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Priyal Patel

Priyal has 5 years of healthcare industry experience. She has collaborated with project teams from some of the most prominent hospitals and health systems, physician practices, healthcare associations and vendors throughout the United States and internationally to help implement innovative mechanisms to drive down operating costs and provide efficient and effective performance improvement and overall change management.

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Improving Patient Experience – Not Just for Inpatient Settings

Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like. 

With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience.  However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting.  Therefore, it is equally, if not more important for those  in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model. 

patient engagementPositive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting.  However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities.  Here are the exact details they provide:

  1. Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.
  2. Patient retention, loyalty, and growth - By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients.  As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy. (more…)

Happily Ever After: The Benefits of Patient Engagement – #HIMSS14

Once upon a time last year, in a town not too far from you, there was a big hospital where a bright, young physician was providing care to a sick, old patient.  Okay, let me save you some time.  This fairytale, unlike those you are used to, doesn’t end simply by having Prince Charming (the physician) swoop in and save the beautiful, damsel in distress (patient).  This fairytale has a bit of twist that changes the standard storyline.  This twist is referred to as Patient Engagement.

Changing of the Patient-Provider Fairytale

patientengagementThe concept of patient engagement has changed the way providers tell their patient stories.  It is no longer, once upon a time, a patient was sick, the physician cured him/her, the end.

The fairytale now reads more like this…

  1. Patient came in.
  2. Physician introduces him or her to supporting characters (care team).
  3. The patient and physician discuss the plot (disease state) with alternative endings (treatment options).
  4. They co-write the script (care plan), including ideas for props (patient education, care communities, etc.) that will enhance the story.
  5. The physician quickly publishes (uploads to portal) the manuscript and associated material for review and follow-up (provides email, direct scheduling option, mobile alerts, etc.).
  6. And instead of “the end”, it is more like, “to be continued…”

Patient engagement is not a new concept, just one that has been brought to the forefront as part of the healthcare industry’s increased efforts around coordinated care. (more…)

ICD-10: Nine tips to decrease cash flow disruptions

T-minus 9 months!  Are you ready for ICD-10?  Are you really ready?

The Health Information Management Systems Society (HIMSS) Annual Conference is being held in Orlando, Florida this year and I would guarantee that the educational sessions on ICD-10 will be packed with healthcare providers seeking the answer to this very question.  On the other hand, some providers may feel very confident that their organization is ready for the October 1st change.  In fact, being so close to Disney World, they may be singing, “Hakuna Matata” (Disney’s The Lion King song, meaning, “no worries”), through the conference hall thinking that because their organization has performed ICD-10 readiness assessments, developed detailed project plans for implementation and begun the remediation process, they are good to go.

ICD10 Readiness - Minimizing Impact to the Bottom LineHowever, before they start hitting any high notes and doing a dance, they should make sure that they have not only taken the necessary steps to fully understand the impact ICD-10 will have on their workflow and documentation practices, but also to their bottom line.  Healthcare organizations need to understand that “As part of a holistic risk mitigation strategy, providers must understand and be able to forecast possible changes to cash flow and engage in advanced planning to protect revenue losses before, during, and post ICD-10 conversion1.”

According to results from a poll conducted by firm KPMG, 76 percent of providers have completed an impact assessment for ICD-10 and 72 percent had set aside a budget to prepare for readiness2.

“As October 1st inches closer, healthcare organizations have their work cut out to properly absorb the impact that the new coding will have on their businesses,” said Wayne Cafran, an advisory principal in KPMG’s Healthcare & Life Sciences practice. “A full 50 percent stated that they had yet to estimate the new coding system’s impact on their cash flow. With estimates by those who did measure the impact tallying anywhere from $1 million to more than $15 million, healthcare organizations are in for a rude awakening when they finally realize what the new standards will have on their bottom lines1.”

