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When Payor Innovation is Driven By Government

Posted on October 15, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This tweet from Jamey Edwards, CEO of Cloudbreak Health, inspired a really interesting discussion in a Twitter DM (direct message) group I’m in called Healthcare Disruptors. For those not familiar with private DM groups, in this case, there’s a group of 49 people on Twitter that are part of this group and members of the group regularly share information, events, insights, etc and the group comments on it.

Private Twitter DM groups aside, one of the comments in the group highlighted a concept I’ve heard for years. The government (largely Medicare and Medicaid) is the largest payor and the private sector has been taking its queues from Medicare and Medicaid for years. Is it any wonder that we haven’t seen much evolution in the payor space when we’re waiting on a massive government entity to drive the innovation?

Waiting for government to drive innovation largely explains why healthcare hasn’t evolved.

To solve this problem, there are two options First, the government could evolve more quickly and create new models for reimbursement that change the landscape. Is there anyone holding their breath on this one? Don’t get me wrong. I’m quite intrigued by Medicare’s attempts to push telehealth related reimbursement codes and their decision to try and reimburse based on the time spent with patients instead of how much you document in the record. These are big changes and I’m hopeful that they’ll be good changes. Not to mention ACOs which will hopefully help show us the path to a full value based reimbursement world and get us off the fee for service treadmill.

That said, I’ll never forget a CMS listening session that I went to. Someone asked about a specific policy and when we might hear the details of the final rule. The CMS representative said, “Pretty quickly.” Then, he corrected himself and said, “Government quickly which probably means months, not years.” The government moves slow. That’s just the reality. This is why innovation in healthcare shouldn’t depend solely on the government.

The other way for innovation to occur is for other payors to lead the innovation. When was the last time that payors did something really innovative? When did Medicare take something from the private payor space because it was an innovative solution? I’ll admit that I’m not a complete expert on the payor space, but I asked some friends and so far none of us have remembered a time where this happened.

What’s going to change this? The answer to that is not clear. Do you see something I’m not seeing? The better promise comes from something outside this traditional system disrupting healthcare as we know it. It feels like something like that needs to come, because Jamey is right that this is a big problem for many Americans, both republicans and democrats.

Stanford Offers 10-Year Vision For EHRs

Posted on October 12, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Despite many efforts to improve EHRs, few physicians see them as adding value to the practice. Sadly, it’s little surprise given that many vendors don’t worry much about what physicians want, focusing instead on selling features to CIOs.

As a result, they still don’t like their EHRs that much. In fact, a recent survey conducted by Stanford Medicine and the Harris Poll found that 44% of physicians said that the top value of the EHR was to serve as digital storage, which isn’t a ringing endorsement. Just eight percent saw the EHR as having clinical value, with three percent citing disease prevention, 2% clinical decision support and 3% patient engagement as top benefits.

Is it possible to create a new EHR model that physicians love? According to Stanford, we could build out an ideal EHR by the year 2028.

In Stanford’s vision, clinicians and other healthcare professionals simply take care of the patients without having to think about health records. Once examinations are complete, information would flow seamlessly to all parties involved, including payers, hospitals, physicians and the patient.

Meanwhile, it would be possible to populate the EHR with little or no effort. For example, an automated physician’s assistant would “listen” to interactions between the doctor and the patient and analyze what was said. Depending on what is said in the room, along with verbal cues of the clinicians, it would record all relevant information in the physical exam.

What’s more, the automated physician’s assistant would have AI capabilities, allowing it to synthesize medical literature, the patient’s history and relevant histories of other patients available in anonymized, aggregated form.

Having reviewed these factors, the system would then populate different possible diagnoses for the clinician to address. The analysis would take patient characteristics into account, including lifestyle, medication history, and genetic makeup.

In addition to its vision, the survey report offered some short-term recommendations on how medical practices can support physician EHR use. They included:

  • Training physicians well on how to use the EHR when they’re coming on board, as well as when there are incremental changes to the system
  • Involving physicians in the development of clinical workflows that take advantage of EHR capabilities
  • Delivering EHR development projects as quickly as possible once physicians request them
  • Making data analytics abilities available to physicians in a manner that can be used intuitively at the point of care
  • Considering automated solutions to eliminate manual EHR documentation

Technologists, for their part, can take also take immediate steps to support physician EHR use, including:

  • Developing systems and product updates in partnership with physicians
  • Limiting the use of manual EHR documentation by using AI, natural language processing and other emerging technologies
  • Using AI to perform several other functions, including synthesizing and summarizing relevant information in the EHR for each patient encounter and offering current and contextualized information to each member of the patient care team

In addition, to boost the value of EHRs over the long-term, 67% of physicians said making interoperability work was important, followed by improving predictive analytics capabilities (43%), and integrating financial information into the EHR to help patients understand care costs (32%).

