News 12/21/17

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Nearly 8.8 million consumers sign up for health insurance at Healthcare.gov during the shortened 45-day enrollment period – a not altogether disappointing 4.4-percent decrease compared to 2016 figures. Enrollment seems to have surpassed last year’s figures in the 11 states that run their own exchanges, and is still going on in New York, California, Minnesota, and Massachusetts. Hurricane-affected states also have extended enrollment periods, leaving final figures in a somewhat nebulous state.

While technical glitches seem to have been minimal compared to previous years, it seems strange that CMS Administrator Seema Verma would offer kudos to CMS staffers for a customer service workload that was for all intents and purposes cut in half. Granted, she did tweet that only 21.5 hours of the 60 allotted were used for website maintenance.

HIStalk Practice Announcements and Requests

HIStalk Practice will not publish the week of December 26th. See you in the New Year!

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information about our production and promotion services.

Announcements and Implementations

Arizona-based NextCare will roll out Solv’s urgent care appointment-booking and check-in app to patients at its 136 urgent care locations across the US. Solv got its start in early 2017 in the Dallas-Forth Worth area. CEO Heather Fernandez came from real estate listings website Trulia.

EnSofTek develops an “Unplugged” version of its cloud-based EHR for providers working in areas without Internet access.

Acquisitions, Funding, Business, and Stock

In New York, Cornerstone Family Healthcare takes over ailing Middletown Community Health Center, transforming it into a multi-specialty medical practice with 16 locations serving 40,000 patients. MCHC had suffered a litany of financial troubles that resulted in an $850,000 loss in 2016, a lapse in employee health insurance, the sudden departure of its CEO, and multiple lawsuits from vendors for unpaid bills. “Inefficient billing software” has been named as a culprit. It seems the center chose SuccessEHS as its EHR/billing software vendor in 2013. Readers may remember that Vitera Health acquired SuccessEHS in 2013 – the same year Vitera merged with Greenway Health, which has vowed to combine all of its technologies into one software solution over the next two years.

Government and Politics

In South Carolina, Governor Henry McMaster declares a public health state of emergency around the opioid epidemic and the formation of an Opioid Emergency Response Team. South Carolina follows Alaska, Arizona, Maryland, Florida, Massachusetts, and Virginia in declaring such an emergency, which will, among other things, reduce acute and post-operative opioid prescriptions for Medicaid patients from 90 to five days and free up emergency management resources.

New data from the CDC shows a decrease in life expectancy for the second straight year – a development researchers largely attribute to the opioid epidemic, and expect to continue for a third straight year. “We really do need to get a handle on this,” says Bob Anderson, chief of the mortality statistics branch at the CDC’s National Center for Health Statistics, “and I hope that this data will be of use to policymakers in formulating something that will take care of this problem.” Anderson is no doubt referring to President Trump’s decision to declare a public health emergency because of the epidemic rather than a national state of emergency, which would free up more money than the $57,000 currently in the government’s public health emergency fund.

Research and Innovation

Based on input from 174 practices, KLAS Research’s latest ambulatory RCM services report highlights Athenahealth, Aprima, and NextGen Healthcare as strong performers, while Cerner and Allscripts suffer declines. Greenway, Athenahealth, and CareCloud are top performers in the small-clinic market.

Other

New data from the Association of Medical Colleges show that women may soon surpass men when it comes to enrollment. Women outnumbered men in this year’s class for the first time in history, making up just over half of the 21,338 people that enrolled this year. Female enrollees have increased by 3.2 percent since last year, while males have decreased by 0.3 percent – stats that have been playing out in similar fashion since 2015. Analysts attribute the uptick in women to more diversity efforts at schools and a broader effort across educational institutions to promote STEM fields. Alas, medical schools are still experiencing an overall decrease in applications, which means the industry overall has quite a job to do in making itself attractive to future professionals.

