Readers Write: Should Your Patients Trust You With Their Data?

Should Your Patients Trust You With Their Data?
By David Thomas

It seems innocent enough. Collect email addresses and birthdays so you can reach out to your most loyal patients on their special day. But where is this data stored? Who has access to it? How is it protected?

In the digital economy, customer experience is paramount. Data lets us deliver a personalized experience in real time. But making the patient record richer and more valuable to your organization also makes it more valuable to others.

Data is the new oil. It’s the fuel powering growth and innovation, and bad actors can’t wait to get their hands on it. Even a seemingly innocuous piece of information such as an email address or birthdate can be used in identity theft. Today, all personal data is sensitive and there’s more of it all the time.

If you’re in the healthcare industry, you handle sensitive personal data about customers, employees, and partners; and you’re about to handle much more of it. As digital transformation expands across new areas of our lives, increasingly sensitive types of data will need to be shared and accessed by more entities, more frequently. We may not mind our ride-sharing service knowing our favorite destinations, but we care who sees our medical, legal, and financial records.

The days when organizations could be casual about personal data are officially over. It’s time to assess the situation and put technologies and practices in place to ensure your patients can trust you with their personal data. Building that trust will reinforce a positive view of your brand, and protect you against the damaging effects a high-profile breach can have on your organization’s reputation.

It’s also a matter of regulatory compliance. All over the world, regulations are evolving to address growing concerns about protecting personal data. Complying can be complicated and consequences for missteps serious. Europe’s new General Data Protection Regulation for 2018 includes fines of up to four percent of global annual revenue. A fine of $10 million on $250 million in earnings is a significant incentive (or penalty, depending on your perspective). Technologies and regulations will continue to change, requiring companies to be vigilant and proactive about protecting personal data.

Find your data

The first step to improving security is discovery. You’ll need to ask a series of questions to determine the extent of the personal data you collect and hold. What types of personal data do you ask for? Where is this data held? What systems and processes handle it? Who has access to it? What security measures are in place to protect it? Which partners need access to this data, and how do they ensure it’s handled securely? How might personal data assets expand in the future?

Craft your data security strategy

For many organizations, data is fragmented and spread across multiple divisions and partners, with varying degrees of security in place to protect it. To prepare for the rapid expansion of data and access that digital transformation is bringing about, you need to craft and implement a strategic plan for governing and protecting personal data. Every partner contract, for example, should spell out requirements for data security standards and practices.

Consult with IT

As marketing becomes more involved with data-driven analytics and personalization, it’s important to look to the IT organization for guidance, expertise, and best practices. The right data protection policies, processes, and training need to be prioritized and fully ingrained in organization functions. At a minimum, baseline security technologies and capabilities such as encryption need to be selected, deployed, and routinely tested.

Choose your partners wisely

Given the complex and dynamic nature of protecting personal data, it makes sense to minimize what you hold. For most organizations, the right course will be to partner with a technology provider focused on streamlining the handling of personal data. Some new API-based services can help deliver the information you need without saddling you with the responsibility of keeping and protecting sensitive data. The right solution should ensure that data is dispersed, not held centrally. It should pull information from authoritative sources. It should depend on permission from the individual for access. And it should be continuously refreshed with the latest updates.

We need these solutions in order to support the expansion of digital business. Last year’sEquifax breach exposed 145 million Americans to identity theft. That was followed by Yahoo’s three billion customer accounts being compromised. Still, significant progress is possible. Equifax not withstanding, the financial services industry has long pioneered leading-edge data security strategies and technologies, making online banking and credit card transactions reliable and secure. Now healthcare is in the personal data hot seat as they transition to digital – so get ready.

New and more serious threats, rising patient expectations, the expansion of our digital lives, and new technologies such as AI and the IoT mean that protecting personally identifiable data will be an ongoing challenge in the healthcare industry. Now is the time to find ways to protect your organization and your patients from data breaches, and to build relationships with the technology partners who can help you implement effective security strategies now and in the future. Giving your patients the confidence to share the details of their lives with you may already be a competitive differentiator.

David Thomas is CEO of data security company Evident in Atlanta.

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Readers Write: Telehealth Essential to Overcoming SDOH obstacles

Telehealth Essential to Overcoming SDOH Obstacles
By Jessica Robinson

A recent industry analysis estimates that 40 percent of clinical outcomes are determined by social and economic factors, while 30 percent are due to patient behaviors, and 10 percent are attributed to the physical environment, such as transportation and housing. That leaves only 20 percent of outcomes that are driven by direct clinical care.