Quality Payment Program Tops List Of Regulatory Burdens On Medical Practices

Posted on October 10, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new survey by the Medical Group Management Association has found that meeting the demands of the Medicare Quality Payment Program tops the list of regulatory burdens named by respondents in medical practices.

The survey, which collected responses from 426 medical groups, found that their regulatory burdens were climbing, with 86% reporting that such burdens had increased over the past 12 months. A smaller but similar share of respondents (79%) reported that the overall regulatory burden associated with participating in Medicare specifically had increased during the same period.

When asked to name the regulatory requirements they considered to be very or extremely burdensome, 88% named the Quality Payment Program, followed by prior authorization (82%), lack of EHR interoperability (80%), government EHR requirements (77%) and audits/appeals (68%). In contrast, just 49% of respondents saw compliance with HIPAA privacy and security requirements to be a major concern.

Given the challenges it imposes on practices, it’s no wonder that the MGMA respondents struggle with MIPS, with just 9% stating that they were satisfied or very satisfied with the performance feedback the program offers. Two-thirds of respondents told the MGMA that at least in its current form, MIPS doesn’t support their practice’s clinical quality priorities.

Perhaps the most irksome aspects of the MIPS program seemed to be the full-year quality reporting period and scoring methodology. Roughly two-thirds of respondents were dissatisfied or very dissatisfied with these aspects of the program. “The lack of clarity and constant readjusting of the MACRA regulations regarding MIPS/APMs is also frustrating,” one group member said.

In addition, despite ongoing efforts to support patient data exchange, the percent of respondents who rated a lack of EHR interoperability as very or extremely burdensome has climbed over the last 12 months, from 68% last year to 80% in 2018.

Ultimately, this problem could have serious financial consequences for some organizations. “Interoperability will never be achieved at the rate we’re going without bankrupting most private medical practices,” wrote one respondent. “As each of the EHR vendors moves towards their own interpretation of interoperability, they create different versions of their own software that cost all of us more to implement and we can’t afford any more.”

If these issues aren’t addressed, it seems likely Medicare’s drive toward value-based payment will be less successful than its leaders would hope.  Seventy-nine percent of practices responding to the MGMA survey said they didn’t think the move toward value-based payment had been successful to date, and it doesn’t seem likely that this will change if physicians continue to feel overburdened and misunderstood

A Next Step For Personalized Medicine? Vendor Brings Genomics To Ambulatory EHR

Posted on October 8, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Most physicians have some sense of the value personalized medicine can bring to their practice, but I doubt that many have ready access to the tools they’d need to harness its power.

In an effort to close that gap – and of course, to make its platform irreplaceable – a vendor serving medical practices has struck a deal giving physicians the ability to order genetic tests and leverage them to improve care.

The vendor, DrChrono, offers a suite of electronic systems for physicians, including an EHR which can be customized by bundling in affiliated apps. Its new partner is Genomind, a personalized medicine platform offering genetic testing for psychiatry practices.

Physicians using DrChrono will have access to two Genomind test kits, along with some analytics tools they can use to make use of the testing data.

One of the tests is Mindful DNA Professional, a genetic test used by clinicians to help them guide wellness decisions. The test targets aspects of a patient’s genetic details which could have an impact on overall health, such as variants suggesting that they could have sleep issues or a predisposition to anxiety, depression or impaired cognition.

DrChrono users will also have access to the Genecept Assay, the results of which can guide the treatment of psychiatric conditions. Once test results become available on the Genomind system, doctors can use its gene-drug-environmental interaction tool, the Genomind Drug Interaction Guide, to inform their treatment decisions. With the help of the Guide, clinicians can analyze the patient’s current medication regimen and flag gene-drug interactions.

An interesting side note to all of this is that the final test results from Genomind will be stored in the DrChrono information library for the patient and become part of the patient’s medical record.

Looked at one way, sharing the Genomind test results seems almost like a no-brainer in a world where casual genetic testing (think 23andMe) is becoming the norm. On the other, though, I don’t want to gloss over the fact that using genetic data to search for relatives is one thing and putting it into your personal medical record is quite another. It suggests that of consumer-driven demand for precision treatment is maturing, and that Genomind is on the right side of this trend.

