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Is It Worth The Trouble To Drop Fax Use?

Posted on August 17, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

Not long ago, ONC held its 2nd Interoperability Forum in Washington, DC. One of the big ideas being kicked around at the event was killing the use of fax machines to share health data.

During her keynote address, CMS leader Seema Verma went so far as to say that she’d like to see all provider organizations go fax-free by 2020. Apparently, Verma wants providers to switch to other means of digital information sharing.

Sounds good, right?  Well, maybe not. Despite its flaws, faxing does have the advantage of being easy to use, available in virtually every provider office and fairly reliable. I’m not sure we can say that about most other forms of digital health data exchange. In fact, dropping faxing may leave doctors with bigger problems than they had before.

After all, before we stop faxing, we’ll have to find a digital document format that plays nicely with other systems and makes patient information easy to access. That, not surprisingly, may be tougher than it sounds.

I particularly like the way Jay Anders, MD, broke these issues down in a recent email message. Anders, chief medical officer of Medicomp Systems, makes the following observations:

  • E-paper may not be interoperable: In fact, it may create new barriers to data sharing, he suggests: “Electronic paper is not effective. It [can] create a data tsunami in healthcare – a flood of clinical data that physicians cannot access at the right time with the right patient.”
  • Free text is a burden: While e-documents may be easy to pass back and forth, making use of the data within can be really tough, he says. “When the EHRs receive these PDFs with mountains of free text, how do they interpret that data? How do they present that data to physicians? How do they make that data into actionable information?

His bottom line here is that while providers can use e-documents to share data, there’s no point in trying unless they can offer useful information at the point of care.

After taking in Anders’ questions, I have another one of my own. If providers will still need to go through contortions to extract data from e-documents, how is that better than using faxes? After all, if you run faxed documents through a sophisticated OCR process, you can capture and even format health data information.

In other words, given the issues inherent in using digital documents, putting faxing to bed may not be worth the trouble. I have to agree with Anders’ conclusion: “So, how does sending electronic communication of scanned PDFs rather than faxes enable interoperability? The answer is that it doesn’t.”

For another view on Seema’s comments and the fax machine in healthcare, check out John Lynn’s post on the real problem when it comes to replacing fax machines in healthcare.

Within Two Years, 20% Of Healthcare Orgs Will Be Using Blockchain

Posted on August 16, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

I don’t know about you, but to me, blockchain news seems to be all over the map. It’s like a bunch of shiny objects. Here! Look at the $199 zillion investment this blockchain company just picked up! Wow! Giant Hospital System is using blockchain to automate its cafeteria! And so on. It gets a bit tiring.

However, I’m happy to say that the latest piece of blockchain news to cross my desk seems boring (and practical) in comparison. The news is that according to a Computerworld piece, 20% of healthcare organizations should be using blockchain for operations management and patient identity by 2020, or in other words within two years. And to be clear, we’re talking about systems in day-to-day use, not pilot projects.

The stats come from a report by analyst firm IDC Health Insights, which takes a look at, obviously, blockchain use in the healthcare industry. In the report, researchers note that healthcare has been slower out of the blockchain gate than other industries for reasons that include regulatory and security concerns and blockchain resource availability. Oh, and while the story doesn’t spell this out, good ol’ conservative decision-making has played its part too.

But now things are changing. IDC predicts that in addition to supporting internal operations, blockchain could form the basis for a new health information exchange architecture. Specifically, blockchain could be used to create a mesh network capable of sharing information between stakeholders such as providers, pharmacies, insurance payers and clinical researchers, the report suggests. This architecture could be far more useful than the existing point-to-point approach HIEs use now, as it would be more flexible, more fault-tolerant and less prone to bottlenecks.

