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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 www.ciox.com

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.

Overcoming Data Silos Within The Health Care Ecosystem

Posted on May 30, 2018 I Written By

The following is a guest blog post by Dave Corbin, CEO of HULFT.

While there’s a barely an industry or sector that hasn’t been heavily influenced or redefined by the onslaught of data, in healthcare the impact is especially acute. Health care industry players are now having to negotiate a delicate balance between exploiting the opportunities that come with the deeper insights and actionable intelligence, with managing the growing technical complexities that arise.

Let’s face it – the health care sector is renowned for the depth of its silos. It’s a significant and wide-ranging challenge. It starts in the closed world of drug R&D to a generation of providers still using fax machines (remember those?) to share patient medical records. In theory, we’d all agree that improved health data exchange is a win-win for everyone involved (providers, policymakers, patients, etc.) In reality, before we can even begin to leverage the vast troves of data from electronic medical records (EMRs), we need to overcome two key issues.

The first is data security. According to the 2018 HIMSS Cybersecurity survey, the majority of respondents, 75 percent, experienced a significant security incident in the last 12 months. The threat landscape has grown in complexity and volume and it’s critical for health care organizations to invest in privacy-by-design defense mechanisms such as encryption, security analytics, and multi-factor authentication to protect valuable patient data. For seamless data sharing to become the norm, everyone in the ecosystem must be vigilant about data protection and online privacy.

The second is interoperability – the extent to which different IT systems, software applications, and devices can exchange data and interpret that shared data. Or, to be more specific, making EMRs more “portable” so they follow a patient’s journey. After all, care is happening at multiple venues – it’s happening in hospitals, rehab facilities, long term care facilities, hospices, and more.

My own knee surgery started with the orthopaedic surgeon, who referred me to external providers that would supply me with MRIs, blood tests, and EKGs. The day of surgery included not just the surgeon, but an outside surgery center and an anaesthesiologist, all requiring separate contracts. The net result was that my medical information for a relatively routine surgery was spread over five locations and many data types.

Without an enforced standard of interoperability, data exchanges can get complicated and time-consuming, which then hinders not just the flow of information but patient care. We can do better by reducing data complexity for the patient, doctor and service providers.

Speed, security, and accessibility when it comes to health data management and sharing don’t have to elude us. A holistic approach to health data security and ecosystem interoperability can be achieved in partnership with an intuitive data logistics platform that scales to evolving data complexities and cuts development time. This can help lead your organization to transcend healthcare’s many silos often without the need for a major overhaul of existing IT system. And that’s a powerful prescription.

Dave Corbin is CEO of HULFT, a comprehensive data logistics platform that provides both the secure back-end data transfer and integration technologies to help health care organizations form a foundation for an overall enterprise data strategy that makes data more accessible and useful. HULFT is a proud sponsor of Health IT Expo, a practical innovation conference organized by Healthcare Scene. Learn more here: hulftinc.com.    

The Bad and the Ugly of Prior Authorization and How Technology Will Fix It

Posted on May 16, 2018 I Written By

The following is a guest blog post by Karen Tirozzi, VP of Solutions, ZappRx.

Specialty drugs, which are usually defined by their complex instructions, special handling requirements or delivery mechanisms, are typically priced much higher than traditional drugs and cost more than the average American family’s salary. These medications are priced higher for a variety of reasons such as manufacturing costs, smaller patient populations and patient services like IV administration or at-home care required to support patients who will take these medicines.

Due to the costly nature of these treatments, payers insist on a comprehensive prior authorization (PA) process to ensure qualified patients are receiving the medications they need. The PA process involves cumbersome paperwork and fax machines and are a huge burden to physician’s and their staff. Physicians have even resorted to hiring extra, dedicated staff just to process these prescriptions as nurses, NP’s, PA’s and medical assistants tend to fall victim to the prior authorization nightmare. According to a recent study, it is estimated that $85,276 was spent on personnel costs to address billing and insurance issues associated with prior authorization, which is approximately 10 percent of practice revenue.

To put just how inefficient the PA process into perspective, a recent AMA survey of 1,000 physicians providing 20 or more hours of care a week, showed that doctors receive an average of 37 PA requests a week, which took an average of 16.4 hours to process. Extrapolate 16.4 hours a week over a year and clinicians are spending around 41% of their time annually doing paperwork, making calls and or sending faxes just to navigate PA and get medications to their patients. It includes enrollment forms and signatures from the patient, which can be done while the patient is in the office, however, it’s often done through mail, which slows down the process even more. Providers also have trouble ensuring they have the right forms for the insurer’s preferred specialty pharmacy, as sending to the wrong pharmacy also causes delays. Providers are tangled in faxes and phone calls for weeks on end so that all parties have all the information they need to approve just one prescription. In 2018, how is it that the medical community still heavily relies on fax machines to process information and deliver life-saving drugs to patients.

