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From the Consultant’s Corner 8/25/16

August 25, 2016 News No Comments

Mitigating Revenue Risk During IT Implementation

From small practices to large integrated delivery networks, the ability to evaluate and select the appropriate IT applications is increasingly important. A number of drivers are pushing healthcare organizations to look critically at their IT vendor mix, especially their revenue cycle applications, including clinical integration initiatives (and the need to extend clinical and business applications to affiliates), the shift to value-based reimbursement, competitive merger and acquisition activity, and vendor market consolidation.

No matter the reason, developing a strategy to mitigate disruption to cash flow is a crucial component of any billing system or EHR implementation. The potential risk to revenue is no less an issue for private practices than for IDNs, yet, too often organizations devise their plans to protect revenue after the vendor selection has been completed and contracted. A better option is to address your Risk to Revenue Mitigation Strategy as part of the vendor selection and contract negotiation processes.

For example, practices should include both implementation staffing needs and ongoing staffing demands (i.e., for application maintenance and user support) in their “total cost of ownership” analysis. Keep in mind that, although most vendors have pre-defined implementation approaches that include helpful standard workflows and staffing structures, these vendor-defined best practices may not adequately address an individual practice’s unique workflow or business requirements. Organizations with a single billing office, for instance, will have vastly different workflows and training requirements than those with decentralized hospital/professional billing and customer service.

To mitigate risk to revenue during revenue cycle or EHR implementations, consider adopting a comprehensive strategy inclusive of these seven elements:

1. Create a business intelligence blueprint prior to go-live. This is the number-one mechanism for mitigating revenue risk, but it’s often overlooked. While most vendors offer robust reporting and BI tools, during the sales process, these same vendors often do not set realistic expectations as to the work effort required to build them before go-live.

2. Don’t skimp on training. In fact, training should be the last place to look for cost savings. In reality, IT implementations always involve changes to workflows, policies and procedures, user roles, application navigation, and personalization tools. Practices must balance vendor recommendations and methodologies against these changes because lost productivity doesn’t just impact financial performance — it also impacts the patient experience. Whenever affiliated practices or hospitals are included in an implementation, the negative PR of a less-than-successful implementation can — and often does — impact future clinical alignment plans and opportunities.

3. “Accelerate” cash flow before go live. As early as eight to 12 months prior to go live, organizations should begin cleaning up their A/R and identifying opportunities to accelerate cash flow. The goal is to create a cash buffer to offset any dips in cash flow caused by declines in clinical productivity or billing performance once billing begins in the new system.

First, design a plan to aggressively work down legacy A/R in the old system before the new system is activated. If internal staff don’t have the bandwidth to shoulder the responsibility, consider outsourced opportunities for an interim period.

Then, decide how to handle the period of time between when some staff must work out two separate systems to work legacy A/R out of the old system and current billing out of the new system. Operating in dual environments — with two different workflows and two different sets of policies and procedures — presents challenges. Old habits are reinforced through use of the old system, just as you’re trying to instill new roles, workflows, policies, and procedures. To overcome these challenges and hasten the learning curve on the new system, many practices outsource A/R from their legacy system after the first two or three months, during which most of the easier-to-collect accounts are resolved.

4. Develop application talent internally. The key is to tap trusted employees who fully understand the practice’s business, values, and culture. Outside assistance is best used to streamline your team’s learning curve on the new system, to advise you on alternative implementation decisions (and their strengths and drawbacks), for peak periods of build, for date conversion or short term technical expertise, for training, and for go-live support and stabilization.

5. Convert clinical activity to cash through focused integration of clinical and revenue cycle functionalities. Don’t make the mistake of replicating legacy workflows; use the implementation as an opportunity for process improvement, such as the consolidation and/or standardization of visit types. Look at your documentation, charge capture, charge triggering, and charge routing for ways to improve physician efficiencies, and to produce thorough, timely, and clean claims. The ability to close encounters in a timely manner is a necessity. In addition, validate vendor recommendations to make sure your organization’s unique operational requirements — not just application best practices — are supported. Conduct integrated testing with real-life scenarios.

6. Automate data conversions. Some vendors advise against the automated conversion of certain patient and scheduling information. This may be due to the extensive amount of in-house technical expertise an organization would need to have on the brand-new application — which is not typically present. However, such data conversions involve a concentrated work effort for only a finite period of time. If qualified resources aren’t available internally, organizations may find it worthwhile to engage with an outside consultant. Automating data conversion offers a major ROI opportunity compared against tens of thousands of hours of manual data entry.

