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Readers Write: Disrupting the Traditional Physician Practice

March 21, 2017 Guest articles No Comments

Disrupting the Traditional Physician Practice
By Waqaas Al-Siddiq

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The emerging field of connected healthcare is rapidly becoming a reality and has the potential to overturn a healthcare system deeply rooted in pen, paper, and people. This leaves healthcare workers wondering what their future role will be. Big data at the individual level will introduce terabytes of biological, anatomical, physiological, and environmental information that a human will simply be unable to process. This data-deluged future will require synergy between man and machine, which will ultimately transform life science into data science. It will also markedly improve healthcare and health outcomes.

Remote patient monitoring is the use of wireless, remote technology to manage patients at a distance. This includes not only apps on smartphones and tablets, but smart sensing technologies coupled with artificial intelligence. They have low-power connectivity, streamlined user interfaces, data processing, and the capacity to store and analyze data for medical use. This, and other kinds of connected care, promises to make diagnosis, treatment, and prevention widely accessible at a fraction of current costs. Even today, wearable devices are available that can diagnose heart conditions; asthma monitoring sensors that detect poor air quality and adherence to medication; and glucose monitors that send the data of diabetics straight to their smartphones. By improving patient adherence and preventing unnecessary physician visits, connected care technologies like AI-enhanced RPM promise to reduce costs and improve lives.

A facet of healthcare that is particularly poised to benefit from AI-enhanced RPM is chronic care management. CCM is the most expensive branch of care, soaking up 86 percent of America’s healthcare dollars. Typically, a physician will prescribe medicines, suggest lifestyle changes, and schedule follow-up visits, which leaves much of the ongoing “management” of the disease to the individual.

In their summer 2015 Equity Research publication entitled “The Digital Revolution comes to US Healthcare”, Goldman, Sachs & Co. name two specific ways that RPM can improve chronic care management:

  1. By digesting and presenting data in a customizable and comprehensible way, RPM applications will enable physicians to act immediately. This will also help the patient to immediately understand their health status and counter any negative progression.
  2. By continuously monitoring a patient’s vital signs, AI-enhanced RPM can catch or even predict acute care events and initiate action that will save the patient.

Currently, cardiologists use Holter monitors to capture a patient’s heart’s activity over a 48-hour period. The data is brought back to the physician, who then renders a report based on that past activity. Conversely, RPM would capture and relay activity in real-time to doctors, catching any immediate dangers as well as conditions that take longer periods of time to diagnose. The AI would then analyze the data for variances, comparing it to other patient data, and amalgamating a personalized data set. This will not only improve health outcomes, but more effectively leverage a physician’s time by eliminating the need to compile reports and personalized treatment plans. This will free their schedule so that they can interact with more patients, and focus on the complex cases that require human intervention.

Jack Kreindler, MD founder of London’s Center for Health and Human Performance, sees great potential for RPM enhanced with AI. He envisions being able to move beyond the simplistic rules of current monitoring to “use these technologies to eliminate all avoidable hospitalization and in the process, solve the trillion-dollar problem of chronic disease, which is crippling our economies.”

Properly employing healthcare technology can result in better patient outcomes, improve convenience, and potentially lower healthcare costs, but there is still concern about the doctor’s future active role in patient care. The shift in the healthcare reimbursement paradigm from fee-for-service to value-based care is only the first step towards the implementation of connected healthcare, which began with the desire to keep patients out of hospitals beds. Now that the motivations of both patients and physicians are aligned, technology is positioned to facilitate and empower this new collaboration. Implementing highly sophisticated tools like AI-enhanced RPM would allow physicians to engage patients and offer better treatment that is also more comprehensive.

AI-enhanced technology is poised to disrupt the current healthcare paradigm. It will support the physician’s traditional role in healthcare while also empowering patients, and inviting collaboration and knowledge, which will result in a better partnership for overall health.

Waqaas Al-Siddiq is founder and CEO of Biotricity in Redwood City, CA.


