Recent Nobel-recipient Bob Dylan wrote “The Times They Are A-Changin’” in 1963—a time of growing social upheaval reflected in the song’s lyrics, which called for listeners to acknowledge and embrace the transformations taking place around them. As I listened to this song over the past weekend, I couldn’t help but draw a correlation to the radical transformations we are currently experiencing in our industry. The past several years have epitomized the term “change” as the nation has taken big steps to transform the delivery of healthcare.
The American Recovery and Reinvestment Act, signed in 2009 by President Barack Obama, was one of the catalysts for this transformation by requiring the “meaningful use” of digital systems in healthcare. Since then, change has been the only constant that we have been able to count on. Government regulations, payment models, and product innovations have continued to evolve in disruptive ways—both good and bad. As soon as we become comfortable with one wave of change, another wave is already threatening to drench us to the bone (for us, the next big one is MACRA & MIPS).
So, coming off nearly a decade of constant uncertainty, what’s next? Well, you guessed it—more change! Starting in 2017 we will have new policy leaders in place who have promised to significantly restructure the incumbent’s healthcare programs. President-elect Donald Trump’s appointment of Tom Price as the head of HHS may be indicative of the changes on the horizon. Price, a 6-term congressman from the Atlanta, Georgia, area, was formerly an orthopedic surgeon. Will a specialist at the helm help make government programs, that have typically been focused on primary and in-patient care, more meaningful for specialists?
Time will tell, but the one thing that is certain is that, as the song says, the wheel is still in spin. In other words, the times they are still a-changin’.
CMS 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.
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!
I love that our annual event is called the SRS User Summit – because this year, the news was so good that I wanted to shout it from the top of the tallest mountain! (Or, maybe sing it, but I’m no von Trapp family member…) Every member of the SRS team felt the same way. Thankfully, after hearing our big news, so did the clients who attended.
Here’s the shout-worthy news: SRS has completely transformed into an intelligent data-focused solutions provider. Our days of being a document management company are behind us. And rather than tweaking existing template-based systems as many of our competitors have chosen to do, we pioneered a specialist-oriented solution that simply doesn’t exist elsewhere. We have invented a new approach to data that is totally revolutionary – balancing speed, efficiency, data collection and sharing.
Why? Demands on medical practices have become even steeper, and the main path followed by other HCIT vendors won’t help specialists reach their goals. That’s why SRS is carving out new trails in order to provide the level of partnership that is needed today and tomorrow. Together, we will achieve:
- Better patient engagement
- Better clinical outcomes
- Better operational efficiency
I know that’s a lot to claim. That’s exactly why I was so excited to unveil the new SRS at the User Summit: because as someone with a high say/do ratio, I’m thrilled to say that we can back up every claim we are making! Here are a few examples of what’s available now, and what is coming soon:
- Patient Engagement Platform– streamline the registration process by enhancing the digital intake experience and reduce appointment “no shows” with automated reminders. Influence patient behavior through meaningful engagement in both pre and post visit by customizing patient forms to practice requirements, and leveraging patients to complete forms online before their appointment.
- Smart Workflows™ –our revolutionary patent pending Smart Workflows allow you to collect more data and quickly document patient encounters with customizable workflows, provide standardized care efficiently through protocols, drive compliance with regulatory and quality improvement initiatives, and demonstrate the value of your services through analytics and outcomes.
- Data Interoperability – capture then share discrete clinical data with other information systems across all parts of the healthcare network through the use of our APIs.
- Flexible Data Platform –capture the data you want, when you want, and how you want with our data capture platform. It empowers users to drill down and capture and report on any discrete data point that is truly relevant to them.
- Integrated Best of Breed – enjoy the seamless user experience of our tightly integrated healthcare IT ecosystem—including EHR, Practice Management, Patient Portal, and Transcription—each selected for their ability to serve high-performance specialists and to easily integrate with your practice’s other HCIT solutions.
- Patient Population – improve patient outcomes through tailored outreach campaigns that educate them post encounter, as well as setting up reminders and sending out surveys to collect more relevant data.
Of course, some things about SRS remain the same – and we promise, they won’t change! For example, we will continue to guide you through regulatory compliance, thanks to our own governmental Sherpa, Lynn Scheps, who has already dug into the 2,398 pages of the new MACRA rule released a week ago. Plus, the superb client service for which we are known will continue to be core to the SRS experience.
We understand that the future will continue to be an uphill climb. But with SRS by your side, you’ll have the right tools on the right paths. Now that is something to sing about!
