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.

 

The True Cost of Patient Registration Errors

The true cost of patient registration is hard to analyze because most providers and hospitals have convinced themselves they need to handle patient registration, instead of the patient handling it themselves. Therefore, the cost for patient registration can’t be improved and constantly increases based on new industry standards, such as meaningful use questions and ever-increasing staff costs. The result of this attitude and approach is that patient registration often takes more time than necessary. If the patient is unable to control his or her data during the registration process, lengthy wait times and increased dissatisfaction occur—costing providers both time and money.

Patients, on average, spend about 20 minutes in waiting rooms of healthcare organizations. When these organizations don’t focus on streamlining the patient check-in process, patient throughput suffers. Staffing expenses increase because staff must take time to clarify patient data or fill in missing pieces at the point of service. In addition, the potential for denied claims is higher due to a lack of data verification, raising overall collection costs.Impatiently-Waiting

Today, just 5 to 10 percent of healthcare organizations offer self-service solutions for patient registration and check-in. This is a missed opportunity to improve patient satisfaction, reduce costs and increase revenue. There are three benefits of self-service check-in technologies healthcare leaders should consider.

Speed. At Montgomery Cancer Center in Montgomery, Alabama, an electronic patient check-in solution decreased patient check-in time to just 41 seconds. Putting the registration process in the hands of patients not only provides them with the ability to manage their experience, but also limits check-in time simply by eliminating a visit to the front desk. This increases patient throughput and ensures that the time staff does spend with patients is of higher value.

Consider the airport registration process. When passengers fly, the last place they want to go to is a desk staffed by an airline employee. Instead, the first stop is to a kiosk or a mobile application with built-in technology that recognizes individuals with the touch of a few buttons, thanks to information they have been able to input in advance.

The experience in most hospitals and physician practices is often the opposite. Patient check-in is heavily dependent on staff—and breakdowns in processes occur when staff call in sick. They also occur when staff follow the same steps for each patient rather than customizing the registration process to the patient’s situation and needs. This increases the potential for error, which can lead to lost revenue.

Some hospitals and physician practices have tried to automate the registration process with the use of tablets rather than self-service platforms that verify data in real-time. However, this approach has critical flaws. For example, to receive a tablet, patients must go to the front desk, just as with traditional, manual processes, and any front-desk encounter adds time to the visit and costs hospitals and physician practices money. Every patient visit to the front-desk is an incremental cost for the hospital or physician.

Patient experience. Why is it that patients spend more time in the front office than with their physician or a nurse? It’s because front-office processes are broken. When patients spend more time than necessary dealing with a provider’s front-office processes and staff, satisfaction plummets—and there is a cost to lost patient loyalty.

One of the biggest misconceptions in healthcare is that front-office staff in physician practices and hospitals provide a personal touch to the patient encounter. But think about what this encounter typically looks like: “We have a few questions we need you to answer. Here is your paperwork [or tablet]. Please return this with your insurance card and driver’s license …” Is this really the personal touch we’re seeking to provide in healthcare?

Meanwhile, patients complain about the amount of paperwork they must complete before being seen by a physician. The personal touch they want is time spent with their physician. Anything that impedes their ability to see their physician impacts their experience.

Ideally, patients should spend two minutes or less on registration activities when they arrive for their appointment. While the amount of time spent at check in will vary by specialty, look for a self-service check-in solution that can ensure a two-minutes-or-less process.

Improved communication. So often in healthcare, it appears no one has time to truly talk with patients. Front-desk staff don’t always have the experience or time to have a meaningful conversation with patients. Nurses and technicians are under too much pressure to move patients through processes quickly. When the patient does see a physician, the backlog of patients—stemming in part from inefficient check-in processes—limits time for a meaningful encounter beyond the reason for the visit at hand.

Yet studies consistently show that the quality of patient communication has a direct impact on patient satisfaction. Effective communication is critical to the patient experience, which is now measured and tied to value-based payments. It’s also vital to understanding the patient’s total health needs and managing the patient’s health beyond a single episode of care.

A self-service check-in process opens the door to more meaningful communication with patients not just by freeing up staff time, but also by improving throughput. For example, nurses and physicians are better able to share information about additional services the patient may wish to consider. Staff can then augment these conversations by providing patients with brochures that offer greater detail about these services. Staff time also can be spent on patient follow up, making sure discharge instructions are clear and future appointments are scheduled.

Additionally, a self-service check-in solution offers real-time authentication of data and the opportunity to survey patients. Communicating financial information to patients can’t be done through the current paper process; however, when a patient uses a digital check-in solution, their data can be immediately authenticated, which allows for immediate communication of copays and remaining deductibles. Patients can also relate their experience with a staff member or physician in a post-office visit survey to actively share their suggestions for practice improvement. Not only do patients feel listened to, but their suggestions also help providers increase satisfaction and value.