Tips to protect your bottom line

ICD-10 implementation is fast approaching, and providers need to take aggressive steps to ensure that their efforts focus on adequately assessing the potential cash flow problems that may arise after October 1.  Don’t start panicking just yet.  Here are 9 tips, from Beth Mahan, to calm the panic and help mitigate the potential impact to your bottom line1

  1. Discuss budgeting avenues for additional cash reserves if material delays in payment occur.
  2. Conduct financial modeling to understand financial implications moving from ICD-9 to ICD-10 and determining the revenue impact by provider or system facility, service line and geography.
  3. Review managed care contracts to negotiate protective language relevant to reimbursement in the event payment shifts occur that could have a negative impact on your bottom line.
  4. Engage with your high-volume payers to assess their readiness state to process your claims coded in ICD-10
  5. Conduct clinical documentation improvement reviews using ICD-10 code set.
  6. Develop a strategy for coding, billing and claim backlogs to improve cash flow.
  7. Determine strategy for denials management pre- and post-ICD-10 conversion.
  8. Assess readiness state of external vendors who support coding, billing, follow up and denials.
  9. Review audits occurring that may be impacted by compliant use of ICD-10 over time.

If your organization has truly taken the necessary steps to mitigate the risk to its cash flow, then I would recommend that the organization perform an internal audit for ICD-10 implementation and compliance to assure that when October 1st comes you really are set.  Taking the aforementioned steps plus this extra step can bring your organization peace of mind and save you big bucks in the long run.

Then when asked, “Are you really ready for ICD-10?” you can really sing, “Hakuna Matata!”

 

Will you be HIMSS?

Meet Priyal and the rest of our healthcare team at Booth #2035. Contact us to set up a meeting.

himss14_top

Resources for this blog post:

  1. http://www.govhealthit.com/news/icd-10-revenue-neutrality-9-ways-protect-your-cash-flow
  2. http://www.nuemd.com/news/2014/01/13/providers-lack-understanding-icd-10-revenue-impact/
  3. http://www.successehs.com/item/6-tips-to-protect-cash-flow-during-the-icd-10-transition.htm

The Value in Voice-Natural Language Processing in Healthcare

Guilty!  I text while I drive…eek!  I know, I know, it is really bad and those anti-texting and driving commercials get me too.  That is why I am making a concentrated effort to ease up this one vice (stop laughing those that know me!) of mine.  Instead, I am beginning to use the voice text option and good ole Siri on my phone, which when I speak like a robot and articulate every word, does alright.  But old habits die hard, which is why I understand and sympathize with physicians constantly having to change their behavior in light of all the regulatory demands in recent years.

One behavior that physicians are being asked to change is their practice patterns of dictating or handwriting clinical notes and discharge summaries.   The change comes from the desire to move away from unstructured data to more structured data for consistent, easily minable and extractable information for more robust and quality NLPreporting and analytics.  80% of clinical documentation that exists in healthcare today is unstructured and is buried in electronic medical records (EMR) and clinical notes1.  Many healthcare providers are looking to natural language processing (NLP) technologies to assist in taking their valuable unstructured data, and turning it into meaningful and actionable structured data to improve patient care.

Natural Language Processing and Clinical Language Understanding

In its simplest definition, NLP is the interaction between artificial intelligence and linguistics.  It encompasses anything a computer needs to understand typed or spoken language and also generate the language2.  More specifically, NLP applied to the medical domain is called Clinical Language Understanding (CLU), with the main difference being that CLU works off of a complete, highly granular medical ontology, which has been tuned to relate and identify all kinds of medical facts so that the underlying NLP engine can “understand” what the caregiver is saying1.  NLP has been around for years, but it wasn’t till recently that healthcare industry took notice of the value of this effectively powerful technology.

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Milk, Bread, Cereal…Healthcare?

Okay, show of hands, how many people have received their flu shot this year?  Where did you go?  If you are like me and most Americans these days you probably didn’t want schedule an appointment with your doctor.  You most likely needed a few things at your local grocery store, or needed to pick up extra Halloween candy at Wal-Mart or Target and ended up in their retail health clinic line on your way to the checkout line.

Retail health clinics are popping up everywhere.  You can barely go into any drugstore or supermarket without seeing one.  The sudden burst of these walk in clinics comes retail clinic cartfrom the fact that more and more healthcare needs are being driven by consumers and these days, when it comes to healthcare, consumers want what they want, when they want it.

Impact on Triple Aim

Healthcare consumers are looking for affordable, accessible and quality care without having to wait hours, days, or even weeks for basic primary healthcare services1. Retail and pharmacy-based care clinics provide just that.

