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What Happened to Care Pricing and Provider Quality Transparency?

Posted on August 21, 2018 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

I’m on the Utah HIMSS board and we’re hosting an event called “Full Disclosure- Price Transparency & Provider Ratings in Healthcare.”

At the event on August 29, 2018, we’ll be talking about pricing transparency and physician outcomes. The Pricing Transparency question has multiple goals and remains a complex problem in healthcare IT and other areas. Leaders in Utah Health IT will come together to discuss resources and experiences from Utah.

Pricing in healthcare remains the number one concern for many different stakeholders. Informatics departments are still concerned with denials and claims administration. Patients are unsure of price of care. Physicians’ practices are not clearly aligned with billing codes and claims can account for up to 30% of healthcare spending waste. In April of this year, Seema Verma announced that requirements for hospitals to post standard pricing would be the start of a broad initiative to increase transparency about healthcare prices.

Can price transparency & provider ratings help manage the costs of healthcare?

Price transparency might have the single biggest effect in informing the public about healthcare costs and could support a more efficient health care delivery system in the United States. Utah HIMSS members and others are invited to submit questions for panelists.  

Please register for the event and follow the Utah HIMSS pages Linkedin and Twitter.

Here’s a look at the panel members that will be involved:

Moderator: Holly Rimmasch- Health Catalyst

Holly Rimmasch is an Executive VP/Chief Clinical Officer of Health Catalyst.  She currently leads population health, patient safety and improvement services.  Ms. Rimmasch has over 30 years of experience in clinical and operational healthcare management. She has spent the last 20 years dedicated to improving clinical care and better understanding how to sustain and achieve better value.

Holly has extensive healthcare and operational experience.  Prior to joining Health Catalyst, she was an Assistant VP at Intermountain Healthcare responsible for Clinical Services.  While at Intermountain, she also served as the system Clinical Operations Director for Cardiovascular and Intensive Medicine.  Holly co-founded and was a Principal in HMS, Inc, a healthcare consulting firm focusing on population health.

Ms. Rimmasch holds a Master of Science in Adult Physiology from the University of Utah and a Bachelor of Science in Nursing from Brigham Young University.

Price Transparency

A key question that Holly has focused on is “Are we making a difference in both quality and costs?”  “Does it translate into cost savings for those that are paying?” Part of her work involves bringing data sources together (clinical, financial, claims, etc.) to create transparency to services and care being provided and at what cost.  Over the last 6 years, Holly has been involved in developing a more accurate activity-based costing system. Accurate costing leads to more accurate pricing and more accurate pricing leads improved price transparency.

Panelist: Rep. Norm Thurston- Utah State Legislature

Personal & Professional

Dr. Thurston has a Masters and Ph.D. in economics from Princeton University, and an undergraduate degree in Spanish and Agribusiness Management from Brigham Young University.  His areas of specialty include insurance markets, health care provider markets, labor markets, and public finance/economics. 

Dr. Thurston has been a policy analyst and health economist for the Utah Department of Health since 2003. Currently, he is the Director of the Office of Health Care Statistics which is responsible for the collection, analysis, and dissemination of data related to health care cost and quality for the State of Utah.  In previous roles he has served as policy adviser and executive staff for health system reform efforts in the State of Utah. 

Before joining the state, Dr. Thurston worked for eight years as an assistant professor of economics at Brigham Young University.  He has published several articles on health care markets in nationally recognized economics journals.  He is a life-long resident of Utah, growing up in Morgan County.  He has native-level fluency in Spanish and was a Fulbright Scholar teaching economics in Argentina in 2001. He and his wife Maria have three children and two grandchildren.

Legislative

Rep. Thurston was elected to the Utah House of Representatives in 2014 from District 64 (Provo, Springville).  Currently, he is a member of the Government Operations Committee, the Economic Development and Workforce Services Committee, and the Social Services Appropriations Subcommittee.