Reengineering the patient registration experience is critical to eliminating front-office errors and delays that cost healthcare organizations money. It’s also essential to creating a more positive experience for patients as well as staff—a key step toward improving value.

 

gerard-white-clearwaveSRS Health guest blogger: Gerard White, President & CEO of Clearwave

With 20 years of technology leadership experience, Mr. White is responsible for successfully implementing the Clearwave Corporation vision and strategy. Mr. White co-founded the company in 2004 to carry out a vision of technology that spans the healthcare continuum through the creation of a healthcare network and a single patient identifier that allows accurate patient data to be shared regardless of what provider a patient visits.

Mr. White has extensive experience working with some of the most respected companies in the world including EDS, Security Mutual, Saturn, Lennox Industries, Continental Airlines, GTE, Alltel, Hitachi, Grant Thornton and Blue Cross Blue Shield. Both his knowledge and leadership experience provide a solid groundwork for Clearwave Corporation’s active role in revolutionizing the healthcare industry.

Prior to joining Clearwave, Mr. White was the CEO of 1stOrder, focusing on IT consulting services and wireless application development. He holds a Bachelor of Science degree in Business Management and a Bachelor of Applied Science degree in Information Systems.

If You Build It, Will They Come?

Let’s take a moment and talk about the ideal development-to-adoption scenario. For the sake of the exercise, you’re Kevin Costner. You hear a whisper about building it. You continue to explore what it is until you realize that you have been asked to build a baseball field. Through hard work and perseverance, the request becomes reality. In no time at all, ghost baseball players emerge from behind corn stalks and play a game.

That right there folks, is the dream of every software developer. They aspire to build what you need and then have you faithfully use their creation. Alas, like Field of Dreams (beautiful film), that aspiration typically falls under the genre of fantasy.

How can that be? Why wouldn’t a user take advantage of an enhancement to their software? Truth be told, there are number of reasons as to why, including, but not limited to:

  1. Lack of awareness.
  2. Aversion to change.
  3. The functionality doesn’t meet your exact needs.
  4. The perceived effort of deploying the change outweighs the benefit.

As an end user, you should want and need to maximize the feature set that your software has to offer. Why is this so important? In the graphic below, I have listed only a few of the ways that software enhancements can impact the bottom-line.

improved-bottom-line-700px

As I challenge myself to seamlessly interject concepts from other cherished feature films, this is where I say, “Help me, help you!” When it comes to your software, aspire to A.C.E. the experience.

Accountability: Appoint an Internal Software Administrator (ISA). This person would be responsible for forging a relationship with your software vendor(s). They need to be familiar with the vendor’s release cycle and understand what each new version has to offer. They would then be responsible for scheduling recurring meetings with key stakeholders to discuss their findings and recommendations. They should also volunteer to participate in any focus groups that your vendor may offer. This is a great way to ensure that your vendor understands the specific needs of your organization and how they fit into the big picture.

Collaboration:  Who are these “key stakeholders” that I mentioned above? They would be your Change Control Board (CCB). This group should be comprised of members of each functional department of your business, as changes may have ripple effects throughout the organization. Affecting change is often easier when the decision is made jointly as initial buy-in will be stronger.

Execute: Assuming the CCB finds value in certain enhancements, develop a plan to implement them. This will often involve initial training, shadowing and follow-up that could span a few weeks. Remember that each implemented change is a deviation to someone’s routine. Depending on the work flow adjustment required, a fair degree of staff coaching may be involved.

In fairness, I realize that I’m making all of this sound really easy. It’s work and it requires commitment. Alas, if it means that you can add to your bottom-line, become more efficient or play a round of catch with “Shoeless” Joe Jackson, it is worth exploring.

Now go A.C.E. your experience!

You Say You Want a Revolution…

This past February, SRS Health sponsored its third annual hackathon. Hackathons are the proving grounds for new ideas. These events stimulate creativity and encourage risk-taking to develop innovative solutions to new or persistent problems.Hackathon Blog ImageThis year’s hackathon was organized around the theme of Data Revolution, and when you think about it, there’s a revolutionary quality to the very idea of hackathons. The word “hackathon” is a portmanteau of the words “hack” and “marathon,” where “hack” is used in the sense of exploratory programming. It’s this exploratory aspect of hackathons that enables participants to be super creative, push boundaries, think outside-of-the-box and develop revolutionary ideas. We solicit ideas from customers and SRSers that can range from practical enhancements to futuristic solutions for tomorrow’s problems.

At SRS Health, we’ve noticed some strong benefits to running hackathons:

  • Feedback – If our product is going to help solve your problems, we need to know what those problems are. Hackathons allow us to discover problems and explore solutions.
  • Engagement – Hackathons build team and community spirit. Participants have fun, and they get a chance to collaborate with others with whom they don’t typically work with on a daily basis.
  • Diversity – Having a wide range of participants generates a variety of fresh perspectives, both on existing problems and for future possibilities.

