Eight in 10 healthcare businesses impacted by bad hires

A new survey by CareerBuilder found that this year eight in 10 healthcare businesses have been impacted by bad hires, costing companies thousands of dollars.

In a survey conducted by Harris Interactive for CareerBuilder, one of the largest online employment companies in the country, 79 percent of healthcare employers reported being adversely affected by a bad hire in 2012. Thirty-nine percent of those businesses said they estimated the cost of a single bad hire to be over $25,000 and 22 percent estimated over $50,000.

The survey, conducted online between Aug. 13 and Sept. 6, 2012, questioned 276 hiring managers and human resources professionals employed at healthcare companies nationwide.

“All companies make bad hires. It’s inevitable. You can’t always be 100 percent,” said Jason Lovelace, president of CareerBuilder Healthcare.

But the cost of bad hires adds up fast, Lovelace said. There are the financial costs to recruit and train the bad hire and a possible replacement, as well as “soft” costs, such as the time lost in training and recruiting bad hires; overall employee morale is impacted, which may drive down productivity; and there may be legal entanglements and negative impacts on customers/patients.

Survey respondents classified bad hires as employees who didn’t produce the proper quality of work; who didn’t work well with other employees; who had a negative attitude; and who had immediate attendance problems, among other behavioral- and performance-related issues.

How do bad hires happen? The most common reason cited by healthcare hiring managers and human resource professionals was the need to fill a position quickly. The pressure to fill positions as quickly as possible is compounded by issues of supply and demand, Lovelace said. “The need is so great to find people with the skills necessary for clinical type positions, or just healthcare type positions in general,” Lovelace said, “(that) they’re making bad decisions because they can’t find the individuals that they need. They’re willing to settle, and typically if you settle, it’s a bad hire.”

While avoiding bad hires is impossible, it is possible to minimize bad hiring decisions, Lovelace said. Companies need to train their hiring managers where to find the types of people they need and to figure out what characteristics to look for in potential hires. It is also imperative that they put in the time to do due diligence. “Go through the process,” Lovelace said. “Speed will kill you. … an open position is better than a bad hire.”

Source: healthcarefinancenews

7 Strategies to Develop a Clinical Integration Network

Clinical integration is an increasingly popular strategy for hospitals to align with physicians and improve the cost and quality of care. Dennis Butts, a manager in Dixon Hughes Goodman's healthcare strategy practice, shares seven strategies for hospitals to successfully develop a clinical integration network.

1. Cultivate physician leaders. A successful clinical integration strategy requires the integrated network to be physician led and physician driven, according to Mr. Butts. "Physicians have to have enough power and authority to effect change — to [determine] how quality is defined, what protocols will be developed and how to hold each other accountable for meeting objectives." 

To lead the network effectively, it is critical for physicians to be involved in creating the clinically integrated model from the beginning; they need to have a voice in designing the structure of the network. "You can't expect a physician-driven initiative after you've already planned [the network] in the hospital and expect them to buy in to what you've already developed," Mr. Butts says.

Giving physicians leadership roles may require a cultural change in the hospital, as historically hospital administration and physicians have worked separately. "It's a real paradigm shift for most organizations where they're allowing physicians to have a significant say in how things are done at the hospital," Mr. Butts says. Physicians may also have to change their workflows to be successful in their new roles. "Physicians are going to be asked to do things differently and be held accountable for things they maybe haven't been in the past," he says.

2. Provide hospital management. Creating a physician-led clinical integration network does not mean clinical integration is solely run by physicians, however. The most successful programs have embraced a physician-led, professionally-managed culture that maximizes the experience and expertise of physicians and hospital administration, according to Mr. Butts. The hospital can provide data analytics and other resources and expertise to ensure the network is supported from a management perspective.

3. Communicate often. Another critical aspect of clinical integration is frequent communication between all parties. Clinical integration is a major change initiative and leaders should seek medical staff input early and often, according to Mr. Butts. He says one common mistake in developing clinical integration networks is when leaders assign small committees to work on different initiatives, but don't have a robust strategy for these committees to communicate with each other and to the broader medical staff.

4. Choose metrics. Clinical integration networks should choose metrics that span the continuum of care, according to Mr. Butts. "Make sure your metrics cover the inpatient side as well as the outpatient side, so you're not focused on just what happens in the hospital, but also what's happening in the physician practice," he says. He also suggests focusing on metrics related to care transitions between sites and adopting the same metrics across payors.

5. Invest in infrastructure. A successful clinical integration network requires investment in infrastructure that can connect the hospital and physicians through patient registries and other electronic systems. A robust infrastructure provides the tools physicians and hospitals need to monitor quality and cost. "Without that infrastructure in place or access to real-time data, physicians will not be able to change [clinical] patterns to achieve the objectives of the network," Mr. Butts says.

Clinical integration networks can reduce the cost of developing appropriate infrastructure by building off an existing structure. For example, Mr. Butts says the network can build upon the infrastructure already in place from a messenger model physician-hospital organization or independent practice association if they exist. "Instead of recreating the wheel, see if there's an entity already created that is still usable to reach the objectives you're trying to meet," Mr. Butts says.

6. Create a short-term win. When hospitals and physicians develop a clinical integration network, they can build payors' support of the network by quickly demonstrating improvement. Targeting low-hanging fruit to demonstrate improved quality and cost can help validate the clinical integration model. Oftentimes hospitals go after low-hanging fruit by starting with hospital efficiency initiatives in the acute setting or within the hospital-sponsored health plan. When the network negotiates with payors, it can use data from these initial improvements to attain favorable contracts, according to Mr. Butts.

7. Determine a distribution method. Leaders must develop a methodology to distribute incentive dollars once they are in the network. The distribution methodology should 1) distribute funds based on measurable performance, 2) be transparent, 3) reward physicians for their individual contribution and performance and 4) maintain a level of simplicity, according to Mr. Butts. He says leaders of the network often build individual and network incentive pools into the distribution methodology to achieve these objectives.

Source: beckershospitalreview

Mobile e-prescribing can add many benefits to a physician practice

The adoption of e-prescribing is not only rewarded by the federal government, but a failure to do so could leave practices open to federal penalties. According to the American Medical Association, physicians who don’t adopt e-prescribing when eligible will face penalties starting in 2012. Eligible physicians are subject to a 1.5 percent Medicare payment reduction based on their 2013 Medicare Part B fee schedule amounts during the year. The penalty is 2 percent in 2014.

Mobile e-prescribing allows physician practices to monitor patient adherence to medication more effectively anytime and anywhere, increasing quality of care. Research has shown that e-prescribing is among the top five requested mobile features by physicians. Many physicians say mobile e-prescribing helps them handle prescription requests as soon as they are needed. Regardless of the doctor’s location, they can continue to give fast, accurate care to their patients.

Another advantage is that e-prescribing increases patients’ compliance to medication usage by simplifying the prescription-filling process. With e-prescribing, a refill request goes directly from the doctor’s office, home or mobile device to the pharmacy electronically, and the practice gets an automatic confirmation that the pharmacy received the request and filled the prescription. Paper prescriptions, on the other hand, may lead to a breach in the patient care continuum because doctors have no accurate means of monitoring if patients have filled the prescription.

E-prescribing saves time and money, streamlining the prescription process in many different ways. First, doctors may prescribe a medication or refill a prescription from anywhere and at any time with a mobile device, without the need to wait until they arrive to the office. Second, the prescription request is sent directly to the pharmacy with the click of a button.

