Hayes' Healthcare Blog

Optimizing Your EMR Project: Utilize Your Lessons Learned

Posted by Lisa Laravie on February 22, 2017 at 9:00 AM

“If I knew then what I know now…”

How many times have we all uttered that phrase? It’s easy to see mistakes or opportunities for improvement once a project or event is complete. The trick is taking that knowledge and utilizing it for current or future projects to avoid unnecessary headaches.

Nowhere is that truer than when you’re implementing an EMR. Learning from your experience during implementation helps you fill in functionality gaps and optimize your EMR as you go. If you’re like most organizations, your EMR projects represent a huge undertaking.  With the resource management, legacy systems to adjust, and new processes to be put into place, you will find it hard to keep track of all the details.  You can often be left wondering how you’ll maintain the project on time and on budget, let alone how to optimize the change. 

Read More

Topics: project management, clinical optimization, EMR implementation

Driving Cultural Transformation: Bringing an Innovative Mindset to Healthcare

Posted by Mark Long on February 15, 2017 at 9:00 AM

By Mark Long, Group Vice President, Digital Innovation, Providence St Joseph’s Health

During my time at NASA, Zynx Health, several startups and Amazon I learned a thing or two about innovation. The key lesson is best summed as “Success is not delivering a project or product; success is learning how to make your customers great at what your customers care about.”  This has been written about by many other thought leaders including Steve Blank (Customer Development) [1], Kathy Sierra (Making Users Awesome) [2], and Eric Ries (The Lean Startup) [3].  It’s grounded in a learning culture.

The healthcare industry is going through a transformation driven by many forces including changes in regulations, risk and price structures, and consumer expectations set by other industries. Technology is playing an increasingly important role in healthcare, but the answer is not to focus on the development of more tools and apps for their own sake. Instead success will come from an iterative learning process that leverages technology to focus on new ways to improve the lives of our patients, members, and providers.  

When we committed to digital innovation at Providence St. Joseph Health, we vowed we were not going to be a passive player in the healthcare transition game. We were determined to lead this revolution and reinvent healthcare along the lines of our mission.  Many Pacific Northwest organizations have reinvented industries such as Boeing, Microsoft, Costco, Nordstrom, Starbucks, REI, and Amazon. Now it’s our turn. 

After several years on the front lines of the revolution, Providence has identified four key concepts that we feel are essential for traditional healthcare organizations to disrupt the way they deliver services and stay relevant.

Read More

Topics: healthcare transformation, Hayes Thought Leadership Blog Series

Verifying Patient Eligibility: Leveraging Epic Benefit Collection Workflow for Improved Collections

Posted by Karen Lilly Castle on February 8, 2017 at 9:00 AM

The turmoil in the healthcare industry is no more apparent than the effect it is having on patient health insurance. Rising costs in premiums and deductibles, the establishment of healthcare exchanges under the Affordable Care Act (ACA) and a workforce that continually changes jobs is forcing mass confusion in the healthcare insurance market.

As people assume more responsibility for payments, they are shopping for less expensive insurance options. To accommodate this new consumer mentality, insurance companies are offering a wider variety of plans than ever before. These dynamics place even more stress on the already overburdened front office function of most providers.

With patients moving from plan to plan, verifying eligibility has become crucial for hospitals and physician practices. The complexity of plan options makes the process even more challenging for front office staff. Determining coverage, benefits, co-pays and deductibles for each patient can be an overwhelming task.

Despite widespread use of electronic business transactions, many providers are still handling eligibility verifications manually. A recent report from CAQH Explorations reveals that health plans fielded more than 72 million phone calls on eligibility in 2015. The same report says the cost of a manual verification process is $8.39 per transaction, more than 17 times greater than the $0.49 cost of an electronic verification. In all, CAQH estimates the healthcare industry can save over $5 billion by using an electronic eligibility verification process.[1]

Read More

Topics: clinical optimization, epic, Real Time Eligibility

How Analytics Can Benefit 4 Key Members of the Compliance Team

Posted by Robert Freedman on February 1, 2017 at 9:00 AM

As healthcare organizations have reached near universal adoption of EHR and practice management systems, the amount of available billing and claims data has grown exponentially. This data has the potential to offer insight to issues that can adversely affect the organization both from a regulatory and financial standpoint. Compliance and revenue cycle leaders are both coming to realize the benefits of collecting and analyzing this valuable information.

However, as compliance teams move from static auditing schedules to proactive risk-based programs to help identify and manage risks, it has become clear that it’s not just managers and supervisors who can benefit from data analytics. A robust analytics program can provide valuable insight that can help every member of the compliance team perform his or her job better.

In particular, use of analytics can significantly improve communication between the compliance team and other departments in the organization. There can often be friction between an auditor and those being audited, but focusing on data and providing a bigger picture view for both parties helps foster better working relationships and more effective issue resolution.

Using actual data instead of hypothetical situations can diffuse disputes and make audit finding discussions positive and more productive. It can also provide a wider view of a potential issue that can aid in instituting effective corrective action, both huge benefits for the compliance team.

For example, an auditor may find an instance of an incorrect E&M billing. It can easily be written off by the physician as a one-time error. However, analytics can reveal a pattern and show it was not an isolated instance. The auditor and physician can then rationally discuss the issue backed by data. That can be a tremendous advantage for compliance teams and helps take the emotion out of findings discussions.

Here are four key members of the compliance team that can get significant value from an organization’s analytics program.

Read More

Topics: Healthcare Analytics, compliance programs

Want more from Hayes?

5 Cool Things in Healthcare

Sign up for our weekly 5 Cool Things in Healthcare newsletter.  Every Friday we give you five stories of innovation, disruption, and - you guessed it - coolness. 

Here's how:

Subscribe to Email Updates

Recent Posts

Posts by Topic

see all