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Sure, it sounds easier, maybe even cheaper, to purchase clinical (EHR) and revenue cycle management (RCM) applications from a single vendor. Most vendors will even require you to do so, holding your practice hostage to an EHR developed either in-house or by a preferred partner. While this approach may simplify your decision making and support processes, what happens if these all-in-one solutions don’t meet the needs of your patients and staff? Here are three important questions to consider when making your decision: Is it better to hire multiple RCM consultants, or a single interface expert?There’s an old saying that applies to these situations: A penny wise, a pound foolish. A single vendor approach could make sense if an EHR and an RCM were the only two vendor-provided applications in your facility. (Ah… one can dream.) However, since most modern hospitals have hundreds of vendors in place – the average healthcare organization now uses approximately 928 cloud applications – should you really compromise quality simply to reduce your vendor count from, say, 100 to 99? Especially for two of the most important application domains in your hospital? Take your RCM solution, for example. When the RCM solution provided by your best choice EHR vendor is NOT the best RCM choice for your hospital, you will have to contend with lost time-to-value, not to mention the additional costs of hiring even more staff to make a one-size-fits-all solution actually, well, fit your facility. So when making your decision, ask yourself: Are you willing to settle for a less capable RCM solution to avoid a single additional interface? And, is it really cheaper to hire a team of RCM consultants rather than a single interface expert? Is it worth it to prioritize the needs of one department over another in the long run?Continuing with our RCM example, the result of prioritizing the needs of your clinical staff over those of your business staff will be unnecessary tension between your two most important departments. In a single-vendor situation, your business team will be tied to an application selected primarily to solve the needs of clinical staff. Your business team will then be charged with “making it work,” inevitably leading to a slew of consultants, additional hires, and, inevitably, resentment. This can be harmful to your hospital’s performance in the long run, especially as the rise of big data continues to require stronger bonds between clinicians and business staff. Be sure to ask yourself what you are compromising in the long run when you conform to the demands of a single-vendor during system selection and negotiation. Or, in the single-vendor case, lack of negotiation. Will your RCM choice breathe life into your hospital, or will it stifle growth?A good EHR is necessary for improving diagnostics and patient outcomes. A good RCM is critical to maintaining the financial performance of your hospital, allowing you to deliver quality care, finance expansion, and increase executive bonus plans, just to name a few. Too many hospitals seem to assume that any EHR or RCM will do – that is, until denials reach the millions of dollars, days in A/R creep into the 50s or 60s, and revenue is negatively impacted through lost reimbursements. Simply put, there is too much at stake for your hospital to compromise on an EHR or RCM solution that does not meet their specific needs, no matter the vendor.

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Medicare accounts for an increasingly large portion of all long-term acute care hospital (LTACH) discharges, with current estimates indicating that approximately two thirds of all LTACH discharges are Medicare discharges. Between 2004 and 2013, Medicare spending on patients in LTACHs increased from $3.7 billion to $5.5 billion. These rising costs have not translated to improvements in patient outcomes. For example, though Medicare pays for 2,000 days of post-acute care (PAC) services for every 1,000 patients, roughly one fifth require readmission to hospitals, often for preventable conditions. By contrast, Kaiser Permanente averages just 600 days of PAC services per 1,000 patients, and enjoys much lower readmission rates. Medicare Reform In an effort to contain these rising costs, Medicare dramatically altered its LTACH payment model with the Pathway for SGR Reform Act of 2013. This change, implemented in fiscal year 2016, aims to reduce the payment rate for certain discharges and will significantly impact LTACHs and the healthcare industry as a whole. The most important change is the shift from a prospective payment system (PPS) toward a “site-neutral” payment model. Rather than prospectively defining reimbursement for groupings of patients with similar characteristics, Medicare will calculate payments as the lesser of two rates based on tighter patient characteristic criteria. The resulting payments will be similar to what Medicare pays in the acute care setting, and will either be calculated as an inpatient PPS (IPPS) comparable per diem amount, or the estimated costs of the case. Bracing For Change In an attempt to mitigate negative effects on the industry, the rollout of these changes has been gradual. The full force of the changes are expected to hit LTACHs this year, and will have serious implications for LTACHs across the country, particularly those in the New England and West South Central regions. Research by Berkeley Research Group indicates that LTACHs in Texas, Louisiana, Oklahoma, and Mississippi will see a 19% drop in Medicare payments, while New England states could see drops as high as 38%. A recent report by Standard & Poor offers a bleaker outlook: “We expect a material portion of the approximately 435 LTACH facilities nationwide to close over the next few years amid the phase-in of lower reimbursement.” With the second phase of payment changes still on schedule to roll out in 2018/2019, we must begin asking ourselves if we are truly prepared. Futureproofing the LTACH Industry There are many strategies LTACHs could employ to offset the effects of the recent Medicare reform, such as Changing year-end reporting dates Diversifying through acquisitions Portfolio optimization Cutting costs Shutting down unprofitable facilities Attracting patients still eligible for the attractive LTAC-specific rate. These strategies help optimize your census to maximize profitability. Another strategy that can positively affect the survival of LTACHs is one you’ve likely already heard of: dedicated care coordination from pre-admission to post-discharge. Historically, LTACHs have been slow to improve care coordination and reduce readmissions, content to wait for the emergence of third-party companies that will specialize in care coordination… for a hefty fee. This is a mistake. Only aggressive action towards in-house care coordination will ensure the long-term survival of your business while significantly improving outcomes for your patients. — To find out how to build a strategy for your LTACH, be sure to read the second installment in theLTACH Futureproofing series!

