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Doctors Work 2 Hours on EHR Tasks For Every 1 Hour of Time With Patients – Are You OK With That?

Posted on December 10, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

At NoteSwift, we’re passionate about providing clinicians with the tools and workflow support they need so they can focus on delivering great care to their patients. It’s become increasingly clear over the past few years that EHR workflows are a big frustration for many doctors. This leads us to today’s question:

As a healthcare industry, are we satisfied with a system that forces clinicians to spend two hours inputting and completing EHR records for every one hour of actual time with patients? Is this the kind of health care we aspire to provide?

In thinking about this topic, I’m reminded of a blog I read a couple years ago which passionately addressed the issue of EHR time burdens from the perspective of a physician. Hear the passion in the author’s voice, and consider the tips and workflow adjustments he’s been forced to adopt in order to minimize the time they spend in EHR work.

The author calls the amount of time many EHRs require a “national disgrace” because it pulls doctors away from time with patients. We hear this story from nearly every clinician we talk to — it’s painful and frustrating to train for years to care for patients, yet feel forced to spend most of the day typing notes and clicking EHR check boxes.

A recent white paper looking at studies across the industry backs up this frustration with even more data. Doctors today are forced to spend two hours on EHR entry for every one hour of patient care. This EHR time burden is directly connected to the increase in physician burnout being reported across nearly every physician specialty. You can access this white paper here.

I believe it’s our obligation as an industry to continue improving our EHR workflows to better serve clinicians working on the front line of health care and who need more time to build relationships with patients, not EHR workflows.

At NoteSwift, we believe there is no reason for a clinician to spend 2 hours manually completing an EHR record, and we are working on exciting A.I. solutions to reduce the time doctors spend in their EHRs. Our solution, Samantha, the real-time EHR transcriptionist, allows clinicians to dictate the patient narrative one time; from there, powerful A.I. parses the narrative, creates structured data elements, adds those elements across the entire EHR, and offers the clinician a review screen to finalize the note. The entire process is automated, accurate, and efficient.

The author ends his blog with the following sentence: “Every day on my way into work I make a conscious decision to do everything possible to spend face-to-face time with patients.” I think this is a great mantra for doctors to adopt, and it’s the responsibility of all of us in health care to continue improving our EHR workflows to make better patient care a reality.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

The Extraordinary Value of Chronic Care Management As Seen Through The Lens Of The Patient

Posted on November 28, 2018 I Written By

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

The concept of adding chronic care management (CCM) to primary care practices is appealing on many different levels, but implementation has been sporadic.  The dismal uptake is multifactorial and is largely based on the perception that the value (return) may not be worth the investment.  However, Wendi Capers, Practice Manager of Priority Health Group, a primary care practice in Las Vegas, Nevada, recently relayed to me three patient stories that are guaranteed to change your perspective.  This group was an early adopter of CCM and is using Cariatrix as their CCM provider.

Patient #1 is an 82-year-old male veteran who was becoming increasingly isolated, lonely and depressed after the death of his dog.  The patient did not have any family or friends.  He had no physical complaints that would have necessitated a call to his doctor and did not feel he had any reasons to request an appointment.  The Care Ally from Cariatrix noticed that the patient was not responding to the regular emails and texts that give reminders about upcoming preventative health measures. She called the patient and astutely picked up on the feelings of isolation. After their conversation, she found a program that could provide animal therapy for vets.  She also located a community center that held classes in Tai Chi, one of the patient’s favorite forms of exercise.  The patient is responding well to these interventions and has “turned around.”  Now the patient promptly responds to the emails/texts, and even calls the Care Ally every month just to check in, clear signs of greater engagement and well-being.

Patient #2 is a 62-year-old male with diabetes that was not well controlled, as evinced by a baseline A1C that was elevated to 11.9.  When asked about the suboptimal A1C result, the patient was taken aback, saying, “I can take care of myself.”  Again, this patient did not see the need to contact his doctor.  But the CCM team slowly won him over through multiple contacts.  The Care Ally then observed during medication reconciliation that there were extended periods between refills of his insulin and oral medications.  The patient at first did not acknowledge this gap, but then finally admitted that the co-pay had forced him to delay refills. He remarked, “I can eat and heat my home, or I can get my meds, but I can’t do both.”  The Care Ally was able to petition the manufacturers for hardship papers, and now there is no gap in prescription refills.  Most importantly, his A1C has been reduced to 7.9!

