Patient-Reported Data Collection and Return on Investment

ROI-300x300-screenDetermining ROI Metrics

The determination of when an investment recoups its costs is in many instances a fairly straightforward matter. In other instances however, it isn’t quite that simple. As the transition to value-based healthcare advances, providers are keenly looking for ways to assess the impact of patient-reported outcomes data on their bottom line.

The identification of a specific ROI metric to the cost of deploying a patient-reported outcomes data platform deployment is dependent on a number of factors that are not always easily quantifiable. Much depends upon what kind of data is being collected, the purposes for which it is being collected and both the qualitative and quantitative nature of the data.

To ensure a credible and reliable calculation of the ROI of patient-reported outcomes data collection, providers should rely upon a rigorous systematic approach for evaluation. One such methodology can be found in the work of the ROI Institute, through their “evaluation framework,”1 which categorizes results in a prescribed, logical order. This recommended sequence represents a chain of impact that can attribute and account for benefits realized. This framework consists of 5 levels of information to consider:

  1. Reaction to the program, particularly the perceived value of the program.
  2. The extent of learning such as skills, competencies, knowledge, and insights in the program.
  3. The extent of application and use of knowledge, skill, and insights acquired during the process.
  4. The program’s effect on the data such as, sales, productivity, quality, time, and costs.
  5. The ROI, the net monetary benefits compared to the cost of the program.

Patient-reported outcomes data collection offers its users a myriad of ways to generate value. For researchers, the data analysis tools provide powerful opportunities to analyze deep data sets. Practice managers are enabled to follow physician members to uncover best practices. And of course physicians can optimize their CMS reimbursement adjustment amounts by monitoring their performance scores throughout a performance year. The point is each user has a unique basis from which to evaluate and determine the overall benefit Patient-reported outcomes data collection contributes to a provider’s practice. Any valid assessment of an ROI must be tailored to the specifics of each user. Any generalized metric is clumsy at best and more than likely misleading.

Value Return to Physicians

The value of any patient-reported data collection platform to a physician must be measured by an array of considerations requiring objective and deliberate analysis. Each aspect of a physician’s practice that is impacted, whether directly or indirectly, necessarily needs to be factored into the equation. Failure to pursue such diligence in the assessment process will more than likely produce an incomplete and misleading result.

Application of the ROI Institute’s evolution framework offers a substantive foundation on which to assemble a meaningful appraisal. The framework is flexible enough to enable application to each unique practice configuration, yet establishes cumulative benchmarks that result in a succinct and useful metric. The sequential nature of the framework reinforces an approach that captures seemingly disparate variables and leverages them collectively to reveal a deeper and more nuanced valuation of deploying a patient-reported outcomes measurement system.

Data mining technology, such as OBERD’s “Mountain,” can factor prominently in generating value out of the data being collected. With it, physicians have the power to slice and dice information in a myriad of ways for infinite uses. For example, providers may measure effectiveness of care, by specific procedure as well as in aggregate. These insights, which can be generated on-demand, can empower physicians with invaluable and actionable information. No longer is a physician constrained to wait for an annual, boilerplate report.

The capacity to robustly leverage data enables insightful benchmarking for both patient and practice analysis can fortify operational best practices. By incorporating efficiencies and successful procedures revealed through tools such as Mountain, new competitive and productive gains can be realized.

A byproduct of this ability to mine data is to provide physicians the opportunity to license newly uncovered knowledge to manufacturers for research and development by the medical and pharmaceutical industries.

Patient Engagement

Patient portals and other technologies that identify and fortify patient touch-points provide opportunities to encourage patient participation in their own care. Heightened patient engagement can lead to better healthcare outcomes at a lower cost by increasing the efficiency of the healthcare system/care offered. In addition, the deployment of patient defined outcomes instruments offers to maximize clinician-patient communication by facilitating an environment that involves patients in their care leading to a better understanding of their conditions and quality outcomes.

Tracking patient reported outcomes for research purposes provides an exceptional marketing tool to showcase your advancement in medical treatments/surgical practices. OBERD’s powerful analytic tool, Mountain, offers providers a platform to analyze and mine the data you collect, and to benchmark against other data sets, global or local.

