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Last week, the Supreme Court upheld the Affordable Care Act’s individual mandate ruling it constitutional as a tax or penalty. The mandate would require everyone to have health insurance beginning in 2014 forever changing the way the country views healthcare. With this announcement, we can now move forward with the modernization of healthcare delivery through technology innovation.I think it is important to look at some areas where the ruling will help accelerate technology innovation in the healthcare industry. Here are three areas where the recent ACA ruling will help accelerate technology innovation:

  1. Telemedicine/Remote Patient Monitoring: The ruling protects the previous investments in telemedicine made by the Center for Medicare and Medicaid Innovation (CMMI) making the funding status unaffected. The CMMI and several healthcare organizations across country have invested heavily in telemedicine pilot and other remote healthcare services. Also, the ruling does not affect any provisions for managed and accountable care, medical homes, and care coordination where telemedicine can provide quality, cost effective healthcare services. Over time, healthcare organizations will continue to increase the adoption of telemedicine/remote patient monitoring projects increasing quality of care and patient satisfaction.
  2. Big Data: Consumers will increasingly demand for access to their health information making big data “ analytics” a vital area as the consumer becomes increasingly more proactive approach to managing their own healthcare. Innovation in analytics provides immense value across the entire healthcare ecosystem allowing healthcare organizations to analyze and leverage clinical, financial, claims, bio-medical, and public health information. Some of the key challenges that will spur innovation in analytics is being able to effectively decipher this information and building the appropriate infrastructure to support this.
  3. mHealth: The ruling will bring millions of new insured participants into the healthcare system that will cause a increased demand due to the shortage of providers. As the healthcare systems moves away from a fee for service  model and more towards an outcomes based reimbursement model, this will  increase the adoption of mobile health apps. Mobile health applications will provide an economic solution for improving the health outcomes of consumers and provide consumers with tools to  effectively monitor/manage chronic diseases.
The ramifications of the ACA ruling will have a positive impact of the continued innovation and adoption of these technology areas further accelerating the deployment rate of these technology areas and others that will help shape future of healthcare delivery.

HIMSS recently published an infographic shown below on their official blog highlighting the growing demand for qualified health IT professionals. With a 66% increase in IT staff shown in the infographic highlights the growing need for qualified health IT professionals to support all related HITECH initiatives.  Earlier this year, HIMSS released a leadership survey stating that IT staff shortage was the key barrier to meeting IT priorities.

CLICK TO ENLARGE

Packard Children’s is partnering with Cisco Systems to meet the needs of families in our community and beyond. The video shown below is an overview of their  innovative telehealth network promises to bring our world-class care to the patients, rather than the other way around. Given the recent Supreme Court Ruling on the individual mandate, Telehealth is one of the key areas that will spur innovation as a result of the ruling.

Contributed by Michael Sandwith, Director of Business Development at ICA

The Accountable Care Organization (ACO) aims to change the way hospitals deliver care by changing the financial incentives.  There are different payment structures than can be used to encourage hospitals to lower costs, improve quality, or both.  Since the goal of an ACO should be to lower costs and improve quality, using an accountability payment structure – one in which costs and quality are linked–will be the most effective. [1]

For most hospitals and health systems, appropriately synchronizing changes in payment incentives, aligning of physicians, and the clinical model will prove a tall task.  The pacing and sequencing of investment and change must be very carefully managed to ensure the financial sustainability of innovation.  Accepting more payment change without sufficient clinical innovation leads to underperformance against new clinical and financial measures of success.  The opposite is equally true: changing a care model without a revenue model to capture the value created promises to improve someone’s bottom line, but not the hospital’s. [2]

Hospital ReviewsWhat is a hospital or health system to do?  Begin evaluating internally, focusing on ways to optimize care efficiency and cost control within the acute care walls of the hospital, and then extending the care continuum within the post acute care market place.  The advantage to this approach is as follows.  First, improvements within traditional acute care operations address the performance risk all hospitals face.  Second, improvements that directly benefit hospital finances can expand capabilities to manage utilization risk in the post-acute care realm down the line.

A recent survey by Buck Consultants, 2011 Health Care Organizations Health Care Reform Readiness[3], outlines how hospitals and hospital systems were addressing the various initiatives of healthcare reform.  For example, when asked, how are you adjusting your business to adapt to this new era of healthcare reform? Fifty percent responded that they were structuring quality measurements with their physicians, whereas only 17 percent were creating an ACO.[4] The survey points out that hospitals and hospital systems are focusing on performance risks and financial incentives with their approach to controlling hospital infections (76%) and reducing patient readmissions (67%).

Quality improvement is the basis for ACOs. The intent of ACOs is to promote accountability for the care that patients receive, and quality measurement is a key element of accountability.  Without such measurement, it will be very difficult to assess the quality of care that patients receive and determine whether that care improves over time.

