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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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Cost Accounting to Improve Care Delivery: #HIMSS15 Session Recap

Cost Accounting to Improve Care Delivery: #HIMSS15 Session RecapI was fortunate to participate in the Health Information Management System Society’s (HIMSS) Annual Conference in Chicago last week. More than 42,000 other healthcare professionals attended the conference this year. I was in awe of how much innovated brain power was under one roof and how far information technology has come within the healthcare industry.

I was able to attend an interesting session with one of my colleagues called, “Reducing the Cost of Care Through Real Time Intelligence,” where Dr. Barry P Chaiken was speaking on how real-time analytics can help provide a true understanding of the cost of delivering care. He stated that the value of healthcare is really a basic equation: Healthcare Value=Quality of Care/Cost of Care and that there needs to be a true investment into the quality of care given the cost. To illustrate his point he provided an analogy to hotel room towels, stating that if you pay for a Motel 6 room, you wouldn’t really think twice about the quality of towels, but if you pay for a room at the Ritz and have Motel 6 quality towels you’d question why this is. Same thing goes for healthcare, if the U.S. has one of the highest per capita spends as a country, why is the quality of care so low compared to other countries – paying for the Ritz Hotel (high cost) but getting Motel 6 towels (outcomes).

He focused on the operations side of things, specifically labor and supplies as a starting point to help reduce costs throughout the healthcare delivery system. The problem – this data is rarely provided real-time. He outlined four steps that were followed by Community Medical Center on their “journey” to achieve real-time, actionable intelligence around operational cost management1:

  • Identify ways to obtain labor and supply cost near real-time
    1. Pilot process to obtain critical data sets
  • Improve data collection by modifying charge capture process
    1. Timeliness and accuracy of supply charge capture
  • Expand data sets – quality indicators, patient satisfaction, care team
    1. Use analytics to identify drivers of quality, satisfaction, care team
    2. Expand use of predictive analytics – impact on cost and quality
  • Develop KPIs through meetings with operational leaders
    1. Plan limited release of initial set of KPI’s
    2. Focus on value to users
    3. Launch mobile application leveraging real-time
    4. Create process for alerts to key manager

Dr. Chaiken was able to present the impacts of implementing the four steps through some solid analytics that were derived from the work. He made a great point on using “little successes” to make such a large journey achievable. He gave an example of how during childhood we would set little goals, such as jumping to the next rung on the monkey bars, rather than being too ambitious and trying to jump two rungs. His point was that over ambitious executives, clinicians and IT staff sometimes set unrealistic expectations when it comes to IT and business/clinical intelligence. More  often than not they fail and failure in healthcare is not something anyone can afford.

It was a great session and it really got me thinking about using some basic clinical and administrative data, not to achieve grandiose outcomes, but more immediate and meaningful outcomes that can truly help us begin to better understand the cost of care in our healthcare systems.

 

Sources:

  1. http://files.himss.org/2015Conference/handouts/93.pdf

Predictions for the Top 3 Trends at #HIMSS15

Predictions for the Top 3 Trends at #HIMSS15Holy Cow!! (Little tribute to Chicago legend, Harry Caray!) The Health Information Management Systems Society (HIMSS) Annual Conference has come back to Sweet Home Chicago. Nearly 38,000 HIMSS15 attendees will fill Chicago’s McCormick Place April, 12-16, 2015. It’s a given that there will be many conversations about the Chicago Cubs, deep dish pizza, the crazy winds off of Lake Michigan, Soldier Field, the beautiful Chicago skyline, and other iconic Chicago things.

In addition, to the conversations about the windy city,  I predict that there will be infinite conversations throughout the Conference, and thereafter, surrounding three hot healthcare trends:

  1. ICD-10: With less than 7 months remaining till the October 2015 implementation of the new and expanded diagnosis codes, ICD-10, providers and health plans are either embracing it or praying for yet another postponement. The conversation surrounding cost impact will most likely be the fuel that sparks the hot debates among attendees – does it cost more to implement or delay ICD-10?