As part of the report, IDC offers some advice to healthcare organizations interested in taking on blockchain options. It includes recommendations that they:

  • See to it that any blockchain-related decisions are evidence-based and informed and that stakeholders share information about the pros and cons of blockchain interoperability freely
  • Develop a blockchain interoperability proof of concept which demonstrates how decentralized, distributed and immutable properties could make a contribution
  • Pitch the benefits of blockchain interoperability to providers and patients, letting them know that it could eliminate barriers to getting the data they need when and where they need it
  • Adopt blockchain interoperability early if at all, as this can offer benefits even prior to implementation, and gives leaders a chance to tackle concerns privately if need be

Of course, these suggestions and factoids barely scratch the surface of the blockchain discussion, which is why IDC gets $4,000 a copy for the full report. (Though I should note that the article goes into a lot more depth than I have here.)

Regardless, what came across to me from the article was nonetheless worth thinking about when kicking around possible blockchain strategies. Broadly speaking, providers should get in early, keep everyone involved (including patients and providers ), work out differences over its use privately and see to it that your rollout meets concrete needs. You may want to also read this article on 5 blockchain uses for healthcare. It may not be in places you’d have thought previously.

And now, back to silly blockchain news. I’ll let you know when another set of practical ideas shows up.

Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting

Healthcare Scene Meetup in Chicago

Posted on August 14, 2018 I Written By

John Lynn is the Founder of the 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 and 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’m always amazed at the power of meeting up with people in the world of Healthcare IT. It’s a surprisingly small world and it’s always great to mix and mingle with colleagues who work in the field. Often this is at big conferences, but it’s also fun to bring the community together in more informal settings near their home.

That’s why I’m excited to share that Healthcare Scene will be doing an informal meetup next week in Chicago. The meetup is happening Thursday, August 23, 2018 at Vapiano. You can find all the details and register for the event here.

One of the amazing things about the Healthcare Scene community is that we include a wide cross section of people. This is particularly true when you include the various social media communities including the #HITsm, #hcldr, and #HITMC communities as well. If you live in or near Chicago, we hope you’ll join us for a fun night of networking and connecting with those in the community.

If you can’t join us in Chicago, be sure to keep an eye on our list of Healthcare IT Conferences and Events. We’re about to update it with our Fall schedule of conferences and events. No doubt we’ll be coming to a city near you. We love meeting readers in person, so please let us know if you’ll be at an event.

What events are you planning to attend this Fall 2018 and in 2019? Are there other events we don’t have on our list that we should include? Which events do you find most valuable and why? Share with us your thoughts and perspectives in the comments or on social media with @HealthcareScene.

The Biggest Lesson Learned from IBM Watson

Posted on August 13, 2018 I Written By

John Lynn is the Founder of the 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 and 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 no sexier marketing story than IBM Watson. When IBM Watson beat Ken Jennings on Jeopardy, there was an explosion of coverage. The most promising area for IBM Watson was healthcare. However, as the Wall Street Journal recently reported, IBM Watson has fallen short of expectations in healthcare.

More than a dozen IBM partners and clients have halted or shrunk Watson’s oncology-related projects. Watson cancer applications have had limited impact on patients, according to dozens of interviews with medical centers, companies, and doctors who have used it, as well as documents reviewed by The Wall Street Journal.

In many cases, the tools didn’t add much value. In some cases, Watson wasn’t accurate. Watson can be tripped up by a lack of data in rare or recurring cancers, and treatments are evolving faster than Watson’s human trainers can update the system. Dr. Chase of Columbia said he withdrew as an adviser after he grew disappointed in IBM’s direction for marketing the technology.

No published research shows Watson improving patient outcomes.

No doubt, part of the problem is that IBM Watson could never live up to the hype. The hype was too big. However, it seems that IBM Watson has really fallen short from even the most conservative hopes for it. That’s a big problem.

One thing that’s interesting about IBM Watson is that they spent no marketing on it. Especially in healthcare. At the IBM Think events the past couple years they didn’t have any healthcare press or influencers at their event. Their marketing team’s response was that they didn’t have any budget to market to healthcare because they got so much coverage for IBM Watson already.

Fair enough. IBM Watson has gotten a ton of exposure in healthcare, but maybe if they’d invited the press they could have had some real conversations about whether IBM Watson was real or was it memorex (Sorry for those that don’t know this old reference). While not always the case, the healthcare IT press and influencers are a different breed that asks deeper questions about a product and what it can do to impact healthcare. It feels like IBM Watson had so much hype that not enough people held them accountable for actually delivering results to healthcare organizations.

