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Best Practices Guide for Designing Accountable Care Financial Systems

Posted by Matthew Smith on Aug 29, 2012 12:07:00 PM

ACO Best Practices GuideAs an ACO leader, you probably find yourself shifting your attention and activity from high-level planning to the everyday operational nuts and bolts of your ACO organization. Your challenges are daunting and seemingly endless. Do you have all the right resources lined up? Do you have access to the ACO thought leaders you need to guide you in the right direction?

Health Directions helps organizations of all sizes with their ACO strategies and infrastructure support. Our President & CEO, Daniel J. Marino, has been recognized by Accountable Care News as one of the country's leading thought leaders on ACO strategy. Our ACO service offering includes:

  • ACO Readiness
  • ACO Workflow Assessment and Design
  • Clinical Interventions
  • IT Infrastructure and system design
  • GPRO and technical guideline interpretations
  • Tracking of ACO clinical outcomes for reporting and clinical performance
  • Provider incentive programs
  • Clinical Integration

Using our ACO experience as a blueprint, Health Directions created a Best Practices Guide to assist you in the financial design of your ACO organization. Simply download the Health Directions Guide: Best Practices Guide for Designing Accountable Care Financial Systems" to get a better understanding of:

  • ACO Readiness
  • ACO Workflow Assessment and DesignClinical Interventions
  • IT Infrastructure and system design
  • GPRO and technical guideline interpretations
  • Tracking of ACO clinical outcomes for reporting and clinical performance
  • Provider incentive programs
  • Clinical Integration

Knowledge is power! Make sure you're "in the know" when it comes to Accountable Care. Click on the button, below, and you will be directed to download your copy of Health Directions' Best Practices Guide for Designing Accountable Care Financial Systems

Topics: Accountable Care, ACO, Clinical Integration, healthcare consulting firm, Accountable Care Organizations, Best Practices

A Provider's Story: Achieving EHR Meaningful Use--A Team Effort

Posted by Matthew Smith on Jul 11, 2012 9:46:00 AM

EDITOR'S NOTE: Dr. Marie T. Brown, MD, FACP, and Dr. Janet Y. Forbes MD, (whose practice is in Oak Park, IL) recently achieved Stage 1 Meaningful Use attestation. Their personal account follows.

Meaningful Use“Our team is pretty small (there are only six of us)—two doctors, two LPNs and two front desk staff (no IT department, no education department, and no HR or billing department). I had been quoted as saying, ’I’ll retire before I go electronic.’ So when it came time to choose and implement an EHR, it was up to two very busy physicians with no experience and great trepidation. Fortunately, we noticed a mailing offering support from IL-HITREC. It felt like someone threw us a life preserver.

We contacted IL-HITREC, not knowing who they were or what they would do for us. We paid a grant subsidized fee for each provider for what they promised was assistance with not only choosing an EHR and attesting for meeting Meaningful Use, but also full implementation with consultative services which would have cost us several thousand dollars.

The IL-HITREC – North East Satellite Office assigned us to a health care consulting company called Health Directions. REAL people came to our office and SPOKE with us. They interviewed all of the staff, individually, to assess all concerns before we began this transition. The range of emotions ran the gamut—from excitement to paralyzing fear.

They coached us, listened to us, developed a project plan, worked with the EHR we chose, and held our hand every step of the way. They were also fun to work with. Three months after going ‘live’, one of the IL-HITREC consultants was physically present to help me attest to Meaningful Use, and eight weeks later the $18,000 incentive payment was deposited directly into my account.

Our entire six-person team shared in the work, frustration, confusion and rewards (financial as well). We could not have done it without IL-HITREC and Health Directions. We are now almost completely paperless. Though it is still sometimes challenging, we see the advantages and our patients are proud of us! The biggest difference is that we don’t waste time looking for charts and adding mounds of paper to the chart and several people can ‘use‘ the chart at the same time. Health Directions taught us that we needed to change how the work flows—and not just replace paper with digital records. We are pleased to be a part of the digital age and couldn't have done it without IL-HITREC's support.”

-- Marie T. Brown, M.D., FACP

 

The Illinois Health Information Technology Regional Extension Center’s (IL-HITREC) Northeast Satellite Office, managed by the MCHC, congratulates Dr. Brown and Dr. Forbes for reaching Stage 1 Meaningful Use attestation.

IL-HITREC is one of 64 Regional Extension Centers in the U.S designated by the Office of the National Coordinator for Health Information Technology (ONC). IL-HITREC’s northeast satellite office has contracted with Health Directions to assist suburban Chicago-area primary care physicians in the facilitation and delivery of health information technology.

