You Say You Want a Resolution…

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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resolutions-blogOK, I’ve taken some liberties with one of John Lennon’s most famous lyrics, but it’s the first blog post of the year, so I thought I’d need a little extra attention-getting power to break through the post-holiday fog. Chances are, only a few days ago you were pondering how you would implement change in your life in 2015. You may even have proclaimed those resolutions loudly and proudly as the ball dropped in Times Square. Seven days in, how well are your new year’s resolutions doing at becoming reality? I’ve kept mine so far . . . 😉

All kidding aside, we’re doing more than just hoping that the changes we want to effect at SRS will happen this year—we know they will happen, because we have a system in place to ensure that we keep our promises to ourselves and to others. It’s not complicated, and it’s something anyone can use at home or at work to help ensure that their “Say/Do Ratio” remains high. Simply, there are four key elements: communication, transparency, collaboration, and accountability.

Lose weight. Work out more. Eat better. Since health is always one of the top New Year’s resolutions, let’s start with that example. Experts say it takes 21 days to turn something into a habit, but why do some resolutions become habits while others become failed attempts? Because commitment must be systematized for maximum success. So if my resolution was to get to the gym three times each week, the first thing I’d do is communicate that goal . . . to everyone, not just to whomever happened to be around on New Year’s Eve. It’s easy to tell yourself something and then forget about it. By telling my whole support network—my family, my friends, my team at the office—my motivation to do what I said I’d do is increased immeasurably. In terms of transparency, I’d start posting somewhere (perhaps on Facebook) each time I worked out as a proof point. I’d collaborate with others by starting or joining a workout group, maybe even implementing some sort of competition within the group. Finally, I’d enable true accountability, empowering my supporters to check in on my progress.

At SRS, healthcare is our core focus—and so our corporate fitness is critical to helping our clients strengthen their productivity while remaining focused on the wellbeing of their patients. At our User Summit in October, we discovered what was most important to our customers and then we created a system of actionable initiatives to ensure that our promises become the change we all want to see. And we are doing it by following this same four-step system.

No matter what your resolution is, big or small, by supporting it systematically with these four key elements, you’ll do more than wish for something to be different . . . you’ll turn a resolution into a revolution.

Can You Satisfy the Government and Your Patients?

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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Never before have healthcare professionals operated in a time of such rapid technological blog-image-111714change—and faced the great uncertainty of today’s complex industry regulations. Unfortunately, it’s not a trend we see ending anytime soon. It’s getting harder and harder to even understand what the government is asking us to do, let alone satisfy those requirements. Does data collection have to mean data distraction—taking the focus off of what matters most to each physician: the patient?

At our annual User Summit last month, big data was the big topic of discussion. While our users recognize there can be very real benefits to elements of meaningful use, there is a lot of friction surrounding its integration into medical practices. It often feels like the data we are being asked to capture—the data that is supposed to make everything more productive—interferes with what we are trying to accomplish. Physicians can find themselves required to ask questions that make no sense, that take up valuable office visit time, and that possibly cast a little doubt in the patient’s eye. Where is the ROI on that?

Medical professionals need more, because that’s what MU is asking of them. HCIT companies have to provide more than technology—they have to provide expert guidance to help navigate the MU waters. Together, technology and expertise can help physicians satisfy government regulations while also achieving their industry and business goals. From strategic planning through product execution, we must provide more predictable solutions. This goes beyond “certified solutions”—this is about creating working solutions that allow medical professionals to be compliant without interfering with their practice goals.

It all comes down to ECR: Efficiency . . . Care . . . and Revenue. The right HCIT solutions will:

  • create efficiencies, allowing doctors to spend more time with more patients;
  • improve care, providing flexible solutions that don’t interfere with the doctor–patient relationship; and
  • increase revenue, helping doctors earn more by reducing malpractice risk and insurance, creating additional revenue streams, and more.

We heard it loud and clear at our User Summit: increased data requirements cannot be accomplished at the expense of patient care. EHR solutions aren’t real solutions if they slow you down—they have to capture data with minimum interference while ensuring maximum productivity.

At SRS we’re working even harder to help our clients navigate government and industry demands and translate them into meaningful products that will satisfy more than MU: they’ll satisfy your patients. And they’ll satisfy you.