A Brighter Future

Digitizing the entire prior authorization process will significantly reduce the administrative burden on clinicians and get patients their medications in a much more streamlined manner. Healthcare providers should be able to, in one place, order a specialty prescription, see the paperwork and signatures needed and follow its progress until it reaches the patient’s hands. The healthcare industry needs to start utilizing the technology available today to streamline workflows and decrease operational expenses, which in turn, can help save patients’ lives.

By embracing technology, clinicians can also leverage the rich data sets generated to better understand their patients’ needs, trends within the space they’re treating and ultimately, improve patient care. Data can also be used by pharmacies to understand how their medications are trending within the market and catch any snags that may cause delays. The potential for pharma companies to use this level of information to provide insights and improve products in real-time is invaluable.

Let’s take the next step

Inherently risk adverse and with siloed stakeholders, healthcare must begin taking steps toward change. With what the space has at its disposal from a next-generation technology standpoint, there is no excuse to remain chained to the fax machine.

The good news? Providers, pharmacists and biopharma have options to improve this cumbersome process today. Forward thinking innovators are beginning to break down silos and uncover new methods with technology to streamline the prior authorization process and get patients their specialty medications in days, not weeks.

About Karen Tirozzi
ZappRx Vice President, Solutions, Karen Tirozzi, leads a fast growing team that is focused on transforming the specialty pharmaceutical prescribing process. With a focus on client success, Karen and her team are innovating technologies to automate traditionally manual and cumbersome processes in an effort to save clinicians time and resources, and deliver lifesaving drugs to patients in a timely manner.  Having spent more than 15 years in the industry, Karen’s unique background in HIT and clinical social work serve as the basis for her ability to deliver successful programs in highly disruptive healthcare services and IT companies.

How to Improve Communication So You Can Improve Satisfaction

Posted on May 9, 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

In attempts to boost revenue, practices often find themselves mired in the complex tasks of generating marketing, improving scheduling, reducing inefficiencies, and more. And while these practice management pieces are important, sometimes we make things more complicated than they really need to be. When it comes down to it, the foundation of a financially-healthy practice is simple—keeping your patients happy.

Happy patients are the patients that show up—and come back. They’re the patients that refer you to their friends. They are the ones who leave those all-important online reviews. They truly are the bread and butter of your practice’s bottom line. Research backs this up—multiple studies have found a direct correlation between revenue and patient satisfaction. In fact, one study found that those healthcare practices delivering a “superior” customer experience achieve 50 percent higher net margins than those providing just an “average” customer experience.

Use Surveys to Uncover Problems

Obviously, creating a happy patient base is key to a successful practice. But how do you know if your patients are happy? Well, you ask them—in person, in focus groups, and online. The most effective way to gather this data, however, is through surveys. Surveys are an easy and efficient way to find out where you may be falling short.

And since a study in the Journal of Medical Practice Management found that 96 percent of all patient complaints are related to customer service rather than care or expertise, every person in your practice can be involved in making improvements.

Some of the most common complaints of patients include:

  • Excessive waiting times
  • Inadequate communication
  • Disorganized operations

Last month, I discussed the importance of reducing excessive wait times. You can read that article here. In this post, we will be exploring how to avoid those communication problems that lead to low patient satisfaction.

There are two main areas where communication tends to break down within a practice—between staff members and between the practice and the patient. How can you improve?

Communication within the Office

From the front desk to nurses to doctors and even to the billing department, it is critical that everyone within the practice works as a team to support your patients. Failure to do so leads to errors, confusion, and unhappy patients. Unfortunately, experts estimate that problems take place in 30 percent of all intra-team healthcare communication. There are some ways you can combat poor intra-office communication.

  1. Daily team huddles. A daily huddle meeting is not a full staff meeting. It is a quick (10-15 minute maximum) meeting where each member of your team gives a status report. It’s a great way to align your team and know what to expect that day. Do you know an incoming patient is celebrating a birthday? Just graduated? Do you have holes in your schedule? All of these types of issues can be addressed during a quick huddle.
  2. Escalation processes. While critical care specialties have an acute need for escalation processes, every practice can improve their communication by implementing a designated process for difficult or complex situations. Decide which situations in your individual practice may warrant extra care. Lay out a plan for handling and monitoring these situations. Include the way you refer patients to other offices and communication between practices as part of this process.
  3. Use of a standardized communication tool. While your daily huddle is a great way to get everyone together each day, it is also important to have ways to communicate in real time as new issues arise. Healthcare is definitely a dynamic environment—constantly changing throughout the day. The best way to make sure everyone stays on the same page during the busy day is through the use of an instant messaging app to make communication accessible at all times.

