Spring 2014  
ICD-10: Now Get it Done Correctly
By Brad Boyd
Since the delay of ICD-10 until October 1, 2015 at the earliest, many healthcare organizations have questioned what the delay means to their existing ICD-10 implementation programs.
Most of the organizations we work with have expressed frustration at the delay. They appropriately took control of their own fate, identified and managed risk, and prepared or were preparing their organization for this change. Regardless of your organization’s degree of readiness, the plan forward is simple: take the newly allotted timeline to get it right.
Many organizations have delayed other important transformative or IT efforts until after ICD-10 given their limited resources and the work effort necessary just to achieve ICD-10 compliance. Some organizations took a much broader strategy for their conversion, leveraging this challenge as an opportunity to better enable their physicians and clinical staff to optimize clinical documentation workflows - thus improving quality reporting and patient outcomes.
With the delay now in place, organizations should absolutely continue implementing their ICD-10 program. However, the delay does provide opportunities for ensuring the broader success of the ICD-10 program in preparing your organization to more effectively compete in the era of expanding value-based reimbursement models.
Organizations should take advantage of this opportunity by re-evaluating project scope. Identify opportunities for including other initiatives into the ICD-10 conversion program in order to more fully streamline clinical documentation workflows. Ensure your training program is inclusive of new workflows and EHR functionality, not just coding principles and requirements. Engage payers and intermediaries to ensure your testing program is robust. Expand your use of dual coding and evaluate reimbursement variance to prepare your organization for the downstream financial impacts. Optimize the use of informative, specifically predictive analytics and clinical decision support within the EHR.
ICD-10 does pose several risks. Take advantage of the delay to not only ensure compliance, but also to improve your ability to manage your patient’s health.
MyChart - The Patient Engagement Experience
By Tom Gantzer
Spotlight Article
As Meaningful Use (MU) Stage II approaches, organizations continue their focus on meeting and exceeding the published measures that includes 50% of all unique patients are provided online access to their health information and that 5% of those patients access the information provided electronically. For most organizations, providing patient portal access to 50% of patients has become achievable during MU Stage I with the use of MyChart and its automation in sharing certain information. The challenge now lies in the ability to engage patients in a meaningful, multi-faceted way that promotes the utilization of the portal once their information is available.
Stage II, with this challenge is an opportunity to explore and utilize new functionality that in addition to helping your organization meet quality measures facilitates the effort of empowering your patients to take an active role in their healthcare. Epic has also taken steps in the last two releases (2012 and 2014) to enhance the tools at an organization’s disposal. From enrollment options, interaction (at a provider and application level) and ease of use perspectives; Epic continues the evolution of MyChart to help meet these challenges with a focus on patient enrollment and engagement.
Below is a subsection of common themes around enrollment and engagement that are frequent topics of conversation in the industry and among our clients when discussing MU Stage II and MyChart optimization initiatives. Providing a combination of these features, if already not in place, will give an organization the flexibility to connect with patients in various ways ensuring MU Stage II criteria is met, but more importantly continuing improvement towards patient involvement.
In recent releases, the ways to enroll a patient continues to expand. Organizations now have the ability to enroll a patient at nearly every step of the visit workflow. While at check in, check out, or in the exam room, Epic offers options to promote enrollment by displaying hyper-links in the patient header or even alerts for front office staff to enhance the traditional enrollment workflows. Most recently, in 2014, the patient now has the ability to independently self-sign-up online with little organization interaction initially, increasing the convenience for MyChart registration.
Once the patient accesses MyChart, Epic provides a robust suite of tools that invites the patient to interact with their health record but also clinicians as intuitively as possible:
  • User Interface for Patients – Epic optimized the interface to more logically present the options and tools a patient may need when logging in to MyChart. Navigation is more visual and better highlights not only tools that are most commonly used but emphasizes those that are required to achieve MU Stage II such as provider messaging.
  • Self-Scheduling – Self-scheduling became a major feature early in MyChart’s existence and with growth in patient’s access to mobile device technology, enhancements such as mobile scheduling and auto waitlist notifications increase satisfaction while improving provider utilization.
