Readers Write: Patient Relationship Management Key to Attracting (and Keeping) Millennial Patients

Patient Relationship Management Key to Attracting (and Keeping) Millennial Patients
By Jim Higgins

Ask any physician what they think of millennial patients, and you’ll often get a skewed perspective of people born between 1980 and the late 1990s. Compare a typical millennial patient with their physician and you’ll probably find that they use different technologies, have contrasting communication preferences, and have distinctly different expectations when it comes time for an appointment.

For all the good-natured (and sometimes snarky) ribbing they take, millenials are a presence not to be ignored – especially when it comes to their roles as patients. By 2025, they are expected make up 75 percent of the US workforce. As such, their healthcare needs will grow, along with their earning power. And while millennials love technology (more than nine out of 10 own smartphones), they also love personal attention in the healthcare setting.

As millennials influence the marketplace, a physician practice’s success will be increasingly tied to its ability to attract more of this age group. By leveraging new technology platforms to reach millennial patients in compelling ways, healthcare organizations will be in a better position to engage existing patients, improve satisfaction, boost retention — and even save their physicians from burnout.

A Closer Look at Their Technology Habits

As physicians consider the benefits of updating their outreach efforts and business practices to better appeal to millennials, it’s important to first understand this demographic via their love of technology. When it comes to finding a doctor, nearly 88 percent of consumers trust online reviews (e.g. Yelp, Healthgrades) as much as personal recommendations. This research shows that millennial patients find significant value in the testimonials of other patients. In terms of scheduling an appointment with their physician of choice, a majority of adults aged 18 to 24 (63.6 percent) said they would prefer using an online calendar over talking on the phone to schedule appointments. Often times, information comes through social media channels: 87 percent of adults online in the US ages 18 to 29 use Facebook; 53 percent use Instagram; 37 percent use Twitter; and 34 percent use Pinterest.

With a wide range of preferences, it’s no wonder that millennials require a different engagement strategy. Don’t let the stats intimidate you, though; these patients can be loyal consumers once a business has won them over and proven its value.

Reaching Millennials via Patient Relationship Management

Understanding how millennials think is a great start, but only by truly leveraging the right patient relationship management technology will physicians truly be able to target them in a – dare I say it? – meaningful way. PRM technology enables physicians to engage with these patients in a smarter, more personalized way – one that is aligned with their preferences. In doing so, PRM helps a healthcare organization not only attract 20- and 30-somethings, but also engage with patients in a way that will ultimately improve outcomes and retention.

The challenge of engagement is the most pressing issue among providers, who are under more pressure than ever before to seek out new ways to connect with patients between office visits. PRM solutions feature multiple applications, such as appointment reminders and secure messaging. For millennials, text and email is always a better way to connect and ensure scheduled visits aren’t missed.

PRM tools can also help a practice boost its marketing efforts and better monitor its online reputation. For example, a practice could use a PRM tool to dispatch a post-visit satisfaction survey immediately after a patient’s scheduled appointment to gauge how they thought things went went. A practice would then be able to tailor their outreach to those specific patients moving forward. For example, if a patient was not happy with their visit, the practice could offer immediate resolutions before an issue affects a practice’s rating and turns off potential new patients.

The most compelling way a PRM tool sets itself apart from other technology solutions is through its email and social media marketing platforms, which help providers deepen their connection with patients on a regular basis.

Since millennials tend to stay loyal to businesses that they can engage with, leveraging digital technology with the goal of growing great patient relationships helps organizations stay fresh and relevant — while keeping their patients happy.

Jim Higgins is CEO of Solutionreach in Lehi, UT.

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Readers Write: A Proposed Rule Peace Offering: More Regulatory Slack

Proposed Rule’s Peace Offering to Physicians: More Regulatory Slack
By Kerri Wing, RN

Items outlined in the proposed rule for the 2018 Inpatient Prospective Payment System (IPPS) recently released by CMS signal a growing awareness of the need for relaxed regulatory burden in healthcare. The proposed rule seeks to counter regulatory sprawl by realigning various reporting programs around common quality measures, and by actively seeking stakeholder feedback on additional opportunities for reporting program simplification.

While the bulk of the rule relates to hospital reporting programs, proposed changes for eligible professionals are also highlighted. Items in the proposal impacting physicians and EPs include:

• Bringing the EHR Incentive Program (Meaningful Use) reporting period and clinical quality measures into alignment with the Merit-based Incentive Program (MIPS).
• Eliminating MU penalties for EPs using de-certified EHR technology.
• Exempting EPs who furnish “substantially all” of their services in ambulatory surgery settings from MU payment adjustments.

