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The Secret to Coding Accuracy Is In The Training Tools

Posted on September 24, 2018 I Written By

The following is a guest blog post by Scot Nemchik, Vice President of Coding Education and Auditing at Ciox.

Accurate coding has become more important to healthcare organizations and more critical to their bottom lines than ever before. While the traditional value of coding to an organization was simply in its effect on timely reimbursement, outside entities like IBM Watson Health and the U.S. News & World Report, among many others, are today utilizing the same broader organizational coding data to assess outcomes, provide company profiles, drive news, assign ratings and rankings, and determine value in the healthcare organizations they assess.

Because the impact of accurate coding in the modern era extends beyond reimbursement into reputation, perception, and new business development capabilities, it’s clear that the stakes have been raised for most organizations. With added importance assigned to coding accuracy, many of these companies are today assessing how to drive greater coding accuracy within their organization. Yet, the methodologies by which organizations assess new hires for coding capabilities, and by which they train and enhance their existing workforce, are largely unchanged in the last decade or more.

Coding is an industry that requires specialized skills, and so it is important for several reasons to make quality hires at the onset. It is far more profitable for an organization to retain its coders, which requires better upfront assessment. A study from the Society for Human Resources Management (SHRM) on employee retention suggests that the cost to an organization in replacing an employee is between 50 and 75 percent of their salary. In an industry like medical coding, better screening measures must be in place to get the right people involved on the team the first time.

One of the primary ways companies can look to achieve better candidate hires is by moving away from simple multiple-choice assessments of coding skill during the screening process, as those assessments are not as predictive of coding aptitude as modern measures. A more effective approach is achieved through the use of platform-based assessment techniques, in which the candidate can respond to hypothetical medical reports with actual codes, providing more meaningful insight into coding aptitude.

Those same training platforms also serve as a solution for companies looking to bolster the accuracy of their existing coding teams. Traditionally, organizations have relied heavily on passive forms of training (e.g., webinars, LMS assignments) to convey important coding instruction, hoping that instruction is put into practice in the daily work settings. Today, through active, platform-based training, the results are far more scalable and effective.

Coders Learn by Coding

By training in an active coding learning environment, coders learn by doing, a proven method which accelerates learning and optimizes retention. Through a hands-on learning approach, coders can put their skills to the test and learn from any mistakes in real time.

Platform learning provides not only pre-hire testing, but also baseline performance assessment. By giving new hires and existing teams alike the same metric tests, organizations can identify their best assets. Additionally, platforms for coding training offer effective and efficient cross-training, allowing organizations to diversify the capabilities of their coders and cross-pollinate or backfill specific coding teams for more flexibility. Beyond cross training, existing teams benefit from the development of their assets through ongoing education. Coding is a dynamic field with annual changes, and access to the newest codes and guidelines is critical. A comprehensive learning platform offers all of these capabilities and measurements in real-time.

As companies look for ways to improve the accuracy of their coding staff, whether through new hires or incremental improvements to existing teams, transitioning to a platform-based training and assessment environment, with a host of experiential and measurement capabilities, can provide the solution.

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

How to Text PHI with Patients and Stay Compliant

Posted on September 19, 2018 I Written By

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

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

Texting Reigns as Favorite Communication Tool

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

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

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

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

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

Implementing Texting in a Compliant Way

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

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

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

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

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

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

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

Is Value Based Care Just Regulatory and Reimbursement Hoop Jumping?

Posted on September 17, 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.

In theory, we all love the move to value based care. Why aren’t we paying healthcare providers to improve care. It just makes sense. In fact, the fee for service model in many ways feels so unnatural. While the theoretical value based care sounds good, getting there is much easier said than done. Translating the simple idea of value based care into regulations and reimbursement is a really hard thing to do.

I’ve often asked the question, “Is value based care just a regulation and reimbursement hoop jumping activity?” Does he who can jump through the hoops the best win? Or is it really the person who improves the care the most win?

I found two Twitter threads discussing ACOs that may shed some insight into not only ACOs, but the shift to value based reimbursement. Plus, I think it might help to answer the question above.

