From the Consultant’s Corner 4/12/13

The Next Available Appointment Is…
By Brad Boyd

Have you ever gone to the doctor for a routine checkup, only to be told that you should really see a specialist to take a closer look at that issue you’re having? Perhaps you have frequent migraines or your asthma symptoms are getting worse. As you try to make the appointment, you are told that the only time you can see the specialist is in six weeks, on a Tuesday, at 10:45 a.m., because the doctor is not available any other time.

This situation is not only irritating for you—the patient—it is also aggravating for your primary care physician. When patients have trouble gaining access to specialists, it can mean delayed treatment, potentially compromised patient care, and more headaches for the primary doctor. I’ve observed that some primary care physicians cope with this problem by referring patients to specialists outside their network, which presents issues for both the physician and the network.

As healthcare organizations pursue clinical alignment and integration initiatives—such as Accountable Care Organizations and other value-based reimbursement strategies—I have found they focus on steps like implementing integrated information technology systems, standardizing medical management, and fostering greater physician alignment.

While these are important aspects of an integrated approach, what many organizations fail to realize is that they also have to address patient access issues. If patients have trouble getting in to see their doctor or specialist, there could be some pretty significant patient care, satisfaction, and revenue effects.

I’ve noticed this problem happens most often when academic institutions seek clinical alignment and integration with non-academic organizations, such as physician practices. In these situations, physician compensation in the academic medical center may not be aligned with productivity expectations. In other words, the compensation model for specialists doesn’t incentivize them to see large numbers of patients. They may limit the number they see, choosing instead to focus on research activities or other priorities.

Improving patient access and the overall patient experience requires a holistic view of the academic institution-physician practice partnership, taking into consideration governance, leadership, and management issues. I recently tackled this type of holistic assessment for one of my clients, an academic group practice. Together, we developed a patient access optimization program which we piloted across two departments.

The result was a 25 percent increase in appointment slots and a 14 percent growth rate in ambulatory revenues. Satisfaction scores also improved for employed and aligned practices as well as their patients because patient care was better coordinated across the health system. In addition, referrals to competing health systems went down substantially. Based on the success of the pilot, the organization is deploying a new standardized "patient care model" throughout the remaining clinical departments.

Spending time looking at patient access and figuring out ways to increase specialist availability can ensure that any clinical integration program you pursue is successful. By addressing this issue, you can make the road toward clinical integration a little easier and ultimately reach your goals in this effort.

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

News 4/11/13

Athenahealth files a lawsuit against CareCloud, a four-year-old PM/EHR company that athena claims is infringing on one of its patents. The 2001 patent addresses the way claims processing rules are injected into athenahealth’s billing workflow. Above is a 2011 tweet from Jonathan Bush. Several former athenahealth employees now work for CareCloud. Athenahealth’s director of communication was unable to comment on the lawsuit, but CareCloud CEO Albert Santalo provided us with this statement:

“To the best of our knowledge Carecloud is not infringing on Athenahealth’s 13-year-old outdated method and we won’t be making any additional comment at this time.”

Main Line Health (PA) implements eClinicalWorks EHR across 42 practices.

The Polyclinic (WA) selects Phytel’s Population Health Management solution and Verisk Health’s Provider Intelligence program for population health management.

CMS creates a fact sheet to help providers if they are selected for EHR incentive program audits. CMS notes that documentation supporting attestation responses should be retained for six years and should support all payment calculations, such as cost report data.

Arkansas Heart Hospital selects eClinicalWorks EHR for its physician clinics.

HIMSS Analytics recognizes the ambulatory clinics of NorthShore University HealthSystem as the first group of ambulatory facilities to reach Stage 7 of the Ambulatory EMR Adoption Model.

Clinical effort, teaching, and research are named as the factors that most heavily influence physician compensation in academic settings in an MGMA report on academic practice compensation. Other factors influencing compensation: department rank, specialty, and geographic location.

Intuit Health announces that seven million patients have now registered for the Intuit Health Portal, including one million in the last six months.

Athenahealth celebrates the fifth anniversary of its Belfast, ME location, which now employs 570.

Bankruptcy attorneys and physicians blame a weak economy, shrinking reimbursements, changing regulations, and rising malpractice and drug costs for a recent spike in physician practices filing for bankruptcy. The American Bankruptcy Institute reports at least eight filings by physician practices in recent weeks.

E-mail Inga.

News 4/9/13

From SensibleShoes: “Re: Walgreens. This is absolutely insane. Walgreens has no idea what they are doing but they just found a way to sell more of their drugs on their shelves!” Walgreens becomes the first retail store chain to to offer diagnosing and treatment for patients with chronic conditions. Walgreens officials say they are not trying to take over primary care but instead are offering patients more access points for testing and care management. The AAFP does not welcome the news, saying it’s difficult to manage care when patients are treated in various settings. I am sure that AAFP’s objections have nothing to do with the fact that the 300+ retail clinics are staffed by PAs and NPs and not FPs.

Baylor Quality Alliance (TX) selects Greenway Medical to participate in its EHR program, which aids community physician practices in the evaluation, selection, and implementation of EHR applications.

The producers of NPR profile several physicians in rural Missouri, most of whom lack the necessary funds to transition to EHRs. Many practices are turning to large health systems for financial support while older providers are choosing to opt out of EHRs and use paper records until retirement.