For healthcare providers, that small impact on outcomes may seem discouraging. However, what this finding also shows is tremendous opportunity to explore new care delivery methods that confront the other 80 percent. Telehealth, for example, has the potential to engage patients, change behaviors, and overcome some of these non-clinical factors, which are typically grouped under the social determinants of health category.

Defined as “the immediate and structural conditions in which people are born, grow, live, work, and age,” SDOH can be more efficiently and effectively confronted through telehealth for numerous reasons. One of the most important is that it removes many barriers to accessing physical care. Moreover, when used in conjunction with a population health management strategy and platform that is integrated with the telehealth solution, providers can identify and begin overcoming SDOH challenges.

Starting with the basics

Delivering care to patients at their home through a computer or mobile device is gaining strong acceptance across the country, driven mainly by consumers and employers. A recent survey shows that 77 percent of consumers are interested in receiving more care through telehealth, while 96 percent of employers offered telehealth benefits in their company health plans.

Adoption is also poised to increase among providers. The CMS Next Generation ACO program, for example, recently released a waiver that eliminates current medical facility and geographic restrictions for assigned beneficiaries, allowing them to receive telehealth services from their home. Other new legislation, such as the 21^st Century Cures Act, may also remove those restrictions when Congress reviews a report on telehealth payment policies in 2018.

All of these telehealth trends can help overcome many SDOH obstacles, the most immediate of which are transportation challenges. Allowing patients to remain in their home to receive care eliminates that hardship while also enabling patients with physical limitations — another SDOH challenge — to access care more easily.

Understanding social determinants of health

Determining if a patient falls into a social determinant category that would prevent them from accessing care or adhering to a care plan can be a challenge. However, it may be as simple as asking some pertinent questions during registration at an office visit. For example, asking the patient if they have reliable transportation to and from a provider’s facility is an important question, as is inquiring if their work schedule permits them access to care during typical business hours.

Once that data is gathered, it can be aggregated with medical histories and other clinical information to be analyzed through a PHM platform that helps care managers identify and monitor patients who may need additional support. That insight might reveal that a patient is an ideal candidate for a telehealth-augmented care plan. Regardless, PHM and telehealth platform integration is critical to ensure efficiency and that providers have seamless access to the data they need at the point of virtual care.

Further information can be captured about a patient’s SDOH through a home visit combined with a simultaneous virtual visit. Using the organization’s PHM platform, a care manager can arrange a home visit where a nurse or other clinician can meet with the patient to discuss care plan adherence obstacles and conduct an assessment of the home environment. If needed, that clinician can contact a physician or other specialized healthcare professional through a virtual visit so that the patient can ask questions and obtain needed guidance immediately and with less effort, reducing the risk of unnecessary accidents or potential crisis situations from occurring.

Telehealth care quality

Not only can patients overcome some care access challenges more easily, but many patients report a more positive and meaningful care experience through telehealth. That finding is likely because delivering care through telehealth requires physicians to concentrate on the patient through their computer monitor, which can eliminate some of the distractions of a busy medical facility. That concentration, combined with a limitation to only visual and aural observation, means conversations can be more interactive and engaged. The patient, too, is less distracted and more at-ease speaking to the physician from the comfort of their own home.

Further, telehealth is ideal for high-need patients who may need more regular provider visits. Often, regular encounters with these patients serve as check-ins for vital signs and to see how the patient is doing. Most high-need patients have equipment available in their homes to monitor their vitals, and telehealth allows their provider to touch base on how they look and are feeling, without having to work around space or scheduling restrictions. This streamlined visit opens up providers to spent appropriate time and attention on these patients, while opening up their office space and appointment slots for more crucial or urgent cases.

Above all, strengthening that engagement can overcome SDOH obstacles that are leading patients and providers away from their care goals. When used in conjunction with a PHM strategy that helps identify and align telehealth resources with appropriate patients, ACOs and other clinically integrated networks can achieve the outcomes that distinguish themselves in their respective markets as high-performance organizations.

Jessica Robinson is VP of product management and delivery for The Garage in Orlando.

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Readers Write: Three Key Things Practices Should Do to Prep for MIPS/MACRA

Three Key Things Practices Should Do to Prep for MIPS/MACRA
By Polly Friend, RN

Providers have had two tracks of MACRA to choose from in 2017 – the merit-based incentive payment system (MIPS) and an advanced alternative payments model (APM). Most providers were, by default, placed in the MIPS program, and they put in a lot of hard work to avoid penalties during the uncertainty of MACRA’s first year. In 2018, there will be even more changes as we transition to full implementation by 2019 and beyond. Some of the new regulations for the second year include allowing providers multiple submission mechanisms within the ACI quality and improvement categories; an exemption allowance for practices with less than $90,000 in allowed charges for up to 200 patients in Medicare Part B; and the option of participating in MIPS as an individual or a group, including a new virtual group option.

