The ABC of Healthcare is split and sold!

In healthcare news this week, it was announced that The Advisory Board Company agrees to be acquired for $2.58 billion dollars. The news on Tuesday this week that this stalwart of healthcare consulting and advisory services, with an estimated *5,700 healthcare organizations as clients, was being purchased by Optum, a division of UnitedHealth Group surprised many, including yours truly. The merger is expected to be finalized by the end of 2017.

The Press Release here mentions details of the sale. It is understood that Advisory Board chief executive, Robert Musslewhite will head the combined healthcare advisory services after the merger is completed.

*Source – Washington Post, 8/29/17

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Physician Burnout! A disturbing trend

Burnout1

Since my last post about my late Grandfather, I didn’t have the motivation to write; but then I thought about all of the times he encouraged me to write, it reminded me to follow my passion, so here I am with my thoughts again, this time on the disturbing trend of Physician Burnout.

Physician BurnoutOver the last 7 years since the time of the “Great EMR Implementations”, we have always discussed physicians retiring because they did not want to learn technology and use the EMR. I put it down to older physicians not keeping up with the times. I’m not so sure about that anymore.  The reason being that one of my friends who is a physician went through a very visible burnout episode that surprised everyone recently. She said that she was working until the middle of the night trying to keep up with documentation and it finally became too overwhelming for her to take. This surprised me tremendously. This wasn’t something that happened to younger, more savvier physicians…or so I thought. IBurnout2n a June 29th, 2017 article in the Harvard Business Review, points such as loneliness at work is also a factor that is identified as the reason for burnout (it doesn’t discuss physician burnout in particular though). Similarly, in a June 22nd article in Time Magazine, titled “Doctor’s on Life Support”, it starts by saying that “Doctors are stressed, burned out, depressed, and when they suffer, so do their patients. Inside the movement to save the mental health of America’s doctors“. The  signs of stress are evident. IT departments can and should do more to collaborate with clinic practices and primary care and specialties to help develop efficiency within the every day use of technology. Technology “A-Teams” should be identified to work with their physicians, understand the challenges that they are facing, whether in the EMR, wireless “dead zones” in clinics that drop the connection, old laptops and PCs that need to be updated, that sometimes may mistakenly be attributed to an EMR deficiency or other areas where the process can be smoother for the physician and/or clinic staff.

All of us as Healthcare Information Technology professionals needs to bear in mind that we need to do all we can do reduce and eliminate physician burnout and improve the processes for the physician so that we can enable them use technology for better, faster and more efficient patient care. The burden of EMR documentation should be lessened and, at the end of the day, it will be the patient that will gain and the quality of care will increase with a happier, less stressed, care provider.

 

2016 – The year of Disruptive Living

With 2016 behind us, it’s hard to believe we somehow survived this year. Whether we admit it or not, we’re not used to big changes and politics does play an important part of our lives. Whether it’s in that realm or in technology, we are creatures of habit and rarely like our world or ecosystem to change. The biggest challenge I’ve always encountered on a project is change; whether it’s process or technology changes, it’s always a challenge to get people to change and adopt a new way of working. Physicians are particularly challenging to change as they are very set in their ways.

Whether it’s the elections that occurred that seemingly swung the pendulum a different direction than what was in motion for the last 24 years or the endless march of technology like Amazon Go, (which I believe could have applications outside of Retail such as in Healthcare), our lives have been greatly disrupted as we see that the status quo is not acceptable anymore.

I’ve been asked by a few people whether MACRA will get scrapped under the new US administration or whether some of the current other reporting requirements will be changed. Currently the view has been only time will tell as there has been no specific policy that has mentioned anything one way or another. Will much of the work accomplished or investment over the last 5 years be set aside or will we be able to build off that and leverage this paradigm shift for the greater good?

Only time will tell. Whatever it is, there are many people that would like to see 2016 into a distant memory and hope that the new year brings with it better fortunes than the current one has dealt many.

In Memorium: Carrie Fisher aka Princess Leia (1956 to 2016)

“Help me Obi-Wan Kenobi, you’re my only hope.”

Are EHR vendors becoming Population Health corporations?

An interesting article surfaced in Healthcare IT News that suggested that executives at some healthcare software vendors want to transform themselves from generically being deemed as an EHR vendor and become a Population Health company like Cerner’s CEO Zane Burke told Healthcare IT News. 

Being able to access data relevant for patient care should be possible regardless of the format it is presently in or whether it is in an EHR,  national database or in pdf format. 
The constraints that “EHRs” are presently may not allow for this functionality  (yet). The article goes on to state that providers are also moving towards precision medicine, accountable care management, chronic care management and value based reimbursement. 
Movement for many on the ground is still in the initial stages and only those provider organizations with deep pockets and the ability to leverage collaborative working relationships with solution vendors can think about moving forward with all of the initiatives mentioned above in a meaningful way. 

