Infographic: Physicians on the Front Line of Healthcare

July 31st, 2015 by Melanie Matthews

As the healthcare industry moves increasingly toward a value-based system of healthcare delivery and reimbursement, a growing number of physician practices are delivering care in a more systemized way, according to a new infographic by Bain & Company.

The infographic illustrates this change—with 75 percent of physicians using electronic medical records, up from just 29 percent two years ago and 81 percent of practices using treatment protocols, up from 34 percent two years ago.

The infographic also examines the number of practices using metrics, participating in risk-based contracts and the change in management of physician practices.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination.

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Post-Acute Care Payment Bundles: Catalyst for Clinical Redesign, Improved Care Transitions

July 30th, 2015 by Melanie Matthews

Brooks Rehabilitation jumped at the opportunity to participate in CMS' Bundled Payments for Care Improvement (BPCI) program to be at the forefront of learning more about healthcare payment reform, said Debbie Reber, MHS, OTR, vice president of clinical services, Brooks Rehabilitation.

We saw it as an opportunity for post-acute care providers to help make some of the healthcare policy changes related to the future of healthcare reimbursement. We also really want it to serve as a catalyst for our business to begin working better as a system of care, Ms. Reber explained during last month's webinar, Bundled Payments for Post-Acute Care: Four Critical Paths To Success, a Healthcare Intelligence Network webinar now available for replay.

Post-Acute Care Payment Bundles: Catalyst for Clinical Redesign, Improved Care Transitions

Brooks Rehabilitation achieves 19 percent savings over historic spend and reduces readmission rates to 15 percent through Bundled Payments for Care Improvement Program.

"Our move toward bundled payments was a great opportunity to improve our care transitions, our continuum," said Reber. "The other huge opportunity is to experiment with clinical redesign. As we approached bundle pay, we approached it with 'we have a blank slate. We can redesign the care to look and feel however we want it to be. If we were doing things all over again, what are the things or the gaps or cracks to the clinical care that we could really improve upon?'"

"We knew that we wanted to have a strong voice regarding future policy and payment reform changes. We really wanted to show that we were sophisticated enough to take risk and play a primary role with that continuum of care," she added.

Brooks is serving under CMS' Model 3, in which it selects from a list of DRGs. It started in October 2013 with fractures, hip and knee replacements as well as hip and knee revisions.

Brooks added congestive heart failure, non-cervical and cervical fusions and back and neck surgery bundles this past April.

"All of our bundles are for an episode length of 60 days with the only exception to that being congestive heart failure. We did heart failure for 30 days just due to the tremendous risk of managing those cases and to decrease our risk overall with that population," Reber explained.

Brooks begins its process when the patient leaves the acute care facility.

"We are then responsible for all non-hospice Part A and B services, including physician visits, DME, medications, post-acute therapy or rehab services, as well as any readmission," she said. Of particular note is that the readmissions are not just related to the acute episodes that we are seeing them for…it's for any reason that the patient would be readmitted.

Understanding what those readmission reasons are is huge to our success, Reber explained. For example, on the orthopedic side, even though the patients have just been seen for an orthopedic surgery, the primary reason for readmission is predominantly around cardiac issues or pulmonary issues that are more likely due to prior comorbidities. It's really just managing those issues more.

Brooks has achieved an overall savings of about 19 percent over its historic spend and has decreased its readmission rate to about 15 percent across the 60-day time frame within this program. And, has also seen increases in patient functional improvement and patient satisfaction rates.

During the webinar, Reber walked participants through the four domains that have been critical to its success in the BPCI program, including: using standardized assessments across care settings; patient and caregiver engagement; the in-house developed Care Compass Tool, which includes a longitudinal care plan; and enhancing the role of the care navigator.

Guest Post: 5 Ways to Use CDI to Smooth ICD-10 Implementation

July 30th, 2015 by Deborah Neville, Elsevier

Clinical documentation is far from an add-on or afterthought. Without it, ICD-10 implementation will fail to achieve its full potential. Instead of taking clinical documentation for granted or moving it down the executive to-do list, healthcare organizations (HCOs)—hospitals, health systems, physician practices and medical groups—must address clinical documentation fully and in parallel to the implementation and optimization of electronic medical record (EMR) systems’ fulfillment of meaningful use (MU) requirements and the transition to ICD-10.