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Readers Write: Change and Inadequate Tools Pose New Challenges for Physicians

March 14, 2017 Guest articles No Comments

Change and Inadequate Tools Pose New Challenges for Physicians
By Joe Marabito

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Physicians are the most important element in delivering quality, cost-effective healthcare. They are the avenue through which all meaningful improvement in healthcare will occur. However, they find themselves in an era of unprecedented change. They are being asked to:

Fundamentally change how they practice medicine – shifting from art to science using an overwhelming and impossible-to-digest stream of new research and outcomes data from countless different sources, and accessing patient-specific data from a variety of un-integrated, disparate medical record sources in a non-digestible way at the time and place of decision making. Standardization of care is essential to improving quality, but how can the latest care practices be adopted if they are unavailable to the physician when she needs them?

Shift from volume to value. For physicians, the two models are diametrically opposed. Put patients in hospital beds versus keep them out of hospital beds. Get paid for doing more versus get paid for doing less. From a process perspective, it’s kind of like changing our driving convention from the right side of the road to the left. Even worse is that right now it seems like physicians are doing both at the same time.

Refer care to unfamiliar specialists. If you want to know which physicians practice quality care and which do not, just ask physicians. They should know. Today, due to narrower networks and risk-based contracts, they are being forced to refer care to specialists they wouldn’t normally use or wouldn’t voluntarily choose, potentially at the expense of quality outcomes for their patients. Quality care requires effective collaboration between physicians. How effective can that collaboration be when physicians don’t even know each other, haven’t worked with one another, and perhaps otherwise wouldn’t choose to work with one another?

Do more with less. After recently being asked to increase the number of patients he sees every day AND having his compensation reduced, my primary care physician decided to step off the treadmill and shift to a privately funded practice model. Essentially, he felt he could not spend sufficient time with patients in order to deliver care that met his own standards of quality. He believes patients don’t open up about sensitive but vitally important health issues until after 15-20 minutes of interaction. The new patient throughput standards of his practice wouldn’t have permitted the necessary time with each individual patient.

Deal with unprecedented administrative complexity. ICD-10 contains five times more diagnoses codes than ICD-9. Government regulations have never been more complex to administer, and compliance penalties are severe, requiring more extensive documentation of both diagnoses and treatments. Some of this documentation is helpful to delivering quality care and medical research, but most is imposed to inform and justify payment. We’ve effectively increased the administrative burden on physicians – significantly – by requiring them to document items of questionable utility to quality outcomes.

What have we as an industry done to help physicians accommodate all this change? Mainly due to government financial incentives, we’ve purchased and implemented incredibly expensive EHR systems, which, as it turns out, do not talk to one another. Additionally, the expense of EHRs crowds out other innovation inside the health institutions that adopt them. Worse, existing best-of-breed physician tools are being retired in order to fund the cost of implementing and maintaining EHRs. And because the primary function of an EHR is to store medical records, scant attention is paid to how physicians use them to serve patients. The result is a step backward from a physician workflow perspective. EHRs are not designed around doctors. Doctors need to share and receive relevant decision-support information on mobile devices at the point of care and to collaborate with the rest of the care team. Some EHRs don’t even offer a mobile solution that isn’t anything more than an afterthought.

The drive for EHRs, while essential and necessary for better care, has encouraged the adoption of a single central system, closed-architecture model that inhibits innovation. Monolithic systems rarely, if ever, do everything well. Innovation flourishes in other industries by connecting disparate best-of-breed systems and data via open architectures and interface standards. It is an approach that encourages innovation by inviting the best ideas to compete and letting the market determine the best solutions for specific challenges. Apple’s mobile device business has flourished in large part by opening its app store to anyone who provides a useful application that meet their standards. In short, they tap the ingenuity of the world to drive higher utility and value for their customers. The result is incredibly useful smart devices. Healthcare will get there too, eventually, if only because it must. Market forces will drive it. In the meantime, doctors are suffering through a time of unprecedented change, hoping it won’t take long.

Joe Marabito is CEO of Ingenious Med in Atlanta.


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Readers Write: 5 Tips for HIPs to Help Jumpstart MIPS Readiness

March 9, 2017 Guest articles No Comments

5 Tips for HIPs to Help Jumpstart MIPS Readiness
By Chris Gluhak

Despite rumblings among the new administration and some members of Congress about dismantling the ACA, one thing remains certain: The move toward a performance- and outcome-based healthcare economy is critical to ensuring affordable access to quality care. MACRA is designed to do just that by establishing baseline performance requirements aimed at improving both the quality and cost effectiveness of care to benefit patients, providers, and payers.