The first ACO thread is in response to an NGACO report from CMS that was shared by David Muhlestein.

In response to David’s tweet, Adam Solomon offered his perspectives in this tweet storm:

Sorry to chime in late. Our NGACO experience was very interesting. Our benchmark was based on our historical utilization for a similarly attributed population. They then added a very low trend factor to come up with a final target.

In the end, our PBPM cost was actually lower than the benchmark, but we still owed over $5 million to CMS. What happened?

Because the baseline year risk was calculated in the 2014 model and year 1 was the 2016 model, they couldn’t directly compare the acuity of the two populations. Therefore, the utilized a ratio comparing our trend to that of others. Our RAF score didn’t jump as much as theirs.

So our RAF “decreased” suggesting our active population was healthier than our baseline. That accounted for over $2.5 million dollars of “loss.”

The other hit was the way they calculated stop loss. Sure, there was an elective level of aggregate stop loss, but they also assigned a PBPM cost for individual stop loss based on expectations for number of patients with claims over the 90th percentile.

Because California has historically high costs, they estimated that we would have an abnormally high number of patients that exceeded that threshold. That was something like a $20 PBPM hit or another $3.5 million of artificial cost to us.

In the end, although we saved CMS money, we still needed to pay them for our “loss.”

Separate from that, the NORC Report noted above uses a different methodology to estimate savings. Instead of using ourselves as a baseline, they used a regional reference population.

The saddest part for us was that our utilization was always at the top end with little room for improvement. As an example, here’s admits/k for year 2 NGACOs. We’re dark blue.

In a separate tweet storm, Farzad Mostashari, Former National Coordinator at ONC and now Founder of Aledade offered this look at the ACO results:

1/ 2017 #MSSP #ACO Results!
ACOs have scaled rapidly across the country!

In aggregate, the 472 ACOs were accountable for nearly 9 million Medicare beneficiaries and $95 Billion- that’s a quarter of all fee for service, and almost half of the entire Medicare Advantage market.

2/ If you add up all the actual costs versus benchmarks, these 472 ACOs were collectively $1.1B under their benchmarks (more on whether that’s the right counterfactual later).

Medicare shared $780 million in payments with the ACOs, netting the taxpayer $313M

But wait!

There’s lots of evidence that the benchmark under-estimates the savings produced. @JMichaelMcW et al have shown convincingly that a true “difference in difference” approach would show substantially higher net impact.

The green eyeshades folks at CMS OACT said add 60%

3/ So that means that the best guess for MSSP savings is actually $1.75B in 2017, with Medicare paying out $780M (45%)- not a bad deal for the taxpayer!!!

That does NOT count savings that come from lower costs to the taxpayer from Medicare Advantage rates that are keyed off FFS

4/ Here’s how the CMS actuaries put it:

And on quality- the average ACO earned 92% on their quality scores- and the scores improve the longer you are in the program according to the ACO Rule’s Regulatory Impact Assesment.

(The Aledade average quality score applied was over 95%, and as high as 99.8% #GoKANSAS)

6/ Lemme say that again….

ACOs saved Medicare over a Billion dollars in 2017.

Cheaper than FFS, cheaper than MA.

And they did it without cutting payments to doctors or narrow networks

And they did it with higher patient quality.

That’s called delivering what was promised

7/ the Track 1 ACOs more than held their own here

Best guess is that Track 2/3 generated 190M in savings (w 60% spillover) and received $95M (50%)

Track 1: $1.5B in savings, $685M in payments (44%)

(I’m still a believer in moving to 2-sided risk to help weed out ACO squatting)

8/ You know what was a great investment? Giving small and rural physician-led ACOs an advance payment to help them invest in infrastructure and setup costs.

It was critical to the success of several of our @AledadeACO

More commercial payors should do this!

9/ But what this initial release does not help us do is see which type of ACOs are creating the most value.

My guess is that it’s not much different from what the CMS actuaries found for PY 2016- ACOs that include hospitals and directly control more of the cost of care do worse

10/ The “low revenue” ACOs (in the OACT analysis – less than 10% of total cost of care came to them) were only a third of the lives in the program, but generated roughly 98% of the savings.