It would seem that we have a lot of work to do in the area of quality measurement considering that only between six and eight percent of the respondents felt that the quality of healthcare will improve substantially over the next five years by implementing healthcare reform initiatives.  Whereas 33 to 37 percent felt it will improve somewhat, 20 to 36 percent felt that it will stay the same, 13 to 28 percent felt that it will deteriorate somewhat, and six to 13 percent felt it would deteriorate substantially.

If You Can Measure It Then You Can Manage It

ACOs are one of the key features in the Patient Protection and Affordable Care Act (PPACA) but they require a tremendous amount of administrative and operational oversight, in addition to managing risk, coordinating care, and improving overall health status.  Just being able to comply with the Medicare version of accountable care requires seven additional participation and experience measures.  This will include measuring care coordination, special patient safety, and outcomes along with ACOs wanting to control utilization, streamline care, reduce practice variation, control readmissions, and eliminate unnecessary procedures.  To guide patients and position your ACO initially within the market place, you will have to develop a measurement infrastructure to support the collection and dissemination of both quality data and patient perception survey results.  CMS has already identified 33 quality indicators for ACO accreditation and is expected to release an ACO member experience of care survey in late September 2012.

Issues for the Hospital or System

Given current market conditions, the question about whether to develop an ACO is still a strategic decision.  A hospital or system that succeeds and participates as an ACO will definitely see reductions in acute inpatient utilization and other services.  It is doubtful that any shared savings participation will be sufficient enough to make up for the potential losses, so it will be imperative for the ACO to build market share.  If a hospital or system does not create an ACO and their competing organizations do, the non-ACO organization will more than likely lose market share, maybe not in the short-term but definitely in the long-term.  Commercial insurers, Medicare and Medicaid will continue to reduce fee-for-service reimbursement and reward healthcare providers for managing the total risk of a population, therefore forming an ACO should be a strategic first step.  The determining factors will depend on individual community market place competition, physician collaboration, and strategic relationships with all payers (commercial, Medicare, and Medicaid) and let’s not forget about the developing health insurance exchanges.

A hospital or health system that succeeds with an ACO will probably not make a lot of money from the ACO directly, but it may succeed in transforming its organization into a patient-focused, integrated provider of high-quality care with a strongly-aligned medical staff that can provide high-value, low-cost care not only to the governmental but also to the commercial payers.

Conclusion

The ACO must be more than a new way to pay healthcare providers. Instead, it must encourage healthcare providers to change the way they deliver care by improving quality and care coordination through a patient-centered approach.

If ACOs are to fulfill their potential goal in lowering costs and improving quality, it is crucial to structure their payment models and quality measurement requirements appropriately.  The focus must not be solely on lowering costs. Payment models will need to be structured in a way that will encourage meaningful change by the healthcare providers.  Linking any payment or financial incentive to quality measurements and performance requirements will ensure that providers are lowering healthcare costs through delivering improved care, not by limiting access to medically necessary care.  Publicly reporting the quality measurements and cost information will provide a new level of accountability to patients, the public, and payers.

Whether the ACO model succeeds in changing the way healthcare providers deliver care will depend on two key elements: financial incentives and performance requirements.  If the financial incentives are not strong enough, providers will not be encouraged to change the way they deliver care.  If the performance requirements are not set high enough, then quality will not improve and could even decline.


[1] Engelberg Center for Health Care Reform, The Brooking Institution, and ACO Learning Network Tool Kit (Washington: Engelberg Center for Health Care Reform,January 2011).

[2] “Making Good on ACOs’ Promise-The Final Rule for the Medicare Shared Savings Program”, Donald M. Berwick, MD, N Eng J Med 2011, 365: 1753-1756 | November 10, 2011

[3] “Health Care Organizations Health Care Reform Readiness Survey”,  Buck Consultants, A Xerox Company, 2011

[4] “Health Care Organizations Health Care Reform Readiness Survey”,  Buck Consultants, A Xerox Company, 2011

Accenture released a survey and infograpic last week stating that 90 percent of  patients want to self-manage their healthcare leveraging technology, such as accessing medical information, refilling prescriptions and booking appointments online, but nearly half (46 percent) are unaware if their health records are available electronically.  The survey is based on an online survey of 1,110 U.S. patients to determine the preferred channels of electronic health information and services. The online survey was fielded March 30 through April 4, 2012. One of the leading results of this survey is the desire to manage consumer health through mobile devices, which should come as no surprise with the increasing growth in the mHealth space. The infographic shown below summarizes the key highlights of the survey:

CLICK IMAGE TO ENLARGE

The detailed survey findings is available for view and/or download here

droz_300x282Mehmet Oz, MD, host of TV’s Dr. Oz Show and a heart surgeon at New York Presbyterian Hospital, shares his views on current business and technology challenges facing small physician practices. One of the key gaps Dr. Oz highlights is the lack of a repository of trusted health information and the importance of collecting information prior to the patient’s visit to enhance the patient care.