MIPS Compliance

The determination of any unambiguous ROI regarding MIPS compliance relies upon several factors that presently are premature to firmly assess and are simply not available. No reliable computations can be made until CMS has aggregated Composite Performance Scores (CPS) of all physicians participating in MIPS performance year one, 2017. All scores achieved during this initial year will be used to determine a “CPS Threshold” against which providers will be compared in order to assign reimbursement adjustments that will affect payment year one amounts in 2019. Until that threshold is published, it is simply impossible to identify express ROI expectations.

That said, close monitoring of CMS communications are beginning to reveal benefits through the thoughtful and strategic usage of patient-reported data measurement for the collection, analysis and reporting of patient-reported outcomes data.

CMS has published guidelines to demonstrate how reimbursement will work through the Quality Payment Program (QPP) but has yet to provide specific monetary values. The program has allocated $833 million dollars yearly for the next 5 years that will be distributed based on eligible clinician merit with a focus on quality outcomes, which is reflected in one’s CPS.  The better one’s CPS, the higher the probability that positive reimbursement adjustment will follow. Beyond the funding set aside to incentivize performance merit, here is an additional $500 million dollars available annually for the next 5 years reserved for those with an overall composite score of 70 points or above.

OBERD continues to closely monitor CMS announcements and regulatory developments. As each iteration of QPP rules are revealed, OBERD will continue to refine its products to optimize results for its customers.

Reinforcing a Practice’s Marketing Message

The publication of CMS’s Physician Compare website, by publishing clinician measure scores, allows patient to embody the role of a consumer in shopping around for the best healthcare and for providers that demonstrate higher quality outcomes. CMS has further advanced the promotion of provider score transparency by empowering qualified clinical data registries (QCDR) to supplement Physician Compare website information with enriched content that will further empower patients to see additional information about providers and their practice. OBERD, as a CMS-approved QCDR, is developing multi-modality scorecards to showcase a provider’s best qualities, identify top performers, identify best practices and establish additional practice marketing opportunities.

Summary

As the transition from a fee-for-service to a value-based care system continues to evolve and accelerate, the ability to efficiently and economically collect, analyze and communicate patient-outcomes data will be foundational to a provider’s success. Evidence-based healthcare decisions will rely on leveraging a patient’s involvement in their own healthcare. By increasing the role of a patient to communicate on their own individual situation and progress, that patient is afforded a more active role, which promotes better patient experience and satisfaction. Better performance scores directly impact reimbursement computation.

Of the ROI Institute’s five point evaluation framework mentioned earlier, it needs to be underscored that the first three elements address subjects that do not lend themselves to quantifiable measurement. The perceived value derived from acquired knowledge, skills and insights precludes the value received in the application of those newly realized observations. Application of the new knowledge in turn can directly impact and drive a provider’s best practice.

The ROI evaluation framework begins to address quantifiable activities in step four only after the first three steps of the process are accomplished. These activities, such as sales, productivity and costs can only be accurately assessed in the context of framework steps 1-3. The ROI Institute’s framework requires that all four steps are necessary, a condition precedent, before any actual ROI, the net monetary benefit compared to cost, can be accurately assembled.

OBERD understands that providers desire to be free from the routine task of data collection. Providers can now harness exceptional new methods to gather information from their patients, learn from them and to apply those insights towards that patient’s care. A healthcare provider should be able to practice medicine, and not have to monitor every single regulatory change. OBERD is set up to do just that. Be assured that OBERD will continue to advance solutions that address the latest in compensation strategies that generate optimized benefit to its customers.

As seen in OBERD’s Insights Blog.

Learn how you can take your value-based care to new levels with our new outcomes solution in partnership with OBERD.