As part of MACRA compliance, the MIPS Quality Payment Program kicks off this year, requiring healthcare providers to start collecting and reporting on quality metrics to CMS. With the first clinician scores set to be published in 2019, the stakes are high for providers in demonstrating that they meet performance and outcome expectations.

Not only is MIPS required for successful population health management and adequate reimbursement under CMS guidelines, but the trend toward healthcare consumerism will also force providers to compete for market share on the basis of their performance. Consumers care about ease of access, transparency of care and costs, affordability, and outcomes. These factors are driving patients to select providers more carefully. With these kinds of metrics soon to be publicly available, clinicians are under increasing scrutiny to maximize their performance scores to maintain market share.

As a result, Health Information Professionals (HIPs) are in a powerful position to help providers implement accurate, efficient data collection and reporting processes to meet these new standards for reimbursement and market satisfaction. Here’s where your expertise is needed most:

1) Determining performance measures. Clinicians can choose what types of data they will submit to CMS in order to measure performance. Several scoring criteria relate directly to the work of HIPs including the use of end-to-end electronic reporting through certified EHR technology; heavily weighted activities like member outreach and engagement, care coordination and population management; and IT-related requirements, such as establishing reporting structures for measures on individual and group levels, and planning for including Part D cost data into cost reporting. Choosing the right scoring criteria can make a substantial difference in the reportable success of the practice, and HIPs can help practitioners understand which metrics make the most sense for their practice.

2) Implementing MIPS systems. One of the most critical aspects of MACRA will be implementing the necessary infrastructure to support timely and accurate submissions. That means IT systems must provide for efficiency and accuracy in collection, documentation, reporting, tracking, and submission of clinical metrics. One of the biggest obstacles in this process is often the inability to use unstructured data in clinical charts. Manual analysis is exceptionally expensive and time-consuming, and frequently prone to error. To resolve that problem, HIPs should investigate and lobby for a MIPS solution that uses an advanced natural language processing engine to automate the extraction of all data from clinical charts.

3) Integrating data across reimbursement processes. In addition to required MIPS reporting systems, practices may also find that integrating data collection and analysis across all of their reimbursement processes, including clinical data collection, analysis, and tracking, will provide for additional efficiencies, as well as reveal insights into practice management. Again, implementing the right technology can enable this integration. Solutions that provide a versatile data acquisition and integration suite that supports a wide range of interfaces, with the ability to ingest and integrate data from even the most complex and disparate sources are ideal. HIPs can assist in this process by collaborating with payers and other partners to ensure congruency across data fields, ensuring all data fields and patient records are complete and accurate, and monitoring data entry processes for data cleanliness and efficiency.

4) Educating providers. Providers must be made aware that the performance scores for all participating clinicians (or groups of clinicians) will be made public by CMS in 2019. It’s imperative that they understand the implications of this publication, in terms of both reimbursement and competitive positioning. As stewards of the information, HIPs can play a primary role in articulating the importance of positive performance metrics in maintaining a strong CMS relationship, and a successful practice overall.

5) Continuous evaluation. Along with emphasizing the importance of the initial score publication, HIPs can also play a critical role in establishing internal monitoring mechanisms that keep clinicians informed of their performance status relative to others in the organization, and relative to themselves on an ongoing basis. This type of continuous evaluation not only provides benchmarking data to improve practice performance and care quality overall, but also to help maintain a strong position in the marketplace as consumers begin to gravitate toward practices that demonstrate top-notch performance.

With the initial MACRA/MIPS reporting period already underway, HIPs must act quickly to ensure their practices are in compliance both operationally and technologically. In order to earn the maximum benefit through CMS, clinicians must submit a full year of data by March 31, 2018. Implementing the most effective IT systems and processes now will ensure accurate data collection throughout the year, for the most thorough and efficient reporting now and into the future.

Chris Gluhak is director of risk adjustment – solutions consultant at Health Fidelity in San Mateo, CA.


