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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.

Remote Release of Information: The Next Step in Secure and Compliant Exchange of Patient Health Information

Posted on July 18, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox & Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Across the industry, there is an influx of health information management (HIM) departments and medical groups moving their HIM operations from hospital main campuses and individual physician practices to centralized, offsite locations to gain efficiencies and make better use of valuable square footage in their facilities. For many organizations, this move began decades ago with the implementation of remote coding and/or the need to free up space for patient care.

These ‘virtual HIM” departments can be located at a separate facility, home-based office or remote vendor locations, and result from the continued adoption of electronic health records (EHR) and pressure to manage costs, offering HIM directors and practice administrators the opportunity to reorganize and form more efficient spaces and processes. Outsourcing functions, such as release of information (ROI), allows HIM staff to focus on other priorities of data governance while maximizing available space.

From a financial perspective, costs associated with regulations, staffing, printing, mailing and square footage are increasing; and in some instances, volumes of requests are increasing due to health plans, lawsuits and the portability of healthcare. Furthermore, allowable fees for releasing medical records are decreasing in some states. As a result of these rising financial pressures, healthcare providers are finding it more difficult to make ROI a profit center in their organizations.

HIM departments are experiencing additional pressures from rising health plan request volumes, requiring flexible operational solutions in order to meet the increasing demand. In a typical year, the volume of health plan requests tends to increase to the order of 20-30 percent, and this year those numbers are expected to triple. With such an influx of requests, moving to a virtual model allows for the onsite staff to be augmented with the remote team, fulfilling these large volume requests without impacting the core ROI and patient requests.

Another prevalent challenge is timeliness. With the advent of rebranding the Meaningful Use program to focus on promoting interoperability and the increase in various governmental and payor audits, timeliness of response to requests for medical records is critical and penalties for non-compliance are steep. As such, healthcare providers are reaching the point of diminishing returns in regards to managing the ROI function on their own, and in some cases, will not be able to meet the time deadlines imposed upon them to gain incentives, avoid penalties and takebacks.

These new industry influences create the need for even faster, more efficient, error-free fulfillment of medical record requests and pave the way for a new approach designed to help your organization meet this demand: Remote ROI.

The Remote ROI Process

The ROI process is a time-consuming administrative challenge for HIM professionals, requiring compliance expertise, secure and efficient technology, and a trained and knowledgeable staff. The Remote ROI process starts at your healthcare facility when requests for release of health information are received. From there, your chosen third party vendor, such as Ciox, receives the request from the hospital or practice via a mutually agreed upon, secure mechanism. Securely connected and able to access the hospital or practice EHR, an offsite ROI Specialist then reviews the requests for proper authorizations, identifies and captures the records to be released, and transmits the medical records from your facility’s EHR in an encrypted electronic format to the third party vendor’s ROI centralized processing center. The release is delivered to the requestor through an automatic print and mail process or electronically via a secured delivery method. Ciox’s process is computer-assisted using artificial intelligence and natural language processing thereby reducing turnaround time, improving patient satisfaction and ROI outcomes.

When creating your Remote ROI process, follow these three fundamental steps to ensure its success:

1. Determine the method of access to the Request Letter/Authorization received by the hospital or physician practice.

There are several mechanisms by which requests and authorizations are securely made available to Remote ROI Specialists for ROI processing. The most common methods include:

  • Requests/Authorizations are scanned into the EHR – Staff at the facility scans the requests/authorizations into the EHR. The Remote ROI Specialist accesses the EHR to view the information and begin the process.
  • Requests/Authorizations are faxed – Staff at the facility faxes the requests/authorizations to a fax-in queue provided by the third party vendor. The Remote ROI Specialist accesses the fax-in queue to view the information.
  • Requests/Authorizations are scanned and placed in a shared folder – Staff at your facility scans the requests/authorizations into a shared folder accessible by the Remote ROI Specialist at the third party vendor’s secure Remote ROI Processing Center.
  • Requests/Authorizations are automatically received via health data exchange or health information exchange.