7 Tips for Reducing Stress While On Call

  1. coc-blogMake sure you know your schedule- No one likes surprises. So make sure you know when you are on call.  If there are conflicts take care of them with enough time to get someone to cover for you.  Ideally you want the schedule made far in advance with easy access to view it on a shared calendar.  Many practices use google calendar or something similar.
  2. Don’t make big plans- Depending on your practice, being on call may be extremely busy or pretty slow. However, you need to be available for urgent and emergent patient issues that arise.  Trying to make it to a concert or take a family vacation while you are covering your practice after hours is a recipe for disaster.  You may be setting yourself up for medical liability and certainly making it difficult to enjoy your time off. Instead, swap calls with a partner or develop a relationship with a friendly competitor in your area to help cross-cover your practices.
  3. Ensure that patients can get through easily- At the beginning of call review the process that patients take to reach you. For some it may be checking that your phones are being forwarded properly and the call center knows your contact preferences. Ideally they should have your cell phone, home phone and email. Make sure they know how you want to be contacted.
  4. Try not to get angry or grumpy- It’s not always easy to sound enthusiastic when you get awoken in the middle of the night or disturbed during dinner to speak to a patient for an issue that doesn’t seem very important. Try to remember that the patient is not as knowledgeable as you are about health issues and wouldn’t be bothering you unless they were very concerned. Even if the call turns out to be non-urgent be sure to be polite and reassure the patient; you will both sleep better if the tone is pleasant.
  5. Educate your patients- Tell your patients to call if they are having difficulties or have questions about their care; try to be specific about the type of symptoms to look for.  This is especially important for patients who have had recent surgery or are taking new medications. By explaining what serious post-operative symptoms or potential medication side effects may be will reduce potential problems for you and the patient.
  6. Have a process to document calls- Your job is not done when you are finished speaking to the patient. Find an easy and reliable way to document the call and your recommendations. Some practices have a voicemail system that they call into to tell staff members about patients that called. You can also keep notes and fax back to the office.  We don’t suggest email or texting your office staff since this is likely to be in violation of HIPAA regulations. The easiest way to document is with an app based on-call service which allows for immediate documentation that is sent to the office staff as well as into your EHR.
  7. Designate staff to follow up after hour issues- No matter how you document the calls you need to designate someone in your office to handle the follow-up and charting of after hours calls. Ideally that person gets in early so they can call patients that need urgent appointments.  Make sure you have a way to track which calls were reviewed and charted by your staff.  Signature and time/date stamp is helpful.

We invite you to learn more about solving on call challenges as well as other pain points your medical practice may be facing and we look forward to speaking with you.

rheeDavid Rhee, M.D. – Retinal Specialist and Co-Founder of Connect On Call

David graduated from Harvard University with a BA in Biology, and obtained his MD from UC-San Diego. He then completed a residency in ophthalmology at Tufts University and a vitreoretinal Surgery Fellowship at Wills Eye Hospital in Philadelphia. David has a keen interest in the Android platform and other open source platforms and designed the wireframe layout of the mobile web app for ConnectOnCall.

2018 MACRA (MIPS) Proposed Rule: The Abridged Version

lynns-notesThe proposed rule is here, and it’s another long one! So for those who don’t have the patience (or the time) to read through the 1,000+ pages, here are some highlights from what CMS is suggesting for the second year of MIPS. Bear in mind that these are proposals; they must be confirmed in the Final Rule, which will be released by November. (What had already been set in stone within the MACRA legislation itself is the maximum penalty and related incentive: 5% in 2020 based on performance in 2018, up from 4% in 2019 based on performance in 2017.)

