Tag: Health iT

Physician referral issues causing more out-of-network care

 

 

Dive Brief:

  • Some providers aren’t properly referring patients, which could lead to inappropriate and out-of-network care, according to a new survey by Kyruus.
  • The online survey of 200 primary care and specialty physicians found that 34% of out-of-network referrals could be avoided if providers had more information on other doctors’ specialties and areas of focus.
  • Kyruus found that 77% of providers recognized the importance of keeping patients in-network for care coordination, but 79% admitted that they refer patients out-of-network.

Dive Insight:

Kyruus said the survey shows that improving referral processes can help health systems improve patient retention.

A leading theme in the report is that providers don’t have the information needed to make sure patients are getting clinically appropriate, in-network care. Nearly half of doctors surveyed said they have trouble determining who is in-network. The doctors estimated they could avoid one-third of out-of-network referrals if they had more information about in-network providers.

Another problem that can hurt patient retention is that 42% of patients leave a provider’s office without a necessary referral appointment booked.

A whopping 72% of providers acknowledge that they or their staff usually refer to the same provider for a specialty rather than figuring out whether there’s another provider with more specific expertise or who has an earlier appointment. On the flip side, 42% of providers said they’re not practicing at the top of their license most or all of the time, which the report said can hurt physician satisfaction.

Erin Jospe, chief medical officer at Kyruus, said knowing who’s in-network and their specialties is a long-held challenge for physicians. “This new research reaffirms the widespread need to empower physicians with better insights and capabilities, so they can make the best referrals for their patients and help guide their care more effectively,” she said in a press release.

Beyond care coordination and provider satisfaction, the issue of out-of-network care goes to balance billing, also called surprise billing, and rising out-of-pocket costs. A recent Kaiser Family Foundation report found that nearly 20% of inpatient admissions in large employer health plans include a claim from an out-of-network provider. Those claims are especially problematic for patients getting outpatient mental health services.

Rising out-of-pocket costs are causing Americans to delay healthcare. A recent Bankrate survey of 1,000 adults found that 22% said they or a close family member delayed necessary medical care because of the cost, and 77% said cost worries had led them to avoid care.

For 7th Year DAS Health Listed on Inc. 5000

TAMPA, FL, Aug. 16, 2018 (GLOBE NEWSWIRE) — DAS Health, the Tampa-based industry leader in health IT and management, has been ranked on the Inc. 5000 List of the nation’s fastest growing companies for the 7th year in a row. This is a remarkable accomplishment, as only a fraction of companies have made the list twice, and only 3.5% of companies ranked have made the list seven or more times.

The list represents a unique look at the most successful companies within the American economy’s most dynamic segment—its independent small businesses. Microsoft, Dell, LinkedIn, Yelp, Zillow, and many other well-known names gained their first national exposure as honorees on the Inc. 5000.

DAS achieved over 180% growth in just the last 3 years. “Our rapid growth has resulted in seven consecutive years on this prestigious list and is attributed to our strategic and unmatched position in the Health IT and management sector,” said David Schlaifer, President and CEO. “Through our relentless focus on client success and exceptional service, we have become an essential solution for physician offices nationwide.”

ACOs using medical home physicians save money, yield higher quality, report finds

 

 

Dive Insight:

With 10% of the U.S. population in ACOs and almost 1,000 available around the country, these findings are widely applicable for healthcare players in both the public and private sectors as they work out new payment models amid the turbulent rise of value-based care.

This report, co-created by the PCPCC and the Robert Graham Center, coalesces two promising approaches in the space, as PCMHs and ACOs (although created separately) both exist in the same ecosystem focused on outcomes-driven care.

PCMH is a care delivery model where a patient’s care is coordinated through their PCP, and the system aims to produce coordinated, team-based holistic treatment. They have become more widespread over the past decade, with nearly 500 public and private sector PCMH initiatives being tracked across the U.S., according to the report.

Introduced in 2006, ACOs are similar but more broad. They hold groups of providers across different care settings accountable for both the cost and the quality of a cohort of patients. The providers therefore share the risks and rewards of patients’ health, prioritizing value.

“ACOs and patient-centered medical homes are cut out of the same cloth,” said Robert Mechanic, executive director of the Institute for Accountable Care in a panel convened by PCPCC on Wednesday.

He also pointed out that, although both PCMH and ACO performance have varied in U.S. studies, a wealth of evidence supports the role of robust primary care delivery in bolstering population health, reiterating the importance of continued studies such as this report.

The study also stressed that the characteristics that lead to the success of ACOs were also pivotal to the success of advanced primary care models such as the PCMH.

The study, which is the first of its kind to examine the interaction between these two models, also identified six domains that contributed to successful ACOs, with success defined as ACOs with shared savings, improved quality or adroit use of healthcare services. The six categories were leadership and culture, prior experience, health IT, care management strategies, organization and environmental factors and incentive and payer alignment.

Regarding leadership and culture, one important factor referenced throughout the literature was physicians acting as “clinical champions,” acting in leadership roles and lobbying on their patient’s behalf. Diverse, collaborative governance structures were also noted as important to foster coordinated communication across the ACO, along with establishing a culture of shared commitment and accountability.

“Providing care is a service, not a building,” said Ann Hwang, director of the Center for Consumer Engagement in Health Innovation. The focus should always be on the patient as a whole being, not a set of symptoms, she said.

From a provider perspective, two things are inserted into this equation, according to Farzad Mostashari, chief executive officer of Aledade: total cost of care accountability and voluntary alignment of practices. Successful ACOs must be a coalition of the willing, as the “whole dynamic of the network is incredibly powerful.”