2. Establish connectivity to the EHR to validate the authorization, review the medical records and process the request.

An acceptable baseline for securing the connection to your EHR system(s) must be established for Remote ROI. The appropriate connectivity scenario depends on the underlying technologies at your facility. When understanding which technologies are at your disposal and establishing connectivity, remember that security is key in this part of the process. Keep that in mind when selecting a third party vendor, as it’s paramount to select a company that makes the security of the exchange of protected health information a top priority. Furthermore, it’s of critical importance to select a vendor that has earned certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST CSF Certified Status ensures that key healthcare regulations and requirements for protecting and securing sensitive private healthcare information are met.

3. Ensure compliance standards to track when and who accessed protected health information.

As an added security effort, it’s crucial to follow compliance standards that allow insight as to who accessed patient health information and when it was accessed. To ensure maximum security, computers located at the third party’s Remote ROI processing facility should be secured utilizing encryption, anti-virus protection and web filters.

Passwords should be provided by the facility for access to their specific EHR and stored in an electronic password vault. The password vault should be linked to the third party’s directory that is only accessible by the ROI Specialist using their directory account. Third parties should provide complete audit trail capabilities to track personnel accessing the EHR and processing medical record requests from your applications.

By moving some or all of the onsite ROI functions to a Remote operation, you can streamline the ROI workflow, reclaim square footage for other purposes and have additional capacity available for request volume fluctuation. As an added benefit, the immediate access to requests and authorizations speeds turnaround times on processing requests, which is particularly important when considering tight timelines for meeting Meaningful Use and audit-related releases.

If you’re looking to make HIM operations more efficient and cost effective, Remote ROI can open the doors to achieving those goals.

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 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

Revenue Cycle Trends To Watch This Year

Posted on July 13, 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.

Revenue cycle management is something of a moving target. Every time you think you’ve got your processes and workflow in line, something changes and you have to tweak them again. No better example of that was the proposed changes to E/M that came out yesterday. While we wait for that to play out, here’s one look at the trends influencing RCM strategies this year, according to Healthcare IT leaders revenue cycle lead Larry Todd, CPA.

Mergers

As healthcare organizations merge, many legacy systems begin to sunset. That drives them to roll out new systems that can support organizational growth. Health leaders need to figure out how to retire old systems and embrace new ones during a revenue cycle implementation. “Without proper integrations, many organizations will be challenged to manage their reimbursement processes,” Todd says.

Claims denial challenges

Providers are having a hard time addressing claims denials and documentation to support appeals. RCM leaders need to find ways to tighten up these processes and reduce denial rates. They can do so either by adopting third-party systems or working within their own infrastructure, he notes.

CFO engagement

Any technology implementation will have an impact on revenue, so CFOs should stay engaged in the rollout process, he says. “These are highly technical projects, so there’s a tendency to hand over the reins to IT or the software vendor,” notes Todd, a former CFO. “But financial executives need to stay engaged throughout the project, including weekly implementation status updates.”

Providers should form a revenue cycle action team which includes all the stakeholders to the table, including the CFO and clinicians, he says. If the CFO is involved in this process, he or she can offer critical executive oversight of decisions made that impact A/R and cash.

User training and adoption

During the transition from a legacy system to a new platform, healthcare leaders need to make sure their staff are trained to use it. If they aren’t comfortable with the new system, it can mean trouble. Bear in mind that some employees may have used the legacy system for many years and need support as they make the transition. Otherwise, they may balk and productivity could fall.

Outside expertise

Given the complexity of rolling out new systems, it can help to hire experts who understand the technical and operational aspects of the software, along with organizational processes involved in the transition. “It’s very valuable to work with a consulting firm that employs real consultants – people who have worked in operations for years,” Todd concludes.

Approaches For Improving Your HCAHPS Score

Posted on June 27, 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.

Improving your HCAHPS scores gets easier if you make smart use of your existing technology infrastructure. To make that work, however, you have to know which areas have the greatest impact on the score.

