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Hiring Motivated People and Inspiring Them

Posted on July 8, 2015 I Written By

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

I found this great leadership quote on LinkedIn that was shared by Shanthi Iyer:
Leadership Quote

This is some really great advice to hospital CIOs as they approach hiring at their hospital or health system. Hiring motivated people and inspiring them is a great way to lead an organization. You’d think that inspiring people in healthcare wouldn’t be hard. However, it’s amazing how quickly people can become disillusioned with what’s happening in healthcare IT. Government regulations aren’t usually inspiring.

With that said, all of us in healthcare should be inspired by the possibility that we can save lives. I know that many doctors scoff at the idea that a technology person could have that kind of impact, but we absolutely can. No, we don’t get our hands bloody as we stitch up a patient after surgery. However, we can create systems that make the doctors better and prevent mistakes that would happen otherwise.

Of course, if we’re going to take on the opportunity to save lives we have to also take on the responsibility that if we do our job poorly we can actually damage lives. Both sides of the coin are equally important. Certainly that’s inspiration enough for everyone in healthcare. However, a great leader finds ways to casually remind staff of this vision. That’s the challenge a healthcare CIO faces. Luckily, if you hire motivated people and inspire them, you’ll be amazed by the results.

RAC Audits Infographic

Posted on July 6, 2015 I Written By

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

RAC audits have quickly become a reality in every hospital system. Plus, the costs of managing these audits is increasing for many hospitals. HealthPort has put out this RAC Audits Infographic that highlights some of the trends with RAC audits.

The Year of Audits Infographic.Rev1.6.11.15

Needless to say, managing these RAC audits effectively is going to be extremely important to a health system going forward. From the AHA RACTrac survey which was the source for the infographic it says that “53% of all hospitals reported spending more than $10,000 managing the RAC process during the 4th quarter of 2014, 32% spent more than $25,000 and 8% spent over $100,000.”

What’s even more interesting is that HealthPort notes that many of the other payers are starting to make similar audit requests to measure the acuity of new patients entering the health system thanks to Obamacare (ACA). As this increases, the financial implications continue to increase as well.

What are you doing to make sure your RAC audits and other similar audits are managed effectively?

8 Biggest Epic Price Tags in 2015

Posted on July 3, 2015 I Written By

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

Akanksha Jayanthi from Becker’s Hospital Review has aggregated a list of Epic purchases in 2015. The article does make the disclaimer that some hospitals and health systems have not yet disclosed the price of their Epic purchase. So, there are likely more Epic purchases. However, the Becker’s list gives you some insight into how much it costs to purchase Epic.

  • Partners HealthCare: $1.2 billion
  • Lehigh Valley Health Network: $200 million
  • Mayo Clinic: “Hundreds of millions”
  • Lahey Hospital & Medical Center: $160 million
  • Lifespan: $100 million
  • Erlanger Health System: $97 million
  • Wheaton Franciscan Healthcare: $54 million
  • Saint Francis Medical Center: $43 million

This list isn’t surprising for me. In fact, the most surprising part is that Epic would sell a $43 million implementation. That would have previously been unheard of from Epic. However, we’ve seen Epic moving slowly down the chain. I’m not sure if that’s because the top of the chain has dried up or something else, but Epic has definitely been doing smaller implementations which they wouldn’t have considered before.

What should also be noted is that many of these numbers are estimates. With projects of this size, it’s really easy for the cost of the EHR implementation to balloon out of control. In fact, the Partners HealthCare Epic implementation at the top of the list is a great example. It was originally estimated at $600 million and you can see that estimate has doubled.

When you look at these numbers, is it any surprise that investors want to take down Epic? I’d like to see a list of the Epic renewal prices. Can you imagine what the Epic renewal for Kaiser’s $9 billion Epic EHR implementation will be? That’s where the opportunity lies for someone wanting to disrupt Epic.

Patient Financial Clearance: Ensuring a Successful Revenue Model in Emergency Medicine

Posted on July 2, 2015 I Written By

The following is a guest blog post by Jordan Levitt serves as a Managing Partner and Founder for PayorLogic.
Jordan Levitt
In emergency medicine, most providers know this to be true: medical triage and rendering healthcare services is often the easy part. Financial clearance and obtaining payment is the challenge. This is particularly relevant in light of the Emergency Medical Treatment & Labor Act (EMTALA) that ensures public access to emergency department (ED) services regardless of one’s ability to pay.

