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Insights, Intelligence and Inspiration found at #AHIMACon18 – HIM Scene

Posted on October 15, 2018 I Written By

The following is a guest blog post by Beth Friedman, BSHA, RHIT.

Last month’s HIM Scene predicted important HIM insights would be gained at the 90th AHIMA Annual Convention. And this prediction certainly came true! Thousands of HIM professionals discussed changes to E&M coding, physician documentation and information security during the organization’s Miami event. HIM’s expanding role in healthcare analytics was also recognized. Half of AHIMA’s “hot topics” presentations covered data collection, analytics, sharing, structure and governance.

For example, HIM’s role in IT project management was the focus of an information-packed session led by Angela Rose, MHA, RHIA, CHPS, FAHIMA, Vice President, Implementation Services at MRO. She emphasized how enterprise-wide IT projects benefit from HIM’s knowledge of the patient’s health record, encounter data, how information is processed and where information flows. In today’s rapid IT environment, there is a myriad of new opportunities for HIM—the annual AHIMA convention casts light on them all.

Amid all the futurecasting, AHIMA attendees also received valuable insights and fundamental best-practice advice for the profession’s stalwart tasks: enterprise master person index (EMPI), clinical coding and release of information (ROI). Here are few of the highlights.

Merger Mania Brings Duplicate Data Challenges

Every healthcare merger includes strategic discussions, planning and investments focused on health IT. System consolidation can’t be avoided—and it shouldn’t be. Economies of scale are a fundamental element of merger success. However, merging multiple systems into one means merging multiple master person indexes (MPIs).

Letha Stewart, MA, RHIA, Director of Customer Relations, QuadraMed states, “It’s not uncommon to see duplicate medical record rates jump from an industry average of 8-12 percent to over 50 percent during IT system mergers due to the high volume of overlapping records that result when trying to merge records from multiple systems or domains”. As entities come together, a single, clean EMPI is fundamental for patient care, safety, billing and revenue. This is where HIM skills and know-how are essential.

Instead of leaving HIM to perform the onerous task of duplicate data cleanup after a merger and IT system consolidation, Stewart suggests a more proactive approach. Here are four quick takeaways from our meeting:

  • Identify duplicate data issues during the planning process before new systems are implemented or merged.
  • Use a probabilistic duplicate detection algorithm to find a higher number of valid duplicates and lower number of false positives.
  • Clean up each system’s MPI before IT system consolidation occurs and as implementations proceed. Be sure to allocate sufficient time for this process prior to the conversion.
  • Maintain ongoing duplicate data detection against the new enterprise patient population to prevent future issues.

Maintaining a clean MPI has always been a core HIM function—even back to the days of patient index cards and rotating metal bins. Technology in combination with merger mania has certainly upped the ante and elevated HIM’s role.

Release of Information Panel Raises Red Flags for Bad Attorney Behavior

Another traditional HIM function with nascent issues is ROI. A standing-room-only panel session raised eyebrows and concern for AHIMA attendees regarding a pervasive issue for most HIM departments: patient-directed requests.

Rita Bowen, MA, RHIA, CHPS, CHPC, SSGB, VP Privacy, Compliance and HIM Privacy, MRO, moderated the panel that included other ROI and disclosure management experts. Bowen, a healthcare privacy savant, asked how many attendees receive patient-directed requests that are actually initiated by an attorney’s office. Dozens of hands went up and the discourse began. Here’s the issue.

To avoid paying providers’ fees for record retrieval and copies, attorneys are requesting medical records for legal matters under the guise of a patient-directed request. During the session, four recommended strategies emerged:

  • Inform your state legislators of this bad attorney behavior
  • Discuss the issue with HIM peers in your area
  • Hold meetings with your OCR representative to determine the best course of action
  • Question and verify suspicious patient-directed requests to clarify and confirm the consent

Finally, no AHIMA convention would be complete without significant attention to clinical coding!

Coding Accuracy Takes Center Stage

One of the AHIMA convention’s annual traditions includes announcement of Central Learning’s annual national coding contest results. Eileen Tkacik, Vice President, Information Technology at Pena4, sponsor of the 3rd annual nationwide coding contest to measure coding accuracy, reported that inpatient coding accuracy fell slightly in 2018 compared with the 2017 results. “Average accuracy scores for inpatient ICD-10 coding hovered at 57.5 percent while outpatient coding accuracy experienced a slight bump from 41 percent in 2017 to 42.5 percent in 2018,” according to Tkacik.

