The Top 5 Challenges for Orthopaedists

In a recent article featured on Becker’s Healthcare, 19,200 physicians representing over 27 unique specialties were surveyed on what the most challenging parts of their careers were.

Here are the top 5 challenges for orthopaedists:

The Top 6 Challenges for Orthopaedists

It is also interesting to note that “Despite challenges, 79 percent of orthopedists would choose a medical career again, and 95 percent would choose orthopedics again.”

Would you?

2018 MACRA (MIPS) Proposed Rule: The Abridged Version

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

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.

If You Build It, Will They Come?

Luis Marcos

Luis Marcos

Senior Operations Manager at SRS Health
Luis began his tenure with SRS-Health nearly 8 years ago as an Implementation Specialist. In that time, his attention to detail and planning garnered accolades from clients and colleagues alike, making him a star within the department. In 2015, he shifted his attention to organizational project management with an emphasis on operational efficiency while overseeing activities in Professional Services. His focus shifted in mid-2016 and he now oversees the activities of both the Support and Service Delivery Teams.
Luis Marcos

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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!

The Importance of Flexible Technology in High-Performance Practices

Adam Curran

Adam Curran

Product Marketing Manager at SRS Health
Adam Curran is a Product Marketing Manager at SRS. He oversees marketing intelligence to support the development of strategic marketing plans. Prior to joining the organization, he was a key member of a pharmaceutical software company’s Clinical Development Business Unit, specializing in the clinical data management elements of the drug development lifecycle. He was also the editor for their microsite’s blog. Adam has also held roles at the UK’s National Energy Foundation and Skills Funding Agency.
Adam Curran

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

Outcomes: It’s What’s Inside That Counts

Scott Ciccarelli

Scott Ciccarelli

CEO at SRS Health
Scott Ciccarelli, Chief Executive Officer at SRS, has more than 20 years of diverse management and operations experience garnered as a senior executive at GE, where he headed two of the company’s businesses—most recently, GE Healthcare’s Services, Ambulatory and Revenue Cycle Solutions. His areas of expertise include business strategy, leadership development, operational rigor (Lean Six Sigma), and the delivery of enhanced value for customers through quality improvement and innovation.
Scott Ciccarelli

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lightbulb-gears-blogTwo weeks ago, more than 40,000 people came together to network, share, and learn more about health data management at HIMSS17. As expected, we heard about the latest developments in top tech trends of tomorrow like artificial intelligence, data security and virtual care. One of the hottest discussion topics by this highly focused group was how to improve patient and practice health through meaningful and usable analytics. After much time listening to and participating in conversations on this critical subject matter, we are more committed than ever to helping our clients improve patient care through outcomes, and when it comes to outcomes, it’s what’s inside that counts.

What do I mean by that? This familiar phrase has been shared from generation to generation when describing what’s important about people. So how can these words of wisdom about humanity possibly apply to HCIT and outcomes for specialty medicine practices? It’s more appropriate than you might think…

In an ambulatory setting, specialist teams need the ability to analyze and make decisions within their HCIT ecosystem. They need insight within their workflow. They need to know how to deliver the best care at a lower cost. And the only way to do this in today’s data-driven world is by bringing insight and analytics inside their workflow. Not outside.

External solutions focus on providing isolated results rather than a holistic approach to patient and practice health. What’s an outside solution? It’s anything that requires you to offload data, thereby taking you out of the ecosphere. If that data is not contained in the ecosphere – if the information is not inside the workflow – these solutions are not actionable immediately.

We believe that the only way to achieve the best outcomes is through frictionless data solutions that provide actionable insights that net immediate, holistic results. Of course, too much data can be overwhelming, so how do we maximize data intelligence for specialists without disrupting the quality of patient care?

That very question is what led to the development of SRS EHR Smart Workflows®. We’ve replaced complexity with streamlined data relevancy in a way that helps provide the frictionless clinical experience of the future…today.

