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Important Patient Data Questions Hospitals Need To Address

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.

Obviously, managing and protecting patients’ personal health information is very important already.  But with high-profile incidents highlighting questionable uses of consumer data — such as the recent Facebook scandal – patients are more aware of data privacy issues than they had been in the past, says Dr. Oleg Bess, founder and CEO of clinical data exchange company 4medica.

According to Bess, hospitals should prepare to answer four key questions about personal health information that patients, the media and regulators are likely to ask. They include:

  • Who owns the patient’s medical records? While providers and EHR vendors may contend that they own patient data, it actually belongs to the patient, Bess says. What’s more, hospitals need to be sure patients should have a clear idea of what data hospitals have about them. They should also be able to access their health data regardless of where it is stored.
  • What if the patient wants his or her data deleted? Unfortunately, deleting patient data may not be possible in many cases due to legal constraints. For example, CMS demands that Medicare providers retain records for a fixed period, and many states have patient record retention laws as well, Bess notes. However, if nothing else, patients should have the ability to decline having their personally-identifiable data shared with third parties other than providers and payers, he writes.
  • Who is responsible for data integrity? Right now, problems with patient data accuracy are common. For example, particularly when patient matching tools like an enterprise master patient index aren’t in place, health data can end up being mangled. To this point, Bess cites a Black Book Research survey concluding that when records are transmitted between hospitals that don’t use these tools, they had just a 24% match rate. Hospital data stewards need to get on top of this problem, he says.
  • Without a national patient ID in place, how should hospitals verify patient identities? In addition to existing issues regarding patient safety, emerging problems such as the growing opioid abuse epidemic would be better handled with a unique patient identifier, Bess contends. According to Bess, while the federal government may not develop unique patient IDs, commercially developed master patient index technology might offer a solution.

To better address patient matching issues, Bess recommends including historical data which goes back decades in the mix if possible. A master patient index solution should also offer enterprise scalability and real-time matching, he says.

To Avoid Readmissions, Hospitals Trying Post-Discharge Clinics

Posted on December 12, 2011 I Written By

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

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

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

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

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

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

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

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

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

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

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

 

 

 

Hospitals play unfair games with Medicare observation status

Posted on November 14, 2011 I Written By

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

Most hospital visitors don’t care a whole lot whether they’re classed as inpatients or outpatients  — unless it affects the size of their bill. But lately, many patients are getting hit with unexpected fees after spending days in a hospital, thanks to tricks hospitals are playing in an effort to lower their readmission rate numbers, a newly-filed lawsuit contends.

These days, hospitals are under intense pressure to lower readmission rates, as such rates figure into their ratings on various types of quality scales.  In some cases, of course, they have no direct control of this number, as readmissions often have far more to do with the care they receive from community physicians and their willingness to comply with discharge instructions.

But ever-resourceful administrators have found a loophole that allows them to rejigger the admissions numbers. Under Medicare rules, they’re allowed to keep patients on “observation status,” deliver care and let patients go without ever classing them as inpatients. All of which might be well and good, except that if patients are in a hospital for days, they rack up a big bill — one they’re expected to pay far more of if the visit is billed as outpatient care under Medicare Part B.

Even more delightful for these patients, the fact that they haven’t logged three or more “real” inpatient days means that Medicare won’t pay for follow-up in a skilled nursing facility after discharge. So seniors either do without, or end up having the state pay through Medicaid.

Nice way to look out for patients, guys. Being old and sick and scared isn’t bad enough; now seniors have to wonder if their hospital costs are paid for even with Medicare coverage in place.

With this kind of mumblety-peg becoming fairly common, a consumer group called Center for Medicare Advocacy has filed a lawsuit to call a halt to the fun. The group is asking CMS to simply end observation status as a billable category.

While I sympathize with hospitals to some degree, who are also hoping to dodge scrutiny from the RECs by avoiding inpatient claim reviews, setting up seniors for high costs by playing unfair games is bad for you, the industry and the patient. Cut it out.