From the Consultant’s Corner 10/7/15

Strategies to Mitigate Risk During Physician Practice Onboarding

The onboarding process for adding newly acquired or aligned physicians often has a strong and lasting impact on the overall relationship between the organization and its new clinical staff. Development of a comprehensive onboarding program that supports the organization’s strategic goals is imperative. This should include a comprehensive and integrated framework of tasks, sequencing, and timeline for major milestones, resource plan, and a communication strategy, which together will proactively mitigate onboarding risks while enhancing the physician experience.

Onboarding involves a variety of tasks, many of which are inter-related and must be sequenced and timed appropriately in order to mitigate potential disruptions or risks to physician and practice performance, while accelerating a physician’s “time to production” timeline.

A robust onboarding framework involves over 100 individual and inter-related tasks. These tasks can be organized to address the following risk categories:

• Marketing
• Human resources
• Physician productivity
• Finance (capital investment)
• Payer contracting
• Credentialing
• Revenue cycle
• IT (EHR, practice management, patient portal and connectivity)
• Clinical integration (quality and cost management)

Whether one is interested in assessing or improving an existing onboarding program, or developing a new program to support physician employment or alignment models, the following guiding principles are recommended:

1. A comprehensive onboarding program must be aligned to support the organization’s strategic goals (ex. clinical integration). This will include a comprehensive and detailed framework of tasks, sequencing/timeline, milestones, and resources, along with a communication strategy, which together will proactively mitigate onboarding risks.
2. Develop the necessary infrastructure to ensure the successful onboarding of newly acquired practices. Our goal is to streamline the process for physicians, assigning one person as the key contact for the practice who will serve as the go-between with the various departments that are involved in the onboarding tasks.
3. Provide operational guidance to the enterprise’s stakeholders involved in the onboarding process to include the office of medical affairs, provider credentialing and enrollment, marketing, patient access (scheduling templates), IT, and revenue cycle.
4. Communication strategy and feedback mechanism between the business development and onboarding functions. The purpose of this deliverable is two-fold. First, the individuals responsible for the business development activities will provide knowledge transfer into the nuance of each practice and individual physicians. This ensures continuity from the acquisition tasks through the implementation tasks. Secondly, if issues arise during the onboarding process that can and should be mitigated during earlier acquisition activities, this serves as a process improvement opportunity carrying forward.

The goals of this onboarding program framework are not only to mitigate the various financial risks associated with this transition, but also to enhance the physician experience. Specifically, this program should emphasize physician service in order to facilitate positive relationships with the acquired practices which will contribute to an organizations longer term goals and strategies.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/6/15

Top News

ONC releases the final version of its Interoperability Roadmap, a 90-plus page document outlining the ways in which public and private-sector stakeholders can work together to advance interoperability over the next several years. Over a year in the making, the roadmap (aka “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap”) stresses urgency and action in getting interoperability off the drawing board and into the EHRs of physicians and hands of patients. Speaking during a press conference call about the roadmap’s release, National Coordinator Karen DeSalvo, MD stressed the need to finally show physicians a return on investment after slogging through six years of EHR adoption. I found it refreshing that ONC representatives kept emphasizing the roadmap’s focus on action (mentioned 107 times) rather than further discussion, though I couldn’t quite reconcile their sense of urgency with the continued delay of final Meaningful Use modifications. In tandem with the roadmap’s release, ONC is planning a November event that will give stakeholders an opportunity to publicly declare their commitment to interoperability goals outlined in the report.

HIStalk Practice Announcements and Requests

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Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

#HIStalking Tweet Chat

Loran Cook (@loranstefani) will host the next #HIStalking tweet chat on Thursday, October 15 at 1pm ET. Stay tuned for discussion topics. Check out past chat recaps here.

Acquisitions, Funding, Business, and Stock

Wichita, KS-based Pulse System, part of Paris-based Cegedim’s healthcare software business, acquires the US-based PM business of Nightingale Informatix Corp. for an undisclosed sum. Pulse will integrate Nightingale’s Northern Health, Medrium, Ridgemark, and Secure Connect products into its suites of electronic healthcare management systems for specialty providers.

Medical marketing firm Educated Patients rebrands as MedPB to better reflect its practice-building capabilities for ENT specialists, hearing specialists, and audiologists.

Announcements and Implementations

EHNAC partners with the Healthcare Administrative Technology Association to offer HATA members discounts on its Practice Management System Accreditation Program.