The Meaningful Use / MIPS Crossover

Proposed updates echo the “pick-your-pace” flexibilities extended to physicians under MACRA, which reduced clinical quality measure (CQM) and reporting period requirements for physicians on the quality payment program’s MIPS track. Under the IPPS rule, CMS is proposing to modify the MU reporting period for EPs to a continuous 90-day period during the 2017 calendar year. The rule also proposes that CQMs available to EPs under MU mirror those available under MIPS.

Streamlining that CQM cross-walk should simplify reporting for physicians and specialists participating in hospital programs. It’s nice to see CMS recognize that hospitals are part of the larger hub where data resides, and the value of migrating the industry in unison.

EHR Limitations

From a clinician perspective, the biggest challenge is having the right technology to meet CMS requirements. Providers often struggle to keep pace with reporting periods because regulations often don’t leave EHR vendors enough time to develop the regulatory requirements. The proposed rule would give providers hinged to EHR technology that has been de-certified by the ONC an opportunity to apply for penalty exemption.

Keeping up with ONC certification is a challenge that only so many EHRs can sustain, and market consolidation leaves providers with fewer options. Many providers who have invested heavily in these platforms are at the mercy of their EHR for quality reporting, but the technology is unable to maintain updates needed to keep pace with shifting requirements. The proposed penalty avoidance keeps providers from suffering twice for EHR limitations and offers providers breathing room to evaluate alternative technology solutions. (Though it’s worth noting that although MU penalties may be avoided, certified EHRs are still required for MACRA.)

ASC Exemptions

Many specialty EPs furnish the majority of their services in ambulatory surgery center settings. The proposal to exempt these EPs from 2017 and 2018 MU payment adjustments would eliminate reporting burdens for EPs with limited office time. CMS is requesting feedback on whether to set the “substantially all” ASC threshold at 75 percent or 90 percent of patient cases.

An Industry-wide Rally for Less Regulatory Burden

While the IPPS proposed rule’s impact on EPs is limited, the message it conveys is promising for physicians. CMS recognizes regulatory burdens to be a widespread problem. Offering more of a grace period and relaxed reporting requirements reduces the burden on everyone.

Equally notable is the open invitation to submit feedback on a gamut of issues related to regulatory overhaul. This includes an RFI on topics including but not limited to data sharing, payment system re-design, reporting elimination or streamlining, and how CMS issues regulations and policies. The RFI points to increased opportunities for provider influence and collaboration in assuaging regulation.

Providers interested in weighing in on the RFI have until June 13 to comment. Those commenting should encourage CMS to continue aligning quality reporting programs and further streamline the submission process. Essentially: Do more of what you’re doing right now.

As the industry inches towards a universal reporting program, it behooves both hospitals and physician practices to stay attuned to regulatory changes in inpatient and outpatient settings alike. Additional reporting program crossover is highly probable.

Kerri Wing, RN is director of clinical analytics at IHealth Innovations in Louisville, KY.

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Readers Write: Carrot or Stick? Physician Compensation in Value-Based Cancer Care Delivery

Carrot or Stick? Physician Compensation in Value-based Cancer Care Delivery
By Lucy Langer, MD and Lalan Wilfong, MD

A previous post on re-designing cancer care in the context of the Centers for Medicare and Medicaid Innovation’s (CMMI) Oncology Care Model focused on physician engagement in cancer care delivery redesign and how to create a framework to engage physicians in quality improvement and the delivery of better patient care. In this article, we will discuss considerations around physician compensation when trying to strike a balance between productivity and value in this new care model.

The OCM pilot, which began in July 2016, is an alternative payment model designed to test whether specific changes in the payment for cancer care delivery can result in better care, smarter spending, and healthier people. Under the OCM, physician practices are subject to both financial and performance accountability during episodes of care defined by active chemotherapy administration to cancer patients. Reimbursement in the OCM is fee-for-service, but also includes a per-beneficiary Monthly Enhanced Oncology Services payment. According to CMS, this $160 MEOS payment is intended to assist participating practices in effectively managing and coordinating care for oncology patients during episodes of care. The potential for a performance-based payment is designed to incentivize practices to lower the total cost of care and improve the quality of care for beneficiaries during treatment episodes.

