Enterprise Growth in the Ambulatory Space – The Benefits & Challenges

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

“Leadership is the challenge to be something more than average.” Jim Rohn

trees-growth-39281207_sEnterprise growth is an emerging trend in the ambulatory specialty space. The shift to a value-based market with an emphasis on quality rather than volume, together with associated pressures in the healthcare landscape, has fueled the consolidation of individual practices into super groups.

This trend was a predictive model and growth strategy for hospital systems as the shift to value-based care loomed on the horizon. Hospitals understood the need to grow by becoming better—leveraging cost, quality, and service advantages to attract key decision-makers as opposed to pursuing prior, price-extractive growth strategies that were driven purely by increasing size through acquisitions and expanded market share. (Advisory Board: Health System Growth Strategy for the Value-Based Market)

A similar shift is occurring with ambulatory specialty practices, which face challenges from declining reimbursement, increased costs, changes in government regulatory requirements with the advent of MACRA/MIPs, hospital system pressure and competition, and the shift from a fee-for-service model to value-based care. Physicians have realized that, in order to remain independent and profitable, they need to come together and create regional—and in some cases statewide—groups united under a common brand name and/or the formation of clinically integrated networks (CINs).

Enterprise growth empowers physicians to practice independently and compete with area hospitals and health systems. Enterprise specialty groups are a strong sustainable alternative to hospital employment and they support ancillary growth opportunities like ambulatory surgery centers (ASCs), urgent care, imaging, and physical therapy locations. They provide a platform from which to negotiate local/state/national contracts inclusive of malpractice premiums, and to direct employer opportunities. This bargaining power allows for a reduction in overhead together with an improved revenue stream. Enterprise groups also have the advantage of scale to tackle infrastructure and HCIT investments, improvements, customizations, and maintenance.

In any industry, growth through acquisition and consolidation brings challenges. It’s not easy to merge management, staff, locations, and office cultures—it requires strong leadership and governance. A unified community-facing brand, a shared growth strategy /approach, and the development of KPIs are key determinants of success. Performance metrics may include market share, geographic reach, patient growth vs. physician density, annual revenue by specialty, total cost of care, and outcomes quality. Other important considerations are developing an integrated approach for human resources, employment contracts, health and malpractice plans, purchasing/procurement, and Bundled Payments for Care Improvements (BPCI).

The emerging organization must keep the community it serves as its top priority as it transitions and the pieces come together. The main driver of enterprise growth—the need to demonstrate quality outcomes and low-cost episodic care—also serves as the attraction for referral sources within the surrounding medical community and their consumers, the patients.

Done well, the demonstration of quality outcomes will support a strong brand reputation, providing the necessary bargaining power needed with payers and employers. To accomplish this, many groups seek a common HCIT platform for patient engagement, regulatory compliance, and outcomes reporting. While this represents yet another change during a time of transition, the right HCIT partner is an integral part of the success of the organization. Other key considerations are the ability to integrate these solutions to drive a seamless experience for both the clinician and the patient. Equally important is that the HCIT solution participates in a collaborative dialogue regarding ongoing needs, and supports each individual specialist’s clinical workflow preferences and patient volume while providing reliable, dedicated, hands-on support.

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.

What We’re Grateful for—Our Clients!

Diane Beatini

Diane Beatini

Vice President, Sales at SRS Health
Diane Beatini is the Vice President of Sales. She oversees the Sales, Account Management, and Sales Operations teams. She works to promote the complete SRS product suite of HCIT solutions to medical practices of varied sizes and specialties. Diane’s background includes an MBA in marketing and finance with 15 years of executive sales and customer service management experience in the radiology, medical device, and pharmaceutical industries.
Diane Beatini

we-give-thanks

I joined the SRS Sales Management Team in 2012. One of the attractions to join the SRS Team was the corporate culture — an environment that fostered cross-functional communication, interdependency, and most importantly, client evangelism. At the time, SRS employees were referred to as ETPs, which is an acronym for Eager to Please. This attitude permeated the entire organization from the top down and is still present today. In fact, under our CEO Scott Ciccarelli, this founding principle has been taken a step further by involving the voice of the SRS client in our design and development process. Through our Client Advisory Board and User Centric Design Groups, our clients work with our development teams to provide valuable feedback, clinical insight, and recommended enhancements to our software. This process allows SRS to truly serve our clients as a business partner and ensure they are pleased as we release new innovations.