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Telehealth – Impacting Access, Cost and Quality

Where did 2014 go? It flew by…then again after I turned 30, I feel like every year is flying by. As this year Telehealth Impacting Access, Cost and Qualitycomes to a close and planning begins for the upcoming year, like most organizations in the United States, my organization is going through an “open enrollment” period for healthcare benefits, allowing employees to make adjustments to their current healthcare benefits for next year. I rarely change my healthcare benefits. I usually just skim through the HR documents in the slim chance something major changed from the year prior. Ninety-nine percent of the time, nothing changes. However, to my surprise, this year, something maj or, and impressive, did change. For the first time, our healthcare benefits were going to include telemedicine. Amazing!

What is Telemedicine…or is it Telehealth?

Oftentimes we see “telehealth” interchangeably used with “telemedicine,” but there is a slight nuance between the two. According to Dr. Stephen Perkins, Vice president of Medical Affairs UMPC Health Plan, “Telehealth is a general term describing the delivery of health-related services and information by the use of telecommunication technology. It can include phone calls between physicians, videoconferencing or even robotic technology.” Telemedicine has a narrower definition: The specific use of medical information that is exchanged from one site to another via electronic communications for the health and education of a patient or a health care provider for the purpose of improving patient care. It includes consultative, diagnostic and treatment services1.”

The Impact of Telehealth

As the healthcare industry continues to go through major transformation, it is no surprise that healthcare providers are trying to find innovative ways, such as telemedicine, to deliver efficient and effective patient care. Through telehealth, providers can impact access, cost and quality to help achieve this.

  1. Improve AccessibilityTelemedicine allows providers and patients to bridge the distance and time barriers that separate them. Rashid Bashshur does a fantastic job, describing the impact to access of care from both the provider and patient side2:

Providers2: Accessibility for providers in both remote and central sites relates to convenience, opportunity cost, and work load. Providers located in remote and isolated areas and institutions will have ready access to consultants and referral sources. With telemedicine, they may encounter less “red tape” in arranging for both consultations and referrals. Remote providers may be able to alleviate their work load and coverage during off-hours because of their link to medical centers and the use of non-physician providers. Providers located at tertiary care centers will be able to offer their expertise to a much larger and diverse provider and client population compared to those only seen at their medical centers.

Patients2: The target populations and the major beneficiaries of telemedicine are the geographically remote, the institutionally confined, and those otherwise medically underserved, including inner city residents and the elderly. The substitution of telemedicine for person to-person encounters reduces the need for travel and the related opportunity costs and other inconveniences encountered in the process of obtaining care. Instead of having to travel to distant tertiary care centers for specialized, and sometimes even routine, services, residents of rural areas, correctional institutions, and nursing homes could receive an array of services via telemedicine. Only when it is determined appropriate through consultation with specialists would it be necessary for clients to be referred or transferred to be served at the medical centers.

Patients don’t have to live in rural or remote areas to reap the benefits of access to care through telehealth. Access can also be related to sheer convenience. Many of us truly just don’t have time to get to the doctor. Penciling in a lunch-hour visit with our physician can prove challenging, especially when a can’t-miss conference call absorbs the bulk of our afternoon3. According to Jessica Harper, telemedicine eases this problem -through video, Web chat, or phone, workers can follow-up on a prescription or diagnosis with a physician and reduce the time you spend in the waiting room, flipping through yet another mind numbing magazine3.

  1. Influence Costs – Telehealth reduces overall healthcare costs and can potentially generate an increase in revenue.

Contain Cost – The Center for Information Technology Leadership estimates that widespread use of telehealth systems to promote preventive care, early intervention and effective information sharing could save the United States $3.61 billion annually4. Telemedicine reduces travel expenses, especially for those living in rural communities, where they would need to normally travel hours out of their way to access key health services3. In addition, the number of days of work people take for routine visits can add up in lost wages. According to a recent study, with telemedicine, 92% of patients saved $32 in fuel costs; 84% saved $100 in wages; and 74% saved $75-$150 in family expenses5. Even more astonishing, $1.2 billion could be saved by video consultations between doctors and patients in cases where office visits are not practical5. In addition, many providers actual charge less for a telemedicine consultation than they do for a face-to-face visit.

