HIStalk Practice News 10/3/16

Top News

Time to decorate those firewalls: President Obama declares October “National Cybersecurity Awareness Month” in light of the exponentially increasing number of industry-agnostic cyberattacks over the last several years. Data breaches in healthcare rang in at 112 million records last year, and show signs of keeping up with that figure as the last half of 2016 gets into full swing. I’m willing to bet greeting cards commemorating the month are not far off.

HIStalk Practice Announcements and Requests

My nearly week-long excursion in the Smokies was both relaxing and physically challenging. (If you’ve ever hiked – and then climbed – to the Chimney Tops and hit the hot tub afterwards, then you’ll understand where I’m coming from.) I missed National Health IT Week festivities, but am back in the news-gathering saddle just in time for National Primary Care Week, which seems to focus mainly on helping medical school students understand the importance of this increasingly understaffed and underpaid profession. I’m sure the #NPCW tweet stream will have some interesting resources to share over the course of the week.

A big thank you to the authors and physicians who stepped in with content while I was out of the health IT loop. Check out their contributions:

• DOCtalk with Dr. Gregg: Vendor Apologies Work
• Readers Write: Improving Clinical Documentation Through Better Physician Engagement
• 5 Questions with Shawn Purifoy, MD Malvern Family Medical Clinic
• 5 Questions with Gary Singer, MD Midwest Nephrology Associates
• Readers Write: Population Health Must-Haves for Primary Care

Finally, MGMA is just a few weeks away, which means it’s time to start putting together the annual MGMA Exhibitors Guide. If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and I’ll include your company in our downloadable attendee guide.

Webinars

October 13 (Thursday) 2:00 ET. “Glycemic Control During Therapeutic Hypothermia.” Sponsored by Monarch Medical Technologies. Presenter: Tracey Melhuish, RN, MSN, clinical practice specialist, Holy Cross Hospital (FL). Using therapeutic hypothermia (TH) as a method of care can present risks of hyperglycemia, hypoglycemia, and blood glucose variability. Maintaining safe glucose levels during the cooling and rewarming phases of TH reduces the risks of adverse events. Tracey Melhuish, author of “Linking Hypothermia and Hyperglycemia,” will share best practices for optimal glucose control during TH and the success Holy Cross Hospital sees while using a computerized glucose management software.

Contact Lorre for webinar services. View previous webinars on our HIStalk webinars YouTube channel.

Announcements and Implementations

The Central Virginia Coalition of Healthcare Providers, an ACO serving patients in Virginia and North Carolina, selects chronic care management software from Smartlink Mobile Systems.

New York City-based urgent care chain CityMD signs on for referral management technology from Par80.

Brevard Eye Center (FL) implements Compulink’s Ophthalmology Advantage EHR and PM technology.

People

Mark Wilhelm (Aramark Healthcare) and Andrea Velasco (Greenway Health) join Specialdocs Consultants as executive directors of business development.

Al Knowles (Dynamix Healthcare Innovations) joins Scribe as VP of coding, RCM and PM.

Telemedicine

Physician practice marketing company Officite will offer customers access to SkyMD’s teledermatology services.

MarijuanaDoctors.com adds telemedicine capabilities to its resources for physicians and patients looking to offer and access medical cannabis services.

Government and Politics

Rhode Island announces 100-percent enrollment in its PDMP, created via legislation in 2014. The local news, however, reports that utilization is less than 25 percent. Health department officials plan to improve this number next year by working with providers to connect their EHRs to the PDMP for more streamlined access.

AHRQ and CMS award $13.4 million to six grantees associated with the National Committee for Quality Assurance, Seattle Children’s Hospital, Children’s Hospital Corp., and several universities to study the feasibility and usability of newly developed pediatric quality measures at the provider, payer, and state levels.

Research and Innovation

A Black Book survey of 2,000 independent practices and 200 hospital-based practices paints a rather bleak picture when it comes to physician preparation for value-based care models. A few stats:

• 96 percent of practice managers report inefficient billing processes.
• 97 percent of practices experience high business staff turnover.
• 95 percent of practices with less than five physicians believe themselves to be “not tech savvy.”
• 90 percent of practices identify as unprepared financially and technologically for the transition to value-based care.
• Physicians gave Cerner and Navicure top marks in RCM outsourcing services and end-to-end tech and software, respectively.

