HealthLeaders Finance Editor Jack O'Brien speaks with Meghann Hutchison , CFO of Lovelace Medical Center in Albuquerque, New Mexico, about how the organization responded to COVID-19, what the plans are to bring back elective procedures, and how to prepare for a potential second wave in the fall.
HealthLeaders Finance Editor Jack O'Brien speaks with Steve Lawler , president of the North Carolina Healthcare Association, about the ongoing coronavirus disease 2019 (COVID-19) outbreak, what business strategies provider executives should put into place to bolster the bottom line, and the future of telehealth solutions.
Using proactive external peer review to mitigate the risk of high-dollar lawsuits
Medical necessity investigations and lawsuits are a significant threat to healthcare providers, especially those that rely on internal medical staff peer review programs to identify adverse patterns in clinical behavior, according to the new brief Medical Necessity: Checks and Balances Most Hospitals Don't Have, but Should.
"All too often, the medical staff is not up to the task of policing for medical necessity and therefore does not produce adequate oversight," says Rick Sheff, MD, chief medical officer and national director of external peer review at The Greeley Company. As a result, healthcare executives may not know the extent to which their organizations are at risk for fraudulent billing.
This is a critical issue, given the OIG has recently settled numerous multimillion-dollar lawsuits with hospitals and physicians for performing medically unnecessary tests and procedures.
Whistleblower lawsuits in particular are damaging to a hospital’s reputation and bottom line. "There is no shortage of people willing to blow the whistle in medical necessity cases and retire comfortably for their trouble," says Thomas Anthony, an attorney with Frost Brown Todd LLC. Whistleblowers receive between 15% and 30% of the amount recovered by the government.
Hospitals face big risks when the medical staff peer review process does not lead to medical necessity decisions that match OIG guidelines.
The brief describes how to establish an effective medical necessity surveillance and accountability program. One key step includes creating an external peer review process, which is a best practice for hospitals looking to reduce risks related to medical necessity. Experienced external peer reviewers not only perform impartial assessments, but also raise the red flag when self-reporting might be warranted. Go here to learn how to structure and implement medical necessity checks and balances.
Kindred Hospital Rehabilitation Services, August 1, 2018
Learn key strategies for increasing rehab patient engagement through technology.
The patient's experience, along with a hospital's reputation, is vital for long-term success. Studies indicate strong patient and family engagement in clinical care positively contributes to a favorable experience, as well as improved health outcomes and reduced costs.
Reputation, whether good or bad, plays a large part in attracting patients, employees, physicians and partner healthcare institutions—and patient and family engagement are vital drivers of a hospital's reputation.
The following contains strategies for incorporating technology into patient engagement initiatives. When providers understand these strategies and their key benefits, they are better positioned to overcome the challenges of today's healthcare environment.
New Opportunities in Patient Engagement and Empowerment
The Centers for Medicare and Medicaid Services (CMS) have emphasized the role of patient engagement through new acute care payment systems and strategies. As a result, many hospitals and care providers are seeking new ways to use data and technology to improve patient engagement, empowerment and throughput opportunities.
One example of this is Kindred Hospital Rehabilitation Services' (KHRS) new app, RehabTracker. Since the technology launched, a majority of sites have experienced improvements in FIM gain and discharge to community.
"Our patients are medically complex, so it helps them focus on their goals," explains Muhammad Khan, physical therapist and program director at St. Catherine Hospital, where the app was first piloted for the hospitals of Community Healthcare System. "Motivating them every day is a big challenge, and we have seen improvement in our functional gain scores since January. We do believe that motivation by any means, whether it is sharing stories or information, helps with a patient's recovery."
Three Benefits of Patient Engagement
A commonly-held definition of patient engagement focuses on care providers working with patients to encourage involvement in their own healthcare decisions. Evidence shows that individuals engaged in their health are more likely to achieve better outcomes, and technology can be a significant contributor.
Improved outcomes: Tracking and reporting features illustrate improved patient progress.
Enhanced communication: Providers, patients and caregivers can better communicate with one another, providing updates on the patients' condition.
Increased patient satisfaction: Informed, engaged patients are likely to be more confident regarding their condition and satisfied with their experience and outcomes.
CMS Supports Tools to Foster Patient Engagement
Research underscores the growing value of a positive patient experience and demonstrates that hospitals that deliver a better patient experience perform better financially.