While some were concerned about the results, others expected a decline as payers become more aggressive with coding denials and impose greater restrictions on coders’ ability to determine clinical justification. This is especially true for chronic conditions—another hot coding topic among AHIMA attendees.

Nena Scott, MSEd, RHIA, CCS, CCS-P, CCDS, Director of Coding Quality and Professional Development at TrustHCS, emphasized the need for accurate hierarchical condition category (HCC) code assignment for proper risk adjustment factor (RAF) scoring under value-based reimbursement. Everything physicians capture—and everything that can be coded—goes into the patient’s dashboard to impact the HCCs, which are now an important piece of the healthcare reimbursement puzzle.

Finally, Catrena Smith, CCS, CCS-P, CPCO, CPC, CIC, CPC-I, CRC, CHTS-PW, Coding Manager at KIWI-TEK, presented an informative session on the new coder’s roadmap to accuracy and compliance. She reiterated the need for compliance with coding guidelines and shared examples of whistleblower cases. In addition, Smith provided valuable pointers for newly employed clinical coders to consider:

  • Understand the important role that coders play in compliance
  • Know the fraud and abuse laws
  • Implement checks and balances to compare payer-driven code requirements to best-practice coding guidelines
  • Review the components of an effective compliance plan
  • Do not participate in fraudulent activities because coders and billers can be held civilly and/or criminally liable

Inspiration Found at the Beach and on the Dance Floor

Beyond the convention center, the educational sessions and the exhibit hall, I made time at this year’s AHIMA convention to enjoy the beach. Two power walks and a few meditation moments were the icing on my #AHIMACon18 cake this year. I intentionally found time to enjoy the warm sunshine and moonlit evening festivities including MRO’s signature event and AHIMA’s blanca party. Dressed in white, AHIMA attendees kicked up their heels to celebrate 90 years of convention fun—and think about AHIMA 2019 to be held September 14–19 in Chicago, Illinois. We’ll see you there!

About Beth Friedman
Beth Friedman is the founder and CEO of Agency Ten22, a healthcare IT marketing and public relations firm and proud sponsor of the Healthcare IT Marketing and PR Community. She started her career as a medical record coder and has been attending the AHIMA conference for over 20 years. Beth can be reached at beth@ten22pr.com.

Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Informed Consent: Let Go of the Status Quo

Posted on October 1, 2018 I Written By

The following is a guest blog post by Shahid Shah.

We’ve all heard it before: “healthcare is slow to adopt new technologies.” In fact, we’ve heard it so many times that we just accept it as gospel and don’t give it much thought.

It’s not true though.

For example, I remember when the iPhone was first released, it was easily adopted by doctors because it gave them something they craved: increased freedom by having access to information on the go.

What’s probably true is that “healthcare institutions are slow to adopt new technologies that impact status quo.

Why is that?

Because the perceived cost of maintaining the status quo is smaller than the cost of the innovation (e.g. product or solution), even if that innovation is free.

When the cost of not doing something new is low, nothing will change: and bad leadership is often able to keep the cost of maintaining status quo very low. Poor leaders add hurdles, like requiring unknowable ROI analyses, for introducing innovation but don’t penalize maintenance of status quo. This means that it’s easier to not introduce anything new – because the cost of not innovating is low but the cost of innovating is high.

Let’s take a look at digital patient consent as an example of an innovation – obtaining patient consent to perform a healthcare service is something that no hospital can do without. Called “informed consent”, this is a document that patients are required to sign before any procedure or health service is delivered. You’d think that because this form is the initial and primary document before almost any other workflow is started, that it would be the first to be digitized and turned into an electronic document.

Unfortunately, it’s 2018 and informed consent documents remain on paper. Thus:

  • JAMA reports that two-thirds of procedures have missing consent forms
  • JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing hospitals over $500k per year
  • Joint Commission reports over 500 organizations annually experience compliance issues because of missing consent forms. There’s almost a 1 in 4 chance that your own organization has this compliance problem.
  • A recent JAMA Surgery paper estimated that two thirds of malpractice cases cited lack of informed consent, which increases liability risk
  • Superfluous paperwork directly contributes to clinician burnout
  • Patients often don’t understand their procedures or aren’t properly educated about the service they’re about to use

Today, many healthcare institutions go without automation of consent documents – which I’m calling the status quo. Even though this document is essential, and its non-digital status quo creates many financial, clinician, and compliance burdens, it’s not high in the list of priorities for digitization or automation.

