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When Payor Innovation is Driven By Government

Posted on October 15, 2018 I Written By

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

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

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

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

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

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

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

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

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.

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.

Walgreen’s Perspectives on Patient Engagement at #DHIS18

Posted on August 15, 2018 I Written By

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

The past 2 days I’ve been attending the Digital Health Investor Summit that’s hosted by KLAS. It was a classy event and the people they had in attendance were phenomenal. I’ll be offering up a number of insights I got from the event across the Healthcare Scene network of blogs, but a couple slides from Chet Robson really stood out for me today. Chet is the Medical Director, Clinical Programs & Quality at Walgreens.

The slides that Chet Robson shared were around some views on patient engagement. Or as he framed it: patient engagement, patient activation, patient involvement, patient participation, patient adherence, patient compliance, patient empowerment, or patient experience. I love that we have so many terms for the same concept.

Here’s the first chart he shared for patient engagement:

The 3 dimensions in the chart listed above seemed like a good framework for patient engagement. So, I was glad when Chet then shared this slide:

I think that more things could be added to the above expectations. However, it’s a really good start. Imagine if all of healthcare implemented these principles.

As timing would have it, I’ve actually done 3 appointments at Walgreens in the last month. Without going into all the details of why, I’m happy to say that Walgreens delivered on these expectations. The visits were easy to schedule, quick and painless, and the experience was great. My only complaint was that the appointment process wasn’t clear. I wasn’t sure if you could only schedule certain appointments or if you could also do walk-ins. The answer is that it’s best to have an appointment. Otherwise, when you walk in, the computer will have you schedule an appointment and unless you’re lucky, you’ll likely be waiting for a bit. However, this is a minor learned thing that can easily be fixed.

What do you think of looking at patient experience from a behavioral, cognitive, and emotional dimension?

Looking Back: Facebook in Healthcare

Posted on August 1, 2018 I Written By

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

Today I decided that I’d start regularly doing a series of blog posts called Looking Back. In this blog post series I’ll look back at some of my popular (and maybe some not so popular) blog posts I’ve written and see how it holds up today. Have things changed? Were we totally wrong? Did we forget those lessons? I’ve done this on occasion, but with over 12,000 blog posts I think I want to make this a regular feature. There’s a lot of value in looking back at old posts and remembering where we came from and how things have changed.

Today’s “Looking Back” post was published in October 2014 and was titled Facebook in Healthcare. I’ll wait here while you go and read the post.

Now that you’ve read the post…

It’s fascinating for us to think about Facebook in healthcare. Especially with what we now know about people using Facebook to influence elections and other nefarious things. It’s sad, because those same people could have used Facebook to do some good things for healthcare, but they didn’t. That’s not to say that there aren’t some good Facebook healthcare groups that provide value for patients. There are, but they aren’t really stuff that Facebook has been working on as a specific product.

What’s crazy is that even back in 2014 when I wrote the previous post, I suggested that many people didn’t trust Facebook with our health info. Today that’s true times 10. That said there are still a lot of people that would have no problem sharing health info on Facebook as well. It’s amazing to think about the separation between the people who would still share pretty much anything on Facebook and those who don’t want to use Facebook for anything.

What’s surprising today is that the post didn’t even look at other big companies that are now becoming big players in healthcare. I mentioned Google which was just starting back into healthcare after the failure of Google Health. However, I don’t think even back then I would have been able to predict all of the healthcare things that Google is doing through Alphabet.

The other big company that wasn’t mentioned at all is Amazon. Back in 2014, I can’t even remember Amazon being mentioned in any healthcare conversations. That’s not true today where it seems like Amazon is mentioned in almost every healthcare conversation.

Looking at things as they are now, I think Amazon will be a big player in healthcare and will have a big impact on it. However, they’re going to do it in new ways. They’re going to create new opportunities and new gateways to healthcare and healthcare services. If we look back on this post 4 years from now I think we’ll have had no idea of the ways Amazon will impact healthcare. I think of all the big tech companies out there, Amazon will have a bigger impact on healthcare than others like Apple, Google, Samsung, etc.

What’s your take on these big companies impacting healthcare? Which ones do you think will be effective and in what ways? We’ll look back on this post in 4 years and see if we’re right.

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.

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.

Value Based Care: We Need a Better Health IT System to Measure It

Posted on April 16, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

At HIMSS this year in Las Vegas I looked at the nature of the EHR and if we have the current computing and data infrastructure to enable better value based care.  Our data capabilities are failing to allow providers to align reimbursement with great care delivery.

Under the premise of “what gets watched gets done”, we understand that improving care delivery will require us to align incentives with desired outcomes. The challenge is that, among the many ills plaguing our version of the truth mined from data found in electronic health records systems, reimbursement data presents the core issue for informatics departments across the country. To resolve this issue, we need documentation to reflect the care we are delivering, and we need care delivery to center around patient care. Health information management should be heavily involved in data capture. To truly improve care, we need better tools to measure it, and healthcare data is expanding to answer difficult questions about care delivery and cost.

Our first challenge is stemming the proliferation of extraneous documentation, and healthcare is still addressing this issue. What used to be written on a 3-by-5 index card (and sometimes via illegible doctor’s notes) is now a single point in a huge electronic record that is, surprisingly, not portable. Central to our issues around the cost of care, we have also seen that quantity is valued more than quality in care delivery.

Duplicated testing or unnecessary procedures are grimly accepted as standard practice within the business of medicine. Meaningless and siloed care delivery only helps this issue proliferate across the health of a population. To resolve these issues, our workflow and records need to capture the outcomes we are trying to obtain and must be customized for the incentives of every party.

