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Surescripts Deal Connects EMR Vendors And PBMs To Improve Price Transparency

Posted on November 22, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I’m no expert on the pharmacy business, but from where I sit as a consumer it’s always looked to me as though pharmaceutical pricing is something of a shell game. It makes predicting what your airline ticket will cost seem like child’s play.

Yes, in theory, the airlines engage in demand-oriented pricing, while pharma pricing is based on negotiated prices spread among multiple contracted parties, but in either case end-users such as myself have very little visibility into where these numbers are coming from.  And in my opinion, at least, that’s not good for anyone involved. You can say “blah blah blah skin in the game” all you want, but co-pays are a poor proxy for making informed decisions as a patient as to what benefits you’ll accrue and problems you face when buying a drug.

Apparently, Surescripts hopes to change the rules to some degree. It just announced that it has come together with two other interest groups within the pharmacy supply chain to offer patient-specific benefit and price information to providers at the point of care.

Its partners in the venture include a group of EMR companies, including Cerner, Epic, Practice Fusion and Aprima Medical Software, which it says represent 53% of the U.S. physician base. It’s also working with two pharmacy benefit managers (CVS Health and Express Scripts) which embrace almost two-thirds of US patients.

The new Surescripts effort actually has two parts, a Real-Time Prescription Benefit tool and an expanded version of its Prior Authorization solution.  Used together, and integrated with an EHR, these tools will clarify whether the patient’s health insurance will cover the drug suggested by the provider and offer therapeutic alternatives that might come at a lower price.

If you ask me, this is clever but fails to put pressure on the right parties. You don’t have to be a pharmaceutical industry expert to know that middlemen like PBMs and pharmacies use a number of less-than-visible stratagems jack up drug prices. Patients are forced to just cope with whatever deal these parties strike among themselves.

If you really want to build a network which helps consumers keep prices down, go for some real disclosure. Create a network which gathers and shares price information every time the drug changes hands, up to and including when the patient pays for that drug. This could have a massive effect on drug pricing overall.

Hey, look at what Amazon did just by making costs of shipping low and relatively transparent to end-users. They sucked a lot of the transaction costs out of the process of shipping products, then gave consumers tools allowing them to watch that benefit in action.

Give consumers even one-tenth of that visibility into their pharmacy supply chain, and prices would fall like a hot rock. Gee, I wonder why nobody’s ever tried that. Could it be that pharmaceutical manufacturers don’t want us to know the real costs of making and shipping their product?

UPMC Plans $2B Investment To Build “Digitally-Based” Specialty Hospitals

Posted on November 20, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

The University of Pittsburgh Medical Center has announced plans to spend $2 billion to build three new specialty hospitals with a digital focus. Its plans include building the UPMC Heart and Transplant Hospital, UPMC Hillman Cancer Hospital and UPMC Vision and Rehabilitation Hospital. UPMC already runs the existing specialty hospitals, Magee-Womens Hospital, Western in Psychiatric Institute and Clinic and Children’s Hospital of Pittsburgh.

UPMC is already one of the largest integrated health delivery networks in the United States. It’s $13 billion system includes more than 25 hospitals, a 3-million-member health plan and 3,600 physicians. If its new specialty centers actually represent a new breed of digital-first hospital, and help it further dominate its region, this could only add to its already-outsized clout.

So what is a “digitally-based” hospital, and what makes it different than, say, other hospitals well along the EMR adoption curve? After all, virtually every hospital today relies on a backbone of health IT applications, manages patient clinical data in an EMR and stores and stores and shares imagines in digital form.   Some are still struggling to integrate or replace legacy technologies, while others are adopting cutting-edge platforms, but going digital is mission-critical for everyone these days.

What’s interesting about UPMC’s plans, however, is that the new hospitals will be designed as digitally-based facilities from day one. UPMC is working with Microsoft to design these “digital hospitals of the future,” building on the two entities’ existing research collaboration with Microsoft and its Azure cloud platform.