Price Transparency:

“Norm Thurston is the director of the Office of Health Care Statistics (OHCS). The office collects, analyzes and disseminates data on health care utilization and costs for the State of Utah. Their two main data efforts include collecting information about patient encounters at hospitals and emergency rooms into the Healthcare Facilities Database and information about claims paid by health plans for all types of services into the All Payer Claims Database.

These data are used by a variety of entities, including healthcare facilities, plans, researchers, and public health programs.”

Panelist: Bob White- Intermountain Healthcare

Bob White, Vice President and Chief Operating Officer

Bob has over 27 years of experience in the Information Technology industry. He has been with SelectHealth for 20 years and currently leads member services, business systems support, program management, process improvement, business continuity, and information technology.

Previously, Bob was employed by the IBM Consulting Group. He attended Brigham Young University and holds a bachelor’s degree from DeVry University. He currently serves on the board of Trizetto Customer Group

Panelist: Katie Harwood- University of Utah Hospitals and Clinics

Patient and Financial Services Manager at the University of Utah Hospitals and Clinics

Katie Harwood is a Revenue Cycle Manager with University of Utah Health. She has been with the organization since 1995, most recently responsible for the admissions and financial counseling  teams. She is currently serving as the president of the American Association of Healthcare Administrative Management Utah Mountainwest chapter (AAHAM). She also participates with the National Association of Healthcare Access Management on the Certification Commission and is  a Certified Healthcare Access Manager. Outside of work she enjoys her two sons, dog, and Zumba.

Katie had the opportunity to participate in the development of the pricing transparency tool University of Utah Health. The goal was to create a tool that would have full care pricing available for consumers. She is excited to share what our experience in pricing transparency has been and how the consumer benefits from the use of it .

Patient Safety Market Heating Up with Mergers and New Product Announcements

Posted on July 26, 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.

For the past few years the patient safety software market has been stable with little in the way of new products and company activity. That has changed with a flurry of recent announcements:

  1. The merger of two market leaders: Datix and RL Solutions
  2. Health Catalyst entering with their new Patient Safety Monitor™ Suite: Surveillance Module
  3. VigiLanz expanding their platform to include Dynamic Safety Surveillance

When something goes wrong in a healthcare facility it is referred to as an adverse event or a medical error. According to a recent study by Johns Hopkins, 250,000 Americans die each year from medical errors making it the third leading cause of death in the United States. The Journal of Patient Safety estimates that non-lethal adverse events happen 10-20 times more frequently than lethal events. This puts the total number of adverse events somewhere between 2.5 – 5 million per year. The financial cost of these events is enormous. Frost & Sullivan estimates that the financial cost of adverse events in the US and Europe will reach $383.7 Billion by 2022.

Traditionally, adverse events have been recorded and logged in incident reporting systems (sometimes called risk management software) – like those offered by Datix and RL Solutions. These systems rely on voluntary reporting of events by staff members and patients. Once entered, these events are reviewed and analyzed by specially trained risk managers to determine root causes. When patterns emerge, changes are made to policies, procedures and physical environments to prevent similar events from happening in the future.

The most recent Research and Markets report estimates the global patient safety and risk management software market is poised to grow at a CAGR of 10.9% over the next decade to reach $2.22 Billion by the year 2025. I believe there are three key drivers for this this growth:

  1. Hospitals transitioning away from traditional after-the-fact adverse event reporting systems to real-time surveillance platforms that take advantage of the data being collected in EHRs and other electronic repositories
  2. The movement towards value-based care where a focus on patient safety has meaningful impact on reimbursements
  3. Realignment of patient safety as part of overall patient experience vs a function of compliance and legal.

According to a report by the Agency for Healthcare Research and Quality (AHRQ), it is estimated that less than 6% of adverse events are reported voluntarily. This means that healthcare organizations are potentially missing out on 94% of events that are happening within their four walls. In addition, very few organizations have effective ways to capture near misses – adverse events that did not occur because they were stopped BEFORE someone was harmed. There is a better way.