While increased patient participation and engagement are well-recognized as a core component of high-quality care, patient engagement is also central to achieving high-quality person-centered care, and has been associated with improved self-care, better physical functioning, and satisfaction with care. Fortunately, many new technologies are available to providers and hold the potential to better motivate and engage patients to take an active and ongoing role in their recovery—and much of that technology is, literally, in the patients' hands.
Research shows that technology benefits rehabilitation patients specifically, by clearly identifying purpose, goals, rules and a feedback system.
Strategies to Create Patient-Centric Tools
Providers must be prepared to face challenges when developing successful patient-centric technology solutions, such as difficulty securing funds and IT resources, the lack of healthcare knowledge among developers, different communication preferences and easily navigable design.
To address these issues, providers should work hand-in-hand with developers so design is informed by medical expertise and experience to provide patients and their loved ones valuable information based on their unique condition and treatments. Specifically to rehabilitative care, digital platforms should include input from experts in rehab services so patients understand their rehab plan and receive the necessary feedback to motivate them toward their goals.
RehabTracker—A Solution Designed With Your Patients in Mind
By partnering with rehab experts like KHRS, providers gain access to innovative tools without the heavy lift of creation from the ground up. The RehabTracker app ensures the patient, clinical team and family are all on the same page by allowing patients to:
Set goals with therapists
Document care plans and important information during bedside shift report, physician visits or interdisciplinary rounds
Track progress
Share results with invited family and friends, even over long-distance
Receive messages of support and celebrate milestones through recovery
RehabTracker is invaluable in improving patient engagement scores for host hospitals of rehabilitation units and helps prepare post-acute facilities for the future of value-based payment models.
Kindred Hospital Rehabilitation Services' expert therapists and staff are dedicated to treating the needs of highly acute patients in a compliant environment, thereby meeting patient goals, improved recovery and successful discharge. Our culture of patient advocacy, and focus on developing and implementing technology solutions, can help our partners focus on their goals of improving outcomes, increasing patient engagement, and operational efficiency.
How We Can Help
To learn more about KHRS and how RehabTracker can help your patients, and their family and friends, easily receive, monitor and share important milestones on the path to recovery, visit kindredrehab.com.
AAPA's Center for Healthcare Leadership and Management created the Employer of Excellence Awards to showcase hospitals and health systems that excel in creating positive work environments for PAs. Learn more about this award.
No matter the profession, employers are an important and memorable part of any job. When looking back over a career, some employers will always stand above the rest. They afford opportunities for professional growth, create progressive work environments, and are invested in their employees’ success.
For PAs (physician assistants), the best employers are those that implement practices that create positive work environments and encourage collaborative provider teams. PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal provider. They work in every state, in every medical setting and across all specialties.
To showcase progressive employers and their inspiring work, the American Academy of PAs’ (AAPA) Center for Healthcare Leadership and Management (CHLM) launched the Employer of Excellence Awards. For the inaugural year, eight hospitals and health systems were selected as Employers of Excellence:
Brigham Health – Brigham and Women’s Hospital – Boston
The Cleveland Clinic – Cleveland
El Centro Family Health – Taos, New Mexico
Hospital for Special Surgery – New York
MidMichigan Health – Midland, Michigan
NYU Langone Health – New York
Seattle Cancer Care Alliance – Seattle
Wake Forest Baptist Health – Winston-Salem, North Carolina
When employers support their PA workforce and utilize PAs to their full potential, they see benefits not only to their organization but also to their patients. PAs are committed to team practice and working in collaboration with other providers. Ensuring that they can work at the top of their education and experience in engaging environments improves healthcare teams. And that’s good for patients.
CHLM partnered with HealthStream, a leading provider of workforce, patient experience, and provider solutions for the healthcare industry, to gain an understanding of what PAs value in their place of employment and to determine the criteria for recognition. Based on the survey findings, the criteria for the Employer of Excellence Awards focused on key drivers of engagement including:
Establishing a positive and supportive PA work environment.
Providing opportunities for PAs to provide meaningful input that leads to positive organizational change.
Keeping PAs informed about organizational activity and decisions.
Involving PAs in leadership efforts to improve the quality of patient care.
Creating processes for effective conflict management.
Awardees will retain their designation as an Employer of Excellence for two years, and then must re-apply to maintain the designation. This year’s winners were formally recognized by their peers at AAPA 2018 in New Orleans, but there are many other benefits that come with this recognition.
