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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

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

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.

Real-world Health AI Applications in 2018 and Further

Posted on August 29, 2018 I Written By

The following is a guest blog post by Inga Shugalo, Healthcare Industry Analyst at Itransition.

In contrast to legacy systems that are just algorithms performing strict tasks, artificial intelligence can extend the task itself, creating new insights from the information fed to it. Current healthcare AI is powerful enough to undertake such complex challenges as automated diagnosis, medical image analysis, virtual patient assistance, and risk analysis, supporting health specialists in making more swift and informed decisions.

In 2016, Frost & Sullivan predicted the healthcare AI market to reach $6.6 billion by 2021. Meanwhile, 2017’s Accenture report estimates AI saving $150 billion annually for the U.S. healthcare economy by 2026. “At hyper-speed, AI is re-wiring our modern conception of healthcare delivery,” researchers from Accenture say.

Standing in the middle of 2018, the industry already hints on its course regarding further AI expansion. Spoiler alert: as well as with blockchain AR, VR, and any other kind of innovative custom medical software, the adoption challenges persist.

Current and prospective AI directions in healthcare

Diagnosis support

One of the most fascinating and valuable directions for AI to evolve is its ability to help providers diagnose patients more accurately and at a higher pace. We are thrilled to see how 2018 erupts with many healthcare organizations adopting artificial intelligence and creating unprecedented cases of assisted diagnostics with it.

Geisinger specialists applied AI to analyze CT scans of patients’ heads and detect intracranial hemorrhage early. Intracranial hemorrhage is a life-threatening form of internal bleeding, affecting about 50,000 patients per year, with 47% dying within 30 days.

Geisinger was able to automatically pinpoint and prioritize the cases of intracranial hemorrhage, focusing the attention of radiologists on them and thus allowing for timely interventions. This approach reduced the time to diagnosis by 96%.

Mayo Clinic currently uses IBM Watson’s superpowers to match patients with fitting clinical trials. The clinic’s officials stated that only 5% of patients enrolled in trials in the U.S., which significantly hinders clinical research and innovation in cancer therapies. On the other side, manual patient-trial matching is a time-exhausting process.

Watson runs this process on the background, comparing the patients’ conditions with available trials and suggesting the appropriate trials for providers and patients to consider including in a treatment plan. Since its implementation in 2016, Watson was able to deliver about an 80% increase in enrollment to Mayo’s trials for breast cancer.

Patient risk analysis

“…Healthcare is one of the most important fields AI is going to transform,” Google CEO Sundar Pichai noted during the Google I/O 2018 keynote. Last year, the event presented Google AI, a “collection of our teams and efforts to bring the benefits of AI to everyone.”

In 2018, Google uses their AI to tap into critical patient risks, such as mortality, readmission, and prolonged LOS. Cooperating with UC San Francisco, The University of Chicago Medicine, and Stanford Medicine, they analyzed over 46 billion anonymized retrospective EHR data points collected from over 216 thousand adult patients hospitalized for at least 24 hours at two US academic medical centers.

The deep learning model built by researchers reviewed each patient’s chart as a timeline, from its creation to the point of hospitalization. This data allowed clinicians to make various predictions on patient health outcomes, including prolonged length of stay, 30-day unplanned readmission, upcoming in-hospital mortality, and even a patient’s final discharge diagnosis. Remarkably, the model achieved an accuracy level that significantly outperformed traditional predictive models.

According to Pichai, “If you go and analyze over 100,000 data points per patient, more than any single doctor could analyze, we can actually quantitatively predict the chance of readmission 24 to 48 hours earlier than traditional methods. It gives doctors time to act.”

Of course, researchers don’t claim that their approach is ready for implementation in clinical settings, but they are looking forward to collaborating with providers to test this model further. Hopefully, we will see field trials and, who knows, even early adoption in 2019.

EHRs “on steroids”

HIMSS18 was all about artificial intelligence and machine learning. Surprisingly, all major EHR vendors – Allscripts, Cerner, athenahealth, Epic, and eClinicalWorks – came up with a promise to include AI into upcoming iterations of their platforms.