The HIT Regional Extension Centers were established as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act; Title IV in Division B of the American Recovery and Reinvestment Act (ARRA). Signed into law by President Obama Feb. 17, 2009, the HITECH Act authorizes the Centers for Medicare and Medicaid Services (CMS) to provide a reimbursement incentive for physician and hospital providers who demonstrate the meaningful use of an EHR.

The ARRA stimulus package includes financial incentives for healthcare providers who achieve meaningful use with an EHR. Medicare incentives can provide up to $44,000 per provider over five years, and Medicaid incentives up to $63,750 per provider over six years.

Want to learn more about the current state of Meaningful Use? Simply click on the button, below, to access our detailed Meaninful Use Overview. Content includes:

  • Background of “Meaningful Use”

  • Identify the incentive dollars available

  • Medicare vs. Medicaid Programs

  • Introduce the Meaningful Use measures

  • Plan to achieve MU in 2012


Topics: EHR, EMR, Meaningful Use, HIT, Attestation, Practice Management, healthcare consulting firm, Medical Practice

5 Steps for Targeting Healthcare IT Triple Aim

Posted by Matthew Smith on Jul 5, 2012 9:37:00 AM

Healthcare IT Triple AimWhile health care’s complexities and challenges are unmatched by other industries, no one would disagree that our industry needs to make better use of IT. The success of healthcare IT projects depends on their ability to deliver on three main objectives comprising the Healthcare IT Triple Aim:

  1. improve care, 
  2. reduce costs, and 
  3. enhance the worker experience.

By adopting the Triple Aim, we can ensure that healthcare IT solutions have a positive impact and advance health care’s stature with regard to leveraging IT. The following are five keys to hitting the technology Triple Aim.

I. Technology is the Enabler, not the Driver

The Triple Aim is the driver and technology is the enabler, not the other way around. Technology implementations are complex and sometimes develop a life form of their own, and before we know it, assume the role of driver. Another challenge is that IT departments often end up driving the implementation of IT solutions, which is not the best approach. Solutions should be driven largely by stakeholders and users who will benefit from the solution. IT departments are not necessarily to blame for assuming control as they often end up filling a void created by the lack of leadership. 

II. Trust the Technology

Remember when eCommerce came into being? One of the key issues was consumer trust in these new, Internet-based technologies that a user could not touch, talk to or see. Fear of stolen identity, financial loss and general mistrust of this new, technologically advanced way of doing things slowed adoption. We are in a similar place today with health care technology. Physicians, hospitals and patients are being asked to be more transparent and share information. We are entering a world where electronic visits and remote health monitoring are moving toward the norm. Health care providers are being asked to look at and respond to clinical and financial performance data, and are being told that their income will depend on that data. Like it or not, health care is fueled by data, and there is likely no escape. 

III. Pay Attention to the Often Overlooked Driver

Of the Triple Aim objectives, improving the health care worker experience is the one most often overlooked. Technology projects are usually born out of a desire to save money and decrease risk exposure thereby improving quality of care. Some electronic health record (EHR) projects were started with the notion that they would make a physician’s job easier. However, EHR implementations, in general, have not delivered on that objective; in fact, most have had the opposite effect. If technology doesn’t simplify a job, the job may not get done; or if the job does get done, it will be done at the high cost of lost productivity and worker dissatisfaction – negatively impacting the quality and cost of care. 

IV. Measure It

Is our technology improving care? Reducing costs? Enhancing worker satisfaction? If so, how and to what degree? These are questions that should be asked and measured specifically and quantifiably. Create key performance indicators (KPI) detailing the goals that support the overarching Triple Aim objectives. Items to be measured will vary by worker group. For example, physicians, nurses, schedulers, billers and administrators should all have unique KPI dashboard measures related to their specific objectives, and their capacity to impact care and cost. In addition, they should have their worker satisfaction evaluated on a regular basis. KPI’s may also vary depending on what issues the technology solution is intended to address but could include:

  • patient waiting time
  • gaps in care
  • patient satisfaction surveys
  • number of visits per day
  • number of same day visits
  • worker satisfaction surveys
  • hours required to wrap up the day after the last patient visit
  • traditional billing and financial measures.

V. Improve It

Improvement naturally follows measurement. With regard to IT improvements, there are two important things to keep in mind:

  1. Today’s solution may not suffice tomorrow, and if we think it will, we’ll get left in the dust. 
  2. The complexity of health care’s issues require adjusting on the fly.