This takes me back to DrChrono, which while not itself reinventing the wheel has struck a smart deal here. Not only has it brought a tool on board which could offer some benefit to physicians, its supporting the collection of information (genetic data) that patients are beginning to want. If DrChrono can give patients their genetic info via a decent portal, the company may find itself to be in demand with patients. Way to stay abreast of the times.

What Can the Casino Industry Teach Healthcare about Patient Experience?

Posted on October 4, 2018 I Written By

The following is a guest blog post by Spencer Kubo MD, Chief Medical Officer at CareCognitics.

Two of the hottest topics in medicine today are patient engagement and patient experience.  It is well accepted that patients who are engaged in their medical care have better outcomes, compared to patients who “passively” receive instructions, likely due to variable adherence to doctor recommendations.  It is also becoming increasingly clear that patients who have better experiences with medical contacts will have higher levels of patient engagement. But the medical community has been slow to identify, measure, and implement the specific steps that would enhance patient levels of engagement and experience.

This lack of momentum within the medical community is not surprising to some since “traditional” interactions with medicine are now often viewed by patients as paternalistic.  Indeed, many practitioners within the medical community have trouble adopting the term “customer” and still favor the use of “patient,” viewing medical interactions as inherently different from consumer interactions.

These challenges have caused doctors and health care administrators to look outside of the medical community for better ways to improve the patient experience and engagement.  The CareCognitics team spoke to a Product Manager at Nordstrom, a company with legendary customer service and loyalty, who noted, “The most important factor in making the customer feel special is to create the sense that the sale or interaction was special to both the sales associate AND the customer.”  And in many instances, doing this creates no additional cost to Nordstrom; the very basic rules of respect and personable service are all that are needed.

In our work at CareCognitics, we’ve seen success with improving patient experience and engagement using a similar focus on making the patient feel special.  CareCognitics is a digital health company founded in 2016 that leverages casino and hospitality loyalty principles, along with data science, to improve the patient experience.  Sunny Tara and Vishal Argawal, co-founders of CareCognitics, shared some of the “secret sauce” that is already helping five clinics in Nevada and California: “We started small and focused our efforts on chronic care management, especially since these activities were well supported by chronic care management code CPT 99490 and therefore brought in additional revenue for each clinic.” Here are just a couple of the ways that Tara and Argawal were able to ameliorate patient experiences by leveraging the best practices of the hospitality industry.

Make the conversation two-way: Traditional communication with patients, outside of in-person doctor’s visits, usually occurs via phone and is restricted to business hours.  CareCognitics developed a HIPAA compliant digital platform so that patients could engage in a dialogue with the medical team using a format that was convenient to the patient’s schedule and not confined to office hours.  Tara also commented, “We were also pleasantly surprised to break many myths about digital literacy in the Medicare population – over 70% of patients were responding to texts and emails.”  People loved having a “conversation” and felt the platform provided a much more interactive experience with the doctor’s office. “Our success is not defined by the technology we use, but rather by personalized content that is delivered to the patient every month, that reinforces the feeling that their doctor cares about their well-being.  We use technology and digital channels to strengthen the patient-physician relationship and provide personalized care at scale,” Tara explained.

Offer encouragement and a personal touch: “Let’s face it – completing tests as part of a chronic care management (e.g. flu shots and mammograms) is not very exciting,” says Agarwal.  Each time a patient completes a test, CareCognitics sends a congratulatory note and a message on the importance of the test (e.g. dramatically reducing the chances of suffering from flu symptoms.)  And each message is branded to the physician office (rather than a 3rd party), so the patient feels the communication is with the doctor’s staff.

In addition, CareCognitics supplies a “Care Ally,” a Certified Medical Assistant (CMA) who can respond to requests for additional details, schedule changes, etc., on behalf of the physician’s office, further enhancing the personal VIP touch, similar to a VIP host in the casino industry.  All patients who enroll in the program get instant benefits like “VIP phone” access (a special priority access phone line that physician offices aren’t responsible to run), next day appointments, and interactive personalized care.

All these perks help to reinforce the relationship between the patient/customer and the physician’s office.  The patient feels “special” because there is a pervasive sense of being uniquely cared about by doctors. Many of these principles of VIP service overlap with the principles of concierge medicine, but in this program, there is no large monthly fee to the patient!  All the patient has to do is be an active participant in his or her own healthcare.