Third, pharmacists can see the e-prescription information on their computer or mobile device, drastically reducing their chances of misreading the prescription. The need to call the doctor’s office for clarifications is also greatly reduced, if not eliminated. Currently, 30 percent of all prescriptions require pharmacy call backs, according to the National Committee on Vital Health and Statistics (NCVHS). Considering that 3 billion prescriptions are filled in the U.S. every year, 900 million calls result from pharmacies clarifying information – which makes the time an average practice spends on the phone clarifying prescriptions staggering. Unlike a paper prescription, an e-prescription is clearly presented and comes with detailed information about the medication, including dosage, side effects and medications with which the prescription may counteract. This ultimately helps doctors, pharmacists and patients prevent mistakes and lead to better patient care.

Lost paper prescriptions can become a thing of the past. Paper prescriptions can be misplaced or lost, which in a best-case scenario is inconvenient for both the patient and the doctor. An even worse outcome of a lost prescription might include patients not refilling the prescription at all, possibly resulting in adverse health consequences. E-prescriptions also reduce the possibility of fraudulent behavior or illegally filled prescriptions, because prescription requests can be sent directly to and viewed exclusively by the pharmacist.

Patients want the convenience that mobile e-prescriptions bring. Research shows that patients want the ability to request a prescription renewal through a patient portal using their mobile device. As a society, we are entering a phase of patient empowerment – fueled by mobile access to information, improved care and convenience. A physician’s decision to e-prescribe demonstrates that the doctor is up to date on his or her medical methodologies for treating patients and is willing to make changes to benefit them.

Physicians who e-prescribe enable patients to take full advantage of doctor-pharmacy technology, gain important insight into prescription information and select the location where patients want their prescription filled, so they can conveniently pick it up. These important capabilities benefit the patient and strengthen patients’ view of their physician’s technology practices.

Source: mhimss

Focus on branding to attract healthcare consumers

As patients assume more active roles in healthcare decisions, hospital executives should make branding a top priority, according to the new issue of healthcare marketing report Protocol from Smith & Jones. With an active brand strategy, hospitals can align physicians and staff with the hospital's mission and identity, as well as make communications consistent.

"Until recently, it wasn't necessary to advertise healthcare services," Smith & Jones President and CEO Mark Shipley said today in a statement. "Hospitals are now forced to brand and market their services to retain even their local consumers' care spending."

Meanwhile, patients are choosing health insurers based on brand reputation, reported The Financial. That should signal a warning to hospitals that they need to strengthen their brands to attract patients in today's competitive healthcare environment.

"More than ever before, consumers are paying increased attention to their healthcare options and selecting products and services they prefer to consume. As a result, positive brand recognition has become and will increasingly be critically important," Debra Richman, senior vice president of healthcare business development & strategy at Harris Interactive, said in the article.

To develop a strong brand, hospital executives must gauge the brand from the patient's point of view to figure out what they like or dislike about the brand, according to a March blog post from StrategicPlanningMD. It also noted that a great hospital brand appeals to emotions with a powerful experience that goes beyond quality metrics and connects to patients.

Some of those strategies can be seen in Washington state, where EvergreenHealthcare has rebranded itself as EvergreenHealth to better emphasize its highly personalized care and dedication to patients and the community, the hospital district announced earlier this month.

Source: fiercehealthcare

Brain health technology market to exceed $1B by year's end

The market for brain health technology will surpass $1 billion by the end of 2012, and is set to grow at a brisk thereafter, to between $4 and $10 billion by 2020, according to SharpBrains, a San Francisco-based market research firm.

The industry report, "The State of the Digital Brain Health Market 2012-2020 – Transforming Health with Digital Tools to Assess, Monitor and Enhance Cognition across the Lifespan," offers insights into the digital revolution transforming brain health and heath overall, officials say.

Such software includes computerized Web-based and mobile cognitive assessments, cognitive training and cognitive behavioral therapies, as well as biometrics-based monitoring and brain training tools that measure physiological responses such as heart rate variability and electroencephalography. 

"A major driver of this growth in consumer and provider demand is a significant ongoing demographic trend: an aging population," according to the report's executive summary. "On a global scale, with the total senior population expected to triple (to 1.5 billion) over the next 30 years, aging populations will make brain health even more important moving forward."

"We see a growing portion of the 78 million baby boomers in the U.S. alone investing time and effort into retaining their mental sharpness," the report reads. "This trend also motivates healthcare and insurance providers to introduce and test innovative solutions, mainly from a health & wellness (although not yet clinical) perspective."

The report finds that a market of some $6 billion is the most likely scenario by 2020. It predicts the Asia Pacific region will likely surpass North America and Europe by 2017 in its usage of the technology.

In addition to analyzing consumers' use of this technology to manage and improve their brain health and performance outside clinical settings, SharpBrains conducted in-depth analysis of more than 200 companies operating in this sector, and asked scientists to identify the most important innovation opportunities from their published research, officials say.

Among the study's findings with regard to consumers:

• 94 percent of consumers agreed or strongly agreed with the statement: "Addressing cognitive and brain health should be a healthcare priority."
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• 83 percent agreed or strongly agreed that, "I would personally take a brief assessment every year as an annual mental check-up.'"
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• The same percentage agreed or strongly agreed that, "Adults of all ages should take charge of their own 'brain fitness,' without waiting for their doctors to tell them to."
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• Nearly three-quarters (73 percent) agreed or strongly agreed that, "Digital technologies can significantly complement other behavioral and drug-based interventions."

"Despite the economic downturn, this market has still grown from $600 million in annual revenues in 2009 to more than $1 billion by the end of 2012," said Alvaro Fernandez, CEO of SharpBrains. "With more than two billion people worldwide currently suffering from brain-based health and productivity challenges, it is rewarding to see a new generation of technologies and methodologies being developed and implemented to confront this challenge in efficient and scalable ways."

Source: healthcarefinancenews

Cost of treating morbidly obese patients continues to trend up

The costs associated with treating morbidly obese patients continue to rise, according to a report released Monday by healthcare supply contracting firm Novation.

In its 2012 Bariatric Report, Novation reports that 74 percent of the facilities that responded to its survey have seen an increase in the number of bariatric surgeries in the past 12 months. More than half of respondents also spent more on the treatment of morbidly obese patients in the last 12-18 months than they had in previous years.

Other key report findings include:

• Sixty-one percent of respondents have seen an increase in the number of bariatric-related reconstructive surgeries in the last 18 months.
• The estimated cost of all expenses related to the treatment of morbidly obese patients ranged from $200 to as much as $5 million in the last 12-18 months. Beds account for the highest total costs and/or the greatest increase in bariatric product spending at member facilities.
• Thirty-six percent indicate that they invested in the physical renovation for their facilities to accommodate morbidly obese patients in the past year. The estimated cost of all morbidly obese-related renovations ranged from $12,000 up to $4 million.
• Fifty-three percent have a fitness program in their facilities, 60 percent have a weight loss program and 61 percent have a counseling program.
• In light of healthcare reform changes, the majority of respondents plan to enhance their obesity education and prevention programs. Fifty-six percent will enhance the programs for patients, while 64 percent will enhance these programs for their own employees.
• When asked about workplace injuries related to caring for morbidly obese patients, 59 percent have seen a decrease in the past year. Of the 59 percent, 77 percent believe that it was due to purchasing specialized equipment for obese patients or offering training programs.

“The member hospitals we serve have seen a continual rise in the costs of treating obese patients, while also facing the financial pressures of the economy, reduced reimbursement and changes under healthcare reform,” said Cathy Denning, vice president, sourcing operations at Novation.

Denning believes this upward cost trend is likely to continue.

“We see childhood obesity continuing,” she said. “From that perspective, we can anticipate this will be a problem for many years to come… To close our eyes and not accommodate (for these patients) is foolhardy.”