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In my previous blog, I discussed how LTACHs have been slow to improve care coordination and reduce readmissions. I said that only aggressive action towards in-house care coordination could ensure the long-term survival of your business while significantly improving outcomes for your patients. But what, really, is care coordination? And how do you achieve it? The term is used frequently, but very few can offer a clear definition, or describe discrete steps to accomplish it. Without a clear understanding of the term, it runs the risk of becoming just another meaningless buzzword. The official definition of care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care. Translation: coordinated care is really just a fancy term for improved communication. The key to coordinated care is improved communication across the care continuum. When caregivers at different points of care have access to detailed, complete documentation, they are able to make more effective clinical decisions. On the other end of the spectrum, this detailed documentation then has positive impacts on reimbursement processes, reducing AR days and increasing overall revenue. The business team – coders and billers – must be able to provide feedback if documentation is missing or incomplete. When they are dealing with a stack of paper forms with multiple serious errors – or, worse, a stack of paper forms with only one serious error – they then must trace down the clinician to have them correct the error(s). This may involve a series of emails, scans, faxes, or phone calls, each of which take significant amounts of time. And then the claim gets denied by Medicare. Lather, rinse, repeat. This feedback loop shrinks dramatically when coders, billers, and practitioners all fully understand guidelines, processes, and procedures.   Except that there are mountains of procedures, not to mention the many thousands practitioners don’t have the time or the bandwidth to follow them. Unsurprisingly, the secret to coordinated care is integrated health technologies that facilitate and improve communication between teams. I know. Shocker. But bear with me.   Source:  2016 CAQH INDEX: A Report of Healthcare Industry Adoption of Electronic Business Transactions and Cost Savings. Let’s use LTACH pre-admission screening as an example. At Cantata Health, spent over five years developing a pre-admission screening portal in partnership with our clients, ensuring that the technology was tailor-made to the needs of LTACH pre-admission procedures. But you don’t have to use Cantata Health products to achieve coordinated care (don’t get me wrong, we would certainly like it if you did). But there are some features you should look for when evaluating an electronic health solution that will actually facilitate coordinated care. Coordinated Care Solutions Should Be Web Based Web based electronic health solutions allow practitioners to conduct screenings and complete documentation in real time. Returning to the pre-screening portal example, our web based screening documentation can be ready for financial review in three easy steps on a tablet or laptop as your liaisons go about their tasks. This allows them to focus on the relevant conversations, data, and metrics that they need to complete their documentation. While the increased mobility is a huge benefit, web based solutions are becoming increasingly more common with the steady migration to cloud-based technologies. And as demand for healthcare continues to increase, this transition will only accelerate in the coming years. Coordinated Care Solutions Should Be Integrated I know I said “integrated” before, but I really mean it. There’s no reason to fill out the same information multiple times on electronic forms. That’s why our pre-admission portal integrates seamlessly with our EHR and RCM software. Any demographic information entered during the pre-admission process is automatically compiled and uploaded into your EHR and RCM tools, not only ensuring that any and all forms are completed correctly, but also eliminating redundancies in a practitioner’s routine. Integration also prevents mistakes or inaccuracies across forms that may impede payment processes or, worse, compromise patient care. Which brings me to my next point. Coordinated Care Solutions Should Be Real Time If a pre-admission liaison completes a the pre-admission process, the resulting forms should be available to the coding and billing team for immediate review. This way they can identify and flag inconsistencies and then… wait for it… communicate them back to the liaison so that they can address these concerns, often prior to leaving the acute care facility. Closing this feedback loop rapidly accelerates the admission process, getting patients to the care they need faster. Coordinated Care Solutions Should Be Data Centric Not only should coders and billers be able to access pre-admission forms in real time, they should also have detailed analytical history about the referring physician, clinical indicators, and number of referrals. That’s why our product includes an analytics dashboard, allowing a broader view to improve high-level business decisions that in turn improve the overall function of your organization. These types of data based decisions are extremely important now, but will become even more essential as the healthcare industry transitions to payment for care quality and overall cost effectiveness.