Hey, let’s not forget about the docs!

Yes, the focus of all these activities is on the patient, but physician acceptance is critical for the program to be sustainable and incorporated as an essential feature of medical treatment, and not just a fancy add-on. Physicians’ feedback has pointed out at least 4 features of this chronic care management program which are particularly attractive to physicians: engaging dialogue with patients, natively documents in the EMR, improved PQRS scores, and incremental revenue. 

According to Dr. Cliff Molin, a family practitioner with PHG, physicians like the fact that patients are engaging in a dialogue with representatives of the physician practice, without taking time out away from the daily workings of the practice. The key elements of interaction are embedded into the EMR, so physicians can oversee the progress without having to access a different website. Because the program encourages completion of positive health behaviors, all the practices are reporting improved results on PQRS quality reports.  And finally, the program has brought in incremental revenue since all the care coordination activities are reimbursed by CMS at ~$42 pmpm.

Carecognitics improves physician’s ability to compete with large health systems and provide excellent care while improving payment for the work they do. Technology is leveling the playing field in improving patient care without increasing costs for physician practices.

Note: John Lynn, Founder of Healthcare Scene, is an advisor to CareCognitics.

Revenue Cycle and Patient Communication Dominates MGMA18 Exhibit Hall

Posted on October 3, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Two themes emerged from the exhibit floor of this year’s MGMA annual conference (1) Practices are spending money on improving Revenue Cycle Management – RCM and (2) Practice managers are looking for more comprehensive ways to communicate with patients.

The exhibit hall of the 2018 MGMA Annual Conference (#MGMA18Annual) came to a close today and as the booths were quickly deconstructed, I took time to reflect on 25 pages of notes that I took from the various conversations I had. As I flipped through my blue-ink chicken scratches, I kept seeing two words in the margins: “PtComm” (my short hand for Patient Communication) and “RCM” (Revenue Cycle Management). On page after page, I scrawled these words to summarize the conversations.

In the Health iPASS booth, I had the chance to speak with one of their customers – Judith Basile, MSM, FACMPE, Practice Administrator at Associates in Orthopedics. Basile told me that implementing Health iPass’s RCM platform made “a huge impact on the financial health” of their practice and that it allowed them to “catch up to the consumer experience patients have outside of healthcare, where they can make payments quickly and easily”. With Health iPASS, Associates in Orthopedics experienced a 35% improvement in patient payments. They had only been on the platform for 18 months.

Over in the Pulse Systems booth, I spoke with Dar Griffeth, the company’s new SVP of RCM Services. Griffeth’s role was created because the company recognized the need their customer had for expert RCM advice. His job is to work with customers to identify how components of the Pulse solution can be adapted to improve the RCM process. This is in contrast to the common approach of deploying technology and then redesigning the workflow to fit – an approach that often results in slow adoption or outright failure. Griffeth’s role would not exist if RCM was a low priority for physician practices.

Matthew Hawkins, CEO of Waystar, the company that resulted from the combination of ZirMed and Navicure, shared where they had been focusing some of their development efforts. “Lately we have been focused on helping reduce or eliminate claim denials,” said Hawkins. “Having a claim denied is terribly inefficient. Practices have to spend precious time and effort investigating and correcting the claim. We thought – why does it have to be this way? What if we could eliminate denials altogether? That’s what we’ve been working on and our customers are happy we have made significant strides in this area.”

The exclamation point was Waystar’s announcement that it was acquiring Ovation – a claims monitoring technology from UPMC to further enhance Waystar’s claims processing platform.

The conversation turned to patient communications when I stopped to speak with Rick Halton, VP of Product and Marketing at Lumeon. I was unfamiliar with Lumeon and was curious to find out more. Halton argued convincingly that the current paradigm of care coordination was flawed – that the top-down approach where a central care coordinator is expected to shoulder the work to gather data from patients and keep patients adherent to their care programs. was doomed to fail. Instead, an approach where patients are full partners in their care was needed. In Halton’s opinion, the key was two-way communication between patients and their care teams.

Lumeon’s Care Pathways Management platform allows for a more automated and orchestrated approach to care delivery. One that is centered on the ability for patients and care teams to communicate in a seamless manner via text and in-app messages. “Everything from discharge to pre-operative readiness to lifestyle coaching is possible through the platform,” said Halton.