The Azure relationship dates back to February of this year, when UPMC struck a deal with Microsoft to do some joint technology research. The agreement builds on both UPMC’s fairly impressive record of tech innovation and Microsoft’s healthcare AI capabilities, genomics and machine learning capabilities. For example, in working with Microsoft, UPMC gets access to Microsoft’s health chat bot technology, which is being deployed elsewhere to help patient self-triage before they interact with the doctor for a video visit.

I’d love to offer you specific information on how these new digitally-oriented will be designed, and more importantly how the functioning will differ from otherwise-wired hospitals that didn’t start out that way, but I don’t think the two partners are ready to spill the beans. Clearly, they’re going to tell you all of this is the new hotness, but nobody’s provided me with any examples of how this will truly improve on existing models of digital hospital technology. I just don’t think they’re that far along with the project yet.

Obviously, UPMC isn’t spending $2 billion lightly, so its leadership must believe the new digital model will offer a big payoff. I hope they know something we don’t about the ROI potential for this effort. It seems likely that if nothing else, that technology investment alone won’t drive that big a rate of return. Clearly, other major factors are in play here.

CHIME Suspends the $1 Million Dollar National Patient ID Challenge

Posted on November 17, 2017 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.

CHIME just announced that they’ve suspended their National Patient ID Challenge. For those not familiar with the challenge, almost 2 years ago CHIME Announced a $1 million prize for companies to solve the patient identification and matching problem in healthcare. Here’s the description of the challenge from the HeroX website that hosted the challenge:

The CHIME National Patient ID Challenge is a global competition aimed at incentivizing new, early-stage, and experienced innovators to accelerate the creation and adoption of a solution for ensuring 100 percent accuracy in identifying patients in the U.S. Patients want the right treatment and providers want information about the right patient to provide the right treatment. Patients also want to protect their privacy and feel secure that their identity is safe.

And here’s the “Challenge Breakthrough” criteria:

CHIME Healthcare Innovation Trust is looking for the best plan, strategies and methodologies that will accomplish the following:

  • Easily and quickly identify patients
  • Achieve 100% accuracy in patient identification
  • Protect patient privacy
  • Protect patient identity
  • Achieve adoption by the vast majority of patients, providers, insurers, and other stakeholders
  • Scale to handle all patients in the U.S.

When you look at the fine print, it says CHIME (or the Healthcare Innovation Trust that they started to host the challenge) could cancel the challenge at any time without warning or explanation including removing the Prize completely:

5. Changes and Cancellation. Healthcare Innovation Trust reserves the right to make updates and/or make any changes to, or to modify the scope of the Challenge Guidelines and Challenge schedule at any time during the Challenge. Innovators are responsible for regularly reviewing the Challenge site to ensure they are meeting all rules and requirements of and schedule for the Challenge. Healthcare Innovation Trust has the right to cancel the Challenge at any time, without warning or explanation, and to subsequently remove the Prize completely.

It seems that CHIME’s legally allowed to suspend the challenge. However, that doesn’t mean that doesn’t burn the trust of the community that saw them put out the $1 million challenge. The challenge created a lot of fanfare including promotion by ONC on their website, which is a pretty amazing thing to even consider. CHIME invested a lot in this challenge, so it must hurt for them to suspend it.

To be fair, when the challenge was announced I hosted a discussion where I asked the question “Is this even solvable?” At 100% does that mean that no one could ever win the challenge? With that in mind, the challenge always felt a bit like Fool’s Gold to me and I’m sure many others. I thought, “CHIME could always come back and make the case that no one could ever reach 100% and so they’d never have to pay the money.” Those that participated had to feel this as well and they participated anyway.

The shameful part to me is how suspending the competition is leaving those who did participate high and dry. I asked CHIME about this and they said that the Healthcare Innovation Trust is still in touch with the finalists and that they’re encouraging them to participate in the newly created “Patient Identification Task Force.” Plus, the participants received an honorarium.

Participation in a CHIME Task Force and the honorarium seems like a pretty weak consolation prize. In fact, I can’t imagine any of the vendors that participated in the challenge would trust working with CHIME going forward. Maybe some of them will swallow hard and join the task force, but that would be a hard choice after getting burnt like this. It’s possible CHIME is offering them some other things in the background as well.

