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Is There a Case to Be Made that Interoperability Saves Hospitals Money?

Posted on April 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.

Back in 2013 I argued that we needed a lot less talk and a lot more action when it came to interoperability in healthcare. It seemed very clear to me then and even now that sharing health data was the right thing to do for the patient. I have yet to meet someone who thinks that sharing a person’s health data with their providers is not the right thing to do for the patient. No doubt we shouldn’t be reckless with how we share the data, but patient care would improve if we shared data more than we do today.

While the case for sharing health data seems clear from the patient perspective, there were obvious business reasons why many organizations didn’t want to share their patients health data. From a business perspective it was often seen as an expense that they’d incur which could actually make them lose money.

These two perspectives is what makes healthcare interoperability so challenging. We all know it’s the right thing to do, but there are business reasons why it doesn’t make sense to invest in it.

While I understand both sides of the argument, I wondered if we could make the financial case for why a hospital or healthcare organization should invest in interoperability.

The easy argument is that value based care is going to require you to share data to be successful. That previous repeat X-ray that was seen as a great revenue source will become a cost center in a value based reimbursement world. At least that’s the idea and healthcare organizations should prepare for this. That’s all well and could, but the value based reimbursement stats show that we’re not there yet.

What are the other cases we can make for interoperability actually saving hospitals money?

I recently saw a stat that 70% of accidental deaths and injuries in hospitals are caused by communication issues. Accidental deaths and injuries are very expensive to a hospital. How many lives could be saved, hospital readmissions avoided, or accidental injuries could be prevented if providers had the right health data at the right place and the right time?

My guess is that not having the right healthcare data to treat a patient correctly is a big problem that causes a lot of patients to suffer needlessly. I wonder how many malpractice lawsuits could be avoided if the providers had the patients full health record available to them. Should malpractice insurance companies start offering healthcare organizations a doctors a discount if they have high quality interoperability solutions in their organization?

Obviously, I’m just exploring this idea. I’d love to hear your thoughts on it. Can interoperability solutions help a hospital save money? Are their financial reasons why interoperability should be implemented now?

While I still think we should make health data interoperability a reality because it’s the right thing to do for the patients, it seems like we need to dive deeper into the financial reasons why we should be sharing patient’s health data. Otherwise, we’ll likely never see the needle move when it comes to health data sharing.

Value Based Reimbursement: Another Challenge for HIM Professionals

Posted on August 3, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

How many times have you heard something along these lines: “HIM professionals must stay relevant and current with the continuous healthcare changes.” I must sound like a broken record to my team but it is absolutely true! HIM professionals provide the bridge between clinical data and reimbursement methodologies through CDI, coding, documentation integrity, and health data analytics to name a few. It has been proven time and time again that these HIM skills are vital to healthcare organizations but these skills must also be adapted and be put to good use each time a new guideline or rule is introduced.

Value-Based Reimbursement is an area that continues to grow with the push for quality patient outcomes and healthcare savings with potential penalties for excessive costs and poor quality of care. Reimbursement incentives that are tied to quality of care make perfect sense and HIM professionals need to take the plunge into these initiatives. By marrying departments and cross-functioning teams, we are able to generate proactive data and improve performance.

At my facility, I oversee the HIM department as well as the Quality department because we work closely together and will continue to have an even closer relationship throughout healthcare reform. This is becoming very common in the industry.

In this roundtable article for the Journal of AHIMA, we each outlined how we are bringing HIM to the table for Value Based Reimbursement initiatives and maximizing the tried and true skills of HIM professionals.

I have said it before and I will continue to say it: Always keep your finger on the pulse of healthcare and stay relevant by taking on these new challenges!

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

Value Based Care Hurting Most Vulnerable Hospitals

Posted on March 25, 2016 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.

In an article by the Washington Examiner, they highlight an interesting impact of the shift to value based reimbursement on hospitals:

Safety-net hospitals are getting hit by Obamacare’s push to penalize poor quality, the latest evidence of problems with the law’s effort to improve quality of care.

A new study from Harvard Medical School found that safety-net hospitals that treat many low-income or uninsured individuals are being penalized more for hospital readmission rates than other hospitals.