Patient #3 is an 83-year-old male who has a cognitive impairment.  After an annual wellness visit, the primary physician ordered home health care visits to help with the patient’s weakness and general limitations.  However, the patient became increasingly disoriented and refused to let the home health aide into the home, thinking she was a photographer.   As in the other cases, this patient was not responding to the regularly scheduled emails and texts that are standard components of CCM.  However, the Care Ally received an automated alert, read about his refusal to admit the home health aide in the EMR, and then called the patient directly.  The Care Ally immediately recognized the patient’s disorientation and called the police department to do a well check on the patient.  The police found the patient to be obviously confused and called an ambulance to take the patient to the hospital for an emergent evaluation.

You will notice some common themes in these patient stories.  The first is that the CCM program had established a digital two-way communication platform with the patient.  This is a game changer from the traditional paradigm of medical interaction, which is dependent upon the patient calling the office to report a problem.  None of these patients felt they had any reason to call the doctor’s office (in that they were unable to recognize that they were in need of any care). However, the lack of responses to email and texts served as an indicator to the Care Ally that something might be amiss. In the traditional paradigm, corrective actions are initiated only AFTER the patient contacts the doctor about a problem.  In the new CCM paradigm, there is outbound communication that can help detect problems even if the patient is not contacting the clinic.

Second, the CCM program could provide VIP services that truly made a difference in patient outcomes–these are simple yet extraordinarily effective.  One problem with the term “VIP Services” is that many think of limousines, suite upgrades and free meals.  But here we see that “VIP Services” can be low cost but directed interventions to resolve specific issues facing a patient.  Most clinical practices do not have the resources to contact patients who are not complaining, and most do not have the resources to respond to the cases above in the same proactive fashion that CCM allows.  A CCM program can truly provide that competitive edge and get medical practices paid for the effort!

Third, these examples point to the synergistic effects of technology and the human touch.  Technology is an answer because it can help us monitor patients for signals and provide additional communication channels.  But we need the human touch in many cases to really make the difference.  As a practicing cardiologist, I get excited about how much technology can help, but at the same time, I am humbled by how much technology still cannot do. It is the balance of technology and human touch that will be a game changer in healthcare.

Finally, it is important to assess the value of CCM in terms of revenue, improvement in quality scores and other hard metrics.  But there is a “softer” side to the value equation that makes CCM valuable and helpful to patient outcomes.  These stories from the “trenches” of CCM providers happen all the time–they form a compelling testament to the value of CCM!

About Spencer Kubo, MD
Spencer brings a diverse set of experiences and expertise to the chronic care management strategies of CareCognitics. Previously, he was Medical Director of the Heart Failure-Heart Transplantation Program of the University of Minnesota, where he authored over 250 original articles and abstracts. He has also been Chief Medical Officer or a consultant to numerous medical device companies developing breakthrough treatments to improve the lives of patients with cardiac diseases. He maintains a part time clinical practice and most recently was the Physician Lead of the Heart Failure Service Line for Allina Health. In that capacity, he leads a multidisciplinary group focused on improving outcomes of heart failure patients treated at any of the 12 hospitals and over 90 clinics in the Allina system.

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

Voice Technology: A Disruptive Force in Healthcare

Posted on November 19, 2018 I Written By

The following is a guest blog post by Adam Sabloff, CEO of VirtualHealth.

Voice technology is a disruptive force across many industries, and healthcare is no exception. In sync with tools like Amazon Alexa and Echo, voice-user interfaces (VUI) have the potential to take care management to the next level, and the advantages extend far beyond simple conveniences for patients. 

The world of healthcare lives in siloes: patients, family members, doctors, care managers, and health aides, just to name a few. All are inputting valuable health information from disparate systems, devices, and other sources—resulting in a fragmented view of the patient’s health.

A growing number of healthcare innovators, myself included, believe that voice technology is one solution that can help bring all the pieces together.

I joked during a presentation at Amazon’s VOICE Summit, where I addressed the use of voice technology as a patient engagement tool, that I had received a late-night text from my sister-in-law that four flavors of Goldfish crackers – which she knows I love – were being recalled due to salmonella. Imagine if Alexa knew my ordering behavior, understood what I had in my pantry and alerted me immediately to the recall. Now imagine if Alexa also automatically sent me a box to return the bags in question or merely alerted me to throw out my Goldfish stash and arranged for my refund.

When you apply those “what ifs” to healthcare, they take on new, more significant meaning.