  • CMS would allow clinicians to use either 2014- or 2015-Certified EHR technology to report for 2018. Acknowledging the slower-than-anticipated pace at which EHRs are achieving the next required certification, this accommodation will facilitate more successful, non-rushed upgrades and provide sufficient time for training on the new capabilities and associated requirements. To encourage the move to 2015 CEHRT, 10 ACI bonus points would be awarded for its exclusive use.
  • The Quality reporting period returns to full year, but ACI (Advancing Care Information) and Improvement Activities remain at a minimum of 90 days. Cost is still unscored, but performance in this category will be evaluated by CMS and feedback will be provided to clinicians to prepare them for 2019 when, by law, the cost category must account for 30% of the MIPS score.
  • The proposed performance threshold separating “the winners” from “the losers”, (i.e., recipients of positive vs. negative payment adjustments), would increase from 3 points out of 100 in 2017 to 15 MIPS points in 2018—still an eminently achievable bar.
  • CMS would implement increased protection for small groups (≤15 eligible clinicians)—these are the practices that had been predicted to be the most vulnerable to penalties.
  • Many more clinicians would be exempt from MIPS altogether because the eligibility threshold would increase from $30,000 to $90,000 in annual Medicare revenue and from at least 100 to at least 200 Medicare patients.
  • Small groups that do participate in MIPS would receive 5 bonus points toward their score, in an attempt to level the playing field.
  • And my favorite proposal is one that specialists, in particular, will appreciate: the elimination of the restriction that all 6 quality measures had to be reported by the same submission method. In 2018, clinicians would be able to mix and match submission methods within a category. Specialists, who have typically been faced with an insufficient number of relevant eCQMs, would be able to continue reporting those measures which are available by EHR submission, but could supplement them with registry or claims measures that are also specialty specific. The result would be more meaningful reporting and more equitable scoring. This is a request that SRS has included in its comments to each of the previous proposed and final MACRA rules, so we were very happy to see this change.

MIPS is only one of the two MACRA participation options, and CMS has also proposed some changes designed to accelerate the shift from MIPS to Alternate Payment Models. More on that topic in a future post.

CMS Overpaid $729MM in MU Payments: What Does That Mean for You?

overpaid-blogIt’s been all over the press for the past week—CMS paid a lot of money in the form of EHR incentives (Meaningful Use) to providers who did not truly earn them. These inappropriate payments were revealed in a report by the OIG (Office of the Inspector General) that reviewed CMS’s compliance with Federal requirements in the Medicare EHR Incentive Program for eligible professionals from 2011-2014. Although the subject of the OIG’s audit was CMS—in contrast to the audits of providers (pre- and post-payment) that have been conducted by Figliozzi and Company—there are some important implications for providers.

Here are two of the OIG’s major conclusions:

  • 14 EPs (Eligible Professionals), out of a sample of 100 who attested to having met MU one or more times did not actually meet the MU requirements. They either could not support their attestation with sufficient evidence or had errors in their attestation. Affected payments to these providers totaled $291,222. Extrapolating on this data, the auditors estimated that CMS inappropriately paid over $729 million.
  • In addition, 471 payments to EPs who switched between the Medicare and Medicaid incentive programs were incorrectly calculated, accounting for another $2.3 million.

The report recommended that CMS:

  • recover the $291,222 from the EPs who had the unfortunate luck to have been sampled [editorial comment is mine, not the OIGs!] and found to be non-compliant;
  • recover the $2.3 million in overpayments to EPs who switched programs; and
  • try to recover some of the estimated inappropriate payments made to other providers.

It’s likely that CMS will pursue the first two recommendations, but yet to be determined what—if anything—they will do about the third. That said, however, one thing is certain: CMS will intensify its oversight going forward. (This was another of the OIG’s recommendations.) Does this mean you should abandon your plans to participate in MIPS and/or MU (Medicaid program)? Absolutely not! It does, however, imply that it will now be more important than ever to keep full documentation to support everything you submit. And, make sure to keep it somewhere that will survive any future changes in software, hardware, and/or practice staff.

Will Robots Replace Healthcare Providers?

robot-blogLeveraging interpretive intelligence in clinical workflows

Automation has been making human workers superfluous for centuries, but until recently, workers whose jobs required high-level cognitive skills have been able to rest easy, confident no machine could possibly replace them when it came to making nuanced decisions based on the evaluation of complicated, sometimes contradictory data.

But that was before Artificial Intelligence (AI) came along, stepping out of the pages of science fiction and into our daily lives. It now seems possible — even probable — machines will replace many mid-level knowledge workers and the question arises whether someday robots will replace doctors and nurses.

