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ACOs Not Scaling Well, But Health IT Helps

Posted on March 13, 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.

ACOs were billed as the next big thing in healthcare, a model which would create economies of scale and tame rising costs of care. In theory, unifying hospitals and doctors into an overarching entity – and creating shared clinical and financial goals – should improve care and boost efficiency.

Of course, creating them doesn’t come cheap. In fact, creating even a modest ACO typically calls for between $1 million and $3 million in capital investment, according to Michael Deegan, MD, who recently developed a course on ACOs for the University of Texas at Dallas. It also takes 18 to 24 months to launch an ACO, Deegan told an interviewer at UT.

But once all of the Ts have been crossed and the Is dotted, ACOs can meet their stated goals, right? Actually, not so much, though health IT can help things along, according to Indranil Bardham, a colleague of Deegan’s at UT Dallas who serves as professor of information systems.

According to an article in HealthcareITNews, Bardhan recently completed a study on ACO performance which concluded that health IT had a measurable impact on their efficiency. The study, which drew on 2013-2015 data from CMS, reviewed the performance of 400 ACOs.

Among the key takeways Bardhan took from his research was that the larger an ACO was, the more likely it was to be inefficient. This flies in the face of conventional wisdom, which would suggest that bigger is better when it comes to improving efficiency.

On the other hand, health IT use had the effect its champions might hope for, though modest in scope. The study concluded that a 1 percent increase in HIT usage was associated with an 0.5 percent increase in ACO efficiency.

The thing is, these measures represent just a couple of ways to evaluate ACO performance, making it hard to tell just what is working, Bardhan told HIN. “Healthcare, with respect to ACOs, is fascinating because there is not just one single output measure that you are using to compare performance,” he told the magazine’s Bill Siwicki. “…It is difficult to measure the performance of organizations against each other when you have multiple outputs that cannot easily be transformed into a single dollar number.”

This squares with commentary by other ACO researchers, who seem to agree that the whole ACO evaluation process is a bit mysterious. As health policy analyst David Introcaso notes, in a review of ACO-based Medicare Shared Savings Program, CMS isn’t helping either. “While CMS details financial and quality performance results, the agency does not explain, at least publicly, how results, favorable or unfavorable, were achieved.”

Without knowing more about what we should measure, and why – much less what steps helped in achieving their results – it’s too soon to tell what type of health IT should be deployed in ACOs. But looked at more optimistically, once we have a better idea of what ACO success factors are, it seems likely that health IT tools will help execs address them. (For a look at one completely health IT-based ACO concept, see this piece on the Virtual ACO.)

Will How Well You Document Determine Your Quality Ranking?

Posted on March 6, 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.

We all know that the best doctors in the world are determined by how well that doctor documents the visit.
-Said No Doctor Ever!

Seriously, it’s an absurd claim that the quality of a doctor’s documentation would be how we rank the quality of a doctor. I’m sure just reading the headline probably pissed you off. I was upset just typing it. We all know that there are a lot of great doctors who are really awful at documenting. We know there are some awful doctors that’s documentation looks beautiful.

Since we all know this is the case why would I ask the absurd question about a doctor’s documentation determining their quality rating? Because I can see a path where we head this direction.

Yes, it’s scary to consider, but that’s why it’s so important that we consider it. I think this could be the impact of the quality reporting scores that come from MACRA/MIPS/APMs. It seems like it’s only just a matter of time before these scores will hit the Physician Compare website.

Don’t be surprised if they’re also made publicly available so that every health rating site on the internet pulls them down from CMS and uses them as one more factor in how they determine the highest quality doctors. If you don’t believe this will happen, then you haven’t followed what they’ve done with other CMS data.

Remember that these websites don’t have to have actual quality data. They just have to show the perception of quality data. Most consumers aren’t smart enough (or diligent enough) to know the difference. In fact, CMS itself calls it quality data, so they’ll be able to use that word freely. Imagine the doctor who gets ranked lower because their MIPS quality score was lower or non-existent because they have a small Medicare population or because they chose not to participate in the program. This is not a far fetched idea and is a fear I’ve heard from many health systems.

It’s too bad we don’t have a real way to measure quality. Then, we’d all want that data to be shared. However, I’m close to the conclusion that you can’t truly measure clinical quality. At least not in any scalable way. I’m hoping one day we’ll get there, but I don’t see it happening anytime soon. Until then, companies will use whatever perception of quality they can find and many high quality doctors will suffer because of it.

Hospitals Using Market-Leading EHR Have Higher HIE Use

Posted on July 29, 2016 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 new study concludes that hospital engagement with HIEs is tied with the level of dominance their EHR vendor has in their marketplace. The study, which appeared in Health Affairs, looked at national data from 2012 and 2013 to look at how vendor dominance related to hospitals’ HIE involvement level. And their analysis suggests that the more market power a given vendor has, the more it may stifle hospitals’ HIE participation.