With the exponential growth in the quantity of healthcare data and the rapid increase in computing power, it is now possible to mine medical data to detect adverse events and near misses in real-time. For example, it is possible to look at EHR data to determine if the wrong medication was given to a patient based on their diagnosis. It is also possible to track the number of times the drug-drug interaction warning message is displayed to clinicians (each being a near miss). Justin Campbell of Galen Healthcare Solutions recently wrote an article about mining EHR audit log data to uncover workflow bottlenecks that touches on this same approach – commonly referred to as “real-time surveillance”.

Stanley Pestotnik, MS, RPh, Vice President of Patient Safety Products at Health Catalyst had this to say about this detection methodology: “The current approach to patient safety is like doing archaeology – digging through ancient safety events to identify the causes of harm, which does nothing to help with the patient in the bed right now. Our patient safety suite, along with our quality-improvement services and the Health Catalyst PSO, turns the current paradigm on its head. Unlike other approaches to using analytics within a PSO to identify and address episodes of patient harm, we monitor triggers in near real-time to reveal whether a patient is currently at risk for a safety event, so clinicians can intervene to prevent it. And we provide constant vigilance; no patient encounter goes unnoticed.”

Real-time surveillance of adverse events is the approach that Health Catalyst and VigiLanz have incorporated in their product offerings.

“The RL+Datix merger comes at a time when patient safety events are surging,” states Erik Johnson, Vice President of Marketing at VigiLanz. “It is not surprising that consolidation is happening as companies try to address the needs of the market.”

Johnson points to a recent Frost & Sullivan report that predicts further market consolidation. The report states that by 2022, adverse patient events will lead to 92 million hospital admissions and 1.95 million deaths in the US and western Europe. These avoidable hospital admissions will be a drag on financial performance – especially as we move to a value-based system.

Under the value-based models, healthcare organizations are reimbursed based on patient outcomes and satisfaction scores, not on treatment volume. This means organizations are no longer compensated for patients that are re-admitted or stay longer due to an adverse event experienced at the facility. This has put a spotlight on patient safety initiatives and is a key reason why healthcare organizations are once again investing in this aspect of their operations.

“We are seeing organizations take the opportunity, as they transition from volume to value, to renew their patient safety protocols and technologies to ensure they are capitalizing on the lessons learned from incident data,” continues Johnson. “It’s not just patient incident data either. Adverse events can happen to guests and employees as well. Hospitals are looking to get a better handle on all their events – not only to capture them, but to derive deeper insights on root cause and even further to automate the detection of events through surveillance technology.”

A request for comment from Datix and RL Solutions on their recent merger was politely declined. A company spokesperson pointed back to the press release announcing the merger which states: “the combined company will contain the largest repository of patient safety data in the world, enabling the creation of data-driven insights for healthcare stakeholders across the continuum of care.”

The final driver for growth is the recognition that patient safety is closely linked to patient experience. In the past, adverse event tracking fell to the Risk Management team inside a hospital which typically reported up through the CFO or legal counsel. It was seen as a compliance and back-office function. In recent years, however, there has been a realization that the patient safety function is a better fit under the umbrella of patient experience since the two are closely linked.

“From our perspective at The Beryl Institute, if we approach healthcare from the lenses of those that use the system not only safety, but also quality, service, cost and more are all part of the experience someone has within healthcare,” says Jason A. Wolf PhD CPXP, President of The Beryl Institute – the world’s leading community of practice for patient experience. “To differentiate safety from experience diminishes both, relegating safety to processes and checklists and experience to satisfaction or amenities. Rather, experience is the integration of all the above.”

Wolf cites the recent State of Patient Experience from The Beryl Institute where healthcare leaders acknowledged quality and safety as essential to overall experience. A parallel study, the Consumer Perspectives on Patient Experience mirrored the provider result with 68% of global healthcare consumers agreeing that safety is part of the healthcare experience.

