January, 2015:

Data Sharing in 2015: Still a Hot Potato-

At a healthcare panel last week in Austin, TX, attendees heard from the former E-MDs CEO, an ACO CEO and a legislative HIT coordinator here in Texas.  While the 110M medicaid fraud FBI investigation has stolen the spotlight in town, most of the dialogue circled around data sharing, privacy and patient engagement.

All of the panelists held, to some degree, two core opinions: 1) Patients don’t own the data in our current healthcare model and 2) Organizations continue to lack incentives to drive data sharing.

Let’s examine the first – for many of you who have tried to collect your medical history, there is no ‘download’ button as we have with our financial history.  We’ve got to make phone calls, sometimes faxes, and often multiple requests to the same organization but to different departments.  We’ve no idea how the material will return to us – sometimes by CD, paper copies, or if lucky, an emailed PDF.  Don’t forget, there is usually a charge associated with the data collection and disbursement, in addition to signed waivers or paperwork.

But isn’t this the patient’s information? Do we own it? Should we have exclusive access and a right to determine to whom and where it is shared?  This debate is far from mature.   We can take a lesson from social media – our ‘likes’, personal profiles, behavior, purchasing decisions and much more are all on the open market – for a nice price.  We sign those permissions away in crafted fine print for fun tools of daily life.

The stakes may be higher with health data interoperability.  Lives can be saved if a medication history is readily available thousands of miles away from a patient’s home in a medical emergency.  The pharma and insurance industries also have much to gain – by learning your outcomes, behavior and medical history, their business model will evolve, too (pharmacogenetics and personalized insurance plans…) – to become more efficient, though also more profitable.

This leads us to the second – if data sharing is ultimately good for the patient and industry, why are we still waiting for a responsible, comprehensive solution?  The panelists called out several rationales:

  1. Open data means stiffer competition.  If the neighbor can analyze our weaknesses, we could be incentivized to improve, but we can also fail.  CMS demonstrations are forcing transparency, though not without exemptions.
  2. Information exchange requires billions of ‘information transactions’ – this is costly.  Should providers be paying? Organizations? The patient?  Everyone could benefit, including the payers – but no single entity wants to bare the cost today.  We’re seeing more Care Collaboration organizations being created to pool resources.
  3. Vendors want to help their own, first.  Some vendors have aligned to create a corporate entity to pay for sharing, while other Vendors are large enough to build a network among their own.

Carl Dvorak (President of Epic), in 2014 government testimony shared the following impediments to faster adoption of interoperability:

  • point of care authorizations
  • Phone book containing all exchange ready participants
  • Single trust authority
  • Governance where patient data is ONLY used for treatment
  • Stronger ONC support for eHealth Exchange which supports unplanned transitions of care

CMS required a 10% transition of care exchange rate to comply with MU Stage 2.  This may become 50% for care transitions to include a summary or care record with 10% electronically in Stage 3.  Even the ONC has a 10 year plan, with the patient at the center – able to orchestrate where and when personal information is shared.

The panelists agreed, it is unlikely to see significant legislation driving any renewed independent HIE effort.  Instead, the interim may find continued pressure on organizations to adopt more forms of sharing at their own expense – too great a risk not to keep the reimbursement coming in.  

Interoperable health information is on the way, though we’ll need to find more competent data experts, a louder community voice and market incentives that share the benefits and costs across all.

 

Director Epic Practice

Director Epic Practice

Is an SBO right for You?

Executives from Integrated Health Systems all over the country are contemplating whether or not the SBO model is right for their organization.  Typically, the consideration for becoming an SBO comes with the decision to migrate to a new revenue cycle technology platform.  This migration affects an organizations’ Hospital and Physician billing workflows and as a result during the strategic planning process, the inevitable question is posed:  “Given our new technology and its integrated capabilities, should we merge the Hospital and Professional Business Offices?”

As you evaluate the utilization of a single billing office, key requirements include:

  • Validation of current state organizational goals
  • Establishment of revenue cycle/IT governance structure
  • Assistance with system design to support SBO approach
  • Inventory of informatics/business intelligence program

Clients who have developed an SBO have seen the resulting benefits:

  • Consolidated patient friendly statements inclusive of hospital and professional charges
  • Enhanced customer service and patient satisfaction
  • Streamlined single workflows: consolidated statements, payment posting, payment plans, collections and bad debt
  • Easier patient follow-up from single worklists

As patients continue to have more options when choosing how their care is delivered, health systems are looking to find ways to make access to care less complicated and efficient.   Developing an SBO enhances integration and is key to increasing patient engagement and satisfaction.

 

What Do You Do?…I am a Healthcare Consultant-

I attended a New Year’s Eve party to ring in 2015.  As usually happens when you meet new people you engage in conversation to try to find common ground.  Inevitably, questions about marital status, kids and home life are presented, followed by the big question, “what do you do”?  I cringe at the question because what I do is not easily explained, understood or defined by a simple title that makes sense to most people.  Say, for example, you are an Attorney.  That’s impressive for sure and everyone knows, in general, what it means to be an Attorney and the conversation takes its normal course; what type of law do you practice, are you with a firm or a sole practitioner and so on.  It’s comfortable.  It makes sense.  There is no ambiguity.  Then, there is me.  I am a Healthcare Consultant and here is how I usually explain it.

Healthcare is one arena–especially in the U.S.–that is undergoing so many changes, so rapidly that most hospitals, clinics and community providers are having difficulty remaining viable.  Federal regulations now dictate that patient charts be kept electronically and those entities that fail to do so will be penalized financially and therefore, will have a difficult time staying afloat.  And, this is where I come in.

Hospitals and providers are in the business of taking care of patients and managing their patient population, period.  And, quite frankly, this needs to remain their focus.  And, I am lucky enough to be in a position, as a Healthcare Consultant, to assist them by assessing current processes, guiding the system selection process, re-engineering workflows to optimize the use of the system selected, configuring and implementing the system, training the providers and staff on system use and analyzing the resultant data.  All of this allows hospitals and providers to remain viable in this ever-changing healthcare landscape and promotes better patient care and healthier communities as a result.

What I do involves a whole host of education, skills and knowledge found in so many other professions rolled into one.  What I do is about strategy, change management, resource management, IT, project management, process re-engineering, training and development.  What I do is help patients stay healthier by helping those who care for them every day.  What I do is make sense of process, implement technology and unravel the complexities of the world of healthcare technology so health care providers can focus on patients and keep us all healthier.  So, what do I do?  I help.  I am a Healthcare Consultant.