As I enter my third decade as a health IT architect, after having built dozens of solutions in the space that are used by thousands of people, I still find it difficult to explain why even something as simple as an informed consent isn’t prioritized for automation.

It’s not because solutions aren’t out there – for example, FormFast’s eConsent is a universally applicable, easy to deploy, and easy to use software package with a fairly rapid return on investment. With eConsent software, clinicians aren’t interrupted in their workflows, patients are more satisfied, compliance becomes almost guaranteed, and procedures aren’t delayed because of lost paperwork.

A senior network engineer at East Alabama Medical Center recently wrote “the comparison of creating a form in the EHR vs. an eForms platform? There is no comparison. We are saving thousands of dollars by using eForms technology and the form creation is simple.”

Why do you think even something essential like patient consent forms remain on paper? Drop us a line below and let us know why the status quo is so powerful and what’s keeping your organization from adopting electronic forms solutions.

Note: FormFast is a proud sponsor of Healthcare Scene.

Montefiore Health Makes Big AI Play

Posted on September 24, 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.

I’ve been doing a lot of research on healthcare AI applications lately. Not surprisingly, while people find the abstract issues involved to be intriguing, most would prefer to hear news of real-life projects, so I’ve been on the lookout for good examples.

One interesting case study, which appeared recently in Health IT Analytics, comes from Montefiore Health System, which has been building up its AI capabilities. Over the past three years, it has created an AI framework leveraging a data lake, infrastructure upgrades and predictive analytics algorithms. The AI is focused on addressing expensive, dangerous health issues, HIA reports.

“We have created a system that harvests every piece of data that we can possibly find, from our own EMRs and devices to patient-generated data to socio-economic data from the community,” said Parsa Mirhaji, MD, PhD, director of the Center for Health Data Innovations at Montefiore and the Albert Einstein College of Medicine, who spoke with the publication.

Back in 2015, Mirhaji kicked off a project bringing semantic data lake technology to his organization. The first pilot using the technology was designed to find patients at risk of death or intubation within 48 hours. Now, clinicians can also see red flags for admitted patients with increased risk of mortality 3 to 5 days in advance.

In 2017, the health system also rolled out advanced sepsis detection tools and a respiratory failure detection algorithm called APPROVE, which identifies patients at a raised risk of prolonged ventilation up to 48 hours before onset, HIA reported.

The net result of these efforts was dubbed PALM, the Patient-centered Analytical  Learning Machine. PALM “represents a very new way of interacting with data in healthcare,” Miraji told HIA.

What makes PALM special is that it speeds up the process of collecting, curating, cleaning and accessing metadata which must be conducted before the data can be used to train AI models. In most cases, the process of collecting data for AI use is largely manual, but PALM automates this process, Miraji told the publication.

This is because the data lake and its graph repositories can find relationships between individual data elements on an on-the-fly basis. This automation lets Montefiore cut way down on labor needed to get these results. Miraji noted that ordinarily, it would take a team of data analysts, database administrators and designers to achieve this result.

PALM also benefits from a souped-up hardware architecture, which Montefiore created with help from Intel and other technology partners. The improved architecture includes the capacity for more system memory and processing power.

The final step in optimizing the PALM system was to integrate it into the health system’s clinical workflow. This seems to have been the hardest step. “I will say right away that I don’t think we have completely solved the problem of integrating analytics seamlessly into the workflow,” Miraji admitted to HIA.

Looking Forward to #AHIMACon18 – HIM Scene

Posted on September 19, 2018 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.

This weekend is the start of the AHIMA Annual Convention happening in Miami, Florida. For those not familiar with the AHIMA organization, it brings together HIM professionals from across the country. Something that I think makes AHIMA unique is that around the HIM conference are multiple days of training and certifications for HIM professionals. I’m always amazed at how much work HIM professionals have to put in to keep up with their certifications and to stay up with things like the ever-changing world of medical coding. HIM definitely doesn’t get the credit they deserve in this regard.

As I think what topics will be hot at this year’s AHIMA Annual convention, I’m most interested to hear what the HIM crowd thinks about the changes to the Physician Fee Schedule and E&M Coding. This is going to be a big deal for healthcare and medical coders are going to be the ones charged with dealing with the changes. Sure, doctors will have to change how they are documenting as well, but verifying that it was documented correctly and making sure the medical coding matches that documentation is mostly done by HIM professionals.

