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Hospital Mobile Strategy Still In Flux

Posted on January 8, 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 www.ziegerhealthcare.com.

The following is a look at how hospitals’ use of communication devices has changed since 2011, and what the patterns are now.  You might be surprised to read some of these data points since in some cases they defy conventional wisdom.

The researchers behind the study, communications tech provider Spok, Inc. surveyed about 300 healthcare professionals this year, and have tracked such issues since 2011. The report captures data on the major transitions in hospital mobile communications that have taken place since then.

For example, the report noted that in 2011, 84% of staffers received job-related alerts on pagers. Sixty-two percent are using wireless in-house phones, 61% desk phones, 77% email on their computers, 44% cell phones and 5% other devices.

Since then, mobile device usage in hospitals has changed significantly. For example, 77% of respondents said that their hospital supports smartphone use. The popularity of some devices has come and gone over time, including tablets and Wi-Fi phones (which are nonetheless used by 63% of facilities).

Perhaps the reason this popularity has risen and fallen is that hospitals are still finding it tricky to support mobile devices. The issues include supporting needed infrastructure for Wi-Fi coverage (45%), managing cellular coverage infrastructure (30%), maintaining data security (31%) and offering IT support for users (about 30%). Only 11% of respondents said they were not facing any of these concerns at present.

When the researchers asked the survey panel which channels were best for sharing clinical information in a hospital, not all cited contemporary mobile devices. Yes, smartphones did get the highest reliability rating, at 3.66 out of five points, but pagers, including encrypted pagers, were in second place with a rating of 3.20. Overhead announcements came in third at 2.91 and EHR apps at 2.39.

The data on hospitals and BYOD policies seemed counterintuitive as well. According to Spok, 88% of facilities supported some form of BYOD in 2014, or in other words, roughly 9 out of 10.  That percentage has fallen drastically, however, BYOD support hitting 59% this year.

Not surprisingly, clinicians are getting the most leeway when it comes to using their own devices on campus. In 2017, 90% of respondents said they allowed their clinicians to bring their own devices with them. Another 69% supported BYOD for administrators, 57% for nurses and 56% for IT staffers. Clearly, hospital leaders aren’t thrilled about supporting mobility unless it keeps clinical staff aligned with the facility.

To control this cacophony of devices, 30% said they were using enterprise mobility management solutions, 40% said they were evaluating such solutions and 30% said they had no plans to do so. Apparently, despite some changes in the devices being used, hospitals still aren’t sure who should have mobile tools, how to support them and what infrastructure they need to keep those devices lit up and useful.

Hospitals Puts Off Patient Billing For Several Months During EMR Rollout

Posted on January 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 www.ziegerhealthcare.com.

Here’s something you don’t see every day. A New Hampshire hospital apparently delayed mailing out roughly 10,000 patient bills going back as far as 11 months ago while it rolled out its new EMR.

According to a report in the Foster’s Daily Democrat,  members of Frisbie Memorial Hospital’s medical staff recently went public with concerns about the hospital’s financial state. Then a flood of delayed patient bills followed, some requesting thousands of dollars, the paper reported.

Hospital officials, for their part, said the delay was planned. Hospital president John Marzinzik said Frisbie needed time to implement its new Meditech EMR and didn’t want to send out incorrect bills during the rollout.

In fact, Marzinzik told Foster’s, under the previous system, records generated during doctor visits weren’t compatible with forms for hospital billing.

Rather than relying further on this patchwork of incompatible systems, Marzinzik and his staff decided to wait until the process was “absolutely clean” for patients. The hospital decided to have a staff member validate every balance shown on a statement before sending them out, he says.

Previously, in December of last year, anonymous Frisbie medical staff members sent Foster’s a letter to share concerns about the hospital and its administrators. The criticisms included skepticism about the over-budget implementation of the $13.5 million Meditech system, which they named as one of the reasons they lack confidence in the hospital administration. The staff members said that this cost overrun, as well as other problems, have undermined the hospital’s financial position.

As is always the case in such situations, hospital leaders took the stage to deny these allegations. Frisbie Senior VP Joe Shields told the paper that the hospital is in sound financial condition, and also said that the only reason why the Meditech project went over budget by $1.5 million was that the administrators delayed the implementation by seven weeks to give the staff holiday time off.