If we wait for the perfect roadmap, the project will never get off the ground. Complex implementations such as ambulatory EHR solutions leave users feeling like overwhelmed. Likewise, data intensive accountable care models are complicated and not fully defined, requiring a lot of discovery and invention along the way. There is no linear path; missteps and rabbit trails will be the norm, not the exception. Many consulting firms and health system IT departments have assembled EHR optimization teams that follow implementation by 90 or more days, and work to improve processes of adoption after everything has settled. Technology optimization initiatives that involve a systematic plan of reviewing and responding to performance metrics should be widely used.

Seasoned veterans know that the devil is in the details when it comes to applying IT solutions to the complex issues of health care. Sometimes the biggest challenge is getting the proper stakeholders to spell out objectives and play a key role in the execution of the project to ensure that they are met. If you are considering a new technology implementation or find yourself in the throws of adversity from a previous implementation, it’s not too late to revisit the project and align with the Triple Aim objectives.

Topics: healthcare consulting firm, Triple Aim, IT

Avoiding Physician Backlash: 7 Tips Toward a Successful EHR Rollout

Posted by Matthew Smith on Jul 3, 2012 9:13:00 AM

Hospital Information System6 resized 600Nationwide, hospitals are aggresively acquiring physicians and creating tighter affiliations with physician groups. Building a strong physician network is always difficult, but the challenge is even greater when it is combined with an electronic health record rollout — a necessary move that will allow the partners to share information and take advantage of new payment initiatives.

Implementing a new ambulatory EHR system often will disrupt practice workflow, impair physician productivity and affect physician income. But when a hospital is providing the system, cultural and political issues come into play that can damage or kill relationships. For many hospitals, the EHR rollout creates a physician backlash just when the integration strategy is getting off the ground.How can a hospital mitigate the risks of implementing an ambulatory EHR system? The following seven steps will help minimize conflict, contain costs and increase your chance of a successful rollout.

1. Form a Multi-stakeholder Governance Team

Some hospitals treat an EHR implementation as just another information technology project. Information technology staff members lead the system selection and installation process, executives take a hands-off approach, and physicians are relegated to the role of "receivers." This approach does not work well with electronic health records.

EHR use has a huge impact on physician practice as well as hospital strategy and finance. For that reason, a governance team that includes hospital executives and physician leaders must direct the EHR implementation. Multidisciplinary governance is key to helping physicians transition from independence to collaboration. 

2. Get Agreement on Objectives and Be Honest About Differences

Conflicts arise during an EHR implementation that easily can derail the project. For instance, physicians often request electronic connections to independent labs. But this undercuts the goal of clinical integration. To avoid such distractions, the governance body needs to establish agreements on the strategy and core objectives.

Hospital culture tends to be methodical and risk-averse, while physicians are used to making quick decisions, with little need to consider the impact on others. Agreeing on the basics will help smooth out these cultural differences. A common understanding of strategy and core objectives can help:

  • physicians focus on the needs of the system and the importance of careful planning;

  • hospital administrators make faster decisions and allow stakeholders to proceed more independently;

  • both parties understand how to pick their battles by delineating what is open to debate and what is not, what is a critical concern and what is a side issue.

3. Hire Medical Practice Expertise

Hospital administrators who have not worked in a medical practice usually do not understand medical office processes and needs. This is true in every hospital department, and IT is no exception. The problem: EHR implementation teams that do not grasp ambulatory workflows often create needless disruptions.

The solution is to hire an expert who understands medical practice workflows, management processes and culture. The ideal expert is someone with direct experience working in a small practice setting — for example, a former practice manager who has been through an EHR implementation.

An implementer with medical practice expertise will understand how to interact with physicians and office staff. He or she will be able to foresee implementation problems and configure the EHR system to meet individual practice needs.

4. Form Collaborative Task Forces

Even with medical practice experts on the implementation team, hospitals need a way to learn from medical practice staff members about what will — and will not — work in their office. The solution is to create implementation task forces that include key individuals.

Nurses, practice administrators, medical records staff, billers, even receptionists all should be represented. Establish an overall task force to plan EHR configuration and processes, and break out smaller groups to tackle specific issues like template design and process metrics.

Collaborative task forces can anticipate user problems that hospital IT staff would never see coming. They also build a sense of shared ownership for the EHR system. In addition, task force members are able to support their coworkers after implementation, reducing the practice's reliance on hospital IT.

5. Build a System, Not an Assembly Line

Implementing an EHR system for a physician network will require medical practices to adopt some standard workflows and clinical protocols. While standardization is necessary, it can create problems in individual situations and for certain medical specialties. A rigid approach to workflow design will breed resentment and result in a poorly functioning system.

