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Changes in Healthcare – Barry P Chaiken, MD and Steve Fanning at Inforum14

October 12, 2014 Featured No Comments
Changes in Healthcare – Barry P Chaiken, MD and Steve Fanning at Inforum14

Hear about the upcoming changes in healthcare and how to respond to the changes. Barry P Chaiken, MD, MPH, CMIO and Steve Fanning, VP, Healthcare Strategy at Infor speak to these coming changes.

Bacchus and Healthcare

Bacchus and Healthcare

Showing great wisdom, our mothers cautioned us to never judge a book by its cover. Yet, when we purchase wine, we often look for the fancy label design, interesting back label story, or colorful capsule covering the cork. That said, most wine drinkers use price as the most important indicator of wine quality. Surely a $100 wine must be better than a $15 bottle, otherwise why would the retailer charge more for it?

In the absence of understandable, easily accessible quality metrics, we utilize price as a surrogate for quality. Sure, we may search reviews looking to see if the pretty label represents a 90+ point wine, but in the heat of the moment in a restaurant we read the wine list right to left choosing a wine by its price rather than its pedigree. Frankly, most consumers employ this this approach when they purchase products where quality and value are difficult to judge or trusted quality information is unavailable.

As we move to value-based reimbursement models where price matters, linking quality to price becomes more important than ever. The passage of the Affordable Care Act (ACA) dramatically changed the healthcare marketplace and the economics driving it.

Excerpts from: Bacchus and Healthcare. PSQH, May/June 2014

Photo Courtesy of  Don Guerwitz PhotographyGauchos, Tupangato, Argentina

WhatsApp Lessons to Engage Patients

WhatsApp Lessons to Engage Patients

Information technology has achieved some amazing changes in consumer behavior. Over the last 20 years, companies have decreased their costs simply by transferring the work previously done by employees to consumers. For example, think about the last time you took an airline trip. You probably bought your ticket online through an airline or travel website. You printed your boarding pass at home, at the airport kiosk, or pulled it up on your smartphone.

If you checked a bag, you entered the data into the airport kiosk while the agent simply checked your government ID and placed the tracking tag on your bag before tossing it onto the luggage belt. Does anyone miss the paper folder we used to hold our boarding passes and itinerary?

If you reviewed the typical airport counter a decade ago, you saw more than a dozen agents working quickly to assist travelers. Today, just two or three agents hold court at the counter. Instead, you see busy travelers doing much of the work formerly done by those agents. Numerous other industries present a similar story.

Rather than think this consumer engagement only benefits the companies deploying the technology, consumers embrace these new processes because they also obtain benefits from doing so. While information technology assists other industries to reduce costs and improve processes by transferring some of the work to engaged consumers, healthcare lags in its use of information technology to similarly engage patients.

Excerpts from: WhatsApp Lessons to Engage Patients. PSQH, March/April 2014

Photo Courtesy of  Don Guerwitz PhotographyFishing in the Moat, Hue, Vietnam

At All Cost?

At All Cost?

During the dot-com boom in the late ‘90s, many new companies based their business plans on the volume of website visits. This revenue model assumed that by capturing the attention of users as measured by clicks on the company website, the organizations would generate wild profits; however; when these companies went public, they assumed very high valuations without generating revenue. These companies never thought through their business models, nor understood their real costs.

For more than a half century, the healthcare industry applied the same confidence in similarly flawed models. Volume-based reimbursement tied revenues to volume, so organizations that maximized volume, in turn maximized profits. There was little incentive to focus on costs because organizations just inflated their charges to account for what they calculated as a rough estimate of their costs. If their calculations proved wrong for a particular line of business, they just upped the fees the following year to make up for it.

Recent reports from New York State Health Department, detailed in a December 9, 2013, article by journalist Nina Bernstein in The New York Times, show how variable and out of control healthcare costs are. The report listed hospitals with their charges and costs for a variety of conditions from 2009 to 2011. According to Bernstein, prices ranged from an $8 bill for treating a case of gastritis (cost: $2) to a $2.8 million charge for a blood disorder case that cost $918,462.

Without even knowing the details of the case, it is hard to believe the $8 bill for gastritis is correct when the cost of the treatment was only $2 – same must be said for the blood disorder case.

How does an industry survive—and how can our society expect healthcare costs to be reasonable—when hospitals do not know their costs of production or reasonableness of the bills they send to patients and insurance companies? How do organizations realistically set prices, compete in the marketplace, and accurately plan for their own survival and growth?

