The Winner’s Circle in Healthcare: How to Avoid Political Paralysis

By Hank Duffy, President & CEO

The political circus around healthcare has dawned, and it’s hard not to get wrapped up in the chaos, confusion and contradictory advice. While the knee-jerk reaction is to become paralyzed and to take a wait-and-see approach, this is wrong.

Instead, it is the right time to focus on what will make care-delivery organizations more effective in managing clinical quality and cost and improving the patient experience.

There are two “no brainer” areas where near-term focus will only enhance competitiveness:

  • Improving how the care delivery network operates
  • Strengthening the primary care component

Improving how the network operates involves more change management than most physicians enjoy, but it is essential to managing clinical quality and bringing down cost. The network should be the “Care Manager.” The quiz to assess how well your network is operating includes:

  • Do we have reliable transitions of care, particularly from inpatient to outpatient?
  • Do we regularly and reliable coordinate care among PCPs and specialists?
  • Are the referral systems “user friendly” and supporting two-way communication?
  • Are we providing data on the effectiveness of care coordination (i.e. readmits, access times, clinical outliers, etc.)?

When it comes to strengthening the primary care component, the obvious question is if there are enough PCPs in the right locations. But an equally important question to be addressed when it comes to keeping, attracting and incenting PCPs is: Are we creating an environment that is a joy to practice in?

Going back to the research done by the Annals of Family Medicine, Inc.’s publication In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices1, there are at least five tests of a practice that is “joyful”:

  1. Proactive planned care with pre-visit planning and pre-visit laboratory tests
  2. Sharing clinical care among a team with expanded rooming protocols, standing orders and panel management
  3. Sharing clerical tasks with collaborative documentation (scribing), non-physician order entry and streamlined prescription management
  4. Improving communication by verbal messaging and in-box management
  5. Improving team functioning through co-location, team meetings and work-flow mapping

Getting care delivery networks fully operational with a world-class primary care provider experience is where the healthcare winners will stay focused in this tumulus time.

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1 2013 Annals of Family Medicine, Inc.;In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices; Christine A. Sinsky, MD, Rachel Willard-Grace, MPH, Andrew M. Schutzbank, MD, Thomas A. Sinsky, MD, David Margolius, MD and Thomas Bodenheimer, MD2
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The Golden Ticket to Healthcare’s Future – Physicians

By: Hank Duffy, President JHD Healthcare Partners

November 8, 2016, had a surprising presidential election outcome that many people, including myself, didn’t see coming. For us in healthcare, it’s very likely there is a wave of changes coming our way.

Yogi Berra said, “Making predictions, particularly about the future, can be very difficult.” So we don’t know what will come in the next few years under the Trump administration, but my sense is the endangered aspects of Obamacare are:

  • The “Individual Mandate”
  • The role of the Exchanges
  • The approach to Medicaid
  • Possibly, the role of CMMI

However, one aspect about our industry I am convinced will not change is The Prime Directive to reduce the cost of healthcare. Whether we have Value-Based Reimbursement, Bundled Payments, Fee-For-Service or Capitation, the pressure to bring down the cost of care is going to continue. This means reducing the Total Medical Expense Ratio – the cost of the clinical care process – not freezing salaries, cutting nurses or Medical Assistants, or closing floors.

There is a golden ticket to succeed at reducing the clinical cost of care – it’s the physicians.

Today, enough focus isn’t on positioning the physicians as the leaders in driving quality up and clinical cost down. They need to be:

  • Better equipped
  • Better supported
  • Incented to focus on larger patient populations
  • Recognized as the “healers” of successfully reforming healthcare

In the midst of the potential chaos, how do we, as an industry, get the golden ticket?