The Chicago HIT REC introduces LAUNCH, an extension of its EHR adoption and training assistance program and available to both primary care physicians and specialists.

American Medical News offers physicians some tips for buying an EHR the second time around. I agree that one of the first things practices should do before jumping into a new system is identify what went wrong the first time to avoid repeating mistakes. Providers then need to prioritize their buying criteria and commit fully to the sometimes painful implementation process.

The AAP and AHRQ develop a set of instructions for EHR vendors that defines functionality and more than 700 requirements that are considered essential to pediatrics.

E-mail Inga.

Bowtie Confidential 4/7/13

Revisiting Healthcare Service Line Strategy and Development

In the past 10 years, service line development has proliferated. The topic was on the cover of the latest HealthLeaders and has been presented at several industry conferences. The heart of the issue is the need to collaborate internally and develop an integrated approach to service line development  versus a siloed approach.

The intent of service line operations is to provide better quality of care with focused resources while managing costs in an effective manner. Typically, service lines are limited to a group of well-defined sets of services and/or interventions. Examples include orthopedics, surgery, cardiovascular services, and oncology. If designed well, they provide pathways to increased operational efficiencies and financial success.

Developing and implementing a service line requires a significant amount of planning. The planning effort needs to take into account ongoing monitoring, evaluating, and modifying operations. Key components of service line development include:

• Governance and organizational structure
• Executive sponsorship – alignment with organizational goals, objectives, and mission
• Physician sponsorship
• Capital budget allocation
• Market analysis (brand management, competition, community need, pricing/cost, ROI, etc.)
• Continuum of care process: vertical vs. horizontal care delivery
• Resource analysis and requirements (clinical, financial, operational, etc.)
• Patient/community input
• Workflow and dataflow analysis
• Data analysis and requirements
• Reporting metrics
• Systems and technology analysis
• Evaluation and tracking methodologies/processes

I have experienced changes in service line modeling over the past few years  — specifically, a trend from vertical to hybrid vertical/horizontal models, which leverage a multidisciplinary approach. Models continue to focus on improving the coordination of operations and data acquisition, which allows organizations and executives to analyze the health and status of the service line(s) for greater profitability and enhanced operations. This is predominantly due to changing regulations, policies, costs, information technology, and other environmental elements.

Strategically, service line thinking needs to be re-evaluated to gain the full benefits that it can offer. Physician, patient, and community participation needs to be considered and included. Clinical service lines provide an opportunity for a comprehensive integrated care delivery model. This model can address patient and community needs throughout the delivery process by enhancing clinical quality and patient satisfaction and simultaneously improving operational efficiency and lowering the cost of care delivered.

In addition, more organizational attention needs to be placed on data governance and management. If your organization is developing a new service line, I recommend the following action steps:

• Use the key component bullets above as an evaluation checklist
• Commit to a well-structured strategic planning effort
• Develop a data governance planning and management strategy
• Build in a periodic service line assessment that provides metrics and dashboards to leadership

The importance of data cannot be minimized or overlooked. Data governance, management, and infrastructure are keys to service line success. Data provides the eyes for information on populations, best practices, overall operations, improving patient experiences, etc. Without a well-structured data governance process, the quality of data and information is suspect, potentially leading to errors in critical decisions.

The key to success in service line operations is to rethink current service line operations and data management. Review current service line strategies, operations (tactics and metrics). Seek support and involvement from the organization’s constituency – physicians, executive leadership, community, staff, and others within the sphere of influence. Look for synergy and integration between service lines and providers to obtain the best path for efficiency, effectiveness, and improvements in the continuum of care (quality). Lastly, seek external support, guidance, and direction for industry best practices and strategy development.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 4/4/13

Vitera launches Intergy Mobile, the iPad companion app to Intergy EHR.

CMS provides updated stats on the MU program, which has paid EPs and hospitals $12.7 billion in incentives though the end of February. A few other interesting tidbits:

• Of the estimated 527,000 EPs, 384,000 (73 percent) have registered to participate
• Over 230,000 EPs have been paid $4.5 billion in incentives. That’s almost 44 percent of all EPs and 57 percent of those registered
• Drug formulary, immunization registries, and patient list are the most popular menu objectives for EPs; transition of care summary and patient reminders the least popular.

Seven New York practices using MEDENT EMR are live on the Southern Tier HealthLink’s RHIO platform and able to use protocols for the Direct Project.

A report from the American Academy of Pediatrics recommends adoption of e-prescribing systems with pediatric functionality, noting that pediatric data supports the role of e-prescribing in mitigating medication errors, improving physician-pharmacist communications, and improving medication adherence.

Nearly 40 percent of physicians are burned out, according to Medscape’s Physician Lifestyle Report. ER and critical care physicians express the highest burnout levels; pediatricians, ophthalmologists, psychiatrists, and pathologists were among the least burned-out.

CMS posts the 2011 PQRS and eRx Incentive Program Experience Report, which summarizes program trends, including  participation and penalties breakdowns by specialty and geographic region.

Rep. Jim Dermott (D-WA) asks HHS to consider renewing its safe harbor provision that allows hospitals to subsidize EHR technology for its affiliated physicians under the federal Anti-Kickback Statute. The provision is set to expire at the end of 2013.

One last plea: please take a moment to complete our annual HIStalk Practice reader survey. Thanks.

E-mail Inga.