Clinical documentation is in a state of crisis. HCOs continue to copy and paste or pull forward irrelevant and incomplete patient information. By failing to accurately record a diagnosis's specific severity, HCOs can alter decisions over medical necessity, quality and mortality risk. By neglecting to precisely document each diagnosed condition or treatment, HCOs may see inaccurate patient outcome comparisons and may also face losses in revenue. They’re far less able, for example, to minimize denials and suspended claims because payers may question whether services are medically necessary and request additional information.

The challenge of clinical documentation demands that clinicians and healthcare leaders launch initiatives focused on clinical documentation improvement (CDI). Only with CDI can HCOs enhance communication and care decision-making, improve quality reporting and minimize financial risk.

CDI enhances an HCO’s operational efficiency, and minimizes clinicians’ frustration over having to sacrifice time usually spent with patients to address queries. Industry-wide trends toward team-based coordination and collaboration in the interests of value-based care and population health management also call for CDI to enhance patient evaluation, diagnosis and treatment.

Fortunately, CDI is already at the core of many HCOs’ efforts to enhance outcomes, streamline workflows, boost financial performance and achieve full compliance. In doing so, these HCOs have the chance to document the status of populations, integrate quality and outcomes measures and minimize gaps in documentation as part of the transition to ICD-10.

CDI Aids ICD-10 Implementation

Following are several suggestions for how HCOs can use CDI as a platform to aid in ICD-10 implementation:

  • Engage clinicians in CDI. By engaging clinicians—physicians, nurses and allied healthcare professionals—in CDI, HCOs can minimize long-term effects of poor documentation that leads to poor data. CDI initiatives provide a template and launch pad for information sharing, reporting, partnership and collaboration among individual healthcare professionals and care teams. As clinicians discover, discuss and analyze available patient data, they’ll be better able to provide complete, timely, evidence-based clinical care. To that end, HCOs should offer clinicians opportunities—both online and face-to-face—to dialogue over possible improvements.
  • Zero in on workflow. Offer clinicians the opportunity to document, analyze, evaluate and re-engineer clinical workflow—perhaps in partnership with a CDI specialist. By reviewing the thought processes that underlie clinical workflows, clinicians can more easily integrate technologies like mobile devices, speech recognition or natural language processing to enhance patient care.
  • Focus on enhanced outcomes. Help clinicians understand how and why more detailed, timely patient data enhances accuracy and promotes consistent communication, resulting in improved outcomes. By linking documentation to clinical workflows, HCOs can help clinicians discover how to collaborate as they zero in on patients with possible complications, initiate early interventions, facilitate discharge planning and control readmissions.
  • Show them the money. Remind clinicians how CDI will improve revenues. Through CDI, HCOs can secure more appropriate, timely reimbursement from payors, make the best use of specialists and develop risk-adjusted outcome profiles that ensure accurate payment. Equally important is that they can avoid the audits, penalties and fines that sometimes accompany lackluster compliance.
  • Go for the long haul. Remind clinicians that while they may still care for individual patients, they must also care for populations and communities. Focus on how CDI benefits overall patient care across lifestyles and lifecycles and why clinicians need documentation of previous diagnoses and treatments to properly care for consumers and patients over time.
  • Beyond ICD-10

    CDI creates a solid foundation for any regulatory change that might emerge in the years ahead. In the short-term, CDI will help HCOs ease the transition to ICD-10 and enhance clinicians’ engagement in patient care improvement, revenue generation, error reduction and operational efficiency.

Resources

AHRQ Quality Indicators Toolkit Facilitates Process Improvement Work at Cedars-Sinai Medical Center

Clinical Documentation in the 21st Century Executive Summary of the Policy Position Paper from the American College of Physicians

Guidance for Clinical Documentation Improvement Programs

Certified Documentation Improvement Practitioner

Clinical Documentation Excellence Program: Tackling ICD-10 challenges

About the Author: Deborah Neville manages Elsevier's development of an integrated system of on-line curricula and tools spanning clinical documentation, compliance, coding, finance and CDI. She has BS degrees in management/human resources and social psychology. She is a registered health information management administrator and holds a certified coding specialist: physician-based credential. Prior to joining Elsevier, Deborah held positions such as revenue cycle analyst for Mayo Clinic; corporate compliance officer; educator; coding manager; and senior consultant.