THAT is why in the ACO Rule CMS proposed letting them stay in low risk models longer

11/ That was the entire thesis behind “the paradox of primary care leadership” that informed the founding of @AledadeACO

That is also why @AledadeACO partners with independent physician practices, not hospitals like others do.

Health Reform and Physician-Led Accountable Care
Even though most adult primary care physicians may not realize it, they each can be seen as a chief executive officer (CEO) in charge of approximately $10 million of annual revenue. Consider that a t…
https://jamanetwork.com/journals/jama/fullarticle/1861359

12/ A quick analysis by the amazing @Travis_Broome divides these 2017 results by whether the ACOs included a “facility/CCN” (CAH, RHC, FQHC don’t count for this purpose) –

Same pattern- 95% of the savings are coming from the ACOs that don’t include hospitals.

13/ Only 3.5M of the 9M ACO-attributed benes were cared for by the smaller ACOs that didn’t include a hospital facility- and they generated 95% of the savings.

If you’re an independent practice seeing these results and the policy direction, why would you join a hospital ACO?
So how did @AledadeACO do?

We are always very transparent with our results- even when things didn’t go our way- to look for ways to be better, and to make policies better that are holding back broader success.

This article 2 years ago was full of pain.
The Opportunities and Challenges of the MSSP ACO Program: A Report From the Field
This article provides a detailed description of a Medicare Shared Savings Program accountable care organization (ACO)’s actions and results, to increase understanding of the challenges and opportunit…
https://www.ajmc.com/journals/issue/2016/2016-vol22-n9/the-opportunities-and-challenges-of-the-mssp-aco-program-a-report-from-the-field

15/ This was a good year for @AledadeACO

Only 1/7 freshmen ACOs made savings- but we have learned to set expectations- it’s a long game.

But 5/8 ACOs that were sophomores or older will get checks.

And 2/3 that didn’t get MSSP crushed it in commercial contracts.

16/ But I’m more proud that EVERY ONE of our @AledadeACO have measurably improved health for the patients we are accountable for.

We have increased wellness visits, transitional care, and chronic care management- and that’s translated into lower ED visits and readmissions

17/ So where do we go from here?

The #MSSP #ACO program has been a hugely successful motivator of nationwide transformation, but it can be reformed, and I believe @SeemaCMS is on the right track.

Here’s what I would expect might change between the NPRM and the final ACO rule:

18/ The GlidePath to risk reduces ACO squatting, and brings revenue-based downside risk to MSSP, but the lowered gainshare in 1st 2 years (25%) is not enough to get new entrants and ACO investments.

(as suggested) “low revenue” ACOs should get higher gain-share and lower MSR

19/ The refined benchmarking method gives greater predictability by allowing risk adjustment and regional trending-which is great!
But the cap on risk adj (3% over 5 years?!) don’t control for rising risk and introduces gaming on falling risk

Instead of a cap, do renormalization

20/ Concern about “windfall profits” led to an ill-advised proposal to cap regional efficiency at 5% – In Medicare Advantage if you are efficient, you get to keep the difference, which has spurred huge innovation in the space. why blunt improvement? 100% tax brackets are not good

21/ Credit to CMS for trying to fix the unintended “regional comparator” problem- where rural ACO savings are reduced in direct proportion to market share. But the “national trend blend” proposal makes NO SENSE.

Let’s just take ACO benes out of the regional comparison please!

22/ But the biggest impact of these results on the proposed rule should be on the idea that the way to benefit the Trust Fund is to protect it from ACO earnings.

These caps, etc reduce ACO earnings- and ACO motivation/participation- and therefore reduced benefit to Medicare

23/ The NPRM RIA estimates through 2024 these caps push $390M in lower ACO earnings, but lower ACO participation under these policies will INCREASE claims costs by $60M- and would prevent beneficiaries from receiving the benefits of the program. That’s not the right balance

24/ The magic of accountable care is when physicians & Medicare partner together to sustainably align financial incentives, help beneficiaries and the Trust Fund.