What’s surprising to me is why CHIME didn’t reach out to the challenge participants and say that none of them were going to win, but that CHIME still wanted to promote their efforts and offerings to provide a solid benefit to those that participated. CHIME could present the lessons learned from the challenge and share all the solutions that were submitted and the details of where they fell short and where they succeeded. At least this type of promotion and exposure would be a nice consolation prize for those who spent a lot of time and money participating in the challenge. Plus, the CIOs could still benefit from something that solved 95% of their problems.

Maybe the new Patient Identification Task Force will do this and I hope they do. CHIME did it for their new Opioid Task Force at the Fall Forum when they featured it on the main stage. How about doing the same for the Patient Identification Challenge participants? I think using the chance to share the lessons learned would be a huge win for CHIME and its members. I imagine it’s hard for CHIME to admit “failure” for something they worked on and promoted so much. However, admitting the failure and sharing what was learned from it would be valuable for everyone involved.

While I expect CHIME has burnt at least some of the challenge participants, the CHIME CIO members probably knew the challenge was unlikely to succeed and won’t be burnt by this decision. Plus, the challenge did help to call national attention to the issue which is a good thing and as they noted will help continue to push forward the national patient identifier efforts in Washington. Maybe now CHIME will do as Andy Aroditis, Founder and CEO of NextGate, suggested in this article where Shaun Sutner first reported on issues with the CHIME National Patient ID Challenge:

Aroditis complained that rather than plunging into a contest, CHIME should have convened existing patient matching vendors, like his company, to collaborate on a project to advance the technology.

“Instead they try to do these gimmicks,” Aroditis said.

I imagine that’s what CHIME would say the Patient Identification Task Force they created will now do. The question is whether CHIME burnt bridges they’ll need to cross to make that task force effective.

The reality is that Patient Identification and Patient Matching is a real problem that’s experienced by every healthcare organization. It’s one that CHIME members feel in their organizations and many of them need better solutions. As Beth Just from Just Associates noted in my discussion when the challenge was announced, $1 million is a drop in the bucket compared to what’s already been invested to solve the problem.

Plus, many healthcare organizations are in denial when it comes to this problem. They may say they have an accuracy of 98%, the reality is very different when a vendor goes in and wakes them up to what’s really happening in their organization. This is not an easy problem to solve and CHIME now understands this more fully. I hope their new task force is successful in addressing the problem since it is an important priority.

Opening the Door to Data Analytics in Medical Coding – HIM Scene

Posted on November 15, 2017 I Written By

The following is a HIM Scene guest blog post by Julia Hammerman, RHIA, CPHQ, is Director of Education and Compliance, himagine solutions.

Data analytics has moved from IT and finance to the majority of business functions—including clinical coding. However, most healthcare organizations admit they could do more with analytics. This month’s HIM Scene blog explores the importance of analyzing clinical coding data to improve quality, productivity, and compliance.

Coding Data in ICD-10: Where We Are Today

HIM leaders are implementing coding data analytics to continually monitor their coding teams and cost-justify ongoing educational investments. Coding data analytics isn’t a once-and-done endeavor. It is a long-term commitment to improving coding performance in two key areas: productivity and accuracy.

A Look at Productivity Data

Elements that impact coding productivity data include: the type of electronic health record (EHR) used, the number of systems accessed during the coding process, clinical documentation improvement (CDI) initiatives, turnaround time for physician queries, and the volume of non-coding tasks assigned to coding teams.

Once any coding delays caused by these issues are corrected, coding productivity is best managed with the help of data analytics. For optimal productivity monitoring, the following data must be tracked, entered, and analyzed:

  • Begin and end times for each record—by coder and chart type
  • Average number of charts coded per hour by coder
  • Percentage of charts that take more than the standard minutes to code—typically charts with long lengths of stay (LOS), high dollar or high case mix index (CMI)
  • Types of cases each coder is processing every day

A Look at Accuracy Data

Accuracy should never be compromised for productivity. Otherwise, the results include denied claims, payer scrutiny, reimbursement issues, and other negative financial impacts.