Even with the influx of patients who now have insurance through Medicaid expansion, EDs are still up against many challenges in terms of collecting payments from urgent care encounters. Emergency patients are frequently transient and difficult to manage. And beyond the traditional self-pay patient population, a growing number of emergency patients are now insured under high deductible health plans (HDHPs). Patients themselves are increasingly responsible for a larger portion of the bill.

The burden is on emergency medicine practice administrators and their billing companies to complete the financial clearance process as early as possible—ideally immediately following medical triage and during the urgent care encounter.  The biggest hurdle is obtaining correct and accurate information to financially clear patients within the emergency setting.

Common Hurdles to Overcome
First, IT systems used during emergency transport and within the ED are commonly fragmented—even within a singular hospital system. Second, emergency encounters must focus first on medical triage and urgent care. Financial clearance is an afterthought. Patient access staff members in the ED often do not have ample time to complete financial clearance before patients are treated—and even released. Third, many organizations experience high turnover in the ED registration area, making it difficult to ensure compliance and consistency.

This article summarizes how one emergency medicine billing company works with its clients to provide financial clearance for emergency encounters—even for patients that present as self-pay.

How it works at ATD Resources, Inc.
As a full-service billing company that serves five emergency departments with a combined 140,000 visits per year, ATD Resources, Inc. knows the financial pressures of increasing patient payment responsibility and non-payment risk all too well. Amy Propp, CPC, CEDC, director of operations at ATD Resources, LLC, sent approximately $1 million to a collections agency each month before revamping her financial clearance process. Furthermore, nearly 50% of ATD’s 180,000 patient statements were returned due to invalid addresses.

To improve revenue capture, ATD focused on obtaining the right information the first time around as close to near-time as possible. This required partnering with a front-end financial clearance solution that integrated with each hospital’s information systems so emergency medicine patient access staff had access to real-time demographics and payment information. A three-step workflow was designed.

Step One:
Verify patients’ social security numbers, addresses, and other demographic information within the emergency department as quickly as possible: upon registration and immediately following clinical triage.

Step Two:
Generate an immediate report of all patients labeled as self-pay/no insurance and use Payor Logic’s financial clearance application to check whether these patients have any billable insurance or other payment sources. For example, in 2014, ATD identified 16% of patients as self-pay for their clients. However, after verification, 35% of these individuals were actually eligible for Medicaid.

Step Three:
For patients with no verifiable or billable coverage, ATD staff members use Federal Poverty Level status information to qualify patients for a discount or charity care—immediately communicating findings back to the emergency medicine group.

Step Four:
Finally, ATD works with Payor Logic to predict likelihood of payment. By calculating a propensity-to-pay score, ATD (on behalf of their clients) focus on patients with the highest likelihood of paying the bill. ATD can identify patients with a history of non-payment, adjust the debt, and quickly forward these accounts to collections.

Thanks to its new financial clearance process, ATD has captured more than $800,000 in revenue over 12 months for its emergency medicine clients. In addition, its returned mail volume was cut by more than 10%.

The Road Ahead
Given the increase in patient financial responsibility, emergency providers and their billing companies must find creative ways to expedite the clearance and collection process.  This critical step is becoming increasingly essential as a new era of self-pay patients are emerging amidst declining pre-acute care reimbursements within emergency services and emergency medicine.

About Jordan Levitt:
Jordan Levitt serves as a Managing Partner and Founder for PayorLogic, a healthcare technology company for self-pay accounts management, insurance verification and financial clearance within emergency services, emergency medicine, laboratory, medical imaging, durable medical, and hospitals. Jordan can be reached at: jordanl@payorlogic.com.

The Top 3 Reasons Your Health IT Systems Take So Long To Integrate – Optimize Healthcare Integration Series

Posted on July 1, 2015 I Written By

The following is a guest blog post by Stephane Vigot, President of Caristix, a leading provider of healthcare integration products and services. This post is part of the Optimize Healthcare Integration series.
Stephane Vigot - Caristix
The push for interoperability is on. What’s at the core of interoperability that truly supports next generation analytics, real patient engagement, true care coordination, and high value population health? Data exchange through interfacing. And that means HL7.