Medicare hasn’t behaved like some commercial payers who are still seeing zero sum. Let’s hold onto that partnership

I’ll let you be the judge after reading through these threads. Are ACOs going to really improve healthcare and lower costs? Will the best healthcare win? Or will the people who understand the government rule making process and healthcare accounting be the big winners?

As I read through these, it seems like you better get your accountants and healthcare policy experts ready. That brings joy to every doctor’s ears…I’m sure!

Don’t Be The Last Practice To “Get” Digital Health

Posted on September 14, 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.

Physicians, are you savvy about the digital health technologies your patients use? Do you make it easy for them to interact with you digitally and share the health data they generate? If not, you need to move ahead and get there already. While you may be satisfied with sidestepping the whole subject, patients aren’t, a recent report suggests.

As you probably know already a growing number of patients, most notably millennials, are integrating digital health tools into their everyday lives.

Research from Rock Health, which surveyed about 4,000 consumers, found that the share of respondents using at least one digital tool (such as telemedicine, digital health tracking apps or wearables) hit 87% last year. To get a sense of how impressive this is, bear in mind that just five years ago, only a tiny handful of consumers had given any of these tools a try.

What’s also of note is that some of these consumers were willing to skip insurance and pay out of pocket for digital care. One particularly clear example of this involves live video telemedicine; Sixty-nine percent of consumers who paid out of pocket for such consults said they were “extremely satisfied” with the experience.

Patients who reported having a chronic health condition seemed less likely to use digital tools to track their health metrics. Case in point: When it came to blood pressure tracking, just 11% captured this data with a digital app or journal. However, this may reflect the higher-than-average of those diagnosed with elevated pressures, a senior population with a lower level of tech sophistication.

Lest all of this sound intimidating, there’s at least some good news here. Apparently, a full 86% of respondents said that they’d be willing to share data with their physician, a much larger share than those who would exchange data with a health plan (58%) or pharmacy (52%). In other words, they trust you, which is a big asset under these circumstances.

If you want to dive into digital health more deeply, here’s a few obvious places to start:

  • Link in-person and telemedicine visits: Rock Health found that a whopping 92% pf respondents who had an in-person visit first were satisfied with their video visit.
  • Be vigilant about data security: Almost 9 out of 10 consumers participating in the survey said that they would be willing to share data with you. Don’t lose that trust to a health data breach; it will be hard if not impossible to get it back.
  • Bring chronically-ill seniors on board: While this group may not be terribly inclined to digitize their healthcare, doing so can help you treat them more effectively, so you’ll probably want to make that point up front.

Like it or not, wearables, fitness bands, mobile health apps, and other digital health tools have arrived. It’s no longer a matter of if you take advantage of them, but when and how. Don’t be the last practice in your neighborhood that just doesn’t get it.

It’s Time To Work Together On Technology Research

Posted on September 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.

Bloggers like myself see a lot of data on the uptake of emerging technologies. My biggest sources are market research firms, which typically provide the 10,000-foot view of the technology landscape and broad changes the new toys might work in the healthcare industry. I also get a chance to read some great academic research, primarily papers focused on niche issues within a subset of health IT.

I’m always curious to see which new technologies and applications are rising to the top, and I’m also intrigued by developments in emerging sub-disciplines such as blockchain for patient data security.

However, I’d argue that if we’re going to take the next hill, health IT players need to balance research on long-term adoption trends with a better understanding of how clinicians actually use new technologies. Currently, we veer between the micro and macro view without looking at trends in a practical manner.

Let’s consider the following information I gathered from a recent report from market research firm Reaction Data.   According to the report, which tabulated responses from a survey of about 100 healthcare leaders, five technologies seem to top the charts as being set to work changes in healthcare.

The list is topped by telemedicine, which was cited by 29% of respondents, followed by artificial intelligence (20%), interoperability (15%), data analytics (13%) and mobile data (11%).

While this data may be useful to leaders of large organizations in making mid- to long-range plans, it doesn’t offer a lot of direction as to how clinicians will actually use the stuff. This may not be a fatal flaw, as it is important to have some idea what trends are headed, but it doesn’t do much to help with tactical planning.