If a hospital readmits too many patients 30 days after they are discharged after being treated for a certain condition, that hospital gets penalized. A hospital could receive up to a 3 percent reduction in its Medicare annual patient payments.

The policy, which started in 2011, a year after Obamacare was passed, is intended to address a quality issue at hospitals. It is part of a larger shift in Obamacare to transition Medicare payments away from traditional fees for service toward a new model that rewards quality care.

We saw something similar to this happen during meaningful use as well. The most vulnerable hospitals couldn’t get the EHR incentive money because the incentive money wasn’t enough to cover the entire costs of the EHR. So, they just went without. In fact, an argument could be made that a large portion of the meaningful use EHR incentive money was paid to hospitals that were already on the path to EHR, but that’s a topic for another day.

When it comes to value based reimbursement it takes the right investment in technology and processes to be successful. I know a lot of hospitals that are just trying to keep their doors open. Where does that leave them time to think about these new complex government regulations? No doubt this shift to value based reimbursement is going to cause a lot of them to close their doors or be merged into the larger hospital systems. In fact, the later has been happening for a while and will continue to accelerate.

The article above does suggest a possible solution:

One alternative would have a hospital be measured by how its readmission rate improves rather than whether it meets a national average.

“Hospitals could be rewarded based on improvements off what their prior performance has been,” Barnett said.

Another alternative is for a hospital to become an accountable care organization. The concept gives a hospital a spending growth target that it has to meet for its Medicare patients.

I like the idea of benchmarking, but that can get really messy really quickly. The more I learn about value based reimbursement the more I worry that we’re just making things more complex without actually solving healthcare’s core problems.

Hospital Readmission Penalties Reward Patient Populations, Not Quality Care

Posted on December 24, 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’ve been really interested in the shift to value based care, accountable care organizations and related initiatives like reducing hospital readmissions. While their goals are noble and their intent good, I’ve always been afraid that these programs could lead to issues related to discrimination against the most vulnerable populations and those who serve them.

Turns out this article from Harvard Medical School highlights this problem when it comes to hospital readmissions:

To encourage hospitals to improve quality of care, Medicare penalizes those with higher than expected rates of readmission within 30 days of discharge.

The logic behind the penalties is that if patients receive high quality care, including proper discharge planning, they should be less likely to end up back in the hospital.

This seems straightforward, but it turns out that the social and clinical characteristics of a hospital’s patient population that are not included in Medicare’s calculation explain nearly half of the difference in readmission rates between the best — and the worst — performing hospitals, according to the results of a study published in JAMA Internal Medicine.

The article later goes on to highlight how hospital readmission penalties are impacting organizations based on their patient population as opposed to the quality of care they provide:

“The readmissions reduction program is designed to penalize hospitals for poor quality of care, but our findings suggest that hospitals are penalized to a large extent based on the patients that they serve,” said J. Michael McWilliams, HMS associate professor of health care policy and medicine, a practicing internist at Brigham and Women’s Hospital and senior author of the study.

No doubt this is a complex issue, but it’s only going to get more complex as reimbursement models get more complex. The article suggests that one simple solution would be to compare an organization against its baseline instead of comparing it against national averages. Of course, this has the problem of penalizing those organizations who are already doing a good job of reducing hospital readmissions. Maybe we need a mix of a baseline and a national average?

As we continue to develop new reimbursement models that incentivize quality care and penalize poor quality of care, we need to be careful to ensure it reaches the goal and doesn’t just cost healthcare organizations that are serving the most vulnerable and difficult patient populations.

Is Your Hospital Embracing or Ignoring Social Media?

Posted on March 16, 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.


At this point, I don’t think there’s any argument that social media influencers our health choices. In the above mentioned survey, 40% of them realize that it’s impacting them. Trying to say that social media doesn’t influence health decisions is like trying to say that your friends and family don’t influence your health decisions. Social media is the new way we communicate with friends and family. They influenced our health before social media and are still doing it, but in the new social media medium.