  • Integrating Technology: The technology is here, but we are not putting enough effort into “optimizing” its use for the physicians and their care teams. As was the case with the introduction of the EHRs, we made the day-to-day work of the physician more difficult. Having the technology is great, making it work to the needs of the specific physicians is essential.
  • Fix Clinical Support Staffing: As an industry, we are not adequately preparing for the coming physician shortage, and we can do more to better leverage the clinical support staff mix. At some point in the future, a Primary Care Panel will be 6,000 – 7,000 lives, which is unmanageable with the current staffing model.
  • Make Clinical Data Usable: A lot of progress has been made in the availability and use of clinical metrics, particularly through CMS programs and the successful ACOs. As physicians take on changing care patterns/pathways and creating true integrated care management, the data needs to be:
    • More credible
    • Easier for them to use
    • Embraced by them
  • Strengthen Financial Incentives: If the physicians are the engine in driving down clinical cost, they need to have the same incentives as the industry. Physician arrangements should be crafted to reward:
    • Productivity
    • Clinical quality
    • Clinical cost
    • Patient satisfaction
    • Citizenship in the clinical enterprise.
  • Facilities: Our ambulatory facilities need to be more user-friendly and designed to support integrated care. It’s a long-term investment, but we will not reduce the cost of care without moving away from antiquated small physician offices.

Physician satisfaction has been decreasing for the past 15 years or more, and we need to start here to succeed with any healthcare change. So while we wait to see what “Trumpcare” brings, it is in everyone’s interest to find a way to:

  • Make the physician work environment easier
  • Align incentives faster
  • Embed the clinical quality and cost data into the care process
  • Accelerate the movement toward clinical integration as a means to bring down clinical cost

EHR Optimization – There is so much to do, where do I start?

Optimizing a new EHR/PM system often feels like trying to swim up a waterfall. And while challenges persist, at times, you may feel like you are drowning.

You happen to have a supply of buckets – or tools available to help you – underneath this waterfall. Where would you place the first bucket?

In this kind of overwhelming environment, the inclination is to place the bucket wherever the loudest complaints are coming from. But, the better response is to place the bucket over our heads so we can breathe easier — taking a step back to gain perspective of the true priorities and those other tasks that can be made simpler or even unnecessary[i].

One common error is to try to cover 100% of the task list at each optimization meeting. On the surface this appears like great goal, but the downside means you are also simultaneously working on the dozens of other tasks, which can ultimately lead you right back into the waterfall. And, without disciplined optimization, leadership will typically step in and re-prioritize the tasks to solve the angriest complainer’s problem first while still not addressing the root cause of the issue.

Optimization takes:

  • Strong leadership
  • Discipline
  • An understanding of project management, healthcare and providers
  • Knowing the intricacies and politics of leadership – as well as the sensitivity and urgency that will allow the team to start to show results

Once results start to happen weekly, and at times daily, the results will stem the complaints and the constant reprioritization of efforts.

 Are you ready to truly optimize your system?

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[i] The One Thing by Gary Keller & Jay Papasan: “What’s the one thing you can do such that by doing it everything else will be easier or unnecessary?”, April 1st, 2013. Hudson Booksellers

EHR Optimization – It’s All About The People

Although the word “optimization” is used synonymously for both EHR Optimization and EHR Customization, they mean two different things. For example:

  • Customization is akin to adding your own code and has its place. Meaning, if an optometry practice needs an inventory module, one can be added through a third party, or by programming your own module.
  • Optimization is all about implementing the built-in feature set of the EHR and using it to its best potential by embedding it into the operations of the practice.

Said another way, optimization is central to improving the way the people use the EHR because, after all, it can’t do anything without people.

Each operation within an EHR can often be done by several different types of people, and in many cases, certain tasks are performed by multiple people. To create efficiency, the ideal state is to create a single touch component.  However, when trying to translate the paper world or a previous EHR to a new EHR, a translation is often not the solution – but a complete rewrite is required.  Such as:

  • What gets routed to a physician or nurse’s in-basket or a scheduler?
  • Who is required to sign-off on a positive vs. negative lab result?
  • What licensure is required to do each task and assigning the correct level to each task?
  • Who should be able to place orders?
  • How are duties assigned based on licensure, compliance & EHR security templates?
  • How can the physician workload be reduced by allowing staff members to work at the top their license?
  • How can work be automatically sent to the appropriate person?