This global report from PwC assesses the market opportunities and challenges for mobile health (mHealth) from the perspective of health care providers, patients and payers. The report finds a growing pervasiveness of technology enabling the emergence of a new, more patient-centric health care value chain that can leverage mHealth. The distinction between traditional health care and mHealth is dissolving as consumers demand a seamless health care experience that can be provided via mobile applications, devices, access, tools and services. These changes have implications for conventional business models.

Key finding of the report include:

Expectations vs. reality

Innovation vs. resistance

Colliding interests, competing visions

Emerging market trailblazers

Solutions vs. technology

Click on links below for report downloads

According a recent Johnson & Coker report, 80% of doctors use smartphones. In addition to making calls and using apps, docs are using their smartphones to take advantage of one of today’s most convenient forms of communication: the text message.

Unlike so much about healthcare – treatment plans, wait times, the reimbursement cycle – texting is quick. And for doctors, as for everyone with thumbs, texting offers a simple way to communicate that doesn’t require making a call, writing down a message, or listening to anything at all.

For physicians, though, texting’s advantages can also be its flaws. Quick and simple as it is, texting has become the easiest way for docs to violate privacy laws and make themselves vulnerable to data breaches. Since it poses such serious threats, is the convenience of texting even worth it for physicians?

It Makes Notification Easy…
When no protected health information (PHI) is involved, texting is harmless. And for the sake of garnering a busy doctor’s attention, texting’s immediacy is hard to beat.

It wasn’t all that long ago that many physicians had to be wired to pagers so that they could be contacted. In place of them, many hospitals and other health systems have built texting into their workflows.

A notification text along the lines of “Cardiac emergency, call 555-2820” doesn’t violate HIPAA. Additionally, a text like that communicates far more than a pager’s buzz and cryptic message system possibly could, and doesn’t require a physician to make a return call and count on some one to answer it just to learn the basics of a situation.

Plus, in spite of some very valid concerns about confidentiality, the argument can be made that a text message, since it can’t be overheard, is in some ways more private than a spoken phone call.

But the Pitfalls are Major
Yet the content of a spoken phone call doesn’t exist electronically once the call ends, which means it’s not subject to the legal rules governing “electronic exchanges,” as texts are. And even though a text message can’t be overheard, it is subject to being viewed by an onlooker with prying eyes.

Because docs are using texting to do much more than notify one another to make a call or come to an office, the threat of unauthorized eyes peeping those messages is a big one. One study says that 94 percent of physicians use smartphones to communicate, manage personal and business workflows, and access medical information – PHI that can be easily overseen in violation of the HIPAA Security Rule.

Plus the convenient, small size of smartphone technology makes he devices easily stolen or misplaced. If a phone full of PHI gets into the wrong hands, a doctor who hasn’t been taking the proper measures to secure his text messages could find himself in some very hot water.

Avoid Text Troubles by Using Caution
Despite its drawbacks, it’s nearly inevitable that physicians will use text messaging for their dealings as doctors because its become such an ingrained method of communication in their personal lives – just as it has for most everyone else these days.

To conduct the safest texting practices possible, physicians should avoid including PHI in their text messages whenever possible. Additionally, they should ensure that their phones are guardedwith adequate security measures.

All doctors should take basic protective precautions, including setting up password protection and deploying an app that gives them the ability to remotely lock and wipe a device in the event that it’s lost or stolen.

Some others, especially those physicians who are more prone to including PHI in their messages, should even consider using a secure encryption service. Companies like TigerText and Doximityprovide organizations with encrypted texting capabilities, though there is a snag: both the texter and the textee must be subscribed to the service or otherwise have the capability to unencrypt in order to send or receive a secure message.

Other ways to text smartly and securely: review the content and spelling of your messages before sending (especially if you’re communicating something medically serious), keep a close eye on the whereabouts of your device at all times, and frequently delete your message history.

A final best practice? When you can, avoid texting altogether and conduct a face-to-face conversation or a discreet, quiet phone call in a private space. Whether you discuss PHI or not, your voice something you won’t need to password-protect – or delete.

About Madelyn Young:

Madelyn Young is a Content Writer for CareCloud who specializes in covering practice management, medical billing, HIPAA 5010, ICD-10 and revenue cycle management. You can read her work on Power Your Practice and the CareCloud Blog. Contact Madelyn with story suggestions, contributor articles or any other feedback at madelyn@poweryourpractice.com.

The following infographic created by Accenture highlights the journey of  connected health and how it aims to connect all key areas of healthcare delivery through the interoperability of information and technology.

CLICK ON IMAGES TO ENLARGE  

Looking for an innovative way to hire healthcare IT trainers and provide an unique opportunity for inexperience professionals to break into the healthcare IT industry? In comes “Big Break”, an American Idol styled audition process where candidates compete to become a healthcare IT trainer that will instruct healthcare professionals on the use of a sponsored healthcare provider’s EMR system. HIT Consultant recently spoke with brainchild of Big Break, Tiffany Crenshaw, President & CEO of Intellect Resources to learn more.

