From the Consultant’s Corner 9/17/15

Downstream Revenue: Evaluating the Financial Return of Clinical Alignment Tactics

Hospital-based medical practices have increasingly become a major component of a health system’s clinical integration strategy. Over the past 30 years, many employed physicians have not viewed hospital-based practice models in a positive light. Governance, organizational structure, and leadership in the typical hospital operational model remain foreign to many physicians coming from private practice. These physicians have struggled with the perceived bureaucracy of hospital systems, and often become frustrated and disillusioned with the relationship.

Hospitals have also struggled to justify ongoing financial support of these physician practices, which on their own frequently operate at a loss. The physician-hospital relationship has historically been one of mutual distrust and perceived competing interests. Developing an employment relationship with physicians without a foundation of trust and a clear understanding of the role and objectives of each party typically results in strained relationships and constant conflict over operations and finances.

The investment in any hospital-employed or -affiliated group is significant. Without an accounting of the impact the group has on the downstream revenues brought into the health system, the parent organization naturally exerts pressures to reduce medical group expenses and losses. Analysis of downstream revenues is much broader than reviewing an individual practice or physician P&L. This would include referrals to specialists within the health system, ancillary services such as lab and radiology, and inpatient admissions. Development of the methodology to quantify the downstream impact of the practice’s physicians has been a historic challenge for every group and parent organization. To effectively and efficiently monitor downstream revenues, organizations often utilize business intelligence tools to evaluate the revenues, expenses, and contribution margin of the health system’s broader ambulatory (i.e., specialists) and hospital service lines.

Ultimately, technology in combination with a strong commitment from executive leadership drives downstream revenue within healthcare organizations. Ongoing analysis of this revenue is critical to both the enterprise and its affiliated physicians. Just as organizations want to understand the value practices bring, providers likewise want to understand their overall contribution to the organization – for business reasons and for personal satisfaction.

Accurate analysis allows healthcare organizations to grow through acquisition and alignment, with the confidence to make informed decisions based on a complete understanding of return on investment. They can build their brands within their communities and grow the number of patients under their care.

Health systems, hospitals, and academic medical centers can no longer afford to write blank checks to acquire practices. To achieve success in a value-based world, they must dedicate the resources – including experienced leadership and technology – to measure and drive downstream revenue.

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 9/16/15

Top News

Senator Lamar Alexander (R-TN), chairman of the Senate HELP Committee, calls for the delay of the Meaningful Use Stage 3 final rule until January 2017, and for it then to be phased in at a rate in keeping with its success – a stance that lines up with the committee’s remarks over the course of five previous meetings. Senator Alexander reiterated that, “My goal is to make sure we implement a electronic health record system as efficiently and effectively and as rapidly as we can in a way that genuinely helps patients.”

HIStalk Practice Announcements and Requests

The first official day of fall is just around the corner, which means the healthcare IT news will be flying fast and furiously between now and the holidays. Take advantage of special rates on HIStalk Practice sponsorships (HIStalk sponsors get an extra discount) to make sure your message stands out. Contact Lorre for details.

And speaking of fall, conference season is well underway. I have four events on my calendar within the next week alone. It’s nice to get away from my desk to mix and mingle with clinicians, vendors, colleagues, and friends. Today’s Health Connect South keynote was, no joke, the best I’ve seen yet. Ian Crozier, MD gave a riveting and heartfelt account of his time working in the Ebola wards in Kenema, the third largest city in Sierra Leone; after which he segued into his own near-death experience as an Ebola patient at Emory in Atlanta. The topic was timely, given that today marks the one-year anniversary of President Obama’s decision to throw U.S. resources behind efforts to eradicate the disease in West Africa. Crozier’s story put a very real, very compassionate face on the outbreak and its victims – a decided contrast from last year’s hysteria-inducing media coverage. I can only hope his graciousness and professionalism rubbed off on those he encountered (and is still encountering) during his clinical journey.      