Aligning the people to the new processes within an EHR will take every optimization project to new levels. Doing this captures the highest levels of efficiencies, brings a greater understanding to each person’s area of responsibility and improves the quality of life for all.

Are you customizing or optimizing your EHR?

Optimization: The Key to Improved EHR Satisfaction

By Drew Nietert, Director, JHD Healthcare Partners

EHRs are pervasive, with 78% of all office-based physicians using one –even though most are unhappy with their EHR.  The widespread use of poorly implemented EHRs has created a range of issues that are likely to keep providers, administrators and IT up at night:

  • Increased physician dissatisfaction, with complaints such as:
    • Needing to work longer hours at home and on weekends to complete documentation
    • Staring at a computer instead of making eye contact with the patient
    • Too much clicking and too many screens to go through
  • Physicians and staff inventing workarounds that compromise documentation
  • Inability for leaders to understand and get accurate data
  • IT is not able to keep up with the challenges the EHR has introduced
  • Decreasing revenue from decreasing volume

The key to overcoming these, and other, EHR issues and getting a good night’s sleep is Optimization. When done well, EHR optimization will:

  • Improve the quality of life for providers
  • Improve documentation
  • Improve coding accuracy
  • Reduce risk of audits and audit penalties
  • Improve provider utilization , which leads to higher revenue
  • Improve practice performance on risk contracts
  • Increase severity calculations such as HCC scores

Taken together, all of these equal a better profit margin and happier doctors – two things every healthcare executive longs for.

Optimization is the path to get you there.

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JHD Healthcare Partners is an advocate for the provider. Our goal is to improve the physician’s quality of life while increasing their income. 

In our experience, the single greatest source of complaints from providers is the EHR – and it doesn’t matter which EHR is implemented. Too often, the EHR is implemented in a dramatic all-hands effort, and then work stops. But the initial implementation is just the first step for the EHR. Clinical operations need to adapt work flows to the EHR architecture and the EHR, wherever possible, needs to be customized for each specialty.

Avoiding Data Dumptrucking, Part Two

Data CelebrationBy Cliff Gallagher, Partner, JHD Healthcare Partners

Perhaps you read my blog on data dumptrucking, and see similarities in your organization. Now, let’s look at steps you can take to steer clear of this fate.

Simply put, data dumptrucking is the process of being handicapped by the very data that is supposed to bring you clarity.  Whether it’s because of the sheer volume of data or that the same data is pulled and used differently across the organization, more data can sometimes mean more trouble. When you’re converting to a new EHR/PM system, that trickle of data suddenly becomes a waterfall of data, and you find yourself with no life preserver.

Establishing a central repository for the data is key to overcoming these issues – or one department responsible for “owning” the data (creating and pulling reports, checking for accuracy, running requested numbers, etc.).  Here are a few other tips to avoid data dumptrucking in your organization:

  • Fully understand the system’s capabilities.
  • Have a rigorous process that defines what you are looking for in your reporting.
  • Consistently ask yourself, does the data even make sense?
  • Collaborate with key stakeholders on what data is most beneficial to decision making, and how can be used effectively.
  • With the new system, clearly define 20 or 30 reports your organization needs and establish a clear process of building them and testing them. Don’t just expect the system to “go” or that the way your old system did things is easily convertible to the new system.

A few items to keep in mind during the transition:

  1. The ability to get more information out of this new system will be worth it once the system is designed the right way for your organization.
  2. The data will help to more effectively achieve the Triple Aim — reduce costs, improve quality and make patients happier.
  3. This is a change management effort, which means what might have worked before isn’t going to work in the future. This is an opportunity to evaluate what was done in the past and improve it to be better at delivering the best care possible to patients.
  4. Once it’s up and running and humming correctly, the system should easily automate functions — from data entry to data analysis, this new data will allow for faster decision-making and quicker reaction to necessary changes.