So while we continue to hear all about the amazing healthcare technologies that are on the horizon, let’s remember to turn our gaze inward. Because when it comes to best outcomes, the best solutions are about what is on the inside. Just like the best people.

The Year’s Innovations – Wrap-up & What’s to Come!

Khal Rai

Khal Rai

Senior Vice President, Development at SRS Health
Khal oversees the Software Engineering, Business Analysis, Quality Assurance, and Product Management teams at SRS. His 17+ years’ experience in software development and healthcare IT have resulted in a true passion for collaborating with customers, then translating their needs into innovative solutions and better service experiences. He believes that motivated employees and satisfied customers are keys to maintaining business success. He has a B.S. degree in Computer Engineering from the University of Cincinnati, and an M.S. degree in Electrical Engineering from Purdue University.
Khal Rai

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2017-lightbulbsDepending on your point of view, 2016 was either a year to remember, or one to forget—just look at the nominations for word of the year. Pundits have proposed everything from “surreal” (Merriam-Webster’s) to “post-truth” (Oxford Dictionaries) to “unhinged” (NPR’s books editor Petra Mayer). Which is just to say, it was a year when conventional expectations were overthrown. And 2017 promises to be just as full of surprises.

For all the uncertainty, though, some trends seem sure to continue, at least in healthcare. The movement toward value-based payment is unlikely to reverse itself, which means that the optimum long-term strategy for medical practices remains the same as last year—cut costs by increasing efficiency, maximize patient base by identifying and standardizing successful treatment approaches, and stay limber by not getting locked into a cumbersome, inflexible software system.

Over the years, we have worked closely with our clients to learn what they needed from us, and to gain the sort of specialty-specific expertise that ensures that our solutions are designed around our clients’ workflows, rather expecting them to tailor their workflows to our design.

This past year, however, has been particularly transformative. We have made a quantum leap forward by upgrading our EHR into something far more—an intelligent, data-focused solution that responds to today’s industry challenges and lays a solid but flexible groundwork for the future. It’s a unique, best-of-breed, specialty-focused approach that gives users the power to define and collect whatever data points are relevant to their success while still maintaining their preferred clinical workflow options.

What we have achieved so far – 2016 recap

We entered last year determined to expand our physician-centric approach to include all stakeholders in the outpatient healthcare delivery system. Because we put our clients’ requirements first, we had to take a fresh look at what their needs actually were in this changing landscape. The biggest need? Tools to capture the data they wanted, but only that data, without anything unnecessary that would distract from their primary focus. (Click here to read my other post about how we do data differently.) We realized that, to meet those needs, we had to transform our offering into more than just an EHR.

We achieved this by creating a  connected software system that lets practices distribute the data-collection process over the entire treatment encounter—before, during, and after the patient visit—in whatever way is most efficient and sensible for them. Here is what we have delivered:

  • Flexible Data Platform (FDP) – Discrete data collection and reporting, free from a forced template-based environment.
  • Smart Workflows (SWF) – Guided workflow to help practices optimize their daily schedules by letting them determine who does what best, where and when.
  • Patient engagement platform – A patient-portal solution that seamlessly engages the patient pre-visit. Success is measured by higher patient compliance, lower check-in costs to practices, and greater patient engagement in their own health post-patient visit.
  • Interoperability – An Application Program Interface (API) that allows for efficient data exchange between systems, and that gives practices the flexibility to choose the best solution to any given problem (e.g., clinical, financial) without sacrificing cost and/or productivity.

What’s next? – Even more data!

We have already laid the foundation for what is required today and tomorrow. The next step is to ensure that we maximize the value of what we offer by providing the following additions to fulfill our vision:

  • Regulatory compliance – Prepare clients to understand, comply, and succeed while retaining productivity and efficiency focus (e.g., MU / MIPS, AMC, PQRS reporting).
  • Outcomes – Invest in solutions and technologies to help practices drive, improve, and document clinical outcomes to improve patient care and increase reimbursements
  • Data and AI – Continue to optimize SRS’s recently released SWF and FDP solutions to leverage data and artificial intelligence to optimize clinical workflows.