Instead, a careful balance between coding productivity and accuracy is considered best practice.

Both data sets must be assessed simultaneously. The most common way to collect coding accuracy data is through coding audits and a thorough analysis of coding denials.

  • Conduct routine coding accuracy audits
  • Analyze audit data to target training, education and other corrective action
  • Record data so that back-end analysis is supported
  • Assess results for individual coders and the collective team

Using Your Results

Results of data analysis are important to drive improvements at the individual level and across entire coding teams. For individuals, look for specific errors and provide coaching based on the results of every audit. Include tips, recommendations, and resources to improve. If the coding professional’s accuracy continues to trend downward, targeted instruction and refresher coursework are warranted with focused re-audits to assure improvement over time.

HIM and coding managers can analyze coding audit data across an entire team to identify patterns and trends in miscoding. Team data pinpoints where multiple coders may be struggling. Coding hotlines or question queues are particularly helpful for large coding teams working remotely and from different geographic areas. Common questions can be aggregated for knowledge sharing across the team.

Analytics Technology and Support: What’s Needed

While spreadsheets are still used as the primary tool for much data analysis in healthcare, this option will not suffice in the expanded world of ICD-10. Greater technology investments are necessary to equip HIM and coding leaders with the coding data analytics technology they need.

The following technology guidelines can help evaluate new coding systems and level-up data analytics staff:

  • Data analytics programs with drill-down capabilities are imperative. These systems are used to effectively manage and prevent denials.
  • Customized workflow management software allows HIM and coding leaders to assign coding queues based on skillset.
  • Discharged not final coded and discharged not final billed analytics tools are important to manage each piece of accounts receivables daily and provide continual reporting.
  • Systems should have the ability to build rules to automatically send cases to an audit queue based on specific factors, such as diagnosis, trend, problematic DRGs.
  • Capabilities to export and manipulate the data within other systems, such as Excel, while also trending data are critical.
  • Staff will need training on advanced manipulation of data, such as pivot charts.
  • Every HIM department should have a copy of the newly revised AHIMA Health Data Analysis Toolkit, free of charge for AHIMA members.

HIM directors already collect much of the coding data required for improved performance and better decision-making. By adding data analytics software, organizations ensure information is available for bottom-line survival and future growth.

If you’d like to receive future HIM posts in your inbox, you can subscribe to future HIM Scene posts here.

AMIA17 – There’s Gold in Them EHRs!

Posted on November 13, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

If even 10% of the research presented at the 2017 American Medical Informatics Association conference (AMIA17) is adopted by mainstream healthcare, the impact on costs, quality and patient outcomes will be astounding. Real-time analysis of EHR data to determine the unique risk profile of each patient, customized remote monitoring based on patient + disease profiles, electronic progress notes using voice recognition and secondary uses of patient electronic records were all discussed at AMIA17.

Attending AMIA17 was an experience like no other. I understood less than half of the information being presented and I loved it. It felt like I was back in university – which is the only other time I have been around so many people with advanced degrees. By the time I left AMIA17, I found myself wishing I had paid more attention during my STATS302 classes.

It was especially interesting to be at AMIA17 right after attending the 3-day CHIME17 event for Hospital CIOs. CHIME17 was all about optimizing investments made in HealthIT over the past several years, especially EHRs (see this post for more details). AMIA17 was very much an expansion on the CHIME17 theme. AMIA17 was all about leveraging and getting value from the data collected by HealthIT systems over the past several years.

A prime example of this was the work presented by Michael Rothman, Ph.D of Pera Health. Rothman created a way to analyze key vital signs RELATIVE to a patient’s unique starting condition to determine whether they are in danger. Dubbed the Rothman Index, this algorithm presents clinicians and caregivers with more accurate alarms and notifications. With all the devices and systems in hospitals today, alarm fatigue is a very real and potentially deadly situation.

Missed ventilator alarms was #3 on ECRI Institute’s 2017 Top 10 Health Technology Hazards. It was #2 on the 2016 Top 10 list. According to ECRI: “Failure to recognize and respond to an actionable clinical alarm condition in a timely manner can result in serious patient injury or death”. The challenge is not the response but rather how to determine which alarms are informational and which are truly an indicator of a clinical condition that needs attention.