Webinars

September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters:  Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.

September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and  Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.

#HIStalking Tweet Chat

Frank Fortner (@iatricFJF) will host the next #HIStalking tweet chat on Thursday, September 24 at 1pm ET. Stay tuned for discussion topics. Check out past chat recaps here.

Announcements and Implementations

Skywriter MD integrates Genband’s Kandy API into its virtual scribe service to offer physicians access to scribes in real-time.

ZenCharts integrates DoseSpot e-prescribing technology into its behavioral health EHR.

Cary, NC-based Medfusion launches the Medfusion Plus app to help consumers aggregate data from disparate EHRs. News of the app comes just two weeks after the company announced a $3 million investment from two local investment firms.

Acquisitions, Funding, Business, and Stock

Fitbit becomes HIPAA-compliant, no doubt making its Fitbit Wellness suite of hardware, software, and services more attractive to employers looking to launch corporate wellness programs.

The local paper highlights Willison, VT-based OpenTempo’s efforts to bring jobs to the state via potential partnership with the Vermont Employer Growth Incentive program and other state-based programs. The workforce management tech company retains a fondness for IDX (now a part of GE Healthcare), where many of its employees came from. “IDX wasn’t just about the technology, it was about the people,” explains OpenTempo CEO Any Comeau. “Under the stewardship of Rich Tarrant and Jim Crook, the team learned about commitment, loyalty, and how to capitalize on growth opportunity. And, it was about giving back to the community. They created good jobs, career opportunities and gave back to the city of Burlington and the state. The life and professional lessons I was taught at IDX stay with me to this day.”

People

Hamid Tabatabaie (LifeImage) joins InfoBionic’s Board of Directors.

Thomas Insel (US National Institute of Mental Health) joins the Google Life Sciences Alphabet group to help expand its healthcare technology efforts.

Government and Politics

President Obama nominates cardiologist Robert Califf, MD to be FDA commissioner. Califf, who has been interviewed for the position twice before, has been deputy commissioner for medical products and tobacco at the FDA since March. He has strong ties to Duke University, having founded its Clinical Research Institute in 2006.

The American Society of Clinical Oncology calls on Congress to take immediate legislative action with regard to ensuring interoperability and penalizing information blocking. The society also recommends that federal officials work with stakeholders like ASCO to ensure providers have the information they need to make smart healthcare IT purchasing and utilization decisions, and that patients and oncologists do not bear the cost of achieving interoperability.

Telemedicine

The US Patent & Trademark Office moves forward with Teladoc’s patent infringement case against American Well. Teladoc initiated the case in March, maintaining that its rival’s claims of being ‘first-to-market’ were false and that “the patents in question are impermissibly broad and cover matters that are too obvious to be patented.” The PTO’s order to proceed notes that Teladoc has a “likelihood” of prevailing. A final ruling is expected next year.

In an effort to differentiate itself from the increasingly crowded field of retail clinics, urgent care centers, and telemedicine vendors, Zugan Health (CA) offers free video consults as part of a “Telehealth Tuesday” marketing push.

Other

Google (courtesy of The Onion) introduces a new “synthetic skin appendage” that can be strapped on to accommodate even more wearable devices. Google’s Larry Page explains, “The possibilities for the number of completely pointless gadgets to strap, bind, and stick to your body are now endless.”

Sponsor Updates

• Billian’s HealthDATA will host “Update: The Road to Health Data Equity” September 22 in Boston.
• EClinicalWorks will exhibit at the 2015 APHCA Annual Conference & Tradeshow September 22-24 in Orange Beach, AL.
• Healthwise will exhibit at the World Congress Patient Engagement Summit September 17-18 in Boston.