Denning cites the need to purchase larger beds, widen hallways and elevators and renovate bathrooms as major cost drivers in the care of morbidly obese patients.

However, hospitals are showing a willingness to spend the money necessary to renovate, she said.

“Hospitals are willing to invest those dollars to do that, even in these times,” said Denning. “Capital budgets are loosening. It speaks well of facilities that are appropriately investing where they need to.”

“We have to take care of these patients safely,” added Denning. “In the future, reimbursements will depend on it. If there is a patient incident in your hospital, you own that.”

According to Donna Simon, bariatric coordinator at Phoenix-based Banner Health, staff training also accounts for a portion of the additional costs associated with caring for morbidly obese patients.

Training includes proper techniques for lifting and moving obese patients and also concentrates on teaching sensitivity, said Simon.

“Sensitivity is one of the biggest things,” Simon said in an interview withHealthcare Finance News in August. “We have staff sensitivity training because everyone is a person, but people don’t know how to treat the obese. Every employee goes through sensitivity training every year, not just at the time of hire.”

Source: healthcarefinancenews

Financing a transition to the cloud

Transitioning to cloud services may be the next big technology move for your organization. What’s involved? How much does it cost? Is it worth it? We talked to some folks familiar with cloud computing for “Navigating the Cloud,” an e-supplement available on our websites in November. Here’s an excerpt from “Financing your transition to the cloud.”

What is the cloud and why does my healthcare organization need it?

Terry Rennaker, vice president, Skanska USA's Mission Critical Center of Excellence, and Andrew Quirk, senior vice president, Skanska USA’s Healthcare Center of Excellence: Cloud is a term for computing that is done on multiple servers and possibly in multiple data centers on a flexible platform that can move the computing around as computing demand and capacity change. A cloud can be small and contained within a single data center and can serve a private use, or can be large, covering multiple data centers and serving multiple clients. … In both cases computing and storage capacity is purchased from the provider who then hosts the computing of the procuring company. This provides a flexible computing base to the customer providing computing and storage in a utility like model; use it when you need it and pay only for what you use.

This decouples the need for building your own facilities and buying servers to satisfy your computing needs.

This is important to healthcare organizations as an outlet for their computing needs, which are growing exponentially as a result of bring your own device (BYOD) pressure, electronic medical records, electronically interconnected medical equipment and

many other demands on IT infrastructure. The cloud can provide a rapidly responsive computing capacity to ever-changing and escalating computing needs.

The challenge for healthcare organizations is to move to the cloud while maintaining all of the security and compartmentalization required by healthcare regulation and patient record security.

What are the costs associated with transitioning to the cloud, and are there “hidden” costs?

Tony Vitelli, director of managed services, Infor: There are costs necessary to facilitate the transition to the cloud, but they are quickly recoverable and can provide an attractive ROI. Depending upon the application, up-front costs may include a migration project and all that those entail (testing, data validation, etc). In many cases the application will not change with a migration to the cloud (no end user effect). Also, by timing these moves to previously planned hardware spend, we find that the initial investment needed can be significantly lower than continuing with the status quo.

By doing the proper amount of due diligence and planning, hidden costs can be greatly minimized or even eliminated. As mentioned previously, by timing your move to the cloud with previously planned activities, the cost of migration can usually be accomplished with existing budget. Even in cases where an existing contract may not have an out clause, changing business requirements may still allow for an attractive ROI. Regarding security, this is always a concern, with a proper amount of due diligence and proper architecture you can be comfortable that your data is safe.

Source: chiroeco

ACA brings new opportunities, challenges for revenue cycle management

The U.S. Supreme Court’s decision on the Patient Protection and Affordable Care Act has brought much-needed clarity to hospitals and other healthcare providers. With the uncertainty gone, providers can now fully assess and plan for the Affordable Care Act’s (ACA) effect on revenue cycle management (RCM).

Virtually every aspect of the ACA affects RCM, including:

Funding Cutbacks: The ACA calls for dramatic funding and reimbursement reductions, including more than $700 billion in future Medicare spending. For non-profit hospitals, Medicare reimbursements will be reduced over 10 years by more than $150 billion, and $14 billion in Medicaid disproportionate share hospital payments will be cut, according to Moody’s Investor Services.

Also, the Supreme Court gave states the option to accept or reject federal money for Medicaid expansion. In some states, providers will have to project whether their state will opt in or opt out of federal funding. If a state chooses to forgo the expansion, a provider could still be faced with significant numbers of uninsured patients and experience Medicaid payment shortfalls.

In terms of RCM, these cutbacks and continued uncertainty in some areas make it even more important to identify and maximize payments and collections since hospitals typically operate on a 1-3 percent bottom line margin. Any cutbacks in reimbursement will have a definite negative effect to the bottom line and could quite possibly make the difference between continuing to serve the local community and closing their doors, especially for rural facilities. Typically in order to add one point to the bottom line margin, there needs to be a 10 percent reduction in costs to the top line. With decreasing reimbursements, this makes managing such cost cutting measures even more difficult. It also makes being competitive in the market place that much more important. 

New Quality-Care Programs, Reimbursement and Incentive Models: With the goal of providing better care at lower cost, the ACA includes pilot or expanded programs to test different models. The Center for Medicaid and Medicare Services’ value-based purchasing program, for example, provides incentive payments to hospitals that meet or exceed certain performance benchmarks set by CMS. Other programs include bundled payments and shared savings initiatives.

In terms of the effect on RCM, all of these programs require comprehensive reporting, including the collection of significant data about clinical outcomes, detailed billing and reimbursement records, and compliance information.

In addition to meeting requirements, more robust RCM systems can also provide valuable insights into costs and help identify areas for improvement. If a hospital is penalized, for instance, for an unusually high rate of readmissions or hospital-acquired infections, it can mine its data to identify root causes and trouble spots, and devise solutions.

Compliance, Oversight and Enforcement: Much of the ACA changes involve compliance with new criteria, such as medical necessity standards. Similar to the outcomes-based programs mentioned earlier, RCM systems must have the capacity to collect and integrate clinical and other types of information.

Along with new compliance standards, the ACA also has an oversight and enforcement component. The Recovery Audit Contractor (RAC) program is designed to root out fraud, waste and abuse. Documentation practices will be put under a microscope, necessitating RCM systems with tight controls, access and audit capabilities. These advanced systems can also help identify areas with recurring errors or other issues.  

Huge Influx of New Patients and Data: Once coverage for the uninsured begins to expand in 2014, providers are likely to see an unprecedented increase in demand. RCM systems will have to capture and analyze a tremendous amount of new information, including: insurance eligibility and authorizations for Medicare, Medicaid and private insurance; coding; medical outcomes; compliance with clinical standards; payment and reimbursement requirements; doctor payments; and claims, billing, payment and collections data.

Increasingly, RCM systems will also have to function as interactive patient portals.

Looking Ahead

As providers determine the best strategy to meet broad new requirements, they may choose to update, modify, replace or outsource RCM systems. With the cost and complexity of RCM, outsourcing will play a more central role, enabling providers to minimize upfront investment costs, increase agility and flexibility, reduce the need for training and hiring, and provide ongoing savings.

Many providers have found that the bottom-line effect of outsourcing is significant. One large RCM provider that works for providers on a gain share basis, which is similar to a contingency fee arrangement, achieved a 400 to 600 basis point improvement in margins for its hospital clients, effectively doubling operating margins.

The ACA has dramatically changed the operating environment for healthcare providers. One of the most important tools they can put in place to help adjust to and benefit from the law is a multi-faceted RCM system. While the changes under way are challenging, they also offer a rich opportunity for healthcare providers to use RCM to make their facilities run more efficiently and cost-effectively and provide higher-quality care to patients.