It’s a provocative question, certainly, but not the most interesting one facing our industry. A more critical question is will the healthcare ecosystem — the vendors and the solution providers — be able to survive without AI? I ask this because I believe doctors and healthcare administrators will increasingly demand answers to questions, and solutions to the challenges, that are difficult, if not impossible, to solve without the aid of AI-driven solutions.

These questions will range from practical issues of practice management to vital questions of patients’ health. For example:

  • How much will it cost to treat this patient?
  • How much and how fast will I get paid?
  • Is medication or surgery the best treatment option for this particular patient?
  • Where and/or when should I schedule this surgery?
  • When will this patient be able to return to his/her normal routine?

Some of these, of course, are the perennial questions that have always faced healthcare practitioners, but the truth is recent changes in technology have made innovative solutions possible in a way never before imaginable. For example, all kinds of data are now readily available in consumable (discrete) forms — from PHI to financials to protocols — and storing and managing this data is getting cheaper every day.

Additionally, healthcare providers are beginning to understand the shift from service to value-based care and are seeing how it can work for them, both clinically and financially. Finally, the healthcare practitioners themselves are changing: computer- and technology-savvy clinicians who got their medical education and training in the 1990s and early 2000s (the so-called Generation X and Y) are now entering into leadership positions where they can affect change.

In other words, there is both a greater supply of data than ever before and a greater demand for it. However, this demand isn’t simply for large data-dumps of undigested information. What’s necessary is for healthcare providers and administrators to have the critical data they need, and only the data they need, when and where and in the form they need it. This is where AI can help make critical decisions about amalgamating and filtering data.

There’s enormous potential for AI (or “smart solutions”) to optimize clinical protocols by drawing on a huge pool of evidence-based results. As we move toward a value-based environment, AI will be increasingly necessary to proactively and dynamically manage patient outcomes. This, in turn, will optimize the treatment experience, leading to greater patient engagement — and this greater continuity of care will promote both healthier patients and healthier practices. Clinicians will also gain insights into how to manage risks, which leads to lower costs and better margins.

Will robots replace healthcare providers? It seems unlikely, but care teams will start to leverage interpretive intelligence in daily clinical workflow. Machine learning, along with AI, will become an integral part of the healthcare mix because the vast resources of critical data will only be truly available when clinicians have tools to track real-time data embedded in their daily workflows resulting in better patient care at a lower cost.

As seen in Health IT Outcomes.

Whether Winemaking or Medicine…It’s All About the Outcome

vintner-blogAt first glance, winemaking and specialty medicine wouldn’t seem to have much in common—most obviously, one works with plants, and the other people. On top of that, the workflows are different—vintners can invest years in cultivating a particular vine or grape, but few doctors’ patients are willing to wait that long for results. And ultimately, their aims are different, too—the mark of a great winemaker is the ability to transform a good product into an exceptional one, while even the greatest doctor must be satisfied with simply restoring patients to a state of average, everyday health.

Yet during a recent vacation in Napa Valley with my daughter, who is now in the first stages of entering the field of medicine, the similarities between the two fields kept occurring to me.

For a start, as any med student has painfully learned, treating patients is a skill that takes years and years of training to perfect. The same is true of winemaking, which is one reason why it is so often a family concern that spans generations. (Admittedly, there’s a recent trend in celebrity wines, but it’s fair to say that behind every great celebrity wine stands an already established vintner or winery.)

At the same time, despite the extensive training in both fields, ultimately, both winemaking and medicine have always involved as much art as science. Of course, the role that science plays in modern medicine is undeniable, but most people are probably unaware of the enormity of the contribution made by science to winemaking.

Related to this is the fact that both are “callings” in the old-fashioned sense of the word. For the best winemakers and doctors, it’s more than a job or a career—it’s a passion.

And finally, success in both professions is rigorously tied to outcomes. No matter how deep their involvement in the process, if the vintner doesn’t at the end deliver up a superb wine, and the doctor a healthy patient, then they have failed.

Those parallels noted, it turns out that there is actually more overlap than you would expect between winemaking and medicine—as we toured various wineries, we discovered a couple of interesting figures who have been a part of both worlds.