According to healthcare communications vendor Spok, hospitals can boost their scores by focusing on five particularly important areas which loom large in patient satisfaction. Of course, I’m sure these approaches solve problems addressed by Spok solutions, but I thought they were worth reviewing anyway. These five areas include:

  • Speed up response to the call button
    Relying on the call button itself doesn’t get the job done. If calls go to a central nursing station, it takes several steps to eventually get back to the patient, it’s possible to drop the ball. Instead, hospitals can send requests directly from the call button to the correct caregiver’s mobile device. This works whether providers use s a Wi-Fi phone, smartphone, pager, voice badge or tablet.
  • Lower the noise volume
    Hospitals are aware that noise is an issue, and try everything from taking the squeak out of meal cart wheels to posting signs reminding all to keep the conversations quiet. However, this will only go so far. Spok recommends hospitals take the additional step of integrating the monitoring of equipment alarms with staff assignments systems, and as above, routing nurse call notifications to the appropriate patient care providers mobile device. Fewer overhead notifications means less noise.
  • Address patient pain faster
    To help patients with the pain as quickly as possible, give staff access to your full directory, which allows nurses to quickly locate provider contact information and reach them with requests for pain medication orders. In addition, roll out a secure texting solution which allows nurses to share detailed patient health information safely.
  • Make information sharing simpler
    Look at gaps in getting information to patients and providers, and streamline your communications process. For example, Spok notes, if communication between team members is efficient, the time between a test order and the arrival of the phlebotomist can get shorter, or the time it takes the patient transport team to bring them to the imaging department for a scan can be reduced. One way to do this is to have your technology trigger automatic message to the appropriate party when an order is placed. Also, use the same to approach to automatically notify providers when test results are available.
  • Speed up discharge
    There are many understandable reasons why the patient discharge process can drag out, but patients don’t care what issues hospitals are addressing in the background. One way to speed things up is to set up your EMR to send a message the entire care team’s mobile devices. This makes it easier for providers to coordinate discharge approval and patient instructions. The faster the discharge process, the happier patients usually are.

Of course, addressing the patient care workflow goes well beyond the type of technology hospitals use for coordination and messaging. Getting this part of the process right is a good thing, though.

Healthcare Communication with Candice Friestad, Director Informatics at Avera Health

Posted on June 25, 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.

Ensuring proper communication in healthcare has become an incredibly important topic in every hospital and healthcare system. No doubt much of this has been pushed along by doctors, nurses, and patients use of mobile communication in their personal lives. The explosion of communication technology has been a challenge for many organizations who are stuck with legacy infrastructure, but it also provides a tremendous opportunity to improve healthcare communication over all.

We saw this first hand at the HIMSS 2018 conference when we talked with Candice Friestad, Director Informatics at Avera Health. She joined us at the Voalte booth to talk about their choice to use the Voalte platform in their organization. Candice also talked about what surprises they experienced when implementing the Voalte platform and their users’ reaction to it.

Beyond that, Candice talked about how Voalte allowed them to more easily find various providers and avoid the phone tag that’s common in many healthcare organizations. Candice also shared how they’re working to handle alarm fatigue as is required by the join commission and how choosing a central communication platform for alarms was key to addressing this issue. She also dives into key integrations they’ve created and a unique use case around athletic trainers at football games.

If you’re interested in healthcare communication and the above topics, watch the full video interview below to learn from an expert on the topic:

If you’d rather skip to various sections of the interview, just click the links below to be taken directly to that question:

A big thank you to Voalte for helping facilitate this interview and thank you to Voalte for sponsoring Healthcare Scene.

What? In Some Cases, Additional IT Spending May Not Prevent Breaches

Posted on June 11, 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.

A new research study has come to a sobering conclusion – that investing more in IT security doesn’t necessarily reduce the number of breaches.

The research, which appeared in the MIS Quarterly, looked at how many breaches hospitals experienced relative to their IT security spending. The study authors started with the assumption that hospitals spending more on security would enjoy better protection from breaches.

The researchers assumed that looked at broadly, some security investments were “symbolic,” making superficial improvements that don’t get to the root of their problem, while others were substantive investments which met well-defined security needs.

After reviewing their data, researchers noted that many classes of hospitals turned out to be symbolic security investors, including members of smaller health systems, older hospitals, smaller hospitals and for-profit hospitals. They also noted that faith-based and less-entrepreneurial hospitals were prone to such investments. The only category of hospitals routinely making substantive security investments was teaching hospitals.

But that’s far from all. Their more controversial conclusions focused on the role of IT security investments in preventing security breaches. In short, their conclusion was pretty counterintuitive.