As adjustments are being made to MIPS, action needs to be taken now, so providers can stay ahead of whatever curveballs are thrown. To some degree, physician practices will need to “build the plane while flying it.” The 2018 second-year rules were finalized on November 2, giving practices lead time to position themselves for success. After months of helping practices design and execute MIPS action plans, we’ve distilled the information gathered into the top three things medical practices can do to get ready for the 2018 MIPS/MACRA landscape.

1. Choose which measures to report on wisely.

Though there are over 270 MACRA measures available, many are specialty-specific, so not all will apply to your practice. Still, narrowing down which ones you will choose to report on can be complex. There are a few ways to approach this. First, it’s important to understand the definition of each measure. When choosing which measures to report on, your practice will be expected to report only on those that are applicable or relevant to the services you provide. For an in-depth look at specific measures that your practice will need to report on, CMS provides a helpful resource library. Additionally, the Early Implementation Review: CMS’s Management of the Quality Payment Program offers valuable insights that can help your practice understand specific MACRA measures.

Once you’ve narrowed the measures down to only those that you could be eligible for, you can turn to your billing data to identify the most frequently reported procedures and diagnosis codes, and look for measures that include those. Another good way of choosing measures is through patient eligibility. Use the analytics tools in your EHR, PM, and billing systems to look at the data of your patient population and identify which measures would apply to them. It’s important to avoid those that have less than 20 eligible cases because they’ll receive an automatic minimum score, regardless of how good your performance is.

When choosing measures for your practice, it’s important to understand not just which ones are applicable to you, but also which ones you can do well with. Setting your practice up for success under the new MIPS/MACRA laws requires some upfront legwork that ultimately will help you mitigate the risk of a penalty and increase your chance of receiving an incentive.

2. Make sure your clinicians are on board.

The shift toward a value-based healthcare system addresses more than just patient satisfaction and practice revenue. There’s also a heavy, albeit indirect, focus on physician burnout. Put simply, when your physicians are overworked and spread too thin, they won’t be able to deliver the best care to their patients. This directly impacts your MIPS score. Before finalizing the measures you’ll report on, it’s important to get your clinicians on board. They will understand better than anyone else which measures are appropriate for them, and which will allow them to best demonstrate the quality of care they provide. Physicians who have gone through rounds of Meaningful Use policies may feel resentment toward this latest set of changes under MACRA.

The ability and willingness of your staff to adhere to value-based care and strive toward the final measures should be weighted heavily. To encourage engagement and ownership, consider having a brown bag lunch session and soliciting ideas for making the transition a success. Another way to engage your providers is to have them brainstorm ways to track and show progress on the measures they’ll be reporting on. For example, they may want to see weekly reports or monthly posters on the practice walls. The way in which your providers want to show progress should be amply supported as another way to encourage participation.

3. Ask your EHR or vendor for help.

Once your entire team is on board with the MIPS measures your practice will report on, you can work with your EHR vendor to determine what documentation is needed. Most will provide you with the support you need so that you can submit the minimal requirements to avoid a penalty, and prepare a plan for next year to achieve the incentive.

One of the most important things your EHR vendor can provide is a guarantee program of some kind. CareCloud offered a 2017 MIPS Guarantee, which ensured clients received full assurance of avoiding penalties during the uncertainty of MACRA’s first year. With the higher threshold of activity that will be required in 2018 and beyond, guarantees like this aren’t as easy to support. Still, you don’t want to carry a double risk by paying for a technology that can’t support your needs while you’re also trying to navigate a program that has a lot of potential for change. Though you may not be able to get a no-penalty guarantee, your EHR vendor should offer some kind of protection on the technology side.

We don’t know what’s ahead with MIPS/MACRA in the year building up to what should be full implementation. Though uncertainty exists, we can still be ready. Taking action now to prepare for pending changes can help your practice mitigate the risk of a penalty and, ideally, work toward earning an incentive.

Polly Friend, RN is senior director of clinical strategy at CareCloud in Miami.

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Readers Write: What Do Patients Want? Digital Convenience, of Course!