Increase in Revenue- If time and distance barriers to care are removed, use of service is likely to increase, which in turn increases the volume without declining the cost and resulting in an increase in revenue generation2. Improved operations can also prove to be a revenue generator. According to a recent study in Telemedicine and e-Health, hospitals that utilized telemedicine technology and referred patients to other hospital facilities, specifically children’s facilities, saw their revenue significantly increase6. The research looked at 16 hospitals’ billings before and after they implemented telemedicine tools. Before the implementation of telemedicine, the 16 hospitals recorded 143 transfer patients. After deployment the number jumped to 285, resulting in a revenue jump, going from $2.4 million beforehand to $4 million6.

  1. Improve Quality-Enhancing quality of care, through more timely delivery care, care coordination and patient engagement is also an advantage to telemedicine.

Timeliness to Care – The National Healthcare Disparities Report (2009), states that, timely delivery of appropriate care has been shown to improve health care outcomes and delaying health care can lead to a diagnosis at a more advanced disease stage and reduce opportunities for optimal treatment5. The window to receive treatment for many disorders is typically small and early detection and diagnosis can be vital. Ongoing remote monitoring and the ability for patients to check in with providers via telemedicine, before something worse happens, makes a positive difference in patient outcomes and satisfaction7.

Care Coordination – According to Kevin J. Boyle, “Transition care typically includes both patient education and medication management components to help ease the transition from hospital to residential facilities and reduce readmissions. While face-to-face communication is ideal, it is often impractical. Telemedicine provides a quick, convenient and more affordable forum for assessing patient recovery, assisting with medication management and keeping patients on track with discharge instructions. Advanced high-definition video capabilities can also help clinicians’ document key indicators of recovery and conduct demonstrations for self-care or physical therapy techniques8”, especially those with chronic conditions.

Patient Engagement – Providers can involve their patients in their own healthcare, thus improving compliance and, over time, clinical outcomes. Randall S. Moore, MD, MBA, states that, “One of the most interesting and promising outcomes of telehealth programs has been the increase in patient participation and self-care. Because patients have an active role in their care plan and are in more frequent contact with their healthcare provider, they gain a better understanding of their condition and become more compliant in their care.9” Patients want to take a more active role in their healthcare and see technology, such as telehealth, as a mean to helping them achieve this important goal.

Telehealth has continued to grow as a unique way of delivering care to patients, while greatly improving access, reducing cost and positively impacting quality. The number of patients using telehealth services is expected to jump from the 350,000 in 2013 to about seven million by 201810. Despite this staggering increase in users, there are still some barriers preventing its wide-spread use, such as resistance on the part of providers, limited insurance coverage and reimbursement, and privacy and security issues. However, over the past few years these challenges seem to be lessening as the healthcare industry, as a whole, is understanding the benefits of telehealth and from the looks of it, it seems like telehealth is here to stay as a recognized part of healthcare delivery.

What do you think? Do you think telehealth and telemedicine can change the healthcare industry?

Resources for this blog post:

  1. http://www.upmchealthplan.com/pdf/smart_business/February_2014.pdf
  2. http://deepblue.lib.umich.edu/bitstream/handle/2027.42/44995/10916_2005_Article_BF02257059.pdf?sequence=1
  3. http://health.usnews.com/health-news/articles/2012/07/24/pros-and-cons-of-telemedicine-for-todays-workers
  4. http://www.corp.att.com/healthcare/docs/connected_hc.pdf
  5. http://accesstelehealth.org/benefits/lower-cost
  6. http://healthworkscollective.com/waxcom/116071/using-telemedicine-increase-hospital-revenue
  7. http://venturebeat.com/2014/10/20/why-telemedicines-window-is-finally-opening/
  8. http://www.healthmgttech.com/articles/201210/improving-care-coordination.php
  9. http://www.psqh.com/janfeb05/viewpoint.html
  10. http://www.healthitoutcomes.com/doc/barriers-to-telehealth-s-growth-0001

Healthcare Benchmarking Part 2 of 2

In my last blog post, I introduced the fundamentals and importance of healthcare benchmarking. I highlighted the benefits of benchmarking as well as the advantages and disadvantages of various types of benchmarking. The main point I hope you took away wasHealthcare Benchmarking - Part 2 of 2 that regardless of the type of benchmarking, the purpose is the same – to help healthcare organizations identify ways to improve their overall performance.

Now that you are aware of what healthcare benchmarking is and why it is important, in this blog post, we will focus on the key steps to implementing an effective benchmarking project to begin reaping those benefits.