  • Patient Entered Data – Patient portal interaction traditionally meant review of information, however, more organizations now offer options to involve the patient with augmentation or completion of aspects including medical and family history that providers can include as part of the HPI or ROS portions of a note. Clients find this decreases miscommunication between the patients and clinicians while providing greater efficiency in note creation.
  • Patient Reported Outcomes – Similar to Patient Entered Data, Patient Reported Outcomes engage patients directly in their healthcare by tracking outcomes of specific treatments. Providers initiate outcomes through Best Practice Alerts, Reporting Workbench or orders. Utilizing outcome questionnaires along with new print groups allow providers real-time updates without an office visit. It also offers the provider the ability to track patient responses over time and the organization to view the aggregate data from all patients participating in the questionnaire series.
  • Video Visits – Video Visits through MyChart provide an option for patients with limited mobility or access to a convenient clinic location the ability to receive necessary treatment. In addition, specialties like dermatology or psychology can replace specific types of visits maximizing the convenience for both patients and providers.
  • Home Monitoring Devices – As home-monitoring and wearable technology becomes increasingly more common Epic’s 2014 release steps towards integration with devices on the market. Already Fitbit and Withings, devices that allow the patient to track blood pressure, weight, pulse readings and pedometer readings are able to be uploaded directly to MyChart setting the stage to be ahead of the curve as the wildly popular trend continues to emerge.
Pathway to a High Performance Analytics Department
By Kyle Swarts
For the past several years, the healthcare industry has been buzzing about the concept of “Reporting and Analytics” then it morphed into "Business and Clinical intelligence", last year it was called “Informatics” and today it is commonly referred to as “Population Health Management.” Regardless of the “acronym” it all means the same. The progressive and sophisticated healthcare organizations are gathering lots of financial and clinical data and running many reports in an attempt to answer key revenue cycle, operations and clinical quality questions. With the implementation of new government programs (Meaningful Use, PQRS, Patient Centered Medical Home, Accountable Care) organizations must have the ability to paint a comprehensive picture of enterprise wide revenue cycle, operational and clinical performance.
The reality is Population Health Management or whatever descriptor you should choose, isn't about the amount of data or types of reports your organization generates; it involves creating a body of knowledge about your organization's patients, total cost of care, revenue cycle performance and the impact of changing reimbursement models so you can transform data into actionable information to drive process improvement and support current and future state decision making.
Investing in population health management is without question a “strategic investment.” Physicians and Business leaders must be engaged and set the short-term and long-term organizational vision. This begins with creating a formal “Data Governance” committee that focuses on ensuring consistency in capturing data elements from your revenue cycle and clinical systems to improve data validity and output. This committee will help clearly define your organization's population health management goals and objectives.
In speaking with clients, many are just starting to understand that provider data is the organizations #1 asset. As concerns about the livelihood of fee for service continue to lurk around C-Suite offices, forward thinking organizations have already put the people, process and technology in place to support the shift from “volume” to “value.” Pay for performance, shared savings and shared risk / capitation will force the late adopters to begin assessing their analytical capabilities.
What I've noticed in talking with healthcare organizations around the country is that many need to revamp their strategy and align analytical initiatives to meet the on-going and increased appetite for data. This is fueled by government programs, data driven cultures, desire for organizations to develop or transform into “high-performing” analytical departments, or to simply help healthcare executives make strategic decisions that will help them survive and grow. How can you engage in risk-based contracts or ACO’s if you can’t paint an accurate picture of total cost of care and how well you are currently managing your patient population today?
A key step in the process of becoming “high performing” is to conduct a comprehensive and honest assessment of your organizations current analytical operations. High Performing organizations have surpassed the data aggregation and ad-hoc reporting phases of the analytical maturation process and use their asset, “data”, to assist with care coordination and patient outreach. Where is your organization in the analytical maturation process?
The pathway to becoming a “high performing” analytical department requires organizations to take a look at people, process, technology and most importantly organizational culture and identify the gaps in each functional area. The “high-performers” have identified internal resources with strong financial (ex-Practice Managers, Revenue Cycle Analyst) and clinical (RN’s) minds to augment the technical resources giving them the ability to complete pro-active analytics in support of population health management. Their reporting request process is simple, their library of standard financial, clinical and operational reports are rich and reliable, their distribution and communication methods of custom reports are defined and revamped to meet the needs and time sensitivity of the end-users and have created an enterprise wide data warehouse to ensure data integrity.
