News 12/19/17

Top News

Technology-enabled physician ACO company Aledade raises $23 million in a thus far hush-hush funding round, bringing its total raised to nearly $98 million since launching in 2014.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

ChenMed will expand its primary care services for seniors to four additional cities next year, and welcome back former president Jeffrey Kang, MD as a board member.

Announcements and Implementations

Chronic disease management technology company Cliexa develops several new behavioral health apps for PCPs and family medicine physicians. The apps, which focus on reproductive health, mental health, and substance abuse, leverage assessment technology from Preventative Technology Solutions.

Pulse Systems includes real-time billing analytics and enhanced reporting capabilities in the latest version of its PulseCloud EHR/PM/RCM software.

Northern Ohio Regional Cancer Center selects oncology care coordination technology from Appian360 Healthcare Innovations.

The Florida Association of ACOs will offer its members patient engagement and management technology from Care Angel, including AI-powered virtual nurse assistant capabilities.

People

Beth Pausic (Big White Wall) joins InfoMC as VP of clinical solutions.

Anesthesia and pain management services company PhyMed Healthcare Group hires Stephen Lorenz (Clinicalign) as EVP of operations and strategic development, and Stephen Mason (Managed Care Advisory Group) (not pictured) as VP of operations.

Health Initiatives Consulting adds Russ Kolski, RN, (Ingham Community Health Centers) as VP of clinical and operational transformation, and Senely Navarrete (SN Health Solutions) as VP of practice transformation.

Former Acting HHS Secretary and National Coordinator Karen DeSalvo, MD will join Dell Medical School at The University of  Texas at Austin as a professor in the fairly new school’s Primary Care and Value-Based Health Division. Her tenure will include a primary appointment in the school’s Department of Internal Medicine and secondary appointment in the Department of Population Health.

Other

Two years after a huge natural gas leak, accountant and local activist Andrew Krowne develops an app to help fellow residents of California’s San Fernando Valley report and track symptoms that he believes may be tied to the local underground natural gas storage facility. The Environmental Health Tracker app already has 130 users and 2,000 reported symptoms – data that Krowne hopes will eventually be used to close down the facility.

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Jenn, Mr. H, Lorre

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From the Consultant’s Corner 12/19/17

Revenue Integrity – A Critical Factor for Revenue Cycle Success

Most healthcare organizations recognize the need for improving the efficiency and effectiveness of their revenue cycle operation. Efficiency refers to reducing the operational costs associated with billing and collections. Staffing and systems are the major expense categories. Effectiveness relates to maximizing cash collections and improving the timeliness of which that cash is collected. Revenue Integrity adds a third dimension to the discussion of revenue cycle performance. Revenue Integrity refers to the thoroughness, timeliness, and accuracy of the charge capture and coding processes.

An effective revenue integrity program ensures that every billable clinical activity is properly captured, coded, and billed in a timely manner. This starts the process by which clinical services are converted into cash.

The benefits of a revenue integrity program include:

• Reduction in lost or missing charges resulting in enhanced charge volumes.
• Reduction in charge and claim lag resulting in accelerated cash collections.
• Improved clean claim rate resulting in reduced costs of collections and accelerated cash collections.

Traditional revenue cycle operations have historically been split between “front-end” or patient access-related activities (i.e. registration, scheduling), and “back-end” billing and A/R management functions. A revenue integrity program incorporates clinical workflow, and the actions and concerns of physicians and nurses into the revenue cycle. Clinical documentation, diagnostic and procedural coding, and the submission of charges are all generated within the clinical workflow, yet performance often appears on back-end revenue cycle reports. The result too often is that accountability falls on the billing office, yet the real performance improvement opportunity rests outside of a billing director’s direct control. Engagement of clinical staff into the overall revenue cycle truly integrates clinical operations and financial performance, assigns accountability to the proper source, and provides appropriate and actionable education to capitalize on improvement opportunities that benefit the entire organization.

As revenue integrity programs have matured, revenue cycle and financial leadership have incorporated new Key Performance Indicators to monitor the integrity of their revenue. These metrics provide a more granular analysis of common measures such as denial rates and A/R days, in order to address performance improvement opportunities directly at their source. Examples of metrics used to measure revenue integrity performance include:

• Medical Necessity Denial volume and charges.
• Charge lag and claim lag, and the degree of manual intervention to resolve pre-bill coding and claim edits.
• Discharge Not Final Billed.
• Documentation that supports 100 percent of all charges.