On the flip side, consider a paper recently published by a researcher with Google Brain, the AI team within Google. The paper, by Google software engineer Peter Lui, describes a scheme in which providers could use AI technology to speed their patient documentation process.

Lui’s paper describes how AI might predict what a clinician will say in patient notes by digging into the content of prior notes on that patient. This would allow it to help doctors compose current notes on the fly.  While Lui seems to have found a way to make this work in principle, it’s still not clear how effective his scheme would be if put into day-to-day use.

I’m well aware that figuring out how to solve a problem is the work of vendors more than researchers. I also know that vendors may not be suited to look at the big picture in the way of outside market researcher firms can, or to conduct the kind of small studies the fuel academic research.

However, I think we’re at a moment in health IT that demands high-level research collaboration between all of the stakeholders involved.  I truly hate the word “disruptive” by this point, but I wouldn’t know how else to describe options like blockchain or AI. It’s worth breaking down a bunch of silos to make all of these exciting new pieces fit together.

2019 CPT Codes To Cover Remote Monitoring And Digital Care Coordination

Posted on September 10, 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.

The American Medical Association has released CPT code set changes 2019, and among them are some new options specific to digital health practices.

While providing such codes is a no-brainer — and if anything, the AMA is late to the party – it’s still a bit of noteworthy news, as it could have an impact on the progress of digital care.  After all, the new codes to make it easier to capture the value of some activities providers may be self-funding at present. They can also help physicians track the amount of time they spend on remote monitoring and digital care coordination more easily.

The 2019 release includes 335 changes to the existing code set, such as new and revised codes for adaptive behavior analysis, skin biopsy and central nervous system assessments. The new release also includes five new digital care-related codes.

The 2019 code set includes three new remote patient monitoring codes meant to capture how clinicians connect with patients at home and gather data from care management and coordination, and two new “interprofessional” Internet consult codes for reporting on care coordination discussions between a consulting physician and the treating physician

It’s good to see the AMA follow up with this issue. To date, there have been few effective ways to capture the benefits of interactive care online or even via email exchanges between physician and patient.

As a result, providers have been trapped in a vicious circle in which virtual care doesn’t get documented adequately, payers don’t reimburse because they don’t have the data needed to evaluate its effectiveness and providers don’t keep offering such services because they don’t get paid for performing them.

With the emergence of just five new CPT codes, however, things could begin to change for the better. For example, if physicians are getting paid to consult digitally with their peers on patient care, that gives vendors incentives to support these activities with better technology. This, in turn, can produce better results. Now we’re talking about a virtuous circle instead.

Obviously, it will take a lot more codes to document virtual care processes adequately. The introduction of these five new codes represents a very tentative first step at best. Still, it’s good to see the AMA avoid the chicken-and egg-problem and simply begin to lay the tracks for better-documented digital care. We’ve got to start somewhere.

 

3 Types of Medical Billing Companies

Posted on August 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.

I was recently talking with the CEO of an EHR vendor. As we talked about their EHR software and what they were working on in the future, the CEO made a really important comment. He said, “The EHR can be great, but if you don’t take care of the medical billing the right way then none of that matter.”

This was such an important point and one that I’d seen first hand. An OB/GYN friend of mine had an EHR that they loved. As the doctor, she loved it for her clinical work. The problem was that it wasn’t tied to a great practice management system. So, she was having issues with her billing. The problem was so bad that she ended up leaving the EHR she loved clinically to find something that would solve her billing problems. Don’t ever underestimate the importance of medical billing.

I recently came across an article on the Kareo blog which highlighted 3 levels of medical billing and RCM (revenue cycle management) services billing companies can offer a practice:

Light

Level of service offered by many billing software vendors.

Full-Service

Level of service offered by some software vendors and most traditional billing services.

Boutique

Level of service typically offered by smaller “mom and pop” billing companies who have expertise in a limited number of specialties and/or provide more oversight.

As you evaluate medical billing companies for your practice, this is a nice framework for evaluating the various medical billing companies that are out there. Each one provides a different set of expertises to help your practice. Understanding that difference is key to choosing one that will work best for you.

