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The Fundamental Challenge of ACOs

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I’ve been openly bullish on ACOs and capitated payment models. The only way to achieve the triple aim – quality, cost and access – is to create a system that is structurally incentivized towards those ends. The fee-for-service model will never be structured in a way that incentivizes the triple aim. On the other hand, ACOs do.

Early ACO data is mixed. Although some organizations succeeded in lowering costs and improving outcomes, about 1/3 dropped out of the ACO program entirely, and another 1/3 reported no significant cost or quality changes. Only 1/3 were “successful.”

Why? Why did some organizations succeed where others failed? What did each organization do differently? It’s been proven that some organizations can succeed under this model. But not everyone.

ACOs are disruptive to fee-for-service payment models. ACOs invert incentives. They invert how every employee should think about their job in the context of the larger care delivery system. In ACOs, healthcare professionals are implicitly asked to think about preventative care, which tends to lead towards both cost and quality improvements. On the other hands, in a fee-for-service model, healthcare professionals are only incentivized to simply treat the patient in front of them with no regard for prevention or cost.

When the board of directors of a given organization recognizes the need to change the course of a business, the board usually replaces the CEO. After a new strategy is devised, the new CEO typically replaces most of the executives and lays off a significant number of the existing staff. This accomplishes a few things:

1) reduces the burn, making the organization leaner and more capable of pivoting
2) replaces lots of senior and middle management, who were trained and wired around the old business model, and who may conspire against the new model if they don’t believe in it
3) sends a signal to the remaining staff that management is serious about change

Although this plan doesn’t guarantee success, it’s fairly common in large organizations because it can create impetus to break from the inertia of the status quo. The only thing worse than going after the wrong business model is maintaining one that’s failing.

This of course begs the question, how are providers adopting ACOs? Management at provider organizations that have adopted the ACOs are early adopters. They are pioneers. They are leaders. They can see a new, better, ACO-based future. The last thing management at these organizations is going to do is fire themselves after deciding to transition to an ACO.

In light of the above, I am particularly impressed by the early success of the ACO program. Only 1/3 dropped out. Given the fundamental change at hand, I would consider the early data a harbinger of better changes to come. I suspect that almost all of the remaining ACOs will see more significant improvements in years 2 and 3 as they mature and refine processes around value.

March 31, 2014 I Written By

Kyle is Founder and CEO of Pristine, a company in Austin, TX that develops telehealth communication tools optimized for Google Glass in healthcare environments. Prior to founding Pristine, Kyle spent years developing, selling, and implementing electronic medical records (EMRs) into hospitals. He also writes for EMR and HIPAA, TechZulu, and Svbtle about the intersections of healthcare, technology, and business. All of his writing is reproduced at kylesamani.com

Surviving 2014: The Toughest Year in Healthcare

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The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:

ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.

In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.

Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.

We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.

Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.

Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.

The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.

Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.

The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.

Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Medicare.gov Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.

Conclusion

These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.

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Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

March 26, 2014 I Written By

Why Everyone Better Learn About ACOs

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While I wasn’t working in healthcare at the time, I’ve heard a number of doctors say that doctors missed out on being part of the HMO process. Their voice wasn’t part of the process and they suffered as a consequence of that decision. As I consider that idea, I wonder if doctors aren’t in the same position again with ACOs.

I was reminded of this as I was reading through this whitepaper called ACO & Collaborative Care – The Basics. The whitepaper digs into a number of good ACO discussions, but I was struck by one of the opening phrases:

Health reform IS REAL and NOT GOING away.

That struck me, because I think many doctors are just hoping that this shift to ACOs and value based reimbursement will just go away. Certainly some of this hope is founded since ACO is such a nebulous concept and we’re not sure how it’s going to be implemented. However, just because a concept isn’t totally defined doesn’t mean that it’s not going to be the future of healthcare. I assure you that this shift in reimbursement isn’t going anywhere.

The fact that ACO is a nebulous concept is exactly why doctors should get involved in the process of defining an ACO. When there’s uncertainty, there’s opportunity. The question is whether the opportunity is going to be taken by doctors or by someone else. Ideally all parties will be involved and there will be a give and take. However, I think currently physician voices are underrepresented and they’ll suffer for it.