I’m really interested to hear what HIM professionals think about these medical coding changes. What do you think of the new time based coding options? Does this make life easier or not? Let us know what you think and what you’re hearing in the comments. The obvious part to me is that in the short term it’s not going to make medical coders’ lives easier at all. It’s just one more code they’re going to have to deal with and it doesn’t have a history of practices to support what’s acceptable or not. It’s not like these new codes are doing away with the old codes. At least I don’t think that’s how most practices are going to handle these new codes, but we’ll see. Let us know your thoughts in the comments.

Another big change that could impact HIM professionals, particularly medical coders, are the new remote monitoring and digital care coordination codes. I’ve heard a lot of people saying that these codes show some promise. However, I’m starting to hear overtures that the codes aren’t going to live up to their billing (excuse the pun). What are you seeing when it comes to the new coding for telemedicine, remote monitoring, and digital care coordination?

Outside of these two big topics, I’ll be interested to hear how HIM professionals are looking at security and privacy. It’s become a huge topic in the CIO and healthcare IT world. I wonder how much it will impact the HIM world. There’s always an interesting dance when a breach happens. The HIM world is great at understanding disclosures and HIPAA violations, but breaches often bring out a lot of different people. The reality is that when a breach occurs it needs to be all hands on deck. However, my guess is that many HIM professionals aren’t part of the discussion when a breach occurs. How’s your experience been in this regard? If you haven’t had a breach (lucky you), you should still have some policies and some drills in place to make sure you’re ready. So, you should have an idea of what HIM’s role would be in a breach.

Another trend I’ve been watching for a number of years is the push for more and more HIM professionals to be involved in things like healthcare analytics. This was highlighted by a recently published article in the Journal of AHIMA that makes the argument that all healthcare professionals need to learn data analytics. I argued something similar in this article on how HIM professionals can use Information Governance to ensure they’re heard. These are important messages that I think many in HIM are largely ignoring. It will be interesting to see how this shakes out. Those that embrace the changes will be well positioned for the future.

What other things should we be watching for from an HIM perspective? What’s keeping you up at night? What’s getting you most excited about your job? Let us know in the comments or on Twitter @HealthcareScene.

Looking to Improve Patient Experience? Simple Options Can Yield Big Results.

Posted on September 18, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

Improving patient experience is a top priority. Instead of grandiose new programs, hospitals and practices would see better results by focusing on simple options that have a big impact – like an eConsent solution. eConsent makes it easier for organizations to treat patients with respect and gets patients involved in their care.

Over the past several years more and more attention has been placed on improving the patient experience. This is partly due to a recognition by healthcare organizations that experiences could euphemistically be called less-than-ideal and partly because of changes to reimbursements that tie $$$ to patient satisfaction (specifically HCAHPS scores). From a patient and patient champion perspective this attention has been a welcome change.

There is a tendency, however, for healthcare organizations to gravitate towards large-scale projects to improve patient experience. Although projects like renovating patient suites and implementing AI chatbots can indeed have a positive impact, these initiatives are resource-intensive and can take a long time to yield results. Instead, hospitals and physician practices should focus on doing small things better and reap the benefits of improved patient experience sooner.

According to a study published by BMJ Open in 2016, positive patient experiences were “closely linked to effective patient-health professional interaction and logistics of the hospital processes”. The authors of the study also found that “positive aspects of the hospital experience were related to feeling well informed and consulted about their care”.

In 2014 a study found that delays in healthcare (wait times) impacted the perceived quality of care received. The longer the delay, the more that confidence in the care provider eroded. Having confidence in the care provider is a key factor in the online ratings patients give to healthcare organizations. Online ratings are the new real-time way to gauge patient satisfaction.

Taken in combination, these studies tie patient satisfaction/experience directly to (1) interactions between patients and their health professionals; and (2) smooth hospital processes.

Interactions with Patients

So what can hospitals do to improve interactions between health professionals and patients? They could implement new communication tools (like real-time chat). They could renovate offices so that patients and clinicians can look at screens together. They could even hire navigators to help patients interact with health professionals. All of these are fantastic initiatives, but all of them will take time and in some cases, a lot of resources.

There are, however, a number of simple things that hospitals could do that do not require significant investments of time or dollars. One would be to train clinicians to ask patients: “Is there anything we have covered today that I can help clarify or that you have questions about” rather than the standard “Do you have any questions?”. Another would be to implement electronic forms during the intake process so that patients only have to enter their information once. There is nothing more annoying than having each department ask for the same information over and over again.

Along these lines, an often overlooked yet quick-hit improvement area, is the informed consent process. The American Medical Association defines it as follows.