Source: healthcarefinancenews

5 ways to reduce staff turnover by promoting wellness

The nature of a healthcare organization is to help others improve their health, but it would save money and reduce turnover if these organizations also focused on their own employees by promoting healthy living and wellness for them.

"There's a huge cost to employers when there's turnover of any kind," said Susan Moriconi, vice president of human resources at Omnicell, a medication and supply automation company based in the San Francisco Bay area. "But when an organization is invested in and committed to the health of their employees ... those people will want to remain with their employer and make a career. Which means organizations can retain institutional memory and scale of knowledge that people gain while they're working." Additionally, healthy employees are both more productive and genuinely happier people.

Moriconi shared her list of five approaches healthcare organizations can take to help reduce turnover costs by promoting healthy living for their own employees.

1. Develop a wellness program

"Programs exist where companies can offer health benefit programs with scaled healthcare premiums if an employee has undergone biometric testing or other screenings made available to them," said Moriconi. Other programs offer financial incentives, like a reward of $75 for having a health screening provided by the company. Offering access to an on-site gym, exercise classes with fitness trainers at no charge and educational courses on healthy lifestyles is also beneficial to employees and employers alike.

2. Support from supervisors

Support from top leadership is incredibly important and influential. When an approach to wellness is initiated and championed by a CEO, employees see it as encouraging.

3. Offer flexible schedules

"Managers should help employees have flexible schedules which would allow them to take advantage of the programs offered," Moriconi said. It's one thing for a company to simply offer health and wellness opportunities, but it's much more beneficial if they take a proactive approach at making sure their employees have the time to take advantage of them.

4. Create work-out rooms to work in

Many companies these days are creating rooms with treadmills where people can hold a meeting or have a conference while walking.

5. Employee engagement

"Allow employees to pick something new they would like to do – a new healthy food or activity they've never tried – and reward them for it," suggested Moriconi. "Offer stress-busting challenges and have employees participate in them a couple times a week over the course of a few months." They can then earn points toward programs such as scaled premiums.

Source: healthcarefinancenews

Control costs, improve care with holistic healthcare management

Large and small healthcare systems across the country are facing a tidal wave of management and cost pressures--a confluence of new regulations, oversight, quality requirements--that are about to get even more complex. The impending changes in reimbursement, regulations, and closer scrutiny of patient outcomes are just the tip of the iceberg.

CFOs, CEOs, and their entire leadership teams are increasingly coping with continually soaring costs (which have led to staff layoffs when hospitals find no other way to meet budgets), shortages of personnel and supplies, increased waiting time, and changing relationships between providers and payers. Given that hospital costs are already among the highest in the nation, it's clear that the pressures to find ways to effectively manage and improve patient outcomes are only going to get worse.

Talk to the CEO/CFO of any hospital system and odds are he or she will be able to cite pockets of success. But ask about the overall impact on the patients and the bottom line, and most would admit falling short.

And that is the problem in a nutshell: Healthcare system improvement is being attacked in "the C-suite" in isolated pockets instead of looking at the whole. The CFO focuses on cost. The CMO looks at quality of care. The CIO is sure that IT will be the solution to most of the problems. The CEO is thinking about whether to join a new provider network or negotiate partnerships with other providers or payers. And radiology institutes streamlining that may throw a monkey wrench into cardiology's processing patients. Department heads innately focus on ensuring that their people are working most effectively and efficiently ... often at the expense of other treatment units. No wonder there is negative synergy created, when improvements in one area cause worse performance in another.

To navigate through the increasingly complex landscape of healthcare, healthcare managers, particularly those charged with watching the bottom line, need to start looking at things more holistically, so that improvements that impact cost and service can be synchronized horizontally--not just vertically.

Actually, the model for success may lie in the movement towards patient-centered care, where practitioners work together to coordinate all the treatment a patient receives--and to make sure that all the components are working together and not in conflict with each other. If you think of the "patient" as the healthcare system, the metaphor is a perfect fit.

Holistic patient-centered care applies in another way. The one thing that can align all the components of a healthcare system is making sure everyone is looking at the system from the patient's perspective. Getting "macro" around how you deliver care to a patient and how the patient receives that care is not easy, but developing that perspective throughout your organization can help you decide where and how to deploy unified and coordinated improvement efforts.

Taking this holistic view of your organization, shaped by the patient's perspective, today is an urgent component in developing a high-performance healthcare culture that can address the myriad of challenges ahead and significantly affect the successful management of costs.

The C-suite, as well as leadership at all levels, must think and act more holistically to synchronize performance improvement to achieve a tangible difference in patient and institutional success.

Source: fiercehealthfinance

Study: Docs increasingly using social media to share medical info

Research published this week in the Journal of Medical Internet Research finds a growing number of physicians using social media to share medical information and stay up to date. American Medical News previously noted YouTube being used in that way, with physicians using videos to present research papers or talks from professional meetings.

In the JMIR survey of 485 practicing oncologists and primary care physicians, 24.1 percent used social media daily or many times daily to scan or explore medical information, while 61 percent did so weekly. Just 14.2 percent contributed new information daily, though 46 percent added material weekly.

The researchers had expected those who view social media positively to be more engaged with it. They found 57.5 percent of respondents considered social media to be beneficial, engaging, and a good way to get current, high-quality information. Roughly the same percentage said that social media has helped them to care for patients more effectively, while 60 percent said it improved the quality of patient care they delivered. Not surprisingly, ease of use and usefulness were the determining factors in doctors' use of social media for sharing information among peers.

With colleagues pointing them toward relevant research and other information, social media can effectively be part of physicians' continuing professional development, the authors said.

Wendy Sue Swanson, an Everett, Wash.-based pediatrician and avid social media supporter, has on several occasions talked about social media as an effective way to share credible health information with patients. Other doctors use Facebook, Twitter and YouTube to engage with patients and market themselves.

Though the debate rages on about the appropriate use of social media by physicians, one bit of advice that could help busy docs is to organize incoming information into customized groups or themes. "Perhaps the most useful is the list I've titled 'essentials,' wrote physician blogger Mark Ryan in a post on KevinMD.com. "When I have only a short window of time, I can skim the essentials list and get high quality information in short order."

Source: fiercehealthit

Medical device M&A activity remains steady

The number of mergers and acquisitions in the medical device sector has been steady over the past three and a half years, according to research and publishing firm Irving Levin Associates’ new report The Medical Device Acquisition Report, Second Edition, 2012.

During the period covered in the report (January 2009 through June 2012), the medical device M&A market accounted for 632 transactions. The 88 deals announced in the first half of 2012 amount to about 14 percent of those deals, a level of activity that is on target to match or exceed the average number of deals transacted in each of the previous three years.

Comparing the number of transactions that were announced in the first six months of 2012 (88) to those announced in the comparable period in 2011 (89), the level of activity appears to be stable. The current year is on track to at least meet the 173 deals announced in all of 2011, according to the report.

The dollar value for transactions for the first half of 2011 was $48.15 billion compared to $14.9 billion for the first half of 2012. The drop in dollar value was primarily due to a $21 billion transaction in April 2011. However, dollar volume for the first half of 2012 exceeded the $13.9 billion reported for the entire year of 2009.

Medical device M&A dipped in the third quarter of 2012 compared to earlier in the year, but it has since rebounded nicely, said Steve Monroe, partner at Irving Levin Associates.

 “We are not quite sure why the volume of medical device M&A dropped so much in the third quarter, other than the usual summer slowdown, concerns about the European debt crisis and our own uncertainty with regard to the ... elections,” said Monroe. “That said, in October, healthcare M&A volume across the board spiked up, and there were 12 medical device deals announced, compared with 19 in the third quarter.”