Comments from RNs in adverse-event reports shared in a 2016 presentation to the Association for the Advancement of Medical Instrumentation (AAMI) sums up this challenge nicely:

“Alarm fatigue is leading to significant incidents because there are so many nuisance alarms and no one even looks up when a high-priority alarm sounds. Failure to rescue should be a never event but it isn’t.”

“Too many nuisance alarms, too many patients inappropriately monitored. Continuous pulse oximetry is way overused and accounts for most of the alarms. Having everyone’s phone ring to one patient’s alarm makes you not respond to them most of the time.”

This is exactly what Rothman is trying to address with his work. Instead of using a traditional absolute-value approach to setting alarms – which are based on the mythical “average patient” – Rothman’s method uses the patient’s actual data to determine their unique baseline and sets alarms relative to that. According to Rothman, this could eliminate as much as 80% of the unnecessary alarms in hospitals.

Other notable presentations at AMIA17 included:

  • MedStartr Pitch IT winner, FHIR HIEDrant, on how to mine and aggregate clinically relevant data from HIEs and present it to clinicians within their EHRs
  • FHIR guru Joshua C Mandel’s presentation on the latest news regarding CDS Hooks and the amazing Sync-for-Science EHR data sharing for research initiative
  • Tianxi Cai of Harvard School of Public Health sharing her research on how EHR data can be used to determine the efficacy of treatments on an individual patient
  • Eric Dishman’s keynote about the open and collaborative approach to research he is championing within the NIH
  • Carol Friedman’s pioneering work in Natural Language Processing (NLP). Not only did she overcome being a woman scientist but also applying NLP to healthcare something her contemporaries viewed as a complete waste of time

The most impressive thing about AMIA17? The number of students attending the event – from high schoolers to undergraduates to PhD candidates. There were hundreds of them at the event. It was very encouraging to see so many young bright minds using their big brains to improve healthcare.

I left AMIA17 excited about the future of HealthIT.

Five Key Takeaways from CHIME17

Posted on November 10, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

I recently had the chance to attend the 2017 CHIME Fall CIO Forum (CHIME17) for the first time. It was a fantastic experience.

What struck me most about the event was the close-knit feeling. In the hallways and in the sessions, it felt more like a class reunion than a healthcare IT conference. It was common to see groups of attendees engaged in deep conversations and there were frequent shouts of “hello” from across the hall. I can honestly say that I spoke with more CIOs at CHIME17 than the all the other 2017 conferences I have attended combined.

I learned at lot from my CIO conversations. Below are my top five takeaways:

Hospital CIOs are real people

At every other conference, you have to search pretty hard to find a hospital CIO. They tend to hide and run quickly from one pre-arranged meeting to another. They also do not spend a lot of time visiting the exhibit hall except with companies they are doing business with. At CHIME17 CIOs roamed the halls freely and were very approachable, especially at lunch. It was easy to strike up conversations at CHIME17 and it didn’t take long before funny stories of technology gone awry were being told. I came away from CHIME17 with a much stronger appreciation for CIOs – they are funny, caring people under a lot of pressure.

Optimization is the new black

Many of the conversations at CHIME17 were around the best ways to optimize existing IT systems – particularly EHRs. This optimization had two flavors. First, CIOs spoke about optimizing the user interfaces to reduce clinician frustration and to streamline workflows. This form of optimization was seen as a “quick win”. Second, CIOs spoke about optimizing/leveraging the data collected by their various systems. Many were investing in analytics tools and talent in order to unlock the value in the health data within their EHR, imaging and other applications. Optimization was the dominant topic at CHIME. For more details, check out my blog on this topic.

Attracting and retaining talent is a challenge

Another hot topic of discussion, or more accurately, a heated point of frustration at CHIME17 was the difficulty in attracting and retaining IT talent. CIOs at large urban hospital were frustrated at losing talented staff to HealthIT vendors and to “cooler” tech companies in their cities (like Google and Amazon). CIOs at smaller rural hospitals were frustrated at losing talented staff to their urban counterparts and to those same tech companies. With healthcare budgets frozen, CIOs were having to find more creative ways to attract and retain staff – like allowing work-from-home, hiring out-of-state resources and providing time for employees to pursue their own healthcare research projects. This war for HealthIT talent threatens to stymie healthcare innovation and is a challenge worth keeping an eye on.