7. Test, test, test. The importance of system testing cannot be overstated. At a minimum, organizations should test their top volume- and top revenue-generating clinical services through a fully integrated clinical and revenue cycle. That means testing that starts with patient access, continues through the clinical encounter (including clinical documentation and charge capture), and continues through the entire billing cycle (including claims production, remittance, denial management, payment variance analysis, and reporting).

As healthcare organizations continue to align with affiliated practices, IT system builds are becoming more complex. Consider, for example, what happens when multiple practices and facilities all share a common billing system, yet their disparate financial information must be kept separate. In all such situations, a vendor’s standard implementation approach and timeline must be vetted and either validated or modified according to practice needs. Training and go-live strategies should always be grounded in reality; it’s better to reset expectations upfront than to put revenue at risk on the back end.

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Brad Boyd is president of Culbert Healthcare Solutions.


Contacts

JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

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News 8/24/16

August 24, 2016 News No Comments

Top News

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South Carolina public radio looks at the ways in which private practice physicians are getting into telemedicine through partnerships with organizations like Palmetto Care Connections, Hope Health, the Medical University of South Carolina, and public schools. Danette McAlhaney, MD offers virtual consults with local schools from her office in Bamberg, and also receives a fee – typically $15 a pop – for helping patients connect with specialists via her office’s telemedicine capabilities, provided with help from PCC. “Let’s face it,” she adds, “I don’t get electricity for free and my staff doesn’t come to work for free,” she said. “I have to be aware of the bottom line.”


HIStalk Practice Announcements and Requests

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I’m hoping to hit the road for a fall foliage tour the last week of September, which, coincidentally, is when HIMSS will host National Health IT Week activities. I don’t want to leave HIStalk Practice readers hanging, however, and so am open to running, in lieu of the usual news updates, guest posts that fit the following criteria:

  • Topical (extra points for humor).
  • No gratuitous use of company or product names.
  • No hyperlinks.
  • Between 500 and 800 words.
  • Author headshots a must.

Feel free to contact me if you’d like to contribute.


Webinars

None scheduled in the coming weeks. Contact Lorre for webinar services, including produced and promoted options. Past webinars are on our HIStalk webinars YouTube channel.


Acquisitions, Funding, Business, and Stock

Patient intake technology startup HealthAsyst joins Athenahealth’s More Disruption Please program, adding its CheckInAsyst software to the MDP marketplace.


Announcements and Implementations

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The Bronx RHIO formally implements the ZenPRM CRM tool from Algonquin Studios after beta testing it for the last several months. The RHIO is part of New York’s SHIN-NY statewide HIE.

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Alpine Foot and Ankle Clinic (UT) rolls out a patient portal from EClinicalWorks.

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Access Community Health Network adopts the UpToDate Anywhere clinical decision-support tool from Wolters Kluwer across its 36 FQHCs in Chicago. Access has integrated the tool with its Epic EHR.


People

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Barry Mathis (HIS Professionals) joins Pershing Yoakley & Associates as principal.

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David Buxton, MD (ApolloMD) joins MyIdealDoctor as CMO for behavioral health.

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CitiusTech names Mohit Kaushal, MD (Stanford University) to its Board of Directors.


Other

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You’ve got mail: San Antonio, TX resident and Medicare beneficiary Debra Garcia receives 505 letters from CMS in a single day – all Medicare part B statements from 2011 to 2015, and all duplicates of statements she’d previously received. “They complain about paying for a needle for injection,” Garcia says, “but they have the money to mail out so many letters.” For those keeping count, that amount of mail amounts to $187 in postage.


Sponsor Updates

  • GE Healthcare employees volunteer at Milwaukee area schools to help spruce up classrooms before students return for the new school year.
  • EClinicalWorks will exhibit at Medical Fair Asia August 31-September 2 in Singapore.

Contacts

JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

JennHIStalk

News 8/23/16

August 23, 2016 News No Comments

Top News

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MediPortal and Integrated Data Services plan to roll out consumer-facing CommonWell services by the end of the year. Consumers will be able to sign up for access, connect their CommonWell records to that of their providers, and query and view data. Six other members including Aprima, Athenahealth, and Modernizing Medicine have pledged to launch similar capabilities in the near future.


HIStalk Practice Musings

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Listening: The somewhat new Poddy Break podcast from comedian Tim Hawkins. I’ve been binge listening in the run up to seeing him perform live last weekend – a performance that did not disappoint. (How can you not laugh at someone riding a Segueway?) His only nod to healthcare was a well-received Obamacare joke, and a brief bit on the panic he felt at being booked to perform at a conference for optometrists. What he lacked in eye care jokes, he made up for in a set that lasted a good hour-plus, not including an intermission and opening act.