Most importantly, the organizational leadership and culture are aligned to support the current and future state vision of the analytical department while continuing to provide the necessary tools and technology to help improve patient care, revenue cycle performance and overall operational efficiency. Healthcare organizations must continue to make this “strategic investment” and view financial and clinical data as their #1 asset which will allow them to march down the pathway to high performing.
Clinical Integration Case Study
A large academic medical center embarked on creating an affiliated medical group as a cornerstone of its clinical integration strategy.
Recognizing that they were late to the physician practice management arena, leadership sought out professional assistance in the establishment of the medical group and the infrastructure needed to support the 200+ physicians anticipated to become members of the enterprise. Managed Care rates for private physicians and small groups in this particular area are significantly below Medicare. Physicians in this area are struggling to keep their heads above water and are hard pressed to be able to make the investments needed to keep pace with the changing healthcare environment. Many do not have EMRs and have delayed changes in their infrastructure due to the poor reimbursement.
Culbert Healthcare Solutions was engaged to provide initial support to the newly hired Executive Director in the selection of the electronic health record and practice management solutions to support the new practice. After engaging the significant vendors in the market for software and revenue cycle management (RCM) services, Allscripts was selected to provide the software, hosting and RCM services. With our client using Allscripts Sunrise clinical and financial systems it gave Culbert and our client the opportunity to integrate data across the hospitals and physician enterprise creating the ability to capture patient data throughout the continuum of care.
Culbert’s engagement was then extended to provide interim management support for the operations, information services and revenue cycle development. Culbert assisted in the development of physician contracts, physician compensation program, clinical and administrative job descriptions and workflow for practice sites in the clinical and administrative areas.
During the course of 2013, Culbert assisted in locating and moving into new corporate headquarters at a very attractive rate, initiated the Allscripts Enterprise PM and Enterprise EHR over an accelerated period. By the end of 2013, 24 physicians were acquired into the physician enterprise. Participating with the hospital’s managed care contractors, rate increases to be comparable or better than Medicare were achieved. 2014 will see our client grow to 88 providers in Cardiology, OB/Gyn, Internal Medicine and Family Practice.
Culbert’s approach to the interim management was to have PM/EHR implementation consultants on site to “imbed” themselves into the organization. The physicians and staff do not think of the staff from Culbert as consultants but as members of the organization.
Culbert’s 8th Annual Company Meeting
Culbert had its 2014 annual company meeting with all employees held at The Sheraton Inner Harbor hotel in Maryland February 6th -9th. Culbert knocked it out of the park at Camden Yards with a private tour and dinner reception at the stadium.
Culbert employees gathered for 3 days of education, networking and a celebration of the amazing accomplishments made throughout the past year. Finally we collaborated about our vision for 2014 and beyond.
A special thanks to our keynote speakers, Randy Jones, Health Systems Affair Associate Vice President & Chief Administrative Officer for Ambulatory Care, UT Southwestern Medical Center and Steve Burr, Senior Vice President, Revenue Cycle, Carolina’s Healthcare System. Their presentations were both extremely informative and led to some excellent discussion.
In addition to our guest speakers we had a few business partners from Optum and RCX Rules join us at the annual meeting which also helped insure our meeting was a huge success.
Culbert employees are located throughout the continental US and the annual meeting provides an opportunity for employees to meet their colleagues, learn about important topics facing our customers and to learn how Culbert is helping clients meet those challenges head on. “It’s a great way to say thank you to all our employees for their hard work and dedication throughout the year. It’s a wonderful opportunity to share our vision and reward our staff for their service excellence” said Rob Culbert, President & CEO.
This year we had a record number of Anniversary Rewards and we had 22 consultants meet the Presidents Club criteria. The Presidents Club honors our top producing consultants with an all expenses paid trip for the consultant and their spouse or guest to celebrate their achievements. We will be revisiting the exclusive Round Hill Resort in Montego Bay, Jamaica.
800 West Cummings Park, Suite 6000, Woburn MA 01801 Tel 781.935.1002