One other thing that the ACO & Collaborative Care – The Basics whitepaper points out nicely is that you can’t just go out and buy an ACO. There’s no off the shelf ACO solution that will solve your problems. It’s not a software. It’s not a program. It’s not an organization. It’s likely going to include all of those things and that means that it takes some planning, coordination and collaboration. You’re not going to be ready for it if you’re not part of the ACO conversation.

March 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

This Geek Girl’s Singing: HIMSS 14 Social Media Finale

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As one of the inaugural crop of HIMSS Social Media Ambassadors, a second-generation native Floridian, and a former Orlando resident, it is my sworn duty to summarize, recap, and perhaps satirize the last group of Blog Carnival posts, to metaphorically sing the HIMSS opera finale. And you folks submitted some doozies! I’m very grateful to the HIMSS (@HIMSS) and SHIFT Communications (@SHIFTComm) team for providing me with links to all entries. Y’all have been BUSY!

A man after my own heart, and a frequent #HITsm participant who weathers harsh criticism with witty aplomb: Dan Haley’s (from athenahealth, @DanHaley5) piece on 3 Takeaways From HIMSS – Policy And Otherwise caught my attention with the line, “Regulators are from Mars…” He stole my favorite blog entry prize with the line: “Orlando is magical when you are a kid. Kids don’t attend HIMSS.”

First-time attendee Jeffrey Ting (from Systems Made Simple) outlined his experiences with some of my favorite topics in his piece, HIMSS Reflections By A First-Time Attendee: HIEs and interoperability. I agree with him: the Interoperability Showcase’s “Health Story” exhibit was one of the best presentations of the whole conference.

Dr. Geeta Nayyar’s perspective as a board member of HIMSS and CMIO for PatientPoint gave her a unique vantage point for her post, HIMSS 14: A Truly Inspiring Event. Take note, HIMSS conference planners – your monumental efforts were recognized, as was the monumental spirit of the closing keynote speaker, Erik Weihenmayer.

HIMSS Twitter recaps permeated the blogosphere, with my favorite being the inimitable Chuck Webster’s (@wareflo) HIMSS14 Turned It Up To 11 On And Off-Line!. Chuck also periodically provided trend analysis results of year-over-year #HIMSS hashtag traffic for each period of the conference, complete with memes for particular shapes: Loch Ness monster humped-back, familiar faces of frequent tweeters.

Health IT guru Brian Ahier’s (@ahier) wrapped up the “Best In Show” of HIMSS Blog Carnival , complete with Slideshare visuals awarding Ed Parks of Athenahealth “Best Presentation” and providing an excellent summation of must-read posts.

Interoperability was one of the most prevalent themes of HIMSS, and a plethora of posts discussing the healthcare industry’s progress on the path to Dr. Doug Fridsma’s (@Fridsma) High Jump Of Interoperability (Semantic-Level) were submitted to the Blog Carnival. Notable standouts included: Shifting to a Culture of Interoperability by Rick Swanson from Deloitte, and Dr. Summarlan Kahlon’s (of Relay Health), Diagnosis: A Productive HIMSS 2014, which posited that, “this year’s conference was the first one which convinced me that real, seamless patient-level interoperability is beginning to happen at scale.”

And who could forget about patient engagement, the belle of the HIMSS ball? Telehealth encounters, mobile health apps and implications, patient portals, and the Connected Patient Gallery dominated the social media conversation. Carolyn Fishman from DICOM Grid called it, HIMSS 2014: The Year of the Patient, and discussed trepidation patients feel about portal technologies infringing on face-time.

Quantified-self wearable-tech offered engagement opportunities, as well. Having won one such gadget herself, Jennifer Dennard (@SmyrnaGirl) gave props to organizations like Patientco and Nuance for their use (and planned use) of wearable tech in support of employee wellness programs, and posited on the applications of such tech in the monitoring and treatment of chronic disease in her piece, Watching for Wearables at HIMSS14.