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From the Consultant’s Corner 2/7/16

February 7, 2017 Guest articles No Comments

Healthcare Reform’s Impact on Revenue Cycle Integration

The Affordable Care Act has expanded access to more than 20 million Americans who were uninsured. MIPS will accelerate the shift from fee-for-service to value-based reimbursement. While only 30 percent of healthcare payments were value-based in 2015, that is expected to rise to 50 percent by 2018. This shift demands closer integration between clinical and financial operations. After years of working to qualify for Meaningful Use, PQRS and other reimbursement incentives, value-based programs including MACRA now require organizations to tackle even tougher clinical/financial integration issues, such as how to improve patient access and better manage care quality. Managing patient care, in terms of access, services, and costs, however, requires clinical and financial operations to coordinate their efforts and align their priorities. The integration of EHRs, clinical workflows, and care coordination are vital to the revenue cycle. A clinically-driven revenue cycle has created a paradigm shift in the traditional revenue cycle mindset.

Healthcare reform and the shift to value-based care has placed a greater emphasis on improving patient access. This includes access to the appropriate medical services in a timely fashion (patient satisfaction, patient “keepage,” and care management), patient-centric financial counseling and proactive self-pay strategies. A more defined focus on patient access in the front-end sets the foundation for a clinically-driven revenue cycle. With these thoughts in mind, there are three key areas of the revenue cycle where healthcare organizations must focus integration efforts:

1. Patient Access

A clinically-driven revenue cycle starts from the time a patient calls to schedule an appointment. The increase in patient payment responsibility places critical emphasis on front-end functions including eligibility verification, prior authorization, and financial counseling. These activities, as well as patient check-in, also represent an ideal opportunity to address outstanding patient responsibilities.

Financial transparency can also increase patient satisfaction and help reduce the current bad debt average of 25-30 percent, but this requires an adjustment of focus and resources to the front-end of the revenue cycle to improve overall performance measures. An increasingly common approach adopted by many organizations is to centralize patient access operations, standardize policies and procedures, and leverage PM technology in order to:

  • Ensure the capture of clean demographic and insurance data.
  • Validate insurance coverage.
  • Educate patients on their estimated responsibility.
  • Assess patient propensity to pay and offer financial counseling.
  • Collect patient payments like co-pays when registering or at time of
    check-in.

A centralized access center provides the patient with a single point of contact to address all front-end related questions and allows staff to be proactive rather than reactive. These preemptive measures will enhance patient satisfaction, which greatly influences reimbursement. A satisfied patient is less likely to seek services outside of their system. From a reimbursement perspective, this enables more effective care management in a value-based environment.

2. Integration of Clinical and Financial Workflows

With patient access and front-end operations being a large influencer of reimbursement, another factor that affects the revenue cycle is how clinical documentation and coding workflows are implemented and executed. Clinical workflows and EHR design must support, not hinder, a clinician’s ability to document patient care. It is also essential for physicians and staff to be properly trained on those systems. If diagnoses, orders, procedures, etc., are not properly documented/coded, it will ultimately result in billing delays or potentially lost revenues. If something is not captured, it will not be billed for on the back-end, which results in a loss of revenue. Long-term, this also impacts the ability to effectively manage population health programs.

The various technologies available to healthcare organizations contributes to revenue cycle workflows. Workflows and processes must parallel the technology being utilized. Fully integrated clinical and financial systems do provide several benefits. Organizations should adapt IT systems to support the clinical workflow and resist the urge to alter their workflow to accommodate IT platforms.

3. Reimbursement Analysis

Value-based contracts require more complex reimbursement analysis than periodic, retrospective reviews to see whether insurance claims were paid according to contract terms. Going forward, both financial and clinical teams will need to work together to assess reimbursement. The quality department will need to continually monitor clinical metrics for accuracy, for example, while the financial department will need to ensure accurate payment based on those metrics. Tight clinical/financial system integration — or clinical and financial reporting from one system — can help practices better manage cost and quality data together.

New Opportunity

Consolidating patient access, developing collections efficiencies, and bringing clinical and financial viewpoints to the reimbursement process can help practices thrive under value-based care. Keep in mind that these strategies all require integrated technologies, not technology-dictated workflows. With emerging value-based models, tremendous opportunity exists for organizations to create a clinically-driven revenue cycle that reduces costs and improves the patient experience — all the while achieving key tenets of healthcare reform.