Evolving Models

Physician engagement is an essential component for success in payment models like the OCM. Practices can change physician behavior through the compensation model. Most oncologists are compensated based on relative value unit-generation, and some contain a small, additional bonus or incentive for activities such as supporting leadership roles in the practice. But how will compensation models evolve in the era of value-based care delivery?

New compensation models ought to include:

• Productivity measures.
• Incentives to provide high-quality care and thresholds that are relevant to the practice.
• Visibility and reporting once key quality metrics are included.
• Physician buy-in and full engagement to support the quality initiative.

In the new era of value-based care, practices must determine how to recognize physicians for their contributions to the larger practice’s ability to meet quality and cost-containment targets. This means creating a financial incentive for balancing both personal productivity and practice accountability to improve the quality of care provided.

Real-World Experiences

The US Oncology Network brings together more than 1,400 independent physicians from more than 45 physician-owned practices and over 400 sites of care across the United States, including primarily medical oncologists, radiation oncologists, surgeons, and urologists. We are both part of a committee within the network that has come together to think through and provide guidance as we transition to value-based care. Collectively, this committee has put resources in place to help 14 affiliated practices successfully enroll more than 19,000 Medicare patients (to date) in the OCM. In addition to the OCM, many practices affiliated with our network are participating in similar APMs.

As a result of this level of participation and the potential impact of these programs on each practice’s financials, key questions regarding physician compensation have emerged. For instance, with more than 420 physicians, Texas Oncology is focusing efforts to use a small proportion of compensation to incentivize clinical guideline- or pathways-based treatment protocols. With the implementation of a clinical decision support tool and tying 2 percent of salary to pathways performance, we have seen pathway adherence increase from 78 percent to 90 percent over a one year time frame^*. On the other hand, Compass Oncology, with over 40 practitioners, is pursuing a different model and moving towards implementation of a novel total compensation model that shifts away from RVUs to a “Balanced Scorecard.” The Balanced Scorecard emphasizes three key elements – practice growth, fiscal responsibility, and quality metrics – that identify where physician behaviors can align with practice goals, patient needs, and payer contracts.

Productivity remains an important contributor to the health of a practice, and eliminating productivity from physician compensation entirely would be unwise. By pairing productivity with value and quality goals set at the practice level, we believe that physicians will be more likely to alter behaviors towards a more team-based approach.

The transition to true patient-centric care is the essence of new payment models aimed at reducing waste, enhancing patient services, and optimizing patient outcomes. An engaged physician brings value to the practice by providing leadership as a member of a larger team focused on meeting the patient needs. While the doctor-patient relationship remains central to this care, additional services are recommended to meet the needs of the patient. These include social work and financial counseling to decrease the barriers to receiving care, survivorship and palliative care to address patient symptoms and advance care planning, and triage nursing and advanced practice providers to provide clinical services between physician visits. Physicians should be incentivized and compensated for facilitating effective teams and providing mentorship, education, and leadership to drive practice transformation and success in value-based payment policies.

Metrics, Metrics, Metrics

Practices that participate in the OCM and similar models will be held to reportable metrics that emphasize value. Payments will be made based on performance compared to historical data for our own practices as well as the performance of other practices in the model. Baseline value metric data is available to us through CMMI, and tracking performance to these value metrics is an important element when considering physician incentives.

We believe that by incentivizing performance via novel payment models to address quality metrics and improvements in patient care, we must also ensure this approach fully aligns with our practice culture, values, and goals. Metrics that are widely held to be important in oncology as indicators of ‘best practice’ and high-level care, such as days on hospice, performance to established pathways and guidelines, and patient satisfaction, are under consideration for inclusion in the model.

Carrot or Stick?

Ultimately, in considering how to incentivize and motivate physicians through enhanced compensation models, each practice will have to wrestle with some fundamental questions: Is it better to use a carrot or a stick? How can the practice ensure ‘buy in’ to any major changes in compensation? What are the underlying values and strategic goals that you are trying to achieve? How do we balance productivity and value-based care? While we do not purport to have THE answer to physician compensation in the era of value-based care, it is clear that for our practices, legacy RVU models may not truly reflect physician activities that contribute to success with non-fee-for-service contracts. Each practice will have to customize any compensation formula to fit the practice culture, demographics, and payer contract mix.