Communication Between Provider and Patient

The vast majority of providers work hard to communicate with patients. But the sad truth remains—patients struggle to remember your instructions. One study showed that patients only recalled 40 percent of the information they were given. Even worse, around half of what they did remember was actually remembered wrong. This means that the way information is conveyed to patients is just as important as the actual information communicated. There are a few tips to improving your communication with patients.

  1. Use open-ended questions. When speaking with a patient, make sure to ask questions that leave room for patients to expound on their thoughts. Yes or no questions often leave many things undiscussed.
  2. Read non-verbal cues. Much of the communication that takes place between a patient and their provider occurs through nonverbal communication. So pay close attention to the patient’s face and their body language. After explaining something to your patient, do they look confused? Are they worried? If so, there is a good chance they will not follow your instructions. Follow up based on the body language of each patient.
  3. Use the teach-back method. One of the best ways to ensure your patients have a good grasp of the things you’ve taught them is to ask them to teach you. This may take an extra few minutes, but can have a lasting impact on patient outcomes (and satisfaction!).
  4. Continue communication between visits. Communication does not end when a patient leaves the office. Continue sending educational tips and encouragement through regular newsletters, social media, and email.

Communication is one of (if not THE) most important component of the patient-provider relationship. It is also the cornerstone of the financial success of every practice. Effective communication helps practices and patients better understand each other and develop a closer bond. It makes for not just healthy—but happy—patients.

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.

Addressing Common Patient Frustrations: Wait Times

Posted on April 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

Experts agree that it is critically important that practices keep their finger on the pulse of patient satisfaction—and one of the best ways to do this is through patient surveys. However, the question remains: what should a practice do if a survey reveals there is a problem?

It is of utmost importance that any issue found in a survey be studied and addressed. Interestingly, the vast majority of patient irritants do not relate to the quality of care at all. In fact, a study in the Journal of Medical Practice Management found that 96 percent of all patient complaints are related to customer service rather than poor care. Some of the biggest complaints include:

  • Excessive waiting times
  • Inadequate communication
  • Disorganized operations

Over the next few months, we will be digging in to each of these topics in depth. Today we will start with the top frustration of patients: excessive wait times. These long wait times, often associated with poor time management, are also some of the major criticisms reported by respondents of the Patient Provider Relationship study. Check out some of these numbers:

  • Sixty-eight percent of patients say that the wait times in their medical office are not reasonable.
  • Sixty-six percent say that they have to wait too long to schedule an appointment.
  • Sixty-eight percent say they feel like messages are not returned in a timely manner.

The problem is only getting worse. Average practice wait times have risen by 30 percent since 2014. Unfortunately, the common patient response to long wait times is simply to change practices. Around one in three patients say they are likely to find a new medical practice in the next couple of years. So how do you reduce long wait times?

  1. Understand how long is too long. Studies have found that about 20 minutes is the maximum amount of time a patient is willing to wait before becoming frustrated. Unfortunately, it is estimated that 53 percent of physicians say patients at their practice typically wait for more than 20 minutes. If you are not sure where you stand in terms of wait time, carefully track your wait times, both in the waiting room and the exam room. There are a variety of programs and apps that can do this for you. Or if you’d prefer to go old-school, you could acquire a supply of timers. When a patient checks in or is taken to the exam room, simply press the START button. Keep an eye on the timers and recognize when a patient has waited longer than is optimal.
  2. Provide clear communication. One of the easiest fixes for long wait times is often overlooked—communication. Eighty-six percent of patients say that if they were told in advance about a long wait time that they would feel less frustrated. So make sure to let patients know if the doctor is running behind schedule. You can also consider shooting off a quick text message to incoming patients if your office is running very late. If you are tracking wait times, make sure to acknowledge the inconvenience and apologize when the wait goes longer than 20 minutes. This would minimize frustration for nearly 70 percent of patients.
  3. Improve front desk workflow. Melanie Michael, lead author of a study that looked at interventions for lowering patient wait times found that one of the critical factors in reducing wait times was the front desk management. She noted, “[At one practice], we found that these people were trying to answer phones, field questions from patients in the waiting room, check patients in, secure insurance info, and many other tasks.” Automation of these tasks enables practices to get patients seen by the physician faster and more efficiently. Appointment reminders, scheduling, and check-in are all processes that can (and should) be automated.