“The process of informed consent occurs when communication between a patient and physician results in the patient’s authorization or agreement to undergo a specific medical intervention. In seeking a patient’s informed consent (or the consent of the patient’s surrogate if the patient lacks decision-making capacity or declines to participate in making decisions), physicians should:

(a) Assess the patient’s ability to understand relevant medical information and the implications of treatment alternatives and to make an independent, voluntary decision.

(b) Present relevant information accurately and sensitively, in keeping with the patient’s preferences for receiving medical information. The physician should include information about:

  • The diagnosis (when known)
  • The nature and purpose of recommended interventions
  • The burdens, risks, and expected benefits of all options, including forgoing treatment

(c) Document the informed consent conversation and the patient’s (or surrogate’s) decision in the medical record in some manner. When the patient/surrogate has provided specific written consent, the consent form should be included in the record.”

The informed consent process is a golden opportunity for hospitals to improve the patient experience. It is a chance for health professionals to engage patients in their care. This engagement has numerous benefits including:

  1. Reducing the anxiety patients have about the upcoming procedure, which in turn helps improve patient outcomes. This study published in the British Journal of Surgery, shows patient who are less anxious have fewer post-procedure wound complications.
  2. Demonstrating that the health professional (and by extension the hospital) care about the patient as a person.
  3. Mitigating the risk of malpractice. Lack of communication and feeling like clinicians didn’t care about them are common reasons cited by patients who decide to sue for malpractice. This New York Times article has an excellent summary of various studies into this phenomenon.

A simple way to improve the informed consent process is to move away from paper-based consent forms, which can be lost and are often confusing to patients, to electronic consent forms (commonly referred to as eConsent).

According to Robin McKee, Director of Clinical Solutions at FormFast, which offers an eConsent solution, “It’s the right time to be having the conversation about the costly risks associated with a paper-based process. Over 500 organizations recently experienced compliance issues due to missing informed consent forms according to the Joint Commission). Adopting an electronic solution is an easy and quick way to offer a better patient experience during the consent process.”

With an eConsent solution like FormFast’s, hospitals would be able to:

  • Have patients fill out forms on a user-friendly tablet
  • Pre-populate information on the forms with EHR data
  • Link to educational material that explains the procedure and risks in more detail
  • Quickly recall consent forms prior to the procedure by scanning the patient’s wristband
  • Provide a copy of the consent form (and links to the educational material) to patients

Smooth Hospital Processes

Feeling respected as an individual is key to a good patient experience. In fact, a 2015 Consumer Reports Survey found that patients who said they did not feel respected by the medical staff were 2.5 times as likely to experience a medical error versus those who felt they were treated well.  One of the easiest ways to show respect for patients is to value their time and prevent long delays during their hospital stay.

For patients, it is a horrible feeling to show up at the appointed time for a procedure, only to be carted to a waiting area in nothing but a flimsy robe and left to wait with no explanation. Now imagine how it would feel after 20 minutes of waiting to have a member of staff come and ask you to fill out another set of consent forms because your originals had been lost. Of course, while the patient is filling out the form, the staff member must review all the risks and implications of the procedure before you can sign the forms again. I know I would be about as calm as a palm tree in a hurricane.

This situation is referred to as “gurney consent” and is something that many hospitals are trying to eliminate. The National Center for Ethics in Health Care has a special guideline that prohibits gurney consent – VHA Handbook 1004.01 – Informed Consent for Clinical Treatments and Procedures. That handbook states that “Patients must not, as part of the routine practice of obtaining informed consent, be asked to sign consent forms ‘on the gurney’ or after they have been sedated in preparation for a procedure.” This clause was meant to ensure the consent does not occur “so late in the process that the patient feels pressed or forced to consent or is deprived of a meaningful choice because he or she is in a compromised position.”

Sadly, gurney consents are an all too common occurrence in hospitals that use paper-based consent forms. JAMA reports that missing consent forms cause 10% of procedures to be delayed, costing each hospital over $500K each year. This of course does not count the emotional toll it takes on patients.

It would be remiss not to point out that members of staff equally hate the need to have patients re-sign consent forms. It’s not comfortable to be the bearer of bad news and stand there while an upset patient vocalizes their displeasure. After all, the staff member is not the one that lost the form. Medscape’s recent National Physician Burnout & Depression Report found that the top contributor to physician burnout was excessive administrative tasks. Asking for another consent form from a patient certainly qualifies as an excessive administrative task.