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A doctor’s job isn’t easy. And with the ongoing shift towards value-based care, it’s only getting harder. Doctors are rigorously trained to treat individuals, committing decades of their life – not to mention hundreds of thousands of dollars – to their education and practice. The advent of value-based care, however, is forcing many to acquire an entirely new set of skills, or risk being excluded from the transition altogether. Rather than focusing on the needs of individual patients, they are now being asked to lead big data initiatives and strategically examine large groups of patients, taking a holistic view to determine broader trends in entire patient populations. This additional level of analysis also requires a specialized skill set, and has generally involved thrusting additional responsibility on already overworked clinical staff. this trend should open the door for an unexpected, but mutually beneficial, partnership. The Benefits of Big Data in Healthcare Big data initiatives in healthcare are dramatically expanding the capabilities of medical care providers, researchers, and their partners. From precision medicine to population health, big data tools promise to save thousands of lives in the coming decade. Tools that enable vast amounts of data to be pulled from internal and external sources include EHR systems, labs, insurance companies, and pharmacies, among others. Initiatives to implement and integrate these resources are happening within singular health systems and across entire states, with the goal of uncovering patterns, trends and other insight among various patient populations. As with any data-based research, the more data you can access, the more insightful your analysis becomes. With the right information in hand, practitioners can determine best practices to improve patient-centric care and reduce costs – as mandated by the value-based care initiative.   As the name implies, however, big data analysis initiatives are a massive undertaking. They require integration capabilities to pull data from disparate systems in participating facilities and then aggregate them into an analytics platform for analysis. They frequently employ analytic methods developed in data mining, including classification, clustering, and regression, and extend far beyond traditional clinical epidemiology. Business intelligence (BI) and analytics tools transform this abundance of data into insights and opportunities, but often require specialized knowledge of multiple platforms, applications, and their various capabilities. For a busy doctor – 65% of whom report being overworked – simply learning how to operate these tools, let alone spend hours mining them for useful insights, is simply not possible. Building Effective Partnerships Most healthcare business offices have analytics tools in place, as well as staff that have the skills to use them. If they don’t, this function is likely outsourced to a business partner or consultant. Regardless of where the skillset resides, analysts can (and should) work with clinicians and doctors to help them mine the wealth of information created by big data analytics initiatives for useful insight. This collaborative effort, however, requires breaking down the silos between business office staff and doctors, who have traditionally had only limited interaction. Initiating a dyadic leadership structure – which pairs an administrative leader with a clinical leader – will help break down these silos. A great place to start is a pilot project that pairs an analyst with a doctor, making each available to the other at regular intervals for in-person conversations. Encourage the doctor and analyst to collaborate on creating specialized reports that will benefit clinical staff and improve their decision making abilities, and to determine a reporting schedule that ensures timely, accurate data. This will leverage the data analysts existing skill set, while allowing doctors to understand  and utilize the wealth of data available to them as they make daily treatment decisions. Additionally, it improves the analyst’s connection to the clinical side of the hospital’s operations. This will become even more critical as the role of the business office evolves during the transition towards payment for care quality and overall cost effectiveness. Use this time to create awareness among participating doctors of the analytical expertise that already exists within the business office, and the benefit of these relationships as they implement value-based care initiatives. Further, measure improvements before and after implementing the program to prove these benefits. This will help transform the clinician / analyst partnership into a cooperative relationship for the benefit of patients, which is the ideal goal. Doctors and clinicians should not be alone when it comes to big data analytics. A wealth of analytical knowledge exists within the business office. With a little clinical guidance, significant improvements can be made in quality care and the lives of patients. A version of this post was originally posted on Becker’s Hospital Review.