At the event, Epic announced a new partnership with Nuance to integrate their AI-powered conversational virtual assistant into the Epic EHR workflow. Particularly, the assistant will enable health specialists to access patient information and lab results, record patient vitals as well as check schedules and manage patient appointments using voice.

Similarly, eClinicalWorks puts AI into work on voice control but also prioritizes telemedicine, pop health, and clinical decision support. According to the company’s CEO Girish Navani, “We spent the last decade putting data in EHRs. The next decade is about intelligence and creating inferences that improve care outcomes. We can have the computer do things for the clinician to make them aware of actions they can take.” The new EHR’s launch is expected in late 2018 or early 2019.

Athenahealth also added a virtual assistant into their EHRs to improve mobile connectivity and welcomes NoteSwift’s AI-based Samantha technology to enhance clinical workflows by introducing robust automation. Samantha can grasp free-text and natural language, process information, structure it, assign ICD-10, SNOMED or CPT codes, prepare e-prescriptions and orders.

Pre-existing challenges for healthcare AI adoption

Gartner predicted that 50% of organizations will miss AI and data literacy skills to gain business value by 2020. Certainly, a lot of healthcare organizations will get in this 50%, and there are two reasons for that.

Regulations and security concerns are the main pre-existing challenges that delay practically any technology adoption in healthcare and entail an array of new challenges along with them.

First, an AI application or device has to be approved by the FDA. The catch is that the existing process focuses on the hardware or the way that algorithms work, but not the data it should or would interact with.

Speaking of data, another challenge is security breaches. Safeguarding sensitive information is a must for healthcare because patient data is a constant target for identity theft and reimbursement fraud. In Accenture’s new report, nearly 25% of healthcare execs admitted experiencing “adversarial AI behaviors, like falsified location data or bot fraud.” While this doesn’t mean AI threatens patient data, such claims do increase the concerns related to its adoption.

Still, artificial intelligence is growing in healthcare and will continue to do so. Maybe not at rocket speed, but the most recent cases show consistent improvements in major care delivery gaps. Healthcare AI’s future appears bright.

About Inga Shugalo
Inga Shugalo is a Healthcare Industry Analyst at Itransition. She focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Inga’s articles explore diagnostic potential of healthcare IoT, opportunities of precision medicine, robotics and VR in healthcare and more.

Three Ways You Might Be Unintentionally Violating HIPAA

Posted on August 6, 2018 I Written By

The following is a guest blog post by Tim Mullahy is the Executive Vice President and Managing Director at Liberty Center One.

For the most part, HIPAA is pretty straightforward – if a little extensive. It lays out some fairly clear-cut rules for protecting patient data, and an incredibly specific framework on what constitutes said data. But as with any set of regulatory guidelines, there are some gray areas.

And there are also some lesser-known aspects that a lot of organizations – both healthcare agencies and covered entities – tend to miss. The problem, obviously, is that ignorance in this case is no excuse. A HIPAA violation is a HIPAA violation, no matter how well-meaning the person responsible.

With that in mind, today we’re going to discuss a few of the most common ways both you and your staff might inadvertently run afoul if HIPAA (and more importantly, how to avoid doing so).

Through Employee Posts on Social Media

It’s a pretty common story these days. An employee says something they shouldn’t on social media. Their employer finds out, and next thing you know, they’re being let go.

That’s exactly what happened to Olivia O’Leary in 2017. An X-Ray technician at the Onslow Memorial Hospital in Jacksonville, North Carolina, O’Leary commented on a Facebook post that the victim of a car accident should have been wearing a seatbelt. Here’s the problem – the victim of the accident was brought to the hospital.

There’s some contention over whether or not O’Leary actually violated HIPAA (the news that the victim was not wearing a seatbelt had been made public by the time she commented). Even so, this story should still serve as a warning. It’s your responsibility to make your staff aware that even a seemingly harmless comment could be construed as a HIPAA violation.

By Not Keeping Proper Track of Employee Devices

Personally-owned smartphones and home computers are a huge no-no for HIPAA. Yet all too frequently, clinicians and other healthcare staff bring personal devices into the workplace, or else use them to work on patient data from the comfort of their own home. The problem isn’t that they’re using these devices, per-se.

