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How Are Ambulatory Practices Going to Compete with Health Systems?

Posted on July 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.

We’ve all seen the stories about the explosion of data and the way healthcare is getting more personalized. However, David Chou recently pointed out how the data is one thing, but figuring out the role everyone plays in your healthcare organization is just as important as the data itself. It gets complex quickly as this graphic David shared shows:

This is a great graphic of the healthcare analytics roles and responsibilities that will be needed to make the personalized medicine future a reality. Plus, it will be key to getting a lot of the value out of our past EHR investments. Many hospitals and health systems already have these roles filled or are working to have them filled. We’ve seen this first hand when we see data jobs being posted to our healthcare IT job board.

While this work is extremely exciting and shows a lot of promise, I imagine a graphic like the one above is just completely overwhelming to consider for a small ambulatory practice. Even a large group practice would likely find the above graphic challenging to consider in their relatively small healthcare organization. How can they compete with a large health system with that kind of complexity? Do graphics like the one above just provide one other illustration of why small practices are going to soon be extinct?

I don’t think so and I hope not. However, graphics like the one above do illustrate the tremendous challenges that ambulatory practices face when they don’t have a massive health system behind them. What’s the path forward for smaller practices then?

The first thing to remember is that even though a health system is large, it doesn’t mean it’s going to do things well. In fact, it’s easy to argue how large organizations are much less efficient. It’s not hard to see how a large health system will focus all of their analytics work on the acute care environment and leaves out ambulatory practices. Smaller healthcare organizations are going to have to use this to their advantage.

While it’s unlikely that ambulatory practices will do all of the healthcare analytics work on their own, it is possible for ambulatory practices to tap into third party vendors that do the work for them and hundreds of other ambulatory practices. Smaller healthcare organizations partnering with corporate and entrepreneurial vendors is going to be the best way for these healthcare organizations to compete with the large health system. In fact, it’s a huge opportunity for them to show why patients should visit their practice instead of the large health system.

One thing that’s holding these efforts back is EHR vendors’ decision to close the doors to outside vendors. There are a few EHR vendor exceptions and areas where every EHR vendor is more open (ie. labs, pharmacy, etc), but it won’t be enough going forward. My friend Jeremy Coleman recently described why in this series of tweets:

I don’t see any healthcare future where centralization will survive. Sure, it will put up a good fight for a while, but the number and variety of applications that are coming out in healthcare are going to be so varied and dramatically important for doctors to incorporate into the care they provide that EHR vendors won’t have a choice but to create APIs that facilitate all of these applications.

An EHR vendor that embraces this approach is going to be essential for every ambulatory practice. Eventually, ambulatory practices will be stuck with the need to switch EHR systems or sell to the health system (which generally means switching EHR systems too). However, an ambulatory EHR that provides an open ecosystem for the latest and greatest in health IT will allow ambulatory practices to thrive even against the much larger health systems.

What Kind of CIO Are You?

Posted on November 1, 2017 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.

Leave it up to David Chou to provide the perfect visual for the path that many healthcare CIOs find themselves on and what they need to do to get on the right path.

The problem that’s described in this graphic is real. I’ve met many healthcare CIOs that just want to “keep the lights on.” Their goal is to just provide the tech and let other people figure out the business. The problem with this thinking is that you’re just making yourself a commodity that’s easily replaceable since you’re not adding to the bottom line of the business.

What’s not illustrated in this graphic is how hard it is to get off the treadmill of putting out fires and starting to think strategically about where you need to take your organization. Those fires feel so pressing that it’s easy to fill all your time with things that don’t strategically help your organization in the long run.

The good news is that the solution is simple. Start allocating more time thinking strategically about what your IT organization is doing to improve your organization by increasing revenue, lowering costs, improving efficiency, and higher quality care. Yes, you still have to balance this with still maintaining the infrastructure. However, I see more and more CIOs delegating the infrastructure challenges so they can spend the time needed to make sure that IT is a strategic part of their organization and not just a commodity service.

Myth: Healthcare Is Different From Other Industries

Posted on May 5, 2017 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.

If you don’t follow David Chou on Twitter, then you’re missing out on some really great content. This is particularly true if you’re a healthcare leader. A good example of this was the following tweet that David shared:

The topic of whether healthcare is different from other industries is an important one that’s worth discussing. The chart above and the research by McKinsey&Company would suggest that healthcare isn’t all that different from other industries. However, I think there’s a nuance in their reality check.

The nuance is that healthcare have similar expectations of healthcare as they do with other non-healthcare companies. However, that doesn’t assume that healthcare consumers act the same as they do in other industries.