From the same WSJ article linked above is this great quote:

“The discomfort that I have—and that others have had with using it—has been the sense that you never know what you’re really going to get…and how much faith you can put in those results,” said Lukas Wartman of the McDonnell Genome Institute at the Washington University School of Medicine in St. Louis. Dr. Wartman said he rarely uses the system, despite having complimentary access.

The concepts of AI and machine learning that IBM Watson represent are incredible and I believe will impact healthcare for good. However, it’s still not there yet. The trust isn’t there.

The core lesson I take from IBM Watson is that things like Jeopardy can create hype for a certain product, but in healthcare we need more than hype. We need trust. If a healthcare provider can’t trust the result, then your product won’t go anywhere and won’t be used. Unfortunately for IBM Watson, beating Ken Jennings on Jeopardy creates a lot of awareness, but does nothing to build trust.

The jury is still out on IBM Watson on healthcare. They’ve spent billions on it and so it’s not like it’s going to just disappear. Hopefully, it does turn the corner and becomes a trusted tool for many in healthcare. Trust just takes consistency over time. That’s an important lesson for many healthcare IT products.

Edge Computing Provides Security for EHR, Healthcare Applications

Posted on August 10, 2018 I Written By

The following is a guest blog post by Eric Fischer is the Digital Marketing Specialist for Estone Technology.

As more and more practices, both small and large, move from traditional patient records to fully electronic health records, the advantages of cloud-based EHR systems are becoming more readily apparent. In a cloud-based EHR system, data is stored on an external server, usually owned and operated by a third-party company, reducing an individual practice’s investment. Setup is often limited to installing certain software, and subsequently, data can be accessed anywhere.

However, in the modern day of HIPAA rules and patient privacy regulations, sending all of your patient data to a third party service can be dangerous if not managed properly. Even worse, as more and more devices gain intelligence and connectivity, joining the Internet of Things, patient data is often sent as soon as it as gathered, without human input, creating backlogs of pointless data and additional windows for data theft or misuse.  Though cloud-based records systems should offer flawless security, it only takes one person at any level in data processing to be careless with their password, or one device affected with malware to render patient records totally insecure. In a recently reported story, a security expert identified a data breach caused when an employee plugged their eCigarette into their work computer’s USB port to charge. The eCigarette had been loaded with secret data harvesting software.

The IoT has made the problem more severe as it grows, as many simple, connected devices lack any sort of security measures whatsoever, and simply send gathered data on as they have been programmed to do, no matter how they were programmed to do so. It is shockingly simple for these devices to be compromised and misused. The benefits of patient data recorders that automatically send their data to EHR’s is obvious, but the danger is also quite clear.

Cloud-Based IoT systems automatically send much of requested patient data from sensors directly to third party companies, ripe for data theft as well as failure in a network outage. *Data from the Journal of Intensive and Critical Care.

Fortunately, there is a solution. As small, embedded chips and boards have become more and more powerful, the need to send all data to the cloud to be processed and stored has lessened. Today, the IoT is shifting rapidly towards a new model of computing – Edge Computing. In this new computing format, data from individual IoT devices like patient monitors and data recorders is processed by intelligent, embedded boards and devices at the edge of the local network. Once the processing has been completed, any relevant data can be encrypted and forwarded to the cloud for additional processing and storage.

This improves data security in a few very simple, fundamental ways – first of all, more data stays local. Everything from blood pressure to MRI scans can be processed locally by edge devices using machine learning techniques. Most of this data is, of course, irrelevant and can be discarded. But when the Edge Computing device identifies something important, it can forward that data to the cloud-based EHR system, ready for additional use.

Secondly, since these devices are more powerful, and managed locally, they’re easier to secure than other IoT devices, or third-party managed cloud devices. It’s possible to load embedded boards performing edge computing functions with modern operating systems and anti-malware programs that keep data secure. This barrier between your internal devices, and the digital world offers a layer of protection for your most sensitive patient data.

