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Looking to Embrace Population Health? Focus On Your People, Process, and Technology

Posted on July 20, 2016 at 9:00 AM, Don Livsey

By Don Livsey, former Vice President and CIO, UCSF Benioff Children’s Oakland, Founder DZL Solutions

Big data, informatics, business intelligence, and data mining have all been floated as “silver bullets” to solve the riddle of healthcare reform. One that will likely have the biggest impact, however, is population health. HealthcareIT News recently reported that population health and data analytics are the top two topics of interest for 2016. Everyone wants it, but few can clearly define what it is, and we don’t know what it will cost.

David Kindig of the Department of Population Health Sciences at the University of Wisconsin and Greg Stoddart from the Department of Clinical Epidemiology and Biostatistics at McMaster University in Ontario, are credited with this first attempt at a definition of population health in 2003:

“The health outcomes of a group of individuals, including the distribution of such outcomes within the group. These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group.”[1]

A 2015 survey of 100 healthcare leaders conducted by Milken Institute School of Public Health noted that the definition was accurate but focused strictly on measurement and didn’t explain or acknowledge the “role that healthcare providers must take to impact those outcomes.”[2]

What isn’t in dispute is the fact that population health will be a significant focus of the healthcare industry going forward. A recent industry 2015 report identified three key trends involving population health:

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Topics: value-based care, Hayes Thought Leadership Blog Series, population health

7 Things to Know for Successful Provider Education

Posted on July 13, 2016 at 9:00 AM, Beth Enders

The first six years of my career, I worked for two providers in a small privately-owned family practice in the southwest.  My responsibilities included rooming patients, checking vital signs, updating medical information in patient charts, and poking countless patients with needles. Early on I learned how to build a rapport and more importantly, build trust with people of all ages and personalities including the two temperamental doctors who yelled and threw charts.  Little did I know the skills I was developing over those six years would teach me how to handle many difficult situations and people throughout my career.

Twenty-six years later I am still in the medical field and have learned just how vital it is to the success of an organization to have a positive working relationship with the providers, even the difficult ones.  I feel the first step to do this is training the physicians and mid-level providers on proper medical record documentation.  The goal is not to turn the providers into coders, but rather to give them the information and tools they need to be able to document their services accurately and thoroughly.

Across all specialties, we frequently identify common documentation deficiencies.  Physicians and other providers are often unaware of which data elements must be separately documented and are critical for proper code assignment.  Add to this the inherent complexity of E&M coding guidelines that make it difficult for a busy physician or mid-level provider to select the correct code from an often densely populated charge ticket or EHR.  Thus, it has become necessary for people like me, a coder and clinical documentation specialist, to work with these providers to help them understand the do’s and don'ts in the world of clinical documentation and coding.

Over the past several years I have been training and conducting provider education on best practices for clinical documentation and coding and have come up with seven tips for communicating with physicians and mid-level providers.

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Topics: physician education, codes, healthcare compliance, provider education

4 Steps to creating super users for your system implementation

Posted on July 6, 2016 at 9:00 AM, Susan Eilman

In the world of healthcare technology, there are numerous system implementations occurring each year.  In order to make an implementation successful, it is crucial to develop your users into “super users” during the implementation process.  It is common for implementations to include and involve roles such as Project Managers, Practice (Operations) Managers, IT System analysts, and trainers, among others.  Each of these roles  have well defined parameters and expectations.  Often implementations involve super users, but this role is not always well defined and expectations are not always clear. 

A super user is your department’s champion for system knowledge and workflows. This person becomes your expert for the system implementation and teaches other employees how to use the new system features. Once you've identified your super users, you need to have clear expectations for this critical role. 

Questions should be asked early when selecting the super user.  Questions to consider include: Which user should you pick? What qualities should a super user have? How do you train them? Sometimes, you may pick someone that you feel is right for the job but turns out to be someone that is not quite fit for the role. 

Consider the following tips when choosing your super users for your next implementation:

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Topics: training, EHR, EMR training, revenue cycle management

MACRA 101: 9 Things You Need To Know

Posted on June 29, 2016 at 9:00 AM, Don Michaels, Ph.D.

Congressional passage of the Medicare Access and CHIP Reauthorization Act (MACRA) last year was only the beginning of a major upheaval in Medicare reimbursements. This past April the other shoe fell – all 962 pages of it. The Centers for Medicare & Medicaid Services (CMS) released the Notice of Proposed Rulemaking (NPRM) providing the details on the plan to transition healthcare providers from a payment system based on volume to one that rewards value. MACRA is the next step in driving healthcare organizations from a fee-for-service to a value-based care reimbursement model.

The massive NPRM document will be dissected and discussed (and maybe even read) for many months to come, but the implications for clinicians providing care under Medicare Part B are real and far-reaching. The major consequence for those of you who are Medicare providers is that you will soon have to choose to operate under a merit-based incentive program or transition to an Alternative Payment Model. Other than leaving the practice of medicine, there is no third choice.

Here are nine things you need to know to help you begin digesting this next significant change in the healthcare industry.