LISTEN BELOW OR CLICK HERE TO DOWNLOAD

HIT Consultant:Give me a brief background overview of yourself and Intellect Resources  

Tiffany Crenshaw:  A little known fact about Intellect Resources is we spun out of Healthlink, which was, in the day, a really well-known boutique consulting firm that sold to IBM. But I came in to join them when there were about 30, actually less than 20 employees. And I came in to be their first recruiter and lead their recruiting efforts to help them grow the company. And was with Phil Augustine, the CEO of time, for several years, helped him build this company to about a 100 consultant firm. Then he looked at me one day and said, “You get bored really easily and we’re growing really well, so what are we going to do?” And I put the business plan for Intellect Resources on his desk. And quite honestly, I said, ”Gosh, Phil, there are a lot of consultants out there, excuse me, a lot of candidates out there who can’t travel like you need them to do, but they’d be great candidates to work for somebody else.” We, I try to recruit a lot of managers away and they don’t want to get on the road either. And they don’t need consultants, they need full time employees.

These two companies can operate very well together. And he said, ”Great, let’s do it!” And that’s how Intellect Resources spawned. We operated out of the Healthlink office. We use a lot of the same infrastructure. And when Healthlink was acquired by IBM, I was able to take the Intellect Resources. And ran Intellect Resources independently on my own, meaning I was the sales and the recruiter, it was just me for a number of years and then we started growing. Through the years, we’ve added on, not only the recruiting side, but also consulting go-live and then the I.R. Big Break, which I know we’re going to talk about that. Those are all the services we’ve added on through the years. And we have about 20 core non-billable employees, and we have about 300 consultants out in the field right now. So that’s the little story about how Intellect Resources started as the tiny little company that spawned out of Healthlinks.

HIT Consultant: Wow, I really didn’t even know that. So, tell me a little bit more about Big Break. First, what compelled you to start Big Break?

Tiffany Crenshaw: Well, Big Break is my baby. I get all jazzed when we talk about this. It’s just such an exciting, just an exciting event in general.  It’s exciting for the clients, it’s exciting for my team, and it’s really exciting for the Big Breakers to come out to it. So what Big Break is, it is an opportunity for a hospital, to basically, and please don’t take offense to the word, but basically to breed new healthcare IT talent.  And it’s a great opportunity for those that are trying to get into this industry, to get their big break and their foot in the door.So, there’s two sides to this story. One is the client side. We had a client in New York that was getting ready, getting closer to their go-live event with Epic. And they realized that their original plan for the 90 trainers they were going to need, the original plan wasn’t going to work. And we’d been a recruiting and consulting partner for them, at that time, for like 5 years. And they called and they said “We need 90 trainers. We need them in 3 months. We have very limited budget. We have absolutely no time. We want to do an American Idol type audition. That’s all we’ve got. Can you help us?” And we said, “You’ve called the right folks!” And so we kind of took their need, and Big Break was our response to it. So what we decided to do with, since they had a limited budget and couldn’t really get experienced trainers because they didn’t have the time to go about recruiting 90 experienced people, you know, the idea of the done in a  day audition was perfect. So, we rented out the Marriott Marquis in Time Square and we had invited roughly 400 contestants to come in as their big break into the healthcare IT industry and they came kind of to a gauntlet of exercises. They came in, they did a speed interview, they had to do an open mic in front of the camera, and then they came into an audition room with a group of judges.

We then, you know, extended offers to 100 potential trainers of course as you go through the on-boarding and the background checks, and that we ended up with 90 consultants. Those 90 folks came from all walks of life. We had folks from educators, we had people from the IT field, we had people from the healthcare field, we had people from customer service, we had fresh graduates; Folks that had minimal work experience but they were all selected, one because they had the hunch to come out such an event and two, they really shown in the event. They came in, they worked with a lot of poise, they could give impromptu presentations, they did well in front of the camera and that’s why we selected all of those folks. We got them all aboard, we trained them in Epic, they hit the classroom as Epic trainers, they went on to do the go-live event, as go-live, at the elbow support, go-live consultants. And now those folks, several of them were hired by our client at the end of the day, and they’re now permanent full-time employees of the client. Several have come to work with us on other projects and then the rest of them are all dispersed out in the field. Some have gone to work for hospitals, some for consulting firms, some, a lot of them are on the go-live circuit, doing that.  So that was really what Big Break originally was, an answer to a client’s needs. We were so excited about the results, the client got great talent, they got it at a very economical price, their training and their go-live was a success. And then for all those folks that took that chance and, you know, kind of were our trial there, are now all out in the field working. So, very, very exciting. Now our second hospital that we did this for, we kind of had a better understanding about what Big Break could be.

And the second hospital, they liked all the benefits. It was a done-in a-day event, we could get good, strong, local talent, it was an economical  alternative than getting experienced consultants. And this, our second particular hospital, was really wooed by the whole marketing idea. Wow, here’s a great way to bear the name of our hospital, really promote that we want to build up our New Orleans community and we really want to invest in our own people versus bringing outsiders in. So, the next Big Break that we did has all the benefits of we did for the hospital in New York, but this one really got excited about the marketing aspect of Big Break.