Improved Experience through Access:

Conveniently located in retail locations, such as pharmacies and drugstores, supermarkets, big box retailers, and other high-traffic retail settings with pharmacies, these clinics have provided convenient and accessible primary care to more than 20 million people nationwide1.  These clinics are typically open 7 days a week, with extended hours, appointments generally only last 20 minutes and there are little to no wait times.  If you do have to wait, most provide a restaurant-style pager so people can walk around the store while they wait2.

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Meaningful Use for Mobile Health

Stop reading this blog and look up.  What do you see?  I bet the majority of you, especially if you are in a public place, will see most people with their heads down looking at their cell phones (be honest, are you reading this blog on your phone?).  Am I right?  I bet I am!  You can’t go anywhere these days without seeing people, from the ages of 9 to 90 on a cell phone.  More and more people are using their cell phones as the ultimate go-to for information.   And why not, it has truly become a one stop shop – you can do pretty much everything with a few taps on your cell phone…including managing your health.

Did you know the number of U.S. adults using mobile phones for health-related activities, including looking up health information, grew from 61 million in 2011 to 75 million mobile healthin 20121? That is an increase of 14 million in one year!  With numbers like this, it is no surprise that healthcare organizations are looking to mobile health as an effective tool in helping them not only improve patient care, but also address the demanding regulatory requirements placed upon them, specifically Meaningful Use (MU).  “Mobile health refers to health-related services that are supported by mobile devices, such as cell phones and tablets. Mobile health technologies can help physicians monitor patient health, collect medical data, deliver information to patients and colleagues, and even provide care at a distance2.” (more…)

Predictive Analytics – Healthcare’s Crystal Ball

Given the constant quality, financial, and legislative pressures healthcare organizations are facing, the million dollar question remains, how do we get the right care to the right patient at the right time?  Many healthcare organizations have turned to business intelligence (BI) as a way to bring information from desperate systems together, in a more efficient and effective manner, to drive better business decision to start answering this question.  Implementing BI is a great first step in the right direction, however, simply building a data warehouse and doing some reporting from it alone will not provide the much needed answer to this very important question.

The answer to this question will help organizations get closer to delivering optimal patient care.  In order to achieve great care, organizations not only need to know the patient’s history and present condition(s), but should be able to predict, to some degree, future outcomes.  BI will provide the former, and advanced analytics will provide you the later, specifically, predictive analytics.

Trevor Strom states, “There is a critical difference between simply examining historical data and reporting on previous organizational performance, versus providing crystal ballpredictive capabilities that support proactive decisions. For example, during an influenza outbreak, it is one thing to know how many cases of influenza presented to an already crowded Emergency Department last week; it is entirely different (and much more valuable) to predict, with reasonable accuracy, how many will show up tomorrow and over the next couple of days1.”

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Chronic Disease Management through Disease Registries

Chronic diseases, those diseases lasting 3 months or more that cannot be prevented by vaccines or cured by medication1, are placing an increasing burden on our healthcare system.  Unfortunately, the United States has one of the highest rates of illness, disability and death due to chronic diseases, such as asthma, diabetes, coronary heart disease and obesity.  According to the Centers for Disease Control and Prevention (CDC), 7 out of 10 deaths among Americans each year are from chronic diseases and as a nation, 75% of our health care dollars goes to treatment of chronic diseases2.  In 2005, 133 million Americans, almost 1 out of every 2 adults, had at least one chronic illness1. Regardless of the impact of these preventable diseases, a recent survey found that only 56% of recommended care is being provided for patients with chronic illness3.  As a result, provider organizations are seeking new strategies for effectively managing these large and expensive populations4.  “There is a great need for a systematic and comprehensive approach to caring for patients with chronic diseases to help improve the quality of chronic care delivery.” 4  One such strategy is implementing disease registries to capture and track key patient information that assists care team members in proactively managing patients with chronic diseases5.

In this blog post, we will take a high-level look at the some of the key functions and limitations of a disease registry as it relates to chronic disease management.