Transforming Care Delivery with Greater Insights

Driven by the massive popularity of Alexa and Google Home, VUI is transforming care delivery by empowering providers with greater insights like these and better engaging patients in behavior change that leads to overall better health and outcomes. Implementation of VUI can enhance process across a variety of use cases such as:

  • Prompting patients to schedule appointments and follow through with care plans
  • Reminding patients about medications
  • Guiding patients through procedure preparations
  • Standardizing care information provided before or after treatment.
  • Enable interaction to complete assessments

The sky is the limit when it comes to implementing VUI, but the immediate goal is identifying medium-risk individuals before they become high-risk. What if Jane just had knee surgery but lives in a 4th floor walk-up? Her care team knows that compliance with her discharge plan may prove difficult. Voice technology can be the intuitive, patient-friendly layer that allows data to flow into healthcare systems faster.

Aging at Home

One of the biggest topics being addressed these days is Medicare’s unprecedented push into the home—a shift driven by an aging population that is outgrowing the amount of available senior living beds.

By weaving VUI-based smart home products like Amazon Alexa and Google Home into the fabric of healthcare technology, we can provide a better quality of life to seniors while allowing them to age gracefully in the comfort of their own homes.

Last month,, an Amazon spokesperson told a reporter that the company frequently receives positive feedback from “aging-in-place” customers who use Alexa’s smart-home features as an alternative to going up and down stairs. Amazon’s Echo Show is another product that offers users Tap to Alexa, a screen interface that lets users who are deaf and hard of hearing tap common commands. Microsoft, for its part, recently launched an A.I. for an accessibility program to create inclusive, affordable technology.

While a number of aging in place-focused technologies like these are already available, more still are being explored. We are seeing seniors embrace today’s connected devices to stay safely independent. Everything from blood pressure and glucose monitors to motion sensors are making seniors’ homes safer and smarter. Furthermore, voice devices can serve as the central data hub for all the connected devices in a person’s home. 10 years from now, I anticipate that most seniors who live independently will do so in smart homes equipped with passive devices that continuously monitor vital signs and activities of daily living. I also foresee the use of other monitoring devices, such as food trackers that monitor inventories and replenish when needed.

Addressing Social Determinants

Social factors such as lower income, education level, or high-crime area have been shown to significantly affect health outcomes. Subsequently, social determinants can cause care gaps such as difficulties with transportation, proper nutrition, understanding educational materials on a specific condition, or lack of a support network to help ensure compliance.

According to Lyft, 3.6 million Americans have transportation issues that prevent them from getting to or from doctors’ appointments, and 25% of lower-income patients have missed or rescheduled their appointments due to lack of transportation.

That’s where voice technology can help.

If John Smith needs to go to the doctor and Medicaid will pay for the appointment, John can say, “Alexa, I need to go to the doctor next week.” Alexa might respond, “Your doctor is available at 10 am on Tuesday. I’ll arrange for a Lyft to pick you up.”

It’s the same with nutritional needs. If John says, “I need meals,” Alexa might say, “You’re on a low sodium diet. Your choices for this shipment include asparagus or carrots.” By making solutions easier to reach, VUI can close the care gaps more efficiently and effectively than a care manager reaching out via email or phone.

To be sure, there are a lot of lofty ideas out there when it comes to VUI and healthcare, but it’s not practical to boil the ocean; instead, it’s important to hone in on those aspects of healthcare where it can have the greatest impact in the shortest amount of time.  By engaging patients in their homes – particularly those who make up the most high-risk, complex populations – VUI applications can keep patients out of the doctor’s office or hospital, while still providing strong outcomes.

About Adam Sabloff
Adam Sabloff, CEO and Founder of VirtualHealth, is a nationally recognized leader and executive in the healthcare industry. Adam’s impact in the field can be traced back to the mid-2000s, when he co-created the Ritz-Carlton Residences in Baltimore and discovered a significant gap leaving seniors and the chronically ill without access to essential care delivery and technology.

That insight, coupled with the loss of a loved one to a late-stage diagnosis, led Adam to develop VirtualHealth, the first comprehensive care management solution purpose-built for integrated value-based care. Designed for use by payers and providers, the platform aggregates and normalizes patient data from multiple sources effectively providing healthcare organizations with the tools to provide proactive, quality care.

Adam is a frequent speaker at healthcare and technology events, including the annual J.P. Morgan Healthcare Conference, Parks Associates’ Connected Health Summit, and the Amazon Voice Summit where he discusses topics including the need for advanced health IT solutions to achieve a true “whole-person” view of the patient.

The Common Thread Connecting Top-Performing Practices

Posted on November 14, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

A top-performing practice. Isn’t that what every organization in the healthcare industry is striving to become? But how do you get there? According to MGMA’s recent Winning Strategies From Top Medical Groups report, there are a few things that top performers have in common—from exceptional strategy, to smooth operations, and strong culture. But one interesting finding of the study was that top performing medical groups have a radically different approach to investment than the rest of the industry.