We know that social media is influencing health decisions, but is your hospital embracing the power of social media or trying to ignore it? I bet most hospital CIOs have no idea. I bet most hospital CMO (Chief Medical Officers) don’t know much better either.

There’s a simple way for you to know how well your hospital is embracing social media. Just ask yourself the question, “Is social media in my hospital considered a marketing and PR task?”

If the answer to that question is yes, then you have not embraced social media in your hospital. Certainly there is a lot of opportunity for a hospital marketing and PR department to use social media and they should (Side Note: I have a conference focused on hospital social media, so I intimately know the power of it in marketing and PR). However, if social media is only considered a marketing and PR task, then your hospital is missing out on so many benefits that can come from a hospital using social media.

The first step to embracing this culture is involving your hospital CIO and hospital CMO (Chief Medical Officer) in social media. They’ll have ideas and insights into how to use social media that go well beyond marketing a hospital’s services. In the new value based reimbursement world, this new form of outreach and connection to patients is going to be critical.

The second step to embracing hospital social media is to put budget and resources (ie. people) behind the initiatives that are created by your marketing/PR team, IT team, and medical team. There’s very little value that’s created from a meeting of these people without the ability to follow through on the ideas and suggestions they create.

Sadly, most hospitals have never even had this meeting (possibly because they don’t want to commit the resources). Those few hospitals who have had this meeting haven’t committed the resources needed to turn their ideas into reality. I think these are both failed strategies for hospitals that will catch up to them in a big way. I think a hospital’s approach to social media will soon tell us a lot about a hospital’s approach to patient care.

The Unsustainable Financial Realities of Hospitals

Posted on September 3, 2014 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.

There’s a great blog post up on the Medsphere blog which talks about the challenging financial realities that hospitals are facing today. I especially like this summary list of the unsustainable healthcare business based on a Moody’s analysis of hospitals:

  1. Private insurers did not increase payments to hospitals.
  2. Medicare reduced payments due to federal budget cuts.
  3. Demand for inpatient services declined as outpatient care options rose.
  4. Retail outpatient options now compete with hospital clinics.
  5. Patients with higher copays and deductibles chose not to seek care.
  6. Hospitals are buying up physician practices.
  7. The costs of electronic medical record systems are impacting the bottom line.

As we talk about why healthcare in the US costs so much money, we always talk about programs that will lower the costs of the healthcare we provide. I often point out that while we love to talk about lowering the costs of healthcare, from a hospital perspective that translates to lowering the revenue they generate while keeping their costs the same. This is the real challenge we face in trying to lower the costs of healthcare. There are really large organizations that stand to lose if we lower the cost of healthcare.

The shift to Accountable Care Organizations and Value Based Reimbusement is a step towards dealing with the issue. If done right, these programs allow a hospital organization to get paid a similar amount while lowering the number of patients they see. The concept is good, but when you get into the details it’s much more complicated with a lot of odd incentives. Plus, I think it’s likely not nearly enough to save many of these hospitals that are already struggling. These programs are new and often just lead to the rich hospitals getting richer.

Unfortunately, as the list above shows, the EHR has been a cost pressure as opposed to a cost saver. Long term, the EHR has the potential to really lower costs, but in the interim many hospitals are suffering under the costs associated with EHR.

It’s not a pretty financial picture for most hospitals. What do you see on the horizon that could change this outlook?

What You Need to Know About Health Reform, ACOs, and Collaborative Care

Posted on March 7, 2014 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’ve always loved the common phrase that ACOs are like a unicorn. Everyone knows what it is, but no one’s ever seen one. I think that’s starting to change and this whitepaper called ACO & Collaborative Care – The Basics has provided the best overview I’ve seen of the healthcare reform, ACO and collaborative care world.

For example, it offers this statement that’s worth considering: “Health reform IS REAL and NOT GOING away.” Related to this is an equally powerful statement, “Value has become competitively relevant.

Chew on those statements a little bit. Let it roll around on your tongue and consider what that means for the future of healthcare. Once you get past the anger that many will feel around these changes and the lack of clarity of the changes, then you realize that it’s true. Health Reform, ACOs, and Collaborative Care are all going to shape the future of healthcare.