As referenced earlier, monitoring these indicators would be a fruitless exercise if physicians and nursing staff were not engaged in the process. Billing managers alone would have minimal ability to reduce medical necessity denials resulting from lacking diagnosis information. Reviewing this information with physicians, informing them of the financial impacts of lacking information, and engaging the EHR teams to optimize clinical documentation tools would be a much more effective approach that benefits all parties, including the patient.

To develop a sustainable revenue integrity program, or to improve the effectiveness of an existing RI program, I recommend the following activities:

• Define goals, objectives, and scope for the program.
• Develop a project plan.
• Track and implement the project plan.
• Design the organizational chart, with resource requirements.
• Define roles, skillsets, and workflows within RI.
• Create relevant RI job descriptions for human resources.
• Identify and acquire tools needed for the department’s optimal performance; e.g. software coding references, library of coding books.
• Develop RI workgroups and a steering committee to include key leaders from IT, clinical operations, compliance, RCM, and finance. (Depending on specific objectives, you may want to include RI SME’s and analysts.)
• Identify and train RI charge capture resources (Charge Guardians) by departments and/or clinical product lines.
• Develop best practice RI policies and procedures, to be reviewed annually and revised as needed.
• Define baseline benchmarks and performance indicators to measure and trend performance over time.
• Develop and implement RI training program content and timelines for RI analysts and auditors.

Brad Boyd is president of Culbert Healthcare Solutions.

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News 12/18/17

Top News

An Atlanta business paper updates a story it published on Greenway Health’s layoffs last week, clarifying that the EHR vendor is only closing its Atlanta offices but will keep its Carrollton, GA offices open. Five hundred Greenway Revenue Services employees and those with other customer-facing functions will continue their work in Carrollton. The company will also hire another 100 RCM employees for that location in the next few weeks, and is hiring for its Tampa office.

Not to be deterred by conflicting layoff reports, the company announces top KLAS ratings for ambulatory RCM services among small clinics.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock

Denver-based house call company DispatchHealth brings its app-initiated services to Las Vegas. The company has raised nearly $35 million since launching as True North Health Navigation in 2013. Co-founders Mark Prather, MD and Kevin Riddleberger both seem to have spent overlapping time at ITriage, a consumer healthcare app acquired by Aetna in 2011.

Not to be outdone by the mega mergers of their hospital peers, Florida-based Primary Partners and Central Florida Affordable Care merge to form an independent group of 90 PCPs.

Net Health’s management team will acquire the specialty-focused EHR company alongside financial partners Level Equity and The Carlyle Group. Terms of the deal were not disclosed. Net Health CEO Anthony Sanzo spent 11 years prior heading up TeleTracking Technologies.

Government and Politics

Texas practices in areas impacted by Hurricane Harvey will not be subject to MIPS penalties thanks to the successful lobbying efforts of the Texas Medical Association.

Per the 21st Century Cures Act, OCR launches several new resources to help providers and patients better understand HIPAA and its role in sharing and protecting a patient’s mental and behavioral health information.

Telemedicine

An Australian nurse becomes his own patient when he begins experiencing chest pains while manning a telemedicine clinic in the remote area of Coral Bay. After calling an ambulance and prepping his own adrenalin and shock pads, he called in to a physician in Perth using the Emergency Telehealth Service. Bea Scichitano, MD was on her first ER shift when she took the video call. “I think it probably took me a few seconds to cotton on to the fact that he was the nurse and the patient at the same time,” she said, “so that was a bit of a shock.”

Other

No spoilers please: While I haven’t yet seen The Last Jedi, I am relieved to know that astronauts aboard the International Space Station will receive a digital copy they can watch via laptop or their on-board projector. Fun fact: The ISS has a digital library of over 500 movies (yes, including 2001: A Space Odyssey).

NHS researchers highlight the need for easy-to-understand patient educational materials when it asks nine year-olds to write up leaflets explaining the before, during, and after of hip surgery. Turns out statements like “Your hip is old and rotten” and “Coca Cola, fries, and chocolate are not allowed before surgery” are easier for patients to understand than the reading proficiency level used to write most patient-facing health pamphlets. Healthcare facilities in the US have also faced their fair share of health literacy miscommunications, with the HHS calling low health literacy levels an ongoing public health priority.

