by Brett Kinsler | Aug 12, 2016 | Consulting, HIT Strategy, Practice Transformation, Value Based Payment
One way we help our provider clients to transform their practices is by helping them prepare for value-based payment models. We are proud to have been selected to guide practices by the New York State Practice Transformation Network (NYSPTN). This is a statewide learning network designed to coach, mentor, and assist clinicians in developing core competencies necessary to transform their practices and thrive in an emerging healthcare environment that emphasizes value of care.
The NYSPTN embraces and supports the “quadruple aim” of better care, better health, lower costs, and greater provider satisfaction.
The program is funded by the Centers for Medicare and Medicaid Services (CMS) to help practices develop quality improvement strategies, and navigate the complex healthcare environment and multiple transformation-related initiatives currently underway.
See the article from HealthLinkNY about the program:
http://www.healthlinkny.com/not-ready-for-value-based-payments-help-is-on-the-way-nw.html
by Brett Kinsler | Apr 13, 2016 | Consulting, Electronic Health Records, HIT Strategy, Interoperability
A fair number of our clients have been asking about FHIR lately so it’s time to fan the flames a bit and shed some light on this developing interoperability standard. FHIR (which is pronounced “fire”) is a methodology that was developed based on the standards from the HL7 organization, a non-profit. It stands for Fast Healthcare Interoperability Resources. Essentially, FHIR is a universal translation tool that will permit the exchange of clinically-relevant data to be shared securely and more easily. Currently, when data is shared among disparate systems, there are limitations to what can be ingested into the system and often the information is trapped inside documents like PDFs that do not become fully integrated into the patient’s incoming chart.
One of the most interesting developments around FHIR is that many EHR vendors have agreed to support the concept and put efforts into implementation. Several of these vendors include industry leaders such as athenahealth, Cerner and even Epic, a system not particularly well-known to share freely with other EHRs.
It is important to note that FHIR is not yet a mandatory standard and vendors are free to adopt or ignore it at this time. Whether or not it succeeds in the goal of unifying clinical information exchange depends on a number of factors:
Fueling the FHIR:
1. Idealism. True interoperability is the right thing to do — providing a complete clinical picture of the patient improves quality of care and reduces needless time-consuming tasks for the patient, health systems and medical offices.
2. Apps. The market for applications that can be used across any and all EHRs will expand so industry pressures from outside the EHR vendors will help push adoption.
3. Regulatory. Government, regulatory agencies and payors may require FHIR adoption and tie its use to incentive-based payments. Following the money, this will advance the use of the standard.
Mixed Results:
1. Divergence. The ability for users to move more easily from one EHR to another will make some vendors fearful of losing customers while others will jump at the change to migrate new users to their products.
Extinguishing FHIR
1. Time. Changing to new standards across so many vendors is not a quick or easy process. It will probably be several years before there could even be moderately widespread usage. In the meantime, something new or better may emerge which will overshadow the FHIR initiatives.
2. Evolution. FHIR is far from complete and improvements will have to be made. However, if you consider how often apps send updates and companies like Google and Apple improve their APIs, this is to be expected.
3. Fear. Health systems and providers may not be willing to share data as freely as interoperability standards might require. Often, this is out of fear of leakage, or the loss of patients to another system or provider.
Interoperability is not just a technical problem of connecting pipes and watching the information flow. There are change management, financial, and strategic issues at play that must be properly handled. And though the government may step in and force the hand of vendors and providers, eliminating many of the choices, being prepared for multiple eventualities and planning in advance will help payers, providers and vendors position themselves for the future.
Strategic Interests has expertise in past, current and future interoperability standards including strategic planning, implementation and deployment. If you have questions or concerns about FHIR or other interoperability situations, let us help you plan your roadmap for success.
by Brett Kinsler | Dec 12, 2015 | Physician Stress, Quality Care, Telemedicine
A recent publication in publication Mayo Clinical Proceedings (2015;90(12):1600-1613) concluded that in the United States, physicians are worse off than they were just three years ago. The work-life balance has suffered and more than 50% of physicians report professional burnout. This is in contrast to the high degree of professional satisfaction reported with their career choice.