What’s been your experience with medical billing companies? Do these 3 types make sense to you or would you look at them from a different angle?

AI-Based Tech Could Speed Patient Documentation Process

Posted on August 27, 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.

A researcher with a Google AI team, Google Brain, has published a paper describing how AI could help physicians complete patient documentation more quickly. The author, software engineer Peter Lui, contends that AI technology can speed up patient documentation considerably by predicting its content.

On my initial reading of the paper, it wasn’t clear to me what advantage this has over pre-filling templates or even allowing physicians to cut-and-paste text from previous patient encounters. Still, judge for yourself as I outline what author Liu has to say, and by all means, check out the write-up.

In its introduction, the paper notes that physicians spend a great deal of time and energy entering patient notes into EHRs, a process which is not only taxing but also demoralizing for many physicians. Choosing from just one of countless data points underscoring this conclusion, Liu cites a 2016 study noting that physicians spend almost 2 hours of administrative work for every hour of patient contact.

However, it might be possible to reduce the number of hours doctors spend on this dreary task. Google Brain has been working on technologies which can speed up the process of documentation, including a new medical language modeling approach. Liu and his colleagues are also looking at how to represent an EHR’s mix of structured and unstructured text data.

The net of all of this? Google Brain has been able to create a set of systems which, by drawing on previous patient records can predict most of the content a physician will use next time they see that patient.

The heart of this effort is the MIMIC-III dataset, which contains the de-identified electronic health records of 39,597 patients from the ICU of a large tertiary care hospital. The dataset includes patient demographic data, medications, lab results, and notes written by providers. The system includes AI capabilities which are “trained” to predict the text physicians will use in their latest patient note.

In addition to making predictions, the Google Brain AI seems to have been able to pick out some forms of errors in existing notes, including patient ages and drug names, as well as providing autocorrect options for corrupted words.

By way of caveats, the paper warns that the research used only data generated within 24 hours of the current note content. Liu points out that while this may be a wide enough range of information for ICU notes, as things happen fast there, it would be better to draw on data representing larger windows of time for non-ICU patients. In addition, Liu concedes that it won’t always be possible to predict the content of notes even if the system has absorbed all existing documentation.

However, none of these problems are insurmountable, and Liu understandably describes these results as “encouraging,” but that’s also a way of conceding that this is only an experimental conclusion. In other words, these predictive capabilities are not a done deal by any means. That being said, it seems likely that his approach could be valuable.

I am left with at least one question, though. If the Google Brain technology can predict physician notes with great fidelity, how does that differ than having the physician cut-and-paste previous notes on their own?  I may be missing something here, because I’m not a software engineer, but I’d still like to know how these predictions improve on existing workarounds.

HPV Surveillance Project Reminds Us Why HIEs Still Matter

Posted on August 24, 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.

When healthcare organizations use EHR data to improve care or streamline processes, it seems like an obvious way to go. There are many benefits to doing so – certainly far more than I could cover in a single story—and odds of finding better ways to leverage such data further keep increasing over time.

Given the attention commercial EHR data use gets, it’s easy to forget the role of such data in improving public health. Yes, medical practices need to meet criteria that converge with public health objectives, such as managing diabetes and its side effects. And of course, population health management efforts directly mirror and sometimes overlap with public health goals. But it’s seldom the work of which rockstars are made.

However, given that the bulk of efforts have typically been spearheaded by government agencies or independent non-profits in the past, it’s a good idea to keep track of what they’re doing, especially if you’re wondering what else you can do with patient health data. It’s even more important to remember that even a cache of regional health data can be very valuable in supporting community health.

I was thinking about this recently when the following story turned up in my inbox.  On the surface, it’s not a big deal, but it’s the kind of cooperative effort that can improve community health in ways that work for everyone in healthcare.

This story looks at the kind of data harvesting exercise that flies under the radar of most providers. It describes an HPV surveillance effort, the HPV Vaccine Impact Monitoring Project (HPV-IMPACT), which is sponsored by the CDC and implemented by the Center for Community Health and Prevention at the University of Rochester.