Other

The local paper profiles the patient-centered medical home journey of Pediatric & Adolescent Health Partners. With the assistance of Anthem, the 40 year-old practice underwent the transformation in about 12 months. Founder Ted Abernathy, MD says that staff satisfaction has gone up despite the additional workload. Technology seems to have played a minor part in the practice’s move to a more value-based care model. Most interesting to me is the addition of discussions around social determinants of health: “Everybody was uncomfortable,” Abernathy says of having to ask patients about barriers to good health in their homes. “Everybody’s still a little uncomfortable. Until you get that first parent that says, ‘Yes.’ It’s easy when they say no, but what happens when a mom says she doesn’t have enough food? We’ve had to build a system of resources that we can call.”

A new kind of news: Vitenas Cosmetic Surgery issues a press release to announce the practice has received 2,000 online reviews – “an exciting achievement few plastic surgery practices ever accomplish.” I suppose the announcement speaks to the social media saviness of the practice’s staff, but it also gets into the murky waters of incentive reviews. Are staff pushed to persuade patients to leave them? Are patients compensated in some way? Readers, feel free to weigh in on your personal/professional experiences with online reviews.

Sponsor Updates

• PerfectServe will exhibit at ANCC 2016 October 5-7 in Orlando.

Blog Posts

• Need help meeting your 2016 goals? Finish the year strong! (Nordic)
• Nordic’s 5th annual Open House Recap (Nordic)
• Who’s Ready for MACRA/MIPS? Why Aprima Is, of Course! (Aprima)

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Contact us online.
Become a sponsor.

Readers Write: Population Health Must-Haves for Primary Care

Population Health Must-Haves for Primary Care
Three critical priorities as value-based care moves closer to home
By William Gillespie, MD

Value-based care is progressively becoming reality for primary care practices. Some, for example, have just considered participating in Comprehensive Primary Care Plus (CPC+), a new reimbursement model CMS calls the “largest-ever multi-payer initiative to improve primary care in America.” While the stated aim is to give doctors more control over care delivery, at its core the model is simply data- and incentive-driven population health management.

In response to such initiatives, providers are actively seeking best practices for managing their patient populations. Yet the quest for guidance poses its own fundamental challenge: Despite the endless industry buzz about population health management, fully tried-and-true best practices are still emerging. That makes it tough for primary care providers who must learn how to “quarterback” patient care at a practical level, despite ever-present manpower and resource shortages that often seem to put proactive care coordination out of reach.

However, with infrastructure and workflow designs that leverage existing data, primary care providers can realize the advantages of a sustainable population health management initiative built on these three fundamental components:

1. Stratify clinical condition within your practice population.

Managing value-based reimbursement begins with an understanding of the inherent risks within your patient populations. Practices have to identify their highest-cost, highest-risk patients — such as those with chronic conditions or complicated, comorbid conditions — to accurately predict the clinical and financial risk they face.

Armed with clinical condition stratification information, care teams can help practices minimize both clinical and financial risk by devising tailored plans to close gaps in care, manage medication adherence and heighten patient engagement. What’s important to recognize, though, is that you likely lack this crucial visibility whether or not your practice has an EHR.

While EHRs provide a nice starting point for collecting and accessing data, many don’t have the analytics capabilities needed to effectively stratify populations based on clinical condition. Acquiring this actionable intelligence, which can help capitalize on your EHR investment, requires infrastructures that overcome barriers to data exchange.

2. Stratify current and future risk.

Once a practice understands patient clinical conditions and associated risks, the next priority is preventing healthy patients from developing chronic conditions. A chronic condition equates to treating a problem that’s already arisen. The question is, how do you prevent that from happening in the first place?

The answer, again, is visibility; this time into those patients who are displaying the tell-tale signs of clinical decline. For instance: Which patients are gaining weight? Which are coming into the practice more often? Which have an increased number of complaints?

Rules-based infrastructures that track and monitor key indicators like these can enable practices to identify patients at risk of progressing toward undesirable co-morbidities and potentially chronic (and costly) clinical conditions. Through risk stratification, practices can more effectively utilize resources to prioritize treating these patients, driving down the cost of care while improving clinical outcomes.