There are great examples of this. When you’re in the back of an ambulance after a heart attack, you’re not acting like much of a consumer. They’re taking you to the hospital of their choice and you’re going to largely get the care that the ED feels you need. In what other industry does this occur? There are other examples like elective procedures in healthcare that are very much an experience like other industries.

What the study illustrated above does teach us is that even if the consumer decision making process in healthcare is different, there are core expectations that we have regardless of how we chose to interact with the healthcare system or not. There are some universal tenants and expectations that healthcare should remember:

  • Providing great customer service
  • Delivering on expectations
  • Making life easier
  • Offering great value

I’ve started to see more and more healthcare organizations worry about these tenants of a great patient experience. When you see it broken out like the above, it sounds so simple. Implementing the ideas can be amazingly tricky. However, this is exactly where I see healthcare headed.

MACRA Stats – MACRA Monday

Posted on April 17, 2017 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 post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

I love a good stat. I realize that you can make stats tell you whatever you want. However, if you look at them with a critical eye, you can learn something about both the organization producing the stat and the population that the stat represents.

It’s no surprise that I found these MACRA stats shared by David Chou to be of great interest and a perfect MACRA Monday discussion.

The stat that stands out to me is the 51% of physicians who reported that they weren’t getting paid on a performance basis or that their compensation had a very small performance based piece to it. For those of us following the cutting edge of what’s happening in the world of healthcare, it’s sometimes important to remember that while the shift to value based reimbursement is happening, it still has a long ways to go.

I found David Chou’s tweet with these stats interesting when he said “Most physicians prefer the old model of payment vs MACRA.” I would look at these stats a bit differently than David.

I would suggest that these stats say that doctors prefer reimbursement models they understand and ones that pay them well. This is proven out in the stat that 71% of physicians surveyed would participate in value-based payment models if offered financial incentives to do so. It’s not really a shocking insight that doctors are happy to shift models if there are financial incentives to do so.

The challenge is that most doctors don’t think that a value based reimbursement model is going to pay them more for the work they do. They’re probably right. This explains why nearly 8 in 10 physicians surveyed prefer fee-for-service or salary for their compensation. If a new model came along that would pay them more than their current fee for service model, then they’d happily switch models.

Sometimes we make things too complicated. Physicians just want to be paid well for the work they do. Sounds like all of us no? The concern for most physicians is that these models are unlikely to pay them more. In fact, it’s quite possible they’ll pay them less or at least pay them the same for more work.

I haven’t seen any plan or projections to pay doctors more. In fact, the rhetoric in society is that we pay too much for healthcare (which is true). As a society, we all agree that we should be paying less for healthcare. However, as a healthcare provider or healthcare organization the idea of paying less for healthcare translates to getting paid less. Who’s going to take the hit when it comes to getting paid less? Providers? Hospitals? Pharma? Med device companies? Health IT Companies?

Could value based reimbursement models theoretically cost less and pay all of these stakeholders the same amount of money because patients were healthier? Works great in theory, but looking at the past history of these programs tells another story. So, it’s no wonder that most doctors would happily stay in the fee-for-service reimbursement world they know vs moving to value based reimbursement models.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Fitbit Data in the EMR?

Posted on November 3, 2015 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.

People keep telling me they want their Fitbit and other personal device data in their doctors EMR. While it seems reasonable that your doctor would want as much data as possible available to them in the EMR, a whole wave of Fitbit data is unlikely to impact the care your doctor provides you. Your doctor doesn’t have enough time to look at your current chart. When is she going to have time to look through all your Fitbit data?

There likely are times when Fitbit and other health sensor data is going to impact the care you receive and the care provided by a doctor. However, I don’t believe your EHR vendor is going to provide those insights. At best your EHR would be a storage place for that data. I don’t see many EHR vendors doing the work required to turn that outside health sensor data into actionable insights.

Most doctors I know would be happy to have an external system inform them of insights related to your health sensor data. In fact, many would welcome it. David Chou recently blogged about the move to more personalized care and much of that is built on the back of this sensor data. He takes it even further including the system reminding you to order a low calorie diet when your GPS shows you visiting a fast food restaurant. Will EHR software do that? I don’t think so.

I guess you could summarize my view on health sensor data in that I’m bullish on the potential of what all this health sensor data can do for a person’s health, but I’m bearish on the EMR being the software that does it. The EMR might play a role in presenting the insights to the doctor, but that doesn’t require the EMR to have all the data. They just become a communication pathway. What do you think?