In an era of cutting costs and reducing overhead, many medical practices avoid spending money like the plague. However, top performers do the opposite. They are significantly more likely to spend additional money on their practice. They then maximize the returns on these investment, ultimately achieving lower overall operating costs. As MGMA President and CEO Halee Fisher-Wright, MD, recently said, “We have found that better performers are systematic about improvement and continually invest time and effort in new resources while maximizing the tools and information already available to them.”

Technology for the Future

If top-performers are investing more, where is that money going? One of the best investments—not only for today but the future as well—is technology. Emerging technologies are a critical aspect of the future of the healthcare industry. In fact, an SAP/Oxford Economics study recently found that 70 percent of healthcare executives say that investing in technology is essential to a practice’s growth, competitive advantage, and the quality of a patient’s experience. Thomas Laur, global president of SAP Health, explained, “Digital innovation will fuel the next wave of breakthroughs in healthcare and accelerate the broader shift toward data-driven care for healthcare organizations. Unlocking actionable data insights in real time is critical for the future success for value-based care.”

The technologies expected to create the highest return on investment include:

  1. Efficiency-fueling technologies. Most healthcare organizations are riddled with inefficiencies throughout their patient care processes. One of the biggest inefficiencies lies with unwieldy administrative processes. In the healthcare industry, 31 percent of employees deal solely with administrative challenges. As a comparison, across other industries, just 13 percent of workers perform administrative work. That’s a whole lot of wasted time! Technologies that standardize and streamline administrative processes will reduce this burden, improving efficiency levels and overall patient care. This includes automation of appointment reminders, recall messaging, billing, scheduling, and more.
  2. Technology that personalizes care. For years and years, uniform medicine has been the norm in healthcare. The large majority of patients with the same disease will end up receiving the exact same treatment as one another. This is not the most effective nor efficient way of treating patients. It is estimated that a staggering $700 billion each year is spent in the U.S. on health care efforts that do not improve health outcomes. This is where the technology of personalized medicine comes in to play. A variety of tools are emerging that target patient’s health at an individual level. From technology that predicts a patient’s likelihood of contracting any given disease to technologies that can take into account an individual patient’s makeup before prescribing medications, more and more options are available for personalized care. And these technologies are very popular with patients. According to one study, more than three-quarters of consumers say they would like to undergo diagnostic tests that develop personalized prevention or treatment plans. Implementing these options differentiates you from the competition.
  3. Patient engagement technologies. Todays’ digital patients want access to tools that give them greater understanding and control over their own care. Since patient engagement is a major goal of the healthcare industry as well, implementing technology that engages patients is a no-brainer. From patient portals to text messaging to targeting patient education, the options to get patients involved and excited about their care have never been more diverse.
  4. Security-based technology. Data breaches and security concerns have become a hot-button issue in the industry. While it is impossible to completely eliminate all security threats, there are more and more options to safeguard your data. Some of the most exciting trends include next-generation firewalls (NGFWs), block chain technology, cloud-based securities, secure messaging and health information exchange, and biometric security applications. You can read more about each of these emerging technologies here.
  5. Remote-health monitoring. Remote wearables and apps are not only fun and popular with patients, but can also provide healthcare providers access to extended monitoring, greater disease prevention, and improved fact-based care decisions. Practices should look for ways to maximize the use of remote monitoring tools.

In order to obtain long-term success, healthcare organizations need to find ways to invest in the future. Looking at some of these most popular technologies is a great way to get started. Choose just one or two that you would like to focus on and then expand from there. This will put you in a great position for the future.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.

Is EHR Use Causing Physician Burnout?

Posted on November 12, 2018 I Written By

The following is a guest blog post by Wayne Crandall, President & CEO of NoteSwift.

Over the past decade, numerous studies have been published with the same concerning conclusion – physicians are increasingly expressing feelings of burnout, frustration, and a lack of support from their employers and technology solutions. There is no single cause for this burnout, but there are plenty of signals pointing to a primary cause:

EHR use, requirements, and regulations are leading to incredibly high levels of physician burnout.

The data is increasingly clear on this issue. Consider this statistic: according to a 2015 survey, almost 90% of doctors feel moderately to severely stressed and burned out on an average workday.

And this one: A new study by the University of Wisconsin and the American Medical Association (AMA) found primary care physicians spend almost six hours (5.9) on EHR data entry during a typical 11.4 hour workday.

Because of this rapid rise in physician burnout and clear connection to EHR use and management, we decided to look more deeply into the causes, symptoms, and possible solutions to the physician burnout crisis. The result of this research is a newly published white paper we’ve created in partnership with Dr. Robert Van Demark, Jr., a leading voice on the issue of physician burnout.