As an active member of AHIMA, she has participated in the Quality Initiatives & Secondary Data Practice Council, chaired the Coding Policy and Strategy Committee and Board member for the Society of Clinical Coding. She has authored journal articles, been a presenter of audio conferences and often speaks at national and state conventions.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Improving the Patient Experience

July 29th, 2015 by Melanie Matthews

Some 67 percent of healthcare executives agree that the role of customer service will change more in the next two years than in the last 10, according to a new infographic by Aspect.

The infographic compares the healthcare industry's focus on the consumer experience with other industries and the percent of healthcare organizations that offer technology-enabled customer service applications.

11 Profitable Value-Based Reimbursement Models: Lessons from Early AdoptersCMS's ambitious agenda for moving Medicare into alternative payment models is driving the U.S. healthcare system toward greater value-based purchasing at a furious rate. Private payors also have pledged to continue to shift payments away from fee for service and into alternative payment models such as accountable care organizations (ACOs). Fortunately, many healthcare organizations are already exploring value-based payments—often a single innovation at a time—testing models that reward providers for meeting Triple Aim goals of improving patient experience and population health while reducing healthcare's per capita cost.

11 Profitable Value-Based Reimbursement Models: Lessons from Early Adopters encapsulates nearly a dozen such approaches, from Bon Secours' building of a business case for its multidisciplinary care team to the John C. Lincoln ACO's deep dive into data analytics to identify and manage the care of high-risk, high-cost 'VIP' patients to 'beat the benchmark' to WellPoint's engagement of specialists in care coordination.

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Infographic: Business Associate Risks in Healthcare

July 27th, 2015 by Melanie Matthews

Many healthcare covered entities feel that their business associates' inadequate security precautions pose one of the top threats to their organizations, according to new study by ISMG, "Healthcare Information Security Today."

A new infographic by CynergisTek, Inc. highlights the risks associated with business associates as well as examples of recent breaches that have occurred at a business associate.

Business Associate ManualBusiness Associate Manual is a template-style manual that can be easily adapted to align with your compliance needs as a business associate (BA). All content complies with the Omnibus Rule.

Specifically developed to help BAs meet complex privacy & security compliance requirements. The Business Associate Manual includes: 6 privacy policies; 30 security policies; 6 policies that address common requirements of both the privacy and security rules; 1 breach notification policy; and 4 forms and templates.

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Infographic: Meeting 2015 Healthcare Goals with Mobile Technology

July 24th, 2015 by Melanie Matthews

While the use of mobile technology can improve healthcare systems, healthcare organizations are still evaluating the ROI and whether they can overcome key barriers to mobile patient engagement, according to a new infographic by CGS.

The infographic looks at the top priorities for healthcare organizations and the role mobile can play in addressing these priorities.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based SystemEncouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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Infographic: Social Media’s Impact on Health Literacy

July 22nd, 2015 by Melanie Matthews

Healthcare costs attributed to wasteful spending are estimated to be $800 million each year, according to a new infographic by iTriage.

Half of that total can be attributed, directly or indirectly, to low health literacy, including missed prevention opportunities; preventable errors; and unnecessary services or patients going to the ER when less expensive yet appropriate care could be obtained at another facility.

The infographic examines the opportunities for social media to improve health literacy.

Advancing Health Literacy: A Framework for Understanding and ActionAdvancing Health Literacy: A Framework for Understanding and Action addresses the crisis in health literacy in the United States and around the world. This book thoroughly examines the critical role of literacy in public health and outlines a practical, effective model that bridges the gap between health education, health promotion, and health communication.

Step by step, the authors outline the theory and practice of health literacy from a public health perspective. This comprehensive resource includes the history of health literacy, theoretical foundations of health and language literacy, the role of the media, a series of case studies on important topics including prenatal care, anthrax, HIV/AIDS, genomics, and diabetes.

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ACO Evolution from 2011-2015: 8 Year-Over-Year Trends

July 21st, 2015 by Patricia Donovan

ACO Trends 2011-2015

Today's ACOs are larger, busier and better staffed than they were four years ago, according to a HIN year-over-year analysis.

Adoption of accountable care organizations (ACO) has more than tripled in four years and clinical integration continues to challenge non-adopters, according to a Healthcare Intelligence Network analysis of accountable care organization benchmarks from 2011 to 2015.