The role of the Hospital CIO is evolving rapidly

Several sessions at CHIME17 were dedicated to the rapidly changing role of technology in healthcare organizations and to the role of the CIO itself. There was a lot of talk about the new emerging roles of:

  • CSO – Chief Security Officer
  • CMIO – Chief Medical Information Officer
  • CNIO – Chief Nursing Information Officer
  • CDO – Chief Data Officer
  • CHIO – Chief Health Information Officer

As information technology permeates everyday hospital operations, the CIO role will fracture into hybrid operational+technology roles like the ones listed above. There was heated debate as to whether all these roles should report into the CIO or whether they should be kept separate from. John Lynn wrote a great blog on this topic.

Size doesn’t matter

The challenges being discussed by the CIOs at CHIME were independent of the size of their organizations. Whether it was attracting talent, finding good vendor/partners or dealing with slashed budgets – CIOs from small rural hospitals to large urban systems, were struggling with the same challenges. On one hand it was comforting to know the problems were universal but on the other, it was worrying to see how pervasive these challenges were.

BONUS: Marketing tchotchkes are an invasive species

CHIME is one of the few healthcare conferences that does not have an exhibit hall. Despite this, there was still a lot of tchotchke available to attendees – proving that Marketing Tchotchke should really be labeled as an invasive species at healthcare conferences.

Shout-out to CHIME organizers for putting on such a fantastic event.

Healthcare Cloud Hosting with Chad Kissinger, Founder of OnRamp

Posted on November 8, 2017 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.

Cloud hosting is a reality in pretty much every healthcare organization. This is particularly true in hospitals that have hundreds of healthcare IT solutions with many of them being hosted in the cloud. While some are hosted in the health IT vendor’s cloud, I’m also seeing more and more hospitals looking to get out of the data center business and moving their various health IT software to a third party data center. I expect this trend will continue and we’ll eventually see hospitals who don’t have any onsite data center.

As the highly regulated healthcare IT world has moved to the cloud, I’ve seen data centers crop up that cater specifically to the needs of healthcare. One of those companies who’s focused on healthcare data center and cloud offerings is OnRamp. I recently sat down to interview Chad Kissinger, Founder of OnRamp, to learn more about their approach to healthcare cloud hosting and what makes healthcare hosting unique. I also talked with Chad about OnRamp’s recent HITRUST certification and what that means for healthcare providers and what OnRamp is doing to ensure security beyond the HITRUST certification. Plus, Chad offered some great insights into where he sees this all heading.

You can watch my full video interview with OnRamp CEO, Chad Kissinger, embedded at the bottom of this blog post, or click on any of the links below to skip to the sections of the interview that interest you most:

Be sure to Subscribe to Healthcare Scene on YouTube and check out all of our Healthcare IT video interviews and content.

Full Disclosure: OnRamp is a proud sponsor of Healthcare Scene.

Epic Mounts Clumsy Public Defense On False Claims Lawsuit

Posted on November 6, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A former employee of a health system using Epic filed a False Claims Act whistleblower suit claiming that the vendor’s platform overbills for anesthesia services by default. The suit claims that Epic’s billing software double-bills both Medicare and Medicaid for anesthesia, as well as commercial payers.

At this point, let me be clear that I’m not accusing anyone of anything, but in theory, this could be a very big deal. One could certainly imagine a scenario in which multiple Epic customers colluded to permit this level of overbilling, which could generate staggering levels of overpayment. If so, one could imagine hospitals and health systems paying out judgments that add up to billions of dollars. To date, though, nobody’s made such a suggestion. In fact, Epic has said essentially the opposite and pointed to the need to understand how medical billing works, but we’ll get to that.

In the suit, which was filed in 2015 but unsealed this month, Geraldine Petrowski contended that Epic’s software was billing for both the base units of anesthesia for procedures and the time the procedure took.