All of us at SRS are grateful for our clients, not only for their valued support, but for their invaluable feedback, which has allowed SRS to evolve from an expertise in transitioning high-volume specialty practices from paper into being a flexible, data-driven, full-HCIT-solutions partner. Through the voice of our clients, SRS continues to evolve, improve, and thrive!

So as Thanksgiving approaches, we would like to give thanks for our clients and recognize how much they have given back to the SRS Team throughout the year.

Our clients keep us human. Many of the departments within SRS are client-facing and work with clinicians and staff on a daily basis to answer questions, interpret government regulations, solve workflow issues, and support the SRS product suite. The SRS Account Management Team serves as a single point of contact and will often act as the advocate for the practice, ensuring all of their needs are met and they get the information they need without having to speak with several people. Through this consistent contact, we develop close working relationships with our clients and truly care about them, not only on a professional level, but on a personal level as well. Our clients keep us human when they share stories about the challenges and triumphs they face in their clinics and in their personal lives. These working relationships allow us to take pride in our work and feel a connection that makes our jobs more meaningful.

Our clients make us feel as if we are making a difference. It’s no secret that physicians and their clinical staff prefer to focus their efforts on their patients rather than on HCIT solutions. Our clients make us feel valued when they express excitement over our efforts to streamline a clinical workflow, develop and improve a form, or drive efficiencies through the creation of clinical protocols. As we improve their user experience and interaction with the software, we also feel as if we have helped to improve the doctor/patient experience.

Our clients advocate for us. The hallways at SRS corporate headquarters are lined with framed letters of recognition from clients. Most were written following the implementation and go-live process, and they recognize the dedicated Implementation Specialist assigned to the project who made everything come together—allowing for a smooth transition. Our clients have been, and continue to be, the best form of advertising for SRS, promoting their individual experiences and referring their colleagues and affiliates. This recognition is invaluable and allows us to grow and continue to innovate to support them.

For all that you do, we are forever grateful to the SRS client family and extend our best wishes to you and your families for a wonderful Thanksgiving holiday!

Sincerely,

Diane Beatini

MACRA News: CMS Yields to Pressure with “Pick Your Pace”

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

yieldAs everyone is in the midst of anxiously trying to prepare for MACRA while awaiting the Final Rule, (due November 1), CMS announced yesterday that it is stepping back the requirements and the timetable to make it easier for providers to avoid the 2019 negative payment adjustments set out in the Proposed Rule. This decision comes in the wake of 4,000 comments and subsequent pressure from professional groups and from Congressmen/women pleading for relief from the rushed implementation of a complex and overly aggressive set of requirements that would negatively impact many practices, particularly small groups.

Andy Slavitt, Acting Administrator of CMS, published a blog that gave an overview of the new options that allow providers to “pick their pace” of complying. It appears that the only way a provider would receive a negative adjustment in 2019 would be if they do almost nothing in 2017. He outlined 4 options for participation:

  1. Do something! Avoid a negative payment adjustment in 2019 by submitting some data in 2017. This begs the question: what constitutes “some data?” Does this mean some data in each MIPS category, some data in one category, quality data only? (To me, the wording in Slavitt’s blog is reminiscent of CMS’ past MU shift to “capability enabled” or “met for 1 patient”.)
  2. Report for a short reporting period (“a reduced number of days”) could qualify you for a “small” positive payment adjustment.
  3. Comply with MIPS as defined in the Proposed Rule—or I assume, as it will be defined in the Final Rule— for the full calendar year and you could qualify for a “modest” positive payment adjustment.
  4. Participate in MACRA’s Advanced Alternate Payment Model option. CMS is hinting that it may broaden the definition of an APM.

This news will no doubt be greeted with relief and cheers by most providers, but I wouldn’t be surprised if they are left feeling more uncertain now of what will be required in 2017 than they did before the announcement! What constitutes sufficient reporting in options 1 and 2 above? How many days are in a short reporting period—90 perhaps? How do the revised “small” and “modest” payment adjustments compare to the potential 4% proposed for 2017 and to each other? Will performance still be evaluated relative to other providers? And what happened to budget neutrality, i.e., where is this money coming from if hardly anyone will receive a negative adjustment?