The HPV-IMPACT project is relying in part on data by the Rochester RHIO, which is sharing anonymized patient health information collected between 2008 to 2014. The researchers are also using data from California, Connecticut, Oregon and Tennessee.

The goal of HPV-IMPACT is to identify trends such as changes in the percentage of women screened for HPV, the implications for different age groups and overall test outcomes. Once they complete this analysis, research will use it to determine whether HPV incidence rates can be attributed to vaccine use or alternatively, decreases in detection.

While this kind of project is bread-and-butter research, something that won’t ever make headlines in medical journals, it deserves some thought.

With things being as they are, it’s easy to dismiss HIEs as parts of a broken national interoperability effort. Hey, I’ve been as guilty of this as anyone. For many years, I waited for the HIE model today, in part because it just didn’t seem to be a sustainable business model, but at least some just kept on chuggin’.

As it turns out, regional HIEs aren’t abandonware — they just have their own niche. This kind of story reminds me that even limited health data collection efforts can make a difference. Keep up the good work, folks.

The Independent Small Healthcare Provider is In Trouble

Posted on August 17, 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 week I attended the Digital Health Investment Summit hosted by KLAS. They brought together a great group of people from the healthcare provider, vendor, payer, and investor space. We had some really great conversations and I heard a lot of great perspectives. However, if there was one theme I had coming out of the event it was this:

I’d take this statement one step further. I don’t think I heard one thing said at this event that indicated that there’s something that was going to be beneficial to the small practice. Everything that was said was building towards the need for big data, comprehensive solutions, and tools, relationships, and technology that was largely only going to be available to large health systems.

As one person on Twitter pointed out, this is unfortunate because there have been a lot of studies that have shown how the small ambulatory practices are much more cost effective than the corporate ones. Plus, patients often love that personal relationship as well. However, patients also love the advanced services and personalization that future healthcare IT can provide when you have the right scale.

This reminds me of what we’ve seen in the banking industry. There used to be a lot of local banks. Now, they’re all but disappearing as the large corporate banks take over. Sure, there are some credit unions and a few local banks left, but it’s really hard for these to compete with the kind of services the large corporate banks can provide. The same is likely to happen in healthcare and it seems to be happening fast. One health system executive told me at the event, “Practices are coming to us saying they want to be part of us. We can’t keep them away.”

I’ve mentioned before that the one hope for small practices is that large health IT companies that provide some of these advanced services could make them available to small practices. Basically, a healthcare IT company could provide a service to enough small practices that all the small practices together share in the costs associated with the advanced services like genomics for example. To go back to the banking industry, that’s what we’ve seen. A small bank or credit union doesn’t create their own online banking tech with the scan technology for mobile deposits. However, they can use a third party to be able to provide those services.

The only problem with this view is that most entrepreneurs look at the small practices as the worst market. Talking to the investors this weekend and other startups, almost none of them are targeting the small practice as their market. There are a lot of reasons for this. It’s notoriously hard to get to the decision makers at a small practice. We can thank pharma sales reps for this. Plus, small practices are quite cheap when it comes to investing in technology. All of this makes for a really challenging sales process for companies that want to sell into the small practice. The large health systems have a long sales cycle, but at least the reward is big when you make the sale.

While there are so many things going against the small practice. I still hope they find a way to survive. I also think it will be interesting to see how super groups do in this environment. If you have all the gastroenterologists in your area in a group, that can give you a lot of power to resist the health system taking you over. A fair number of direct primary care practices seem to be doing well also and could very well survive as well.

Watching some of the past senate hearings for various legislation, you can see how the government wants to do things to keep the small practice alive. Will what they do be enough? I don’t think many of us want to put our faith in government in this regard, but they may surprise us. There are some interesting rules and regulations for rural that has allowed many of them to survive.

I’d love to hear opposing viewpoints. Do you see reasons why the small practice can survive? What does this mean for healthcare? Should we be doing more to support small practices? If so, what can we do? I think it’s clear that most would like to keep small healthcare providers around, but it’s hard to see how they’ll be able to compete as technology continues to evolve.