The result? An event filled with fun, high-energy, free food, great ideas, engaging presentations and amazingly talented people. There are a number of concepts that we are very excited about and could make its way into future editions of our products.

So, if you have a revolutionary idea that you’d like to see become part of our product—or even just an evolutionary step that fixes a chronic problem—let us know about it. It may be the perfect candidate for our next hackathon. The truth is, we all want to change the world of healthcare, and we’d love to explore and define that future together with you!

 

 

 

The Importance of Flexible Technology in High-Performance Practices

flexible-tech-blogAn article posted recently to LinkedIn—about the jobs most and least likely to fall victim to robot replacements—started me thinking about the place of technology in healthcare. One takeaway from the article is that automation is best deployed for tasks that are manually or cognitively repetitive, freeing humans to specialize in tasks that are non-repetitive and non-predictable, ones the writer describes as requiring “human intuition, reasoning, empathy and emotion.”[1]

That was exactly the promise of electronic health record (EHR) technology—routine bureaucratic tasks would be automated, freeing doctors and staff to do what they do best: treat patients. Yet in a recent study published in the Annals of Internal Medicine, ambulatory physicians spent an average of a full hour at the computer for every hour they spent face to face with patients.[2] Imagine automating a factory and discovering that workers now worked twice as long, or produced half as much, because of the time required by the new technology that was supposed to reduce their workload.

Paradoxically, with recent advances in technology, it is now more possible than ever for EHRs to fulfill their original promise—and more; the problem is that most of the EHRs being offered to medical practices are simply the wrong technology. In an attempt to meet standardized government regulations, vendors have created standardized EHRs—gigantic, one-size-fits-all behemoths that attempt to meet the needs of all physicians, but end up missing the mark with nearly everyone. Particularly when it comes to specialists. KLAS’ Ambulatory Specialty 2016—One Size Does Not Fit All—Performance Report found that although traditional EHR vendors try to cover all specialties, fields like ophthalmology, orthopedics, and dermatology still lack the functionality required.[3]

This is why one size definitely does not fit all. The right EHR solution for a hospital or general practitioner, seeing a limited number of patents with a wide variety of conditions, will look quite different from the EHR for specialists who see a high volume of patents with similar complaints. And of course, different specialties won’t want exactly the same EHR, either, making flexibility—rather than universal applicability—a major prerequisite.

No wonder that 86% of specialists, according to Black Book Market Research, agree that the single biggest trend in technology replacements these days is the move to specialty-driven EHRs because of the workflow and productivity complications that accompany conventional, template-driven EHRs.[4]

Unfortunately, the problems with inflexible, template-driven EHRs don’t end with the lack of specialty-specific solutions. A secondary, but still significant, concern is the inability of many EHRs to be tailored to the need of individual physicians within the practice. One doctor may prefer taking notes, another inputs her own data, while a third dictates; one may be comfortable communicating through a patent portal, another prefers the phone. True flexibility means that no provider has to change the way that he or she has been practicing medicine simply to satisfy the demands of a generic template.

It also means that, when it comes to increasingly crucial matter of data collection, the decision about how data should be collected—what should be collected electronically and which should remain manual—is left up to the individual practice. In the next blog, I will look at what is called “role-based data entry,” and how this can increase productivity and cut costs.


 

[1] https://www.linkedin.com/pulse/5-jobs-robots-take-first-shelly-palmer

[2] http://annals.org/article.aspx?articleid=2546704

[3] Ambulatory Specialty 2016—One Size Does Not Fit All—Performance Report. KLAS. April 2016.

[4] https://blackbookmarketresearch.newswire.com/news/specialty-driven-ehrs-make-a-comeback-reveals-2016-black-book-11534546

Hot Topics for Orthopaedics

SRS Health attends the annual OrthoForums and AAOS meetings as a way of remaining in sync with the topics that are top of mind for our clients. As an HCIT solutions partner, we are continually striving to provide our clients with relevant solutions, training, and advice on resources so that they can meet challenges head on while remaining productive and focused on the practice of medicine. The forums and academy meetings provide us with additional insight outside of our day-to-day interactions, and often serve as springboards for our collaborative efforts.

This year, the prominent topics in the orthopaedic community include:

  • prescription safety
  • data mining/outcomes;
  • cost reduction/operational efficiencies; and
  • MACRA/ MIPs readiness.