In this paper, you’ll find the following:

  • Compilation of recent data and studies on the symptoms and causes or physician burnout.
  • Researching connecting physician burnout to employee retention
  • Examination of how EHR use contributes to the burnout crisis
  • A look ahead to emerging solutions to this crisis

There are many compelling examples for why this research is more timely and important than ever. In a time where many physicians are questioning whether the burnout, stress, and anxiety are worth it, health care systems are reporting massive costs for recruiting and replacing doctors who leave due to burnout and overwork. The stakes could not be higher for health systems, doctors, and patients who need access to expert care.

The paper also takes a closer look at the innovative world of artificial intelligence and how it holds much promise for improving health care and EHR entry through automation and understanding. At a time where physicians are looking for more ways to control their workflow and create better, more efficient care for patients, the world of artificial intelligence is leading the way toward better solutions and better care.

I was recently reading a helpful LinkedIn article on the topic of physician burnout, and the author noted how many practices and health care systems focus on treating the symptoms of physician burnout instead of treating the actual cause of this burnout. More meetings, more committees, more work for doctors, while the underlying causes go untreated. EHRs are a primary cause of this burnout, and we believe that finding a better way to handle our EHR work is major way we can improve workflows and reduce physician burnout. Hopefully this white paper can lead the conversation in that direction.

To receive your complimentary copy of this white paper, “Physician Burnout By The Numbers,” click here. You’ll receive instant access to the paper as a resource for you and your team.

About Wayne Crandall
Wayne Crandall’s career in technology spans sales, marketing, product management, strategic development and operations. Wayne was a co-founder, executive officer, and senior vice president of sales, marketing and business development at Nuance Communications and was responsible for growing the company to over $120M following the acquisition of Dragon and SpeechWorks.

Prior to joining the NoteSwift team, Wayne was President and CEO of CYA Technologies and then took over as President of enChoice, which specialized in ECM systems and services, when they purchased CYA.

Wayne joined NoteSwift, Inc. at its inception, working with founder Dr. Chris Russell to build the team from the ground up. Wayne has continued to guide the company’s growth and evolution, resulting in the development of the industry’s first AI-powered EHR Virtual Assistant, Samantha(TM).

NoteSwift is the leading provider of EHR Virtual Assistants and a proud sponsor of Healthcare Scene.

2019 MACRA Final Rule Overview

Posted on November 5, 2018 I Written By

The following is a guest blog post by Joy Rios, Health IT Consultant at Chirpy Bird.

It happened right on time this year. The 2019 MACRA Final Rule was released on Thursday, Nov. 1, the weekend of Daylight Savings Time – so those of us who track these laws carefully got one extra hour to read through the 2878-page document. Thanks CMS!

First, I’d like to point out that we expect the rules to change each year. If fact, my colleague, Robin Roberts, and I often joke that CMS starts writing the next rule before the ink is dry on the one they just released. However, this year it feels like there’s a lot more to get up to speed on than that which we’ve grown accustomed.

The expansion of the rule’s title alone, which is both comprehensive and overwhelming, hints that this year’s ruling is far-reaching and will impact a great many stakeholders across healthcare.

Look for yourself: The difference between the proposed and finalized titles:

Proposed Title:

Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program

Finalized Title:

Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program–Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions from the Medicare Shared Savings Program–Accountable Care Organizations–Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

The subtitles from the Finalized rule that I reviewed are broken out below with the main bullet points:

1. Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019

  1. Supports access to care using telecommunications technology.
  2. Medicare will pay providers for new communication technology-based services, such as brief check-ins between patients and practitioners, and pay separately for evaluation of remote pre-recorded images and/or video.
  3. CMS is also expanding the list of Medicare-covered telehealth services.
  4. CMS is delaying implementation of E&M coding reforms until 2021.

“Physicians will see some immediate changes in 2019 that reduce burden and even more significant burden reduction in 2021, when broader changes to the E&M framework take effect,” said Seema Verma.