We understand that no two practices are alike—they all have different rates and style of data collection. One practice may need to automate everything immediately, while another may only automate elements that will drive down costs, and decide to keep other processes manual. Our solution is designed with this level of flexibility in mind—to satisfy each practice’s requirements for today while having the functionality to support their evolving needs in the future.

Wrapping it up

The underlying SRS strategy is a physician-centric approach we call “practical innovation.” We are more than just a solutions vendor . . . we focus on finding a solution to the specific challenges facing specialists. We partner with practices to solve their actual business problems—we help them stay independent, drive revenue growth, lower costs, stay compliant with regulations, and demonstrate clinical quality.

If you’re looking for a partner who will really listen to you and understand your needs, who will help engage your patients and produce better clinical outcomes, who will keep your practice competitive in a changing environment, then SRS is your partner of choice—for today, and for whatever unpredictable tomorrow awaits us down the road.

The Final MACRA Rule: Free Pass or Risk-Free Opportunity

Lynn Scheps

Lynn Scheps

VP, Government Affairs & Consulting Services at SRS Health
Lynn Scheps is a leading resource on MACRA, MIPS, and Meaningful Use. She is the SRS liaison with government policy makers. Representing the voice of specialists and other high-performance physicians, she develops strategies to respond effectively to government initiatives.
Lynn Scheps

opportunity-ahead-blogCMS has given providers an early holiday present with the Final MACRA Rule, affording everyone the opportunity to easily avoid a penalty in 2019. This is surely reassuring news and has been widely received with a huge sigh of relief—but before you let your guard down, it is important to acknowledge that the program will build back up to an only slightly modified version of its originally proposed self, with many of the complexities and challenges intact. CMS is calling 2017—and to a lesser extent 2018—“transition years.” Treating them as such offers an opportunity to prepare for the future, while treating them as a free pass only delays the inevitable.

In 2017, eligible clinicians who participate in MIPS can protect their 2019 Medicare fee schedule by merely reporting any ONE of the following:

  • 1 quality measure, or
  • 1 Improvement Activity (formerly called Clinical Practice Improvement Activities), or
  • The 4 required Advancing Care Information (formerly Meaningful Use) measures.

Anyone who has participated in Meaningful Use and/or PQRS has already far exceeded these requirements, and will find this an extremely low bar. So why not aim for one of the more advanced “pick your pace” participation options and potentially benefit from an upward adjustment to your fee schedule? All it takes is reporting anything more than the above for a period of at least 90 days, and you could earn a “small” adjustment in 2019. Participate more fully—for anywhere from 90 days to a full year—and you could be eligible for the maximum, albeit “modest,” payment adjustment. (Note that it is performance that drives the payment adjustment, not the length of the reporting period.)

The downside of this new flexibility is that these “small” and “modest” adjustments for successful MIPS participants will now be very small or modest in 2019—far short of the originally planned 4%. Congress mandated that MACRA be budget neutral, so with dramatically fewer losers in 2017 to fund the gains of the winners, bonuses will be scaled down. Near-term financial rewards are unlikely to be a strong motivator of compliance this year.

However, by 2020, the difference between the most and least successful providers will exceed 18% (i.e., 2022 payment adjustments will range from -9% to +9% with potential additional bonuses available for the highest performers). So while it might be tempting to sit back and relax next year, consider using 2017 instead as it was intended—as a transition from MU and PQRS to MACRA. If you have been successful in the past, now is a good time to experiment with new workflows, new technologies, and/or alternate measures or reporting methods that might improve your performance. If you’ve never participated in these programs before, you can start now and get off the penalty track.

You can view the 2017 Final Rule as a free pass or as an opportunity—the choice is yours.