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The Shifting Health Care IT Markets

Posted on November 5, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’m at the end of my Fall Healthcare IT Conference season (although I’m still considering attending RSNA for my first time) and besides being thankful to be done with all the travel, I’m also taking a second to think about what I’ve learned over the past couple months as I’ve traveled to a wide variety of conferences.

While the EHR market has been hot for so many years, I’m seeing a big shift in purchasing to three areas: Analytics/Population Health, Revenue Cycle Management, and Privacy/Security. This isn’t a big surprise, but the EHR market has basically matured and now even EHR vendors are looking at new ways to market their products. These are the three main areas where I see the market evolving.

Analytics and Population Health
I could have easily added the other buzzword “patient engagement” to this category as well. There’s a whole mixture of technologies and approaches for this category of healthcare IT. In fact, it’s where I see some of the most exciting innovations in healthcare. Most of it is driven by some form of value based reimbursement or organizations efforts to prepare for the shift to value based reimbursement. However, there’s also a great interest by many organizations to try and extract value from their EHR investment. Many are betting on these tools being able to help them realize value from their EHR data.

Revenue Cycle Management
We’re seeing a whole suite of revenue cycle solutions. For many years we’ve seen solutions that optimized an organization’s relationships with payers. Those are still popular since it seems like most organizations never really fix the problem so their need for revenue cycle management is cyclical. Along with these payer solutions, we’re seeing a whole suite of products and companies that are focused on patient payment solutions. This shift has been riding the wave of high deductible plans in healthcare. As an organization’s patient pay increases, they’re looking for better ways to collect the patient portion of the bill.

Privacy and Security
There have been so many health care breaches, it’s hard to even keep up. Are we becoming numb to them? Maybe, but I still see many organizations investing in various privacy and security programs and tools whenever they hear about another breach. Plus, the meaningful use requirement to do a HIPAA Risk Assessment has built an entire industry focused on those risk assessments. You can be sure the coming HIPAA audits will accelerate those businesses even more.

What other areas are you seeing become popular in health care IT?

7 Strategies for Revenue Cycle Management Success

Posted on August 17, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I came across a whitepaper called 7 Strategies for Revenue Cycle Management Success. I continue to be amazed by how many practices can benefit from better revenue cycle management. So much so that hundreds of companies thrive on the back of a practice’s revenue. This is true for a number of EHR companies as well.

For those who don’t want to download the full whitepaper with all the details on the 7 strategies, here’s the list:

Strategy #1: Monitor Payments
Strategy #2: Perform Financial Clearance
Strategy #3: Collect from Patients
Strategy #4: Manage Denials
Strategy #5: Establish Employee Expectations
Strategy #6: Avoid the Snowball Effect
Strategy #7: Report on Key Performance Indicators (KPIs)

As I look through this list and read through the whitepaper, all of it just points to quality management of processes. There’s nothing on the list that’s rocket science. It’s just taking the time and effort to make sure that all of your practice’s processes are well organized and thorough. As you can imagine, that’s a problem for many organizations. That’s why so many practices outsource this work to another company.

When I consider where revenue cycle management is headed, I wonder how these new value based reimbursement models will impact revenue cycle management companies. My guess is that many of them will just see it as the same process applied to new clinical values and measures. However, I think that value based reimbursement is going to require companies to go much deeper with a practice. If the practice is now responsible for a population of users and not just the ones they’ve seen in their office, that’s going to take a very different skill set.

What is clear to me is that many practices are going to need some help from an outside company even in a value based reimbursement environment. I’m just not sure which companies will be providing those services.

Five Commonly Overlooked ICD-10 IT Transition Strategies

Posted on December 1, 2014 I Written By

The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
Daniel M. Flanagan, Executive Consultant, Beacon Partners
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared.  About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.

ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today.  However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.

Below are five often overlooked transition planning steps:

  1. Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing.  We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
  1. Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces.  Extensive remediation is needed after the readiness assessment is completed in such cases.  Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
  1. Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions.  End-users can also be valuable in identifying potential solutions.  Involving end-users as early as possible in transition planning can avert wasted time.  For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
  1. Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin.  In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness.   A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
  1. Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR.  The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe.  The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly.  Define clear objectives and create a detailed plan to monitor progress for achieving each goal.  For example:
    • Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
    • IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
    • Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.

Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.

About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.

Study: Doctors Favor Integrated EMR, Practice Management System

Posted on September 13, 2013 I Written By

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.

While large institutions may not be jumping onto cloud-based technologies — or admitting it, in any event — the majority of doctors in a new Black Book survey are gung-ho on cloud solutions to their revenue cycle management dilemmas, according to a new piece in Healthcare IT News.

A new Black Book study, “Top Physician Practice Management & Revenue Cycle Management: Ambulatory EHR Vendors,” surveyed more than 8,000 CFOs, CIOs, administrators and support staff for hospitals and medical practices.

The research has concluded that 87 percent of all medical practices agree that their billing and collections systems need to be upgraded, HIN reports. And the majority of those physicians are in favor of moving to an integrated practice management, EMR and medical software product, Black Book concluded.

According to Black Book rankings, the revenue cycle management software and services industry just crossed the $12 billion mark, pushed up by reimbursement and payment reforms, accountable care trends, ICD-10 and declining revenues.

Forty-two percent of doctors surveyed said that they’re thinking about upgrading their RCM software within the next six to 12 months. And 92 percent of those seeking an RCM practice management upgrade are only planning to consider an app that includes an EMR, Healthcare IT News said.