Excerpts from: At All Cost. PSQH, January/February 2014

Photo Courtesy of  Don Guerwitz PhotographyProboscis in a Tree. Bako National Park, Sarawak, Malaysian Borneo

Our Tower of Babel

November 5, 2013 Featured, Health IT, PSQH No Comments
Our Tower of Babel

The Bible describes why humans speak so many languages:

The narrative of the city of Babel is recorded in Genesis 11:1-9. Everyone on earth spoke the same language. As people migrated from the East, they settled in the land of Shinar. People there sought to make bricks and build a city and a tower with its top in the sky, to make a name for themselves, so that they not be scattered over the world. God came down to look at the city and tower, and remarked that as one people with one language, nothing that they sought would be out of their reach. God went down and confounded their speech, so that they could not understand each other, and scattered them over the face of the earth, and they stopped building the city. Thus the city was called Babel.

Although this explains well why communication is so difficult among people from different countries, it fails to address the inability of our various healthcare information technology (HIT) systems to exchange patient data seamlessly.

Although God confounded our speech to prevent us from turning away from His teachings, there is no equally important reason that HIT systems today do not communicate.

During a presentation to healthcare CIOs at the recent CHIME13 Forum in Scottsdale, Arizona (Chaiken & Vengco, 2013), attendees expressed their belief that the lack of interoperability among HIT systems represents a substantial barrier to utilizing innovative information technology tools, such as social networking applications, to manage the delivery of patient care. Only after what they described as a miracle event – true interoperability – did attendees believe that these new technologies could be used effectively to impact the quality and cost of patient care.

It is time to focus on the value delivered to the patient and our community derived from universal, easily managed HIT interoperability. Such a capability promises to deliver improved patient care; fewer redundant, unnecessary tests; and more accurate diagnoses and treatments.

Excerpts from: Our Tower of Babble. PSQH, November/December 2013.

Photo Courtesy of  Don Guerwitz PhotographyStreetcorner Dentist. Hoi An, Vietnam

Evolving to Health 3.0

October 8, 2013 Featured, Health IT, PSQH No Comments
Evolving to Health 3.0

The dramatic shift to value-based reimbursement requires all providers to completely disrupt their care processes and workflows to ensure the delivery of high quality, safe care at a reasonable cost. For more than four decades these same providers thrived in an environment where providing more care easily generated higher prices and profits. In that former reimbursement model, a serious and dangerous moral hazard existed where the instinct to “do no harm” clashed mightily with a similarly powerful driver to maximize income.

Organizations that will survive under the new realities of ACA recognize the power of healthcare information technology (HIT) to assist them in reworking their business processes and clinical workflows to achieve the goal of high quality, affordable care. Effective approaches to change include leveraging recent HIT investments and the reinvigoration of legacy systems.

The era of Health 3.0 ushers in new, disruptive uses of HIT that leverage past technology investments to obtain maximum value from newly created technologies and digital trends. Health 3.0 pioneers the innovative use of information technology’s proved valuable in other industries to enhance the quality and safety of care delivery while delivering superior cost outcomes.

Excerpts from: Evolving to Health 3.0. PSQH, September/October 2013

Photo Courtesy of  Don Guerwitz PhotographyThe Mezquita. Cordoba, Spain

‘Show Me the Money’ Revisited

‘Show Me the Money’ Revisited

In the immortal words of Ronald Reagan, “There you go again.” Something that can be explained simply is twisted to look infinitely complicated with plots and subplots that would make J.K Rowling proud. The recent controversy over the use of EMRs to increase reimbursements to providers suggests intrigue, fraud, and bad intent. In contrast, if you learn how the money flows, you will better understand the true reasons for the outcomes seen in organizations using EMRs.

A New York Times report published in September 2012 documented an increase of $1 billion in Medicare reimbursements in 2010 over the amount paid five years earlier. The report partly attributed this payment increase to changes in billing codes assigned to patients in emergency rooms.

Such stories send shivers through the EMR community. To date, hospitals, EMR vendors, and the government struggle to demonstrate the value of EMRs in enhancing patient care and delivering cost savings. With billions of federal dollars earmarked to payment incentives for the use of EMRs, government officials anticipate some kind of return on this investment. Government EMR advocates did not expect to see an increase in reimbursements by public and private payors to providers through “enhanced” billing practices (code optimization [legal] or code maximization/up-coding [illegal]) activities.

Compared to paper records, EMRs allow for more rapid and complete documentation. In addition, EMRs slow the documentation process. Wait, how can EMRs both speed up and slow down documentation? It all depends upon deployment of the EMR and the constructed documentation workflows.

Unfortunately, EMRs focus on two important objectives at the same time– 1) facilitate clinical documentation to deliver patient care, and 2) facilitate clinical documentation to optimize coding for reimbursement. Documenting for patient care does not closely parallel documenting for reimbursement. As long as reimbursement is tied to documentation, EMR documentation workflow will suffer from inefficient documentation workflows, inaccurate documentation of care from global templates, and accidental (or deliberate) upcoding for reimbursement.

Excerpts from: ‘Show Me the Money’ Revisited. PSQH, November/December, 2012

Photo Courtesy of  Don Guerwitz Photography – Daybreak at the Ganges, Varanasi, India

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