Hmmm. I don’t know about you, but to me, some parts of this story look a little bit bogus. For example:

* I appreciate accurate hospital bills as much as anybody, but the staff was going to check them manually anyway, why did it take 10 or 11 months for them to do so?

* The holidays take place at the same time every year.  Did administrators actually forget they were coming to an event that necessitated an almost 10% cost overrun?

Of course, only a small number of people know the answers to these questions, and I’m certainly not one of them. But the whole picture is a little bit odd.

Merged Health Systems Face Major EHR Integration Issues

Posted on January 2, 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 www.ziegerhealthcare.com.

Pity the IT departments of Advocate Health Care and Aurora Health Care. When the two health systems complete their merger, IT leaders face a lengthy integration process cutting across systems from three different EHR vendors or a forklift upgrade of at least one.

It’s tough enough to integrate different instances of systems from the same vendor, which, despite the common origin are often configured in significantly different ways. In this case, the task is exponentially more difficult. According to Fierce Healthcare, when the two organizations come together, they’ll have to integrate Aurora’s Epic EHR with the Cerner and Allscripts systems used by Advocate.

As part of his research, the reporter asked an Aurora spokesperson whether health systems attempt to pull together three platforms into a single EHR. Of course, as we know, that is unlikely to ever happen. While full interoperability is obviously an elusive thing, getting some decent data flow between two affiliated organizations is probably far more realistic.

Instead, depending on what happens, the new CIO might or might not decide to migrate all three EHRs onto one from a single vendor. While this could turn out to be a hellish job, it certainly is the ideal situation if you can afford to get there. However, that doesn’t mean it’s always the best option. Especially as health system mergers and acquisitions get bigger and bigger.

To me, however, the big question around all of this is how much the two organizations would spend to bring the same platforms to everyone. As we know, acquiring and rolling out Epic for even one health system is fiendishly expensive, to the point where some have been forced to report losses or have had ratings on the bond reduced.

My guess is that the leaders of the two organizations are counting often-cited merger benefits such as organizational synergies, improved efficiency and staff attrition to meet the cost of health IT investments like these. If this academic studies prove this will work, please feel free to slap me with a dead fish, but as for now I doubt it will happen.

No, to me this offers an object lesson in how mergers in the health IT-centered world can be more costly, take longer to achieve, and possibly have a negative impact on patient care if things aren’t done right (which often seems to be the case).

Given the other pressures health systems face, I doubt these new expenses will hold them back from striking merger deals. Generally speaking, most health systems face little choice but to partner and merge as they can. But there’s no point minimizing how much complexity and expense EHRs bring to such agreements today.

Hospitals Excited By Telehealth, Consumers Not So Much

Posted on December 29, 2017 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 www.ziegerhealthcare.com.

When telehealth first emerged as a major commercial phenomenon, consumers were the main market targeted by providers, especially direct-to-consumer models like Teladoc and American Well. But if a new research report is right, the dynamics of the telehealth market have changed substantially, with hospitals and health systems investing heavily in telehealth and consumers hanging back.

The study, which was conducted by telehealth solutions provider Avizia, found that while hospitals and health systems are making increasingly large bets on telehealth, including infrastructure, training and process re-engineering, patients aren’t matching their enthusiasm.

Consumers who do access telehealth seem happy by what they find. When Avizia asked them to rate their telehealth experiences on a scale from 1 to 10, with 10 rating it as a “great experience,” nearly two-thirds ranked their experiences between 8 and 10. Also, consumers who were using telehealth said that they like the time savings and convenience it could offer (59%), cost savings due to a lack of travel expenses and lower wait times to see clinicians (55%).

That being said, many consumers haven’t gotten on board yet. In fact, roughly eight out of 10 consumers told Avizia that they weren’t well versed in accessing telehealth, nor did they know whether their insurer would pay for it.

Providers, for their part, have ambitious plans for telehealth use. According to the study, the top one was the ability to reach or expand access to patients (72% of respondents). However, they face several obstacles, the study notes, including problems with getting reimbursed by health plans (41%), program expenses (40%) and resistance from clinicians (22%).