By being publicly showcased as a top place to work for PAs, awardees can expect enhanced recruitment of highly qualified PAs from around the country. Status as an Employer of Excellence can also help to increase retention rates, reduce turnover rates among PAs, and deliver the message to patients that engaged, involved, and satisfied PAs lead to better patient care and quality outcomes. The Employers of Excellence are model PA employers in the healthcare industry, which provides opportunities for them to share their stories of effective team practice and PA-positive work environments.
Here are just a few examples from these eight hospitals and healthcare systems which illustrate how their PAs can practice at the top of their education and experience:
A program in which PAs independently staff clinics to increase patient access and quality of care;
A creative reporting structure that establishes collaborative partnerships between PAs and physicians;
Comprehensive onboarding programs designed to increase retention rates and competency levels;
And, PA-led councils that provide guidance to the C-suite on how to improve patient care and support for PAs.
This award is perfectly aligned with CHLM’s mission of working directly with hospitals and health systems to enhance team-based patient care. CHLM provides expertise, analytics and industry best practices to help clients evaluate organizational alternatives designed to improve the effectiveness of their provider workforce.
The next application period opens in the fall of 2018. Any hospital or health system in the United States that employs PAs is eligible to apply. The Employer of Excellence Award is the first and only PA-specific award program available to hospitals and health systems. If your hospital or health system employs PAs and fosters a PA-positive work environment, it could be the next winner.
Peer roundtables will share insights and explore solutions, as health systems enter a new era of consumerism.
As patient experience moves center stage at many of the nation’s health systems, leaders responsible for this function are tackling issues related to a maturing discipline. Most have moved far beyond HCAHPS surveys and many are diving into the realm of consumer marketing.
The landscape is rapidly changing as a new generation of tech-savvy millennials is introduced to hospital services through maternity and pediatric needs and as companies such as Amazon, renowned for delivering exceptional consumer experiences, enter the healthcare space.
On September 19–21, more than two dozen patient experience executives will convene at an invitation-only forum during the 2018 HealthLeaders Media Experience Exchange in Scottsdale, Arizona, to discuss the challenges they face and solutions they’re exploring.
HealthLeaders Media spoke with a number of leaders at institutions across the country as a preview to the conference to gain insight into the commonalities they share and concerns they want to explore.
1. HCAHPS: An Antiquated Approach
The HCAHPS survey—the same instrument that gave rise to the patient experience function at many health systems—presents one of the greatest challenges.
Leaders point to the lag time created by "snail mail," as the primary culprit. To improve the patient experience, it is essential to take real-time action when problems occur. In an era of sophisticated technology, data received sometimes months later does not seem to offer meaningful opportunities for improvement.
"The surveys need revising; they need to meet patients where they are, and they need to ask meaningful questions," says Shannon Connor Phillips, MD, MPH, chief patient safety and experience officer at Intermountain Healthcare in Salt Lake City. "We need to be able to do all of the required surveys electronically and do more real-time, in-the-moment surveys."
Amy Thorson, director of patient and family experience at Dayton Children’s Hospital in Ohio, agrees, pointing out that her primary customers are millennial parents who represent the expectations of a new generation. "Current industry-standard survey tools lag behind what appeals to our millennials," she says.
The existing approach reduces response rates and feedback is not timely, she says.
2. Conquering Ingrained Processes
While HCAHPS surveys are relatively new, there is a tougher nut to crack at most health systems: processes that are deeply embedded in an institution’s history and culture.
"Many of our processes are built for our convenience—not our patients," says Kevin Gwin, chief patient experience officer at University of Missouri Health Care in Columbia, Missouri.
"Our processes are built for good reasons, to excel at clinical quality, to be efficient, and to hold down costs, but when we don’t align with our customer’s preferences where we could and it’s appropriate, then that’s where we’re feeling the tension between us and our patient customer," he says.
Piedmont Healthcare, an 11-hospital system based in Atlanta, experiences the same dynamic.
"Some of our larger challenges are adjusting our processes internally to better meet consumer demand and expectations," says Matt Gove, Piedmont’s chief consumer officer.
"Some of our processes have been developed around physician needs, around administrative needs, around EHR needs." While it is crucial to respect those requirements, "when you are trying to refocus everyone on the consumer journey and how to best meet that customer’s needs, it does require a change in mindset," Gove says.
3. Overcoming Administrative Burdens
If patient experience leaders could wave a magic wand and change one thing, many would make administrative burdens on clinicians disappear.