It’s that they’re doing so without any sort of oversight.

Let’s say, for example, a physician looks at some patient data in her home office. She forgets to turn off her PC, and her husband wanders in to do a quick Google search. He sees the patient data – and suddenly a HIPAA violation falls right into their laps.

Or let’s say two doctors are communicating with one another via SMS, discussing a patient’s records. Instead of being careful about what they’re saying, they openly disseminate PHI between one another.

Again, no one here is necessarily acting maliciously. Even so, they’re still putting patient data at risk. Here’s what you need to do:

  • Incorporate some form of document management system that ensures PHI can only be accessed by authorized personnel – no matter if they’re at home or elsewhere. It should also include a timed expiration function so that if a file is left open for a certain amount of time without any activity, it becomes inaccessible.
  • Utilize endpoint management software that allows you to manage, monitor, and control the devices within your workplace.
  • Train and educate your staff on the importance of keeping PHI to approved, secure channels – and if need be, implement a secure messaging solution so they can still keep in touch.

Via Friends and Family

It seems harmless enough. Someone goes to a hospital for an MRI to check if they have a severe spinal cord injury. A few days later, someone else – a friend or family member – asks about the results.

And the physician tells them. No harm done, right? They’re just concerned about someone they care for.

Here’s the thing – that’s still a HIPAA violation, harmless though it may seem. Sure, it was an innocent inquiry. But unless the patient specifically consented for their information to be shared, it doesn’t matter who asks.

You’re still violating their privacy if you share it.

Caution is Key

There are a lot of little stumbling points in HIPAA that tend to catch many healthcare providers unaware. Things that may seem innocent or harmless can actually land you in a world of trouble with regulatory agencies, costing valuable staff their jobs and even bringing about a lawsuit. The best way to avoid such issues is to just be cautious – to treat PHI with the utmost care.

Do that, and you should be just fine.

About Tim Mullahy
Tim Mullahy is the Executive Vice President and Managing Director at Liberty Center One, a new breed of data center located in Royal Oak, MI. Tim has a demonstrated history of working in the information technology and services industry.

Creating a “Clinancial” Model: Bridging the Gap Between Clinical and Financial

Posted on July 25, 2018 I Written By

The following is a guest blog post by David Dyke, VP Product Management at Ciox.

Healthcare at a broad level divides its business into two types of work: The clinical, and the financial. The groups that serve each effort are traditionally siloed. Doctors and nurses, for instance, focus on the clinical health of their patients.  Clinical pathways define the day: What is the plan of care? How do we improve the quality of care? How do we deliver the right course of treatment for this patient in the time we have, based on all of their individual variables?  And how do we apply that broadly to entire conditions and communities?

Separate from clinical practices are the equal and opposite financial forces within the business of healthcare. Healthcare CFOs, for example, are chartered with caring for the financial health of their organization.  Financial pathways rule the day: Ensuring administrative processes, patient experience and strategic plans align to the best operational outcomes.  How can we survive until tomorrow if reimbursement, risk, denials, cash, collections, debt and financing issues are not addressed today?

Yet, for all the division of labor and effort in the healthcare space, the reality is that the two sides of the business exist as the heads and tails of the same coin. When a patient walks into a healthcare provider’s office, clinical and financial pathways alike are opened up, and their relationship is far less siloed and far more symbiotic than the current model of care reflects. What if we approached these two traditionally separate parts of the healthcare system as two halves of the same? How do we break down the paradigm that these are two separate pathways? How do we connect the clinical and the financial?

Perhaps what we need is a new word; one that better reflects the concurrent pathways in healthcare. Maybe we are not laboring along two separate clinical and financial pathways, but a single “Clinancial” pathway.

cli·nan·cial (adjective)

Relating to both clinical and financial pathways in healthcare.

As the cost model in healthcare has shifted, the patient’s interest level in the financial side of the healthcare continuum has shifted dramatically. Health plans are increasingly prescriptive in their services.  Whether specifically defining limitations on choices, options, and access to specific providers, or implicitly influencing behavior through out-of-pocket cost motivators, the financial aspects of healthcare are increasingly top-of-mind.