Blog Posts

• Increase Front Desk Revenue, step 5 of 5 (AdvancedMD)
• Patient Portals – Placing Patients in the Driver’s Seat (Culbert Healthcare Solutions)
• ICD-10 Survival: The Right Partners Will Help You Prepare (Greenway Health)

Contacts

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

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News 9/15/15

Top News

A nearly year-long OIG audit reveals a laundry list of missteps by CMS in managing contractors charged with developing and overseeing Healthcare.gov. The audit, which focused on the 20 contracts most integral to the exchange’s operation, found inexperienced employees in charge of contracts valued at over $100 million, failure of a revolving door of employees to document who was in charge of what project at what time, unauthorized work orders that amounted to millions of dollars in cost overruns, and the inability of the agency to provide auditors with routine documents. OIG’s efforts highlight the fact that accountability for the mismanagement seems to be nil, given that former agency leads Kathleen Sebelius and Marilyn Tavenner have left for greener pastures; and that there’s no evidence CMS contracts are being handled better as a result of lessons learned from the initial debacle.

HIStalk Practice Announcements and Requests

The first official day of fall is just around the corner, which means the healthcare IT news will be flying fast and furiously between now and the holidays. Take advantage of special rates on HIStalk Practice sponsorships (HIStalk sponsors get an extra discount) to make sure your message stands out. Contact Lorre for details.

Webinars

September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters:  Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.

September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and  Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.

#HIStalking Tweet Chat

Frank Fortner (@iatricFJF) will host the next #HIStalking tweet chat on Thursday, September 24 at 1pm ET. Stay tuned for discussion topics. Check out past chat recaps here.

Announcements and Implementations

Lehi, Utah-based Solutionreach launches the Limelight real-time digital scheduling solution for physician practices.

Houston-based Boson Health implements cloud-based medical answering service and mobile paging technologies from TelmedIQ across its network of dialysis clinics and kidney health centers.

Telemedicine

Medical savings company SelectAccount taps Doctor on Demand to provide telemedicine services via its WalletDoc health resource management platform.

Government and Politics

HHS Secretary Sylvia Burwell announces $500 million in ACA funding to help health centers provide primary care services. Nearly $150 million will go to health centers for construction, expansion, or renovation. The remaining $350 million will be allocated to 1,184 centers to increase access to services. The funding builds on a similar round of health center financing announced in August.

Other

Professors (among other illustrious titles) Hardeep Singh, MD and Dean Sittig propose a Health IT Safety measurement framework to serve as a starting point for much-needed HIT-related patient-safety measurement, monitoring, and improvement. The proposed framework calls for new measures and monitoring in three areas: concerns that are unique to technology; concerns created by the misuse of health IT; and the use of HIT to monitor risks, care processes and outcomes, and to identify potential safety concerns before they can harm patients.

Bloomberg looks at the role wearables play in Big Pharma’s efforts to bring drugs to market faster, citing the mass amounts of data researchers are able to glean from clinical trial participants equipped with devices like the FitBit. Such data could potentially help streamline trials, and eventually prove to payers that new-to-market treatments are effective. The VA plans to launch a study on back pain incorporating wearables next February, though it hasn’t yet decided on a specific device. Lead researcher John Piette explains that the wearable data will be combined with pain assessments to develop an algorithm that will determine a veteran’s need for more or less treatment.

The American Academy of Nursing makes the case for capturing of behavioral and social determinants of health in EHRs as part of the industry’s greater interoperability goals. It recommends that vendors provide mechanisms for documenting IOM-recommended social and behavioral determinants of health, mapped to standardized terminologies and physicians. Physicians should “take a stand on adopting the SBHD common assessment standard, and use the information as the foundation to collaborate in developing a plan of care that is individualized for each patient across the continuum of care.”

Contacts

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

More news: HIStalk, HIStalk Connect.

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News 9/14/15

Top News

CMS offers “innovator access” to its Medicare, Medicaid, and assessment data for research purposes. Entrepreneurs and innovators can apply for access via the Research Data Assistance Center as part of product-creation studies or research that creates analyses related to business needs.