Incentives for providers and hospital administrators should center around value: delivering the best outcomes, rather than doing more tests. Carefully mapping the processes of healthcare delivery and looking at the resource costs at the medical condition level, from the personnel costs of everyone involved to perform a medical procedure to the cost of the medical device itself, moves organizations closer to understanding total actual costs of care.  Maximizing value in healthcare–higher quality care at lower costs–involves a closer look and better understanding of costs at the medical condition level. Value and incentives alignment should provide the framework for health records infrastructure.

When you walk into Starbucks, your app will tell you what song is playing and offer options to get extra points based on what you usually order. Starbucks understands their value to the customer and the cost of their products to serve them. From the type of bean, to the seasonal paper cup, to the amount of time it takes to make the perfect pumpkin spice latte, Starbucks develops products with their audience in mind–and they know both how much this production costs and how much the user is willing to pay. The cost of each experience starts well before the purchase of the beverage. For Starbucks, they know their role is more than how many lattes they sell; it is to deliver a holistic experience; delight the customer each time.  

Healthcare has much to learn about careful cost analysis from the food and beverage retail industry, including how to use personalized medicine to deliver the best care. Value-Based Healthcare reporting will help the healthcare industry as a whole move beyond the catch-up game we currently play and be proactive in promoting health with a precise knowledge of individual needs and cost of care. The investment into quantifying healthcare delivery very precisely and defining personal treatment will have massive investments in the coming years and deliver better care at a lowered cost. Do current healthcare information systems and analytics have the capacity to record this type of cost analysis?

“Doctors want to deliver the best outcomes for their patients. They’re highly trained professionals. Value Based Healthcare allows you to implement a framework so every member of the care team operates at the top of his or her license.”

-Mahek Shah, MD of Harvard Business School.

These outcomes should be based on the population a given hospital serves, the group of people being treated, or at the medical condition level. Measures of good outcomes are dynamic and personalized to a population. One of the difficulties in healthcare is that while providers are working hard for the patient, healthcare systems are also working to make a profit.

It is possible to do well while doing good, but these two goals are seemingly in conflict within the billion dollar healthcare field. Providing as many services as possible in a fee-for-service-based system can obfuscate the goal of providing great healthcare. Many patients have seen multiple tests and unnecessary procedures that seem to be aligned with the incentive of getting more codes recorded for billing as opposed to better health outcomes for the patients.  

The work of Value Based Time Data Activity Based Costing can improve personalized delivery for delivery in underserved populations as well as for affluent populations. The World Health Organization (WHO) published the work of improving care delivery in Haiti. This picture of the care delivery team is population-specific. A young person after an accident will have different standards for what constitutes “right care right time right place” than a veteran with PTSD. Veterans might need different coverage than members of the general public, so value based care for a specific group of veterans might incorporate more mental health and behavioral health treatment than value based care serving the frail elderly, which could incorporate more palliative care and social (SDoH) care. Measuring costs with TDABC for that specific population would include not just the cost of specialists specific to each segment of the population, but of the entire team (social worker, nursing, nutritionist, psychologists) that is needed to deliver the right care, achieve the best outcomes, and meet the needs of the patient segment.

Healthcare systems are bombing providers and decision makers with information and trying to ferret out what that information really means. Where is it meaningful? Actionable? Process improvement teams for healthcare should look carefully at data with a solid strategy. This can start with cost analysis specific to given target populations. Frequently, the total cost of care delivery is not well understood, from the time spent at the clinic to prescribe a hip replacement to the time in the OR, to recovery time; capturing a better view includes accounting for every stage of care. Surgeons with better outcomes also have a lower total long-term cost of care, which impacts long-term expenses involved when viewing it through the lens of an entire care cycle. If you are a great surgeon–meaning your outcomes are better than others–you should get paid for it. The best care should be facilitated and compensated, rather than the greatest number of billing codes recorded. Capturing information about outcomes and care across multiple delivery areas means data must be more usable and more fluid than before.

Healthcare informatics systems should streamline the processes that are necessary to patient care and provider compensation. The beginning of this streamlined delivery involves capturing a picture of best care and mapping the cost of processes of care. The initial investment of TDABC in researching these care costs at the patient level can be a huge barrier for healthcare systems with small margins and limited resources. This alignment is an investment in your long-term viability and success.

Once you understand your underlying costs to deliver care, health systems will be better prepared to negotiate value-based payment contracts with payers and direct-to-employers. Pair your measurement of costs with your outcomes. Integrating care delivery with outcomes standards has improved in recent times through ICHOM. Medical systems need to incentivize health if healthy patients are a priority.  The analysis of specific costs to a system needs a better reporting system than a charge master or traditional EHR which is strongly designed toward recording fee for service work. We must align or incentives and our health IT with our desired outcomes in healthcare. The more billing codes I can create in an electronic health record, the more I am reimbursed. Reimbursement alignment should match desired outcomes and physicians operating at top of their license.

Under value-based care, health and well-being become a priority whereby often in the fee-for-service model, sickness can be the priority because you get paid by doing more interventions, which may not lead to the best outcomes. The careful measurement of care (i.e. TDABC) paired with standards of best care will improve care delivery and reduce the cost of that care delivery. Insights about improved models and standards of care for outcomes and healthcare delivery allow patients, providers, and administrators to align with the shared goal of healthier patient populations. I am looking forward to the data infrastructure to catch up with these goals of better care delivery and a great patient experience.

 

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.