It’s also important to be critical of data in the beginning.  Once it’s accurate, it needs to be repeatable, reproducible, and pushed out often.

We have helped organizations successfully transition systems and develop the right data and reporting methodologies that mitigate losses in revenue and gaps in care. Let’s talk about how we can put our expertise to work for you.

Cliff Gallagher is a partner with JHD Healthcare Partners who leads the Practice Co-management service line. Contact JHD Healthcare Partners today to find out how you can avoid data dumptrucking in your organization.  www.jhdhp.com

‘Data-driven’ Doesn’t Mean ‘Data Dumptrucking’

By Cliff Gallagher, Partner, JHD Healthcare Partners

Healthcare organizations are undergoing extensive changes in order to compete successfully in a world driven on integration and quantitative metrics.  They have made significant investments in integrated technology systems – Cerner, Epic, etc. – and now they need to make business decisions tied to data. As data pours in from every corner, they should be able to make informed, clear decisions based on strong, empirical evidence now, right?

Perhaps you have heard the phrase: “Be careful what you wish for – you just may get it”?

In many cases, the plethora of good data becomes an albatross choking a system’s ability to use that data as it intended. Being able to discern good data from bad helps avoid the situation we call “data dumptrucking.”  Just because there is more data doesn’t mean it’s the best data.

To avoid the dreaded data dumptrucking, I recommend establishing a foreman for the data.  One team should be responsible for pulling and managing the data instead of each department running their own reports.  This department is responsible for creating, running and validating reports.  All data comes from one department. Reports should be carefully created and managed, and access to the creation of these reports should be thoughtfully determined beforehand.

Don’t let the incredible amount of new data that your system generates leave your health system gasping for air under a pile of worthless statistics.  Schedule a complimentary 30-minute consultation now to find out how you can make data work for you.

Cliff Gallagher is a partner with JHD Healthcare Partners who leads the Practice Co-management service line. Contact JHD Healthcare Partners today to find out how you can avoid data dumptrucking in your organization.  www.jhdhp.com

Medicare announces a new program to pay primary care practices for managing their own patients

On April 11, 2016 CMS announced Comprehensive Primary Care Plus (CPC+), a significant advancement of an earlier program known as CPC that was launched in 2012.

The new initiative is open to primary care practices that do not participate in other types of comprehensive care programs such as ACOs, including MSSPs.

A unique feature of CPC+ is that CMS wants to include other types of health insurance plans, in addition to Medicare, to participate so that the majority of a practice’s patients are covered.  This will reduce the complexity for participating practices and will create enough of a critical mass to make participation viable.

The CPC+ design is intended to provide partial up-front funding, added to FFS payments, and backward looking quality performance rewards to practices who actively manage the health of a panel of patients.  Many details have yet to be explained, but the Medicare component will contain two Tracks.  Track 1 is intended for practices who want to develop comprehensive care capabilities.  It is less demanding than Track 2, but also comes with lower $PMPM and performance rewards.  The prospective $PMPM will be risk stratified under both Tracks, with the methodology still to-be-determined.  As an example, under Track 1, a primary care practice with an average risk score will receive:

  • Full FFS reimbursement, billed as usual
  • Plus, a $15 PMPM, paid in advance
  • Plus, up to $2.50 PMPM based on quality performance

For a practice with 300 Medicare beneficiaries, the $PMPM payments could amount to $63,000 per year on top of any FFS dollars received.

Track 2 is designed for PCPs who are already advanced in their PHM efforts.  Compensation under Track 2 follows a similar structure, but the amounts have been increased to reflect the additional effort and resources needed.

Commercial and other health plans will need to develop their own parallel programs and coordinate with CMS so that practices can achieve economy of scale by including most, if not all, of their patients.

The next step for the CPC+ program is for CMS to receive applications for participation from insurance in order to define the participating regions.  The regions will be announced in June.  At that time practices who are in a participating region can submit their applications.   Participating practices will be announced in October.

Find out more at http://bit.ly/1sAdIfm.

