Hayes' Healthcare Blog

5 Reasons You Should Use an Independent Healthcare Expert for Clinical Optimization

Posted by Rena Hrivnak on April 12, 2017 at 9:00 AM

EHR technology has reached near universal adoption as organizations continue to invest in their IT environment. The clinical and business side of most healthcare organizations have adapted to the use of EHR’s and as resistance has melted away, there is a clamor to get even more utility from their systems. The general upheaval in the industry has also continued to shrink revenue and squeeze margins, leading organizations to launch cost savings initiatives across the board. Many look to their clinical systems to help them improve productivity, efficiency, and patient satisfaction to help drive revenue increases and trim costs.

Attaining those goals often leads to a clinical optimization program. Though worthwhile, these initiatives can often fall by the wayside or fail to get enough mind share because existing staff is tied up with day-to-day tasks that consume their time. Some organizations look to their EHR vendor to help but this can lead to a narrow, single solution view of potential improvements.

Often the best solution is bringing in an independent expert consultant who can help drive the optimization program and achieve tangible results. Here are five reasons you should consider an independent healthcare expert to help with your clinical optimization program.

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Topics: IT staff management, clinical optimization

Looking to Optimize Your Epic Revenue Cycle? Concentrate on These 4 Things

Posted by Karen Lilly Castle on April 5, 2017 at 9:00 AM

The healthcare industry continues to be in flux. The defeat of the Republican’s plan to repeal and replace the Affordable Care Act ensures that the status quo will continue. However, that status quo means a continuation of revenue reduction and pressure on margins. Meanwhile, the implementation of MACRA, the march to value-based care and a shift to alternative payment methods goes on.

All these factors ensure that revenue cycle optimization is more important than ever and organizations will continue to focus on plugging leaks, streamlining processes and implementing automations. Some of the biggest challenges include billing and collections errors, lack of claims process monitoring and insufficient staff training.

Epic’s end-to-end solution continues to attract new clients and is one of the fastest growing EHR applications in the industry. The comprehensive nature of the Epic solution makes it an attractive option, but the breadth of the platform makes it more critical that you ensure it is integrated properly in your organization. There are dozens of modules in the Epic offering, and they can sometimes be isolated in separate siloes. Without an effective integration plan, you may not see the results you need.

Focusing on these four key areas will help ensure you get the full benefits of your Epic solution.

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Topics: revenue cycle management, epic

4 Opportunities Analytics Can Provide

Posted by Robert Freedman on March 29, 2017 at 9:00 AM

The risks of non-compliance in the healthcare industry have never been greater. In fy2016, the HHS Fraud and Abuse Control Program returned $3.3 billion to the Federal government and private parties. The Department of Justice (DOJ) opened 975 new criminal health care fraud investigations.[1]

In fy2015, Medicare Recovery Audit Contractors (RAC’s) identified and corrected 619,000 claims resulting in $441 million in improper payments - $360 million in recovered overpayments and $81 million in underpayments repaid to providers.[2]

With both top and bottom lines continuing to shrink, you can’t afford to be hit with a massive overpayment penalty or to undercharge for patient activity by hundreds of thousands of dollars.

The key to managing both risk and opportunity is getting into your billing and collections data, and for that you need a robust analytics solution. Here are four opportunities you can take advantage of with a comprehensive analytics program.

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Topics: mdaudit, Healthcare Analytics, Risk-based audits

7 Tips to Cultivate Your Trainer, Part 2 of 2

Posted by Angela Hunsberger on March 22, 2017 at 9:00 AM

This is the second installment of a two-part blog mini-series where I share the tricks of the trade with detailed tips surrounding 7 essential “train the trainer” categories.  Missed the first half? No worries, you can check it out here: 7 Tips to Cultivate Your Trainer, Part 1 of 2.

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Topics: training, clinical optimization

7 Tips to Cultivate Your Trainer, Part 1 of 2

Posted by Angela Hunsberger on March 15, 2017 at 9:00 AM

Preparing your trainer to deliver an impactful learning experience is essential for getting the most return on your training program. Aside from the curriculum, learn how to inspire, groom, and mentor your trainer to enhance your program and promote skill set growth. A good teacher mixed with a thoughtful technique can make the difference in what learners retain.

This is the first of a two-part blog mini-series where I share the tricks of the trade with detailed tips surrounding 7 essential “train the trainer” categories.

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Topics: training, clinical optimization

Managing Denials in a Valued-Based Reimbursement World

Posted by Revenue Cycle Transformation Team on March 8, 2017 at 9:00 AM

Claims denials continue to be a thorn in the side of most healthcare organizations. The transition from manual to electronic documentation and billing has helped but denial rates still consume an average of nearly three percent of an organization’s net revenue annually. In recent years, denials have grown to encompass 15-20 percent of the billing value of total claims. That can mean a $6 million hit for a 200-bed hospital to over $260 million for an 1100 bed facility.[1]

And things don’t figure to get any easier. The switch from fee-for-service to value-based care will complicate billing even further despite new technology solutions. Value-based payments are complex and will undoubtedly lead to more denial issues.

Reducing revenue leakage due to denials is usually at the top of every organization’s focus list. Here are three things you can do to better manage your claims process and minimize denials.

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Topics: denial management, revenue cycle management

The ACA Replacement: How the Views of Trump, Ryan, and Price Tell Us What to Expect

Posted by Don Michaels, Ph.D. on March 1, 2017 at 9:00 AM

“They’re like the dog that caught the bus.” 

That was the comment from Senate Minority Leader Chuck Schumer in a January episode of This Week with George Stephanopoulos referring to the GOP and their pledge to repeal and replace the Affordable Care Act aka Obamacare.

In the more than six years after the passage of ACA, the House of Representatives voted to repeal it 60 times.[1] In December 2015, the Senate used a special budgetary procedure to approve one of the bills with simple majority vote instead of the 60-vote threshold normally needed for major legislation. As expected, President Obama promptly vetoed the bill. But the GOP had finally made a statement.

With the election of President Trump and a majority in both houses of Congress, Republicans can now make policy and do what they have been promising to do since the controversial law was passed in 2009. The GOP has finally caught the bus.

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Topics: value-based care, Healthcare insurance, ACA

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. 

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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.

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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]

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Topics: clinical optimization, epic, Real Time Eligibility

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