Finally, if you’re able to read Lisa Reichard’s (from Billians Health Data) @billians) highlights piece,Top 10 Tales and Takeaways, without busting out into Beatles tunes, you probably wouldn’t have had nearly as much fun as she and I did at HISTalkapalooza, dancing to Ross Martin’s smooth parodies. You also probably don’t have your co-workers frantically purchasing noise-canceling headphones.

I did say I’d be singing to bring HIMSS to a virtual close.

Can’t wait to get back to the metaphorical microphone for HIMSS 2015 in Chicago!

March 14, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

PQRS Incentives, Penalties and the Coming Value Based Payment Modifier

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The following is a guest post by Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff
Much of the focus of healthcare has been on meaningful use and the EHR incentive money. Considering we just reached $19 billion of payouts, it’s definitely a topic worthy of attention. However, a topic which hasn’t gotten nearly as much attention, but is nearly or possibly more important than meaningful use is PQRS and the Value Based Payment Modifier.

Before I dig into some of the details and timelines for PQRS and the Value Based Payment Modifier, it’s really important to note that both of these programs are really just a preview of what’s happening with Medicare reimbursement. These programs are the core of the shift towards paying physicians differentially based on the quality and cost of the care they provide and away from the traditional fee for service model. We’ve seen similar value based payment arrangements with the advent of ACOs, CINs and other clinical networks establishing innovative payment models with payers. Understanding where these programs are going will give you a preview of what’s happening with healthcare reimbursement.

PQRS
When it comes to PQRS, much like meaningful use, there is both a PQRS incentive and PQRS penalty (carrot and stick if you prefer). 2014 is the final year to receive the PQRS incentive money (0.5% of Medicare Part B claims) and participants must submit 12 months of 2013 CQM data by February 28, 2014 if reporting by claims data, March 21, 2014 if reporting by GPRO web interface, and March 31, 2014 if reporting by registry data. (Note: The 2013 MU reporting deadline was moved to March 31, 2014, but the PQRS deadlines have not changed.). However, more important is that providers who don’t report PQRS 2013 data will be penalized 1.5% in 2015. Those who don’t participate in PQRS in 2014 will be penalized 2% in 2016.

Value Based Payment Modifier
While most people have heard about PQRS and are hopefully participating to avoid the penalties, many people haven’t heard about the Value Based Payment Modifier that is built on the PQRS foundation. While you could look at the Value Based Payment Modifier final rule, this Value-Based Payment Modifier summary is a much better overview of the program.

Essentially, the Affordable Care Act (ACA) required that CMS implement a value based payment modifier that would apply to Medicare fee for service payments. This program will start with physicians in groups of 100 or more eligible professionals under the same TIN beginning January 1, 2015, and apply to all physicians and groups by January 1, 2017. CMS also recently announced that this applies to both par and non-par Medicare providers with 100 or more eligible professionals.

Here’s a look at how this new Value Modifier will work for groups of physicians with 100 or more eligible professionals and will likely be a preview of what’s to come for all Medicare physicians:
CMS Value Modifier

While the program starts with relatively small 1% adjustments, this quote from CMS also provides a clear indication of where they want to take this program:

We also anticipate that we would propose to increase the amount of payment at risk for the Value Modifier as we gain additional experience with the methodologies used to assess the quality of care, and the cost of care, furnished by physicians and groups of physicians.

What should you do to be prepared for this new Value Based Payment Modifier?
1. Participate in the PQRS program since it’s the foundation of what’s to come.
2. Keep an eye on changes to the PQRS and Value Based Modifier programs. They are changing regularly and it’s worth knowing what’s changing with these programs.
3. Work with your professional organization to provide feedback on these programs. No doubt they’re keeping an eye on them and providing feedback as part of the government rule making process. Make sure your voice is heard.

CMS looks at this new value based modifier as a budget neutral program. That means that there are going to be winners and losers. By understanding how these programs work, you can better assess if you want to work to avoid the payment adjustments or if you’re ok taking them on.