Benchmarking Process and Key Steps

It is not secret that a well thought out process is essential to the success of any major project. Implementing a benchmarking project is no different. Below are the key areas of focus to consider before undertaking any benchmarking initiative. I have derived many of the specifics using a variety of resources, such as Six Sigma, the Juran Model, etc., to provide further context around each step. You might say, I have taken the “best of the best” from each resource…coincidence, I think not.

Plan and Prepare
Identify Opportunities and Prioritize1 – Top management must decide which processes are critical to the success of the organization and select projects from these. Once a shortlist of processes to be bench-marked is ready, the processes need to be prioritized as per a predetermined set of criteria to fulfill the requirements of all customers (stakeholders), especially the end customer1.

Deciding the Benchmarking Organization1 The next step in the process is to decide the organization whose processes will serve as the benchmark. The benchmark can be a single entity or a collective group of companies, which operate at optimal efficiency2. Information on their processes should be gathered from various sources and the most suitable organization selected1. It is always important to ensure that more detailed information about the selected organization will be accessible and that comparison with the organization’s process will be relevant and useful1.

Organize a Benchmarking Team – The most successful benchmarking projects involve a team approach3. The organization should leverage existing teams that may be involved in similar topics to those that are being bench-marked, if possible. In the event a new team needs to be created for a benchmarking project, The Joint Commission, suggests that the organization seek the following when building the team3:

  • Individuals closest to and most knowledgeable about the process or issues under investigation
  • Individuals critical to implementation of any potential changes
  • Individuals likely to be directly affected by any changes that result from a project
  • A respected and credible leader who has a broad knowledge base
  • An individual who has the authority to make decisions
  • Individuals with diverse knowledge base and strong analytical skills
  • Individuals familiar with benchmarking and how it can be used in performance improvement
  • Individuals who are skeptical, resistant or even opposed to certain ideas and who can service as sounding boards or provide alternative viewpoints.

Collect Data
This step is perhaps the most important, most difficult and most time consuming activity in the process1. It involves creating a plan for collecting data from selected targets, conducting site visits and creating a site visit report4. Many times the information on processes and procedures followed at another company are confidential, and it is not always easy to gather authentic information, even after making a planned and approved visit at another organization1. The preparation for collecting necessary information and documenting this information in a systematic way has to be carefully planned and executed.

Analyze Data
Validation and Normalization5 – The key activities here are the validation and normalization of data. Before any meaningful analysis can be performed, it’s essential that all data be validated to establish its accuracy and completeness. Some form of data normalization is usually required for direct comparisons to be made.

Identify Gaps5 – To be of value, the analysis must indicate the benchmarker’s strengths and weaknesses, determine (and, where possible, quantify) gaps between the benchmarker’s performance and the leaders’, and provide recommendations for the focus of performance improvement efforts. Based on this thorough analysis, an improved process(s) should be developed. Properly identifying the gaps will result in a clear picture of the organization’s processes in comparison with others within the business or industry.

Communicating Results – Communicating the benchmarking results and their implications to significant audiences in the organization and motivating them to carry out changes is vital4. It will result in a complete understanding by the target audiences of the necessity for changes in the processes involved and a desire to carry them out4. The communication must be delivered in a very clear, concise, and easily understood format via an appropriate medium5.

Implement
Create Goals – The project team’s next step is to set/revise goals for the improvement of the organization’s existing process, close the performance gap(s) identified in step 3 and create realistic and unambiguous new standards for the processes involved1&4. These goals can, and probably should, be stretch goals that will result in a process even better than the other organization’s best-in-class process1. Make sure management has approved and that all in the organization/business area understand.

Develop and Execute Action Plan1 – After the improved process and goals are accepted by all concerned or likely to be affected by it, a formal, detailed action plan is drawn with all key activities taken as inputs as well as the organization’s culture. The detailed action plan should carry the important things like a time line, individuals responsible for carrying out the tasks, any short-fall in the completion of tasks and what stretch targets are taken to compensate the short-falls. Those responsible should be committed enough to ensure that the tasks and assignments are completed on time.

Measure
Monitor Process – As with most projects, in order to reap the maximum benefits of the benchmarking process, a systematic evaluation should be carried out on a regular basis2. Senior management must be committed enough to ensure proper coordination of various activities, monitor the progress of implementation of the plan and work as a barrier-remover in the implementation process1. When the revised process is in place, a complete report has to be prepared, showing the benefits of the revised process compared with the expectations at the time of approval of the proposed revision of the process1.