Although Monroe is optimistic about the future of medical device M&A activity, he believes the uncertainty surrounding the implementation of the Affordable Care Act may slow growth in the sector in the short term.

“As 2013 plays out, especially with regard to getting ready for full implementation of (the) ACA in 2014, we will begin to see the outlines of the healthcare delivery system, and the players will begin to line up to make sure they are well positioned for it. One way will be through acquisitions, but we don't really know about the timing. It does appear, however, that deal sizes in the near term will be smaller as buyers will not want to risk too much without knowing the new rules of the game,” said Monroe.

Source: healthcarefinancenews

Many providers are rethinking the revenue cycle

The concept of revenue integrity holds contrasting-but-compatible views on the same subject: One lens is a micro view of the little details while the other lens is a macro view of the landscape. Together, they form a panoramic picture showing an end-to-end revenue cycle with all the pixilated points along the way. At least that is the financial community's vision of it.

Essentially, "revenue integrity" is a new buzz term for rethinking revenue cycle management, said Greer Contreras, vice president of revenue cycle coding for Dallas-based T-System.

"It revolves around the revenue cycle process but refers to a different way of looking at it in complex financial times," she said. "By adding 'integrity,' you are taking a holistic approach  -  another viewpoint to make sure pieces aren't falling off. Organizations have struggled a bit because the revenue cycle is often isolated and compartmentalized. They need to look at it as one piece."

Revenue integrity also consists of taking a close-up view of revenue cycle components. Depending on which and how many services are rendered, patient charges can take a long and convoluted path on the way to becoming a finished invoice. Without a fastidious system that uses data capture technology and seamless transference of patient insurance status, allowables, deductibles and co-payment information, healthcare providers can be losing serious amounts of money that is due to them, Contreras said.

"Financial leaders need to take a start-to-finish look at departmental deficiencies and the integrity of the entire cycle," she said. "It begins with getting the correct information at intake and diligence throughout the process until it reaches the back end."

Taylor Moorehead, partner for Carmel, Ind.-based Zotec Partners' west region, added that revenue integrity should ensure the value of every contracted service.

"If you have an agreement to receive $1,800 for every knee replacement surgery, revenue integrity means that you should be getting that amount every time," he said.

'Blur the divide'

Along with providing a clear information pathway, revenue integrity also stands for compliance, said Steve Everest, executive vice president of financial solutions for Houston-based Prognosis Health Information Systems.

"It means adhering to billing regulations, reporting standards and instituting efficiencies for sending information through the revenue cycle system while maximizing reimbursement for services provided," he said.

Prognosis specializes in serving small community hospitals, which collectively face greater financial and technological challenges than their "big city cousins," Everest said. As connectivity has advanced, he said, so have opportunities to improve revenues.

"They are trying to get better," Everest said. "Instead of laying everything on the back office to sort out after the fact, we're helping them blend the information upfront  -  getting both the financial and clinical groups to blur the divide. We're teaching our clients to address these things as they happen and head off a mess at the end."

Process integration

Revenue integrity is more than a term  -  it is a revenue model itself, said Kevin Arner, CEO of Jacksonville, Fla.-based PaySpan.

"Revenue has traditionally been an afterthought, but it is not something we can continue to manage in that way," he said. "It should begin at the onset of care and requires conversation on the functional capabilities of providers and a dialogue with payers. It should consist of integrating processes across the entire revenue life cycle. The old way doesn't really support the downstream business process that drives reimbursement."

The clinical community, to its credit, has evolved significantly in the quest to capture data at the point of care, said Arner.

"They've taken a big step forward and have done well with the capture," he said. "What hasn't adapted are the financial tools to support the process. They have been antiquated. Patient interactions are different than payer interactions."

Eyeing the middle

Rob Jones, director of revenue enhancement practice for Chadds Ford, Pa.-based IMA Consulting, believes that great attention has been placed on the front and back ends while the largest segment  -  the middle  -  gets neglected.

"These are the aspects of coding and compliance  -  all the dots in the continuum of care within the revenue cycle need to be connected," he said. "We've relied on technology to push information from front to back, but the challenge is only as good as the people who program it and if it is not programmed by experts, there will be gaps. The emphasis is to focus on systems and people so that everyone involved truly understands the complexity from beginning to end."

The claim form may be the most important document in the entire process, Jones said, because it is the catalyst for getting revenue in the door. The form is structured to capture a comprehensive data profile that puts the entire revenue cycle in motion, he said.

"By the time it hits the business office, the staff should be working on getting that claim paid," said Jones. "This is a process with no short cuts  -  it should include everyone, from front to back."

Source: healthcarefinancenews

4 Areas Where Better Documentation Can Improve Hospital Revenue

Clinical documentation improvement programs at hospitals usually conjure up notions of coding and health information management, but CDI goes much further. A main tenet of a successful CDI program is that it should lead to an increase in the hospital's revenue because most hospitals fail to capture the actual severity of illness of patients due to inadequate physician documentation.

CDI programs help hospitals better interpret coded data for comparisons, benchmarking and quality reporting, and the resulting documentation improvement benefits the bottom line in a plethora of ways, says Paul Weygandt, MD, JD, vice president of physician services for J.A. Thomas & Associates, a healthcare compliance and documentation firm.

Dr. Weygandt, an orthopedic surgeon, used to be vice president of medical affairs at Conemaugh Health System in Johnstown, Pa. He has been with JATA for the past eight years, helping hospitals that may be losing money from inadequate documentation. He says documentation problems do not just affect physicians and coders — the impact runs all the way up to the C-suite.

"Many CFOs historically have thought of CDI as a branch of the HIM department for the sole purpose of improving their coding," Dr. Weygandt says. "It really is a collaborative process. That's the key."

Here, he explains four areas that impact a hospital's revenue that could also be improved through a successful CDI initiative.

1. Case mix index. CMI is an essential measurement for any hospital CFO and financial department. CMI measures the relative cost needed to treat a hospital's Medicare population, and it explains the types of patients the hospital treats (by co-morbidities, complications, gender, etc.). Basically, it reflects the average severity of illness of all Medicare patients treated at the hospital. The higher the CMI, the more high-revenue services the hospital performs.

Documentation directly impacts CMI. For instance, if physicians are too vague in their descriptions, the result could could be undercoding, which lowers the CMI and leaves revenue on the table. "The starting point [of CDI] is CMI," Dr. Weygandt says. "Every CFO relates CMI to revenue and to any case-based payment methodology."

2. Management of recovery audit contractors. It's no secret that Medicare RACs are aggressively pursuing hospitals and health systems for potential overpayments. In the third quarter of the 2012 federal fiscal year, Medicare RACs collected $657.2 million in overpayments — the highest total of any quarter in the program's history.

A CDI program can refine and clean up a hospital's claims, which could both provide payment justification to RACs and allow a hospital to spend less administrative resources on managing the RAC process. "Hospital CFOs are acutely aware of short-stay admissions and observation stays monitored [by RACs]," Dr. Weygandt says. "Correct coding of medical necessity for admission is a huge revenue cycle focus. And that's all driven by physician documentation and medical necessity for admission."

3. Quality standards and readmissions. Under the Patient Protection and Affordable Care Act, Medicare readmissions penalties are now under way across all hospitals. Hospitals stand to lose portions of their Medicare funds if their readmission rates are too high, and Dr. Weygandt says readmissions and other quality standards — such as hospital-acquired infections — are often defined by documentation.

This is where the finance, HIM and clinical departments must collaborate. This is especially true for the hospital CFO and CMO. Dr. Weygandt says in order for a hospital to maintain high clinical quality scores, thus maintaining appropriate revenue, CFOs and CMOs must incorporate each other's mindsets into their strategic planning. CFOs must be mindful of clinical standards, while CMOs must be aware of the hospital's cash flow — and better documentation connects the two ideas together.