Petrowski, a former employee with the compliance team at Raleigh, N.C.-based WakeMed Health & Hospitals, alleges that setting the billing to these defaults has resulted in “hundreds of millions of dollars in fraudulent bills” submitted to Medicare, Medicaid and other payers. (WakeMed is an Epic customer.)

According to an article appearing in Modern Healthcare, Petrowski developed these concerns when she worked with Epic as the provider’s liaison for its software implementation between 2012 and 2014. In the complaint, she says that she raised these concerns with Epic, but got a dismissive response. Eventually, after Petrowski kept up the pressure for a while, Epic fixed the billing issue — but only for WakeMed.

Apparently, the U.S. Department of Justice reviewed Petrowski’s case and decided not to intervene, a fact which Epic has not-surprisingly mentioned every chance it gets. Perhaps more tellingly, the vendor has suggested that Petrowski filed the suit largely because she’s clueless. “The plaintiff’s assertions represent a fundamental misunderstanding of how claims software works,” Epic spokesperson Meghan Roh told the magazine.

Now, I don’t want to go off on a rant here, but if the best public defense Epic can mount in this case is to offer some mixture of “everybody’s doing it” and “you’re a big dummy,” you’ve got to wonder what it’s got to hide.

Not only that, trying to brush off the suit as the product of ignorance or inexperience makes no sense given what’s involved. While False Claims whistleblowers can collect a very large payoff, getting there can take many years of grueling work, and their odds of prevailing aren’t great even if they make it through the torturous litigation process.

No, I’m more inclined to think that Epic has tipped its hand already. I’d argue that fixing only the WakeMed billing system shows what the legal folks call mens rea – a guilty mind — or at least a willingness to ignore potential wrongdoing. Not only that, if the system was operating as expected, why would Epic have gotten involved in the first place? Its consulting services don’t come cheap, and I’m guessing that Petrowski didn’t have the authority to pay for them.

It doesn’t look good, people…it just doesn’t look good.

Sure, the hospitals and health systems using Epic’s billing solution are ultimately responsible for the results. Maybe Epic is completely blameless in the matter this case. Regardless, if Epic’s hands are clean, it could do a better job of acting like it.

New York Presbyterian brings ER to patients via Mobile Stroke Treatment Unit

Posted on November 3, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

After a year in operation, New York Presbyterian’s (NYP) Mobile Stroke Treatment Unit (MSTU) continues to be a shining example of how healthcare technology can be used to facilitate true patient-centered care.

“The MSTU program was started with the singular goal of reducing the disability resulting from stroke,” explains Dr Michael Lerario, Medical Director of NYP’s MSTU Program and Assistant Professor of Clinical Neurology at Weill Cornell Medicine. “There is a term we use when we talk about stroke: Time is Brain. Every minute that passes after blood flow is even partially cut off from the brain, 1.9 million brain cells die from the lack of oxygen. This loss can lead to severe cognitive and physical disability for patients.”

Two feet longer than a regular New York City ambulance, the MSTU houses a Samsung portable computer tomography (CT) scanner, a point-of-care laboratory, a complete mobile EHR station (with super-fast WiFi) and a Cisco tele-presence system. The MSTU is staffed by four team members who are specially trained:

  • 1 CT Technician
  • 1 Registered Nurse (RN)
  • 2 Paramedics

With this sophisticated equipment, the MSTU team is able to bring stroke treatment directly to patients where they are instead of waiting for the patient to be transported to the hospital’s ER. Those precious minutes can be the difference between a full recovery and months of rehabilitation (or permanent disability).

When a 911 call comes in, the operator quickly determines if it is a potential stoke situation using a predetermined set of criteria (Plerior referrs to them as “triggers”). This specific protocol was jointly developed by NYP and the New York Fire Department which handles all 911 calls. If the criteria are met, the MSTU is dispatched to the patient’s location.