Like it or not, PQRS is the start of the movement towards quality based reimbursement and likely a small preview of coming attractions. Of course, if the SGR Fix gets funded by congress, then PQRS, Meaningful Use and the Value Based Modifier will be sunset at the end of 2017 and rolled into a new Merit-Based Incentive Payment System (MIPS) that will start in 2018. More on MIPS in the future, but I think we can safely say that MIPS will be an amalgamation of all these incentive programs.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

February 20, 2014 I Written By

Interview with Barry Haitoff, CEO of Medical Management Corporation of America

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The following is an interview with Barry Haitoff, CEO of Medical Management Corporation of America.
Barry Haitoff

Tell us about Medical Management Corporation of America (MMCOA).
MMCOA helps physicians and physician groups increase collections, assure compliance, manage overhead and navigate the maze of EMR/EHR, Meaninful Use, PQRS and other Government incentive programs and regulations. With a focus on revenue cycle management, MMCOA helps our clients stay ahead of the curve with things like the transition to ICD-10.

What are the keys to running a good medical billing company?
Like any successful business, I believe the 2 most important assets are people and systems. We hire, retain and cultivate quality individuals and empower them with state of the art systems and technology. We never settle for status quo and continue to look for better ways of doing things. My style of leadership is one of servitude. It is my goal to provide all staff members a great work environment, financial incentives and proper tools to perform their functions.

What’s your take on the economics of outsourcing medical billing? Where’s the ROI for an office that’s considering going with an outside medical billing company like yours?
I tell physicians, “do what you do best and outsource the rest”. Your tax work is handled by a professional accountant, your legal work is handled by a professional attorney, who is handling your billing? Outsourcing your billing can sometimes be more expensive than keeping it in-house, however, the return should far outweigh the added cost.

Most practices do not have adequate resources in their billing department to do the right job. A great deal of money winds up being left on the table. There is a reason that the tallest buildings in most metropolitan cities are owned by insurance companies. A quality billing company will increase your collections at a rate that will far exceed the fee.

In addition, because the typical fee structure is based on a percentage of collections, not only does the billing company have “skin in the game” to do a good job, the billing overhead of the practice is better managed. If one or more physicians are out of the office on vacation resulting in lower charges, that eventually results in lower collections. With billing in-house the practice still pays salaries, benefits, software licenses etc. All the fixed costs remain in place regardless of collections that month. With outsourced billing company, the practice’s cost for billing is directly in proportion to the amount collected that month.

What are some of the biggest changes to medical billing that have happened over the past couple years?
EMR/EHR, PQRS, ePrescribing, HIPAA, Meaningful Use, Accountable Care Organizations, Value/Quality based reimbursement, Bundling, Health Insurance Exchanges, added governmental regulations, OIG compliance and soon…..ICD-10, ICD-10, ICD-10. ICD-10 will prove to be the biggest challenge to date. We’re ready!

How is medical billing going to be impacted by things like ACOs (Accountable Care Organizations) and value based reimbursement?
Someone will still need to make sure that services rendered are reimbursed properly. More challenging, someone will need to distribute funds appropriately to the myriad of providers involved. There will be a greater need for revenue cycle management as payments are bundled.

Is healthcare ready for ICD-10? What are you doing to make sure you’re ready?
Our research to date says no. Providers and staff are not yet trained. Insurance carriers and software vendors have not yet successfully tested.

We have established an ICD-10 committee headed by our Director of Healthcare Informatics. We have begun informing and educating our clients and staff, researching tools, attending training sessions, initiating dialogue with our software vendors and staying up to date.

In what ways has the Accountable Care Act (Obamacare) and the health insurance exchanges impacted your clients?
I’d say that it’s caused a whirlwind of confusion. Providers must take the time to determine which HIX plan networks they’re in, so as not to provide care outside of a contracted relationship with the HIX plans, which predominantly lack out-of-network coverage. We expect our clients to become busier. We expect the additional covered lives to find their way into our clients’ offices. We have helped our clients figure out if they are participants in the Exchanges in their area.