3. Invest in your patients between and outside of office visits.

Patients spend very little time face-to-face with their doctors and care teams — even if they have, or are on the road to having, a chronic illness. What happens to patients between visits? Although it has a direct bearing on outcomes, providers historically have lacked this critical information. To thrive under value-based care, this must change.

Mobile communication can make a dramatic difference in health status and cost by allowing patients to easily engage with care teams, nutritionists, therapists, and other support systems. For instance: A care team interacting with a patient on a regular basis might determine that connecting the patient with transportation assistance increases the likelihood of care plan follow-through. This can also ensure that when patients do need care, they come to the practice rather than defaulting to an expensive emergency department. Ultimately, providers must have ways to extend care delivery outside the walls of their practices to control clinical outcomes and limit cost.

As reimbursement models and government mandates push population health forward, the real question for primary care providers is how to make the transition practical. Practices can start by embracing infrastructures and workflows that stratify clinical conditions, stratify risk, and strengthen patient communications. By focusing on these three “must-haves,” primary care providers can become elite quarterbacks for their patient care teams.

William Gillespie, MD is EVP of population health and CMO at Medecision in Philadelphia and Dallas.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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5 Questions with Gary Singer, MD Midwest Nephrology Associates

Gary Singer, MD is the owner of Midwest Nephrology Associates in Missouri. The practice, which uses EClinicalWorks and PHR technology from Healow, achieved Stage 2 of Meaningful Use last year and is still actively participating in the program. It employs three physicians, one NP, one practice manager, and five staff members to care for an average of 25 patients each day. As an EClinicalWorks customer, the practice will be able to take advantage of the Carequality Interoperability Framework, which will enable it to exchange data with practices using participating EHRs.

How do you foresee the Carequality framework aiding in your practice’s ability to share health data with other providers?
The Carequality framework will provide significant improvements, specifically allowing organizations utilizing Epic to directly access our progress notes, eliminating the time consuming process of faxing. The process will save time and increase efficiency.

What are your thoughts on vendors opening up the Carequality network directly to patients?
Although I’m certain patients will widely accept and adopt the patient portals on the Carequality [framework], security has to be the highest priority.

Do you think your patients will take advantage?
Yes, specifically the older population. More than ever, people are wanting to be in control of their health and in turn, request access to their medical information. By providing patients access to the data via Carequality, it will finally give them the control they desire and deserve.

In your experience, what barriers do physician practices most often face in their interoperability efforts?
Located in southern Wisconsin, we are a small private practice surrounded by numerous hospital-owned organizations. Unfortunately, like many organizations, our systems don’t communicate and the cost of building interfaces is prohibitive to us. Once more practices adopt interoperability, we will have the ability to communicate, exchange data, and better serve our patients.

Who do you see as the biggest driver of interoperability efforts – the government, vendors, providers, or patients?
While providers and staff should be the drivers for universal adoption of interoperability, in reality the EHR vendors are driving the change. The answer should be providers, but I think it is vendors who want to facilitate interoperability between clinical systems in community-wide settings.  Providers have similar goals, but are uncertain as to how to begin the process.

How do you anticipate greater interoperability will impact patient satisfaction, access, and outcomes at your facility?
As adoption of interoperability increases, I believe patient satisfaction will improve immensely. It will increase patient safety, security and well-being, and improve their overall quality of care. 

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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5 Questions with Shawn Purifoy, MD Malvern Family Medical Clinic

Shawn Purifoy, MD is the owner of Malvern Family Medical Clinic in Malvern, AR. With the help of two NPs, a dozen full-time staff, and two part-time employees, the clinic cares for an average of 70 to 100 patients per days depending on the season. The clinic, which is an EClinicalWorks shop, is working on the first year of Stage 2 Meaningful Use, has applied for the Comprehensive Primary Care Plus program, and is also participating as a PCMH in the Arkansas Medicaid program. The clinic recently signed on to join Aledade’s first ACO in the state.