Plus, it’s also worth recognizing that there are no ACOs in a box that you can just plug and play into your organization and see the results. There are a lot of tools available to help you get where you need to go. Technology and data are going to be tremendous assets on this pathway, but it’s going to take more than just technology to make this a reality.

Either way, if you haven’t dug into what’s happening around changing reimbursement, ACOs, and health reform, I suggest you start by downloading this whitepaper for a basic overview of where it’s going.

Interview with Dana Sellers: Encore Pay for Perfomance (P4P) Managed Services

Posted on February 20, 2014 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.

The following is an interview with Dana Sellers, CEO of Encore Health Resources about their new Pay for Performance Managed Services offering which they’ll be sharing at HIMSS 2014.
Dana Sellers
Tell us your vision for how your new P4P Managed Services will work.
Our vision is to help our clients manage performance and data components against payer contracts to maximize quality, obtain incentives, and avoid penalties. Our offering uses a combination of Encore subject-matter experts (SMEs), software tools, and methodologies that we’ve already tested and proven in large healthcare systems. P4P Managed Services lifts the burden of meeting these value-based demands off our clients’ shoulders and into Encore’s hands. As part of this innovative offering, we also share risks and rewards via multi-year partnerships. We work with clients to ensure that they have the trusted data they need to support performance improvement and obtain incentives.

Our service begins with the P4P Value-driven Roadmap, which identifies the dollars and associated measures at stake in clients’ at-risk, value-based contracts — including projections for the next few years. As input for the roadmap, we perform a data assessment of a client’s EHR and other source systems to determine if they are capturing the right data for the targeted measures. The roadmap defines the multi-year data and process program required to obtain the desired incentives.

Next, we establish this required program along with data governance, technology, and data tools. We also build the value components of the program, including EHR remediation, workflow redesign, change management, data profiling, ETL, and dashboards required to monitor performance.

Once the program foundation is established, the value-management cycle begins. Encore monitors each client’s performance, providing insight through performance analysis and suggesting needed performance improvements to meet all targeted incentives and enhance the quality of care. Also, as new contracts emerge, we work with clients to incorporate new eMeasures into the program.

By creating trusted, transparent data, Encore helps health systems transform and meet new payment-model requirements by using eMeasures to adhere to evidence-based standards. The result is better patient care and an improved bottom line. We provide the consulting expertise, unique methodologies, and our own, in-house developed software tools to help our clients succeed — as we’ve proven by our results in helping other large clients accelerate their achievements through eMeasures.

Why did you choose to offer a service like this?
We know EHR data! Our methodologies and software tools are built around EHR data and eMeasures.

Encore was founded to provide consulting services with a focus on analytics fueled by clinical data. In the broad spectrum of consulting services that we provide – from HIT and clinical advisory to implementation, go-live services, and analytics — our focus is trained on identifying and gathering the data that our clients need to improve healthcare and operational performance. Therefore, our P4P Managed Services offering is a natural extension of our mission. At-risk contracts require the ability to track eMeasures, which has been an Encore strength – and differentiator — since our founding five years ago.

Our vision for P4P Managed Services is also supported by our clients – especially CIOs and CFOs. They have told us that they need assistance with all aspects of data capture, analytics, and performance improvement. When we lift that burden from our clients’ shoulders, it frees them to focus on other critical issues, such as cost reduction, while we leverage our unique expertise and proven experience to manage the value side of the equation.

Which P4P programs do you see Encore supporting?
We support measures — quality measures that go back to incentives. These include Medicare, Medicaid, commercial P4P/Fee-for-Value type contracts, IQR, PQRS, ACO, ACAs, ACCs, NQF/CQMs, PCMH, PCQUS, clinically integrated networks, and the like.

Our methodology and tools tie the eMeasures directly to workflow, so we know how to change each client’s workflow to get better results. Our knowledge bases include over 350 eMeasures.

How much of this offering is technical and how much of it is services.
This is an important question. Encore is first and foremost a services company – a services company that is strongly differentiated by unmatched, in-house-developed software solutions that are uniquely designed to support the services we provide. So our new offering is precisely that: services supported by innovative technology and processes on a flexible, as-needed basis.