Even for patients, the Clinancial pathway to care is here already. It’s not just simple decisions that intersect financial and clinical pathways. These meet again at the intersection of in-network, copays and out of pocket expenses, year to date costs, and whether a patient has a flex plan. All of these financial decisions have bearing on the patient’s end clinical pathway and could be better understood earlier in the process by those whose traditional focus is strictly clinical.

What clinical choices would be different if the outlook included financial realities and variables. What choices would be made in a Clinancial model? Similarly, what financial choices could be made with better clinical information?

From the way we code clinical services to the way we seek to manage reimbursement activities and claims, from denials to audits and at every point where Clinancial lines cross, we in healthcare have an opportunity to improve both our patient experiences and our bottom lines by better rolling together our clinical and financial information for all involved.

If case managers aren’t approaching patient care from the perspective of preventing denials, then they are missing a huge opportunity to improve not only the patient experience and clinical outcomes but also the organization’s ability to do the same thing systematically again tomorrow, and the day after that.

The landscape is continuously changing. Health Insurance Plan Designs vary widely today, and will have more variabity tomorrow. Medical guidelines are always evolving too. The barriers to adopting Clinical Guidelines are well documented, it’s most often a factor of information or population overload.  For example, in 2017 the guidelines for High Blood Pressure changed, effectively “giving” High Blood Pressure to 30 million more Americans.  It’s a business model where we need to know how to be continuously adaptive, how we are engaging with all parties involved, from the healthcare recipient to the insurers, and building a trust network around risk. Yet we traditionally do not evolve, or change, or update ourselves particularly efficiently.

Some organizations are doing this better than others – integrating even just their reporting structure. They ask themselves questions like “Are medical records part of the clinical or the financial operations of a hospital?”

Groups that see the shift have moved within their organizations to form teams with names like ‘Revenue Integrity’, and because of those new delineations they are more closely aligning the “how” and “why” of the clinical process with the “what” and “when” of the financial workflows. And as they have shifted into Revenue Integrity teams, they are looking at things more holistically to uncover key findings. Much like an integrated care team takes a holistic look at a patient, their direct conditions and their social situations. These integrated Clinancial teams can find connections between coding workflows and reimbursement speed, and can design and implement Clinancial Workflows to measure and improve their outcomes.

No matter the structure, integrated Clinancial Teams are doing three things well: They communicate regularly across the siloes, they collaborate across teams on opportunities that affect both the clinical and financial aspects of the business, and they share data, findings and ideas.

The victories are twofold: Organizations have a chance within a Clinancial model to improve patient satisfaction and outcomes, while at the same time better flowing clinical data through into reimbursement. We have entered a new financial reality where the patient’s experience has an increasingly material impact on a provider’s bottom line. By unifying around Clinancial Pathways, we can make strides to improve patient outcomes and experiences, while at the same time gaining operational efficiencies to drive margin improvement now, when we need it most.

And all we needed to do was invent a new word for it.  #easy

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting

The Role of Technology in Patient Satisfaction

Posted on July 11, 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

Over the past six months, we have been discussing the importance of understanding patient needs in order to improve their satisfaction levels. But why does it really matter if patients are happy? Happy patients are the ones who refer their friends and family. They’re are the ones leaving you stellar reviews online. Happy patients stick with you.

One of the most effective (and easiest) ways to improve the patient experience is through the use of technology. According to one study, using technology to communicate with patients increases patient satisfaction scores by around 10 percent. Not only that, but technology saves practices a huge amount of time and hassle. Here are just a few of the ways you can use technology to personalize patient experience and simplify workflow for staff.

  1. Streamline (and personalize) scheduling and check-in

The Patient-Provider Relationship Study found that two of the biggest frustrations patient have around experience are feeling like a number and difficulty with scheduling and wait times. One great way to address these issues is to offer convenient 24/7 online scheduling and electronic forms.