Lucy Langer, MD is president of Compass Oncology in Portland. Lalan Wilfong, MD is medical director of quality programs at Texas Oncology in Dallas. Both practices are in The US Oncology Network.

References

¹J Clin Oncol 34, 2016 (suppl 7S; abstr 187)

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Readers Write: Making Cost Estimates Part of the Patient Financial Conversation

Making Cost Estimates Part of the Patient Financial Conversation
By Jim Denny

Imagine bringing your car in for repair and asking for an estimate, only to be told the mechanic couldn’t provide one. You probably wouldn’t leave your car with this body shop; instead, you’d take it down the road to the mechanic that could give you an upfront price. While most consumers wouldn’t get their cars fixed without fully knowing the cost, healthcare organizations still expect patients to agree to treatment without a full understanding of the cost involved. In some cases, this leads people who have serious health issues to delay treatment for fear of how much they will have to spend. The lack of transparency, coupled with the perceived payment inflexibility, causes patients to feel like they can’t control their healthcare expenses.

The reality is many healthcare organizations are not providing cost information to patients, even if they have it readily available. In a recent national survey, 75 percent of provider respondents stated they can share cost estimates; however, less than 25 percent of patient respondents say they requested one at their last visit, and only 16 percent received one without asking for it. These figures indicate that patients may not always be aware that cost estimates are available to them, and that providers may not always offer this information proactively. This represents a missed opportunity to strengthen communication, limit confusion, and set clear payment expectations.

Why the Disconnect?

One of the reasons that organizations may not offer estimates (even if they are capable of generating them) is a concern about reliability. Healthcare organizations often believe that providing potentially incorrect information could be worse than not providing any information at all. However, survey results indicate that patients have a different view, with most expressing that they would appreciate the information even if it is not 100-percent accurate. In fact, nearly two-thirds of respondents would find any estimate, or one that falls within 10 percent or more of their actual costs, to be extremely helpful. This reinforces the point that a less-than-exact figure is still considered valuable. Organizations should not allow this fear of inaccuracy to hold them back, and should look at operationalizing estimates, providing one before a patient asks for it.

Making Estimates Part of the Routine

To enable these discussions, organizations must make sure that the process of generating and sharing an estimate is embedded into operational workflow. If this effort is too cumbersome or takes staff off task, then they are more likely to skip over it — and given the lack of patient awareness that estimates are available, the patient may not know to ask for the approximation if it’s not offered, leading to even less estimates provided to patients.

To seamlessly weave cost estimation into financial discussions, organizations should consider using technology that streamlines the process, making it as easy for staff as pushing a button during registration or during other front-office activities. Not only should the estimate reflect the total cost of care, but it should also involve a real-time eligibility check that determines unmet deductibles, co-pay, and co-insurance amounts, so the organization can provide the patient with as close an approximation as possible of what the patient will owe. The cost estimation technology should be part of a comprehensive revenue cycle solution that allows staff to see the complete picture of the patient’s account, helping them to knowledgeably answer questions if they arise, while further streamlining the billing process for both front- and back-office staff.

Organizations should also train their staff on what the cost estimate conversation should entail and how it fits into the larger financial discussion. Staff should learn about how to encourage patients to carefully review the estimate and ask follow-up questions. Note that these conversations can be difficult and complex, so proper education may involve scripts and role-playing exercises to ensure that each staff member is comfortable with his or her role in communicating information, and is aware of the impact he or she can have on patient satisfaction.

A Key Step in Improving Transparency

Being proactive about cost estimates is not only the right thing to do from a patient experience perspective, but it also may increase the likelihood of payment because the patient has received upfront information that allows him or her to plan for the expense. The more organizations can incorporate cost estimates into early financial conversations, the more clarity they will provide to patients, ultimately enhancing the transparency of the encounter, and increasing the patient’s trust and satisfaction with the organization.

Jim Denny is founder, president, and CEO of Navicure in Duluth, GA.

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Readers Write: Six (Inexpensive) Steps to Better Cybersecurity for Your Practice

Six (Inexpensive) Steps to Better Cybersecurity for Your Practice
By Lance Hayden

Physicians have a lot on their plates. Running a practice means combining the daily requirements of managing a complex business with commitments to patient care and treatment. Factor in the often daunting regulatory and technology environments of healthcare, and one can understand why practices may sometimes feel a bit overwhelmed. It’s no big surprise when physicians worry about how to address cybersecurity concerns on top of everything else.