First, they found that larger IT security investments did not in and of themselves lower the likelihood of security breaches. Not only that, researchers concluded that the benefits of substantive adoption wouldn’t generate greater breach protection over time.

Researchers also concluded that the benefits of substantive IT security adoption by hospitals would take time to be realized. If I’m reading this correctly, mature IT security systems should offer more advantages over time, but not necessarily better breach protection.

Meanwhile, researchers concluded that the negative consequences of symbolic adoption would grow worse over time.

I don’t know about you, but I was pretty surprised by these results. Why wouldn’t substantively increasing security spending reduce the occurrence of breaches within hospitals? It’s something of a head-scratcher.

Of course, the answer to this question may lie in what type of substantive security investment hospitals make. The current set of results suggests, to me at least, that current technologies may not be as good at preventing breaches as they should be. Or maybe hospitals are investing in good technology but not hiring enough IT security experts to get the installation done right. Plus, purchasing security infrastructure can only do so much to stop bad user behavior. The issue deserves further research.

Regardless, this study offers food for thought. The industry can’t afford to do a bad job with preventing breaches.

Small Financial Innovations that Make A Big Difference for Patients and Hospitals

Posted on May 3, 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.

More and more these days I’m fascinated by the practical innovations that can impact healthcare much more than the moonshot ideas which are great ideas but never actually impact healthcare. I’ve quickly come to believe that the way to transform healthcare his through hundreds of little innovations that will allow us to reach a transformative future.

I saw an example of this when I talked with PatientMatters. They work in a section of healthcare that many don’t consider sexy: revenue cycle management. However, I often say, the financial side of healthcare isn’t sexy, unless you care about money. Given how healthcare is getting pressed from every angle, every hospital I know is interested in the financial side of the equation.

PatientMatters is doing a number of things that are interesting when it comes to a patient’s financial experience in a hospital. They offer a great mix of tools, training, process design, automation and coaching to reframe a patient’s financial experience. This is a trend I’m seeing in more and more healthcare IT companies. It takes much more than technology to really change the experience.

That said, I was most intrigued by how PatientMatters offers unique payment plans to patients based on a wide variety of factors including current credit information, payment history for current financial obligations, and their residual income. From this information PatientMatters does an assessment of a patient’s ability to pay based on these five categories:

  1. Guarantors that generate this designation are the most likely to pay their full obligation. This population predictably pays their full balance more than 94% of the time. Recognizing these guarantors provides key savings to the hospital:
    • Because these guarantors are most likely to meet their obligation, conversations with the registration staff regarding payment are brief and concise.
    • Recognizing the high likelihood of guarantor payment performance, many hospitals elect to keep these accounts in-house and not refer to their early out vendors. This generates vendor savings for the hospital.
  1. These guarantors also have a high collections success rate, but they may need more time and slightly reduced payment plans to meet their obligation. Using data analytics to understand the guarantor allows the hospital to structure a custom payment plan with a high likelihood of performance.
  1. Guarantors in this category require a higher degree of attention from the registration team. This group struggles to meet their financial responsibilities. A hospital that spends the extra time working with the guarantor on a highly structured payment plan will see collection improvements with this population.
  1. These guarantors fall into two categories; a) a low likelihood of meeting their financial commitment or b) guarantor may meet hospital charity program, based on their FPL status. Scripting will help the registration assess the guarantor and identify the best solution.
  1. These guarantors will likely be unable to meet their hospital obligation. Many times these individuals will qualify for the hospital charity, Medicaid, County Indigent or other assistance programs.

It’s not hard to see how this more personalized approach to a patient’s financial experience makes a big difference when it comes to collections, patient satisfaction, etc. However, what I loved most about this approach was how simple it was to understand and process. It’s worth remembering that a hospital’s registration staff are generally one of the lowest paid, highest turnover positions in any hospital. So, simplicity is key.

I love seeing practical, innovative solutions like the one PatientMatters offers hospitals. They make a big difference on a hospital’s bottom line. However, they also create a much better experience for the patients who mostly want to get through the billing process and on to their care. How are you customizing the financial experience for your patients?

Hospital Patient Identification Still A Major Problem

Posted on April 18, 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.