In prior years at MGMA, whenever I talked to people about patient communications my conversations were only about sending out appointment reminders and links to patient educational materials. What Lumeon was showing me was true 2-way communication with patients across many care scenarios.

Further evidence of this shift in patient communications came from my conversations with Well Health, Rhinogram and CareCloud.

Well Health makes a platform that consolidates all patient communications in one place – and allows for seamless transition from broadcast message delivery to real-time two-way communication with patients. Their interface looked intuitive and because they system stored all prior communications, it allows practices to quickly reference prior conversations, helping staff get to the heart of the issue more quickly than having to search through the EHR.

“It’s all about making it easy for both the patient AND the staff in the healthcare organization,” said Bill Kinner, President of Well Health. “We have to realize that in the world of value based care, effective 2-way communication with patients is the cornerstone to keeping people healthy. It’s the last mile of any population health, medication adherence or mental health program.”

Rhinogram had a similar philosophy. A relative newcomer to the ambulatory space, the company has enjoyed years of success with dental practices. I asked Dr Keith Dressler, Chairman & CEO of Rhinogram what set their system apart from all the others on display at MGMA: “Quite simply we see ourselves not as a communication platform, but as an asynchronous telehealth platform that uses text, Facebook Messages and other channels rather than real-time video to connect with patients”

Dressler’s response was a great way to reframe the entire patient communication space and showed me that vendors were moving away from their provider-initiated communication roots to include patient-initiated communication as well.

Nowhere was this shift more apparent than in the CareCloud booth. A year ago I wrote a post about the launch of the company’s then-new Breeze platform – a patient experience platform built in partnership with First Data. Breeze was designed to be the backbone for all sorts of new patient engagement applications. At MGMA18, CareCloud announced the launch of a customizable survey tool for capturing patient satisfaction information on Breeze.

“Our new survey capability is very exciting,” said Juan Molina, Vice President of Strategy and Business Development at CareCloud. “The surveys are customizable by the practice without the need for development resources. This allows our customers to quickly construct surveys that can gather patient feedback on anything – new programs they want to offer or changes they want to make to the practice itself. The sky is the limit. But at the core, this survey capability means our customers have another way to engage patients in a 2-way conversation about their experience.”

I must admit, prior to MGMA18 I had thought the patient communication space was played out. But having spoken with every patient communication vendor on the exhibit floor, I have a new appreciation about where the technology is headed. I’m actually excited to see what advancements will be made in the next 12 months.

PS: I also had great conversations with Kevin Pho MD – founder of KevinMD.com, Todd Evenson – COO at MGMA, Corinne Proctor Boudreau – Senior Manager at MEDITECH and Niko Skievaski – cofounder & President at Redox. Those conversations will be the subject of upcoming articles.

Better Performing Practices Invest in Communications

Posted on October 1, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

MGMA’s Winning Strategies From Top Medial Groups report identifies better-performing practices have invested in: (1) New/upgraded EHRs; (2) Electronic communication systems; and (3) Upgraded coding and revenue cycle management systems.

The Medical Group Management Association (MGMA) released their Winning Strategies From Top Medical Groups report – on the morning of their annual conference. The report is based on data gathered from 3,000+ medical groups that were identified by MGMA as top-performers in at least one of four categories:

  1. Better-performing practices focus on using resources efficiently and create + stick to a financial plan.
  2. Better-performing practices are those whose providers and staff successfully contributed to earned revenue for the practice.
  3. Better-performing practices have lower operating costs as a percentage of revenue and manage their revenue cycle better.
  4. Better-performing practices report on quality metrics while also excelling in at least one other category.

According to the report, being a better-performer reaps significant benefits.

  • Better performing independently-owned surgical specialty practices have 20% lower operating costs vs other practices
  • Better performing primary care practices have 8.6% greater net income per physician vs other practices
  • Better performing practices collect 10% more accounts receivable in the first 30 days vs other practices

Overall, the report identified three key strategies that better-performing practices pursue:

  1. Building an engaging, patient-focused culture
  2. Focusing on long-term, strategic progress
  3. Constantly investing in improving operations

What was the most surprising result in the report? Todd Evenson, Chief Operating Officer of MGMA had this to say “I found it surprising how much more productive Better Performers were in terms of Work Relative Value Units (RVUs). Better-performing non-surgical specialty practices, for example, were found to have an average of 9,115 RVUs per physician compared to 7,300 for all other practices. The report highlights having the right staff, the right technology and the right people can make a big difference.”