 

 

 

Physician Revenue Cycle: A Key to Successful Integration

By Kelvin Drawdy, Director, JHD Healthcare Partners

As hospitals and health systems take steps to develop sustainable relationships with physicians, they are increasing physician practice acquisition and physician employment.  Effectively integrating the revenue cycle should be a top priority because it not only affects the financial performance of the health system, but may also affect the physicians’ compensation, and their satisfaction.

The Healthcare Financial Management Association defines revenue cycle as: “All administrative and clinical functions that contribute to the capture, management, and collection of patient revenue.” In other words, from the point of first patient contact to final payment and settlement of the claim. Each of the following functions must be performed for the revenue cycle to be effective – and must be prioritized as part of the integration of new physicians and practices.

  • Pre-Visit/Pre-Service Processes
  • Front-End Process at Time of Service
  • Encounter – Patient Services
  • Billing
  • Third Party Claims
  • Payment Processing
  • Patient Collections

There are challenges to successfully integrating the revenue cycle functions of the newly acquired practice into the health system and gaining the trust of the physician that the revenue cycle is working.   Efficiencies can be achieved working in a large health system, but if not executed well there is a risk of losing the physician’s trust and lowering the patient’s satisfaction.

If the physician revenue cycle isn’t meeting expectations, this could be an indicator the health system has issues integrating the physician revenue cycle or that it is not effectively prioritized or managed as part of the overall system.  Timely recognition and resolution of these issues will keep physicians and patients happy, and improve the health system’s financial results.

Let’s discuss how your health system is managing the challenges of your physician revenue cycle.

Kelvin Drawdy is a director with JHD Healthcare Partners.  For a complimentary assessment, please visit JHDHealthcarePartners.com.

Yes, PHM Can Get You Paid

Stethoscope and cash sm

Skip Leavitt, PA, MBA, FACMPE

The case for effective population health management couldn’t be clearer. But still there is great reticence on the side of providers and health systems, many of whom believe that adding PHM activities will threaten fee-for-service revenue. They want to be able to increase quality and lower costs for their patients, but there are some commonly held concerns that don’t have to be true:

  • Myth 1. If they are successful with their PHM, then their fee-for-service revenue will drop, and it will drop faster than value-based revenue increases.
  • Myth 2. The tech cost will be very high and they think they have to pay for the technology up-front.

Here is what organizations that have been successful at a transition to PHM have figured out: There are activities documenting a track record of increasing quality that are also reimbursable under the current fee-for-service system.

Let’s take, for example, Chronic Care Management (CCM), which Medicare has just put in place.

If a provider has a Medicare patient who meets CCM criteria, they can get paid $42 per month per person for care coordination, which can be done by non-physician staff, such as an office nurse.  For a typical internist, who has 500 Medicare patients, that’s $21,000/month for doing care coordination. And that’s just one example.

By appropriately documenting the care coordination done for those patients, providers can build their record.  Also, it’s been shown practices doing chronic care management experience a higher rate of Medicare patients coming in for annual medical evaluation — which increases the compliance with the wellness evaluation.

Many practices would like to do care coordination, but are overwhelmed by the day-to-day issues of running the practice. Becoming part of a clinically integrated network can provide the needed expertise and resources at minimal cost.

Another example to show how PHM can get you paid is closing care gaps. We know most patients don’t get the preventive care they need; typically, less than half of the patients get the recommended preventive care measures. Simply identifying those patients, bringing them into the office, and arranging for preventive care increases FFS volumes and also increases the documented improved quality of care.

PHM can be game-changing for your practice, if you’re willing to make a few changes. Don’t let the misconceptions about transitioning to value-based care hold your practice back.  Not only can you set your practice up for success in this new healthcare landscape — but also increase your revenue during the change-over.

Skip Leavitt, PA, MBA, FACMPE, has more than 25 years of healthcare management experience, including clinical and executive positions in both the provider and payor sectors. On the leadership team of JHD Healthcare Partners, Mr. Leavitt puts that expertise to work helping physicians, hospitals and health systems succeed.