People

Jeff Cutler (Vitals) joins TytoCare as chief revenue officer.

John Perales (CoSentry) joins ClearData as channel sales director of its new Excel Partner reseller and referral program.

Government and Politics

CMS updates its Medicare Provider Utilization and Payment Data to include patient demographic and health information including provider-level summary on beneficiary age, sex, race, chronic conditions, and risk scores.

Alaska-based Kenai Vision Center, Alaska Speech and Language Clinic, and South Peninsula Hospital file a class-action lawsuit against Xerox State Healthcare for failing to provide contract services related to the state’s 2013 implementation of XSH’s Medicaid Information Management System. Once installed, the system was incapable of processing new claims for a number of months – a problem the plaintiffs contend XSH refused to fix. The suit points out that delayed or nonexistent reimbursements forced the clinic to cut back its services, while Kenai Vision Center staff spent over 200 hours troubleshooting and has yet to receive $3,000 for Medicaid claims. The plaintiffs are asking for three times their damages plus punitive damages.

Telemedicine

Telemedicine stakeholders will likely get a big boost from an AJMC study that focuses on the amount of time a patient typically spends at ambulatory visits. The average visit of 121 minutes includes 37 in transit and 84 at the doctor’s office (and only 20 of those are spent with the physician). Researchers also found that minorities, the working poor, and the unemployed spend more time seeking care than their better-off counterparts, highlighting a vicious cycle of better care for the better offs that continues to disenfranchise those more inclined to drive up healthcare costs due to lack of access and affordability.

Research and Innovation

A consumer engagement survey of over 3,000 people finds that consumers are slowly making gains when it comes to partnering with providers, using online resources, and relying on technology. The 24-page report provides a deep dive into consumer perceptions on pricing, privacy, and partnering with physicians in decision-making, to name just a few areas. I’m hoping @loranstefani – host of next week’s #HIStalking tweet chat – will bring up the statistical discrepancy between those patients who say they’re willing to engage in decision making with their physician and the fact that not many of those surveyed have actually done so. Good news for vendors: Over 60 percent of consumers believe health technologies have had a significant impact on their behavior.

Other

Health Affairs outlines the changing role of performance metrics in primary care, pointing out a Catch 22 I’m sure many independent physicians find themselves caught in:

“Good primary care requires many hundreds of decisions each day for patients with unique clinical concerns and personal circumstances. Thus, typical quality measures can not address the breadth and depth of comprehensive delivery of primary care. Adding more measures (of quality or efficiency) can complicate this problem by offering myriad distracting and potentially counterproductive signals, as well as risking the problem of ‘reminder fatigue.’”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/5/15

Top News

Premier Inc. acquires InFlow Health for $6 million in cash, and will merge its physician practice analytics business and employees into its Performance Service segment. “InflowHealth’s capabilities will extend Premier’s reach into the ambulatory market, says Premier Performance Partners SVP Wes Champion, “and deepen the holistic ways we address healthcare improvement, providing physician practices with a full picture of performance, as well as actionable intelligence to initiate positive change.”

HIStalk Practice Announcements and Requests

Thanks to GE Healthcare for its continued support of HIStalk Practice. Contact Lorre if your company is interested in taking advantage of HIStalk Practice sponsorship benefits.

If you’re a HIStalk Practice, HIStalk, or HIStalk Connect sponsor exhibiting at MGMA, complete this form and we’ll include your company in our attendee guide. I’ll be reporting from Nashville during the event, which kicks off at the Gaylord October 11.

Webinars

October 7 (Wednesday) 1:00 ET. “Develop Your Analysts and They’ll Pay for Themselves.” Sponsored by Health Catalyst. Presenters: Peter Monaco, senior business intelligence developer, Health Catalyst; Russ Stahli, VP, Health Catalyst. It takes years for analysts to develop the skills they need to build reports and dashboards that turn data into valuable insights. This webinar will describe how to cultivate those analytical skills, including technical prowess and adaptive leadership. Leaders will learn how to develop a culture that fosters improvement, how to encourage analysts to develop the right skills, and ways to remove the barriers that stand in their way.

Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

#HIStalking Tweet Chat

Loran Cook ( @loranstefani) will host the next #HIStalking tweet chat on Thursday, October 15 at 1pm ET. Stay tuned for discussion topics. Check out past chat recaps here.