A number of EHR companies have started doing medical billing. How do you differentiate the services you offer versus an EHR vendor?
Most of the EHR vendors that have just started doing medical billing, just started doing medical billing. MMCOA has been in business for 18 years, growing primarily by word of mouth. Some of the EHR vendors are publicly held companies whose most important stake holder is their shareholders. Our most important stakeholder is our clients. We have had clients leave us for those solutions and have since come back. We will continue to provide quality service on a consistent basis and will never sacrifice integrity for growth.

What are the biggest revenue cycle management issues you see in organizations?
Not enough staff. Outdated or inadequate technology. Lack of leadership. Lack of ongoing training. Lack of incentive.

Where do you see revenue cycle management going in the future?
My crystal ball is broken right now. Seriously though, there is a lot of consolidation in our industry and the smaller billing companies will likely go out of business or be acquired. Physicians and physician groups will continue to need assistance with their reimbursements. Unless all healthcare providers wind up employed by an ACO, Hospital System or other Healthcare entity with adequate revenue cycle management expertise, there will be a need for continued navigation of the maze we know as healthcare revenue cycle management.

Medical Management Corporation of America, a leading provider of medical billing services, is a proud sponsor of EMR and HIPAA.

January 20, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Realizing the Value of Health IT

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I’ve been focused on the value of healthcare IT for a long time. Obviously, I’ve been particularly focused on the value of EHR including a whole series of posts on the benefits of EHR (which I need to finish). I’m a huge fan of the value of EHR and healthcare IT, but I also am a realist. I realize that we aren’t getting all of the value out of healthcare IT that we could be getting. I also realize that poor health IT implementations can actually decrease value as opposed to increasing the value of health IT. Plus, I also see a huge disconnect between the value government sees in healthcare IT and what doctors find valuable.

If you don’t believe healthcare is missing out on the value healthcare IT could provide we don’t need to look any further than the fax machine. A recent Covisint-Porter Research study found that “76% of respondents stated that they are handling their inflow of information via Fax.” Mr H from HISTalk aptly described this: “Healthcare: the retirement home for 1980s technology.”

I’ve also seen illustrated dozens of times the way a poor implementation can actually cause more problems than it solves. The Sutter EHR implementation is one example to consider. No doubt there is a lot of internal politics involved in the challenges that Sutter is facing with their EHR, but soon I’ll be publishing on Hospital EMR and EHR some first hand experiences with that EHR implementation. It’s a sad thing to see when an EMR implementation is done the wrong way. However, the opposite is also true. I’ve seen hundreds of organizations that love their EHR and can’t imagine how they practiced medicine before EMR.

One thing I’ve never heard a practicing doctor say is that they want to show meaningful use to be able to realize the value of health IT. I’ve certainly heard doctors say they have to show meaningful use to get the government money. I’ve certainly heard doctors say they want to show meaningful use to avoid the EHR penalties. I haven’t heard any doctor say they want to show meaningful use because it provides value to their clinic.

To me this illustrates the wide divide between the value government wants to see from healthcare IT and the value healthcare IT can provide a healthcare organization. Currently the government is riding on the back of incentive money and penalties to motivate healthcare organizations. No doubt this has caused many healthcare organizations to adopt an EHR. However, the incentive money and penalties won’t last forever. Then what?

What’s sad for me is that EHR adoption was starting to gain some momentum pre-HITECH act. There was a definite shift towards EHR adoption as organizations realized they needed to head that direction. Then, once the HITECH act hit it threw every EHR organizations plans out the door and created an irrational hysteria around EHR. This has led to irrational selection of EHR vendors, rushed EHR implementations, and cemented in many Jabba the Hutt EHR vendors that the relatively free EHR market wouldn’t have adopted pre-HITECH. To be honest, I’m ready for a return to a more rational EHR market based on value created. That’s when we’ll truly start realizing the value of health IT.

Beyond EHR, we need more brave leaders in healthcare IT that aren’t afraid to move beyond the fax machine. Leaders who don’t need a business model to realize that we can do better than the fax machine and other 80′s technology. It shouldn’t take five committees, two research studies, a certification, and outside money for an organization to do what’s right for patients. In fact, doing so is the very best business model in the world.

What scares me is that we’re going to miss out on the value of healthcare IT because our healthcare leaders are too busy fighting the proverbial meaningful use, ICD-10, and ACO fires.