For me, the most interesting aspect of the report was where HealthIT investments were being made. The report identifies that better-performers had or were planning to invest in:

  1. New or upgraded EHRs to support better patient communication, better provider experience and workflow efficiency
  2. Electronic communication systems (like secure texting) for use between providers and with patients
  3. Upgraded billing/coding software and revenue cycle management systems

I did not expect to see communication so prominent in the top Health IT priorities. For many years communication has been an afterthought. It is encouraging to see that in 2018 practice leaders are putting an emphasis on tools and systems to help bring the people who are delivering care closer to peers and closer to patients.

“The reality is, any practice can achieve top performance when the people within it make a sustained effort to do more of the right things well,” said Ken Hertz, Principal MGMA Consultant. “We developed this report not only to give practices strategies to get the most from their business but to show them that these efforts pay off—for practices and patients alike. When practices invest in improving their business, patients are more efficiently served, increasing patient satisfaction and health outcomes, and improving patient retention rates. It’s a feedback loop that benefits everyone.”

The Winning Strategies From Top Medical Groups report is available exclusively to MGMA members.

Practice’s EMR Implementation Drove Up Costs For Six Months

Posted on September 28, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Everyone knows that providers incur EMR-related costs until well after it is implemented. According to a new study, in fact, one medical incurred higher costs for six months after its implementation.

The study, which appeared recently in The Journal of Bone & Joint Surgery, calculated the impact of an EMR implementation on labor costs and productivity at an outpatient orthopedic clinic. The researchers conducting the study used time-driven activity-based costing to estimate EMR-related expenses.

To conduct the study, the research team timed 143 patients prospectively throughout their clinic visit, both before implementation of the hospital system-wide EMR and then again at two months, six months and two years after the implementation.

The researchers found that after the first two months, total labor costs per patient had shot up from $36.88 to $46.04.

One reason for the higher costs was a growth in the amount of time attending surgeons spent per patient, which went up from 9.38 to 10.97 minutes, increasing surgeon cost from $21 to $27.01. In addition, certified medical assistants for spending what time assessing patients, with the time spent almost tripling from 3.42 to 9.1 minutes.

On top of all of this, providers were spending more than twice as much time documenting patient encounters as they had before, up to 7.6 minutes from 3.3 minutes prior to the implementation.

By the six-month mark, however, labor costs per patient had largely returned to their previous levels, settling at $38.75 compared with $36.88 prior to the installation, and expense which remain at the same level when calculated at two years after the EMR implementation.

However, providers were spending even more time documenting encounters than they had before the rolling, with time climbing to 8.43 minutes or roughly 5 minutes more than prior to the introduction of the EMR. Not only that, providers were spending less time interacting with patients, falling to 10.03 as compared with 14.65 minutes in the past.

Sadly, we might have been able to predict this outcome. Clearly, the clinic’s EMR implementation has burdened its providers and further minimized time the providers spend with their patients. This, unfortunately, is more of a rule than an exception.

So why did the ortho practice even bother? It’s hard to say. The study doesn’t say what the practice hoped to accomplish by putting the EMR in place, or whether it met those goals. Given that the system was still in place after two years one would hope that it was providing some form of value.

Truthfully, I’d much rather have learned about what the clinic actually got for its investment than how long it took to get everyone trained up and using it. To be fair, though, this data might have some relevance to the hospital systems that manage a broad spectrum of medical practices, and that’s worth something.

A Vote In Favor Of Using Scribes

Posted on September 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the past few years, using scribes to complete medical documentation in EHRs has gotten mixed reviews. Some analyses have found that scribe services were too expensive to justify the investment, while others have concluded that the use of scribes can make a meaningful impact on revenue and improve physician productivity.

This month, a new paper has been published whose results fall into the plus column. The small study, which appears in JAMA Internal Medicine, looked at the use of scribes among 18 primary care physicians.

To conduct the study, researchers looked at physicians at two medical center facilities within an integrated healthcare system, gathering data between July 1, 2016 and June 30, 2017.

The research team assigned PCPs randomly to two groups, one with and the without scribes, for 3-month periods, switching physicians between the with and without groups every three months. At the end of each three-month period, the PCPs filled out a six-question survey which collected their perceptions of documentation burdens and visit interactions.

In addition to capturing PCP perceptions of scribe use, researchers also collected objective data, including time spent on EHR activity. They also surveyed patients of participating PCPs to gather data on the patients’ perceptions of visit quality.