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Topics: cms, meaningful use, value-based care, MACRA

8 Things About Healthcare Analytics That May Surprise You, Part 2 of 2

Posted on June 22, 2016 at 9:00 AM, Lisa English

In last week’s post, Lisa English described the growing importance of healthcare analytics in dealing with large-scale initiatives like population health. She also outlined the important role analytics can play in solving the day-to-day problems of monitoring risk areas, supporting continuous risk assessment, and complementing limited compliance resources that organizations face every day.

In spite of the increased reliance on analytics, Lisa stressed that there is still much we need to learn. She outlined four things about analytics that might surprise you. Here are four more considerations surrounding analytics that you may not have realized.

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Topics: mdaudit, Healthcare Analytics, risk management

8 Things About Healthcare Analytics That May Surprise You, Part 1 of 2

Posted on June 15, 2016 at 10:00 AM, Lisa English

Yes, the terms “big data” and “analytics” are buzzwords, but they clearly highlight a shift toward data-driven decision-making with a real measurable impact on outcomes in many different industries. Savvy digital marketers now mine your digital breadcrumb trail to offer you more of what you like and attempt to discern what you need before you are aware of it yourself. This not only drives sales, but also actually helps consumers - if they aren’t “creeped out” by the “Big Brother is watching” when you post on social media then immediately see ads pick up on a word from your post. 

In the healthcare industry, the move to population health is just one obvious application for sophisticated analytics. As we appropriately engage our best and brightest in solving the core healthcare issues of our society, we find the key questions that analytics can help answer: What treatments drive positive health outcomes for patients? How can we curb wasteful, ineffective healthcare? Ultimately, why does the US spend more on healthcare than all developed nations while getting only mediocre healthcare outcomes when looking at our population as a whole?

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Topics: mdaudit, Healthcare Analytics, risk management

How Do We Level the HIT Playing Field?

Posted on June 8, 2016 at 9:00 AM, Roger Davis, President and CEO of T-System

“We are deadly serious about interoperability.”
-Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) at the J. P. Morgan Healthcare Conference in San Francisco in January 2016.

For those of us in the healthcare vendor community, that defining statement sets the tone for the future interaction between organizations. Slavitt was also clear that achieving interoperability means “leveling the technology playing field” and requiring vendors to interchange data. He discussed open Application Programming Interfaces (APIs) as a specific model for integrating and moving data seamlessly between technologies. These are now guiding principles as we collectively try to benefit more from interactions outside our specific verticals.

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Topics: interoperability, cms, HIT, Hayes Thought Leadership Blog Series

4 Tips on How to Involve Your Subject Matter Experts in Your EHR Implementation

Posted on June 1, 2016 at 9:49 AM, Susam Vang

If implementing an electronic health record (EHR) is not already challenging for most healthcare organizations, an EHR system design and implementation’s success or failure is greatly dependent on its stakeholders and subject matter experts (SMEs). A SME is an expert in a particular area or topic. They are the primary intended users – people who will be making decisions on the basis of the workflow analysis, system design, and are a key group of stakeholders. SMEs are important to not only assisting in the system’s development and implementation but also in maintaining the long-term use and effectiveness of the system within an organization.

Striking a balance between the information technology (IT) department and departmental autonomy may be even more of a challenge. Even more so is to effectively augment and involve SMEs, all while keeping everyone happy. The challenge may turn out to be a very difficult one if your SMEs prove to be resistent to change. Based on my past experiences, I have written down four ways to win over SMEs in order to implement an EHR project successfully.

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Topics: subject matter experts, ehr installation tips, healthcare IT project management

Most fear it, others embrace it…Audits!

Posted on May 25, 2016 at 9:00 AM, Jayne Dalton

Success has never felt so good. We have successfully met and surpassed the national ICD-10 implementation from October 1, 2015.  If you were like most organizations, you were ready a year in advance.  Others, however, were relieved when CMS postponed the original go-live date of October, 2014 to a year later.  Some physicians have been very vocal about the challenges involved in learning a new coding system, and we continue to see growing pains as the new ICD-10 codes are implemented. With reimbursements in full swing, how do you ensure your organization is successfully and efficiently implementing all these changes?

One way you can ensure this is by creating, implementing and optimizing an official audit process.

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Topics: clinical documentation, healthcare compliance, Audits

Change in Paradigm: Sharing Healthcare Information Outside the Hospital Walls

Posted on May 18, 2016 at 9:00 AM, Mark Schneider

By Mark Schneider, Vice President, MedStar Health

According to a survey by Hospital and Health Networks magazine, only 39% of respondents integrate clinical data so it is accessible, searchable, and reportable across the care community. That’s up from 33% in 2014 but far short of the type of connectivity needed to ensure quality patient outcomes.

With 10 hospitals, 6,000 affiliated physicians, and 30,000 employees, MedStar, like most healthcare organizations, has its share of IT priorities like Meaningful Use, electronic health record (EHR) optimization, and establishing a consistent set of platforms across all of our inpatient departments. But some of the most exciting and important work we are doing is focused on initiatives outside our hospital walls – connecting to our patients, connecting our clinicians (visiting nurses and geriatric providers making home visits), connecting our myriad of outpatients sites (clinics, physician offices, rehab facilities, urgent care centers) and connecting with other major health organizations, once viewed as competitors, in the Maryland and Washington, D.C. area.[1]

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Topics: healthcare IT, interoperability, HIE, Connectivity, Hayes Thought Leadership Blog Series

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