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I’ve already discussed the wealth of information to be found in medicine’s oft-forgotten business offices, but today I want to focus on the RCM team specifically. I’d like to go out on a limb and assert that your revenue cycle team may even be the key to improving your hospital’s overall performance.Leverage Your Revenue Cycle Team’s InsightWith their unique view on the daily operations of a hospital – the rate at which claims are being pushed out, the volume of patients treated, etc. – your revenue cycle team offers a vital perspective on the efficiency of your business.While your revenue cycle team may be trained to identify faster and easier ways to improve operational efficiency, they should also be consulted on larger trends and be involved in determining important benchmarks. Their ability to mine and analyze organizational data should be leveraged whenever possible. For example, looking at demographic trends in your hospital’s area, combined with clinical insight, can help drive investment decisions, as well as drive outreach programs.Invest in Third Party Input for Long-term RCM SuccessJust as your own internal team may offer unexpected insight, bringing in a third party to help assess revenue cycle and operational processes can help guarantee long-term financial success.The true value of outside assistance lies in their ability to assess the state of your business operations without bias: because they are not immersed in your day-to-day activities, they are better able to evaluate your practices for their long-term implications.When selecting a partner, make sure they have experience running your class of hospital. Ideally you want a national-level consulting group, as they are more likely to know about larger trends, rather than focusing only your local market.And when evaluating cost focus on what it would cost a new change leader, so that you have a realistic level view of cost. Something else to consider is what new revenues and cost containment can be driven by the project. Typically, a savings/pickup of 2-4% of Net Patient Revenue is conservative. Also consider asking if your software/hardware vendors offer this service, perhaps as expanded maintenance, or through Application Management Services.  Prioritize Field Training In an IDN EnvironmentHealthcare providers operating within integrated delivery networks must prioritize field training if they hope to successfully manage a central business office. Put differently, ongoing education is key to ensuring financial success.One of the great challenges of running a true central business office is making sure the member hospitals and providers are all following consistent procedure. Without an education department, it is impossible for IDNs to evaluate whether field staff and registrars are doing what the leadership team expects of them. Trainers should be sent out to the field on rotation to certify staff are following through on verification, maintaining the required financial paperwork, and communicating with patients as appropriate. Furthermore, truly successful education departments learn from the field as well, picking up new ideas, fresh perspectives, and local trends that may impact the IDN as a whole.A version of this post was originally posted on Becker’s Hospital Review.