The Avizia results suggest that hospitals are still wrestling with many of the problems they’ve faced over the past few years in implementing telemedicine.

For example, a study by KPMG released in mid-2016 noted that about 25% of the 120 providers it studied had implemented telehealth and telemedicine programs which have achieved financial stability and improved efficiency. Thirty-five percent of KPMG respondents said that they didn’t have a virtual care program in place, though 40% had said they had just implemented a program.

Another study, released earlier this year by Reach Health, notes that 50% of hospitals and health systems are beginning to shift department-based telehealth programs to enterprise-based programs, which suggests that they no longer see virtual care as an experimental technology. They still aren’t rolling out these larger programs yet.

Still, the fact that hospitals are continuing to push ahead with telemedicine, and even make meaningful investments, makes it clear that they’re not going to be put off by current telemedicine obstacles. When the reimbursement tide floods the gates, I’m betting that hospital telemedicine programs will go from “not unusual” to “omnipresent.”

Pennsylvania Health Orgs Agree to Joint $1 Billion Network Dev Effort

Posted on December 27, 2017 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 www.ziegerhealthcare.com.

If the essence of deal-making is putting your money where your mouth is, a new agreement between Pennsylvania healthcare giants fit the description. They’ve certainly bitten off a mouthful.

Health organizations, Penn State Health and Highmark Health, have agreed to make a collective investment of more than $1 billion. That is a pretty big number to swallow, even for two large organizations, though it very well may take even more to develop the kind of network they have in mind.

The two are building out what they describe as a “community-based healthcare network,” which they’re designing to foster collaboration with community doctors and keep care local across its service areas.  Makes sense, though the initial press release doesn’t do much to explain how the two are going to make that happen.

The agreement between Penn State and Highmark includes efforts to support population health, the next step in accepting value-based payment. The investors’ plans include the development of population health management capabilities and the use of analytics to manage chronic conditions. Again, pretty much to be expected these days, though their goals are more likely to actually be met given the money being thrown at the problem.

That being said, one possible aspect of interest to this deal is its inclusion of a regionally-focused academic medical center. Penn State plans to focus its plans around teaching hospital Milton S. Hershey Medical Center, a 548-bed hospital affiliated with more than 1,100 clinicians. In my experience, too few agreements take enough advantage of hospital skills in their zeal to spread their arms around large areas, so involving the Medical Center might offer extra benefits to the agreement.

Highmark Health, for its part, is an ACO which encompasses healthcare business serving almost 50 million consumers cutting across all 50 states.  Clearly, an ACO with national reach has every reason in the world to make this kind of investment.

I don’t know what the demographics of the Penn State market are, but one can assume a few things about them, given the the big bucks the pair are throwing at the deal:

  • That there’s a lot of well-insured consumers in the region, which will help pay for a return on the huge investment the players are making
  • That community doctors are substantially independent, but the two allies are hoping to buy a bunch of practices and solidify their network
  • That prospective participants in the network are lacking the IT tools they need to make value-based schemes work, which is why, in part, the two players need to spend so heavily

I know that ACOs and healthcare systems are already striking deals like this one. If you’re part of a health system hoping to survive the next generation of reimbursement, big budgets are necessary, as are new strategies better adapted to value-based reimbursement.

Still, this is a pretty large deal by just about any measure. If it works out, we might end up with new benchmarks for building better-distributed healthcare networks.

Catholic Healthcare West Drops Church Affiliation

Posted on January 23, 2012 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 www.ziegerhealthcare.com.

In a move I wouldn’t be surprised to see imitated, big religious hospital chain Catholic Healthcare West has broken its official ties with the Roman Catholic Church, though it will continue to include both Catholic and non-Catholic facilities in its flock.   The chain, which is changing its name to Dignity Health, currently includes 15 non-Catholic hospitals and 25 Catholic hospitals.

The system’s leaders have concluded that they couldn’t meet their ambitious growth targets if forced to adhere to faith-based care guidelines in all of its facilities.

According to CEO and president Lloyd Dean, who spoke to USA Today, he’s had to step away from potential deals several times when partners questioned their role in a Catholic system. This way, it should be much easier for CHW to work with other systems and acquire medical practices, observers say.