A new survey suggests that problems with duplicate patient records and patient identification are still costing hospitals a tremendous amount of money.

The survey, which was conducted by Black Book Research, collected responses from 1,392 health technology managers using enterprise master patient index technology. Researchers asked them what gaps, challenges and successes they’d seen in patient identification processes from Q3 2017 to Q1 2018.

Survey respondents reported that 33% of denied claims were due to inaccurate patient identification. Ultimately, inaccurate patient identification cost an average hospital $1.5 million last year. It also concluded that the average cost of duplicate records was $1,950 per patient per inpatient stay and more than $800 per ED visit.

In addition, researchers found that hospitals with over 150 beds took an average of more than 5 months to clean up their data. This included process improvements focused on data validity checking, normalization and data cleansing.

Having the right tools in place seemed to help. Hospitals said that before they rolled out enterprise master patient index solutions, an average of 18% of their records were duplicates, and that match rates when sharing data with other organizations averaged 24%.

Meanwhile, hospitals with EMPI support in place since 2016 reported that patient records were identified correctly during 93% of registrations and 85% of externally shared records among non-networked provider.

Not surprisingly, though, this research doesn’t tell the whole story. While using EMPI tools makes sense, the healthcare industry should hardly stop there, according to Gartner Group analyst Wes Rishel.

“We simply need innovators that have the vision to apply proven identity matching to the healthcare industry – as well as the gumption and stubbornness necessary to thrive in a crowded and often slow-moving healthcare IT market,” he wrote.

Wishel argues that to improve patient matching, it’s time to start cross-correlating demographic data from patients with demographic data from third-party sources, such as public records, credit agencies or telephone companies, what makes this data particularly helpful is that it includes not just current and correct attributes for person, but also out-of-date and incorrect attributes like previous addresses, maiden names and typos.

Ultimately, these “referential matching” approaches will significantly outperform existing probabilistic models, Wishel argues.

It’s really shocking that so many healthcare organizations don’t have an EMPI solution in place. This is especially true as cloud EMPI has made EMPI solutions available to organizations of all sizes. EMPI is needed for the financial reasons mentioned above, but also from a patient care and patient safety perspective as well.

#HIMSS18: Pushing Inpatient Care Out

Posted on March 9, 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.

At present, we need acute care hospitals. Despite the fact that many types of care can now be delivered in outpatient settings, and chronic conditions managed remotely for connected health, there are still some treatments and procedures which can only be done in a big, expensive building.

That being said, some of what I saw at HIMSS18 has convinced me that the drive to push hospital-type services into the community has begun to pick up speed. While nobody seems to have a completely mature solution to decentralizing acute care, I saw some tools that might begin to solve the problem.

Perhaps the most direct example of this trend was offered by a Taiwanese company called Quanta Computer. (The booth was staffed with five company representatives who had flown here all the way from Taiwan, which may suggest that they are not fooling around.)

Quanta was here to pitch QOCA, whose capabilities include offering a “smart hospital at home.”  QOCA Home, an eldercare/assisted living solution including a central, easy to use terminal supporting a wide range of telehealth and connected health services. While the idea is not completely new, the way this blends a smart home approach with connected health intrigued me.

Other vendors took a different approach to some of the same core problems, i.e. managing the patient effectively outside of the hospital. For most exhibitors, this seemed to involve a blend of connected health, care management and patient/provider collaboration.

For example, vendor Virtual Health promises to deliver “whole person health” by tying together providers, healthcare execs, patients and care coordinators. Two points of interest: its solution include a collaborative workflow tool which seems to include patients, something I don’t believe I’ve seen before. Its platform, which is designed to support patients with highly complex medical needs, also addresses social determinants of health, including financial concerns and nutrition.

Now, I’m not here to tell you that any of this is revolutionary. The industry has been kicking around concepts like virtual hospital care, care coordination platforms and the integration of social determinants of health for quite some time, and I’m not suggesting that any of the vendors I saw seem to be all the way there.

Still, what I saw suggests to me that tech vendors are further along in delivering these options than they have been. If you haven’t looked into new platforms that address these issues, now might be the time. They may not be completely ready for prime time, but they’re well on their way.