HL7 represents 95% of interfacing in hospital environments for clinical systems and many other information systems in healthcare.  Many people make the error of thinking HL7 is just simple strings, but it’s a lot more than that. It’s a system of data organization, a dynamic framework that establishes the base of data exchange through its specifics, syntax and structure. But, despite standards, if you take two identical systems, same vendor, deployed in two different environments, you’ll find discrepancies 100% of the time when it comes to data management.

What’s the result? It takes too long to take systems live. And that means time, money, resource drain, and headaches for integrators, maintenance and quality teams. The most critical impact is on essential clinical care. Beyond that, this negatively impacts your short and long term business goals over time. This impact will grow with the increasing demands of interoperability, particularly with the drive for automation and easy data access and analytics.

There are three primary challenges that feed into this problem of getting a system live. These are:

Aligning the integration goals for business and technology users – This step alone will differentiate success or failure. Without a clear picture of your goals and environment from day one, you can’t measure the required investment and resources. Project planning becomes a wild guess. How do you get everyone involved on deck with a common understanding of the overall project?  Is it crystal clear how your new system fits into your existing ecosystem in the context of your data flow and structure? Do you know what information you need from whom, when? Is all documentation readily available? Are the business impacts of the interface understood?

Complete and clear data transformation requirements – It’s common to manually compare outdated specs, list the differences and jump into the code. This makes it virtually impossible to quickly come up with a complete list. Complete requirements are not identified until too late in the project, sometimes not until it’s in production. Are all data flows and system workflows identified? Are the system’s data semantics clear? Are documented system specs accurate? Has customized data been included?  Are all the transformations and mappings defined?  Have you automated the processes that define requirements?

Testing/Verification – Your QA team knows this is about a lot more than making sure all the dots are connected. You want to get this right before your go live and avoid handling data related emergencies in production with constant break-fix repairs. Are you doing enough testing before go live so your caregivers can count on applications being completely functional for their critical patient care? Are your test cases based on your requirements? Are you testing against your clinical workflows? Do you include edge cases and performance in your testing? Are you testing with de-identified production data that accurately represents your system’s data flow and needs? Is your testing HIPAA compliant? Are you prepared for ongoing maintenance and updating with reusable test cases backed by reliable and repeatable quality measures? Is your testing automated?

What’s the most efficient solution to these three challenges?  Productivity software that supports your integration and workflow process from start to finish. With the right solution, you understand the big picture before you start with complete requirements built upon your specifications that set you up for robust system testing and maintenance. The right solution will cut your project timelines in half, reduce your resource drain and costs, and guarantee predictable results while streamlining the repetitive tasks of your teams. In addition, gap analysis, automatic specification management, HL7 message comparison and editing, debugging tools, PHI de-identification, documentation building, and team collaborative depositories should be included. As seen in the charts below, savings of up to 52% can be realized through optimization with productivity software.
Healthcare Integration Project Time Chart
Do these healthcare integration challenges resonate with you? What is your organization experiencing? We’d love to hear your thoughts in the comments.

Caristix, a leading healthcare integration company, is the sponsor of the Optimize Healthcare Integration blog post series.  If you’d like to learn more about how you can simplify your healthcare integration process, download this Free Whitepaper.

About Stéphane Vigot
Stéphane Vigot, President of Caristix, has over 20 years of experience in product management and business development leadership roles in technology and healthcare IT. Formerly with CareFusion and Cardinal Health, his experience spans from major enterprises to startups. Caristix is one of the few companies in the health IT ecosystem that is uniquely focused on integrating, connecting, and exchanging data between systems. He can be reached at stephane.vigot@caristix.com

How Much Time Do You Spend Cleaning Your Data?

Posted on June 29, 2015 I Written By

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

I recently came across this really great blog post talking about data scientists wasting their time. Here’s a quote from the article (which quotes the NYT):

“Data scientists, according to interviews and expert estimates, spend 50 percent to 80 percent of their time mired in [the] mundane labor of collecting and preparing unruly digital data, before it can be explored for useful nuggets.”
– Steve Lohr, NYT

Then, they have this extraordinary quote from Monica Rogati, VP for Data Science at Jawbone:

“Data scientists are forced to act more like data janitors than actual scientists.”

Every data scientist will tell you this is a problem. They spend far too much time cleaning up the data and they all wish they could spend more time actually looking at the data to find insights. I’ve seen this all over health care. In fact, I’d say we have more data janitors than data scientists in healthcare. Sadly, many healthcare data projects clean up the data and then don’t have any budget left to actually do something with the data.