"There is a blurring between the silos of CMOs and CFOs," Dr. Weygandt says. "CFOs have to be more conscious of quality, and CMOs have to be more conscious of maintaining appropriate revenue, limiting readmissions and preparing for accountable care."

4. ICD-10. CDI initiatives are most closely linked to coding projects, and no coding project is bigger right now than ICD-10. CDI programs could directly help a hospital's ICD-10 implementation, which will affect a hospital's bottom line and budget planning in numerous ways — ranging from IT changes to staff training.

"ICD-10 will be a big transition for the revenue cycle," Dr. Weygandt says. "It's a perfect time for CFOs and CMOs to build the appropriate infrastructure for success, if they don't already have it."

Executive and physician leadership

Dr. Weygandt has more than two decades of experience as a physician leader and CDI specialist, and he reiterates that in order for CDI programs to be successful and assure appropriate hospital revenue, there must be physician buy-in. Hospital executives will need to put their physician relationship skills to the test, and selling the idea rather than ordering a mandate will lead to the desired result.

"A documentation program only succeeds with the cooperation of medical staff," Dr. Weygandt says. "I would push to have the program structured under the medical staff's direction to some extent. For example, it's easier to get physician cooperation if documentation initiatives are driven by physician leadership. If this is thrown at a medical staff, it may be accepted, rejected or somewhere in between."

Source: beckershospitalreview

Sustainability efforts could save healthcare industry $15B over 10 years

A study published last week by The Commonwealth Fund found that hospital sustainability efforts could save the healthcare industry up to $5.4 billion over five years and $15 billion over 10 years.

The study, which was sponsored by the Healthier Hospitals Initiative (HHI) and Health Care Without Harm (HCWH) through grants from The Commonwealth Fund and The Robert Wood Johnson Foundation, tracked nine U.S. hospitals or health systems that adopted sustainability initiatives into their waste management, energy use and operating room supply procurement practices. Each hospital realized significant savings, even those that made initial investments to adopt the sustainability program, according to the study.

"This study turns on its head the belief that introducing environmental sustainability measures increases operating costs," said Blair L. Sadler, an author of the study and a senior fellow at the Institute for Healthcare Improvement, in a press release.

HHI is a national campaign that began in April 2012 to implement a new approach to improving environmental health and sustainability in the healthcare sector. Eleven of the largest U.S. health systems, comprising approximately 500 hospitals with more than $20 billion in purchasing power, worked with HCWH, the Center for Health Design and Practice Greenhealth to create HHI as a guide for hospitals to improve sustainability.

The HHI is a set of six challenges for hospitals nationwide aimed at improving the healthcare sector’s environmental footprint that include engaged leadership, healthier foods, leaner energy, less waste, safer chemicals and smarter purchasing, said Gary Cohen, president and founder of HCWH. The HHI provides a free framework to support the nation’s hospitals in taking on the six HHI challenges.

 “One of the core mandates for healthcare reform is to reduce costs and eliminate waste in the system, so we’re offering a unique way to reduce waste literally, and through that, how to save money,” said Cohen. “And even more than that, if we’re going to address the epidemic of chronic diseases like obesity, asthma and diabetes, healthcare needs to play a role outside of the four walls of its facilities; it needs to create healthier communities and food systems so we aren’t getting our communities sick.”

Gundersen Lutheran Health System in La Crosse, Wis., was the first hospital system to sign up for all six of HHI’s challenges.

"This is not only good for the community, but you can really save money. Our $2 million investment saves us $1 million a year,” said Gundersen Lutheran Health System CEO Jeff Thompson. “The HHI set a high standard for us, and we signed up for all six challenges. It’s a great product to quantify best practices so people can get educated and be inspired.”

The report's authors suggest that given the return on investment, all hospitals should adopt programs, such as the ones offered by the HHI and noted that "... (I)n cases where capital investments could be financially burdensome ... public funds (should) be used to provide loans or grants, particularly to safety-net hospitals.”

Source: healthcarefinancenews

Small Maine hospital shares experiences in making tough financial decisions

When it comes to making difficult financial decisions at hospitals, it’s crucial to maintain transparent communications with employees and the community. How one small hospital weathered a financial crisis was the focus of a presentation Oct. 26 at a hospital best practices workshop presented by the Maine chapter of the Healthcare Financial Management Association in Auburn, Maine.

Wendy Jones, controller at Blue Hill Hospital in Blue Hill, Maine, shared the successes of the hospital’s process of making important decisions during a difficult financial environment.

By the end of 2008, Blue Hill Hospital, a small, 25-bed critical access hospital, was “coming up on a year of huge operating losses with a 2009 fiscal year budget approved with a nearly $1 million deficit,” Jones said.

Historically, Blue Hill Hospital had always received a great deal of endorsement funds, however, due to the financial crisis in 2008, those endorsements had decreased substantially leading to the beginning of the hospital’s financial troubles.

“Blue Hill’s mission had never focused on finance. It was the culture of Blue Hill itself,” said Jones. “Until this financial perfect storm happened, the executive management couldn’t grasp the possible crisis coming, and when it did, the hospital’s governance committed to change but didn’t know what to do.”

Jones said it was at this time that the executive management of the hospital had to start making difficult decisions, which included closing the hospital’s well-known labor and delivery program.

In addition, Blue Hill Hospital utilized support from their hospital affiliate, Eastern Maine Healthcare Systems (EMHS), and began outsourcing areas of the organization to EMHS, including various fiscal services and accounting.

All of these decisions, said Jones, were made in conjunction with effective communication among staff and the community as a whole.

“Physicians were worried about how they would achieve their missions and continue to take care of the community, while the community was wondering, ‘will we still have a hospital to go to?’” she said. “It’s important to understand the diversity of your affected groups and their point of views that they are coming from. Putting as much information out there as early as possible – that tends to work well.”

During this financially challenging time, Blue Hill Hospital discovered a number of tactics for making difficult financial decisions that really worked well for them, Jones said. The successful tactics included management training to ensure managers were given the tools they needed; establishing attainable goals with time parameters; and always maintaining alignment with governance, which, in some cases, required new hospital committees to be formed. Jones added that as far as alignment with governance goes, it’s important to know “when to stop fixing the leak and realize something cannot be fixed.”

Jones also discussed the hospital’s utilization of a voluntary leave program for employees.

“In the process of aligning our budget, the hospital came up with a voluntary leave incentive program and six employees took the opportunity. They voluntarily resigned, and we didn’t have to do layoffs,” she said.

Despite the fact that Blue Hill Hospital was forced to make a lot of difficult decisions in order to get their budget back on track, Jones said the hospital looked at ways in which their decisions could serve as positive opportunities for them.

“It was an opportunity for us to replace low performers and begin a reutilization of space. Our labor and delivery area become an oncology unit,” she said. “Executive management was able to focus on new services and ensure their mission is sustainable into the future.”

Source: healthcarefinancenews

5 ways pharmacy automation saves money

With medication shortages, patient safety and accurate dosing creating daily challenges, some providers have found financial benefits in pharmacy automation solutions.

"Any time you put humans into a process, there's a massive risk of contamination, errors and other costly mistakes," said Bill Shields, global vice president of sales and marketing of Intelligent Hospital Systems in Winnipeg, Canada.

Shields outlined the five specific ways an automated pharmacy operation can save money and improve patient safety.