Shades of health IT?: Keeper Security sues an Ars Technica reporter and the publication for running a story that exposed a vulnerability in its password management software – a story the company contends contained “false and misleading statements.” Industry insiders bristled at the lawsuit, calling it “ridiculous,” a bad precedent for a security firm, and “a dishonorable way to treat a journalist who has covered security for years and takes great pains to get things right.” I can’t recall something similar happening in health IT, other than vendors suing people that brought vulnerabilities to their attention. Perhaps it’s just a matter of time. Keeper’s healthcare customers include Bridgemark Healthcare, Philips, Cornerstone Healthcare Group, and the Robert Wood Johnson University Hospital.

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News 12/20/17

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The FCC identifies nearly 1 million homes and small businesses across largely rural areas of the continental US that are eligible for up to $2 billion for broadband deployment over the next 10 years as part of its Connect America Fund. That money will be awarded to those companies who bid to install the services at lowest cost. “Closing the digital divide is my number one priority,” says FCC Chairman Ajit Pai (who is still suffering fall out from pushing through repeal of net neutrality), “and through this innovative Connect America Fund auction, we are poised to take the next big step in reaching that goal. In rural America, broadband opens the doors of opportunity by connecting remote communities to global markets, jobs, education, healthcare and information.”

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.

Announcements and Implementations

OpenEMR announces availability of its open source Cloud Express EHR on the AWS Marketplace.

B Golden Care Services (TX) selects chronic care management technology from Reliq Health Technologies.

Acquisitions, Funding, Business, and Stock

Veriheal (fka OnePath Medical) will offer online appointment scheduling for its three new medical marijuana offices in Montana. The company, which also has locations in Maryland, New York, and Pennsylvania, also offers a white-label telemedicine solution for providers in telemedicine-friendly states looking to connect patients with appropriate medical marijuana treatment virtually.

PM and EHR vendor ICoreConnect acquires coding and documentation improvement company ICDLogic for an undisclosed sum. This marks the second acquisition for ICoreConnect; it bought IPenMD Solution in 2013 – the same year ICDLogic opened for business.

Government and Politics

As expected, Congress passes the tax reform bill along party lines, including a repeal of the ACA individual mandate. Commonwealth Fund President and former National Coordinator David Blumenthal, MD has penned a summary of the bill’s healthcare implications in the Harvard Business Review. I assume it’s a far easier read than attempting to digest the House and Senate versions of the final bill.

Telemedicine

Just in time for reading over the holiday break, the Center for Connected Health publishes its annual review of state-based telemedicine legislation. Thirty-five states (seven more than 2016), some with multiple entries, are featured.

Research and Innovation

The American Academy of Pediatrics selects Physician’s Computer Company to assist with its research on childhood obesity. PCC has already recruited 18 pediatric practices for the two-year study, and will also manage data extraction and sharing of health data between the practices and the AAP. “So much of what we have to deliver to pediatricians is about a government or insurance requirement,” says PCC Director of Pediatric Solutions Chip Hart, “so we’re delighted to be able to focus on the patients for once. We were also really impressed with our clients’ reaction to this opportunity – they have to do a lot of free work, but they do it because they are pediatricians."

Other

Local public radio looks at the way the delivery of mental healthcare is being reimagined in Austin, TX. Travis County’s mental health agency, for example, has redesigned its bipolar disorder clinic to be more patient-centric. After checking in at the front desk, patients forego the traditional waiting room and are instead escorted to a private, almost apartment-like room equipped with chairs, a couch, and television. Staff come to them instead of patients being shuffled around to different exam rooms. The Austin-Travis County Integral Care clinic has partnered with Dell Medical School on the redesign experiment, which the two groups hope will ultimately lead to more mental health services being provided outside of hospitals.

In her letter to Santa, American Council of Science and Health Director of Medicine Jamie Wells, MD laments the lack of truth in medical advertising, pointing to Theranos, the over-utilization (and sometimes disingenuous) use of the word “provider,” the hype around value-based care, the debacle of EHRs, and the “fix” of interoperability: “Now, interoperability is the latest buzzword,” she explains. “Don’t get it twisted, this is not new, nor is it some breakthrough. It is an attempted fix to the nightmare of EMRs without being honest enough to acknowledge that EMRs were supposed to possess it in the first place. While we are at it, proclaim in their current form that they are little more than glorified billing platforms.”