What does the cost structure look like for this service?
As described earlier, the P4P Managed Services cost structure is based upon a roadmap we define with each client to quantify the value-based, at-risk dollars and the client’s capabilities to manage the quality-performance components of their at-risk contracts. Contract details, therefore, will vary with each client’s situation. The bottom line is that Encore is willing to manage our P4P Managed Services contracts while working with clients to define a risk-sharing arrangement that incents everyone to achieve.

Why would an organization choose to outsource the P4P to Encore as opposed to doing it in-house?
The process of managing performance against eMeasures across a health system is complex, and many clients have not put together a disciplined approach to performance improvement. Further, many of our clients are telling us that they simply do not have the full complement of expertise, resources, technology, and program-management disciplines available to move fast enough against a dizzying array of government and commercial at-risk contracts. But we do, and we – especially our skilled eMeasures experts — have a track record that proves it.

Also, an increasing number of health systems are recognizing that they’ll have to enter a world of eMeasures that is growing every year. With P4P Managed Services, we bring the expertise, skills, tools, and methodology that can take this eMeasure world and our clients under our wing. Our new service provides clients the breathing room to focus on multiple fronts simultaneously – and not leave any dollars on the table as a result.

A third reason for choosing our new offering is because it’s a cost-conscious solution. We eliminate the need for clients to hire more architects, eMeasures specialists, analysts, and report builders.

Finally, P4P Managed Services can preserve endangered species. That is, we supplement our clients’ existing IT department with some of the hardest resources to find: clinicians and operational SMEs with an understanding of data; eMeasures experts; and, technical SMEs with an understanding of the clinical and the operational worlds.

How much accountability is Encore taking on with these P4P Managed Services? Where do you draw the line?
Our new offering is a full life-cycle solution that we approach as a partnership. We nail down the amount of accountability – the risk that we’re able to share – on a case-by-case basis through the roadmap. Depending upon what we learn, we then determine the degree of accountability that both we and our clients can share to incent the highest levels of achievement.

Is there some risk on Encore’s part that the client will fall short on what they need to accomplish for Encore to provide the P4P services? Encore can’t go in and do the documentation for the doctor.
This is precisely what our new service is in place to define. As with every engagement, we use a thorough, careful assessment process to ascertain the nature of the challenges involved. With P4P Managed Services, that means understanding:
• The incentives involved
• The risk involved if our clients can’t achieve optimal revenue reimbursement – say with Medicare and Medicaid contracts
• The risk involved for Encore if those contractual incentives are not earned
Bottom line: we both win, or we both lose. With P4P managed services, we are convinced that we can define on a case-by-case basis the mix of Encore services, solutions, and client resources that Encore will manage to produce a win or multiple wins for both sides.

This feels similar to revenue cycle management (RCM) applied to P4P programs. Can you apply some of the RCM learnings to this type of offering?
Yes, similarities do exist between RCM and the management of quality performance components of at-risk contracts. The way we see it, RCM has been responsible for collecting patient data and getting claims ready for a long time. It remains fairly unchanged and encompasses the management of people, processes, and technology across health systems to improve revenue collection. By tying eMeasures to clinical rather than latent claims data, performance issues can be corrected within a few days. That is because the use of EHR data literally “moves the needle” in real time. Beyond claims data, we use EHR clinical data to affect change that meets the required quality measures thresholds.

At present, there is an increased focus on traditional cost monitoring, which informs RCM. This typically happens at the service line and department level; not at the episode-of-care level. Although direct, indirect, fixed, and ad-hoc costs are certainly important and are included, value-based cost control and reduction efforts must focus on the clinical processes, just like the quality performance components. Both will require tracking the costs and quality across the entire continuum of care, constantly analyzing performance and applying adjustments. And the revenue cycle is a significant piece of this. So the discipline and techniques needed for RCM can certainly inform a health system’s approach to fee-for-value focused management.

Do you see this as the start of offering even more Managed Services offerings?
Yes. We are now working on another offering – it’s in the packaging stages – around Meta-Data Management. Stay tuned for more details later this year.