And in the end of that Big Break, we actually hired 200 people because they have 8 hospitals to bring live over the next several years and these folks will be the trainers and also the go-live resources. So Big Break really started as an answer to a client concern and each time we’ve done this, clients get excited about different pieces of it. And we’re gearing up right now, for our third Big Break. [pullquote] The first two were in the Epic world and the next one will be in the Cerner world so we’re very excited about that.

HIT Consultant: So, there were no qualifications to apply for Big Break? Like no previous healthcare experience? They could just have a different variety of experiences and come in and audition and really have an opportunity to gain entry into the field?

Tiffany Crenshaw:  You are absolutely right Fred, now there are certain qualifications that we were looking for in both. One is the basic technical acumen. So we have an online registration process that is fairly detailed to make sure that they have the basic click and point and being able to navigate through technical instruction. So technical acumen is good. Good communication skills, good grammar, great spelling. Just basic communication. We gathered that from looking at their resumes and that’s also if they came in through the event, we got to see them. Presentation skills were paramount. In both cases, we had folks given presentations in front of big board rooms. We purposely, in both cases, also set, we kind of create this to be a gauntlet of activities that the candidates, the contestants have to go to. It has to be a little bit intimidating, so we need to see how people can work through in stressful situations. There’s a lot of unknowns. A lot of things that pop up that people aren’t expecting because that’s what training life is like for the trainer. You never know what’s going to happen when you pop up in into that classroom.

So, in addition to good communication skills, good technical skills, we need people that can really work in the unknown, can work in fast-moving environments. That can work with the unexpected. That was one of the third requirements that we were looking for there. And, then of course the presentation skills. In both cases and in future Big Breaks, we will say that healthcare or technology or training are preferred, but they’re not required. Interestingly enough, in both Big Break events so far, over 50% of the applicants have had a bachelor’s degree or higher. I think 30% had a master’s degree or higher. And in both cases, we actually had positions that actually came out to Big Break to try just so they could make that move. So, you would be really surprised at the individuals who came out. We actually had quite a few who had healthcare IT background that came out for the first two because of the Epic experience and was trying to get their foot into the door with Epic. But I would say it was all over the gammet of what we got. Some that had experience, some that did not, some that had education and some that did not have it. So, very much across the board. But bottom line, the requirements were technical acumen, good communication skills, ability to handle the unknown and good presentation skills.

HIT Consultant: So, the individuals that were selected, are they guranteed a full-time job or did it depend on the client who was hosting the Big Break, so to speak? Are they starting off as temp-to-perm or is it just a temporary basis until they’ve proven themselves?

Tiffany Crenshaw:  You know, I like to think of it as like the reality show that doesn’t end. Folks, it’s an elimination event.  First they have to apply for the audition, and they either get to the audition or they get eliminated. They get to the audition and through various steps of the way, they either make it to the next step or they get eliminated.  Once they start the position, they come to work for Intellect Resources on our payroll on a contract, hourly basis. Then the next step of elimination, is once they are done being a student, learning the product, learning the healthcare industry, learning how to be a trainer, they have to take a test, kind of the credentialing, and if they can’t pass that, they’ll be eliminated. The majority of people do.

But there are a handful of folks that can never make it into the classroom as a trainer. And then, once they make it into the classroom as a trainer, and then you roll into go-live, you don’t need all the trainers to do the go-live, so there’s kind of an elimination there. And then once you get through the go-live, most of the people go-live in the first couple of weeks, then people start whittling your team back and there’s more elimination there. And then as with the first client, they ended up bringing 10 of those on throughout the summer and they used them in various capacities in the IT or kind of like a long extended, job interview.  And then they hired 3 at the end of the summer, of their best and brightest and their favorite ones. So, I kind of laugh and say it’s the reality show that never ends. And the same thing is very much happening down in New Orleans. People are eliminated at the application stage, throughout the audition stage, some folks, a hand full of folks that may get through the credentialing process and now all those folks are getting ready to step this week into the classroom as trainers. And as the project progresses and the client needs fewer and fewer folks, people will be eliminated throughout that and then they will choose their best and brightest to stay on. And we are very clear when we are doing the marketing of saying this is an elimination event, so it is a great way to encourage consultants to keep their best foot forward always. Get out there, do a great job, have great spirits, great attitude, work well with the team because those do well just get to keep on going. In both cases, we wrote the contract , the hourly contract for the first benchmark and we would just keep extending the people that did a great job.

HIT Consultant: Now what is Big Break doing to ensure that you’re creating a community of people that are finally getting their foot wet in the industry and then kind of making sure they have some type of support after this?

