians are ‘digital omnivores’ who routinely use a smartphone, tablet and computer currently, and 82 percent plan to within the next 12 months. Tablet and smartphone usage accounts for more than 40 percent of clinicians’ at-work digital time.”
Top uses for smartphones are using generic search functions (46 percent), accessing professional resources (38 percent) and communicating with colleagues (38 percent).
Fo r the last several years, there has been an increasing emphasis by the federal government on digitizing the healthcare industry. The allocation of meaningful use dollars to physician practices for converting to electronic health records was only the beginning. The Affordable Care Act (ACA) was the seminal event that demonstrated without a doubt that electronic management of patient information was going to be an absolute if hospitals and health systems are to survive.
The ACA puts healthcare organizations at financial risk for duplication of services, lapses in care coordination and questionable patient safety practices. Population health management demands that electronic patient records be accessible for planning, managing and tracking care coordination. But the fact is fully managing the continuum of care for a patient cannot be achieved without data collection both inside and outside the hospital’s walls. This is a trend that will take on increased importance as healthcare reform rolls out in 2014.
Health systems with forward-thinking HIT executives saw the writing on the wall after the ACA became law and began converting their organizations to electronic medical records. Systems that are considering becoming accountable care organizations (ACOs) – and accepting value-based reimbursement, which will become the predominant reimbursement model – need to find ways to track the health status of individuals in their community before they become patients. How? By embracing the use of technology that closes the healthcare loop before people even know they need those services.