Upon arrival, the MSTU team stabilizes the patient and quickly conducts a number of diagnostic tests using the equipment onboard: PT/INR test, hemoglobin test and a CT scan. The CT images are sent wirelessly in real-time to NYP’s PACS system where the on-call neurologist reviews the results with the MSTU’s RN via a tele-conference. Based on the scans and the onsite lab work, the neurologist and the onsite team can decide the best course of treatment.

If the scans show that the patient is suffering an ischemic stroke (an obstruction within a blood vessel supplying blood to the brain) and is not already taking anticoagulant medication, then tPA (tissue plasminogen activator – a clot dissolving medication) can immediately be administered. Often referred to as the “gold standard” of Ischemic Stroke Treatment, if tPA is administered quickly it significantly improves the chances for a full recovery.

“Right from the beginning we had complete buy-in and support from within our organization,” says Lerario. “The Neurology and Emergency Medical Services departments in particular were very excited about the MSTU program. They had seen the positive impact MSTU’s were having in Europe and the team wanted to bring that treatment to the people of New York City.”

In just one year of operation, the MSTU has been dispatched on 400+ calls and the response from patients has been universally positive. In fact, a number of cases have been highlighted as good news stories in the press including one about a famous Brazilian singer.

“It won’t be long before mobile stroke treatment will become the standard of care,” Lerario continues. “The benefits are now well documented and more and more people are becoming aware of the impact an MSTU can have on your quality of life following a stroke. People are starting to demand this type of care from their care providers.”

MSTUs are also fantastic for healthcare as a whole. It costs far less to operate an MSTU than it does to treat and rehabilitate patients who suffer disabilities because tPA was not administered quickly enough.

From a patient, provider and public perspective, New York Presbyterian’s MSTU is a winning combination of healthcare technology and patient-centered thinking.

RCM Tips And Tricks: To Collect More From Patients, Educate And Engage Them

Posted on November 1, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

Hospitals face particularly difficult challenges when trying to collect on patient bills. When you mix complex pricing structures, varied contracts with health insurers and dizzying administrative issues, it’s hard to let patients know what they’re going to owe, much less collect it.

Luckily, RCM leaders can make major progress with patient collections if they adopt some established (but often neglected) strategies. In short, to collect more from patients you need to educate them about healthcare financial issues, develop a trusted relationship with them and make it easy for them to pay that bill.

As a thought exercise, let’s assume that most patients want to pay their bills, but may need encouragement. While nobody can collect money from consumers that refuse to pay, you can help the willing ones prepare for the bills they’ll get. You can teach them to understand their coverage. In some cases, you can collect balances ahead of time. Toss in some smart patient engagement strategies and you could be golden.

What will that look like in practice? Check out this list of steps hospitals can take to improve RCM results directly, courtesy of a survey of hospital execs by Becker’s Hospital Review:

  • Sixty-five percent suggested that telling patients the amount due before they come to an appointment would be helpful.
  • Fifty-two percent believe that having more data on patients’ likelihood to pay could improve patient collections results
  • Forty-seven percent said that speaking to clients in different ways depending on the state of the finances would help improve patient collections.
  • Forty-two percent said that offering customers payment plans would be valuable.

Of course, you won’t be doing this in a vacuum, and some of the trends affecting patient financial responsibility are beyond your control. For example, unless something changes dramatically, many patients will continue to struggle with high-deductible health coverage. Nobody – except the health insurers – likes this state of affairs, but it’s a fact of life.

Also, it’s worth noting that boosting patient engagement can be complicated and labor-intensive. To connect with patients effectively, hospitals will need to fight a war on many fronts. That means not only speaking to patients in ways they understand, but also offering well-thought-out hospital-branded mobile apps, an effective online presence and more. You’ll want to do whatever it takes to foster patient loyalty and trust. Though this may sound intimidating, you’ll like the results you get.

However, there are a few strategies that hospitals can implement relatively quickly. In fact, the Becker’s survey results suggest that hospitals already know what they need to do — but haven’t gotten around to it.

For example, 87% of hospital respondents said they had a problem with collecting co-pays before appointments, 85% said knowing how much patients can pay was important, and 76% of respondents said that simplifying bills was a problem for them. While it may be harder than it looks to execute on these strategies, it certainly isn’t impossible.