December, 2016:

2016 in Review: Helping Hospitals and Practices Transition Through Five Evolving Opportunities

access Becker’s article

Access to Care ….or Lack Thereof

Long Appointment Wait Time, Your Horrible Parking Lot and Your Mediocre Front Desk: Your New Patients’ Experience

I am back on my “Patient Access” soapbox as a result of a recent visit to your private practice in the suburbs of Philadelphia. I had a fairly significant medical concern and wanted to get to a specialist as quickly as possible in the event I needed treatment.  Knowing that I was seeking an appointment as a new patient in a high demand medical specialty area, I figured it would be weeks or even a month or more before I would secure an appointment, so I got to work right away.  Like most patients, I got on the Internet and started to review specialists in my area; trying to find a physician that was well qualified, accepted my health insurance and would minimize my drive time so that I didn’t have be away from the office for hours.  I chose you, a qualified physician that had a new patient appointment available in twenty-seven days.  Twenty-seven days.  I was actually delighted that I was going to be examined by a high demand specialist in under a month. Delighted! What does this say about physician access for some specialists?  Have we lowered our expectations so much that getting an appointment four weeks from the date of request is considered acceptable? It’s a question that won’t be solved as I write this blog, but it is food for thought.

Twenty-seven days later, I arrived for my 10am appointment. It was 9:30am when I arrived and your parking lot was completely full.  Cars were double parked, and your underground lot was impossible to navigate with a Mini-Cooper, let alone the Chevy Tahoe I was driving.  I had to park across the street and up two blocks risking a ticket as I was not doing business at this location.  I was frustrated and five minutes late for my visit when I opened the door to your office.  When I approached the front desk to provide my name and an apology for being late; I was greeted with silence.  Not a “Good Morning”, not a “What is Your Name”, not a word.  I wondered if I chose not to say anything upon arrival if the sour woman at the window would have acknowledged me at all.  She proceeded to have conversations with her equally sour colleagues behind the window while she grabbed my insurance card and personal identification.  The only words spoken to me were to ask for my $40 dollar copay.  Not even a “Thank You” upon payment, was uttered.  I was completely unsatisfied, to say the least and was silently hoping to receive a patient satisfaction survey in the mail.

To be completely objective, I was pleasantly surprised that I waited only five minutes before being escorted to an exam room and even more pleased when you arrived to see me less than five minutes later. Your exam was thorough and you were on your game. What a shame that so many barriers were put up before I even had the chance to meet you.

Now here’s the question. Was the wait, aggravation and less than courteous support staff worth it?  Would speaking to the specialist about her access problems help?  Would anything actually change?  Should I start again with a new provider that has better access to care and a friendlier staff?  Should I drive further away and wait longer to have a better experience?  The answers to these questions are very personal and real for patients.  Access to care is a serious issue that can and will determine the success of your practice.  Look at the little things.  They are larger than life for the patients on the other side of the window.

Leveraging Best Practices to Optimize Your Enterprise Reporting Strategy

Data and reporting have become an integral aspect of healthcare operations from both a clinical and non-clinical perspective. With the widespread onset of EHR platforms, clinicians now have access to powerful data sets that serve as catalysts for better clinical decision-making. Hospital operators are also able to take a deeper dive into potential clinical inefficiencies and make better business decisions, which ultimately helps improve the organization’s bottom line. With the plethora of reporting solutions and reporting tools at the stakeholder’s fingertips, how can an organization leverage enterprise reporting best practices to ensure that key personnel have access to the right data at the right time?

 Many EHR platforms offer a set of canned reporting solutions out of the box upon installation; however, these reports may not be as robust as needed leading to new report requests. Leveraging the implementation of a structured report request process will help ensure your stakeholders receive a reporting solution that meets their needs in a timely manner. Often, report requests are received in the form of an email with minimal information provided, thus failing to provide the report developer with adequate information to begin development. Consider creating a user-friendly and fillable .pdf form using questions written in non-technical terms that can be distributed to stakeholders and utilized as a discovery document for your reporting solution.

 Defining roles and responsibilities of your reporting staff can also assist in ensuring that your reporting solution is delivered in a timely manner. For example, a reporting coordinator can triage report requests as they are received and provide useful input so that the request is assigned to a developer with an appropriate skillset. Alternatively, if your organization utilizes a service desk platform, report requests can be assigned to a pool of developers and categorized based on the classification of the request (Eg: Inpatient, Ambulatory, Revenue Cycle). Lastly, leveraging the knowledge of your application analysts to assist in report request triage and initial discovery can prove to be of great assistance to report developers as they move forward with report development. Often, the application analysts are better versed in the specific data sets and can interpret the request with the correct context. The coupling of their expertise with the report developer’s technical knowledge can drastically improve turnaround times while mitigating the likelihood of errant data in a report.

 Creating an organized and user-friendly manner for distributing various reporting solutions is an integral step in the optimization of your enterprise reporting strategy. This process often requires analysis of your current user and security build to ensure that the proper groups of users have access to view and run reports related to their job function. Additionally, leveraging metadata to ensure that reports are properly categorized will provide greater accuracy in search results should stakeholders query your reporting library.

 Lastly, development of curriculum and training on various reporting tools for your stakeholders will tie together several of the critical elements of a successful enterprise reporting strategy. As we move in to the next year, many EHR platforms and organizations are placing a strategic focus on putting the power of the data in the hands of the stakeholder. For this to come to fruition with long-lasting effect, a clearly defined education and training initiative should be considered as you move forward with optimization of your current-state reporting strategy.

 

What is the Most Important Thing to Know About MACRA for 2017

You might be hoping that I’m going to say the most important thing about MACRA is that it will go away with a new president and the promise to tear apart Obamacare.   However, MACRA received overwhelming bipartisan congressional support, so ignoring is not an option.

The most important aspect of the Quality Payment Program in 2017 is that it offers everyone an opportunity to pause and reorganize.   2017 is a transition year which requires very little reporting to avoid any penalty to your 2019 FFS payments.   That is great news for the many clinicians who have not participated in PQRS, VM and Meaningful use programs.

However, many organizations that are already reporting all the required measures may not consider pausing and be full steam ahead to report all required measures in hopes of receiving that illusive positive incentive.   Beware, because there will be almost no negative penalty, there will be almost no upside incentive.   Remember the program is based on a balanced budget. Only those at the very top of performance will be eligible to receive part of the $500 million set aside for exceptional performers.

Therefore, the most important thing a health care group can do is pause and decide how they want to focus their energies in 2017.   Are you a top national PQRS/VM performer and therefore likely to earn the exceptional performer bonus based on your 2017 work?  Or, is this an opportunity to regroup and focus on setting up a longer term organizational strategy?  Consider using the Quality Payment Program to help focus resources on longer term cost reduction and quality initiatives so that you hit 2018 in full force.

dr-nancy-gagliano-2