Client Satisfaction Isn’t a Noun

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

Latest posts by Scott Ciccarelli (see all)

People talk about client satisfaction as if it were a static thing—something that never blog-101314progresses or evolves. I believe the “action” in satisfaction means we must continually measure it and make adjustments as necessary. Our world is constantly changing; what made a customer happy three months ago may have nothing to do with his or her needs today. We must check in on a regular basis through a variety of channels in order to create a multi-dimensional living model of what our clients really want. Only then can we understand whether we are truly satisfying our customers. In order for any company to innovate, they must know what is important to clients today—as well as have a sense of what will be important tomorrow. Insights are discovered in many ways, and I believe we should use a variety of tools to determine the most accurate picture. Here are a few:

  • Industry Events – Be present to check the pulse of your industry, hear about issues and trends, and speak to others as an authority and a colleague. Events are already in place for these purposes, so get out there and learn.
  • Focus Groups – Drill down to specific insights that allow you to ask new questions and test ideas that may not yet be ready for a larger forum. Modern focus groups can provide nearly instantaneous feedback and insights at a very reasonable cost, so consider upping the frequency.
  • Social Media – Sometimes it’s the informal comment or question that can trigger a breakthrough innovation. Social media can be the next best thing to actually talking with clients—and sometimes even better, since it gives people a place to share their thoughts in real time.

If you’re really committed to knowing (instead of assuming) what your customers are thinking, why not create a whole experience dedicated to discovering just that? Right now I’m at our annual User Summit, where my team and I will be spending three days with our clients, listening to what only they can tell us. This is the ultimate forum for the pursuit of knowledge, and we look forward to learning how to continue to evolve our company to best serve our customers. Each customer interaction reveals different insights; enabling and acting upon that ongoing dialog is what we consider to be the action in customer satisfaction. It’s what allows us to innovate with purpose. The most significant question our clients ask right now is, “How can I successfully meet government requirements and achieve my practice’s goals without having to sacrifice one to serve the other?” I’ll be sharing more about our answer to that in my next blog post, so stay tuned . . .

How Much More Evidence Does CMS Need?

I was glad to see that CMS was concerned enough about the 17% meaningful use dropout rate to do some research into this rather alarming statistic. Some of what they discovered lends credence to the arguments put forth in the large—and growing—number of recent letters from stakeholder organizations suggesting that the meaningful use train is simply moving too fast.

In a recent presentation, CMS accounted for half of the non-returning providers as follows: 5% retired, 17% switched to a practice without an EHR, and 28% claimed to have simply forgotten or missed the deadline to attest.

The remaining 50% of the non-returners cited a number of reasons—some identifying more than one—that are quite revealing and can only lead to future falloffs in participation. The reasons given are presented in the CMS chart below:

How Much More Evidence Does CMS Need?

What more evidence do we need that physicians simply find meaningful use too complex, too time-consuming, and too costly? And that is only their assessment of Stage 1. Many of the non-returners were unable to meet one or more Stage 1 objectives, yet many Stage 2 measures will be considerably more challenging—for reasons other than increased thresholds. The Stage 1 menu measures that had the highest exclusion or deferral rates—i.e., the measures that most physicians did not select because they considered them to be most difficult—become required core measures in Stage 2. Compounding that challenge is the addition of totally new measures related to interoperability and patient engagement, all of which will require completely new workflows, staff training, and massive patient-education efforts.

Given the experience to date, the associated explanations provided by physicians, and the volume and passion of the requests pleading for some relief—from the burden of the requirements and from the impending penalties—some flexibility is clearly called for. How about at least backing off from the all-or-nothing requirement? Doesn’t it make sense for the long-term success of the EHR Incentive Program to offer physicians some flexibility at this critical juncture?

The Meaningful Use Train is Simply Moving Too Fast

The Meaningful Use Train is Simply Moving Too FastAs 2014 draws closer and the realities of meaningful use Stage 2 set in, many stakeholders are experiencing an increasing and justifiable level of anxiety about the consequences of a program that is advancing too rapidly. Following on the heels of the letter from a group of senators to the secretary of HHS that suggested a “pause” in the meaningful use program, there has been a recent avalanche of pleadings for a delay of Stage 2. These have come from such venerable groups as the AMA and AHA, MGMA, AAFP, HIMSS (the Healthcare IT industry organization), and CHIME (College of Healthcare Information Management Executives), all of which represent sizeable and varied constituencies.