Tiffany Crenshaw: That’s really a good question on the support after. One of the things that we did for the first group, the New Yorkers, we created a LinkedIn Group of which we use to communicate with all of the folks. So there is a community of those first ones so that when we see job opportunities we’ll put it up there and say “Hey guys these opportunities are out there” or interesting articles we might find in the industry. And then of course, they’re all communicating amongst each other as well, posting similar things that they find, job opportunities and things that are going on in the industry. And then we’ve really stepped that up a notch with the New Orleans folks. We have, not, instead of LinkedIn, we’ve done everything on Facebook and we also have a FaceCamp of what we are doing all of those things. That is something that’s evolving.

But right now, it’s really through all that social media, keeping people connected and informed and giving them information and of course, we’re trying to, when we have go-live events come up or contracts come up, our recruiters are very aware of who all the Big Breakers so they know who to call for certain projects and things that come up. Part 2 of this interview/podcast will be posted soon.        

Infographic for Memorial Day that includes statistics about veterans being exposed to asbestos while in service.

Written by Ahmed Mori at Care Cloud:

You wouldn’t know it from the overwhelming amount of positive press it receives, but amplified use of technology in healthcare could be one of the driving factors behind the high cost of healthcare in the United States.

However, it’s not the technology that you’re thinking of.According to a new study from the Commonwealth Fund, the U.S. healthcare system is fraught with high obesity rates, higher prices and more extensive use of medical technology like MRIs and CT exams.

So, despite the fact that the U.S. system spends more on healthcare than 12 other industrialized countries included in the study, why doesn’t it provide notably superior care? Or better yet, why is it spending so much?

High obesity rates and their associated medical costs represent a significant spike in healthcare costs. However, the country’s young population and considerably smaller percentage of smokers relative to the other countries in the study could offset the obesity spending.

Higher prices are more difficult to tackle. If you compare the U.S. healthcare system to Japan’s model – which controls healthcare costs via a government budgeted fee-for-service system that doesn’t restrict access to patients to contain costs – you’ll notice a rather stark contrast between the ways both systems operate, suggesting that the U.S.’s problems may lie at the procedural level.

When suggesting a remedy for America’s backwards system, Commonwealth Fund president Karen Davis points to the Affordable Care Act.

“The United States must use all of the tools provided by [the ACA], including new methods of organizing, delivery and paying for healthcare that will help to slow the growth of healthcare costs, while improving quality,” said Davis.

Things get a little murkier with technology, however, because much of the exorbitant spending in the sector is tied in to the fluctuating price of healthcare services. So in other words, an MRI in one clinic may be very differently priced in another. Your insurance plan also plays a prominent role.

While some of the abovementioned holes in the system are to blame, there is also the way in which technology-reliant healthcare services are delivered. However daunting the regulation of medical technology may seem, it’s not a procedural impossibility.

After examining the results of the study, disorganization seems to be a major contributing factor.

Enter healthcare information technology. Sure, sometimes electronic health records and revenue cycle management systems are too readily touted as the panacea to healthcare’s most pressing issues. But it’s tough to deny that they’re a huge step in the right direction, and they’re built to keep doctors tidy.

These systems are improving the way healthcare is delivered, improving patient safety, ensuring higher precision in the medical billing cycle to ensure less money slips between the cracks at practices and hospitals, providing better access to imaging test results, and making medical offices virtually paperlesswhich could save the system over $150 billion yearly.

Tack on another $140 to $240 billion in healthcare savings and improved health outcomes over the next ten years directly as a result of ePrescriptions, and the outlook is vastly different.

A SureScripts study saw a 10% increase in first-fill medication adherence and higher prescription delivery rates, which translates to fewer doctor visits and reduced risks of hospitalization. Oh, and decreased healthcare costs, naturally.

Information technology in healthcare means the same work is performed with fewer resources, equating to efficiency savings. According to a RAND study, the potential savings for both inpatient and outpatient care could total in the hundreds of billions if most hospitals and doctors’ offices adopted health IT.

So why not fight tech with tech?

icd10codes-resized-600Written by Deborah Robb, BSHA, CPC, Physician Management Consultant for TrustHCS:

The American Medical Association, not satisfied with HHS’s push-back of the ICD-10 deadline to October 1, 2014, has protested again. Perhaps one of the reasons for their continued dissent is lack of guidance and support.

While much has been published about the implementation of ICD-10 for hospitals,the body of knowledge for physician practices and medical groups is sorely lacking. Vendor upon vendor is assisting hospitals, but who is helping the docs?

I readily admit the move from ICD-9 to ICD-10 is a huge undertaking. However, only diagnosis codes change for practices and groups, not procedure codes. And while physician payment is not driven by diagnoses codes, they are still required to show medical necessity. This is where practices must be thoroughly prepared to make the leap.

Specialty Matters

Family practice, hospitalists and internal medicine groups may have a more difficult time converting from ICD-9 to ICD-10. Specialists will find the transition much easier. Why?

Generalists see a large variety of patient conditions. So their documentation and support staff must be educated in all anatomy, physiology and disease processes—while specialists treat a limited sub-set of the patient population. Therefore their documentation needs to be refined in only a few key areas. And staff only needs to focus on one or two body systems.