Webinars

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August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Announcements and Implementations

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Safety Net Connect develops a CCD workaround for its Econsult referral technology, enabling community health centers to more efficiently coordinate care and meet Meaningful Use Objective 5 using their existing EHRs. The company worked with the Community Clinic Association of Los Angeles County to develop the tool.

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PMA Medical Specialists, a Philadelphia-based group of 54 independent physicians, teams with Aledade to apply for ACO status. Once approved, the Aledade Freedom ACO will care for 7,800 Medicare beneficiaries.


People

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Pat Cathey (Fujitsu Americas) joins ClearData as chief revenue officer.

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Pivot Point Consulting names Brett Meyers, MD (Meyers Consulting Services) CMIO and Frank Siepmann (1 Security Solutions Applied) senior cybersecurity advisor.


Telemedicine

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TreatMD, which launched consumer-facing virtual consults last week, develops PM and billing software to help physicians implement the company’s technology as a white-label solution.


Government and Politics

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The Washington Post looks at the ways in which physicians are attempting to wrap their arms around MACRA, emphasizing the results of an earlier Deloitte survey that found most physicians were either not aware of the proposed rule, or were adopting a wait-and-see attitude. “I have no idea what I’m going to do yet,” admits PCP Jean Antonucci, MD whose patient mix is half Medicare. “If I’m going to lose money, I’ll have to see what my options are. I don’t want to spend the bulk of my time doing paperwork or collecting data on my patients. That’s what the doctors in my community who are employed [in larger groups] seem to spend most of their time doing.”

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Aprima’s admittedly “non-scientific” poll of 85 practice employees reveals that nearly half believe Hillary Clinton to be the more beneficial candidate when it comes to future presidential impact on healthcare. “Our clients, most of whom work in independent physician offices, are concerned about a variety of issues and trends, from new payment models, the aging population and declines in reimbursements,” explains CEO Michael Nissenbaum. “I will defer to the political pundits to come up with theories about why our poll turned out as it did.” I believe we have a few pundits amongst our readership, so feel free to weigh in via the comments section below.

The US Patent and Trademark Office launches the Cancer Moonshot Challenge to encourage public use of its patent data to help it learn more about investments into cancer research and therapies. Submissions are due September 12. Three winners have the chance to nab up to $5,000.


Other

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Apple plans to launch “Planet of the Apps,” a new reality show that is part of its push into original programming through ITunes and Apple TV. The show will spotlight developers competing for $10 million in VC funding, guidance from tech experts, and featured-section placement in the company’s app store. I’ll be interested to see how many contestant ideas end up being related to healthcare.


Contacts

JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Contact us online.
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JennHIStalk

DOCtalk with Dr. Gregg 8/23/16

August 23, 2016 News No Comments

Dancing the MACRA-rena

It seems healthcare often lags behind in many things, like IT adoption and pricing transparency. Apparently, it also lags behind in fads. To wit, I just discovered that a certain 1990s dance craze has been reborn with a health IT twist …

————————————

[Chorus:]

Give happiness to your practice, MACRA-rena

‘Cause your patients are for generating money for you

Give happiness to your wallet, MACRA-rena

Heeey … MACRA-rena! Aaay!

(repeat once)

MACRA-rena has a father who’s called…

Who’s called the last name MU,

And while he was taking his oath as near failing,

She was figuring how to fail anew … Aaay!

(repeat once)

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(Chorus)

MACRA-rena, MACRA-rena, MACRA-rena

You’re popular with the princes of Washington

MACRA-rena, MACRA-rena, MACRA-rena

Like insurers’ lobbyists and guns … Aaay!

(repeat once)

(Chorus)

MACRA-rena dreams of new payment models

And driving the latest reforms

She would like living with ev’ry doc

Draining their joie de vivre and more … Aaay!

(repeat once)

(Chorus)

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From the cynical side of the trenches…

“You have to remember one thing about the will of the people: it wasn’t that long ago that we were swept away by the Macarena.” – Jon Stewart

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Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is chief medical officer for Health Nuts Media, an HIT and marketing consultant, sits on the board of directors of the Ohio Health Information Partnership, and is the semi-proud author of “Monsters Don’t Fart!


Contacts

JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Contact us online.
Become a sponsor.

JennHIStalk

News 8/22/16

August 22, 2016 News No Comments

Top News

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HHS doles out $100 million in ACA funds to help 1,304 health centers across the country with quality improvement efforts, including bolstering healthcare IT utilization. The centers, selected based on their performance in a number of categories related to equity, access, coordination, and value, will use the funds to expand quality improvement initiatives and infrastructure, as well as the delivery of primary care services.