As researchers note, federal policymakers have expressed concern that some EHR vendors may be hampering the free flow of data between providers, in part by making cross-vendor HIE implementation difficult. To address this concern, the study looked at hospitals’ behavior in differently-structured EHR marketplaces.

Researchers concluded that hospitals using the EHR which dominated their marketplace engaged in an average of 45% more HIE activities than facilities using non-dominant vendors. On the other hand, in markets where the leading vendor was less dominant, controlling 20% of the market, hospitals using the dominant vendor engaged in 59% more HIE activities than hospitals using a different vendor.

Meanwhile, if the dominant EHR vendor controlled 80% of the market, hospitals using the leading vendor engaged in only 25% more HIE activities than those using a different vendor. In other words, high levels of local market dominance by a single vendor seemed to be associated with relatively low levels of HIE involvement.

According to the study’s authors, the data suggests that to promote cross-vendor HIE use, policymakers may need to take local market competition between EHR vendors into consideration. And though they don’t say this directly, they also seem to imply that both high vendor dominance and low vendor dominance can both slow HIE engagement, and that moderate dominance may foster such participation.

While this is interesting stuff, it may be moot. What the study doesn’t address is that the entire HIE model comes with handicaps that go beyond what it takes to integrate disparate EHR systems. Even if two hospital systems in a market are using, say, Cerner systems, how does it benefit them to work on sharing data that will help their rival deliver better care? I’ve heard this question asked by hospital financial types, and while it’s a brutal sentiment, it gets to something important.

Nonetheless, I’d argue that studying the dynamics of how EHR vendors compete is quite worthwhile. When a single vendor dominates a marketplace, it has to have an impact on everyone in that market’s healthcare system, including patients. Understanding just what that impact is makes a great deal of sense.

Healthcare Price Transparency Driving Choice – Just The Wrong Direction

Posted on July 25, 2016 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 is a true believer in #HealthIT, social media and empowered patients. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He currently leads the marketing efforts for @PatientPrompt, a Stericycle product. Colin’s Twitter handle is: @Colin_Hung

Last month, the Healthcare Financial Management Association held their annual conference – #HFMA16ANI. The topics covered in the sessions and discussed in the aisles of the exhibit hall were wide-ranging. Financial patient experience, scoring based on propensity to pay, patient loans, financing options and price transparency were on the lips of many attendees.

The discussions on price transparency were particularly interesting. Attendees were not talking about transparency as the silver-bullet for reducing costs in healthcare like they were last year. Instead, attendees were talking about it as being just the first step in a long journey to a truly open market in healthcare.

Just a few years ago, price transparency was touted as the necessary catalyst for true consumer/patient choice in healthcare. It was believed that with detailed price information patients would be able to “shop around” for their care using price as a determining factor. Having this choice would mean healthcare organizations would have to become more price competitive – thus driving overall costs lower.

Check out this excellent post from Dan Munro @danmunro back in 2013 that captures the hope of price transparency at that time.

I believe that all the work around price transparency in the past few years has indeed pushed patients to make choices in their healthcare – just not the choices that we want.

This tweet from Annette McKinnon @anetto, a patient advocate from Toronto, during a recent #hcldr tweetchat perfectly illustrates the choices patients are making when they know the price of care:

Armed with price information, patients are not choosing to shop around for more affordable options, instead they are making the choice between forgoing care vs getting treatment. A Gallop poll found that in the US, 33% of families have put off medical treatment because of cost. That same poll shows that 22% of Americans have put off medical treatment for a “very” or “somewhat serious” condition.

So why aren’t patients taking the pricing information they receive and shopping around for cheaper alternatives? The biggest reason in my opinion is that patients do not have value transparency.

To me, value transparency is a state where patients purchasing healthcare services have a clear understanding of the expected outcomes, health benefits, disadvantages, risks and costs associated with it. In addition, patients would know how those services will be delivered (the workflow) and who is doing it. When a patient has access to this type of information and has the knowledge to interpret it, that’s when they have value transparency.

So what do we need to get to this state of value transparency in healthcare? Members of the #hcldr community had some interesting suggestions:

I believe that one day we will have value transparency in healthcare. Price transparency is an important first step. However, price in and of itself is not sufficient information to spur most patients to choose between different providers of care. In its current form, price transparency may be doing more harm than good for patients with chronic conditions that get worse without treatment – they may choose to forgo care due to cost only to end up in a more critical situation later because of the delay in treatment.

My hope is that someone will take today’s healthcare pricing tools and merge them with standardized quality metrics, crowdsourced patient experience data and provider histories to create a value transparency tool. In the meantime, the current crop of price transparency tools can at least help to reduce the fear of the unknown medical bill.