1. Reduced vulnerability to medication shortages

"Drugs haven't increased – doses have. Roughly 80 percent of prescriptions or dosages come from 20 percent of drugs," said Shields. "Pharmacies can't do the volumes needed, so they outsource the drugs. The outsourcers then get priority on the drugs, and in turn the hospitals pay an incredible amount for them. Usually five to six times more than they would normally pay if they were to buy directly from wholesaler in house." And, with more and more drug shortages occurring, what happens is that hospitals are being required to buy extra drugs from outsourcers, and when they do that they're actually just stockpiling them, presenting a whole slew of other issues. "The days of 'just-in-time' ordering are over," continued Shields. "Hospitals are either buying from outsourcers or buying them on a gray market. And if you run out? You're in big trouble."

2. Lowered cost-per-dose of medication

"While some drugs can be $24 per vial, which are single dose vials if a human is drawing off it, a larger vial through automation can be $2.50 a dose per vial. And you can do multiple draws off this, which means multiple dosages," Shields explained.

3. Reduced pharmacy and medication waste

"If a human draws two grams out of a ten gram vial, they have to throw away whatever's remaining. It cannot be used again," said Shields. If you have an automated system that's a fully contained, isolated unit than multiple draws from the same vial can occur because of how sterile the system is. "That's a massive savings when some drugs cost upwards to $40 or $50 a vial. If you're having to discard any, you're literally talking about throwing away thousand and thousands – if not millions – of dollars a year," Shields remarked.

4. Reduced need for medication outsourcing

Hospitals are looking for an easy way to get drugs. "When they go to an outsourcer, it's really about ease and functionality over anything else despite the fact that they're paying an exorbitant amount," said Shields. With automation, healthcare organizations can insource that drug, driving down the cost because of both that and the walkaway capability. "You just load a product in and push go. That human resource that loaded the system can then walk away for three hours while the queue is running through. They can do something else during this time," Shields said. "It's about doing more with less... or doing more with the same amount is really what it equates to: more drug perpetration with the same staff numbers."

5. Enhanced patient safety

By eliminating humans from the process, or at least by keeping them away from the actual reconstitutions in a bag or a syringe – an incredibly intricate process – errors and contamination are minimal. "What automation has over humans is that it does the same thing every time – it becomes predictable and reliable. If you load it correctly, it will never make a mistake," Shields said. It also reduces the risk of liabilities associated with drug errors. Shields explains that the error rate on any drug preparation is about 10 percent. More than half of that 10 percent error rate is attributed to intravenous drugs.

Source: healthcarefinancenews

5 ways to manage the cost of health IT

Managing costs in today's industry has been put front and center. And although incentive funds have been helping organizations to implement health IT, easy tweaks and innovative tips are always welcome to help cut corners.

Industry experts give use five simple ways to help manage the cost of health IT.

1. Think practically. According to Dave Williams, co-founder and principal of healthcare consulting firm MedPharma Partners, consider deploying overlay systems to extend the life of existing systems. An added bonus? This will also help organizations realize extended value from these systems. "Use the opportunity to prioritize the budget according to value generated," he added. "Consider outsourcing more functionality." Although there are ways for departments to prioritize according to need and costs, Williams said a different approach could make all the difference. "A nuanced approach with outside assistance is needed to generate meaningful results," he said.

2. Look for creative solutions. Despite the risks and perceived loss of control, it can be worth it to embrace the "bring your own device" phenomenon, said Williams. "(This allows) doctors and nurses to employ their own smart phones and tablets on the job and foster development of institution-specific apps by users," he said. "Point of care decision tools are relatively inexpensive but contribute greatly to patient care and employee satisfaction." Lastly, Williams looked to basic tools for a thrifty way to manage costs. "Leverage inexpensive cloud services, such as Google Apps," he said.

3. Don't underestimate the cost savings associated with training. It's essential to consider training and to not skimp on putting the time in to educate staff on new products, said Williams. "…Consider the need for training when making an investment decision," he said. "As Apple has shown in the consumer and business world, systems that are more intuitive require less end-user training and result in higher productivity and user satisfaction." Training is particularly important, he continued, when it comes to new IT and protecting PHI. According to Williams, technology to protect personal health information "ranks pretty high, but management processes and training are at least as important as the technology."

4. Think enterprise-directed IT. Lisa Suennan, managing member at Psilos Group and author of the blog Venture Valkyrie, argues the most cost-effective IT to invest in is enterprise-directed as opposed to consumer-directed IT. "Most of the technology that's interesting and cost-effective right now, although it may be different five years from now, isn't consumer directed—it's much more enterprise directed," she said.  Although consumer-directed IT, like those focused on wellness and mobile technologies, may be popular and in-demand, it's important to think ahead and not give into fads. "While they're [helpful] technologies, a vast majority of them aren't cost efficient," she said.

5. Consider investments and their cost savings in the long run. With a myriad of technologies popping up left and right, streamlining investments is key. And it may come as no surprise that, like Williams, Suennan maintains investments that protect against data breaches are some of the most important to be considered. A report released by ID Experts and Ponemon Institute found data breaches in U.S. healthcare organizations have cost providers more than $6 billion a year—an incredible cost that can be diffused with the help of training and smart investments. Some practical ways to protect against costly breaches? Encryption, said Mahmood Sher-Jan, vice president of product management at ID Experts. “An incident may not become a breach if it’s encrypted properly.

Source: healthcarefinancenews

Seamless workflow is key to the revenue cycle

Tight processes crucial for efficiency, effectiveness

From intake to the back end, healthcare providers need a revenue cycle management system that will provide a seamless workflow for each episode of care. From the moment a patient registers in the facility, it is imperative that the correct information follow along each point of care so that accurate billing information can be processed and sent, RCM vendors say.

"It's the old 'garbage in, garbage out' analogy," said Taylor Moorehead, partner for Carmel, Ind.-based Zotec Partners' west region. "We deal with hundreds of different information systems across the country and no matter how good the technology is, it still comes down to reliance on humans to put in the right field in the right format."

Getting the information right at the initial "counter encounter" is paramount, Moorehead said, because this is where the chances for getting something wrong are at their highest. Moreover, he said, failsafe measures should be implemented at various points down the line.

"It's still a 'people' process," he said. "The linkage is especially critical between the RCM company and the provider. That communication channel has to be very fluid and transparent to the extent that any denials are handled by a team."

Feedback has to be continual up and down the line to determine root causes of claims denials, Moorehead said.

"They need to get to the bottom of these denials and what specific errors are being made," he said. "It has to be a candid process or it won't work."

Blurred lines

The workflow process is a bit different at the small community hospital level, so it makes sense to modify the RCM system in a way that one person can manage several functions, said Steve Everest, executive vice president of financial solutions for Houston-based Prognosis Health Information Systems.

Prognosis has developed a system specifically for community hospitals and their unique workflow, Everest said.

"Community hospitals have a different workflow than their big city cousins," he said. "Where a large health system typically has people assigned to case management, revenue cycle and clinical care, those lines are usually blurred at the community hospital level."

Therefore, the Prognosis system increases the capacity for one person to perform all three functions without having to log on to separate systems.

"That way someone who wears a lot of hats can get a single user experience," he said.

Having a simple and effective workflow makes an organization more proactive and the entire revenue cycle smoother, Everest said.

"Silos are still a problem and we're trying to ease it," he said. "But we are helping our clients prepare for the future because with the challenges coming down the road, their jobs will get harder, not easier."

Tracking down $$$

Approximately 15 to 30 percent of provider revenue now comes directly from patients  -  double what it was 10 years ago. That makes tracking down patient deductibles, co-pays and cash liabilities more important than ever, says Kevin Weinstein, vice president of marketing for Louisville, Ky.-based Zirmed.

"Back then it was easy to ignore patient payments because they represented only a fraction of revenues," he said. "It is much different now."