I expect to see other faith-based chains consider similar moves over the next year or two. As we’ve noted in this forum before, having to adhere to religiously-based rules can be a bit of a hassle for secular organizations, especially those that hope to compete in tight markets.  Mergers between the two sides can become a Tylenol headache very quickly.

Consider the struggles the University of Louisville (KY) went through in an effort to merge with Catholic-owned St. Mary’s Healthcare, forcing it propose build a “hospital in a hospital” to provide forbidden services. It makes my eyes water just to think about it. With health reform afoot, mergers a fact of life and new partnership models emerging every day, CHW may have done the only thing it could do.

A Snapshot: Is Free Care in Minnesota What It Appears?

Posted on January 16, 2012 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 www.ziegerhealthcare.com.

With any luck, we’ve finally left the worst of the financial crash behind, and with it the financial challenge posed by large numbers of medically indigent patients.  A recent report from Minnesota’s hospital trade group underscores how bad things were for patients. It also suggests that the hospitals may not quite be as charitable as they claim.

According to the report, the level of free or discounted care provided by the state’s hospitals shot up 27 percent in 2010, driven largely by falling state coverage and rising unemployment.  The Minnesota Hospital Association said that state hospitals provided $226 million in charity care last year, along with $498.5 million expenses generated by Medicaid patients receiving discounted care that wasn’t reimbursed.

OK, let’s break this down. We’ve got, very broadly, $750 million in direct charity care expenses among 135 hospitals.  While I don’t know exactly what they grossed in 2010, we can be pretty sure it exceeds that figure by at least three or four orders of magnitude.

Sure, several million in charity care per hospital is enough to erode the slim margin most hospitals cope with year to year.  On the other hand, we know it’s not a simple matter of money in, expenses paid for charity care.  The accounting gets more complicated than seven-way chess, and let’s admit it, some of the numbers are a bit dicey at best.

Now, I’m not suggesting any individual hospital is gaming the system worse than others. But I am suggesting that if this is the best they can come up with, they’d better get cracking. Neither the IRS or Congress has much patience for charity care numbers that don’t add up, and municipalities (at least in Illinois) are getting into the “yank the tax exemption” act too.

Bottom line, you better keep your nose clean and those charity care numbers better be above board. If you’re not already, it’s time to avoid accounting tricks and play it straight.

ACO Proves Major Political Turning Point For Boston Hospital Chain

Posted on January 2, 2012 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 www.ziegerhealthcare.com.

Transforming a hospital system into a fully-functioning ACO is a huge project, and one which requires a big commitment.  It’s hardly surprising that going through the process would change how its leaders think about their business.  But the following is the first case I’ve heard of in which a hospital system made a major break with its peers over its ACO status.

Apparently,  for-profit Steward Health Care System has just resigned from the Massachusetts Hospital Association, bringing its 10 hospitals (and 11 percent of the MHA’s revenues) with it.  Steward, which was created by the acquisition of six-hospital Caritas Christi Health Care Chain a year ago by VCs, has since picked up four hospitals and done a host of doctor deals.

Not surprisingly, Steward seems to have bruised some competitors’ feelings along the path to ACO-hood, which probably has something to do with its MHA departure, but Steward isn’t copping to that of course.

At this point in its evolution, Steward’s leaders say, the MHA’s positions on politics don’t represent its needs anymore. Particularly when it comes to health reform, Steward’s leaders feel it now has a different take than other members of the MHA, which has to advocate for shared positions across almost 100 hospitals with varied approaches.

As for me, I’m not sure what those differences are; in fact, I’d think that a “real” ACO would be an inspiration for, and partner to, other hospitals on the path to health reform.  In fact, this raises some questions as to how the growing ACO trend will affect hospital relationships this year:

* Are IDNs that work hard at building a true ACO going to upset their peers so much that it will create a drag on their business overall?

* Most healthcare business models have some detractors and some fans, but is this one of the few that can actually divide the industry?

*  Are ACOs a direction every IDN can take, or are there resource constraints (such as the size of a local market or number of unaffiliated doctors) that will prevent some from building one? Will the coming rush create ACO “haves” and “have nots”?