2. Quality Payment Program

a. MIPS: 2019 Performance Year

General Program Changes

  1. Amount at risk to Medicare Part B services:
    1. Max 7% penalty
    2. 7x incentive, which could result in an adjustment above or below 7%
  2. Avoid a penalty: 30 points (double the 2018 threshold of 15)
  3. Earn Exceptional Performance to capture part of the $500M bonus pool: 75 points (up from 70 in 2017 & 2018)
  4. Expansion of Eligible Clinician types:
    1. PT, OT, Speech & Language, Audiologists, Clinical Psychologists, Registered Dieticians/Nutrition Professionals
  5. Low-volume threshold now includes a third criterion. To be excluded from MIPS, clinicians or groups need to meet one or more of the three criterion.
  6. New Opt-in policy for clinicians or groups who meet or exceed at least one, but not all three of the low-volume threshold criteria.
  7. Virtual Groups must designate a representative and email election to MIPS_VirtualGroups@cms.hhs.gov by Dec. 31, 2018 for the 2019 performance year.
  8. Finalizing a policy to assign a weight of 0% to each of the four performance categories and a final score equal to the performance threshold when:
    1. A MIPS eligible clinician joins an existing practice (existing TIN) in the final three months of the performance period year and the practice is not participating in MIPS as a group
    2. A MIPS eligible clinician joins a practice that is a newly formed TIN in the final three months of the performance period year
  9. Small practice bonus 5 to 6, but applied at the Quality Category level, rather than being applied to overall CPS.

Category Changes

Quality

  1. Category weight: 45%
  2. Different quality measures may now be submitted via different collection types. For example, a group or clinician may submit some measures through an EHR and some through a QCDR, and the measures will be scored together as part of one set.
  3. Claims can be reported by individuals or groups (again), but only by clinicians in a small practice (15 or fewer ECs)
  4. Groups who report 5 or fewer quality measures and do not meet the CAHPS for MIPS sampling requirements, will have their quality denominator reduced by 10 and the missing measure will receive zero points
  5. NEW: Extremely Topped-Out Measures: A measure attains this status when the average mean performance is within the 98th to 100th percentile range. Such measures will be proposed for removal in the next rule-making lifecycle for other topped-out measures.
    1. QCDR measures are excluded from the topped-out measure life cycle.

Promoting Interoperability

  1. Category weight: 25%
  2. Requires 2015 Edition CEHRT
  3. Two new measures: Opioid Treatment Agreement & Query of PDMP
  4. PI Score based on a single, smaller set of measures, no longer divided into Base, Performance, and Bonus

Cost

  1. Category weight: 15%
  2. Adding 8 new episode-based measures
    1. Case minimum 10 for procedural episodes
      1. CMS will attribute episodes to each MIPS EC who renders a trigger service
    2. Case minimum 20 for acute inpatient medical condition episodes
      1. CMS will attribute episodes to each MIPS EC who bill inpatient E&M claim lines during a trigger inpatient hospitalization under a TIN that renders at least 30% of the inpatient E&M claim lines in that hospitalization

Improvement Activities

  1. Category weight: 15%
  2. Added 6 new activities, modified 5 existing activities, removed 1 activity

b. APM Performance Year 2019

  1. Several references to 2025 and beyond
  2. CEHRT requirements of Advanced APMs: 75% of Eligible Clinicians in each APM Entity
  3. Other Payer Advanced APMs: 75% beginning in 2020
  4. Expanding the 8% revenue-based nominal amount standard for AAPMs and Other Payer AAPMs through 2024
  5. Quality – must report at least one outcome measure
  6. All-Payer Combo Option and Other Payer AAPMS
    1. Established a multi-year streamlined determination process where payers and Eligible Clinicians can provide info on the length of the agreement as part of their initial submission, and have any resulting determination be effective for the duration of the agreement (or up to 5 years)
    2. Allowing QP determinations at the TIN level, in addition to the APM Entity and individual EC levels
    3. Allowing all payer types to be included in the 2019 Payer Initiated Other Payer AAPM determination process for the 2020 QP performance period
  7. Multi-Year Other Payer AAPMs
    1. Payers and eligible clinicians with payment arrangements determined to be Other Payer Advanced APM must re-submit all information for CMS review and redetermination on an annual basis.
      1. At the time of the initial submission, the payer and/or eligible clinician will provide information on the length of the agreement, and attest at the outset that they will submit information about any material changes to the payment arrangement during its duration.
      2. In subsequent years, if there were no changes to the payment arrangement, the payer and/or eligible clinician do not have to annually attest that there were no changes to the payment arrangement
    2. Updated the MIPS APM measure sets that apply for purposes of the APM scoring standard

c. Public Reporting via Physician Compare

  1. Quality – all measure under MIPS Quality are available for public reporting, unless the measure itself is new (i.e. in its first or second year.)
  2. Cost – subset of Cost measures is available for public reporting, except new measures
  3. PI – Include an indicator for Eligible Clinician or group “successful” performance
  4. PI – include objectives, activities, and/or measures

3. Quality Payment Program–Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year;

CMS has had to respond to some hard-to-face realities* since the proposed rule was released in July. Of note, the first policy addition to the rulemaking provides relief for ACOs, in addition to other MIPS eligible clinicians affected by fires, hurricanes, natural or man-made disasters that have a significant negative impact on healthcare operations, area infrastructure or communication systems. They will have the option to self-attest and receive a hardship exception.