Burnout is a term that reflects emotional exhaustion, a loss of meaning in work, feelings of ineffectiveness and a tendency to view people as objects rather than as human beings. This has profound implications in healthcare and is likely one of the largest causes of high rates of physician turnover. The problem is pervasive and getting worse. The inventors of the Maslach Burnout Inventory (MBI) describe burnout as “…an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”
Researchers noted a 10% increase in burnout prevalence over the last 3 years despite no increase in the number of hours worked, no change in career satisfaction or symptoms of depression. And before you say that this is probably just a human condition of living in the United States, the trend among the general US working population does not follow suit.
What are the possible solutions to this problem? Here are a few suggestions:
1. Increase Efficiency: this does not mean pushing more patients through the office at a faster rate but rather helping organize, calibrate and fine-tune workflows to empower physicians to be more effective in the time they have during an encounter.
2. Promote Work-Life balance: end the ridiculous long shifts of residents and encourage physicians to optimize their career with their families. Create an environment that nurtures community, flexibility and control that will yield more meaning in the care of patients. Establish programs that provide healthy outlets for physicians in the workplace such as exercise facilities and farmer’s markets. Permit physicians to exert control over their work hours whenever possible.
3. Encourage Self-Reflection: give physicians time and space to examine their own wellness as well as personal and professional values. Teach strategies for conflict resolution and stress reduction. Skills for resilience in challenging situations can be taught and learned. Workshops and group discussions can help doctors know they are not alone in their feelings and give them a sounding board for their symptoms.
4. Leverage Technology: utilization of tools such as telemedicine can allow physicians to schedule treatment time without a physical presence. This provides flexibility and a refreshing newness to the work.
5. Focus on the Value: physicians should be permitted to shift their focus to the aspects of health care they find most valuable. For some, this is research. For others, teaching. Finding a good career fit may not be the same thing they thought it was in medical school.
Physician burnout can lead to rising costs, reduced quality of patient care and even medical errors. Doctors who are stretched to the limit are unable to provide necessary empathy to their patients. If you are a physician who is experiencing burnout or an administrator who recognizes the symptoms in your employees, examine whether or not your health system is overworking the providers or simply failing to provide needed support. Changes can lead to improvements in all aspects of the care spectrum, for patients and for the organization as a whole.
by Brett Kinsler | Sep 18, 2015 | DSRIP
We’ve had several meetings with clients who have asked us about DSRIP. For the well-informed, you can skip this blog post, but for everyone else, we offer this brief DSRIP 101 primer:
Q. What is DSRIP?
The Delivery System Reform Incentive Payment Program is a Medicaid restructuring plan that reinvests money into the health care system in an effort to transform how hospitals and providers deliver care to Medicaid recipients.
Q. Why does Medicaid need restructuring?
Really?
Q. Yes, really. What is wrong with Medicaid?
Soaring costs for the government coupled with huge cuts to providers has led to difficulty in access for the patients with Medicaid. Plus, Obamacare requires states to add an additional 20 million people to the system — mostly pregnant women, children and the elderly. Just having a Medicaid card in your wallet is far from a guarantee of care. Many physicians decline to participate citing low reimbursement and mountains of paperwork to complete. There is also evidence that Medicaid enrollees receive a lower quality of care. A study from the University of Virginia found that Medicaid patients have worse surgical outcomes than individuals without insurance, even controlling for numerous confounding factors. As Federal spending for Medicaid has gotten out of control, there have been three bailouts to the system.
Q. How much is spent on Medicaid in New York?
New York’s Medicaid program is the single largest health care payer, serving more than 6 million (one in three) residents. Total spending on Medicaid in New York is expected to reach $62 billion this year alone.
Q. What are the main DSRIP focuses in New York?
Reduce avoidable hospitalizations by 25% through a series of transformative investments in community based care, including expanded care coordination, facilitated access to care, integrated health and behavioral health, and others, and to better manage chronic health conditions.
Q. How much money is available in New York for DSRIP?
$6.42 Billion over the next 5 years.
Q. What is a PPS?
Performing Provider Systems are the groups that submit DSRIP applications. They comprise eligible public hospitals and safety net providers in each pre-existing or newly formed networks. Included are health and behavioral health care providers, social service providers and community-based organizations. Safety net partners can include an array of providers: hospitals, health homes, skilled nursing facilities, clinics & FQHCs, behavioral health providers, community based organizations and others.