Here's a rule of thumb for EHR implementation decisions: Don't force any changes that won't improve care quality or bottom-line results.

Say a group of family physicians wants to use voice recognition software to create referral notes. Some hospital-led implementation teams oppose voice recognition technology on the grounds that it does not generate discrete data within the EHR system. But meaningful use regulations and quality initiatives do not require all documentation to be formatted as discrete data. Since voice recognition technology may improve quality of care and make life easier for physicians, the best decision is to allow its use in the proper place within an EHR environment.

6. Rip Off the Band-Aid®

Even with good planning and risk mitigation, an EHR implementation is expensive and resource-intensive. The issue before hospitals and physicians is this: Do you want it to be quick and expensive or slow and expensive?

Both parties must devote resources up front to ensure a prompt and efficient EHR rollout. Physicians need to set aside time to learn the system, which means temporarily cutting back their schedules. Hospitals need to provide additional support to soften the impact on physician productivity. Some hospitals provide physicians with medical scribes to assist with the transition to electronic charting, while other hospitals supply temporary nursing support to help practices maintain patient flow.

These moves add expense to an implementation project, but they are a small investment when weighed against the risks of a failed rollout.

Here again, agreement on core objectives (see Step 2) is important. Both hospital administrators and physicians must be able to understand why they are making the change if they are to maintain commitment to the implementation and make needed investments.

7. Share Accountability

While the system rollout requires a big push, the work does not end there. All stakeholders must have ongoing accountability for creating high-performance electronic health records.

The hospital, of course, is responsible for maintaining the system and providing training. Physicians are responsible for using the system well. Ultimately, successful EHR adoption and meaningful use depend on what happens at the practice level.

While physicians need to make time to learn the new system, they also need to attend training sessions (you might be surprised by how many do not). Medical practice staff should participate in planning and implementation. Practice representatives also should take part in EHR user groups — collaborative learning groups that allow staff to share best practices and solve system problems, ultimately reducing their long-term reliance on hospital support.

Hospital administrators and physicians need to work together on continuous improvement. This is where the governance structure is still important, because there needs to be a body that identifies improvement goals and enforces behavior change for the sake of the entire system.

Best Chance for Success

Each of these steps will minimize the problems that can arise during a hospital-led EHR implementation. Together they allow hospital leaders to ensure the best chance of success for an electronically connected physician network.

Topics: EHR, EMR, HIT, Employed Physicians, healthcare consulting firm, Hospital Technology, hospital consulting, Affiliated Physicians

Healthcare Consulting Firm Health Directions Heads to HFMA ANI 2012

Posted by Matthew Smith on Jun 22, 2012 12:00:00 PM

ANI resized 600Health Directions is eagerly awaiting the start of HFMA's ANI 2012 this Sunday in Las Vegas. A national healthcare consulting firm, Health Directions looks forward to its largest presence to-date at ANI. President & CEO Daniel J. Marino leads three sessions at this year's ANI, including:

Sunday, June 24—Preconference Workshop: Lessons Learned: Best Practices for Designing Accountable Care Financial Systems (8:00am-11:30AM). 

After this session, attendees will be able to:

  • Establish clinical and financial measures for organizational accountability

  • Plan clinically integrated programs that reduce costs and improve outcomes for specific populations

  • Combine clinical outcomes measures with claims data to track the cost of care

  • Negotiate accountable care contracts using a risk-based, value purchasing or performance-based model

Tuesday, June 26—HFMA Case Study Stage in the Exhibit Hall: MAP Keys for Physician Practice Management: Tools to Drive Practice Performance (1:30PM-2:00PM) 

Wednesday, June 27—Breakout Session: Summit Medical Group: Advanced Strategies for Troubleshooting the Employed Physician Revenue Cycle (3:15PM-4:30PM)

After this session, you will be able to:

  • Describe the framework and key drivers of the physician practice revenue cycle

  • Track the financial performance of an employed physician practice using key metrics

  • Use data analysis to identify performance problems and design process solutions

  • Negotiate accountable care reimbursement opportunities with payers

Health Directions will be exhibiting at this year's ANI in the Exhibit Hall at Booth #1742. Please stop by for a chance to win a $100 American Express gift card and a $50 Amazon.com gift certificate.

Are you unable to make it to ANI 2012 next week? Would you like a preview of Dan's presentations? Don't miss out on the Health Directions presentations. Click the button to access Dan's powerpoint presentations for ANI 2012.

Topics: Accountable Care, Employed Physicians, healthcare consulting firm, HFMA, ANI 2012, Revenue Cycle

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