Recalibrate as Necessary4– The organization needs to ensure it remains on the cutting edge by continuously evaluating the bench-marked practices and re-instituting the benchmarking process when necessary. This will prevent complacency by creating the habit of evaluating procedures to identify opportunities to improve.

Benchmarking is a very powerful performance improvement tool. However, it is vital to understand the basis behind it, follow a proven implementation methodology and gain organization-wide commitment to the cause. Benchmarking is critical for healthcare organizations to achieve and sustain the clinical effectiveness and operational performance they so desperately need.

Does your healthcare organization benchmark? Does the organization have a process that is followed similar to the aforementioned process? Has it proven successful?

Resources for this blog post:

  1. http://www.isixsigma.com/methodology/benchmarking/benchmarking-ten-practical-steps-review-points/
  2. http://www.tutorialspoint.com/management_concepts/benchmarking_process.htm
  3. http://books.google.com/books?id=2mQpVORlulEC&printsec=frontcover#v=onepage&q&f=false
  4. http://www.qualitydigest.com/feb/bench.html
  5. http://businessfinancemag.com/business-performance-management/7-steps-better-benchmarking-0

Healthcare Benchmarking – Part 1 of 2

I am an avid sports junkie. I literally wake up and fall asleep watching SportsCenter. Last month, while watching the NBA Finals (Go Spurs!), I concluded that sports and healthcare have a lot in common. Sport, is a “physical activity that is governed by a set of rules or customs and often engaged in competitively1.” If we simply swap out the words physical activity for medical practice(s) in the aforementioned definition, we would be describing today’s healthcare organization, no?

For me, the parallel of the two industries really lies in their competitive nature-seeking to be the best. The whole premise of sports is to encourage competition, to be the world’s best Healthcare Benchmarking - Part 1 of 2player, team, or country. Similarly, the healthcare industry encourages competition by seeking the best physician, practice, health system, equipment, outcomes, cost and efficiencies. However, you cannot be the best unless you know what “best” means. What is the threshold you are comparing yourself to in order to be called the best? What are the weaknesses that are holding you back from being the best?  What is the benchmark for best?

In sports it is a little easier to identify. For example, after six titles, five Most Valuable Player awards and 10 scoring titles, Michael Jordan is considered to be the best player of all time. He is the benchmark of greatness in the sport of basketball-he is what all other players aspire to be and what they evaluate themselves against. Unfortunately, in healthcare it is not as easy, as these types of statistics are not as readily available. However, in recent years, in an effort to help define and understand “best”, more and more healthcare organizations are finding value in benchmarking as a tool to assess their current thresholds and a way to improve their process and overall performance in an attempt to be the best.

In this blog post, you will be provided a general overview of benchmarking. In the next blog post we will take a closer look at the actual process of benchmarking. (more…)

Changing Delivery and Spending of Medicaid through DSRIP

Well, folks, here’s another acronym for you to add to your healthcare dictionary…DSRIP. DSRIP, or more formally known as the Delivery System Reform Incentive Program, is a demonstration program through the Centers for Medicare and Medicaid Services (CMS) that is designed to result in achieving the triple aim: better care for individuals, better health for the population, and lower costs by transitioning hospital funding to a model where payment is contingent on achieving health improvement goals1.Changing Delivery and Spending of Medicaid through DSRIP

CMS is using the Section 1115 Waiver of the Social Security Act, which gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that support the objective of Medicaid programs2, to encourage hospitals to build innovative service delivery systems. Hospitals may qualify to receive incentive payments for implementing quality initiatives within their community and achieving measurable, incremental clinical outcome results demonstrating the initiatives’ impact on improving their states health care system3.

The program’s main goals are to:

  1. Develop a program that supports hospitals’ efforts to enhance access to healthcare, the quality of care, and the health of patients and families they serve.
  2. Develop a program rooted in intensive learning and sharing that will accelerate meaningful improvement.
  3. Ensure individual hospital DSRIP plans are consistent with their mission and quality goals, as well as, CMS’ overarching approach for significantly improving health care through the concurrent pursuit of the triple aim.

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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…)