"If we could eliminate the extemporaneous expectations, and [clinicians] could only focus on the quality of the experience, as well as delivering a very personal, very compassionate experience each and every time, that would be ideal," says Rose Glenn, senior vice president, chief communications and experience officer at Henry Ford Health System in Detroit.
"But there are so many things that regulatory agencies and others require, that sometimes being able to deliver that individualized personal experience every single time becomes challenging," Glenn says.
One physician explained that for every hour of clinical time, she spends another two hours on medical record administration.
"They will not be able to keep up that pace," says Glenn. "They want to do the right thing, but the impact of all the changes and the increase in expectations makes it difficult to deliver a consistently exceptional patient experience. Unless we address burnout and help our staff become more resilient, I think that challenge is going to continue."
4. Forging a Human Connection
Administrative burdens diminish the human connection that is essential to a positive patient experience.
"Patients don’t want a medical transaction, they want a personal interaction," says Gwin. "They want a relationship with their physicians and their nurses, and they want to feel connected to their hospital and their doctor’s offices. If I could change one thing, I would make us better at discernment, at gauging ‘How is this relationship going?' "
"I want us to pick up on those cues that this is going really well, or this is not going well," says Gwin.
Conner Phillips says, "You don’t get great quality if you don’t have a partnership with your patients."
She wants people working in healthcare "to more intentionally see the connection between quality and safety and experience. You can’t have great experience if we fall short in quality and safety . We can give people great outcomes and keep them free from harm, but if we don’t connect with people and [employ] empathy, then we’re not establishing trust and being respectful. It’s not going to feel right to the patient. If it doesn’t feel right to the patient, they’re not going to participate in their treatment plans and keep themselves healthy or improve their chronic disease because they don’t feel connected to us."
Teaching hospitals have an additional challenge in this realm. Cindy Burger, MS, RN, vice president, patient and family experience at Dayton Children’s Hospital, sums up the concerns expressed by other leaders at teaching institutions, explaining that it is difficult to indoctrinate a philosophy when students constantly rotate in and out of the facility.
Students and residents "are part of our culture, but they are not quite as enculturated," Burger says. "Delivering consistency every time during every interaction becomes a challenge."
5. Expanding the Point of View
As health systems become more invested in the patient experience, the scope of work is broadening. Getting healthcare organizations to act like other consumer-oriented industries, however, is not easy.
"You cannot separate brand from experience," says Gove. "Most successful consumer-facing organizations understand that. But for most of its history, healthcare hasn’t even accepted that it’s a consumer-facing industry."
Piedmont is taking a holistic approach and examining every place people interact with the system—digitally, through advertising, and word of mouth, as well as billing and booking appointments. "There is an enormous opportunity for us to rethink what 'experience' means for a healthcare system," he says.
Henry Ford Health System is making similar inroads.
"As experience officers, we need to do a better job of understanding expectations before the consumer ever enters any of our facilities," says Glenn.
While hospitals are now doing a much better job of understanding patient’s preferences while they are in the facility, she questions how systems can proactively understand consumer expectations before they become patients.
"How do we hardwire the processes and the cultural standards that people expect, prior to the person ever coming into one of our medical facilities?" she says. With players like Amazon, Google, and Microsoft entering healthcare, the picture changes dramatically.
"They have a different take on addressing consumer needs. Healthcare organizations have to get up to speed and have that retail-oriented framework in order to deliver an exceptional experience," Glenn says.
6. Battling the Bottom Line
One final challenge patient experience leaders face is not new for those working in healthcare systems: financial.
"There’s a lot of competition for resources inside a system," says Gove. "As good stewards of the resources that have been entrusted to us by our communities, because we’re a nonprofit health system, how do we continue to convince the system to prioritize [patient experience] work? It does require an investment; technology platforms cost money. How do we keep [patient experience] high in the list of priorities so that we can continue to make the changes needed?"
The Experience Exchange
These are just a few of the issues to be explored at the Experience Exchange, along with solutions that are working for participating health systems.
The Experience Exchange is one of six healthcare thought-leadership and networking events that HealthLeaders Media stages annually. While the roundtables are invitation-only, qualified healthcare executives, director-level and above, will be considered. To inquire about the HealthLeaders Exchange program, email us at Exchange@HealthLeadersMedia.com.
Referential matching holds promise to significantly improve claims denials, reduce medical errors and waste, and improve the patient experience.