To get started, CMS has prepared ICD-10CM information on their website. Now is a good time for practices to test the water with what to expect; and begin developing a training plan, even for single practitioner practices

7 Tips for Physician Practices and Groups 

Our experts at TrustHCS  have also provided some tips for practices and groups to ease the transition to ICD-10.

  1. Practices owned, managed or affiliated with a hospital should reach out for guidance and resources.
  2. A targeted, specific training approach is the most cost effective and practical strategy for specialty practices.
  3. Train in small increments and preferably have another physician involved for peer-to-peer support.
  4. Deepen your staffs’ biomedical knowledge, particularly in the body systems that you treat.
  5. Take a tailored step-by-step approach and do a thorough ICD-10 assessment and planning early.
  6. A period of parallel testing with both I-10 and I-9 codes is recommended if at all possible.
  7. Work with like practices, payers and hospitals as a regional consortium on the I-10 issues facing you all.


About Deborah Robb, BSHA, CPC
Deborah Robb is a Physician Management Consultant for TrustHCS where she is responsible for their Physician Practices business. Deborah has over thirty years of experience in healthcare and extensive experience in clinical settings inclusive of but not limited to hospitals, clinics, long-term care facilities, and free-standing home health agencies. Deborah possesses an extensive teaching background in medical coding and medical insurance. She is also a five time author in Medical Coding and Insurance for e-learning courses by Direct Learning.

Deobrah is the Founder and former President of the Hattiesburg, MS chapter of the AAPC. She has held the position of Medical Program Director for Antonelli College in MS. As Program Director, Deborah designed, implemented, and revised program curriculums for certification requirements. In addition, Deborah has implemented and monitored compliance with QA / CQI and PI programs in accordance with the guidelines and conducted contract-coding programs in which she enhanced the skill and knowledge levels of client employees so they could set for the National Certified Coding Exams.

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Written by our advisory board member, Kara Nance, MD, FACP

No one can deny that healthcare is at a crossroads.  Current thought leaders like Atul Gawande and Richard Baron have proposed that history will label our current time period as the “healthcare revolution”. The introduction and adoption of electronic medical records will have an impact no less powerful than the cotton gin had during the industrial revolution.

If you are working in the medical field, you have felt the tension between the “change-makers” and the “change-resistors”.  Depending upon which camp you are in, you either love or hate what’s happening in the field of medicine.  If you talk to anyone in healthcare these days about EMR, mobile health, payment reform or ICD-10, you’re bound to get a passionate response – sometimes positive, sometimes negative.  Much like our political system, the two camps sometimes face a gridlock.

To help me understand the conflict going on in healthcare right now, I’ve looked to Dr. Helen Fisher’s Personality Type Study which describes four broad basic personality types.  She uses her data to help people find love on her internet dating site Chemistry.com.  I propose that this same framework can help those working in healthcare to find common ground as well.  After all, like marriage, we’re all in this field for better or for worse, so we might as well figure out how to live together so that we can navigate these choppy waters and not overturn the ship!

Per Dr. Fisher, the two most basic personality types are “Explorers” and “Builders”.  Explorers are driven by the neurotransmitter dopamine which fills these individuals with enthusiasm, heightened energy, curiosity, creativity, spontaneity, optimism and the propensity to seek novelty and take risks.  Builders, on the other hand, are calm, social, cautious, persistent, loyal, fond of rules and facts and orderly.  These individuals are driven by the serotonin system.  Given these biologic facts, it’s obvious that Explorers are more likely to be “change-makers” and Builders are more likely to be “change-resistors”.  Asking an Explorer to be more like a Builder or vice-versa is like asking a zebra to change its stripes to spots – it’s not going to happen.

Dr. Fisher’s study shows that in the romantic world, Explorers are attracted to other Explorers and Builders are attracted to other Builders.  We see this in the world of healthcare too.  Explorers are the ones driving the healthcare revolution, and the Builders, given their much more calm and cautious nature, are putting on the breaks.  Evolution has shown us that both character sets are important.  Without the Explorer’s impulsivity, tendency to value rewards more than fear consequences and propensity to try new things, we would not continue to evolve.  Although it is true that Explorers often win big, they are also much more likely to suffer disastrous consequences.  Explorers are the group most likely to come up with revolutionary ideas that lead to big changes or big business rewards, but a much higher percentage of Explorers than Builders may lose big too.  We need the Builder’s caution to balance the Explorer’s impetuousness, but at the same time, we can’t let the Builder’s sometimes excessive caution and fear of change allow us to stagnate.

I’ll reveal that I’m an Explorer that lives and works in a Builder’s world.  This unique, but sometimes lonely position, has given me the ability to truly understand what motivates both camps.  A “radical academic” by nature, I came to the suburbs at the beginning of my child bearing years thinking I wanted to focus on motherhood and just be a “regular doctor”.  This suited me well when high levels of estrogen, prolactin and oxytocin induced by my four pregnancies suppressed my drive to explore new territory.  But when my hormonal-induced fog began to clear, the “change-maker” area of my brain reactivated, and healthcare IT became my new drug and obsession.