When all was said and done, the research team found that scribed periods were associated with less self-reported after-hours EHR documentation work.

Researchers also found that when they used scribes, PCPs were more likely to report spending more than 75% of the visit interacting with the patient and less than 25% of the visit on the computer. In addition, physicians were more likely to finish their encounter documentation by the end of the next business day during scribed periods.

What’s more, 62.4% of patients said that scribes had a positive effect on the visits, while just 2.4% said they had a negative effect.

The researchers’ take away from all this was that the use of medical scribes could be one strategy for improving physician workflow and primary care visit quality.

As I noted previously, other research has drawn similar conclusions. For example, a study published in 2015 (which included the involvement of scribe provider ScribeAmerica) found that scribe use at the two hospitals was linked to an improved Case Mix Index which ultimately led to gains of about $12,000 per patient. Meanwhile, inpatient physicians were able to cut time spent the chart updates by about 10 minutes per patient on average.

Having been over arguments for and against scribe use, my personal conclusion is that working with them can be a worthwhile investment if doing so is a good fit for the physicians involved, but doesn’t work in all cases.

Ultimately, it seems that there’s too much variation between settings in which scribes could be used to make a single blanket statement about their benefits. I guess we won’t be drawing grand conclusions about scribe pros and cons anytime soon.

The Secret to Coding Accuracy Is In The Training Tools

Posted on September 24, 2018 I Written By

The following is a guest blog post by Scot Nemchik, Vice President of Coding Education and Auditing at Ciox.

Accurate coding has become more important to healthcare organizations and more critical to their bottom lines than ever before. While the traditional value of coding to an organization was simply in its effect on timely reimbursement, outside entities like IBM Watson Health and the U.S. News & World Report, among many others, are today utilizing the same broader organizational coding data to assess outcomes, provide company profiles, drive news, assign ratings and rankings, and determine value in the healthcare organizations they assess.

Because the impact of accurate coding in the modern era extends beyond reimbursement into reputation, perception, and new business development capabilities, it’s clear that the stakes have been raised for most organizations. With added importance assigned to coding accuracy, many of these companies are today assessing how to drive greater coding accuracy within their organization. Yet, the methodologies by which organizations assess new hires for coding capabilities, and by which they train and enhance their existing workforce, are largely unchanged in the last decade or more.

Coding is an industry that requires specialized skills, and so it is important for several reasons to make quality hires at the onset. It is far more profitable for an organization to retain its coders, which requires better upfront assessment. A study from the Society for Human Resources Management (SHRM) on employee retention suggests that the cost to an organization in replacing an employee is between 50 and 75 percent of their salary. In an industry like medical coding, better screening measures must be in place to get the right people involved on the team the first time.

One of the primary ways companies can look to achieve better candidate hires is by moving away from simple multiple-choice assessments of coding skill during the screening process, as those assessments are not as predictive of coding aptitude as modern measures. A more effective approach is achieved through the use of platform-based assessment techniques, in which the candidate can respond to hypothetical medical reports with actual codes, providing more meaningful insight into coding aptitude.

Those same training platforms also serve as a solution for companies looking to bolster the accuracy of their existing coding teams. Traditionally, organizations have relied heavily on passive forms of training (e.g., webinars, LMS assignments) to convey important coding instruction, hoping that instruction is put into practice in the daily work settings. Today, through active, platform-based training, the results are far more scalable and effective.

Coders Learn by Coding

By training in an active coding learning environment, coders learn by doing, a proven method which accelerates learning and optimizes retention. Through a hands-on learning approach, coders can put their skills to the test and learn from any mistakes in real time.

Platform learning provides not only pre-hire testing, but also baseline performance assessment. By giving new hires and existing teams alike the same metric tests, organizations can identify their best assets. Additionally, platforms for coding training offer effective and efficient cross-training, allowing organizations to diversify the capabilities of their coders and cross-pollinate or backfill specific coding teams for more flexibility. Beyond cross training, existing teams benefit from the development of their assets through ongoing education. Coding is a dynamic field with annual changes, and access to the newest codes and guidelines is critical. A comprehensive learning platform offers all of these capabilities and measurements in real-time.

As companies look for ways to improve the accuracy of their coding staff, whether through new hires or incremental improvements to existing teams, transitioning to a platform-based training and assessment environment, with a host of experiential and measurement capabilities, can provide the solution.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com