Functions of a Disease Registry

A registry can be defined as “an organized system for the collection, storage, retrieval, analysis, and dissemination of information on individual persons exposed to specific medical intervention who have either a particular disease, a condition (e.g., a risk factor) that predisposes them to the occurrence of a health-related event, or prior exposure to substances (or circumstances) known or suspected to cause adverse health events.” 6

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HIE: 6 Opportunities for Increased Patient Safety

In my last blog post we explored the topic of shared decision making (SDM) and its impact on patient safety. This made me think of an experience we recently had with my dad. He had a stent placed about year and a half ago to open a blocked artery in his left anterior descending artery (LAD). Now I should tell you that the doctors, 3 to be exact, wanted to send him home because all of his tests came back negative, but the stubborn, yet lovable, man that my father is (I know, the apple doesn’t far fall!), found a cardiologist that was willing to listen to him and discuss his concerns and thoughts. He convinced this cardiologist to do an angiogram. They ended up finding, clear as day, a 90% blockage in the LAD and stented him right then and there, no questions asked. Needless to say he bypassed a major heart attack, (a.k.a. the Widowmaker) which could have very easily ended his life.

My brother and I both have clinical backgrounds, so it was a little unsettling how the events of the 48 hours with my dad transpired. We went from an emergency admission to nothing is wrong with him, he can go home, to he has a 90% blockage in his main artery that we need to stent right away. Talk about an emotional rollercoaster, but in the HIE benefitsend we were glad he was okay. However, at time of discharge, another shocking and disappointing incident occurred. The nurse was going over his discharge medication regime. As she was rattling off this medication list at a speed even a pharmacist couldn’t understand, she stated, “…and 10mg of Amaryl two times a day.” My dad, who has NEVER taken a pill in his life (we are Indian so turmeric is our answer to everything!) and was still a little out of it from the whole experience was unable to catch the error that just occurred. Luckily I was there to ask the nurse, “Are you sure it is 10mg and not 1mg of Amaryl?” Her response, “Yes that is what the order states.” Again, I challenged her, “Are you sure, because I thought the cardiologist told us after surgery it was 1mg of Amaryl.” She responded, “I can go check, but I am pretty sure this is correct”. I asked her to call the cardiologist and confirm as pretty sure was not good enough. Just as I suspected, it was an error in dosage. The order was for 1mg of Amaryl, twice a day, specific to before breakfast and dinner. At this point, given all that occurred, I began questioning everything she rattled off and requested (well, damn near demanded) that she go back and reconfirm the entire list. This was my dad, my best friend, I was not going to take any chances that his safety be compromised due to a medication error.

This is just one incident that thankfully didn’t end badly.  However, every day patient safety is being compromised because information is not accurately or readily available.  Up to 18% of the patient safety errors, generally, and as many as 70% of adverse drug events could be eliminated if the right information about the right patient is available at the right time. Health information exchange (HIE) makes this possible1.”

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Shared Decision Making – From Doctor is King to Patient is Key

The words, “because I said so” were like nails on a chalkboard for many children.  I was lucky enough to rarely hear those words.  I was blessed with parents that took the time to explain why they were taking the decision they were and as I got older willing to discuss decisions further, allowing me to make my case for important things like why I needed a hundred dollar pair of jeans (I never got them!).  This is probably why my skin crawls today when my doctor tries to mandate a course of action to me rather than take the time to explain his reasoning or discuss alternative options. The decision is made for me, not with me.  Who died and made him king, especially when it comes to my health?

According to a recent research study in the US, 70% of patients preferred making medical decisions with their doctors.  Interestingly, of those, only one in seven would disagree with their doctor over treatment, some saying it would not be socially acceptable or would damage their relationship with the doctor1.  What is that about?  If the US healthcare system is ever going to increase quality of care while reducing costs, the mentality needs to shift from doctor is the all mighty king to patient is key.