Why did your practice decide the time was right to participate in an ACO?
As an independent practice in a small town, we have been very worried about the changes in healthcare delivery, as well as the new requirements on the horizon. It is my intention to remain independent for as long as possible. We knew that we needed a support system including a way to better utilize our own practice data, and I did not want to partner with a hospital. It seemed like joining an ACO was the natural fit for us. This is our first ACO experience.

Why did you decide to partner with a third party like Aledade, rather than building it out on your own?
I think trying to coordinate with other practices without some entity to manage the data, as well as the personalities that go along with multiple medical practices, would be extremely difficult at best. In our case, we had absolutely no experience in this arena, and I would not have even considered taking on the task of learning the ins and outs of being a part of an ACO without the help of outside expertise.

What role will the Arkansas Foundation for Medical Care play in the ACO?
The AFMC has been a blessing for us on many levels. They provide us with an onsite practice transformation specialist who comes to our office on a weekly basis. She assists us in making the transformation from a totally fee-for-service model to a more accountable care-type system by working directly with my office manager, clinical care coordinator, and myself. AFMC offers training and support while aligning our efforts with other programs we are working on. They play a key role in helping us manage a steep learning curve, and I really don’t know if we would have been able to succeed without their assistance.

What goals does your practice have for its ACO participation?
We want to help the ACO achieve savings, but honestly, we did not join with the intention of making money. We felt that joining was our way to learn the skills we will need to be able to survive in a new world of medicine. We are striving to use the tools that Aledade provides in order to better understand our patients and their needs. We hope to be able to provide smarter and more focused care for our patient population. I believe that if we make our best effort to adopt the advice that we are getting from Aledade, we will not only accomplish these goals, but probably also be able to save money as well.

What technology benefits are you most excited about with regard to setting up and running the ACO?
Aledade has made a wonderful app that assists us on a daily basis. It targets high-risk patients, frequent ER users, and patients who have been admitted to the hospital. We can use this information to contact these patients and get them into the office for follow up. We can also see exactly what charges have been applied to the patient, and we can drill down to actually see which physicians and specialists have billed the patient. More importantly, I can use this information to compare specialists and how they are charging the patients. This can potentially help me to identify duplicate tests and unnecessary procedures. All of this helps me be a more effective primary care provider for my patients.

They have also been very responsive to all of the physician and staff suggestions for improving the app as it has been used, and I am excited about how this will help streamline much of the work that primary care practices are now required to do. I wonder sometimes if other independent practices will be able to make it without this type of support. I certainly don’t believe my practice would be able to do it, and I’m very thankful for the support they’ve given me.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Readers Write: Improving Clinical Documentation Through Better Physician Engagement

Clinical Documentation Through Better Physician Engagement
By James Fee, MD

As a physician, I am passionate about bridging the gap that often exists between clinical documentation improvement (CDI) specialists and the medical staff. Collaboration between the two groups is becoming increasingly important as we shift to a value-based system. This is true for both physician hospital documentation and office notes.

For example, CDI programs are being asked to expand their focus beyond case mix to include documentation improvement opportunities across the care continuum — including ambulatory, physician practice, and post-acute care. Likewise, more physician practices are looking to CDI specialists to maximize efficiencies in the revenue stream and ensure accurate quality report cards through better clinical documentation. As CDI teams work to collaborate with physicians in ways they never have, there are some definite rules of engagement and workflows that will prove effective for both sides of the CDI equation.

Start with a Pre-Bill Review of Clinical Documentation

The first important step in maximizing communication is to understand documentation gaps by conducting a pre-bill review. The review must be completed within 24 hours of discharge to minimize impact on DNFB while also attaining a wealth of information about your medical staff’s current documentation practices.

Based on a program’s maturity, a pre-bill analysis should consider each of the following, and provide a clear roadmap of where gaps with physicians are occurring. The success of a pre-bill review hinges upon establishing an initial focused outcome target with ongoing process refinement. All items cannot be done at once, so the process must be fluid and grow over time. Start with Medicare cases and eventually expand to all payers including a review of:

• CC/MCC capture rates for all MS-DRGs, thereby CMI accuracy.
• MS-DRG frequency and impact by facility.
• Impact of documentation on expected length of stay.
• Hospital-acquired conditions.
• APR-DRG severity assessment.
• Quality measures with associated risk adjustment – readmission, mortality, patient safety indicators.
• Compliance risk due to documentation gaps.
• ICD-10 coding issues (including changes in impact of diagnoses).
• Hierarchical condition categories (HCCs) within ambulatory settings.