Two-thirds of patients think it is important to be able to schedule appointments online. And practices can make that experience even easier with the right technology. When online scheduling in integrated with your practice management system, it can identify existing versus new patients and adapt the forms so existing patients don’t have to provide information that you already have.

Consider having patient forms on the scheduling page or somewhere on your website, or send them out in an email before the appointment. Then, instead of spending 15 minutes filling out forms, patients can relax. This also allows you to spend more time speaking with each patient individually and addressing any concerns they may have.

If you have patients who don’t fill out their forms online or bring them before arriving, consider using a tablet to expedite the process. Tablets make filling out those forms faster, easier, and more accurate. Waiting to see the doctor shouldn’t feel like homework time. Do whatever you can to make this a time, instead, where you connect with your patients.

  1. Implement two-way texting

Texting is the most popular method of communication today (even 80 percent of senior citizens own a cell phone). Just like people want to text their friends and families, they also want to text you. As the Patient-Provider Relationship study found, 73 percent of patients want to text back and forth with you. With two-way texting, you can:

  • Confirm appointments
  • Coordinate care
  • Discuss appointment follow-up instructions
  • Reschedule appointments

Of course, you want to make sure you stay HIPAA compliant whenever you may be sending PHI information via text message. Make sure to use technology that offers the tools to stay compliant.

  1. Upgrade your patient appointment reminders

If you want to stay competitive in today’s healthcare world, automated appointment reminders are a must. Not only does automating your patient reminders make life a lot easier for your staff, but it ensures that no patients fall through the cracks. Make sure to ask patients which way they prefer to be contacted and use that.

Using mobile messages like text message and email for reminders is especially important in this era when people just don’t like talking on the phone. Now your patients can be stuck in a boring work meeting and still get that text message appointment reminder. It saves you a lot of time, improves productivity, and gives you the time you need to focus on what is most important—the patients in your office.

Automated messages also provide another opportunity to personalize and customize communications to each patient. Just like a postcard or phone call, they have the patient’s name, appointment time, and provider listed, but they can also contain other appointment details. Based on the appointment type, they can have instructions like remember to fast or bring your medications. The patient will feel the personalization and your practice will be able to make sure patients show up prepared.

  1. Automate patient satisfaction surveys

As we’ve discussed at length in prior blog posts, surveys can tell you a whole lot about how you and your practice are measuring up to patient expectations. The more you focus on patient happiness, the more likely you are to make it a priority. So always send out patient surveys following patient visits.

In the past, you may have asked patients to fill out paper surveys in the office. That method of collecting surveys is difficult to track, less likely to be completed, and may have answers that are skewed. Using technology to email or text your patients a survey after their appointment increases the likelihood that they will give more honest responses. It also makes it a whole lot more likely that they will be filled out.

When it comes to making patient satisfaction a priority, it’s critical to gauge if your current technology is up to the challenge. Technology can greatly improve how your patients view you and your entire practice. It can also improve the productivity and efficiency of you and your staff.

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.

4 Tricks to Help Busy Practices Stay Organized

Posted on June 13, 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

Over the past several months, we’ve been discussing how to use surveys to find out what your patients think of you—and then how to make the necessary changes. In addition, we’ve been looking at some of the most common complaints uncovered in patient surveys. These include:

* Excessive wait times (read more about that here)
* Inadequate communication (read more about that here)
* Disorganized operations

Today we are discussing the importance of keeping your practice moving smoothly and efficiently. No one likes going to a doctor’s visit only to find that they are running behind, have forgotten you were coming, or have lost your patient records. And yet that happens all too often.

Office managers and physicians are constantly balancing a huge number of tasks, including patient problems, staffing challenges, budget planning, payroll, and more. Unless you consciously strive to improve the organization and efficiency in your practice, you end up spending a whole lot of time putting out fires instead of preventing them from happening. This inevitably leads to more stress for you, lower productivity for staff, and poor satisfaction from patients.

With today’s consumer-focused patients, it’s imperative that you keep your office running like a well-oiled machine at all times. Otherwise, they are likely to simply move their business to the practice down the street instead. So here are a few tips to make juggling all the balls in your life a little easier.