September 16, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Physician Acquisition: Is It The Right Strategy For Your Health System?

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Today I was talking with a vendor of EHR conversion services. I’ll be writing a lot more about our conversation soon, but I wasn’t surprised by his comment that mane of the EHR conversions that they’re doing are due to physician practice acquisition. Whether it’s a large hospital system acquiring the practice or a group practice acquiring a practice, there’s often the desire to move that practice to the same EHR platform.

As I thought about the trend of acquired physician practices, I ran across a whitepaper by athenahealth which asked the question: Physician Acquisition: Is It The Right Strategy For Your Health System? The whitepaper highlights how varying interpretations of the Affordable Care Act (Obamacare), the launch of Accountable Care Organizations (ACO), bundled payment pilots, and the persistent pressure on commercial reimbursement rates makes planning for healthcare leaders a challenging task. However, what does seem clear is that doing the same thing you’ve always done won’t be a viable long term strategy.

All of these pressures are driving the physician acquisition strategy of most organizations. Does anyone see these pressures changing anytime soon? I don’t see any changes in this regard on the horizon.

Despite the widespread physician acquisitions that are happening, there are legal barriers (antitrust) that prevent a clinic from controlling all of healthcare in a community. What does this mean for an organization? How do they integrate with providers that they haven’t acquired? Plus, it’s naive to think that the acquired physicians are going to remain with your organization forever. We have seen the cycle before where acquired doctors leave the mothership and venture out on their own again. Organizations without a strong external strategy are going to be in a difficult position.

The whitepaper does make an interesting case for clinical integration versus full on practice acquisition. This is a great concept that every organization should consider. Can you clinically integrate with an organization that you don’t own? How would that clinical integration work? I think these integrations are still evolving, but the whitepaper had two case studies from organizations that were working on it.

What’s the right strategy for health systems when it comes to physician acquisition?

September 9, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Can Healthcare “Step on a Scale” Today?

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At the Healthcare Forum, Dr. Farzad Mostashari posited an important question: Can healthcare step on a scale today?  Embedded in this question is the idea that healthcare should have a simple way to measure the quality of care it provides.  Dr. Mostashari suggested that most practices today can’t step on the proverbial scale.  However, the technology is now available for us to measure and track how well we are doing at providing care.

The problem with stepping on the scale is that the feedback it provides can often be difficult to accept.  Our normal first response to stepping on the scale is to exclaim, “this scale must be broken.”  Dr. Mostashari suggested that “There isn’t a healthcare provider in the world who doesn’t think they’re doing better than they are.”  This isn’t a condemnation of the healthcare providers, but a simple reality of our own self evaluations.  The way to solve this reality distortion is to provide trusted data which illustrates the realities of the situation.

This proverbial “scale” isn’t some high level concept, but is part of a major shift that’s happening in healthcare measurement and payment.  Dr. Mostashari said that “Reimbursement will be tied to how well we manage a population.  People will have to answer, ‘How am I doing?’”  This shift in payment models is happening quickly and healthcare IT will be the tool that measures our progress in key healthcare quality measures.  We must have the courage to step on the scale and face the reality of our baseline metrics.  We must set goals and take action to improve our performance.

The unique promise of technology is that it can make things better.  One of the core beliefs of Dr. Mostashari and his predecessor, Dr. Blumenthal, is the equation:  man + computer > man

Dr. Mostashari offered some high level ways that technology can help to improve healthcare.  He said, “What we need isn’t necessarily big data in the sky.  We need small data in every interaction we have.  We need to learn from the healthcare interactions and learn from what we’re doing.”  What a drastically different view of health data than what we often see in the market today.  We are collecting a lot of data, but are we using that data in ways that will improve care?  This is the promise of technology in healthcare.

Another way technology could be used to improve healthcare was described as learning as we deliver care.  Think about putting together an A/B trial for emails or letters sent to patients who need to return back to the office.  We can take these care experiences and learn from them.  Our hospital CEOs know what our length of stay is to multiple decimal points, but does our CEO really know what population health management will do for our workflows?