Assemble a team of professionals including coders, CDI, and physician advisors to attack these gaps. Strategize and set objectives based on existing data, and then establish a methodology to coach physicians — one specialty at a time. Here are seven common pre-bill documentation discoveries:

• Incorrect diagnosis and procedure code assignment.
• Overlooked opportunities regarding application of coding guidelines.
• Opportunities for specification of physician documentation for conditions suggested by clinical indicators.
• Compliance risks due to conditions documented that lack clinical validity.
• Errors in documenting complications of medical or surgical care.
• Lack of specific documentation that impacts inclusions and exclusions from quality metrics.
• Missed opportunities for maximizing risk and severity.

Once there is good data in hand and a methodology in place, use findings to drive physician educational efforts.

Seven Physician-Focused Strategies that Work

The success rate in working with physicians is dependent on CDI specialists connecting with them in a meaningful way. Presenting actual quality data as part of the initial interaction sets a valuable tone and quickly engages physicians. The goal is to continually use hard data and real-case scenarios to demonstrate the value of complete and accurate clinical documentation for inpatient and ambulatory cases. There are a number of educational approaches that have proven effective for stronger physician engagement, including the following:

1. Emphasize the four primary benefits of improved clinical documentation – patients, payment, performance and profiling.
2. Conduct peer-to-peer specialty-directed education. When physicians are coached by others in their specialty, educational efforts carry more weight. Peers can also answer specific questions about diagnosis concerns.
3. Use clinical trend analysis from pre-bill reviews to direct concise education. Break pre-bill review findings into a few digestible chunks so physicians begin to see CDI specialists as their go-to experts who can help shore up documentation areas that data shows are weak.
4. Organize by service line with a unique approach for hospitalists as opposed to “nuts and bolts” for medical and surgical specialties. In other words, present the data in a manner that makes sense for each specialty’s way of absorbing information.
5. Extend into ICD-10 CM/PCS documentation issues with a specialized task force that crosses multiple disciplines.
6. Include the use of secure mobile technology for CDI queries, sharing evidence-based documentation guidelines and communicating about specific documentation issues. This circumvents challenging schedules and workloads by giving physicians the ability to work on documentation at a time and place that is convenient and doesn’t interrupt their time with patients.
7. Build a physician advisor program to solidify the outcomes of education and continually build the relationship between CDI specialists and the medical staff.

Could You Be a CDI Physician Advisor?

A physician advisor will enhance the clinical understanding of other physicians, while also providing expert opinion regarding clinical validity assessments and query development for the CDI team. Specialty-specific, line-of-service leaders will impact the area of quality outcomes and ICD 10-CM/PCS unique to their specialty.

The role of the physician advisor will be multifaceted — first, to act as liaison between the CDI team and medical staff. This person should attain specificity while educating other physicians and CDI team members on key issues. Expect query validation and development consistent with best clinical practices, which are evidence based. The advisor can provide peer-to-peer mediation with an explanation of global and individual impact of documentation. And most certainly, this person will facilitate ongoing education with medical staff.

Integrate this role into the pre-bill review process discussed earlier. There is no question that physician involvement enhances pre-bill, so engaging physicians in the process by way of the physician advisor will maximize revenue streams in the most efficient way.

The Future Is Upon Us

A data-driven documentation model with fully engaged physicians will maximize revenue stream, and establish a process for success under value-based reimbursement at both the hospital and physician practice level. A good CDI mantra is this: Put doctors in a good place to practice quality care AND get credit for it!

The benefits of engaging physicians in the documentation process early on, and in ways that make sense, include fiscal responsibility and transparency with accountability. With the shift to quality-based payment programs like MACRA, MIPS, and APMs, we see the increased importance of a physician-centric documentation workflow as the source for accurate quality reporting and financial success.

James Fee, MD is vice president of Enjoin in Collierville, TN.

Contacts

Jenn,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg

More news: HIStalk, HIStalk Connect.

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Contact us online.
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