It’s no coincidence that  doctors are trading up on financial tools. Doctors are playing catch-up financially in a big way, with 72 percent of  practices reporting that they anticipate declining to negative profitability in 2014 due to inefficient billing and records technology as well as diminishing reimbursements. (On the other hand, it’s not clear why doctors aren’t still seeking best-of-breed on both the EMR and PM side.)

While selecting an integrated PM/EMR system may work well for practices, it’s going to impose problems of its own, including but not limited to finding a system in which both sides are a tight fit with practice needs. It will be interesting to see whether doctors actually follow through with their PM/EMR buying plans once they dig in deep and really study their options.

Where is the Value in Health IT?

Posted on August 10, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

What a powerful question that I think hasn’t got enough attention. Everyone seems to be so enamored with EHR thanks to the $36 billion in EHR incentive money. I seem to not be an exception to that rule as well. Although, at least I was in love with EHR well before the government started spending money on it.

While so many are distracted by the government money I think it’s worth asking the question of where the value is in healthcare IT.

Practice Management software has a ton of billing benefits. Is there a practice out there that doesn’t use some sort of practice management software? I don’t know of any.

Health Information Exchange (HIE) has a ton of value for reducing duplicate tests. Certainly we have challenges actually implementing an HIE, but the value in reducing healthcare costs and improving patient care seems quite clear. Having the best information about someone clearly leads to better healthcare.

Data Warehouse and Revenue Cycle Management (RCM) has tremendous value. RCM is not really sexy, but after attending a conference like ANI you can see how much money is on the table if you deal with revenue integrity. I add data warehouse in this category since they’re often very closely tied together.

Since this is an EHR site, where then does EHR fit into all this? What are the really transparent benefit of using an EHR. I know there are a whole list of EHR benefits. However, I think it is a challenge for many doctors to see how all of those benefits add up. EHR adoption would be much higher if there was one big hair benefit to EHR adoption. Unfortunately, I don’t yet think there’s one EHR benefit that’s yet reached that level of impact. I hope one day it will. Not that it matters right now anyway. Most practices wouldn’t see the benefit between the EHR incentive weeds.

Real-Time Analytics and Dashboards for Streamlining Revenue Cycle Automation

Posted on January 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Last month CareCloud announced a new real-time analytics dashboard to help doctor streamline revenue cycle automation. The core of their product is what they call CareCloud Analytics. As I think about the announcement, I wondered if it was really a big deal or not and why we hadn’t seen more of this in the various practice management systems and EHR software on the market today.

Is Data Analytics important in Healthcare?
I think this type of information is a big deal. Information is power and this is never more true than in healthcare. The press release does a great job of describing how real-time analytics and dashboards provide information which provides transparency and accountability to a practice. One quote from the article says, “The practice can now manage the productivity of the office staff, monitor in real time the productivity of billers, and gain transparency into the business side of operations to help form better decisions through data, instead of intuition.”

I’m a huge fan of analytics in my business. I call myself a stats addict. I have 2-3 stats programs running on my websites at all times. I get stats from my ad server, from Google’s ad server, and from every other stats engine I can find that has reliable data. Much of my success with my websites is because of my passion for knowing what’s happening with my websites. To me, Data is power! The same can be said for a practice. Data is the power to make important decisions that are needed for the success of your practice.

Why don’t more EHR and PMS vendors provide these analytics?
I’m sure there are a number of reasons why we don’t see real time analytics happening very often in the small practices. Hospitals are a bit different. There are whole companies devoted to just providing these types of services to hospitals that can pay for a full scale data warehouse environment to provide this type of data. A hospital that doesn’t do this type of data mining is missing out as well, but they have a number of options. Although, I don’t think many hospital HIS vendors offer this info by default.

The key reason I think real-time analytics and customizable dashboards are missing in the small practice environment has to do with doctors demand (or lack thereof) for such a feature. This will surprise some, but most will agree that the majority of doctors don’t care much for the business side of the practice. Sure, they care that the business side of the practice effects how much money they take home at the end of the day, but a large portion of doctors would love their lives a lot more if they didn’t have anything to do with the business of a practice. Yes, I know there are exceptions to this, but most doctors want to practice medicine not business.

With this as background, if you ask most doctors what they want from their EHR and Practice Management software, they’ll start to list off all of the clinical and workflow needs that they have. Very few of them will even venture into the business requests like real time analytics. Plus, even if they did venture into the business side of things, would they know how to request such a feature?

EHR and Practice Management Vendors have to show them why it matters to have these real time analytics. It reminds me of the famous quote attributed to Henry Ford. “If I had asked people what they wanted, they would have said faster horses.” This can often be taken too far, but I think it applies well when it comes to things like real-time analytics of a practice.

One other reason that a number of companies are missing the analytics and its relationship with revenue cycle management is that they’re too focused on EHR. Many just consider the PMS a standard thing that everyone has already and that there’s no room to innovate. Last I checked meaningful use didn’t have any practice management elements and that’s taken up at least one development cycle for most companies. Too many doctors later dismay, the EHR selection process often puts the practice management side of the puzzle on the backseat. This is a mistake that many practices are paying for today.

As one PR rep for a major EHR company said to me, “Revenue Cycle Management isn’t sexy.” Although, she said this directly after telling me how beneficial it was to their bottom line.