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Brad Boyd is president of Culbert Healthcare Solutions.


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Readers Write: MIPS is Here – Don’t Be Afraid

January 19, 2017 Guest articles No Comments

MIPS is Here – Don’t Be Afraid
By Mandy Long

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Some feel that the Merit-Based Incentive Payment System, part of the Quality Payment Program intended to improve the healthcare continuum by advancing quality-based care, has created new risk and uncertainty for a main industry pillar – providers. On the one hand, physicians who have been participating for years in the Physician Quality Reporting System and Meaningful Use state they feel ready for MIPS reporting. On the other hand, some have voiced concerns over needing more time to understand the program and prepare their practices due to a lack of resources, including staff and funding.

MIPS presents opportunities and challenges, and practices should stay educated regarding value-based reimbursement. As the chair of the Electronic Health Record Association’s Clinician Experience Workgroup, I’ve spoken with numerous clinicians, stakeholders, and industry experts about the concerns physicians have over the new reporting requirements and potential pitfalls.

While another mandate may seem daunting, many of today’s modern technologies can help address these changes and aid in the clinical, financial, and operational success of physicians. Here are four common MIPS-related concerns I’ve heard and accompanying reasons why the right technology and EHR vendor can help alleviate those stressors:

1) Concern: Practices are concerned about the lack of resources and time needed to help staff understand the new requirements.

Why? Understanding the complex requirements of MIPS can be difficult and overwhelming, especially for practices that feel they have less time and inadequate resources to develop the necessary knowledge.

Resolution: Work with a vendor that doubles as a responsive training and support team. Not only should they supply a modern solution that is intuitive and easy to use, but they should also offer services such as concierge coaching, education, and advisory services for practices that may not have the necessary in-house talent (or time). With limited resources, it is important to have an expert available to keep your staff well-informed as legislation evolves in our industry.

2) Concern: Practices are concerned that their staff doesn’t have the right experience with EHR systems and skills to leverage data needed for participation.

Why? Most physician practices have limited time to devote to additional administrative duties, including collecting and reporting data on quality measures and completing required documentation needed for participation in the new payment models.

Resolution: Select a vendor that has a proven track record in MU attestations and PQRS reporting, and offers an EHR system with structured data that automates the process. The right system should not increase overhead, but rather make your current team more efficient by streamlining data entry and reporting for each patient visit.

3) Concern: Practices that fight joining larger organizations are concerned that they lack the data needed to compare their performance to that of other practices or benchmarks.

Why? Some industry thought leaders have said that MIPS was a Congressional effort to push doctors to join larger organizations, which many consider better equipped to manage and coordinate care across the continuum. It is believed that practices that do so are more likely to participate in quality monitoring or clinical benchmarking than practices that do not share resources.

Resolution: Implement a solution with native analytical capabilities that documents near real-time comparative benchmarking of quality and cost. Your system should not only track individual physician performance and practice performance, but should also show you where you stand when compared to other physicians in your specialty.

4) Concern: Practices are concerned that they lack financial resources needed to make initial investments.

Why? Practices may not have a budget that can absorb the investments and resources necessary to keep up-to-date on and purchase solutions that meet regulatory requirements, especially when it comes to dedicated headcount to focus on quality programs.

Resolution: Avoid headaches by investing intelligently now with a partner offering services and solutions to help you avoid the end-to-end burden yourself. Your vendor should offer a specialty-specific, all-in-one suite of solutions and help develop a roadmap supporting your practice’s evolving needs. Your system should have MIPS success embedded in its technology, and shouldn’t require you to re-enter data already being collected during the clinical visit. It should offer services to educate and train your staff on how to appropriately document to succeed in the new MIPS landscape, and keep you knowledgeable as requirements evolve.

While CMS recognizes some difficulties that practices will face with new legislation, successfully navigating MIPS ultimately falls to the provider in selecting a partner who will best support their long-term goals. If you’re experiencing concerns similar to those listed above, don’t wait and see how these measures will impact your operations and finances. Find a great partner and adopt the right solution to prepare for the volume to value transition.

Mandy Long is VP of product management at Modernizing Medicine in Boca Raton, FL. 


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