Q. Is membership in a PPS is enough to receive payment from DSRIP?
To receive payment, the PPS must coordinate in order to meet predetermined benchmarks and achieve outcomes related to each project. Goals are set by each PPS in accordance with their community needs. Incentive payments are not guaranteed, but can be utilized at the discretion of the network.
Q. How many PPSs are in New York State?
There are 25 in New York. Our region is part of the the Finger Lakes PPS (FLPPS).
Q. Which states have DSRIP programs?
The program was originally introduced in California and followed by Texas, Massachusetts, New Jersey, Kansas and New York. Other states are expected to establish DSRIP programs soon as well.
Q. Is the program the same from state to state?
DSRIP differs somewhat across state borders but there are some common themes that are universal: DSRIP initiatives promote collaboration, support innovation, and bring renewed attention to social services.
Q. So DSRIP is the same as Managed Medicaid?
Not quite. While DSRIP waivers often share many of the same goals as Medicaid managed care programs – slowing the rate of growth in spending, improving care and offering greater accountability, DSRIP offers providers – rather than health plans – the opportunity to change the way that they provide care. Keeping that in mind, the relative roles of DSRIP-funded provider networks and managed care plans has not been fully defined in all situations.
Q. What does Strategic Interests have to do with DSRIP?
SI has strong relationships with several PPSs, their founding partners and members. We’ve collaborated to define vision, write grants, provide strategic planning and formulate vendor selection in alignment with DSRIP initiatives. We understand the DSRIP big picture for individual organizations up to nationwide commercial ventures and everything in between.
by Brett Kinsler | Sep 15, 2015 | Telemedicine
At the dawn of medicine, when a physician wanted to assess a patient’s heart, he would put his ear directly on the patient’s chest to listen. Then came stethoscopes. At first people didn’t trust they would be as accurate as the human ear alone and deemed the scopes to be simply gadgets.
In the development of modern medicine, when a physician wanted to assess a patient’s heart rhythm, he would use an electrocardiogram. At first, people didn’t trust all of those wires and electrodes and deemed them to be just gadgets. The stethoscope, of course, was the standard.
During the growth of technology based healthcare, when a physician wanted to assess a patient’s cardiac function, he might order an echocardiogram. At first, people didn’t trust their accuracy and deemed them to be just new gadgets. What could deduced from an image that could not be detected from EKG tracings?
Well into the stride of evidence-based, data-driven, patient-centered healthcare, the emergence of telehealth devices allow physicians to assess their patients from a distance of another building, state or even a different country. Whether in real-time (synchronous) or using a store and forward method (asynchronous), remote visits bring a level of care to people who otherwise might not receive it. Specialized telehealth-enabled instruments, like video otoscopes or dermatologic cameras are operated by a nurse, technician or sometimes by the patient. Such procedures increase access, convenience, lower costs and can improve quality of care when a physician or specialist could not otherwise be consulted locally.
Just as prior breakthroughs permitted hearing and seeing what we could not previously perceive, this technology breaks the barriers of geography and access to healthcare and education. Unfortunately, there are people who do not view telehealth this way.
There is a debate occurring in some states whether or not to permit physicians to rely on telehealth when they have not seen the patient face-to-face. In some areas, like Texas, technology is losing the battle. At a time when people need better access to quality care at lower costs, you may think this is a surprising and alarming trend. You will recall that people often fear and dismiss technology they don’t yet understand.
We trust our physicians to prescribe medications, perform surgeries and myriad other procedures that hold a life in the balance of their judgement. If a physician deems a remote visit sufficient to make a diagnosis, and the research supports that decision, shouldn’t he or she be permitted to treat the patient as they see fit? But a great barrier is erected when telemedicine is restrained: research populations remain low and quality measures are often called into question when any measurements have been taken by patients themselves.
Better standards need to be in place for certain, but this can only be accomplished through an increase in telehealth initiatives, third-party reimbursement parity and industry advocacy to standardize telemonitoring data collection. And, as we’ve proven with so many other new technologies in healthcare, it should not be dismissed out of hand but vigerously studied, tested and validated.
To paraphrase The Independent journalist John Diamond, “perhaps there is no such thing as [telemedicine]…just medicine that works and medicine that doesn’t.”
There is no need to apologize for disrupting our beliefs about the traditional doctor-patient relationship; that’s par for the course in technology. Rather, when we find something that is safe and effective, especially when it is an improvement or provides an option where none existed previously, it should be fully enveloped into the scope of modern healthcare.
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