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Medicare accounts for an increasingly large portion of all long-term acute care hospital (LTACH) discharges, with current estimates indicating that approximately two thirds of all LTACH discharges are Medicare discharges. Between 2004 and 2013, Medicare spending on patients in LTACHs increased from $3.7 billion to $5.5 billion. These rising costs have not translated to improvements in patient outcomes. For example, though Medicare pays for 2,000 days of post-acute care (PAC) services for every 1,000 patients, roughly one fifth require readmission to hospitals, often for preventable conditions. By contrast, Kaiser Permanente averages just 600 days of PAC services per 1,000 patients, and enjoys much lower readmission rates. Medicare Reform In an effort to contain these rising costs, Medicare dramatically altered its LTACH payment model with the Pathway for SGR Reform Act of 2013. This change, implemented in fiscal year 2016, aims to reduce the payment rate for certain discharges and will significantly impact LTACHs and the healthcare industry as a whole. The most important change is the shift from a prospective payment system (PPS) toward a “site-neutral” payment model. Rather than prospectively defining reimbursement for groupings of patients with similar characteristics, Medicare will calculate payments as the lesser of two rates based on tighter patient characteristic criteria. The resulting payments will be similar to what Medicare pays in the acute care setting, and will either be calculated as an inpatient PPS (IPPS) comparable per diem amount, or the estimated costs of the case. Bracing For Change In an attempt to mitigate negative effects on the industry, the rollout of these changes has been gradual. The full force of the changes are expected to hit LTACHs this year, and will have serious implications for LTACHs across the country, particularly those in the New England and West South Central regions. Research by Berkeley Research Group indicates that LTACHs in Texas, Louisiana, Oklahoma, and Mississippi will see a 19% drop in Medicare payments, while New England states could see drops as high as 38%.   A recent report by Standard & Poor offers a bleaker outlook: “We expect a material portion of the approximately 435 LTACH facilities nationwide to close over the next few years amid the phase-in of lower reimbursement.” With the second phase of payment changes still on schedule to roll out in 2018/2019, we must begin asking ourselves if we are truly prepared. Futureproofing the LTACH Industry There are many strategies LTACHs could employ to offset the effects of the recent Medicare reform, such as Changing year-end reporting dates Diversifying through acquisitions Portfolio optimization Cutting costs Shutting down unprofitable facilities Attracting patients still eligible for the attractive LTAC-specific rate. These strategies help optimize your census to maximize profitability. Another strategy that can positively affect the survival of LTACHs is one you’ve likely already heard of: dedicated care coordination from pre-admission to post-discharge. Historically, LTACHs have been slow to improve care coordination and reduce readmissions, content to wait for the emergence of third-party companies that will specialize in care coordination… for a hefty fee. This is a mistake. Only aggressive action towards in-house care coordination will ensure the long-term survival of your business while significantly improving outcomes for your patients. — To find out how to build a strategy for your LTACH, be sure to read the second installment in theLTACH Futureproofing series!

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The Centers for Medicare & Medicaid Services (CMS) announced last month that it was rebranding its familiar electronic health record (EHR) Incentive Programs from “meaningful use” to “Promoting Interoperability.” Among the proposed changes are welcome simplifications in reporting protocols, as well as new requirements surrounding EHR capabilities. Specifically, these new requirements seek to improve pricing transparency, facilitate the sharing of patient information between providers, and further engage patients in managing their care. To accomplish this, all eligible providers will be required to demonstrate compliance with 2015 Edition of CEHRT by next year. Which is great – these are excellent and important changes, and I am anxious to see how they could positively impact my patients. On the other hand, I worry that in focusing on external interoperability, healthcare providers will ignore the value of internal interoperability. External Interoperability To clarify, when I say external interoperability, I’m referring to the type of interoperability that CMS is currently emphasizing. Specifically, a hospital or health facility’s ability to communicate clearly and securely with external EHR systems and their patients. There is significant room for improvement in external interoperability. According to Black Book Research, 36% of medical record administrators report struggling to exchanging patient health records with other providers, particularly physicians not on the same EHR platform. A further 24% report that they are still unable to access meaningful patient information received electronically from external sources. These types of provider to provider communication is extremely important. Sharing patient data across providers and EHRs results in better care coordination, with fewer redundancies in testing and treatment that play a large role in the patient experience. Similarly, giving patients access to their health data significantly improves patient-provider communications, which can in turn affect health outcomes. So yes, external interoperability is extremely important. But I worry that focusing exclusively on these capabilities will pull the focus away from something most EHRs still struggle with today – internal interoperability.   