Developers of hospital networks and hospital IT managers, EHR software developers, and other healthcare information technology professionals can work with hardware designers and manufacturing firms to discuss Edge Computing solutions for themselves and their customers.

About Eric Fischer
Eric Fischer is the Digital Marketing Specialist for Estone Technology – a designer and manufacturer of OEM/ODM computer solutions for Medical and Rugged Industries. Our solutions include specialized Tablet and Panel PCs, Embedded Boards, and Industrial Computers. We offer solutions that are IEC-60601 certified, waterproof, and antimicrobial, specialized for hospital environments.

Experts Tell All: How Leaders Ensure Successful Healthcare ERP Adoption

Posted on August 9, 2018 I Written By

The following is a guest blog post by Sallie Parkhurst, Carol Mortimer, Michelle Sanders, and Heather Haugen PhD from Atos Digital Health Solutions.

According to Gartner, approximately 75% of Enterprise Resource Planning (ERP) implementations fail despite the significant opportunity for process management improvement in key business areas including human resources, payroll, supply chain management, and finance.  We gathered critical feedback from experts who have lived through hundreds of implementations across a broad spectrum of industries. Their advice was insightful!

Our discussion focused on three distinct areas where leaders should focus in order to avoid some of the common missteps of large complex implementations. That is, leaders must clearly define their strategic approach to these key business functions beyond the selection of ERP tools. This work spans the system selection and implementation phases of an ERP project. Engaging the appropriate internal experts early in the process ensures effective governance, reality in the “current state” and data accuracy.  This effort is required for the entire life cycle of an ERP.  Finally, leaders need to consider the resources, time and leadership required to continue successful adoption after implementation; this is often left until after implementation and creates significant financial surprises and resource constraints.

Clearly Defined Strategy:

  • Leadership and Communication: Most ERP systems have an impressive array of functions and options to make processes more efficient and effective. How those systems are used in your organization must be defined, communicated, and governed throughout the entire process.  The leadership team is ultimately responsible for this effort, but must consider how to best communicate and engage the entire organization to achieve the goals.  The change management effort is quite extensive and is a key predictor of success!
  • Functionality: The functionality you need should be driven based on your business needs. While this seems obvious, many organizations buy a suite of products that includes more advanced functionality than they need, functionality they can’t take advantage of because of other system constraints, or functionality that requires data from other systems they don’t have. Set the parameters for demos and consider defining the scenarios to get an accurate picture of system capabilities for your specific needs.
  • Interfaces: ERP systems can interface with many different systems ranging from clinical systems to warehouse applications. This is a great opportunity to ensure better overall integration of business processes, but don’t underestimate the work required. Ask about the cost of interfaces, maintenance required, potential impact from upgrades, and any limitations of your current systems and data specifications for accurate and efficient electronic transmission. Also, be sure to ask about any third party vendor software required during discussions involving interfaces.

Engagement of Experts:

  • Knowledge Experts: Most organizations don’t engage their internal experts early enough in the project. Involving your subject matter experts during system selection can be tricky, but it pays big dividends in the end. These experts know the current systems or manual processes, but they also know the workarounds and issues that need to be addressed. Ensure that these people are also involved in defining data tables and other “area specific” customization.
  • Document Current State: This is cumbersome work, but organizations that take the time to define their current workflows gain more efficiency and cost savings from their new ERP systems. When this step is skipped, implementations stressors (time and resources) force the new system to mimic old system processes or manual processes that degrade the overall value of the new system.
  • Competencies and Development: Your new ERP system will probably stretch your team’s competencies, and will often require additional team training. This is a great opportunity to offer growth opportunities in your organization.  It may also require hiring for specific skill sets.
  • Priorities: The toughest question a leader faces when implementing a new system is “What are we going to stop doing to ensure the success of this effort?” Give your team time to focus on and perform high quality work.

Long-Term Commitment

  • Resource commitments: Any large system capable of making dramatic improvements in efficiency and accuracy of business processes will always require an investment of time and resources after implementation. Organizations almost always underestimate the long-term investment associated with maintenance, upgrades, training, and optimization. However, organizations that commit even a few hours per week in a disciplined manner find it easy to maintain and even improve on the value they expect from their ERP.
  • Beyond implementation – achieving adoption: The difference between simply installing a system and achieving business value lies in the long-term commitment by an organization’s leaders to optimize the use of the system.