What do Patients Want? Digital Convenience, of Course!
By Kermit Randa

The era of healthcare consumerism is here. With it, patients expect the same modern, digital conveniences they receive in other areas of their daily lives. They want easier ways to understand what they owe and convenient options to pay their balances. They also want greater freedom to choose their healthcare providers, and growing numbers of patients are increasingly comparing provider pricing. As a result, healthcare organizations are moving from antiquated payment processes to providing patients with the electronic conveniences they seek.

To that end, MGMA and Navicure collaborated to conduct our first Digital Payment Progress Report survey, where we sought to understand billing payment preferences and behaviors among provider organizations. We then compared some of these findings with Navicure’s Patient Payment Check-Up, conducted by HIMSS Analytics, to assess differences in attitudes and behaviors between patients and providers. The results were intriguing.

In particular, physician practices show some clear advantages over hospitals when it comes to the use of digital billing and payment systems. For instance:

Group practices believe patients are more comfortable sharing mobile/email contact information than do hospitals. In fact, while 64 percent of group practices claim patients are comfortable sharing their email addresses, only 56 percent of hospitals say the same. That may be because providers in smaller group practices have a more personal relationship with the patient than hospital providers. And in reality, most patients (79 percent) are perfectly comfortable providing their email address. Still, 77 percent of providers today send paper bills, which creates incredible opportunity for the industry to leverage email to deliver bills electronically, saving scads of paper, postage, and time, thereby reducing days in A/R.

Patients typically pay their physician practice bills faster. Twenty-six percent of hospital respondents say it takes patients longer than six months to pay their balance, while only 13 percent of practice respondents report it takes this long. Our survey also showed group practices having more success with patients paying at the time of service. That’s likely due to the nature of services offered in a doctor’s office being more predictable, making it easier to provide a cost estimate. And, it’s something practices should take advantage of if they aren’t already doing so.

More ambulatory organizations can provide a cost estimate than hospitals. Nearly 80 percent of ambulatory organizations can provide a cost estimate to patients, while only 69 percent of hospitals can offer one. As previously mentioned, this may be because it’s easier to put a price tag on the services provided in a doctor’s office, which translates into a simpler process for providing an estimate; whereas hospitals may not know the final cost until all procedures/services are completed and the patient is released. But, estimates will become increasingly important — our survey also showed that when patients comparatively shop for services, the results they find make a significant impact on the provider they choose. That’s especially true among younger patients: Seventy-five percent of patients comparing prices are between 18-34 years old. Practices will improve transparency, trust, and satisfaction among their patients if they offer pricing up front.

5 Ways to Put These Findings to Use

While practices may be ahead of hospitals in the areas of cost estimation and electronic billing, they’re still behind when it comes to meeting patient demand. Insights from the Digital Payment Progress Report can be helpful as practices look for ways to address patient billing and payment challenges to help bridge the gap between outdated processes that are holding back progress and patient expectations for electronic payment options.

Here are five things practice administrators can tackle to get started:

1. Review the 5 Ps (people, processes, products, performance, and patients) to uncover where disconnects are in the payment process and develop an action plan to reduce them.
2. Ask your patients. Conduct a short online or informal in-office survey to find out what they’re looking for in payment options.
3. Train your teams. Provide ongoing training to help front-office teams educate patients on payment options, and cross-train the entire office to ensure everyone on the team fully understands the impact their role has on the revenue cycle process and increasing patient satisfaction.
4. Educate your patients. Patients want a quick and easy to read, short and uncomplicated, one-page document that explains their payment options. Make sure front-office staff are able to confidently discuss financial responsibilities with patients.
5. Establish measurable objectives for data and quality metrics. Define, collect, and respond to performance metrics to understand your practice’s revenue cycle goals and whether or not they’ve been achieved.

Ultimately, our survey showed there’s strong need for digital payment options such as patient estimates, credit card on file, online bill pay, and more. It also showed there’s agreement all around when it comes to the impact these tools can have on improving collections, reducing days in A/R, and reducing bad-debt write-offs. As healthcare consumerism continues to expand and the future of billing and payments becomes more digital, practices are well-positioned for success when they can pin-point key areas of improvement and proactively give patients what they want – electronic payments and accurate estimates.

Kermit Randa is chief growth officer of Navicure in Atlanta.

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Readers Write: “Are You Even Listening?” How Your EHR Could Be Killing Your Patient Relationships

“Are You Even Listening?” How Your EHR Could Be Killing Your Patient Relationships
By Jordan Miller, MD

You’re at lunch with a close friend whom you haven’t seen in some time. It’s an opportunity to catch up, share what’s been going on, and participate in some meaningful dialogue. And yet your friend is constantly looking at his or her phone – occasionally glancing up at you as you’re talking as if they are listening. As the person speaking, you can only assume that they’re only half-listening to what you’re saying as they type away. Sound familiar?