“I see the movement towards aligning patient safety and patient experience as acknowledgement of all that impacts the overall experience,” adds Wolf. “That first and foremost to consumers, their health matters to them and how they are treated both clinically and as a person is essential to their healthcare experience. This too reinforces the expectations patients and families have always had, that their care will be delivered in a safe and reliable manner.”

lt will be exciting to watch the patient safety space as the three drivers of (1) changing technology, (2) value-based care and (3) realignment under patient experience, continue to push investments in this market. I’m curious to see if the Datix + RL merger is a one-off or if other players like QuantrosRiskonnect, Origami Risk, Ventiv, Policy Medical and The Patient Safety Company will merge or be acquired. This market is definitely heating up!

Hospital execs largely clueless about patient experience

Posted on April 26, 2011 I Written By

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

Just caught the results of a study looking at patient experience in hospitals, and I’ve got to say, it doesn’t reflect well on hospital executives.

The study, by The Beryl Institute, concluded that execs rank patient experience as one of their top three priorities, coming in higher even than cost reduction.

Sure, that sounds nice. But as Beryl notes, these same execs have little idea of how to improve. In fact, 73 percent of the 790 execs surveyed don’t have a formal definition of a good patient experience — though they do consider noise reduction, discharge process/instructions and patient rounding to be key issues.

Honestly, I doubt they’d care this much if HCAHPS measurements weren’t just around the corner, poised to shave down reimbursement levels if hospitals don’t get on board.

Come on now, hospital leaders.  Just walk through a few units of your hospitals and try to imagine yourself staying there.  Do you think your patients feel comfortable, especially when they’re in shared rooms with little privacy and seldom informed about clinical decision making?  Do they feel like a cog in a big machine?  I dare you to work a shift with one of your nurses and see what patients feel day-to-day.

Improving patient experience is a nice goal, definitely, but you can’t do better than make vague stabs at the problems which affect your business, don’t even bother.

 

Would you feel safe in this ugly lobby?

Posted on November 21, 2010 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 patient having his blood pressure taken by a...

Image via Wikipedia

Folks, I’ll never forget that night.  Led gently by my worried husband, who was a bit concerned about my ability to keep breathing, I walked into the lobby of a mid-sized, plain-vanilla 100-odd bed community hospital in my neighborhood.

I already knew, from phone calls to my PCP, that I probably had pneumonia. And I knew that while I probably didn’t need an admission, I definitely needed a hand.  My temp was 104, my cough was in the Black Plague range  and I could barely walk.

So, then medical reality collided with nice, warm, compassionate medical theory.  The details aren’t important — basically, since the ED staff had nowhere appropriate to put me while I waited, and demanded I wear a mask I simply could not tolerate  — I ended up sitting on the floor inside the glass box between the outside and inside doors to the facility.  At least the cold from the winter night kept my temp down a bit.

I’m sorry, but I absolutely cannot fathom why even a not-so-rich community hospital can’t do more to make very, very uncomfortable and scared people feel safe when they enter an ED door.

Why are hospitals spending SO much energy advertising their abbreviated ED wait times?  Customer service, right? Well, guys, I can assure you that it makes more sense to start with EDs that aren’t a nightmare to visit. Get people through quickly? Sure. But for the time they’re in the lobby, much less in case, make that time welcoming and safe.

Yes, I realize not every hospital will spend enough to put Pottery Barn-style couches and deluxe coffee and tea service out there, but what bothers me is that comfort doesn’t seem to be anyone’s aspiration when patients arrive.

The nursing staff in the emergency departments I’ve visited are largely abrupt and impatient, refusing to make the slightest human connection with patients.  The lobbies themselves stack uncomfortable institutional chairs and horrible lighting on top of one another in a graceless manner which rivals sitting in the New York City subway at 2AM.  And if you want food or drink you often have to go on a hunting expedition you’re in no position to conduct.

My take? This is not acceptable. No. Not for a second.  I don’t want to hear any excuses about it.

If your hospital can’t afford high-toned decor, maybe get a volunteer to serve as a concierge to help make people comfortable. Rent a goddamned cot or two for patients who aren’t dying but feel like they want to.  Provide some hot liquids, for Christ’s sake — it’s not going tap out the budget for a mid-sized community hospital.  Remind your front-desk nurses that people are in pain, and base part of their pay on the reports you get from patients.