ERP tools offer a significant opportunity to better manage critical business functions, but adoption of those systems requires:

  1. A clearly defined strategy for the key ERP business functions you plan to implement;
  2. Engagement of your internal experts early and often; and
  3. Commitment of resources and funds to realize the value of your investment.

About the Authors: 

  • Sallie Parkhurst is Senior Project Manager and an expert in Finance for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Carol Mortimer is Senior Consultant and an expert in Supply Chain Management for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Michelle Sanders is Senior Project Manager and an expert in HR and Payroll for ERP implementations for Digital Health Solutions Consulting, Atos.
  • Heather Haugen is the Chief Science Officer for Atos Digital Health Solutions.
  • Inbal Vuletich serves as the editor for Atos Digital Health Solution publications.

What Clients Value about Atos’ ERP Solutions and Services:

  • Expertise across all ERP business functions
  • Depth of knowledge of the ERP systems and how they function in various environments
  • The combination of industry expertise and system expertise
  • Ability to solve problems and understand clients’ challenges
  • How our team cares about their problems and challenges like they are our own

About Atos Digital Health Solutions
Atos Digital Health Solutions helps healthcare organizations clarify business objectives while pursuing safer, more effective healthcare that manages costs and engagement across the care continuum. Our leadership team, consultants, and certified project and program managers bring years of practical and operational hospital experience to each engagement. Together, we’ll work closely with you to deliver meaningful outcomes that support your organization’s goals. Our team works shoulder-to-shoulder with your staff, sharing what we know openly. The knowledge transfer throughout the process improves skills and expertise among your team as well as ours. We support a full spectrum of products and services across the healthcare enterprise including Population Health, Value-Based Care, Security and Enterprise Business Strategy Advisory Services, Revenue Cycle Expertise, Adoption and Simulation Programs, ERP and Workforce Management, Go-Live Solutions, EHR Application Expertise, as well as Legacy and Technical Expertise. Atos is a proud sponsor of Healthcare Scene.

HCCs: An Operational Perspective – HIM Scene

Posted on August 8, 2018 I Written By

The following is a guest blog post by Cathy Brownfield, MSHI, RHIA, CCS, Chief Operating Officer, TrustHCS.

Hierarchical Condition Categories (HCCs) were mandated by the Centers for Medicare and Medicaid Services (CMS) in 1997. In 2003 HCCs were selected as a risk adjustment model to be used to determine reimbursement for Medicare Advantage Plans.  They describe chronic condition diagnoses for patients and are determined from other codes assigned during physician encounters—including ICD-10 codes, CPT codes and medication codes.

The HCC framework is progressively being applied to numerous healthcare reimbursement reform initiatives. As the shift from volume to value advances, so does the importance of accurate HCC coding. This month’s blog explains the correlation between HCC coding and value- based reimbursement.

Two HCC models prevail

There are two HCC models in use by the federal government: CMS-HCC and HHS-HCC. Both models employ a risk adjustment score to predict future healthcare costs for plan enrollees. They operate within a hierarchical structure in which the more complex diagnoses absorb and incorporate less complex, chronic conditions.

The CMS-HCC model addresses a predominantly elderly population (65 years and over) and includes more than 9,000 ICD-10 codes that map to 79 HCC codes; these numbers do change and will increase slightly in FY 2019.

The Department of Health and Human Services (HSS) maintains the HHS-HCC model, which addresses commercial payer populations and covers all ages. This system incorporates CPT and medication codes and is currently comprised of 128 HCC codes.

Relationship to risk adjusted payment programs

The following are some of the risk adjusted payment programs currently using HCCs to determine reimbursement:

  • MA – Medicare Advantage Plan
  • MSSP – Medicare Shared Savings Program (ACO)
  • CPC+ – Comprehensive Primary Care Plus (Medical Home Model)
  • Commercial – Mainly the ACA

Each of the models primarily use ICD-10 codes taken from claims data to identify individuals with serious or chronic illnesses and assign a risk factor score to each enrollee based upon a combination of the individual’s health conditions and demographic details. Each HCC has a risk factor, an individual can have multiple HCC’s and those factors add up to their overall risk adjustment factor.