Wait times are directly correlated to the satisfaction of patients. If your patient survey finds that people are feeling annoyed about the wait at your office, make changes now. If you wait too long, you may find you have no patients left.

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.

Easy Tips to Understand and Leverage Patient Survey Results

Posted on March 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

Multiple studies have shown that surveys are critical to the economic health of medical practices. Experts say that using surveys to improve the patient experience can be a strategic differentiator for practices.

To read more about the increasing role of surveys in reimbursement, profitability, and quality care, check out this post from last month.

Once you’ve started sending out regular patient surveys and getting consistent responses, it’s time to take action. In order to get the most out of a survey, it is critical to analyze the responses and implement changes based on the results. Here are a few tips to get started.

Figure out how many survey responses are needed.

Any time a survey is sent, there must be enough responses received to have a “statistically significant” result. Obviously, if only one or two patients respond to a survey, those answers will not be a true picture of how patients view a practice. What is considered “statistically significant?” This will vary by practice size.

Start by finding out how many active patients visit your practice—for now, don’t count any inactive files. Of course, it would be amazing if every single patient responded to the survey, but that is pretty near impossible. Instead, each practice must decide what margin of error is acceptable to them personally. The greater margin of error found to be acceptable, the fewer responses needed to be statistically significant. For example, if a 10 percent margin of error is okay with you, only 100 out of 3,000 patients need to respond. If, however, a three percent margin of error makes you more comfortable, you would need 810 responses out of 3,000.

Use the following table as a basic rule of thumb when deciding how many responses are needed:

Leverage technology to calculate the hard numbers.

In order to easily understand survey results, responses need to be converted into percentages or averages (depending on question type) and formatted in a way that makes it easy to compare responses. For example, it doesn’t mean much that 281 respondents said that they had a poor experience. If, however, that number is converted into 40 percent that had a poor experience, it is much easier to recognize a problem. Survey answers should be imported into a system that analyzes the results and converts these into simple statistics. Fortunately, it is common for the platform used to originally send the survey to do this automatically. Many will also include trends over time, highlighting if problems are worse or better during certain times of the year. If the survey-sending platform does not include an analysis tool, there are a huge number of programs (including free tools) that can accomplish this task. Even programs like excel work perfectly fine for this.

Take action.

Great—you’re starting to get a feel for what patients think. But now what? Far too many practices collect incredibly valuable information only to sit on their hands and ignore it. But for a practice to really thrive, it is crucial to set goals and objectives based on survey results. After all, patients are communicating what they want. It’s up to you to see how you can accommodate their needs.

My favorite goal creation method can be remembered by the word SMART.

  • Specific– Select a specific goal, being as clear as possible.
  • Measurable– Decide how you will measure the success or failure of your goal.
  • Achievable – Do you have the time, money and resources to complete the goal?
  • Relevan– Not every goal will improve your business. Pick one that will make a real difference.
  • Timely  Set a realistic deadline for goal completion.

Let’s consider a real-life example. A common survey question for healthcare practices is, “How long did you wait to be seen?” If the score comes up as higher than ideal (typically more than 20 minutes), improvements are needed.

This is where SMART goal setting comes into play.

  • Specific—Set a specific goal. For instance, “Our goal is to lower wait times to 15 minutes.”
  • Measurable—Decide how to measure the result. Will you be timing the waits yourself? Will you send out a follow-up survey?
  • Achievable—Set goals that can realistically be accomplished. If your average wait time is over an hour, for example, trying to adjust that to just 15 minutes is probably not currently achievable. Try to set smaller improvements and over time you can reach your ultimate goal.
  • Relevant—Look at the goal you’ve created. Will lowering wait times improve your business? Don’t set goals that won’t really have an impact on your long-term success. In this case, reducing wait times will have a positive impact on your business so it is a relevant goal.
  • Timely— Set a realistic time frame. It probably won’t happen in a week, but you may not want it to take a year. Three months may be the right timeframe to make improvements. Check back at that point to see if you achieved your goal.

As practices consistently strive to make changes based on survey results, the patient experience will improve dramatically. Because setting specific improvement goals is so important to practice success, over the next few months I’ll be addressing some of the most common patient frustrations uncovered on surveys. I will include SMART goals to improve these frustrations and boost 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.