  1. Schedule time for planning.
    One of the best ways to make sure you’re staying ahead of everything is to plan out your day in advance. Do you have a shipment of new supplies arriving? A new employee to train? Emails to be created? In this industry, every day brings something new. In order to make sure that nothing interferes with the patient experience, you’ve got to plan ahead. The best way to do this is to actually block off some time on your calendar where you decide what needs to be focused on—a simple 15-30 minutes each day is usually all you need. Many people find that the end of the day is a great time for this. That way you can be prepared for whatever the next day may bring.
  2. Batch your tasks.
    When doing your planning, give batching a try. Batching is when you select similar jobs and schedule them to be completed in one setting. Productivity experts have found that when we batch tasks, we are more focused, efficient, and, ultimately, more productive. We simply work better when we can focus on one thing at a time. Many large tasks can be batched by day. For example:

    • Mondays—Staff communication and training
    • Tuesdays—Payroll, billing, and other financial tasks
    • Wednesday– Marketing to get new patients (running ads, managing online presence, etc)
    • Thursday—Patient outreach to get returning patients (newsletters, social media, etc.)
    • Fridays—General administrative tasks and planning for the following week

    Of course, there will be times when things come up that need your attention. Be flexible in addressing those issues.

  3. Maximize efficiencies.
    Your practice should make life easier for patients. This means that you need to take a close look at everything from appointment scheduling to the check-in process to the way patients move within your facility to see if there can be improvements. Consider:

    1. Implementing an online scheduling tool, where patients can schedule their own appointments. This will help cut back on time on the phone.
    2. Using an automated wait list to fill last minute cancellations. Using a system to automatically send out an email or text message blast to everyone wanting to be seen sooner can free up time for staff and fill those exam rooms.
    3. Making your reception area easy to locate and clear of clutter so that patients can use it to sign forms. You may also try using a digital check-in process with a tablet or computer.
    4. Reviewing the flow of your practice. Patients should move from the waiting room to the exam room and back without much confusion. This is done best when they always move in a single direction—much like a highway.
  4. Take advantage of technology—but be wise.
    There are a lot of things still being done manually in an office that can be put on “auto” instead. Everything from recall to appointment reminders to birthday messaging and more can be done in a way that doesn’t require daily supervision from you. We have so many amazing technologies that can help us stay organized. Apps, calendars, to-do lists, and so on. It is important, however, to not let technology distract you. Did you know that every time you switch between tasks, you lose around 15 minutes? So every time you check email, for example, in the middle of another task, you lose precious amounts of productive time. Instead, set aside a time when you check your email (or complete other tech-related tasks) each day and stick to it. Perhaps you do it first thing in the morning, after lunch, and before leaving. That way you do not waste tons of time.

Ultimately, every practice wants to deliver exceptional patient care, and a big part of that is practice organization and efficiency. Ask yourself, “Is my office making a real effort to improve processes and make life easier for patients?” If not, implement procedures to do so. It will have a lasting, positive impact on both office staff efficiency and overall patient satisfaction.

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.

Early Lessons from the Front Lines of Value-based Care: How One APM Has Impacted Community-Based Oncology Practices

Posted on June 11, 2018 I Written By

The following is a guest blog post by Dr. Charles Saunders, CEO, Integra Connect.

The Oncology Care Model (OCM) – an alternative payment model introduced in July 2016 by the Center for Medicare and Medicaid Innovation – launched with the ambitious goal to further delivery of higher quality, more coordinated cancer care at a lower cost. Participants include 184 practices representing approximately one-third of community oncologists in the US. They receive a so-called “MEOS” (monthly enhanced oncology services) payment of $160 per beneficiary per month for the duration of a qualifying 6-month chemotherapy period, plus the opportunity to earn a share of savings if they exceed a target threshold. In return, oncologists are expected to take on increasing accountability for patient outcomes and well-being, while also generating sustainable cost savings across all co-morbidities and care settings, into the patient home.