What is Shared Decision Making?

blogPatient-centered care is one effort to rectify this power imbalance between physician and patient.  The Institute of Medicine (IOM) defines patient-centered care as: “Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.2

A key component of providing patient-centered care is shared decision making (SDM).  SDM is a collaborative process where patients are provided with evidence-based information on treatment choices and are encouraged to use this information to have an informed dialogue with their physicians to help them make the healthcare decisions that best align with their values, preferences and lifestyle3.  “SDM honors both the provider’s expert knowledge and the patient’s right to be fully informed of all care options and the potential harms and benefits. This process provides patients with the support they need to make the best individualized care decisions, while allowing providers to feel confident in the care they prescribe.4

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ICD-10 Impact on Productivity – Offensive vs. Defensive Game

Chicago Bulls win the NBA Championship and ICD-10 has been postponed!  Just kidding.  However, as much as I am hoping for the former, I am sure many healthcare organizations are hoping for the latter.  Unfortunately the chances of that happening are as slim as me becoming a Miami Heat fan!  One thing is certain, when ICD-10 kicks in on October 1, 2014, productivity will take a hit.  If you want to come out winning (least impact), you better come prepared with your offensive game.

Areas of Impact

Clinical Documentation – With the increase in granularity of the ICD-10 codes, there will be an increase in the amount of information that a provider must include in the patient record.  This will directly impact the time spent on each patient encounter.  Things that a provider may not have needed to capture with ICD-9 are now being required with ICD-10.  For example, things such as1:bball ICD-10

  • Type of encounter (initial or subsequent)
  • Applied specificity (did the patient lose consciousness?)
  • Acute versus chronic
  • Relief or non-relief (intractable versus non-intractable)
  • External cause (what caused the accident?)
  • Activity (what was the patient doing when she was injured?)
  • Location (where was the patient when she was injured?)

According to a study conducted by Nachimson Advisors, LLC, the move from ICD-9 to the ICD-10 will increase documentation activities about 15 percent to 20 percent2. This is not just an implementation or learning curve increase.  This translates into a permanent increase of 3 percent to 4 percent of physician time spent on documentation for ICD-102.  Those providers thinking that their electronic health record (EHR) will eliminate extra documentation time are sadly mistaken.  Many templates within in the system itself will need to be changed to accommodate the new codes sets resulting in additional work.

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Establishing Data Governance, Part 2: 10 Universal Components

In my last blog post a few months back I introduced some key concepts of data governance and the necessity of healthcare organizations to establish a data governance program as a way to perform quality control on its data.  We touched on the 10 universal components of data governance that the Data Governance Institute (DGI) recommends be implemented to ensure a successful foundation and in the case of healthcare, help drive improved and effective clinical, operational and financial decision making.

In this blog post I would like to take a closer look at these 10 components and then share some of the challenges healthcare organizations face in implementing and sustaining data governance in their organizations.

10 Universal Components of Data Governance

To help refresh our memories we will again draw upon the diagram below to help us visually understand the Data Governance Institute’s 10 components.  Each of the following components will be described in its simplest form directly from the DGI1.  For greater detail, I would encourage you to visit the DGI site.

priyal blogRules and Rules of Engagement1

1)       Mission and Vision: At its highest level, Data Governance typically has a three-part mission:

  • Proactively define/align rules
  • Provide ongoing, boundary-spanning protection and services to data stakeholders
  • React to and resolve issues arising from non-compliance with rules

Along with a mission statement it is also vital to develop a clear vision that will portray what your organization could look like with and without a mature Data Governance program.  It is important to note that mission statements can be dry. On the other hand, the language you use to paint your vision should be rich, evocative, compelling. Your vision should be able to inspire stakeholders, to help them envision possibilities, to encourage them to set data-related goals.

2)      Goals, Governance Metrics and Success Measures, and Funding Strategies: As with most things, goals and metrics for data governance should be SMART (Specific, Measurable, Actionable, Relevant, and Timely).  It can be difficult to determine which goals your organization should purse.  The DGI recommends starting by anticipating the effect of governance efforts on the “4 Ps”: Programs, Projects, Professional Disciplines, and People as individuals.  A useful equation is:  “If we do A, then we should expect B, with a result of C; otherwise, we should expect D, with a result of E.”

3)      Data Rules and Definitions:  This component refers to data-related policies, standards, compliance requirements, business rules, and data definitions. Depending on the organization’s focus they may strive to:

  • Create new rules/definitions
  • Gather existing rules/definitions
  • Address gaps and overlaps
  • Align and prioritize conflicting rules/definitions
  • Establish or formalize rules for when certain definitions apply

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