*Climate Change is real.

4. Provisions from the Medicare Shared Savings Program–Accountable Care Organizations–Pathways to Success;

This policy provides a new direction for the Shared Savings Program by establishing pathways to success through redesigning the participation options available under the program to encourage ACOs to transition to two-sided models, in which they may share in savings and are also accountable for repaying any shared losses.

It also offers to:

  1. Further promote interoperability
  2. Grant voluntary 6-month extension for existing ACOs whose participation agreements expire on Dec. 31, 2018.
  3. Align CEHRT with QPP

5. Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder under the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act

This policy outlines plans to reimburse physicians for virtually checking in with patients and remotely evaluating recorded images.

As it turns out, people treated remotely for psoriasis did just as well as those treated in person — and were much happier about not having to travel to see their doctors.

The final Medicare physician payment rule also expands payment for treatments for stroke, kidney disease, mental health and substance abuse by removing restrictions on originating sites. Those are all provisions from the budget and opioid packages.

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You could take any of these sections and write opinion pieces, draw dotted lines to affected stakeholders, and venture down about 1000 rabbit holes with this rule.

CMS Administrator Seema Verma acknowledges that transitioning to value-based care will require all of us to stretch and maybe sit with a bit of discomfort.

In her words, “If we’re going to move our system to a patient-centered, value-based system, change is inevitable, and change is always hard for those whose livelihood is dependent on the status quo.”

If you’re looking for some direction with MIPS, ACOs, or your place in the value-based care ecosystem, get in touch.

If you want to hear Robin and I geek out over this rule, be on the lookout for a special episode of the HIT Like a Girl podcast, to which you can subscribe here.

Release of Information (ROI): What You Don’t Know Will Cost You

Posted on October 17, 2018 I Written By

The following is a guest blog post by Tarun Kabaria, Executive VP, Provider Operations Ciox.

In today’s evolving healthcare environment, the release of information (ROI) process is not a simple function. It involves up to 45 specific steps, each presenting its own complexities and compliance risks. Adding to those complications, HIPAA privacy and security rules under the American Recovery and Reinvestment Act’s (ARRA) HITECH provisions have elevated the importance of ROI and increased its costs.

Furthermore, the healthcare industry is influenced by a variety of factors that are pushing the limits of operating budgets, including rising volumes of requests from government auditors, the drive to meet Promoting Interoperability criteria for electronic health records (EHR) and rapid-fire advances in medical record technology. The “human” checks and balances that protected health information in the past are slowly disappearing as information moves rapidly from paper-based to fully electronic and online. The stakes continue to rise while the financial penalties for wrongful information disclosures grow.

As a result, many more healthcare facilities – large and small, urban and rural – are seeking cost-effective and efficient ways to manage this process. They are revisiting ROI options, evaluating costs and searching for new, more effective solutions.

As the growing demand for ROI continues to impact our evolving healthcare industry, hospitals are experiencing many repercussions. They are legally required to release medical records and often receive hundreds to thousands of requests a day. At the same time, hospitals must ensure that patient privacy, security and confidentiality are protected. It is a delicate balance that requires the proper management of each request along with the knowledge and expertise of a highly skilled ROI specialist.

According to the Association of Health Information Outsourcing Services (AHIOS), nearly 80% of hospitals nationwide have outsourced their ROI function to alleviate the administrative burden of fulfilling medical requests. Of the hospitals that outsourced, an estimated 40% have done so with at least one vendor-supplied ROI consultant. Significant costs can be incurred when retaining legal counsel and a fully staffed HIM department in addition to paying for the technology necessary to manage high volumes of requests, meet time constraints and comply with privacy demands. However, failure to do so can result in lost revenue due to fines for wrongful disclosures and technical denials from payers and recovery contractors.

Although EHRs have made ROI processing faster, there is also a greater risk for information breach. Many of the human checks and balances inherent within the ROI process have been removed. Furthermore, records are now available to many more people, and much more easily. The advantages of ubiquitous access need to be weighed against the risk for security breaches.

For these reasons, many organizations are choosing to partner with an ROI services company that offers extensive industry experience and understanding of the new laws and rules as well as the new risks. Additionally, by outsourcing ROI to a proven, secure service provider, healthcare executives relieve themselves of rising costs and administrative burdens while also reducing their risk of penalties and fines.

For those who have chosen either a full or shared outsourcing approach, the benefits are clear, with convincing evidence of significant cost savings as well as return on investment. There are three approaches to consider when looking to outsource ROI:

On-site Service

The selected ROI vendor sends a customer service representative to the healthcare organization’s office to perform all aspects of medical record release, including capturing, processing, and conducting QA of the record before sending to its distribution center.