According to the CMS website, “risk adjustment allows CMS to pay plans for the risk of the beneficiaries they enroll, instead of an average amount for Medicare beneficiaries. By risk adjusting plan payments, CMS is able to make appropriate and accurate payments for enrollees with differences in expected costs. Risk adjustment is used to adjust bidding and payment based on the health status and demographic characteristics of an enrollee. Risk scores measure individual beneficiaries’ relative risk and risk scores are used to adjust payments for each beneficiary’s expected expenditures. By risk adjusting plan bids, CMS is able to use standardized bids as base payments to plans.”

How to operationalize accurate HCC coding

The risk-adjustment data for these programs is based on active diagnoses. In order to ensure the information is accurate, providers must conduct face-to-face encounters with their patients and all pertinent diagnoses must be documented in the medical record on an annual basis. Accurate documentation and coding is paramount to proper reimbursement under risk adjusted programs that use HCCs.  Beyond accurate HCC coding, it is important for HIM professionals to be aware of CMS reporting and data collection methodologies when operationalizing HCCs.

Reporting considerations to know

In 2012, CMS began transitioning the Medicare Advantage Organizations (MAOs) data collection method from its original format to an Encounter Data Payment System (EDS). The data collected under the EDS is unfiltered and more detailed than EDS’s predecessor, Risk Adjustment Payment System (RAPS). While CMS has gone back and forth on which algorithm to use, a blend of 85 percent RAPS and 15 percent EDS scores is currently in place for 2018.

Data is submitted directly to CMS where filtering logic is applied to extract the valid diagnosis codes from the data. The codes are then used in the risk score calculation process. With this process, MAOs must verify the completeness and accuracy of the data submitted to CMS to ensure that all appropriate diagnosis codes have been accepted for risk adjustment by CMS.

The RAPS/EDS blend will return to a 75/25 split in 2019. Additionally, CMS is proposing to calculate the EDS risk scores amended with RAPS inpatient diagnoses. Other 2019 changes are listed below.

2019 CMS-HCC Model Changes

  • Behavioral Health Conditions
    • HCC 55 Drug/Alcohol Dependence: Add opioid (and other substances) overdose ICD-10 diagnosis codes to HCC 55
    • Add HCC 56 Drug Abuse, Uncomplicated, Excluding Cannabis, includes opioid dependence diagnoses (among other narcotics)
  • Mental Health and Substance Abuse Disorders
    • Add HCC 59 Reactive and Unspecified Psychosis
    • Add HCC 60 Personality Disorders
  • Add HCC 138, Chronic Kidney Disease Stage 3 (Moderate Only)

Role of HIM and where to learn more about HCCs

In the new frontier of value-based payment, HIM is the purveyor of accurate coding and HCC assignment for organizations and providers. Savvy HIM leaders ensure they have the most up-to-date information by monitoring the following websites and information sources:

About Cathy Brownfield
Cathy Brownfield is the Chief Operating Officer of TrustHCS. She holds over 17 years of operations, auditing and coding experience. Prior to TrustHCS, Cathy served as the Operations Director for HealthPort’s Coding Operations division overseeing scheduling, billing, and quality assurance efforts.

Cathy holds her Master of Science in Health Informatics from Arkansas Tech University. She received her Bachelor of Science in Health Information Management from the same university. Cathy is a Registered Health Information Administrator and a Certified Coding Specialist. As a member of the American Health Information Management Association she volunteers on the Coding Community Council and also the PPE work group.

Hospitals That Share Patients Don’t Share Patient Data

Posted on August 7, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

If anyone in healthcare needs to catch up on your records, it’s another provider who is treating mutual patients. In this day and age, there’s no good reason why clinicians at one hospital should be guessing what the other would get (or not get as the case is far too often).