The solution to this problem is easy to write and much harder to do. The solution is to create an expectation and a culture of clean data in your organization.

I predict that over the next 5-10 years, healthcare data is going to become the backbone of healthcare data decision making. Those organizations that houses are a mess are going to be torn down and sold off to the hospital that’s kept a clean house. Is your hospital data clean or dirty?

Interoperability Becoming Important To Consumers

Posted on June 26, 2015 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 other day, I was talking with my mother about her recent primary care visit — and she was pretty po’d. “I can’t understand why my cardiologist didn’t just send the information to my family doctor,” she said. “Can’t they do that online these days? Why isn’t my doctor part of it?”

Now, to understand why this matters you need to know that my mother, who’s extremely bright, is nonetheless such a technophobe that she literally won’t touch my father’s desktop PC. She’s never opened a brower and has sent perhaps two or three e-mails in her life. She doesn’t even know how to use the text function on her basic “dumb” phone.

But she understands what interoperability is — even if the term would be foreign — and has little patience for care providers that don’t have it in place.

If this was just about my 74-year-old mom, who’s never really cared for technology generally, it would just be a blip. But research suggests that she’s far from alone.

In fact, a study recently released by the Society for Participatory Medicine and conducted by ORC International suggests that most U.S. residents are in my mother’s camp. Nearly 75% of Americans surveyed by SPM said that it was very important that critical health information be shared between hospitals, doctors and other providers.

What’s more, respondents expect these transfers to be free. Eighty seven percent were dead-set against any fees being charged to either providers or patients for health data transfers. That flies in the face of current business practices, in which doctors may pay between $5,000 to $50,000 to connect with laboratories, HIEs or government, sometimes also paying fees each time they send or receive data.

There’s many things to think about here, but a couple stand out in my mind.

For one thing, providers should definitely be on notice that consumers have lost patience with cumbersome paper record transfers in the digital era. If my mom is demanding frictionless data sharing, then I can only imagine what Millenials are thinking. Doctors and hospitals may actually gain a marketing advantage by advertising how connected they are!

One other important issue to consider is that interoperability, arguably a fevered dream for many providers today, may eventually become the standard of care. You don’t want to be the hospital that stands out as having set patients adrift without adequate data sharing, and I’d argue that the day is coming sooner rather than later when that will mean electronic data sharing.

Admittedly, some consumers may remain exercised only as long as health data sharing is discussed on Good Morning America. But others have got it in their head that they deserve to have their doctors on the same page, with no hassles, and I can’t say the blame them. As we all know, it’s about time.

Bosch’s Telemedicine Shutdown Suggests New Models Are Needed

Posted on June 25, 2015 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.

While many new telehealth plays are rapidly gaining ground, the previous generation may be outliving its usefulness. That may be the message one can take from one giant German conglomerate’s decision to shut down its U.S. telemedicine division.

Robert Bosch GmbH recently announced that it would shut down its U.S. telehealth unit, Robert Bosch Healthcare Systems, which makes business-to-business telemedicine systems. Its offerings include patient interfaces, software and platforms.

You may never have heard of this healthcare company, nor of its massive corporate parent Robert Bosch GmbH, but it’s part of a very large conglomerate with virtually infinite resources.

As it turns out, Bosch is a massive firm which competes with market leaders like GE and Siemens. Robert Bosch GmbH, which has existed since 1886, has more than 350 subsidiaries across about 60 countries and employs about 306,000 people. (I could share more, but I’m sure you get the idea.)

While the failure of one company’s telemedicine strategy doesn’t necessarily mean death for all similar plays, it does suggest that the nimble smaller firms may have more of an advantage than it appears.

Bosch Healthcare was actually way ahead of the market with its offerings, which included remote monitoring tools such as a touch-screen device for home use after hospital discharge and a family of mHealth tools aimed at chronic care management.But they appear to have been held back by proprietary technologies in a market that demands cheap and easy.

Ultimately, the end came when the parent company wasn’t happy with how the telehealth division was performing financially, and decided to cut and run. A statement from the company said that Bosch plans to shift its medical focus to sensor technologies to support improved diagnostics.

It’s hardly surprising that a company Bosch’s size would fail to keep up with the marketplace, given its size. No matter how smart the division’s 125 employees were, they were probably saddled with big company politics which prevented them from making big changes. Not to mention low priced tablets appeared and created a low cost competitor.

