The provider community has been begging for documentation reform for over 20 years, and there is no question that simplifying the complex requirements of clinical documentation is necessary. Unfortunately, the recent release of the proposed changes from CMS surrounding evaluation and management (E/M) is not the answer. The benefits of the modest reduction in documentation requirements are more than offset by the devastating impact the changes will have operationally, clinically, and financially.
Hayes' Healthcare Blog
By Peter Butler, President and CEO, Hayes Management Consulting
As part of our commitment to helping healthcare organizations optimize their business processes to achieve greater revenue integrity, Hayes has recently formed a Revenue Integrity Advisory Council (RIAC), a small group of revenue cycle and compliance executives who understand the real-world financial challenges associated with running a large, complex organization. We held our first meeting on March 20th in Chicago, where leaders from some of the nation’s most prestigious healthcare organizations gathered for an afternoon to discuss issues, exchange ideas and develop new solutions for overcoming some of their most pressing concerns.
So what was on their minds? Not surprisingly, the topics covered a range of issues including telehealth, quality-based reimbursement, and high-cost drug reimbursement, as well how to organize the coding function and managing compliance issues.
There’s a familiar quote that says, “Never make predictions, especially about the future.” But ‘tis the season for doing just that so we asked some of the leading healthcare experts to give us their predictions for the industry in 2018. Their outlook on the coming year cover a wide range of issues including technological innovation, EHRs, cloud services, cybersecurity, healthcare costs, legacy data management and the Internet of Things.
By Dr. John D. Halamka, MD, MS, CIO of Beth Israel Deaconess Medical Center
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has been blamed for many things, including the diminished joy of clinical practice.
While HITECH certainly has its flaws, it’s hard to deny the positive impact. In 2008 before the act was passed, less than 10 percent of non-Federal acute care hospitals were using a basic EHR. In 2015, 96 percent of those same organizations had implemented a certified EHR system. No other sector of the U. S. economy has experienced such accelerated technology adoption.
However, HITECH is just one component of the legislation, regulations and demands that have increased practice burden without simplifying processes through automation.
What can we do to transform the EHR from a burdensome requirement into an essential tool that improves the quality of practice life? Ideally the EHR of the near future will integrate patient data from multiple sources - providers, payers, patients, employers and devices then turn that data into wisdom, providing the clinician with actionable advice that will improve quality and reduce total medical expense. To realize that goal there is foundational infrastructure to be built. Instead of wringing our hands and blaming “information blocking”, we should focus on a short term work plan with the following.
By Joseph H. Schneider, MD, MBA, Department of Pediatrics, University of Texas Southwestern
Sitting on the exam table before a routine procedure, I listened as the nurse reviewed my medical information. She checked my name, address, and birthday. All was well until she said “..and you are allergic to Wellbutrin, Toradol, Darvon and sulfa”. My brain sprang to attention as she continued reading that I had shoulder repair and coronary bypass procedures, that my weight was down 50 kilograms and that my father was alive. It was very detailed.
It was also all very wrong. I have no medication allergies, nor have I had any of the named surgeries. My weight hasn’t changed. And my father passed away in the 1980s.
What happened? My record was mixed up with someone else’s and my healthcare information was now seriously incorrect. Fortunately, as a CMIO, I was able to get the 120 pages of my record rapidly corrected.
But what if I was an average person, without the influence to gain quick access and to make corrections? What if I hadn’t been having the procedure? The incorrect data could have led to dangerous consequences.
By Craig J. Nesta, JD, MBA, MS, FHFMA, FACHE, FACMPE
From 2008 to 2013, the number of hospitals with salaried physicians increased from 44 to 55 percent and continues to increase. In that five-year period, there were 599 situations where a hospital transitioned from zero to some form of physician integration. The shift from fee-for-service to new payment models and methodologies, increased overhead, revenue pressures for physician practices, massive industry consolidation and an effort to connect traditional care silos indicates this trend is likely to continue.
Although there has clearly been growth in physician acquisition and hospital employment, this article aims to be neutral and does not take an advocacy position for nor against physician acquisition. There are many physician groups that maintain a goal of and feel strongly about independence and are doing quite well while others are actively seeking a system/hospital suiter. For physician groups and hospitals seeking alignment via employment, there has been much discussion on the most effective ways to integrate new physicians into the organization.
Below are seven lessons learned that may be mutually beneficial for hospitals and physician groups to contemplate for a successful integration.
By Jeff Liddell, Harmony Healthcare IT Consultant, Licensed Social Worker, Emergency Psychiatric Services High Reliability Organization Coach
The buzz and excitement surrounding last month’s NCAA Basketball Tournament provided another example of how the Road to the Final Four has become an annual community ritual encompassing people of all ages and backgrounds. Everyone, it seems, follows the action with brackets in hand as the field is whittled down from 68 to one National Champion – this year North Carolina.
The enormity of the event can be overwhelming, but as I followed the action I was most inspired by the individual stories of these college players - some of them beginning in faraway places like Poland, Africa, and Germany. While the victorious Tarheels cut down the nets amid a shower of blue and white confetti, many of the player stories had already begun to fade away.
Something similar is happening in the healthcare industry. The exhilaration surrounding the innovations in healthcare technology has taken center stage – sometimes at the expense of the stories of the patients the technology is meant to help. As industry leaders, we can’t be dazzled to the point where the patient story is lost beneath the waves of technology sweeping healthcare today. In an environment of mergers and acquisitions, consolidations and the tsunami of new technology and challenges to deliver care, we must be vigilant in ensuring that the patient remains the focus.
It is well known that a key objective in the evolving healthcare landscape is improving outcomes. To meet that goal, many organizations are embracing the tenets of the Institute for Healthcare Improvement (IHI) Triple Aim – improving the health of populations, enhancing the patient experience, and reducing the cost of care.
Achieving success in these tenets requires implementing practice improvement. Traditionally, individual members of clinical teams haven’t been eager to participate in practice improvement programs, largely due to heavy clinical and administrative workloads. However, to accomplish meaningful, productive change, providers on the frontline must be involved in the development and implementation of any practice improvement initiative.
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) , Kathy Sierra (Making Users Awesome) , and Eric Ries (The Lean Startup) . 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.
By Brent D. Magers, FACHE, FHFMA, CMPE, Executive Associate Dean and CEO, Texas Tech Physicians
With the advent of Electronic Health Records (EHR) in the late 2000s came rampant resistance. Meaningful Use requirements forced healthcare organizations to begin implementing an EHR but many were unhappy about it. As we transition from fee-for-service to value-based care – from volume to value – and move from current state to MACRA, adoption of EHRs has become both necessary and nearly universal.
As of 2015, nine out of 10 office-based physicians had adopted an EHR. As of March 2016, more than 90 percent of hospitals eligible for the Medicare and Medicaid EHR Incentive Program have achieved meaningful use of certified health IT. Overall, 96 percent of hospitals have adopted CEHRT.
However, near universal adoption doesn’t necessarily translate to 100 percent acceptance. When it comes to incorporating an EHR, many providers have undergone the five stages of grief - denial, anger, bargaining, depression and finally now, to grudging acceptance. Like death and taxes, EHRs are here to stay and will remain an integral component of the healthcare landscape of the future.
The reality is that EHRs are essential if we hope to meet the overriding goal of providing better healthcare outcomes at reduced costs. EHRs form the basic building block for much of what needs to be accomplished in healthcare. Here are three key initiatives that rely on EHRs for their ultimate success.