According to year-over-year ACO metrics published in 2015 Healthcare Benchmarks: Accountable Care Organizations, the percentage of healthcare organizations in ACOs has climbed from 14 to 50 percent in the last four years.

Leadership of ACOs by payor-provider co-ops or health plans has slowed to a trickle during this period, while the percentage of physician-hospital organization (PHOs) firmly grasping administration reins has nearly doubled—from 15 percent in 2011 to 28 percent among 2015 respondents.

ACO Staffs Support Healthcare Integration

The ACO staff has become more diverse, boasting more specialists, health coaches and clinical psychologists to support integration of behavioral health and primary care, the ‘sweet spot’ of patient-centered medicine. Watchwords are care coordination and care management, according to 2015 respondents who shared ACO success stories.

Staffing within ACOs has swelled as well: 29 percent of 2015 survey respondents support 500-1,000 physicians within its ACO, nearly double the 17 percent reporting this staffing ratio in 2011.

The average ACO is also busier than ever, with 61 percent encompassing 10,000 covered lives or more, up from 42 percent in 2011, perhaps reflecting consolidation occurring across the healthcare landscape.

Today, healthcare organizations are more conservative about time required to adequately frame an ACO, with 20 percent of 2015 respondents reporting that two years or more was needed, up from 4 percent in 2011, while the percentage requiring 12 to 18 months for ACO creation dropped from 50 percent in 2011 to 37 percent this year.

Reimbursement Shifts from Volume- to Value-Based

The retrospective data supports the industry's transition from the traditional fee for service payment environment to the value-based reimbursement structure favored today, with 45 percent of 2015 respondents favoring a FFS + care coordination + shared savings payment model, up from 15 percent in 2012. (Note: 2011 respondents were not surveyed on reimbursement models).

This handwriting is on CMS’s wall, in the form of its pledge to move half of Medicare payments into value-based payment models by 2018. More than half of 2015 respondents—54 percent—expressed faith in the federal payor's ability to meet this financial goal.

Despite the latest benchmarks, operational ACOs insist no two accountable care organizations are alike. In the experience of Steward Health Care Network, a top-performing Medicare Pioneer ACO, “When you’ve seen one ACO, you ‘ve really seen...one ACO.” Having ended Pioneer performance year two with gross savings of $19.2 million, Steward still must scale the perennial hurdles of physician engagement, performance improvement and care management, explained Kelly Clements, Steward’s Pioneer program director.

This year’s ACO survey benchmarks bear this out. Clinical integration, which can only succeed with the support of an engaged physician population, is still the biggest barrier to ACO formation, say 17 percent of 2015 survey respondents with no plans for accountable care.

Source: 2015 Healthcare Benchmarks: Accountable Care Organizations

Infographic: Telemedicine Comes of Age

July 20th, 2015 by Melanie Matthews

Sixty-seven percent of healthcare professionals use some form of telemedicine or plan to in the next few years, according to a new infographic by Vidyo.

The infographic looks at current telehealth trends, future projections and regulatory advances.

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care ManagementReal-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation's (NYCHHC) House Calls Telehealth Program that significantly lowered patients' A1C blood glucose levels.

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Infographic: Curbing Healthcare Costs

July 17th, 2015 by Melanie Matthews

The U.S. healthcare system could save $213 billion annually if medicines were used properly, according to a 2013 study by IMS Institute for Healthcare Informatics. An article in Health Affairs echoed this sentiment and found that just an extra $1 spent on medicines for adherent patients with congestive heart failure, high blood pressure, diabetes and high cholesterol can generate $3 to $10 in savings on emergency room visits and inpatient hospitalizations.

A new infographic by PhRMA looks at the impact of medicine on healthcare costs.

Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and TelepharmacyThese three misconceptions are at the heart of medication non-adherence, says Janice Pringle, Ph.D., of the University of Pittsburgh School of Pharmacy — misconceptions that pharmacists can help to clear up.

Dr. Pringle, named as an Innovations Advisor by the Centers for Medicare and Medicaid Services, is one of three contributors to Pharmacists and Medication Adherence: Brief Interventions, Motivational Interviewing and Telepharmacy. This 50-page resource describes a number of interventions in which pharmacists help to guide patients and health plan members to higher levels of medication adherence — programs that take place in the pharmacy, in the physician practice, or virtually.

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