What I’ve learned during my time in the suburbs is that most private practice physicians, especially primary care doctors, are Builders, which makes perfect sense.  Builders tend to be affable, tactful, careful, orderly, precise, detail-oriented, persistent, patient, conscientious and have exceptional managerial skills.  This absolutely sounds like the skillset I’d like my doctor to have!  But this same group of people, while amazing providers can be a nightmare to those trying to encourage healthcare reform or the broad-scale adoption of HIT because they like routine, predictability, tend to be frugal and are wary of fast changes.  Builders are more likely to hold tightly to the “right” way of doing things and can be closed-minded and stubborn.  The Builder’s realism and caution can also sometimes morph into deep pessimism or fatalism, which leads them to strongly believe that nothing will ever change for the better.

As I began to see the revolutionary changes EMR would bring to healthcare, I initially suffered from many delusions.  I believed that with the right product and optimized workflow scenarios, any physician office could successfully implement the new technology.   I mistakenly thought that the ability to do away with paper, collect structured data and ultimately reduce costs while improving outcomes would automatically appeal to everyone!   As I reflect on my actions during that time period, I can only laugh at my naiveté.  I was completely oblivious to the fact that many of my fellow physicians were NOT exhilarated by this opportunity for change, and actually dreaded it.  But like a bull in a china shop, I was going to prove how wonderful it was.  Needless to say, my first big exercise in change management could have gone better.

An entire industry of “implementation specialists” has evolved to help manage the pain that comes from transitioning from a paper-based to an electronic healthcare system.  What many of these experts forget though is that effective change only happens when the system is ready to embrace it.  Large corporate organizations have recognized this and actually employ many people in full time “organizational readiness” positions.  But with healthcare being so strapped for financial resources, this critical piece of the journey is not often put in place even when monumental changes are anticipated.

The stages of change are often described as pre-contemplative, contemplative, preparation, action and maintenance.  I think many working in healthcare these days are frustrated because attention is not being given to the necessary elements for successfully navigating each stage.  So much has been written about change management, but I’ve gained my deepest knowledge of the process from the Harvard MBA professor Dr. John Kotter who wrote Leading Change.  It’s a great place to start for those trying to steer healthcare innovation.

The inspiration for this posting came from watching my 12-year-old daughter experience the turmoil of a middle school girl.  Adolescents are so awkward because they are changing so rapidly.  We’re seeing the same in healthcare.  Some days are exhilarating, and some days everyone wants to regress and throw tantrums.  As a mother and a healthcare “change maker”, my hope is to continue to study, learn and help others develop the skillsets to navigate this choppy time.

Contact Kara Nance, MD:

Twitter @How2BeHealthyMD

About Kara Nance, MD, FACP:

Kara currently works in private practice in Rolling Meadows, IL. Dr. Nance approaches the care of her patients with a very holistic attitude that targets the many factors that contribute to overall wellbeing. In addition to her clinical practice, Dr. Nance is passionate about electronic medical records and the establishment of electronic health exchanges. She consults with local physicians, hospitals, and medical groups about transitioning over to electronic medical records. Kara also participates in advocacy activities relating to primary care. As a Fellow in the American College of Physicians and a member of the ACP’s Northern Illinois Council, Dr. Nance frequently travels to Washington to lobby for important issues in health care reform.

epic_logoPartner’s Healthcare, the state’s largest healthcare provider in Massachusetts is currently in negotiations with Epic Systems to replace it’s existing number of various electronic health record systems that was built in-house with a single EHR solution. The transition is expected to cost over $600 million over 10 years will move Partners in the right direction towards a more integrated, statewide system for sharing medical records. Epic Systems will allow each patient a single up to date record that is accessible by all Partners providers.

The majority of Partners current systems was developed starting in the 1980s at Massachusetts General Hospital and Brigham and Women’s Hospital before the two institutions formed Partners and when there were no products on the market that could meet the hospitals’ needs. The hospitals have separate but related inpatient systems, distinct from those used by many of their affiliates.

Dr. David Blumenthal, Partners chief health information and innovation officer states, “The result is, when patients move from one place to another, their information often does not follow them in a complete form or as promptly as we’d like. Under the new system, data for a patient who is referred from a primary care office to an orthopedist, has surgery, and later is discharged with home care would be contained “all in the same record and all available in real time.’’ Blumenthal also stated,”the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[pullquote] “the Epic system would make Partners better prepared to share data because it has a uniform interface for outside systems, rather than different “docking stations’’ for data.”[/pullquote]

The potential move to Epic shows the commitment Partners is making towards information exchange; however, the move to Epic does not come with some key challenges. The transition to a new electronic health record system will not be easy for physicians and others who are already accustomed to their current systems. Physicians who have their own homegrown operation may also lose some of their control being forced to use Epic for a more streamlined system.

For Epic Systems, this would be a huge win that would make them the most dominant EHR vendor in Massachusetts further displaying the domination of Epic in the market.