The proposals offer a range of suggestions, and their solutions vary in scope and complexity, but the message is clear, consistent, and undeniable: the meaningful use train is simply moving too fast, and the future success of the program depends on an application of the brakes.

Recommendations include variations on the following:

  • Delay the start of Stage 2.
  • Expand the period for Stage 2 compliance (attestation) by up to a year.
  • Suspend the penalties, at least for those physicians who have successfully attested to Stage 1.
  • Add some needed flexibility by relaxing the “all or nothing” requirements for demonstrating meaningful use.
  • Extend the schedule so that physicians have 3 years at each stage before moving to the next.

Some lay the blame on the EHR vendors, citing lack of preparedness. To some extent they are correct—the certification website reveals that only 15 complete ambulatory EHRs from 12 different vendors have been certified for 2014 and Stage 2 so far—that’s just 3% of the 472 EHRs that were available to physicians in Stage 1. While some physicians will be left without a certified EHR in 2014, it is likely that the remaining major vendors will manage to get their EHRs certified by the end of the year. The fact remains, however, that more time before deployment can only improve the (sorely lacking) usability of the final products. One only has to look at the low average KLAS scores—now in the mid-70s—to appreciate the effects of rushed software development and implementation. Without a relaxing of the timeline, many physicians will be left with EHRs that are certified, but unusable.

The EHR Incentive Program is suffering, and its long-term success is at stake. A full 17% of the physicians who attested for the first year of Stage 1 failed to attest for the second incentive payment. (See “Alarming Fact” EMR Straight Talk post.) They simply could not sustain the use of their certified EHR—with which they were already familiar—for a full year of compliance with the complex rules of meaningful use—with which they were also already familiar. Unless we stop and evaluate why this is happening and make the necessary adjustments, the dropout rate is guaranteed to rise with Stage 2.

We have to stop and assess where we are trying to go in light of where we are now. Stage 3 is hurtling toward the final proposal without the benefit of any experience in Stage 2. The measure of the program’s success cannot continue to be the number of dollars paid in incentives, but should rather be providers’ satisfaction with the EHRs that they have been encouraged to adopt.

 

17% Meaningful Use Dropout Rate—Just the Tip of the Iceberg

17% Meaningful Use Dropout Rate—Just the Tip of the Iceberg

My last EMR Straight Talk post, which addressed the alarming 17% meaningful use dropout rate, generated many comments and resulted in several subsequent media interviews. While CMS has acknowledged the facts regarding this program failure, it does not acknowledge the gravity of the implications for the future of the program. According to a Bloomberg News article, CMS attributes the fallout to many of the same reasons that I have identified from the outset—program complexity, lack of fit with specialty practices, cost, dissatisfaction with EHRs, and inability to meet the meaningful use requirements.

To evaluate the program’s future, it is necessary to understand why physicians participate in meaningful use to begin with, and what their motivation would be to continue to participate once they have purchased a certified EHR and recouped $18,000 of its cost. A simple financial analysis begs the question: Why would physicians do dramatically more work for significantly less money?

One only has to look at the math to predict the future. As the table below illustrates, the financial value of the incentives drops by a factor of 10 at the same time that the program requirements increase precipitously. If 17% of physicians abandoned the program when the incentives fell from $6,000 to $1,000 per month of meaningful use effort, what should we realistically expect to happen when the incentives drop even further and the complexity increases?

Total $ Value of Participating in the EHR Incentive Program


*Estimate based on annual Medicare revenue of $300,000. Penalty = 1% in 2015, 2% in 2016

I am certainly not saying that physicians are only motivated by money—of course they want to do the right thing and provide the best possible care for their patients. And shunning meaningful use does not preclude them from leveraging their certified EHRs to exchange clinical data with other providers. But physicians have been quite outspoken about their concerns from the beginning, expressing their perception of the program as overly burdensome, wasteful, and distracting from their mission to provide that care. Now, the evidence is in—they are not just speaking, but they are walking. Clearly, to ensure the ongoing success of meaningful use, the government must fundamentally reduce the program’s complexity.