Acquisitions, Funding, Business, and Stock

Tampa, FL-based consulting firm Doctors Administrative Solutions expands its RCM services via the acquisition of medical billing firm Spectra Healthcare, a 14 year-old company based in nearby Tampa Bay.

People

Howard Graman, MD (PeaceHealth Medical Group) joins AMGA Consulting Services as vice president.

David Wennberg, MD (Health Dialog Analytic Solutions) joins Quartet Health as head of data science and analytics.

Announcements and Implementations

Document management software vendor Scrypt combines its HIPAA-compliant Sfax solution with Box cloud-storage services, enabling physicians to fax PHI directly to and from their Box accounts.

Aprima Medical Software integrates HealthPrize’s patient engagement and medication adherence gaming technologies into its patient portal. The integrated solution, which will roll out early next year, will enable physicians to track prescription data, including refill pattern and adherence behaviors.

RxNT optimizes its e-prescribing app for the iPad.

Government and Politics

Deputy Administrator and Director of the Center for Medicare Sean Cavanaugh welcomes everyone to ICD-10, outlining the ways in which CMS will riding shotgun with providers during the coming weeks of transition including real-time transition monitoring; systems review; addressing issues that come in via the ICD-10 Coordination Center. Cavanaugh also points out ICD-10 Ombudsman Bill Rogers, MD as the “impartial advocate” physicians should turn to in their time of need. I’d love to know whether his inbox is overflowing with concerns or if all has been quiet on the ICD-10 physician front. (Dr. Gregg provides his take in the latest DOCtalk.)

Research and Innovation

Weill Cornell Medical College researchers find that patient confidence in the security of EHRs increased during the early years of Meaningful Use. Though their phone-based survey of 1,000 patients conducted between 2011 and 2013 saw a six-percent decrease in concerns relating to the security of personal health data, it also revealed that patients were less likely to believe that EHRs improve care. Given that some of the industry’s biggest breaches have taken place within the last two years, I’m willing to bet patient confidence may have peaked in 2013. Feel free to weigh in with your anecdotes via the comments below.

Telemedicine

A late-September letter from 13 senators to the Federation of State Medical Boards highlights the enthusiasm legislators have for FSMB’s efforts to stand up an interstate licensing compact – a move seen as essential to widespread adoption and utilization of telemedicine. “[W]e encourage you to continue to work with your member medical boards and states to consider participation in the compact, which will simultaneously facilitate multi-state practice while ensuring states’ ability to regulate medicine and ensure patient safety,” the authors write. The Interstate Medical Licensure Compact Commission will meet for the first time later this month to begin hashing out how to develop the compact’s infrastructure. Eleven states have joined the compact so far.

Other

Scientists at the University of Sydney and the University of Copenhagen create a blueprint of the molecular reactions to exercise in hopes of identifying the most important and replicating those changes using drugs. Creation of the blueprint took three years, and drug development may take a decade or more. Lead researcher Nolan Hoffman sees enormous potential in an “exercise pill” for the elderly and those suffering from chronic disease. Those of us who adopt a New Year’s resolution to step up our workouts may also see some benefit.

The Ann Arbor, MI-based Altarum Institute will lead Michigan-based efforts as part of the Great Lakes Practice Transformation Network, a three-state initiative led by Indiana University that includes 32 healthcare partners including RECs, HIEs, universities, and state departments of health. The network will strive to help over 11,000 physicians become learning practices capable of delivering better care at lower costs. Altarum will assist 4,000 Michigan-based physicians with quality reporting requirements, value-based payment initiatives, and population health management.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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DOCtalk with Dr. Gregg 10/5/15

I Like ICD-10

Yeah, OK, I realize I’m not likely to make many new friends among my colleagues with a title that expresses love for ICD-10, but “I calls ‘em as I sees ‘em.” And from my personal little corner of the healthcare world, I see nothing yet that tells me anything nasty about ICD-10. In fact, just the opposite.

Before we get too far along, let me point out the obvious: I make this claim of enamorment before any insurance companies have had a chance to make me feel differently. No payment withholds, no denials, no delays – that is all part of the concern going forward for sure, but we’ll just have to see if all that reimbursement doom and gloom (as has been prophesized by some) will come to pass.

For now, I’m just talking about the usefulness of ICD-10 compared with ICD-9. From that perspective, I think there’s a lot to appreciate.