Prescription safety has gained increased focus as numerous studies and reports focus on the increased use and abuse of opioids. As a result, individual states are beginning to enact laws addressing the prescribing of controlled substances. Electronic prescribing of controlled substances (EPCS) is currently legal in all 50 states. New York State was the first to pass mandatory I-Stop legislation requiring ePrescribing of all drugs, with stringent identity authentication requirements for controlled substances as of March 27, 2016. Maine has followed suit with the Act to Prevent Opiate Abuse by Strengthening the Controlled Substances Prescription Monitoring Program, requiring prescriber participation in the Prescription Monitoring Program and setting limits for the strength and duration of opioid prescriptions, beginning January 2017. The law also called for prescribers to undergo addiction training every two years. On February 23, 2017, New Jersey issued a bulletin regarding State Opioid Prescribing Information, alerting prescribers to components of a law governing opioid prescribing that takes effect in May. Minnesota also has a similar CDS law on its books, although not as strictly enforced. The expectation is that stringent monitoring will only become more prevalent, with mandatory requirements that will include patient education. As a result, many providers have voluntarily adopted EPCS practices, and the American Academy of Orthopaedic Surgeons has created a multimedia public service campaign, including display and radio ads, urging physicians and patients to exercise caution in prescribing and taking opioids.Painkillers Campaign Image2

As we embrace the value-based payment model, data mining and patient-reported outcomes are top of mind. The critical piece to the puzzle is the ability to collect and report on pertinent and meaningful data to demonstrate improved outcomes. Many physicians are currently considering the selection of an outcomes solution to integrate within their existing HCIT ecosystem. There is no firm consensus across the orthopaedic space of what constitutes full outcomes data requirements, and many are focused on choosing an optimal solution that delivers minimal PRO requirements—i.e., HOOS (Hip disability and Osteoarthritis Outcome Scores) and KOOS (Knee injury & Osteoarthritis Outcome Scores)—at the right price point.

As the payment model shifts and practices are faced with additional reporting complexities, the ability to drive operational efficiency and reduce costs is a critical focus. Integral to all related topics—prescription safety and the ability to demonstrate outcomes, drive down operating costs and meet regulatory requirements under MACRA/MIPs—is the ability to streamline the patient intake process, satisfy the VDT, meet secure messaging requirements, and integrate patient reported data through a quality patient-portal solution. Core functional capabilities such as ease of use and access; ability to request appointments; facilitated patient communication through notifications; integration of patient information within the EHR; and the enabling of secure messaging/exchange allow orthopaedic practices to reduce the time and resources devoted to patient intake and data input, as well as to limit appointment cancellations and/or no shows. Adoption of a patient-engagement solution supports 20 points under MIPs in 2017 and up to 40 points in 2018 with the addition of patient education. The portal also becomes a critical focal point to enhancing patient care through an ongoing dialogue and supporting patient education.

MACRA/MIPs readiness and the assurance that the EHR software employed by the practice will be 2015 certified is also a topic of interest as the marketplace continues to consolidate and EHR solutions sunset. At the outset of the MU program formulated through the HITECH Act of the American Recovery and Reinvestment Act (also known as the 2009 Economic Stimulus Plan), there were over 500 EHR solutions vendors. Today there are fewer than 300, with continued consolidation expected as companies decide whether to further invest and develop to the 2015 certification requirements. Practices should have regular dialogue with their HCIT solutions vendors regarding their investment and plans to certify; and also the availability of MACRA/MIPs training programs to support their regulatory goals.

Your First MACRA Decision: AAPM or MIPS?

Clinicians have two options for MACRA participation—an Advanced Alternate Payment Model (AAPM) or the Merit-Based Incentive Payment System (MIPS).MACRAs-2-Tracks-final

CMS has structured MACRA to encourage AAPM participation, offering clinicians a 5% lump-sum bonus on top of a share in the savings achieved by the organization. The following questions will help you determine whether you qualify for the AAPM option: 

  • Do you participate in an APM? (An ACO or other risk-based healthcare delivery program?)
  • Is your APM an AAPM? The APMs identified in the image above qualify as AAPMs by virtue of the fact that:
    • the hospital and the clinicians use certified EHR technology,
    • the organization bears both upside and downside financial risk, and
    • the providers report quality measures.

NOTE: The CMS CJR (Comprehensive Care for Joint Replacement) program is now considered an AAPM. (According to the CMS Fact Sheet, this program was recently added to the list of 2017 AAPMs.)

  • Do you meet the participation volume thresholds, i.e., do you derive 25% of your Medicare revenue or see 20% of your Medicare patients through one of these channels?

If the answer to all the questions above is “Yes,” you may be a QP (qualified participant) in an AAPM. Talk to the organization’s sponsor (typically a hospital) about your participation in MACRA.

If the answer is “No,” to all, or some, of these questions, your route to MACRA success will be via MIPS, or a MIPS APM, respectively.

For more information about MIPS and MIPS APMs, see the CMS QPP website or contact me at SRS Health. I also invite you to watch (or watch again) my webinar titled, “MACRA/MIPS: The Future Starts Now.”