“By modernizing document workflows, FormFast gives patients, their family member and clinicians the information they need, when they need it,” says Rob Harding, CEO of FormFast. “Digitizing the informed consent process helps ensure procedures go according to plan – no one is running around trying to find a paper document or asking for forms to be filled out yet again. A frictionless workflow makes for smooth operation which helps both patients and health professionals. eConsent is really a win-win.”

Conclusion

There are a myriad of ways to improve the patient experience. Big, bold initiatives and small, simple changes to existing processes. Although it is not an either-or situation, in the current economic and regulatory environment, hospitals should look for “small wins”, like eConsent, as an affordable and pragmatic way to improve the overall patient experience. As an added bonus, clinicians and administrators will also reap the benefits of lower stress and smoother workflows.

No matter what initiative, a hospital takes, ANY effort made to improve patient experience is a step in the right direction.

FormFast is a proud sponsor of Healthcare Scene.

Healthcare Communication Software with the Patient at the Center

Posted on September 12, 2018 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 was recently at the KLAS Digital Health Investment Summit where I met a ton of great people. One of those people was Brent Lang, CEO of Vocera. I have a long history with Vocera, but I’d never had a chance to meet Brent in person. As fate would have it, we sat down by each other at the opening dinner and had a great conversation about our overlapping connections, about Vocera, and the healthcare communications market in general.

Of all the insights Brent shared, I couldn’t stop thinking about his comment that Vocera was working hard to make the patient be the center of all their communication.

I’m sure some critics out there might wonder why the patient wasn’t at the center to start. Notice that he didn’t say that they were putting the patient at the center of their work. Knowing them as I have, I think they’ve been putting the patient first for a long time. However, as I understand it, Brent is suggesting a paradigm shift in how provider communication is designed.

Here are my thoughts on what he was saying. It makes sense when you’re first designing their popular Vocera badge communication (1 million+ badges) why most of the communication would be focused around the providers. The goal of those communication devices was to enhance provider communication. The nurse and doctors needed an “inbox” for their messages so they could read or listen and reply as needed. Having the providers at the center of those communications makes a lot of sense. The technology was looking to replace things like pagers and overhead speakers and it did that well.

The challenge comes as Vocera has taken on more and more communication modalities. Vocera now has secure text messaging, alarms and alerts, and integrations with a wide variety of clinical and EHR systems. Many of these messages need to be sent to a wide variety of providers and which provider needs the message can change over time. It’s no longer a one to one communication that’s needed. Plus, the history of messages for a specific patient across multiple platforms and multiple providers can be as valuable as the specific, in the moment message. Thus the need to put patients at the center of the messaging.

It’s a powerful idea that a provider could see all the messages for a patient in one location. It is probably how messaging should have always been done, but the implementation of technology is an iterative thing. If you try and do everything you end up doing nothing. It’s great to see Vocera iterating in a way that puts the patient at the center of their communication platform.

As I thought about this change, I wondered what other healthcare IT systems should have the patient at the center. It’s actually hard to think of healthcare IT applications where the patient is at the center. EHRs are largely focused around the provider workflow and not the patient. Some of them are trying to make this shift too. We do see it happening with new healthcare IT companies. I advise a company called CareCognitics that is an example of a company that puts the patient at the center. I recently wrote about Patient Directed that puts the patient at the center as well. It will be interesting to see which older healthcare IT companies adapt and put the patient at the center like Vocera is doing and which new companies come along with this paradigm shift built in.

EHR Efficiency Takes Extra Training, Optimized Systems, and One-on-One Support

Posted on September 6, 2018 I Written By

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

We all know that physician burnout is a real problem and the EHR gets a lot of the blame for that burnout. Well, the team at UC Davis Health decided to address this problem by creating a team focused on it. They called their team the Physician Efficacy Program or PEP for short. PEP was an interesting name for it since in many ways this team were a bunch of highly trained EHR cheerleaders that work with providers to help them work more efficiently in the EHR.

How did this team work and what did they accomplish? UC Davis Health shared what they did and some of their results in these tweets below:

Those are some impressive results. I think every doctor would love to have 25 hours per month of their life back. I’m sure that some organizations that see this will wonder how their organization could afford to have a PEP team go around and train their physicians. At 25 hours per month saved per provider, the better question is how a healthcare organization can afford to not invest in a team like this.

Now we just need the team at UC Davis Health to share more details about what they did to achieve these efficiency gains. I wonder how many of them were individual tweaks and how many of them were broad system changes. How do we get all the experience and knowledge gained by the team at UC Davis Health to the rest of healthcare?

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 www.ciox.com

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.