Partner Service

The healthcare organization’s staff uses the vendor’s technology to capture, process and QA the medical record. Then, the record is sent to the vendor’s distribution center.

Remote Service

The vendor’s customer service representatives access the healthcare organization’s EHR through secure technology to capture, process and QA the medical record from the vendor’s centralized facility. Then, records are sent to the vendor’s distribution center.

These three options provide the flexibility to select the approach that aligns best with an organization’s capacity, staffing resources and expertise. An ROI service partner can manage everything from reducing immediate backlog, handling specific tasks for the ROI process or coordinating the entire process.

Achieving efficient and effective ROI services is possible. It simply requires careful consideration and evaluation of costs and resources available to comply with new regulations to determine which path is the best one for your organization.

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

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.

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

How to Text PHI with Patients and Stay Compliant

Posted on September 19, 2018 I Written By

The following is a guest blog post by Jim Higgins, Founder & CEO at Solutionreach. You can follow him on twitter: @higgs77

Did you know that 73 percent of Americans say it is difficult to reach them by phone? In fact, Americans ignore 337 calls each year and that number is rising. Even if you leave a message, chances are high no one will ever hear it—80 percent of people report that they don’t even bother leaving a voicemail anymore because they don’t believe it will get listened to. More and more, phone calls are seen as invasive, outdated, or ineffective. Instead, people prefer to communicate via modern methods such as text message.

Texting Reigns as Favorite Communication Tool

We all know that pretty much everyone with a cell phone texts friends and family regularly. What is less well-known is that people would like to extend their texting habits to their healthcare provider. According to the 2017 Patient-Provider Relationship Study, 60 percent of patients want text reminders. Seven out of ten patients say they would like text communication beyond just reminders as well. It’s not just millennials. Around half of baby boomers also prefer text messages.

Unfortunately, many practices have shied away from texting or emailing patients through unsecured channels, wary of running into compliance issues. This is especially true when it comes to texting patients when those messages may include protected health information (PHI).

In fact, I suspect that if you were to poll a group of healthcare workers concerning the legality of sending PHI through unsecured text message, you would probably get answers all along the spectrum. Yes, no, maybe so? Many just don’t know.

Last March, at the HIMSS health IT conference Roger Severino, Director of the US Department of Health and Human Services Office for Civil Rights (OCR), the HIPAA enforcement agency, clarified the confusion.  According to Severino, providers may share PHI with patients through unsecure text messages as long as they have informed their patient that texting is not secure, asked for permission, and documented that consent.

“I think it’s empowering the patient, making sure that their data is as accessible as possible in the way they want to receive it, and that’s what we want to do.” Severino said.

Implementing Texting in a Compliant Way

This announcement was a big deal. Patients want to text you…and they want you to text them back. You significantly increase the value you offer to patients simply by giving them this option. So how does the implementation of Severino’s suggestions look in practice? Let’s say that you receive a text message from a patient named Mary asking you for some health-related information. In response, you can send something like this: “Hi Mary. I would love to chat with you more about your health. Text message is not a secure way to do that. Would you still like to continue this conversation?” If you are the one to initiate the conversation, you can send a similar message requesting permission before continuing.

Once Mary agrees and you document that permission, you are then allowed to continue the conversation without concern of violation. A key piece to remember here is that it is important that you make sure your patients are aware that texting is not secure. Then, if the patient feels uncomfortable communicating via that channel, you should move the conversation to a secure method such as a phone call, secure patient portal, or in-office visit. Remember—you are required to make patients aware of unsecured communication and receive authorization before discussing PHI on an unsecured channel.

As one final best practice, always include an opt-out message. Even if a patient has given consent in the past, you must always offer the option to discontinue the communication. This means that it is best to include a message such as “Reply STOP to opt-out” in your text messages.

In summary, if a healthcare provider would like to share PHI with a patient through regular, unsecured text messages, they must first:

  • Inform the patient that texting is not secure
  • Receive permission from the patient to continue
  • Document the patients’ consent
  • Offer an opt-out option

If you are not yet texting with patients (or only sending basic text reminders), this is a critical time to make a change. There is no other form of communication that has such a high level of adoption and engagement. Texting improves the health outcomes for patients as well as the financial outcomes for practices. With this recent clarification of policy by compliance officials, we can expect that the use of text will continue to grow dramatically as we move into the future.

Solutionreach is a proud sponsor of Healthcare Scene. As the leading provider of patient relationship management solutions, Solutionreach is dedicated to helping practices improve the patient experience while saving time for providers and staff.