I was recently fortunate enough to visit two Ritz-Carlton Hotels in the span of a few weeks followed by another premium hotel which I will refer to as Hotel B. If you have ever stayed at a Ritz, the following will come as no surprise, but they seem to read your mind at times. Sure, you are always greeted with a smile at any hotel and offered help with luggage or directions. What I’m referring to is how they anticipate your needs either through past experience or more importantly through listening to what you are not saying.
As an example, while departing Hotel B, my car was brought up, bags were put into the car and I was on my merry way. Whereas when leaving the Ritz, my car was brought up, bags were put into the car, but I was then asked where I was headed. I explained I was headed to San Diego while absently loading an address in my cell phone’s GPS app. Before I looked up, the valet had returned with water bottles stating that traffic could be rough this time of day and I might need them. Additionally he saw the route in my GPS, along with my vacation appropriate attire, and made a recommendation for an alternate route if I didn’t mind a more scenic drive with less traffic. It was this anticipation of needs that inspires guest loyalty, and commands a premium.
As I look around in the healthcare technology space, we must do a better job of anticipating our clients’ needs, rather than just reacting to what they are saying to us. The industry is suffering from a lack of satisfaction and companies are having a hard time standing out from the herd. Most are banking on their next big feature to be a differentiator that certainly has a powerful impact if it solves a particular problem. But without a firm understanding of their needs, it’s not going to resonate. Features will also come and go, requirements will morph, and regulations will change— and that’s due to the very nature of software and healthcare as a whole. I would argue, let’s make service the one thing clients can’t live without. Let’s stop simply listening to clients, and instead try to anticipate their needs and offer them solutions to problems they may not have verbalized yet.
After all, the features we offer are only as good as our fundamental understanding of their needs, spoken AND unspoken.
As I mentioned in my previous post, The Truth Is Stranger Than Friction, some physicians are so dissatisfied with their EHRs that they wish they could return to the days of paper charts. The main culprit is the data collection process, which causes friction between doctors and patients. I argued that workflows should, first of all, adapt to each doctor’s style so that doctors can concentrate on patients rather than technology, and, second, enable seamless data collection during patient interactions so that doctors don’t waste time recording data later. Traditionally, EHRs have been vendor-led in how they were built rather than being designed around how clients wanted to use them.
The role of an HCIT vendor is to understand its clients’ and prospects’ requirements. This step is often overlooked. We are seeing huge dissatisfaction in practices’ experiences with their current EHR solution. This can be seen with the impact these solutions have on the doctor-patient relationship; many practices have seen a reduction in the amount of face-to-face time with patients, as well as a decrease in the number of patients they can see.
According to a recent Medscape study, 45% of patients made complaints either occasionally or frequently about lack of eye contact, excessive questions, or providers focusing more on the equipment than the exam. On top of that, a recent article on Healthcare Scene reinforces that doctors are frustrated by using EHRs because they don’t match their workflows, feel clunky, and require too much time for documentation. The article goes on to say that these frustrations lead to both physician burnout and a decrease in EHR use.
However, is technology the culprit? No. I believe these problems are not a reflection on the technology. We see in other industries how technology has been optimized to improve business operations and improve customer satisfaction. I would argue that the fundamental problem with EHRs is a lack of understanding of what challenges practices face, and how to accommodate and plan for both today and tomorrow’s needs. This lack of understanding usually results in a poor implementation plan that is set up to fail from day one. Unfortunately, with the move toward a valued-based model, this misunderstanding is likely to cause even more problems.
What is needed is not only a way to capture and share relevant data, but a way to do this without disrupting the physician’s workflow. This is especially important for specialty practices with a high-volume of patients. Workflows should be personalized so they fit around the physician’s way of working rather than interfering with it, and a crucial part of this is cutting out the clutter and showing only relevant information as defined by the physician and practice.
Our team’s philosophy has always been to put the clients’ requirements first in everything we do. We work closely with clients to understand their workflow, and then we provide a solution that improves their operations in a way that makes sense to them. Our years of experience in providing best-of-breed specialty solutions to ambulatory practices has given us a strong appreciation of the importance of designing an agile solution that effectively handles a high-volume patient intake and put through while improving practices’ bottom line.
When it comes to data, we feel just as strongly, if not more so! We want to enable seamless data collection during patient interactions, so that doctors are not spending hours recording data later. We want to empower practices to determine who should capture the data they want, when and how they want, in the context of patient encounter. This means providing a flexible solution that is future-proof, leveraging mobile platforms and predictive technologies, while incorporating Outcomes and Analytics that not only keep up with busy specialists, but actually help move them forward.
That is what we mean by data done differently.