Robert Sinskey was a cataract surgeon, an inventor, and a teacher who pioneered modern cataract and implant surgery, driving better results by devising new instruments. The Sinskey hook is likely the most widely used eye surgical instrument to this day. A similar passion led him to develop his winery in Napa Valley in the 1980s—one of the most beautiful and well-kept in the region. The Sinskey label appears on fine wine lists around the globe, and was one of my personal favorites from my trip.

Greg Lambrecht, an MIT graduate and inventor of innovative medical technology, is also the inventor of the Coravin, a remarkably useful invention that allows you to sample a glass of wine without having to open the bottle. Coravin uses a needle-through-the-cork system that siphons wine out without allowing any oxygen in, eliminating any risk of oxidation that would spoil the remainder. It turns out that a wine cork is similar to the subcutaneous implants used for chemotherapy treatments, and so the Coravin needle was based on one inserted through the implant to inject the chemo. With the Coravin, a thin needle is inserted through the foil and cork and the bottle is pressurized with argon, an inert gas that winemakers have used for years. The positive pressure of the argon allows the wine to flow out through the needle and into the glass without admitting any oxygen. When the needle is removed, the cork naturally reseals itself, and the remaining wine can continue to age. The Massachusetts-based Coravin, Inc. has now expanded from this invention to manufacture a range of products for the wine industry.

And if that wasn’t enough, it can’t be a coincidence that winemakers live longer lives. Dr. Sinskey lived into his 90s, as did Robert Mondavi, while Mondavi’s brother Peter outlasted him to the age of 104. Back in 1976, Mike Grgich’s 1973 Chateau Montelena Chardonnay shook up the wine world by winning the famed Judgment of Paris tasting—a group of mostly French judges ranked the California wine above some of Burgundy’s best. Grgich, who was born into a wine-making family in Croatia in 1923, was virtually a spring chicken at the time; he recently celebrated his 94th birthday.

And so, to all the physicians and medical professionals, and to all our exceptional winemakers—thank you for your passion, your skill, and your desire to enhance the status quo and deliver a higher level of your craft—a better outcome. Cheers!

Reimagining a Stable Future

stable-future-blog-v2HHS Secretary Tom Price, an orthopaedic surgeon, stated weeks ago that he wants to “reimagine” the federal department. I would humbly suggest—and hope—that one of the items he “reimagines” is the process by which policy is implemented as it relates healthcare technology.

Since 2011, the healthcare IT (HCIT) sector has been severely hampered by policy uncertainty. Each year, new guidelines and certification criteria are presented. These usually receive some negative reactions from healthcare providers, and then amended as the timelines extend or change. Many times, the policies have been changed a mere two months before their scheduled start date. For providers, the noise around these policy changes creates an environment in which uncertainty avoidance becomes a priority. That means retiring early, merging with a hospital or a larger group to share risks, putting off expansion plans and capital expenditures, and other strategies. For HCIT companies, it means not funding innovation and being forced to focusing on more and more functionality that customers do not value.

In macroeconomics the term “C bar” refers to “the autonomous real consumption expenditures by consumers but as it relates to their confidence.” In layman’s terms, it is the current outlook that consumers have towards the economy and their own financial situation. It reflects their level of confidence or lack thereof. A good level of confidence increases consumers’ likelihood to spend and borrow (otherwise known as their marginal propensity to consume). A poor level signals economic contraction is ahead. It is affected by many factors in our complex economy like housing prices, unemployment, and inflation. However, nothing affects confidence more than uncertainty! In general, when consumers sense they are not reasonably confident of what the future outcome of something will be, they pull back from the table and wait.

You can see evidence of this exact macroeconomic principle in healthcare today. I would venture a guess that if we tracked healthcare’s C bar, we would see that we are in negative territory and likely have been for years.

What we need is stability and a clear direction forward: setting policy and requirements early, providing sufficient time to implement changes, and then not surprising the industry with last-minute changes or corrections. Once confidence is restored, I believe that both providers and HCIT companies will experience a mini boom as all of the delayed investments and innovations work their way back into the sector.