Truly Epic! R&D Spending sensation 


In a story published on September 13th , 2016 by Healthcare IT News (HIT News), Epic Systems’ founder Judy Faulkner  ( just ‘ Judy’ to many in the Healthcare IT world) revealed that Epic invested something like 50% of its operating expenses on research and development, outstripping all organization in and out of the Healthcare IT ecosystem. 

HIT News verified through federal filings that Cerner spent 19%, Allscripts spent 34% and athrnahealth was at 10%. Google spent 45% of its operating expenses on R&D  (or $12 billion) and seemed to be the closest when it came to a percentage of operating budget. 

The thought that ran through my mind was ” Has this translated to better and more efficient and streamlined patient care at Epic’s customers versus provider organizations that have implemented a competing product? I’m all for R&D and believe that it’s really what makes America great  (I don’t think we’ve lost the ‘greatness’ since 1776 when the Founding Fathers declared independence, but that’s another story for another day). The technology of the 21st century has indeed been spurred by American innovation and ingenuity  (Facebook,  Twitter and the entire world of Social Media). R&D brings us medicines that have been life changing to many and previously were inconceivable even in the latter part of the 20th century, but with the cost of patient care rising and many Americans wondering how to get them within reasonable limits anymore, does this only add to our costs in the patient community or will it be the savior of millions and have a lasting impact for the country and the world. Makes you think. …

Holy MACRA! Patient Engagement rides again!

Regulatory-signage“What was that masked legislation? Why that, my boy was CMS! The greatest regulator in the west!” (Cue The March of the Swiss Soldiers in the William Tell Overture aka, theme song for one of my childhood heroes, The Lone Ranger).

What is MACRA?

MACRA is the abbreviated version of the “Medicare Access and CHIP Reauthorization Act of 2015” which was signed by President Obama on April 16th of this year. (Healthcare and CMS sometimes really can’t help it’s communication to the public when they make these abbreviations something that only so called “healthcare insiders” will understand).

The new law repeals Medicare’s sustainable growth rate (SGR) formula and creates a way to increased Medicare payments. At HIMSS16 this year, there was a focus was on “MIPS” or Merit Based Incentive Payment System which is the program that the SGR will be replaced with.

Physician rates are understood to be increased by 0.5% starting in July and each January through 2019 and then, bonuses could reach 12% and then 27% by 2022 (physicians could also face penalties for not meeting quality targets down the road).

On the CMS site, it asks the question, “How does the Medicare Access & CHIP Reauthorization Act of 22015 (MACRA) reform Medicare payment?”

Apparently, in a couple of ways:

It makes 3 changes to how Medicare pays those who give care to Medicare beneficiaries. The changes create a Quality Payment Program (Abbreviated to ‘QPP’).

  1. Ending the SGR formula for determining Medicare payments for health care providers services.
  2. Making a new framework for rewarding heal care providers for giving better care not just more care.
  3. Combining CMS’ existing quality reporting programs into one system.

The changes have been named QPP and replace other Medicare reporting programs with a flexible system that allows providers to choose from 2 paths that link quality to payments either MIPS or something called Alternative Payment Models (APMs)

MIPS – This combines parts of the PQRS (Physician Quality Reporting System), the Value Modifier (VM or Value Based Payment Modifier) and the Medicare Electronic Health Record (EHR) incentive program in which EPs (Eligible Professionals) will be measured on:

  1. Quality
  2. Resource Use
  3. Clinical Practice Improvement
  4. Meaningful Use of Certified EHR technology.

APMs – Alternative Payment Models give new methods to pay healthcare providers for the care they give to Medicare recipients as from the year 2019 to 2024, CMS will pay some participating healthcare providers an incentive lump sum; increase transparency of physician focused payment models and starting in 2026, offer some participating healthcare providers higher annual payments.

 

 

 

 

 

Daylight Savings Time Ended – Did the hospital charge you less?

In the spring of 2014, I wrote a post about possibly getting over-charged for a hospital stay due to synchronizing EMR systems to the correct time. Similarly, this past weekend, when Daylight Savings Time ended, some patients may not have a second bed charge added for the hour that is repeated due to an occurrence in the system.

Many organizations may have the ability to manually update their charges in what is called the hospital billing account after a patient is discharged. This though is a step more than many organizations have the bandwidth to work on these days with all of the regulatory mandates that they are working on.

With Healthcare Payer organizations rejecting claims for even minor defects, this could be a major revenue loss for any provider and would need to have a consistent remediation for Patient Financial Services to be on track with their forecasts. It would be more than likely that they will not unless a patient reviews their charges more carefully. Data for the hour of the double 2am time on Sunday needs to be well documented and validated. Most responsible provider IT Revenue Cycle Management organizations have plans for the time change that have been scheduled far in advance and would be reviewed as I document this post. Is this another reason why we may not need to keep changing back and forth from Daylight Savings Time. Is this one of the reasons why the concept may be moot going into the 21st century? Time will tell.