In a development that holds promise to significantly reduce claims denials, diminish unnecessary repeat tests, and improve the patient experience, Northwell Health has tested a novel approach to reducing patient record duplication, producing results that vastly improved its performance.
The pilot project assessed the effectiveness of referential matching, an innovation developed by Verato. New York State–based Northwell resolved 87% of a sample set of mismatched records after other matching processes were deployed. The 23-hospital system must address 300 mismatched records each day.
Northwell has 5 million records in its system and treats more than 2 million patients annually; typically, hospitals experience a 10% duplication rate, according to the American Health Information Management Association (AHIMA).
Following full implementation of the solution in June, this reduction will considerably lower the case load of records that staff specialists must manually address in a labor-intensive process.
"Duplicate medical records are the nature of the business," says Northwell's IT director Keely Aarnes, "but it has implications that run throughout the healthcare system."
Besides the cost of claims denials, which are time-consuming to rectify, consequences include potential medical errors because a patient's complete record is not available, unnecessary repeat testing when records can't be located, and reputational damage due to poor patient and clinician experiences.
Complex Challenge; Simple Technology
For nearly two decades, health systems have primarily relied upon probabilistic matching to resolve patient record duplication. This approach compares patient records and assesses the probability of whether they belong to the same person.
This method is now built into many EMR solutions, and health systems also can implement third-party technologies, known as Enterprise Master Patient Index, or EMPI, products that also employ the same logic.
"Probabilistic matching has done as good a job as it could possibly do," says Mark LaRow, CEO of Verato, "but there's a basic mathematical limitation to this algorithmic approach."
The technology behind referential matching is surprisingly simple. It involves comparing a patient record to Verato's propriety reference database of roughly 350 million people.
The company combines publicly and commercially available information containing all known names, addresses, phone numbers, and other data for individuals spanning back three decades, providing a comprehensive view into the identity of most people living in the United States.
"We see the full range of both the correct and incorrect versions of a person as they represent themselves [over time]," says LaRow. Depending on the quality of data and the population's characteristics, these automated matches average 92% without human intervention, and can be as high as high as 98%.
Why Health Leaders Should Care
Duplicate medical records are a growing problem due to several factors:
The situation has been exacerbated as hospital systems consolidate and records from different organizations are combined.
More departments now access the EMPI. As the number of access points increases, more decisions are made based on the data available, and additional patient identities are contributed to the system. These variables increase the probability that something will go wrong.
As patients begin directly interacting with their records, more opportunities for problems will occur, including privacy concerns.
This issue creates financial havoc for health systems. In addition to labor costs and resources required to address this challenge, according to a study conducted by Black Book Market Research and reported in an April 10, 2018, news release:
Thirty-three percent of all denied claims result from inaccurate patient identification or information. In 2017, this cost the average hospital $1.5 million, totaling $6 billion annually for the U.S. healthcare system.
The cost of repeated medical care related to this duplicate records averages $1,950 per patient for inpatient stays and more than $800 for emergency department visits.
Northwell's Eye on the Future
Two years ago, Northwell began an aggressive program to reduce duplicate records. At that time, it had about 700 duplicate records daily and a backlog of more than 200,000 potential duplicates.
An outside company was contracted to manually address the bottleneck, and Northwell began using InterSystems' HealthShare Patient Index EMPI product to reduce duplicate records through probabilistic matching to attain its current rate of 300 tasks each day.
"It's a significant improvement, but not quite where we want to be," says Aarnes. Northwell then added Verato to the mix because it was offering referential matching in the healthcare sector, and it features a cloud-based solution, which Aarnes says will further reduce complications and administrative time.
The potential for the future is what excites Aarnes most.
"We are getting really good at resolving potential duplicates," says Northwell's IT director, "but we want to prevent them from even happening."
As staff members are freed from duties related to resolving duplicate records, their responsibilities have shifted to training more than 2,000 registration personnel about how to properly create records and prevent problems. But Northwell has an even bigger vision in mind.
Another pilot program is underway in six of the system's practices, testing a biometric patient registration process that involves scanning the iris. Northwell and Verato are joining forces with RightPatient in this venture.
If successful, "that will be our matching mechanism to be able to link to the right patient," says Aarnes. It also could reduce the need for patients to constantly fill out forms.
"It's all part of our digital transformation," says Aarnes. "Patient matching and patient identification are critical to that success. These two initiatives go very much hand-in-hand."