HIStalk Practice Announcements and Requests

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Peer60 polled C-level health system IT executives (mostly CIOs and CMIOs) this month to determine the reach, influence, and usefulness of the six major health IT news publications and sites. The five-question poll found that HIStalk is:

  • #1 most read
  • #1 most influential
  • #1 in generating interest about companies
  • #1 in providing information most useful for job performance
  • #1 most recommended by executives to others

While the results focused on Mr. H’s unflagging efforts at HIStalk.com, I like to think that Practice also contributes a wee bit to these statistics. In honor of the results, we’re kicking off our annual “new sponsor special” early. (Marketing folks, take note: It’s much easier to reach out now than to wait a few weeks before HIMSS when everyone is clamoring for attention 10 minutes ago.) Contact Lorre, who will also have HIStalkapalooza information soon.


Webinars

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August 24 (Wednesday) 1:00 ET. “Surviving the OCR Cybersecurity & Privacy Pre-Audit: Are You Truly Prepared?” Sponsored by HIStalk. Presenter: John Gomez, CEO, Sensato. Many healthcare organizations are not prepared for an OCR pre-audit of their privacy and security policies. This webinar will provide a roadmap, tools, and tactics that will help balance policies and budgets in adopting an OCR-friendly strategy that will allow passing with flying colors.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.


Announcements and Implementations

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TrainerMD will offer fitness-monitoring earbuds as part of its 360˚ Health Program, set to officially launch this fall. In addition to heart rate, the wearable will stream pace and caloric data in real time to a corresponding app that physicians and trainers can use to better manage a patient’s care. These seem like they’d make great conference giveaways, provided the app is consumer-friendly.

Jopari Solutions offers physicians the ability to exchange digital attachments with workers compensation businesses and payers from within their existing PM software.


Acquisitions, Funding, Business, and Stock

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Reports surface that Apple has purchased personal health data startup Gliimpse. Founded in 2013 by Anil Sethi (who started out as a systems engineer at Apple in the ‘80s) and Karthik Hariharan, the company’s PHR technology is targeted to chronically ill patients, and seems in line with Apple’s recent moves in digital health, which include hiring pediatric endocrinologist and HealthKit app developer Rajiv Kumar, MD and software developer Evan Doll, as well as its patent for a wearable ECG monitor.

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Canadian grocery store and pharmacy chain operator Loblaw will acquire EHR vendor QHR Corp. for $170 million. QHR will operate as a business unit within Loblaw’s Shoppers Drug Mart division, and remain headquartered in Kelowna, British Columbia.


People

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Kevin Hutchinson (MyTaskit) and Ned Moore (Clutch) join HudlHealth’s advisory board.


Telemedicine

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AMD Global Telemedicine updates its Agnes Interactive  software, adding enhanced EHR integration, API customization, session controls, and security.

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Vigilias Telehealth opens its 400 square-foot headquarters in downtown Wichita. Two of the Kansas-based startup’s leaders – President Elisha Yaghmai, MD and Marketing Director Chuck Coffey, MD – both did their residencies at the University of Kansas School of Medicine-Wichita.


Government and Politics

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ONC commemorates the 20th anniversary of HIPAA with a tweet chat highlighting its evolution and the challenges that surround it today. The celebration is timely, given, as @ElinSilveous mentioned, the propensity for some practices and hospitals to prevent patient record access due to a lack of HIPAA understanding; not to mention OCR’s announcement late last week that it will begin to focus its investigations on breaches affecting fewer than 500 people. You can check out my recap of the #HIPAAchat here.

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The AAFP responds to Medicare’s proposed physician fee schedule. I honestly couldn’t bring myself to wade through the 56-page response, which seems polite to a fault. At a glance, healthcare IT-related highlights include sections on telemedicine and clinical decision support software in imaging use cases.


Other

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If you think you might be, then you probably are: Intel summer intern Alexei Bastidas develops an algorithm that will help Twitter users determine if they are, in fact, online trolls. The corresponding app, designed to detect tweets with a tone of harassment, offers users a numerical rating and example tweets that could be seen as harassing.


Sponsor Updates

  • AdvancedMD opens registration for its annual conference EVO16, to be held October 11-12 in Salt Lake City, UT.
  • Intelligent Medical Objects will exhibit at HIMSS Asia-Pac August 23-26 in Bangkok.

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Contacts

JennMr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice updates.
Contact us online.
Become a sponsor.

JennHIStalk

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