A similar scenario is extremely common these days in physician offices. The use of EHRs has been both a blessing and a curse as it relates to patient engagement. In a recent study by Brown University and Healthcentric Advisors aptly titled, “It’s like texting at the dinner table:” A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals,” researchers found the use of EHR systems negatively impacts the quality of physician-to-patient interactions.

The study is based on a 2014 Rhode Island Department of Health survey that asked 744 physicians open-ended questions including, “[h]ow does using an EHR affect your interaction with patients?” The increase in reporting standards and the amount of data that physicians need to report today have resulted in valuable time being diverted from the patient. Instead of the physician and patient maintaining eye contact during the examination, the computer tends to be the focal point. This tends to create an uncomfortable and often cold experience for the patient, and leaves the physician feeling unfulfilled.

This increase in demand for data also attributes to physician burnout* – where the physician works tirelessly to treat patients while keeping up with the day-to-day documentation in the EHR and subsequent reporting. Even the AMA has raised concerns about EHR usability.

While this ripple effect impacts all levels of the healthcare system, it is the patient who suffers the most. With reportedly high levels of physician burnout across the US – between 50 and 75 percent of physicians, by some reports – coupled with poor engagement due to using technology in the exam room, patients get the short end of the stick when it comes to achieving their health and wellness goals.

Shouldn’t medical professionals work as efficiently as possible while improving patient outcomes? With the shift to value-based healthcare and the focus leaning now more on patient outcomes, the answer should easily be yes. But, as we’ve seen from many studies, it’s not that simple. But it should be.

Technological advancements today have positively impacted so many industries, including healthcare (e.g. connected devices, robotic surgery), so why is some EHR technology still lagging?

As a practicing dermatologist, I can attest to the ever-increasing need to document patient information in a way that is usable. If physicians don’t have the right systems and technology in place, it could potentially take a lot time and effort to not only keep a practice up and running, but also make it successful. For years, documenting in a paper chart was the standard, and some physicians still prefer this method. Then it transitioned to what was essentially documenting in a word processing system on a desktop computer. In neither situation is the data collected in a structured way or able to be used for medical wisdom, or collecting and extracting this data to show the physician statistically what might lead to better patient outcomes. Plus, with these methods I had to frequently stay late in the office and bring work home – taking time away from the patient, and from my family.

Throughout my conversations with other healthcare providers, I’ve learned some physicians argue that improving patient relationships starts with the creation and adoption of intuitive technologies that can automate key administrative tasks and simplify documentation during patient visits. Healthcare providers should have an EHR system that improves their daily professional lives and, when it comes to usability, is intuitive and knowledgeable about my specialty, plus saves me time.

In fact, in the aforementioned survey, doctors did recognize that EHR systems can provide benefits to patient interaction related to the easy access to a patient’s history. Other physicians commented that Web-based patient portals improve communication with patients, and some shared that they will often utilize their computers to bring up and display educational illustrations of medical conditions. From the study, it can be assumed that the physicians who bring their EHR system and laptops – or iPads – into the exam room have identified ways to turn a potentially detrimental patient engagement situation into a positive one.

I like to think that I’m a perfect example of a physician who utilizes EHR technology that not only saves physicians time, but also helps improve patient outcomes. Today I use a native iPad platform that’s intuitive, automatically adapts to my preferences, collects structured data, codes patient encounters using the touch-based system and automates outputs. I can reference a longitudinal visual timeline of a patient’s diseases and treatments, allowing me to easily determine if a patient’s conditions are improving or declining over charted time periods. The mobility of the iPad allows me to show my patients exactly what I’m reviewing and use it as an educational tool. It’s technology designed to improve patient engagement and clinical outcomes. Everyone wins.

From a business standpoint, data-driven platforms help make practices more profitable and save time. Health IT systems should allow physicians to document exams while the patient is in the exam room, use that data to automate reporting, automatically generate billing codes with modifiers based on your notes, show your current billing level in real time, and assist with daily operational tasks including referring physician letters and faxes. As precision increases, so could profits. Technology should improve operational and financial outcomes, while at the same time improving patient access and outcomes – and yes, even eye contact.

*If you’re a physician or medical practitioner experiencing signs of physician burnout, there are many helpful resources on the American College of Physicians website.

Jordan Miller, MD is a dermatologist at Northern Arizona Dermatology and senior medical director of dermatology at Modernizing Medicine in Boca Raton, FL.

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