Since I’m already charting that a patient has an issue, and I’m charting what it is, where it is, how it’s doing, what complications have occurred, etc., wouldn’t that data be worth capturing in ways that folks who tally such info can use? If bean counters and population health folks need data, then the better that data can be, the better they can do their assorted analyses, right? Unfortunately, data can’t be easily captured using normal human language – not yet, at least. So we need something that takes all that diagnostic acumen and insight we work so hard to develop and which then translates it, as accurately and as precisely as possible, into tally-able data.

To me, it always seemed that trying to codify diagnoses using the limited ICD-9 set of codes was like trying to discuss cellular morphology using the vocabulary of a toddler. You can sort of do it, getting some of the basic concepts described, but there’s a whole lot that just gets left out due to drill-down specificity that a toddler’s language set just doesn’t cover.

ICD-10, on the other hand, seems more like a developed vocabulary, something more on the order of a teenager. (Well … maybe that of an adolescent, because as many more codes and as much more specificity as it has, I can still see many more potential codes and/or code variations that could be developed.) You can definitely provide a much fuller description of your intended diagnoses with this richer language, with this more robust set of codes.

I know, lots of folks are already complaining about the huge increase in the number of codes from ICD-9 to ICD-10. And it’s true that it won’t be nearly so easy to remember the codes as it was before. But that is of small concern compared with the richer value of data that can now be coded. And, with even more codes – because you know they’re coming – that data will become even richer. And for me, I see that as valuable in the long term, make-a-difference, big picture of healthcare, population management, etc.

Maybe it’s because I’m spoiled since my EHR has done a pretty good job developing well-designed coding software. Type in the natural language version of your diagnoses and up pop the most likely code or codes, and any related possibilities. Plus, I get the full version of each code’s written diagnosis/description. I’m not sure what everyone else’s ICD-10 implementation does, but ours is pretty easy.

Of course, we’re just at the beginning. As I said earlier, no reimbursement deficits or take-backs have had a chance to provide me any pessimistically-oriented cynicism. For the moment, I think the value gained, the specificity added, is a good thing.

I like ICD-10.

From the trenches…

“V97.33XD: Sucked into jet engine, subsequent encounter.” – ICD-10

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Population Health Management Weekly Wrap Up 10/4/15

Predictive analytics WPC Healthcare completes its management buyout from Washington Publishing Company. The now-independent business will now focus on developing and rolling out its Taproot SaaS and other predictive analytics solutions. Guy Crossley (GAC Ventures) has joined WPC as president.

Market research firm CentraForce launches CentraForce Health and its Population 360° Health Intelligence Platform, which enables payers and providers to dive into the location and quantification of populations by disease type, payer type, and other types of criteria.

Patient engagement solutions vendor Emmi and population health technology company Valence Health partner to develop outreach campaigns targeted to specific patient populations, particularly those that have fallen through care gaps. Physician’s Health Services, an independent physicians’ association based in Dalton, GA, has signed on to implement the new service.

Fairfax Family Practice Centers (VA) partners with Privia Medical Group, a multispecialty practice owned by Privia Health, a national PM and population health technology company. “Privia Health has the resources, technology tools, and proven performance in population health management that, when combined with our physician expertise in primary care medicine, will enable us to provide higher quality care for our patients, better access, and improved ability to manage the health of our population in the coming years,” says FFPC CEO Lauri Rustand.

PBS covers Air Louisville, a project in which asthmatics use “smart” inhalers with Propeller Health’s sensor attached to contribute to a database that matches the severity of their symptoms to their GPS-reported locations at the time, helping the city understand how poor air quality affects the 13 percent of its residents with asthma.

Post-acute care consulting firm Pathway Health will integrate PointRight’s predictive analytics solutions into its consultancy. The two companies will in the weeks ahead further partner to develop analytics-driven solutions that assist providers in measuring outcomes, managing costs, and reducing risk.

R&D firm PCCI partners with The US Oncology Network to develop oncology solutions that will run on PCCI’s Pieces software, which interprets real-time EHR data into intervention warning tools. The solutions, developed for Stage IIIb/IV Non-Small Cell Lung Cancer and Stage IV Pancreatic Cancer, will help PCCI developers engineer software that will help physicians make faster, more effective treatment decisions.

Sponsor Updates

• Nordic’s Kevin Dumser and his son’s battled with childhood cancer is featured in the local paper.
• NVoq will exhibit at the American College of Pathologists Annual Meeting October 4-7 in Nashville, TN.
• Intelligent Medical Objects will exhibit at the MUSE International Medical Users Software Exchange October 7-8 in Liverpool, UK.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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