Healthcare is no longer an individual sport.   Healthcare is now a team sport that will require interoperability of healthcare data.  The purpose of clinical notes are no longer short notes for myself or long notes for the CMS auditors, but are data to be used to improve care.

Healthcare improvement needs to happen across the spectrum.  This includes improvement at the community, practice and personal level.  The shared values of health IT are that healthcare can be better, data is the key to making it better, and an optimism that the future will be better than today.  As Dr. Mostashari concluded, “We can use information and tomorrow will be better, faster, and cheaper than today.”

Check out the full Healthcare Forum presentation by Dr. Farzad Mostashari embedded below:

The Breakaway Group, A Xerox Company, sponsored this coverage of the Healthcare Forum in order to share the messages from the forum with a wider audience.  You can view all of the Healthcare Forum videos on The Healthcare Forum website.

August 1, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.

Do Hospitals Need an EDW to Participate in an ACO?

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The following is a guest blog post by Dana Sellers, Chief Executive Officer of Encore Health Resources. Dana’s comments are in response to my post titled, “Skinny Data Solves Specific Problems While BIG DATA Looks for Unseen Problems.” For more context, also check out my post on Skinny Data in Healthcare, and my video interview with Dana Sellers.
Dana-Sellers-Encore-Health-Resources
You did a great job of nailing down the kinds of problems our industry can tackle with BIG DATA on the one hand and smart, skinny data on the other in your blog last Thursday, “Skinny Data Solves Specific Problems While BIG DATA Looks for Unseen Problems.” We here at Encore Health Resources were particularly intrigued when you asked whether skinny data would be enough for ACOs, or whether hospitals will need full enterprise data warehouses – EDWs – to meet the demands of ACOs.

I’d love to take a shot at that. As I’m sure lots of your readers know, an EDW is a collection of enterprise data based on the best guess of what an organization thinks it will need over the long run. So it’s bigger than skinny data (only what we know we need now) but smaller than Big Data (every bit of data available). So now we get to your question…do hospitals need an EDW to meet the demands of participating in an ACO?

If you’ve got one, great! In large part, we know what measures ACOs want a hospital to report. If you already have a mature, well-populated EDW — fantastic! Pull the needed data, calculate the required measures, and go for it.

If not, start with skinny data. Many organizations find that they are jumping into ACOs before they have a mature EDW. So this is a great example of where skinny data is a great idea. The concept of skinny data lets you focus on the specific data required by the ACO. Instead of spending a long time trying to gather everything you might need eventually, focus on the immediate needs: quality, readmissions, unnecessary ED visits, controlling diabetes, controlling CHF, etc. Gather that quickly, and then build to a full EDW later.

Think about a skinny data appliance. One of the problems I’m seeing across the country is that organizations are rarely talking about just one ACO. These days, it’s multiple ACOs, and each one requires a different set of metrics. I talked with an organization last week that is abandoning its current business intelligence strategy and seeking a new one because they didn’t feel the old strategy was going to be able to accommodate the explosion of measures that are required by all the ACOs and commercial contracts and Federal initiatives coming down the road. The problem is that you don’t have to just report all these measures- you actually need to perform against these measures, or you won’t be reimbursed in this new world.

One way to deal with this is to establish a sound EDW strategy but supplement it with a skinny data appliance. I doubt that’s an official term, but my mother never told me I couldn’t make up words. To me, a skinny data appliance is something that sits on top of your EDW and gives you the ability to easily extract, manipulate, report, and monitor smaller subsets of data for a special purpose. As the demands of ACOs, commercial contracts, and Federal regulations proliferate, the ability to be quick and nimble will be critical — and being nimble without an army of programmers will be important. One large organization I know estimates that the use of a smart skinny data appliance may save them several FTEs (full time equivalents) per year, just in the programming of measures.

Bottom line – I believe skinny data will support current ACO requirements. Eventually, an EDW will be useful, and skinny data is a good way to get started. Many large organizations will go the EDW route, and they will benefit from a skinny data appliance.

John, as always, I love talking with you!

July 29, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus. Healthcare Scene can be found on Google+ as well.