Revenue collection is about efficiency and effectiveness, Weinstein said. On the payer side, providers have gotten to be much more efficient at claims filing and on average have about 90 percent of their claims paid on a timely basis, he said.

"It is all about efficiency  -  how to get that 90 percent with lower expenditures and fewer people," he said.

The effectiveness quotient refers to patient collections, which Weinstein says providers only receive about 60 to 70 percent of what they are owed. "There is plenty of room for improvement on this front," he said.

ED: Emergency dysfunction

The chaotic environment of the emergency department is the ideal place to install an automated RCM system. Even in the era of heightened cost consciousness, the ED remains over-utilized as a patient entry point, comprising 60 percent of all hospital admissions, said Mikael Ohman, COO for Dallas-based T-System.

Launching its RevCycle+ in June, the company has developed a comprehensive system specifically designed for the ED that links clinical processes with coding and billing to optimize the revenue cycle. By capturing patient data at the intake point, the system ensures accurate, up-to-date insurance information as well as documenting all billable services.

Over the past few years, the company has transformed its original clinical documentation system into a tool that builds the revenue cycle into the equation so that the components work together. Ohman says the bundling of functions has become a necessary model for running the ED.

"The emergency department is a mini hospital unto itself," he said. "It has historically been an island. If any environment needs an optimized workflow, it is the ED."

Source: healthcarefinancenews

5 benefits of healthcare translation technology

With over 47 million residents in the U.S. whose primary language isn't English it stands to reason that all hospitals and healthcare clinics will encounter multilingual patients. Increasing state and federal requirements for communicating with limited English speakers have challenged hospital administrators to find cost-effective solutions.



Among those solutions are technologies that offer speech-to-speech and text-to-text communication from one language to another, said Jonathan Litchman, senior vice president, Science Applications International Corporation (SAIC). SAIC produces Omnifluent Health, a linguistics translation program integrated with automatic speech recognition technology. "Multilingual communication solutions (have) a huge impact on the healthcare industry,” he said. “Not only does it remove the language barrier between patients and their physicians, it also reduces the cost of medical interpretation and time associated with it, while increasing productivity and accuracy."



Litchman outlined five benefits translation technology has for healthcare.



1. Reduced costs


Healthcare translation technology can significantly reduce costs for hospitals and providers in their interpretation needs, while also boosting productivity. "This sort of technology is a low-hanging fruit CFOs and senior admins hardly recognize," Litchman said. "That cost saving can be leveraged to be used for more critical, clinical applications that are much more sensitive to cost cutting."



2. Reduced administrative and staff burden


Some healthcare organizations have a limited number of people available for interpretation, especially on an immediate basis. "The wait time for interpreters can sometimes be upwards to 25 minutes," Litchman said. Speech-to-speech technology can solve this the wait time problem, which places less of a burden on staff while increasing patient throughput. "That level of healthcare productivity is really a goal for most hospital administrations. It's something that's highly sought after: reduce costs of translation and save money? That hits a benefit twice."



3. Increased quality and accuracy


Accuracy can be a major problem when it comes to translation and interpretation. "Usually the interpreters aren't the ones also filling out the paperwork. It's important to make sure that what was said in one language is accurately being reflected in another language," said Litchman. Inaccuracy can have significant implications on insurance reimbursement, billing, and healthcare record management. "As a patient and physician are sitting side-by-side having a conversation that's being recorded in both languages on a screen, they can see if there's a mistake or if something needs clarification. There's no wait time: immediate corrections can be made with people involved."



4. Mobility


Another benefit of healthcare translation technology is its mobility. Consider the back-up hospitals can face at an emergency department admissions desk due to lack of available interpreters. Having a translation product brought to the ER when needed can reduce wait times for patients. Instead of having to wait for an interpreter to be found, the technology is already available in the hospital. “It would increase the quality of patient care, throughput, and overall healthcare experience, which means patient satisfaction goes way up," said Litchman.



5. Clinical applications


Technology like this isn't just beneficial for the administrative side of hospital life; it also makes a big difference on the clinical side, too. "You have three people in a conversation - the person speaking the foreign language, an interpreter and the physician. It seems like communication should flow freely and evenly in a situation like this, but great nuances can be missed," Litchman said. Having two records in front of a physician, one in the patient's language and a translated version, allows medical practitioners to see whether the questions they're asking are truly being understood by both the patient and the interpreter. "This technology allows us to capture the spirit and intent of a physician’s effort to communicate with a patient while avoiding the game of 'Telephone,'" said Litchman. "The message isn't going to get lost along the way."

Source: healthcarefinancenews

5 financial benefits of voice recognition technology

Many may think of data in terms of numbers and text, but not only does voice documentation have a place in the array of data collection tools that can be used by healthcare companies, it offers financial benefits.

Documentation with voice isn't just about capturing information, which is historically how people have thought about it. "It's now doing it in such a way that the document can be reused throughout an organization's downstream for other efforts like billing, quality assurance functions and medical and utilization reviews," explained Mike Raymer, senior vice president of solutions management at M*Modal, a company that provides clinical transcription services, documentation workflow solutions and unstructured data analytics. "Voice is about turning information into a language of understanding," he said. "It takes unstructured text and brings meaning to it that's transferrable from system to system."

According to Raymer, there are five financial benefits that come with using voice recognition technology.

1. Reusable data

Voice data can be reused like any other data can be. "Studies show that two-thirds of U.S. hospitals are going to be absorbing a lot of penalties from readmissions. Data that's most predictive of readmission are ones bound in free text that's then been transcribed," said Raymer. The reusability that voice offers means accurately-coded and documented care that's immediately available for billing purposes.

2. Flexibility

Voice recognition isn't linked to a single device. "With today's technology there are cloud-based apps that allow the user to share a single profile across the board, so no matter where it's being used physicians have the ability to plug-in," said Raymer. From a reimbursement standpoint, the closer an organization is between delivery-of-care and recording-of-care the more accurate the information is, and the less challenges there may arise from an audit because the clinical documentation more succinctly matches.

3. Better clinical hand-off means less medical errors

The history behind clinical documentation started off when a physician referred a patient to another physician. "There needed to be a good way to hand-off care and provide understanding to one physician around the thought processes and actions of the original clinician," Raymer said. The best way to capture that was to record information with words. Unfortunately, organizations began to create templates that forced a patient's story into a structured format using drop-down lists, radio buttons and checkboxes. Those documents no longer service the hand-off from doctor to doctor, because they don't capture the essence of what's happening. "Think of the most critical conversations in your life," said Raymer. "You want to use your own voice, tone and words to express or explain yourself." The accuracy of that clinical hand-off is critical too, because that's where errors occur. Eliminating medical errors – which can be very costly – by using something like voice is better for the patient, better for budget.

4. Productivity

As EMRs are implemented, the underlying assumption is that physicians will be less productive. "However," Raymer said, "there's been several recent studies that have shown that physicians that document via voice transcription are actually able to see more patients thereby increasing their billing for more hours worked." Some physicians believe they can see one-third more patients by using voice transcription then working with a structured template within the EMR. And with baby boomers coming into the later years of their life and the shortage of physicians expected due to the increase in patients from Medicare, it is going to be crucial that physicians are as productive as possible.

5. "One and done"

According to Raymer, the accuracy rates using voice recognition technology are unparalleled. "Rather than a physician waiting for a transcriptionist, the accuracy levels are so high that they can use the product themselves to capture the information they need directly into their work station or mobile device. They can then see what they said, make small corrections, sign the documentation, then send it off. This 'one and done' advantage eliminates the need for multiple steps and people involved, and makes clinical observations immediately available to everyone else," said Raymer.

Source: healthcarefinancenews