HIStalk Practice Announcements and Requests

Cooler temps in my neck of the woods (finally!) have put me in the mood to offer special rates on HIStalk Practice sponsorships (HIStalk sponsors get an extra discount) for a limited time. Contact Lorre for details.

Webinars

September 22 (Tuesday) noon ET. “Just Step on the Scale: Measure Ongoing EHR Success and Focus Improvements Using Simple but Predictive Adoption Metrics.” Sponsored by The Breakaway Group. Presenters:  Heather Haugen, PhD, CEO and managing director, The Breakaway Group; Gene Thomas, VP/CIO, Memorial Hospital at Gulfport. Simple performance metrics such as those measuring end-user proficiency and clinical leadership engagement can accurately assess EHR adoption. This presentation will describe how Memorial Hospital at Gulfport used an EHR adoption assessment to quickly target priorities in gaining value from its large Cerner implementation, with real-life results proving the need for a disciplined approach to set and measure key success factors. Commit to taking that scary first step and step onto the scale, knowing that it will get measurably better every day.

September 22 (Tuesday) 5 p.m. ET. “Laying the Groundwork for an Effective CDS Strategy: Prepare for CMS’s Mandate for Advanced Imaging, Reduce Costs, and  Improve Care.” Sponsored by Stanson Health. Presenters: Scott Weingarten, MD, MPH, SVP and chief clinical transformation officer, Cedars-Sinai; Anne Wellington, VP of informatics, Stanson Health. Medicare will soon penalize physicians in specific settings who do not certify that they consulted "appropriate use" criteria before ordering advanced imaging services such as CT, MRI, nuclear medicine, and PET. This webinar will provide an overview of how this critical payment change is evolving, how it will likely be expanded, and how to begin preparations now. A key part of the CMS proposal is clinical decision support, which will help meet the new requirements while immediately unlocking EHR return on investment. Cedars-Sinai will discuss how they decreased inappropriate utilization of diagnostic tests and treatments, including imaging.

#HIStalking Tweet Chat

Frank Fortner (@iatricFJF) will host the next #HIStalking tweet chat on Thursday, September 24 at 1pm ET. Stay tuned for discussion topics. Check out past chat recaps here.

Acquisitions, Funding, Business, and Stock

Portsmouth, NH-based ProEx Physical Therapy launches Collectivity, its billing and consulting division for physical therapy practices. ProEx Director of Business Development Benjamin Barron will head up the new operation.

Announcements and Implementations

Medical education and EHR company Pri-Med develops the Panel Insight iPad app to offer PCPs personalized CME learning recommendations. Features include refresher courses based on upcoming patient appointments, clinical risk assessments, CME credit tracker, and benchmark reports.

21st Century Oncology will equip its patients in the US and Latin America with personal medical record USB drives from InfoPeHR Technologies. It is the first major sale for the Boca Raton, FL-based startup, which was founded by former Baylor and Carolinas health system executive Bernard Brigonnet.

Government and Politics

Behavioral economist Shlomo Benartzi looks at how Healthcare.gov’s subpar design and overwhelming number of options leads consumers to choose plans that aren’t the best fit for their medical needs or budgets. He suggests that the use of metal labels for plans, which often confuse consumers into thinking low monthly payments also equate to low deductibles, should be scrapped in favor of labels that refer to a consumer’s expected medical needs, such as Low Medical Use, Medium Medical Use, or High Medical Use plans. “[U]nless consumers are given effective decision-aids,” he explains, “they will be unable to choose the plan that best fits their medical needs.”

Telemedicine

Texas-based telemedicine vendor Chiron Health joins Athenahealth’s More Disruption Please Marketplace.

Research and Innovation

A Vermont Medical Society survey finds that nearly all of its 117 respondents agree that “documentation and administrative issues” interfere with their abilities to serve patients well, while just under a third say they don’t have enough time to spend with their patients. Eighty-six percent of survey-takers also find reporting quality measures to be burdensome, thanks in part to lack of consistency across public and private payer requirements.