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News 12/20/17

Top News

The FCC identifies  nearly 1 million homes and small businesses across largely rural areas of the continental US that are eligible for up to $2 billion for broadband deployment over the next 10 years as part of its Connect America Fund. That money will be awarded to those companies who bid to install the services at lowest cost. “Closing the digital divide is my number one priority,” says FCC Chairman Ajit Pai (who is still suffering fall out from pushing through repeal of net neutrality), “and through this innovative Connect America Fund auction, we are poised to take the next big step in reaching that goal. In rural America, broadband opens the doors of opportunity by connecting remote communities to global markets, jobs, education, healthcare and information.”

Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information.

Announcements and Implementations

OpenEMR announces availability of its open source Cloud Express EHR on the AWS Marketplace.

Acquisitions, Funding, Business, and Stock

Veriheal (fka OnePath Medical) will offer online appointment scheduling for its three new medical marijuana offices in Montana. The company, which also has locations in Maryland, New York, and Pennsylvania, also offers a white-label telemedicine solution for providers in telemedicine-friendly states looking to connect patients with appropriate medical marijuana treatment virtually.

PM and EHR vendor ICoreConnect acquires coding and documentation improvement company ICDLogic for an undisclosed sum. This marks the second acquisition for ICoreConnect; it bought IPenMD Solution in 2013 – the same year ICDLogic opened for business.

Government and Politics

As expected, Congress passes the tax reform bill along party lines, including a repeal of the ACA individual mandate. Commonwealth Fund President and former National Coordinator David Blumenthal, MD has penned a summary of the bill’s healthcare implications in the Harvard Business Review.

Telemedicine

Just in time for reading over the holiday break, the Center for Connected Health publishes its annual review of state-based telemedicine legislation. Thirty-five states (seven more than 2016), some with multiple entries, are featured.

Research and Innovation

The American Academy of Pediatrics selects Physician’s Computer Company to assist with its research on childhood obesity. PCC has already recruited 18 pediatric practices for the two-year study, and will also manage data extraction and sharing of health data between the practices and the AAP. “So much of what we have to deliver to pediatricians is about a government or insurance requirement,” says PCC Director of Pediatric Solutions Chip Hart, “so we’re delighted to be able to focus on the patients for once. We were also really impressed with our clients’ reaction to this opportunity – they have to do a lot of free work, but they do it because they are pediatricians.”

Other

Local public radio looks at the way the delivery of mental healthcare is being reimagined in Austin, TX. Travis County’s mental health agency, for example, has redesigned its bipolar disorder clinic to be more patient-centric. After checking in at the front desk, patients forego the traditional waiting room and are instead escorted to a private, almost apartment-like room equipped with chairs, a couch, and television. Staff come to them instead of patients being shuffled around to different exam rooms. The Austin-Travis County Integral Care clinic has partnered with Dell Medical School on the redesign experiment, which the two groups hope will ultimately lead to more mental health services being provided outside of hospitals.

In her letter to Santa, American Council of Science and Health Director of Medicine Jamie Wells, MD laments the lack of truth in medical advertising, pointing to Theranos, the over-utilization (and sometimes disingenuous) use of the word “provider,” the hype around value-based care, the debacle of EHRs, and the “fix” of interoperability: “Now, interoperability is the latest buzzword,” she explains. “Don’t get it twisted, this is not new, nor is it some breakthrough. It is an attempted fix to the nightmare of EMRs without being honest enough to acknowledge that EMRs were supposed to possess it in the first place. While we are at it, proclaim in their current form that they are little more than glorified billing platforms.”

Sponsor Updates

Blog Posts

Contacts

Jenn, Mr. H, Lorre

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.

Contacts

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.

Contacts

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