The question is, will other large players follow Bosch’s lead? It will be worth noting whether other large companies cede the telehealth market to small and emerging entrants as well. It’s not a no-brainer that this will happen; after all, there’s billions to be made here. But they may actually be wise enough to know when they’re ill-equipped to proceed.

I’ll be particularly interested to see what strategies existing health IT players adopt toward telehealth. It’s unclear how they’ll react to rising consumer and professional interest in telehealth technology, but whatever they do it will probably be worth analyzing.

That being said, with smaller companies out there breaking new ground with next-gen telemedicine apps and tools, they’re probably going to be in the unusual position of playing catch up. And in this case, slow and steady may not win the race.

Lessons To Consider When Weathering M&A Transitions

Posted on June 24, 2015 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.

These days, the need for sophisticated IT infrastructure and the shift to risk-bearing insurance contracts are increasingly favoring large, muscular players. Not surprisingly, healthcare industry M&A is reaching a new peak.  Just about any substantial healthcare organization is facing the question of whether to acquire outside players and bulk up, merge with a bigger healthcare player or risk going it alone.

Particularly if you’re doing the acquiring, however, achieving critical mass is just the first in a long, difficult series of steps necessary to success. Health systems, in particular, face difficult management challenges when they try to integrate all of the moving parts necessary to survive as a next-gen organization.

A new study commissioned by West Monroe Partners, however, may shed some light on how to think about M&A integration issues. The study, which focuses on mid-market deals (between $300M and $2B) looks at post-merger integration across several industries, but I’d argue that its lessons still make sense for hospitals. Their tips for managing post-merger transitions include the following:

  • Start planning early:  West Monroe researchers found that companies which considered integration strategies as they began targeting and negotiating with merger partners were more successful in integration. Specifically, these companies were able to integrate more deeply than firms that didn’t began planning till pre-merger preparations were already under way.
  • Pay close attention to cultures: Here’s an eye-opening stat: more than half of companies surveyed by researchers said that merger value was lost due to lack of attention to differences in corporate cultures. Clearly, giving lip service to this issue but failing to address it intelligently can be costly.
  • Poor change management impacts future dealmaking:  In a clear case of “sadder but wiser,” a whopping 94% of survey respondents said that they would place more emphasis on change management next time they managed post-merger integration efforts. The study doesn’t spell out why but it seems likely that their past efforts blew up on them. Given that many health systems won’t stop at one deal in this climate, this is an important point.
  • Communicating change well is essential: About three-quarters of mid-market execs said that communicating change to their staff was one of the hardest parts of integration, and 62% said that communicating to outsiders was a major challenge. Many seem unhappy with the results of the past efforts, as 57% said this was a key area for improvement.

Some of these suggestions may be discouraging for hospital leaders. After all, required and important changes like the ICD-10 transition and ongoing EMR changes may already have staffers near burnout, and they may react badly to coping with added cultural changes.

That being said, the survey results also suggest that many of the integration challenges healthcare organizations face can be headed off somewhat by smart planning.  At least there’s something execs can do to cushion the blow.

EHR Usability Survey – Share Your Opinions

Posted on June 23, 2015 I Written By

The following is a guest request to participate in a research survey on EHR usability from Natasha Ocean, a Masters student at the University of Tennessee. Natasha said she’d probably be able to share the results with us. So, let’s help her out in collecting the data.

As we embark on an era of healthcare reform in this country, it is vitally important that all hospital employees have the tools they need to be able to do their work effectively and efficiently. Yet there has been little research on whether the EHR system, an important tool for many hospital employees, is designed to help those users optimize their productivity.

That’s why I chose the topic of EHR usability for my Master’s thesis at the University of Tennessee Health Science Center.

I would really appreciate it if you could take about 5 minutes to complete this survey.

The survey contains 20 multiple choice questions about how EHR usability issues affect your efficiency at work.

Please click here to take the survey.

This is NOT a marketing survey; it is being done solely for the purpose of academic research.

You may read the IRB-approved Informed Consent Statement here (short version: the survey is completely anonymous and no personal or identifying information will be collected).

Thank you so much for your assistance!

About Natasha Ocean
Natasha Ocean, originally from St. Petersburg, Russia, was a practicing neonatologist specializing in life support and critical care before moving to the United States in 2004. She then transitioned her career into IT, working first as a technical project coordinator, then as a healthcare data analyst. She can be reached at ocean.natasha@gmail.com.