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The Common Thread Connecting Top-Performing Practices

Posted on November 14, 2018 I Written By

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

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

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

Technology for the Future

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

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

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

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

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

Social Diagnosis? – Fun Friday

Posted on November 9, 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.

It’s Friday as we start to head into the holiday season. A lot of fun and a lot of stress. What an interesting juxtaposition when it comes to your health, no? The good news is that I’m back again with some Fun Friday humor for you. When I saw this cartoon, I loved it immediately:

What’s interesting is that there is so much potential for collaborating with other doctors around challenging diagnosis. I first realized some of the opportunities there when I learned some of what Health Tap is doing.

It’s still a little bit of a wild west for many, but the fact that a patient or doctor can go online and get help with challenging healthcare situations is a very good thing. Technology will continue to enable this. I just hope it’s not quite as depicted in this cartoon.

Problematic Medical Bills Drive Consumers To Cut Back On Care

Posted on November 7, 2018 I Written By

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

As we all know, patients and families are taking over responsibility for a steadily greater percentage of their healthcare costs over time. Not surprisingly, this can affect their medical decisions in negative ways. In fact, a new study has documented that their medical bills are confusing or unexpected, a patient may get overwhelmed and simply skip some forms of care entirely.

The study, which was conducted by Hanover Research and sponsored by HealthSparq, surveyed more than 1,000 Americans on their experiences with unexpected medical bills. The results should be unsettling to anyone in outpatient services, especially those in primary care.

Researchers found that more than half (53%) of respondents had received a surprise medical bill over the past 12 months. This included bills that were higher than expected (60%), for services they thought were covered by insurance but weren’t (62%) and from multiple providers when they expected to get just one (42%).

When faced with these frustrating billing situations, patients may drop out of their care routine to some extent. Many skip routine checkups (40%), routine health screenings (39%) or care for injuries (39%).

A substantial number of respondents (40%) conceded that they could’ve avoided such shocks by doing more to better understand their benefits and healthcare processes, in addition to blaming their insurers (45%) or their health providers (42%). Regardless, it appears that a large number didn’t know who was responsible for the problem, which doesn’t bode well for their future health behavior.

Look, everyone knows that offering an accurate estimate of patient financial liabilities could be a nightmare in some situations, particularly if insurance companies don’t play nicely with the billing department. It’s also true that in some cases, patients simply won’t be able to pay the bill regardless of how you present it, a problem you certainly can’t surmise on your own as a medical practice.

That being said, you can take a look at the bills your practice management system produces and get a sense whether they’re decipherable to those who don’t work within the organization. Even if the PM system does a good job of supporting your end of the process, that doesn’t mean it’s turning out bills that patients can use and understand.

Yes, arguably the most important thing a practice management system does is to support your claims process effectively, but seeing to it that patients aren’t overwhelmed by their bills is clearly a big deal too. Particularly under value-based care, you can’t afford to have them holding off on the services that will keep them well.

2019 MACRA Final Rule Overview

Posted on November 5, 2018 I Written By

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

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

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

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

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

Proposed Title:

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

Finalized Title:

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

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

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

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

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

2. Quality Payment Program

a. MIPS: 2019 Performance Year

General Program Changes

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

Category Changes

Quality

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

Promoting Interoperability

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

Cost

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

Improvement Activities

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

b. APM Performance Year 2019

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

c. Public Reporting via Physician Compare

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

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

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

*Climate Change is real.

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

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

It also offers to:

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

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

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

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

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

************************

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

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

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

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

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

What’s the Breakout of Small vs Large Health Insurance Plans?

Posted on October 31, 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.

It never ceases to amaze me how our perceptions of how large something is can be skewed. It’s easy for us to see a really large company and assume that it must have the majority of the market share. This perception might be even more skewed because of companies like Google, Amazon, and Microsoft which really do have the majority of the market.

It’s a well-known idea in the tech startup world that the big winner will win the majority of the market, a second company will own most of the rest and then a long tail of others will have a small share and then eventually disappear. A great modern example of this is Uber followed by Lyft and then everyone else.

While this is an interesting way to look at a market when investing in tech companies, I’m surprised how often it doesn’t play out the same way in healthcare. The first time I saw this was in the lab market. Everyone knows that the 2 dominant players in the lab market are LabCorp and Quest. While they are both large companies, they still don’t have even close to a majority of the lab market. There are so many other independent labs and every hospital and health system has their own labs as well.

While looking at a recent report on the SMB Health Insurance Market by edifecs, I saw the same situation in the health insurance market. We all know about the massive health insurance companies that dominate the headlines. However, this report highlights the number of small and medium sized health plans out there. It was also interesting to note how these small plans are more concentrated in certain states.

If you don’t want to read the full report, this infographic summarizes a number of the stats and findings:

Is this result surprising to you? What does this mean for healthcare? Is there an opportunity for these small to medium size health plans to disrupt healthcare? Will we see more small plans chipping away at the large health plans?

How Connected Medical Device Platforms Can Conquer IoT Difficulties

Posted on October 29, 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 following is a guest blog post by Abbas Dhilawala, CTO of Galen Data.

The medical industry in the United States and around the world faces unprecedented challenges in 2019. An aging population, growing costs throughout the system, and frequent regulatory changes are just a few reasons why healthcare providers are increasingly adopting new technologies that can reduce costs and drive operational efficiency throughout the healthcare industry.

To that end, a growing number of connected medical devices are using the internet of things (IoT) to collect, analyze and transmit health data or images to internal hospital servers or cloud-based storage. While these innovative devices are slowly changing the paradigm of patient care and lowering costs throughout the system, med tech companies are still facing major barriers in the widespread adoption of connected medical devices.