Please let us know what you think of this latest MACRA news, and stay tuned as we learn more!

MIPS: 5 Things You Can Do Now to Prepare

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

5-things-mips-blogEven though the final MACRA rule is not expected until November 1, 2016, you would be well advised to start putting an action plan in place now. As proposed, the first performance year begins on January 1, 2017, a mere 2 months after the expected release of the Final Rule—you won’t have sufficient time to prepare if you wait until then. Yes, CMS has hinted about a possible delay or a shortened reporting period (in response to numerous concerns expressed in the 4,000 comments to the proposed rule), but you cannot bank on that until it is finalized. There are things you can do to start planning your strategy and improve your chances of success when this first regulatory foray into value-based payment begins:

  1. Focus on 2016 PQRS reporting: Quality reporting carries a 50% weighting next year, which makes it the most important of the 4 MIPs performance targets, (the others being Advancing Care Information, aka MU; Clinical Practice Improvement Activities; and Resource use, aka cost). Take advantage of the next 4 months to improve your quality measure workflow and reporting.
  1. Think about whether to report MIPS as individual physicians or as a group: It’s important to look at your practice’s current MU and PQRS performance as a predictor of which option might be more beneficial. You may already be reporting PQRS as a GPRO—success here makes a strong argument for reporting all categories as a group. (Remember, as proposed, you must report consistently across all 4 MIPS categories.)
  1. Develop workflows to support success: Identify the ACI patient engagement and health information exchange (HIE) measures that are of most interest or relevance to your practice. Analyze and try to enhance the workflows that support these measures. Ask your EHR vendor for a professional services evaluation—they may be able to offer assistance in this regard.
  1. Review the list of Clinical Practice Improvement Activities: Review the list provided in Table H of the Proposed Rule. Are there activities that fit your practice or possibly some that you were considering, even before MACRA?
  1. Evaluate your current technology resources: Is your EHR up to the job—or is it killing your productivity, particularly when you use it to meet the government requirements? If you are not satisfied, now is a good time implement new technology.

The most important step to take now and in the coming months is to keep yourself educated and up to date as the regulations evolve and the start date approaches, (But you clearly know that, since you’re reading this post!) On cms.gov, you will find Quality Payment Program Resources pages. You can also consult your professional societies/academies for specialty-specific guidance or reach out to your EHR vendor for training. I invite you to watch (or watch again) my webinar titled, “MACRA/MIPS: 962 Pages in 30 Minutes”, which is available on demand.

90-Day MU Reporting: Deja-Vu All Over Again!

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

flag-money-stethLast week, in keeping with what seems to have become a mid-year tradition, CMS issued a proposed rule that—amidst its 700-plus pages related to hospital payments—reduces the 2016 MU reporting period from the full calendar year to any 90 consecutive days. (Note that this applies only to providers participating in the Medicare, not Medicaid, EHR Incentive Program, and has no effect on PQRS reporting.) Would it have been better if the announcement had come in a more timely fashion—i.e., at the beginning of the year instead of the middle? Absolutely! But don’t let that keep you from taking advantage of this opportunity.

This is good news for providers who had given up on MU for 2016—or who got off to a slow start on the program this year. Here’s an opportunity to get back in the game and avoid the 2018 payment adjustment (3% or 4%, to be set at the discretion of the Secretary of HHS). It also provides a bit of a breather for those who are successfully demonstrating meaningful use and may be able to identify an already-completed 90-day period during which they met all the requirements. These providers can now turn their attention to preparing for MACRA, which is proposed to be effective on January 1 and in which MU (renamed “Advancing Care Information”) is only one of the four components.

So, what accounted for this change? Is it an indication of a kinder and gentler CMS to come? The CMS Fact Sheet states that CMS is trying to “assist health care providers by increasing flexibility in the program.” Was it in response to the deluge of comments to the MACRA rule that screamed “Help!,” or to the repeated requests for relief submitted by providers, organizations, and members of Congress? Let us know below what you think brought about this change of heart.