OCM Performance Period 1 Results Exposed an Unexpected Misalignment   

As part of the OCM program, CMS tracks practices during 6-month intervals – so-called “performance periods” – then shares results back about one year later. In February 2018, practices participating in the OCM program received visibility into Performance Period 1 (PP1) data, including savings achieved, aggregate quality score, and effectiveness of identifying eligible patients. While most practices were unsurprised by their performance scores, many did not anticipate the extent to which CMS would recoup MEOS payments that it deemed paid in error. The most common scenario involved patients with co-morbidities who, while receiving chemotherapy and related services, also visited other providers regularly. Therefore, the oncology practice did not represent the required plurality of E/M codes for that beneficiary. It was not uncommon for practices to be asked to return up to 30% of the sum they had been paid – a major financial hit.

Lack of Data Hinders Practices’ Ability to Accurately and Proactively Identify Beneficiaries

In May 2018, practices received their Performance Period 2 (PP2) Attribution Lists, which summarized which CMS beneficiaries met OCM eligibility criteria, which episodes were attributed to each respective practice, and episode start dates from January 1, 2017 through June 30, 2017. Unfortunately, because there is a significant lag between actual Performance Period and delivery of CMS findings – delayed up to nearly a year after each performance period has ended – OCM participants were unable to retroactively apply PP1 learnings to PP2.

Why is this especially problematic? Practices are faced not only with MEOS recoupments for erroneous payments but, with only a 1-year window to submit claims, are often unable to bill in full for patients who were missed. Indeed, there are many opportunities to miss appropriate patients, as practices needed to have an accurate view of: 1) all beneficiaries; 2) those with a qualifying diagnosis; 3) those with a new chemo episode; 4) those not only prescribed an oral agent, but those who subsequently filled it; 5) those not in a hospice; and more. Given all the dimensions to track and measure, practices without advanced tools face delivering enhanced services that they cannot correctly bill for.

Best Practices from Community-Based Oncology Practices Include Robust Data

What best practices arose to get attribution right? A vanguard of OCM practices realized that they would need to take proactive steps to enable near real-time visibility into their patient populations, embracing the tenets of population health management. Below is an example of the best practices adopted by several of these community-based oncology practices:

  • Increased transparency into oral chemotherapies: Existing practice protocols did not open an episode when oral agents were prescribed, since there was no in-office administration. To address this, the practice introduced a rule-based algorithm to identify all OCM eligible patients, including those who had been prescribed orals. In addition, they enlisted a combination of automated and personal follow-ups to validate qualification and ensure orals had been filled.
  • Avoidance of duplication: To identify missed billing opportunities while also reducing the risk of duplicated claims, practice leadership invested in a robust analytics tool that enabled personalized queries at the patient level. These reports compared eligibility against their practice management report to identify gaps, from unpaid and unbilled to denied.
  • Targeted patient intervention: To balance the practice’s financial and clinical objectives while optimizing OCM performance, the practice introduced complex care management services and employed a series of triage pathways. This approach ensured engagement with attributed beneficiaries and decreased avoidable high-cost events among at-risk patients, such as inappropriate ER visits and inpatient stays.
  • Optimized treatment choices. As part of its commitment to ensure each patient received the most effective treatment for his or her disease, the practice provided increased transparency around the availability of equally effective generic or biosimilar drugs. They also supported better end-of-life planning for patients facing second or third-line therapies not expected to provide any clinical benefits, but that could significantly degrade remaining quality of life.
  • Continuous performance improvement: To track the effectiveness of these quality improvement initiatives, the practice leveraged its analytics tool to monitor resource utilization and care management performance, then intervened to address outliers in real-time.

In short, to optimize performance under the OCM, practices are beginning to leverage the data to which they already have access – both clinical and financial – to risk-stratify their patient populations; identify OCM eligible patients; and gain near real-time visibility into quality and cost performance. Practices are also investing in better data integration and analytics that enable rules-based identification of eligible patients.

Population Health Analytics Help Practices Be Proactive and Succeed Under the OCM

Oncology is on the forefront of value-based care adoption and these early experiences from the OCM have provided a guide for other specialties. Based on their early results, what has come to the forefront is the need for a combination of comprehensive data management and robust analytics, coupled with the principles of population health management, which enable practices to step up and take control of the cost and quality for their attributed populations.