Here are a few challenges associated with connected medical device platforms and the IoT, and how med tech companies can work to overcome those difficulties in the near future.

Improving Interoperability Between Connected Medical Devices

The technology companies that are building connected medical devices envision a future where wearable medical devices will instantly collect, analyze and transmit patient data to a central data repository where it can be used to update electronic health records and provide physicians with real-time information about patient wellness. One of the major obstacles here is interoperability – such a system would require a standard format for data and a common communication protocol that would allow all of these connected devices to transmit data to a single system.

Health plans, health care providers and medical technology vendors must work together to develop a consensus for interoperability standards that will facilitate more open exchange of data between authorized parties.

Address Growing Concerns over Cybersecurity

As connected medical devices proliferate through our world, it is becoming clear that medical technology companies need to take bigger steps to secure these devices and the data they collect against data breaches and malicious software attacks. Research from the Ponemon institute found that 70 percent of medical device manufacturers believe an attack on their medical devices is likely, but just 17% have taken significant steps to protect against this kind of attack.

We can look at data from recent years to estimate the results of poor security oversight in the world of connected medical devices. McAfee reports that the healthcare industry saw a 211% increase in cybersecurity incidents in 2017 compared to 2016. In the same year, 65% of all healthcare-related ransomware attacks were conducted by exploiting software vulnerabilities in connected imaging devices. However you measure it, the connected medical devices produced today aren’t sufficiently secure to be used in modern healthcare settings without the risk of compromising patient data.

Medical technology companies need to reduce the security risk posed by their devices by investing in improved security measures that reduce or eliminate software vulnerabilities. Medical technology companies should adopt a secure-by-design approach, even if it means adding hardware that increases the power consumption or cost of the product. Healthcare providers and patients need to trust that connected medical devices provide adequate protections for sensitive data.

Work to Fully Understand User Needs

The market for connected medical devices is expected to triple between 2018 and 2023, reaching a value in excess of $60 billion globally. As healthcare plans and providers move towards value-based payment models, the companies that build connected medical devices will have to demonstrate that their devices improve patient outcomes when compared to the alternative.

Manufacturers of medical devices must develop stronger ties to clinicians and patients that use their products and invest more resources in collecting evidence about the efficacy of their devices in improving outcomes for patients. In an outcome-based model, health plans will only want to pay for connected medical devices that create genuine value in the marketplace, and preference will likely be shown for devices that lead the way in software security.

Focus on Actualizing Real Benefits

As IoT medical devices become increasingly common in the marketplace, med tech companies must develop use cases that highlight the benefits they can deliver to early adopters. This includes efficiencies like the ability to transmit data wirelessly to health care providers, the potential to automatically update patient health records using data from wearables, easier access to data for physicians and health plans, and overall lowered costs of medical care.

Medical technology companies are working towards building the systems and functions that will usher in a more data-driven and patient-focused approach to health care. The most successful manufacturers will be the ones that gain industry support by delivering reduced costs and enhancing patient outcomes through repeatable use cases.

Summary

Connected medical devices stand to revolutionize the global healthcare industry, but there are still many challenges to overcome before IoT medical devices take over. Manufacturers of IoT medical devices must improve interoperability between systems to promote data sharing, address growing concerns over device security and generate evidence that their devices can meet user requirements and improve patient outcomes. Med tech companies that focus on creating real, demonstrable benefits for their customers will have the best opportunities to succeed as the healthcare IoT expands in size over the next five years.

About Abbas Dhilawala
Abbas has over 13 years of experience developing enterprise grade software for the medical device industry. He is well versed with technology and industry standards regulating security and privacy of data. His expertise lies in programming, cloud, cyber security, data storage and regulated medical device software.

Lost EMR Data

Posted on October 24, 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.

More and more EMR data is being lost and this trend is just beginning. This is particularly true in the ambulatory space where ambulatory medical practices are being bought up left and right by health systems. In the vast majority of acquisitions, the acquired practice has to convert from their current EHR to the health system EHR. In that process, a few of them will convert some of the data, but in many cases, the health system leaves behind the data from the old EHR system. That data is lost.

Also, just to be clear, when I say the data is lost. It’s probably not fully lost. Most organizations continue to limp along the old system per the state records retention laws or they move it on to some archival solution. However, no one other than HIM has real access to the old system. If a doctor can’t easily access the data from the legacy EHR, then the data is lost from my point of view.

It’s a really unfortunate situation since much of that data has value that can impact the care being given to patients going forward. Plus, in the worst scenarios, the data is truly lost as the IT department sunsets an old system and doesn’t realize the proper way to retire a legacy system.

In a recent tweet, Galen Healthcare, experts in EHR data archiving, offered important insights into archiving old EMR and healthcare IT systems and highlighted some commonly missed data sets.

It’s amazing how many people forget the value and importance of things like a contextual audit trail. You’ll understand their value once you get a release of information request as part of a malpractice case. You don’t want to be there empty handed.

As EHR and other healthcare IT software matures and we start their replacement lifecycles, it’s going to be important that your organization has a detailed process for retiring old systems. You have to ensure your providers still have access to the clinical information they need, but that you also retain the other compliance information that protects your organization. Missing one or the other is a recipe for disaster.

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

Posted on October 17, 2018 I Written By

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

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

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

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

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

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

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

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

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

On-site Service

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

Partner Service

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

Remote Service

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

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

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

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

When Payor Innovation is Driven By Government

Posted on October 15, 2018 I Written By

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

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

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

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

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

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

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

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

Stanford Offers 10-Year Vision For EHRs

Posted on October 12, 2018 I Written By

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

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

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

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

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

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

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

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

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

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

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

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

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