Recent media coverage has put a spotlight on healthcare security. From large security breaches where medical records were stolen, to frightening ransomware scenarios where entire organizations find themselves in a hostage situation with their systems and data, healthcare providers increasingly find themselves wondering, “Could we be next?”

A typical medical practice also faces budget constraints and limited resources to take on new IT security projects. Many doctors feel they lack the knowledge and skills necessary to fully understand security concerns, much less mount an adequate defense against sophisticated hackers and cyber criminals.

Without the confidence to know they are putting effort and resources into the right areas, too many practices fall back on a wait-and-see strategy, or focus only on the “checkbox security” of minimum compliance standards that can pass an audit but may prove inadequate for defending against determined cyber threats. Unfortunately, apathy can set the stage for an attack, which can be followed by chaos and loss if a practice does gets hit with a security incident.

The good news is that it doesn’t have to be this way. Although many physicians worry that security can only be achieved through expensive technologies or consultants, the fact is that the majority of security incidents are not the result of super hackers working technological magic.

Implement a Healthier IT Lifestyle

Security researchers have found that most attacks are preventable; they take advantage of known vulnerabilities that would have been easy to fix if the affected company had made a better effort. In this way, IT security is a lot like preventive medicine. No physician would be surprised if a patient with unhealthy day-to-day habits eventually developed a more serious condition, and the same applies to cybersecurity.

In this spirit, physicians can “heal themselves” of many cybersecurity problems by simply implementing a healthier IT lifestyle within their practices. None of the six steps below takes a lot of money, or a great deal of IT or security skill. But when they become part of a practice’s business habits, they can go a long way towards keeping a physician’s systems, data, and patients safer and happier.

1. Know What You Are Protecting. Do you keep track of your information and IT systems as well as you manage your pharmaceuticals or medical equipment? Information and IT systems are just as important to the success of your practice. You should take the time to inventory them, know where they are located, and understand your legal, regulatory, and business responsibilities for keeping them secure.

2. Keep Good Backups. In some cases, like ransomware, having a good, current backup can mean the difference between an inconvenience and a catastrophe. Make sure all of your important information is backed up, protected offsite, and regularly tested. If you don’t have the resources inside the practice, contract with a vendor to make sure you are prepared in an emergency.

3. Practice Strong Authentication. Even after decades of knowing better, weak and easy-to-guess passwords are still one of the most common ways that attackers get in. Today, it’s very easy to pick strong passwords you won’t forget by using a password manager. And make sure to turn on two-factor authentication wherever possible; this requires users to enter a code from a phone or another device as well as a password when logging in.

4. Lock Down Your Technology. Don’t make your IT systems an easy target. Keep them current by regularly downloading and installing vendor patches and updates. Avoid running open WiFi networks inside your practice. Turn on WiFi Protected Access 2 (WPA2) in your wireless routers, with strong passwords. Don’t let guests connect to the same networks that the practice uses for business.

5. Develop an Incident Response Plan. The worst possible time to be figuring out how to handle a security breach is in the middle of one. An emergency room wouldn’t wait until the ambulance was pulling in to prepare, and you shouldn’t put off planning for a security incident. Develop a protocol for security breaches, including who’s in charge, who gets called, and what steps get taken and in what order.

6. Make People Your First Line of Defense. Effective cybersecurity requires people, processes, and technology to work. And a “human firewall” can be one of your most powerful defenses against attackers. Devote time to writing good security policies and guidelines, and hold everyone accountable for following them. Policies without training are not very useful, though, so make the effort to ensure everyone understands them and knows what they require. Then, test your users against phishing attacks and other common attack vectors so that everyone is prepared in advance.

Implementing these six habits in your practice can go a long way towards protecting yourself from attack, and none of these activities require major budget expenditures. As with medicine, prevention is the best medicine when it comes to cybersecurity.

Additional Resources

Information and resources are easy to find these days if you want to know more. Check out these public websites specifically set up for small businesses as a starting place:

• HealthIT.gov https://www.healthit.gov/providers-professionals/ehr-privacy-security/resources
• Small Business Administration https://www.sba.gov/tools/sba-learning-center/training/cybersecurity-small-businesses
• Federal Communications Commission https://www.fcc.gov/cyberplanner

Lance Hayden is the chief privacy and security officer of EPatientFinder in Austin, TX.

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Jenn, Mr. H, Lorre

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