You know, evidence is piling up that patient satisfaction correlates pretty strongly with profit.  If compassion and common sense aren’t enough to convince the hold outs that it’s time for them to make their front door inviting, I guess nothing will.

Meaningful Use: What is it good for? A lot of smoke and mirrors

Posted on November 19, 2010 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.

EHR Adoption Framework_AD

Image by andyde via Flickr

Meaningful Use?  Whoa! Good God y’all! What is it good for?  Very, very little. Sing it again…

OK, maybe it’s the greatest idea in the history of health IT, or maybe it’s a good idea gone terribly, terribly wrong (my theory), but it it’s not going to move hospitals along any faster than they are already toward smart, sophisticated IT use that saves lives.  There are efforts out there that do stand a chance of improving IT use (take your pick from dozens, which I’ll get to in another post), but has anyone provided clinical, social science or other data suggesting that going to MU first was the best way to spend all of this time and money?

After my months-long absence from the blog that I love (<grin>) I’m freshly charged up with looks to me like another major distraction from improving quality.

Here’s my logic: check me  out here and see if you agree. The harder the government comes down on hospitals, the more dust will get swept under the rug.  And when that “dust” is inefficient processes that stand a chance of killing people,we’re not talking any kind of joke here.

Want an idea of why I’m so skeptical?  Here’s a few (why not a  couple of bonuses):

*  Just got off the phone this week with a children’s hospital CEO, who’s found that 20 percent or less of his colleagues are ready for meaningful use.   And check out an Information Week article below, which reports that just 40 percent of hospitals  meet 5 MU criteria. Wow.

*  Why has it suddenly become a priority, in recent years, to automate processes at the bedside before the processes themselves have been perfected?  When Your Editor attended a conference this week on healthcare IT topics, the bedside came up a lot, but not much talk on whether we’ll be running into a GIGO problem.

* Medical groups and hospitals are under great pressure to form Accountable Care Organizations, a new entity for which there are some precedents (decades of capitation) but no clear-cut model.  With doctors and hospitals struggling to create the most basic levels of partnerships, is now a good time to pressure them to form their work habits around their IT investments? Yeah, yeah, they’re suppposed to fund and find EMRs and HIEs that meet their needs but really, how often will that happen?

If you’re a big MU fan, well, I’m sorry if I offended you.  But I’d much rather you flame the heck out of me here so we can have a nice dialogue on the subject. This is important stuff, people.

Tweet roundup: Data loss at Thomas Jefferson, med records found in dump

Posted on August 15, 2010 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.

Happy weekend!  Here’s a group of tweets from the past few days that might be worth a second look.  If you have tweets you’d like to see in our roundup please feel free to share them.

Cheers,

Anne Z.

____________________________________________________________
Tweets for the week of 8/8/10

> @idtexpert #Medical #IdentityTheft Alert: Huge loss of patient data at Thomas Jefferson #University #Hospital in #Philadelphia ; http://bit.ly/dsTWhd

> @drchrono patient med records found in a Boston dump! sounds like yet another good reason to get an EMR: http://bit.ly/bOEPCP #emr

> @hcapr Regional Med Ctr of San Jose Uses Pocket-Sized Handout to Improve Quality Scores: http://tinyurl.com/2cp7ph2 #HCA #hospital #cms #healthcare (Hey, I’m intrigued; how about  you?)

> @ShigeoKinoshita RT @ingagenetworks: 3 ways to increase engagement and revitalize your healthcare system http://bit.ly/98Fe7s #hcsm #health20

> @AndrewPWilson: CDC Gateway to Health Communication & Social Marketing Practice http://bit.ly/b4udxS #gov20 #health20

> @HealthYRc Lone bedbug sends Kings County Hospital ER into fumigation lockdown – #New #York #Daily #News#Hospitals#Health > http://bit.ly/bSFMlS

> @HealthYRc It’s easy to buy babies at govt hospitals – #Times #of #India#Hospitals#Health > http://bit.ly/ddRmdH (ED: Sounds outrageous but check out the story)