Bellevue Family Practice (NE) staff members get in the holiday spirit with an office decorating contest. I’d love to highlight more festive office spaces. Email me holiday-themed photos from your or your customer’s practice for inclusion in a post later this week.

Contacts

Jenn, Mr. H, Lorre

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Population Health Management Weekly Wrap Up 12/17/17

The Chartis Group adds Carol Chouinard (Deloitte) as director of IT strategy and Tonya Edwards, MD (Impact Advisors) as a principal and member of the company’s Physician Leadership Institute.

Pennsylvania-based Penn State Health and Highmark Health cite development of advanced population health management capabilities, analytics, and care models as among the reasons they will pursue development of a $1 billion healthcare network that will see Highmark move under the PSH umbrella.

ApolloMed and Network Medical Management complete the merger they announced in December 2016. ApolloMed CEO Warren Hosseinion, MD and NMM CEO Thomas Lam, MD will become co-CEOs of the combined company, which will operate under the ApolloMed name.

The Medical Society of Delaware chooses HealthEC’s population health management system and services for its 900-doctor clinically integrated network.

Social determinants of health-focused care coordination technology vendor Healthify acquires community services software company Purple Binder. Healthify co-founders Eric Conner and Alex Villa graduated the startup from the Blueprint Health accelerator in 2013, and raised $6.5 million in a Series A funding round led by BlueCross Blue Shield Venture Partners last summer.

Wellness for Life will leverage Vital Incite’s population health analytics to help its workplace health centers and direct primary care clinics better understand and act on patient healthcare utilization patterns.

Population health management software vendor VirtualHealth raises $7 million in a Series B funding round.

Philips acquires Netherlands-based, 200-employee population health management software vendor VitalHealth Software, co-founded by Mayo Clinic and Noaber Foundation in 2006. The company expands the informatics work Philips started with its acquisition of Wellcentive in 2016. Philips acquired Netherlands-based interoperability software vendor Forcare last week.

To better serve its Medicaid members, Care1st Health Plan Arizona will leverage Equality Health’s CareEmpower care coordination technology and SDOH-focused services.

Citing an inability to come to agreement terms, Evolent Health decides not to purchase the insurance arm of Premier Health (OH) as announced last month.

Population health management systems vendor SymphonyCare acquires Influence Health’s Empower patient portal business.

In Maryland, the Howard County Health Department leverages Healthify’s SDOH-focused care coordination software as part of its new CAREAPP (Community Access to Resources via Enhanced technology Applications for Providers and Public) project.

A six-month chronic disease management pilot study conducted within the Massachusetts General Hospital primary care network finds that care improved more when specially trained population health coordinators with access to clinical registries were a part of the primary care team.

Sponsor Updates

• AdvancedMD is named a leader in Gartner’s “FrontRunners for Mental health” quadrant.

Blog Posts

• Fighting Cancer with CAR T and Big Data (Medicomp Systems)
• How Haitian high schoolers made me a better healthcare consultant (Nordic)

Contacts

Jenn, Mr. H, Lorre

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News 12/14/17

Top News

Arizona Attorney General Mark Brnovich’s office will oversee the settlement of a lawsuit against Theranos brought under the state’s Consumer Fraud Act. Over 75,000 Arizona residents who received lab-testing services from the now defunct company between 2013 and 2016 will receive checks for about $60. Theranos will also pay $200,000 in civil penalties, $25,000 in lawyer’s fees, and will be subject to civil penalties. As readers may remember, Theranos went down in flames after a series of Wall Street Journal investigative articles prompted CMS to revoke its operating rights. The company admitted earlier this year that it’s lab didn’t deliver all that was promisedx.

Announcements and Implementations

Coinciding with its first anniversary, mobile health app collaborative Xcertia releases draft guidelines for app quality, safety, and effectiveness. Comments are due by the end of January. I’m still a little fuzzy on the value of such guidelines, other than as a branding/marketing tactic app developers will use in a fashion similar to “Energy Star” (though that at least is backed by a governmental body.) Xcertia seems to be doing its best to avoid using the word “certification.”