Over the last few years, we’ve certainly seen signs of data sharing progress. For example, in early August the marriage between health data sharing networks CommonWell and Carequality was consummated, with providers using Cerner and Greenway Health going live with their connections.

Still, health data exchange is far more difficult than it should be. Despite many years of trying, hospitals still don’t share data with each other routinely, even when they’re treating the same patient.

To learn more about this issue, researchers surveyed pairs of hospitals likely to share patients across the United States. The teams chose pairs which referred the largest volume of patients to each other in a given hospital referral region.

After reaching out to many facilities, the researchers ended up with 63 pairs of hospitals. Researchers then asked them how likely they were to share patient health information with nearby institutions with whom they share patients.

The results, which appeared in the Journal of the American Medical Informatics Association, suggest that while virtually all of the hospitals they studied could be classified as routinely sharing data by federal definitions, that didn’t tell the whole story.

For one thing, while 97% of respondents met the federal guidelines, only 63% shared data routinely with hospitals with the highest shared patient (HSP) volume.

In fact, 23% of respondents reported that information sharing with their HSP hospital was worse than with other hospitals, and 48% said there was no difference. Just 17% said they enjoyed better sharing of patient health data with their HSP volume hospital.

It’s not clear how to fix the problem highlighted in the JAMIA study. While HIEs have been lumbering along for well more than a decade, only a few regional players seem to have developed a trusted relationship with the providers in their area.

The techniques HIEs use to foster such loyalty, which include high-touch methods such as personal check-ins with end users, don’t seem to work as well for some HIE they do for others. Not only that, HIE funding models still vary, which can have a meaningful impact on how successful they’ll be overall.

Regardless, it would be churlish to gloss over the fact that almost two-thirds of hospitals are getting the right data to their peers. I don’t know about you, but this seems like a hopeful development.

Hospitals Struggle To Get Users On Board With Mobile Policies

Posted on August 6, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or

A new survey has found that hospitals are having a hard time managing and tracking user compliance with mobile communications policies.

The survey, which was conducted in early 2018 by communications vendor Spok, collected information on mobile device communications strategies from approximately 300 healthcare professionals. Forty-four percent of respondents were clinicians, 10% were IT and telecom staff, 6% were executive leaders, and another 40% had a wide variety of healthcare roles.

Spok found that hospitals who do have a mobile strategy in place have had one for a long time, with 42% having had such a strategy for either 3 to 5 years or more than five years. Another 46% have had a formal mobile strategy for one to three years. Only 12% have had a strategy in place for one year or less.

Reasons they cited for creating mobile device strategies included the launch of a communication initiative (46%); a clinical initiative (25%); or a technology initiative (24%). Five percent of responses were “other.” Top areas of focus for these strategies included mobile management and security (56%), mobile device selection (52%) and integration with the EHR (48%).

Other reasons for mobile initiatives included clinical workflow evaluation (43%), device ownership strategy/BYOD (34%), mobile apps strategy (29%), mobile app catalog (16%), mobile strategy governance (14%) and business intelligence and reporting strategy (12%).

However, there’s little agreement as to which hospital department should monitor compliance. Forty-three percent of respondents said the security team was monitoring policies for the hospital or system, 43% rely on a telecommunications team, 43% said a clinical informatics team played that role, and 26% had monitoring done by a mobile team. Twenty-one percent said individual departments enforce mobile policies and 9% said they don’t have an enforcement method in place. Another 9% of responses fell into the “other” category.

Given the degree to which monitoring varies between institutions, it’s little wonder to learn that policies aren’t enforced effectively in many cases. On the one hand, 39% respondents said the policies were enforced extremely well most of the time, and one-third said they were enforced well most the time. However, 4% said the policies were being enforced poorly and inconsistently, and 44% said they are not sure about how well the policies are being enforced.

Hospitals are aware of this problem, though, and many are taking steps to ensure that users understand and comply with mobile policies. According to the survey, 48% offer educational programs on the subject, 42% use technology or data gathered from devices to measure and track compliance, 37% leverage direct feedback from users and 23% use surveys.

Still, 21% said they don’t have a way to validate compliance — which suggests that hospitals have a lot more work to do.