A study of eight primary care clinics and three community mental health centers shows that integrating behavioral health and primary care further burdens EHRs. Providers developed workarounds to deal with double documentation and duplicate data entry, scanning and transporting documents, and reliance on physician or patient recall for missing EHR data, and use of freestanding tracking systems. The study’s authors conclude that EHR vendors need to work more closely with end users to develop integrated care delivery functions including those that better track patients with emotional and behavioral problems over time and settings, and integrate teams working from shared care plans.

Other

The New York Times puts physician angst over ICD-10 front and center, focusing on the expected “sea change” that has led some providers to seek extra lines of credit (some in the $4 million range) in anticipation of denied claims and delayed payments. “The number of codes is exploding,” says consultant Michael Marks, MD. “On October 1 we will be speaking a new language. It’s like switching to German after speaking English for 30 years.”

Kudos to @David_Pittman for alerting me to this New Yorker cartoon.

Sponsor Updates

• TriZetto hosts its Fall Customer Conference September 14-16 in San Diego.
• Versus Technology will exhibit at MiMGMA’s Fall Conference September 16-18 in Mount Pleasant.

Contacts

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

More news: HIStalk, HIStalk Connect.

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Contact us online.
Become a sponsor.

Population Health Management News Weekly Wrap Up 9/13/15

Population health, precision medicine, and chronic-care management company Persivia acquires clinical-decision software vendor IHM Services for an undisclosed sum. The acquisition will enhance Persivia’s inpatient offerings for infection control, chronic-care management, and quality improvement. The company, which spun out of Alere Analytics earlier this year, plans to launch a Bundled Payment Management and Analytics tool for hospitals participating in the Comprehensive Care for Joint Replacement payment model when it becomes mandatory on January 1, 2016. (You can read my June 2015 interview with Persivia CEO Mansoor Khan here.)

IBM Watson Health announces a population health solution that integrates Watson Health with Apple’s HealthKit and ResearchKit. The new business, which tapped former Philips Healthcare CEO Deborah DiSanzo as GM, also announced collaboration with Boston Children’s Hospital and Columbia University.

Chicago-based Oak Street Health implements Lightbeam Health’s population health solution to manage value-based contracts across its 15 primary care practices in Illinois and Indiana.

Partners HealthCare and Health Catalyst will create the Partners HealthCare Center for Population Health, which will train employees of both organizations on care management and population health. Health Catalyst will license Partners intellectual property, while Partners has signed an enterprise-wide Health Catalyst subscription. Partners has been a Health Catalyst investor since 2013 and will increase its equity stake.

3M is exploring the sale or spinoff of 3M Health Information Systems, expecting to reach a decision by early next year. The business generates $730 million in annual revenue in sales of technology for coding, population health management, clinical documentation improvement, transcription, and revenue cycle management.

Send me your population health management news for potential inclusion in future weekly wrap ups.

Sponsor Updates

• EClinicalWorks will exhibit at the International Vision Expo & Conference September 17-19 in Las Vegas.
• Leidos Health will exhibit at InSight 2015 Annual Conference September 15-18 in Nashville.

Blog Posts

• Demonstrating the Power of Analytics in Population Health (Medicity)
• An “Ideal” Arrangement for Radiologists: Proving Innovation and Low Cost Can Come As a Pair (GE Healthcare)
• Coming Soon: Meaningful Use Final Rule … Will You Be Ready? (Greenway Health)
• Infusing Health Content Into an Integrated Member Engagement Strategy, Part 2 (Healthwise)
• Increase Front Desk Revenue, Step 4 of 5 (AdvancedMD)
• Quippe Increases Nursing Satisfaction at Bumrungrad International Hospital (Medicomp Systems)
• Embracing Change: Four Steps to an “A-Ha!” Moment (PerfectServe)

Contacts

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

More news: HIStalk, HIStalk Connect.

Get HIStalk Practice  updates.
Contact us online.
Become a sponsor.