Internal Interoperability Like most physicians, a significant portion of my day is spent interacting with an EHR. Tools which allow us to effectively manage the patient are always appreciated. We want the EHR to work with our workflow not against it. Perhaps this focus on my own EHR user experience seems short-sighted, but there are significant benefits to patients as well. Specifically, I must be able to quickly analyze the different data available to make an educated decision concerning the patient’s healthcare. For me, one of the most important elements to a successful EHR is internal interoperability. By that, I simply mean an EHR that allows easy access to the wealth of information presented to us on a daily basis. This can be as granular as minimizing clicks throughout a workflow, and as complicated as the integration of relevant external data into a record which may make a difference in the management of the patient. Some of the features, over the years,  that will help with improvement of interoperability and better use of an EHR may include:   Fewer Screens I have never been a fan of requiring more than one screen to document. Worse, having to open up the same patient record on each screen and then the sub-folders. Losing time by clicking back and forth, mistakenly selecting the wrong tab or patient, reduces my efficiency and productivity, especially on a busy day. After joining Cantata, I was very pleased that our  documentation module allowed the user to accomplish his or her work on one screen. Information was available without leaving the module which is common in some other systems.   End-to-End Integration Not only do I expect the systems I use to integrate well with each other, but they should just as easily import data from external systems as well. I don’t want to enter the same information into the same (or even separate) systems multiple times. If I enter or update important patient data, I expect that data to populate throughout the system. Similarly, I want to be able to view EKGs, pulmonology studies, imaging results, and historical data on the same screen. Tabs should be well demarcated that direct me to the studies I need. And an efficient EHR will avoid searching for paper results not in the electronic record. We should be able to view everything in one sitting. With our EHR at Cantata Health, we have placed a premium on seamless communication between systems and solutions, which CMS has defined as absolutely necessary for improved interoperability. Two-way Communication Improved communication between individuals is one of the key advantages users can expect from better integration between systems. Let’s take a long-term acute care hospital (LTACH), for example. LTACHs have many specialized communication needs, from pre-admission screening to ongoing family communication. Cantata Health’s web-based LTACH solution allows for web-based screening documentation that can be completed on a phone or tablet, and ready for financial review in minutes. In some cases, the review is completed before the screener leaves the hospital, and they’re able to inform the patient of their eligibility in person, in real-time. Similarly, Cantata Health’s Family portal allows LTACH providers to communicate directly with their patients’ families. Providers can instantly share updates, documentation, forms, and test results to various family members, who can then choose to securely share this information with additional family members. This allows the family to take a more active role in their loved one’s care, which decreases stress and improves patient outcomes. Endless Customization I truly believe that EHR customization should be quick and easy. Updates that improve the physician workflow shouldn’t take months to implement. Similarly, physicians should be able to customize admissions, run specialized reports, develop individualized order sets, and even create their own personal templates. At Cantata Health, we want to empower the physician to utilize the EHR in the best way possible that fits his or her workflow. As more modules and more tools become part of the EHR, this ability to customize how they integrate with each other will become more important in the near future. Physicians will need the ability to decide which parts of an EHR will allow them to improve their workflow and results. A one-size-fits-all solution is no longer acceptable. In the future, physicians will demand a flexible, adaptable, integrated EHR that prioritizes both internal and external operability

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The Centers for Medicare & Medicaid Services (CMS) recently announced a new approach to the familiar “meaningful use” EHR incentive program. Now termed “Promoting Interoperability,” these updated criteria seek to address pricing transparency, facilitate the sharing of patient information between providers, and further engage patients in managing their care. To accomplish this, all eligible providers will be required to demonstrate compliance with 2015 Edition of CEHRT by next year. And while these changes are welcome, they appear heavily emphasize external interoperabilityover internal interoperability. These two types of interoperability are deeply interrelated, but they are rarely considered to be of equal importance. While internal interoperability emphasizes improvements to physician communications and hospital workflows, external interoperability focuses on a health facility’s ability to communicate with external actors, including their patients. And while external interoperability is receiving quite a bit of attention at present, it is the speed and accuracy of internal communications that make external interoperability a reality. Our infographic, below, illustrates the components of internal and external interoperability. How does your EHR measure up?

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Is your LTACH ready for Medicare reform? In an effort to contain rising costs, Medicare has dramatically altered its LTACH payment model with the Pathway for SGR Reform Act of 2013. This change, implemented in fiscal year 2016, aims to reduce the payment rate for certain discharges and will significantly impact LTACHs and the healthcare industry as a whole. While there are still some opportunities to face this coming challenge head on, deciding how and where to spend increasingly limited resources will only become more challenging. Now is the time to critically examine the debilitating costs of paper records and invest in a flexible RCM platform designed to help you cut costs, improve payment processes, and prepare for tomorrow. Our solutions are tailored to the needs of LTACH facilities, and are optimized for a quick and easy transition from existing systems. Because each module can be purchased separately, or mixed and matched with other solutions, we guarantee you’ll get only what you need, exactly when you need it.