What do you think, folks?  Have you seen anything happening in your markets that might answer these questions?

Hospital Uses Disney Magic To Improve Patient Satisfaction

Posted on December 26, 2011 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 www.ziegerhealthcare.com.

Ideally, patients come away from their hospital stay not only healthier, but happier too. So how about taking a page from the Happiest Place On Earth?  Yes, I mean Disney Land.

Dissatisfied with its patient satisfaction scores, one Florida hospital has struck a partnership with Walt Disney Co. to pick up some of that Mouse Magic.  Since then, the hospital’s scores have shot up — and patient volumes, too.

Back in 2009, satisfaction was at rock bottom at 200-bed Florida Hospital for Children. To change its luck, the 200-bed hospital decided to make sure of a pioneering program run by Disney, laying out about $200,000 in consulting fees to bring the entertainment company in.

Not only did Disney help the hospital improve its presentation, it also got tips on improving staff morale and treating patients as customers. (The “staff morale” thing is a bit amusing, since, as all former Florida residents know, Disney’s own employee policies have earned it the title “the Rat.” But I digress.)

These days, when little patients and their parents enter the Walt Disney Pavilion, they’re greeted by a “park ranger” who offers directions, a Disney-theme play area and a ukelele-playing greeter in character costume, according to USA Today.

Behind scenes, some staffers have been tagged as Disney-style “cast members,” and work areas have been renamed “back stage” and “front stage” areas.

While some of this may sound a little silly, it’s generated big results.  Florida Hospital’s patient satisfaction scores have climbed to the 80th percentile of all children’s hospitals nationally. Even better, patient volumes are up by nearly half, administrators told the paper. You can’t beat that with a stick.

Though I’m sure kids are more focused on the fun, park-like attractions, my hunch would be that the back-office changes were as important to Florida Hospital’s transformation as the cosmetic fixes. After all, when it comes right down to it, the parents who pay for care are more worried about things like working with staffers who are upbeat and happy with their jobs.  Still, it’s an intriguing approach overall.

 

 

To Avoid Readmissions, Hospitals Trying Post-Discharge Clinics

Posted on December 12, 2011 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 www.ziegerhealthcare.com.

In recent years, hospitals have been under increasing pressure to keep their readmission rates low. The next bump in the road comes in October 2012, when Medicare will begin cutting back on reimbursement for facilities whose readmit rates are too high.

Hospitals are already hard at work at preventing readmissions due to preventable medical errors, which may not be reimbursed at all by Medicare at all. But it seems like they’re still far behind in the care coordination department.

In fact, research suggests that they’re facing an uphill battle, in part because patients often don’t get the kind of follow-up care they need.

In theory, fragile patients  should move smoothly from inpatient care to their PCP, ideally a medical home equipped to coordinate whatever follow-up care needs they have. Few primary care practices are up to speed yet, however.  In fact, some aren’t even sure when their patients are discharged.

How bad is the problem? According to one study quoted in The Hospitalist, only 42 percent of hospitalized Medicare patients had any contact with a primary care physician within 14 days of being discharged.

One solution to this problem might be a “post-discharge” or transitional care clinic offering primary care on or near a hospital’s campus, the article notes. This makes sense. After all, it’s more likely a patient will follow through and get follow-up care if it’s convenient to do so.

The idea behind these clinics isn’t to replace the patient’s existing PCP; instead, the clinic’s hospitalists, advance-practice nurses or PCPs are there to make sure patients absorbed their post-discharge instructions and are compliant with the meds prescribed during their stay.

Some hospitals have invested significant resources in building out transitional clinics, including Beth Israel Deaconess Medical Center, Seattle-based Harborview Medical Center and Tallahassee (Fla.) Memorial Hospital, which partnered with a local health plan to kick off the effort.

That being said, the idea is a new one and few other hospitals have taken the plunge as of yet. It will be interesting to see whether this approach actually works, and particularly, whether one model of transitional care stands out.

P.S.  I’d particularly like to know whether hospitals can accomplish some of these objectives by monitoring patients remotely after they’re discharged. After attending last week’s mHealth show, I’m betting remote monitoring would be cheaper than setting up a new clinic. Can’t wait to see whether hospitals try that route!