Another subject brought up in Wednesday’s panel was the mounting role of technology in health. Along with using technology to coordinate care, identify high-risk patients and track patient care beyond the ACO, the report highlighted the critical role of health IT in performance data feedback for quality improvement.

William Kassler, deputy chief health officer and lead population health officer at IBM Watson Health, said he sees such technology as an “enabling tool” for providers, stressing that “data is key for quality improvement.”

When asked to identify obstacles to ACO and value-based progress, the panel was quick to provide a flurry of answers, including sluggish public policy, increasing consolidation threatening competition (a notable quote was from Mostashari , “if you’re big, you don’t have to be good”) and binary or reductive analytic results.

According to Anthem vice president of provider alignment solutions Mai Pham, larger structural issues such as a fee-for-service cornerstone of American healthcare are the elephant in the room. Anthem, she said, plans to pivot to a place where it is “ready to leave some providers behind” if they fail to modernize their business models.

A 2017 evaluation of the Medicare MSSP program showed that one-third of ACOs in the program achieved savings, although they outperformed their FFS counterparts on most quality measures. These new findings, taken in tandem with past research, suggest that a foundation of advanced primary care is crucial to successful care delivery reform focused on lowering costs and keeping people healthy and out of the hospital.

CareFirst touts $1B saved with patient-centered medical home program

Dive Brief:

  • Over eight years, CareFirst’s patient-centered medical home (PCMH) program has saved more than $1 billion in healthcare spending, the insurer’s CEO Chet Burrell announced this week.
  • One of the largest plans of its kind in the nation, the PCMH includes more than 4,300 primary care physicians managing care for more than 1 million CareFirst members. It gives participating doctors value-based financial incentives and clinical supports such as nurses and data analytics.
  • Patients in the model have expressed high overall satisfaction in the plans, with ratings averaging 4.5 out 5.

Dive Insight:

The PCMH has contributed to projected overall savings of $5.5 billion for CareFirst. The savings are significant in the growing yet murky field of value-based payment models, which generally have mixed results when tested.

While most healthcare organizations report they are ready to transition to value-based models, many are wary, citing a lack of infrastructure as a roadblock in the shift.

Yet, a Change Healthcare report in June showed that value-based care initiatives reduced unnecessary medical costs by 5.6%, with almost a quarter of organizations reporting savings of 7.5% or more. The successes of CareFirst’s PCMH program point to the potential value-based programs have to save costs without sacrificing patient engagement or care.

CareFirst, the mid-Atlantic region’s largest private payer, first launched the PCMH program in January 2011 in an attempt to stop the continued rise of already-steep healthcare costs. On a per member, per month basis, overall CareFirst cost was increasing an average of 7.5% every year.

Since the introduction of the PCMH, rises in costs have slowed to an average of 3.5% annually, without any meaningful shifts in membership or enrollment, the company said.

CareFirst’s region includes Maryland, parts of northern Virginia, and Washington, D.C. — an area that accounts for some of the highest hospital admission rates in the country. Yet, in the eight years the PCMH has been active, CareFirst’s hospital admissions dropped 23%, Burrell said in a webcast announcing the results.

The PCMH program was able to do this, he said, by stabilizing patients in their homes or in the community, and by focusing on accountability for total cost of care, data availability, patient behavioral change and scalability. The program used payment rewards in lieu of asking providers to accept any downside risk.

CareFirst organized its participating doctors into panels consisting of about 10 primary care physicians and supporting nurses. Each panel received a patient care account, where all expected costs (credits) and all actual costs (debits) were recorded.

CareFirst tracked the expenses and compared debits and credits monthly. If a panel’s credits exceeded their debits, they got to keep a percentage of those savings. Additional incentives were given for long-term program participation, cost-effective referrals, engagement in care coordination and consistent performance.

More than $440 million has been paid out to primary care providers in additional performance-based payments, Burrell said. The average PCP in the program earning a reward received an additional $37,650 in annual income. Participation has been fairly stable, with fewer than 1% of PCPs leaving the program citing dissatisfaction.

On the eve of his retirement from CareFirst, Burrell concluded the performance report with CareFirst’s key takeaways from the program. He stressed consistency in population health-based incentives to build trust with physicians, easily accessible data and accountability.

EHR error rates vary widely across systems, JAMIA study finds

Dive Brief:

  • The amount of time it takes for providers to complete EHR tasks varies widely across health IT systems, and so does the error rate and amount of work required, according to a recent study in the Journal of the American Medical Informatics Association.
  • The study collected keystroke, mouse click and video data from two different EHR vendors, Epic and Cerner, across four healthcare systems. Between 12 and 15 emergency medicine physicians participated from each site, completing six EHR ordering scenarios: two diagnostic imaging, two laboratory and two medication tasks.
  • Error rates varied by task but reached as high as 50%. For certain tasks, there was an eightfold difference in clicks and a ninefold difference in time.

Dive Insight:

The gaping variability across EHR vendors, tasks and healthcare systems highlights the need for improved standardization across systems and better implementation practices — especially since these factors are critical to the safety of the product and the patient.

Many fast decisions are made during the rollout of an EHR, but it can take several months to a year and a half to complete. That affects usability — the efficiency and effectiveness of the technology in the hands of a clinical user. Problems with usability in areas such as diagnostics or medication can contribute to physician burnout and patient dissatisfaction, along with increased risk to quality of treatment.

The study showed errors across three sectors: imaging, labs and medication. It cited usability challenges such as “screen displays that have confusing layouts and extraneous information, workflow sequences that are redundant and burdensome, and alerts that interrupt workflow with irrelevant information” as reasons for the errors.

Study author and scientific director at MedStar Health’s National Center for Human Factors in Healthcare, Raj Ratwani, told Healthcare Dive that, ultimately, “what’s contributing to these types of errors is the way the system is designed, developed and implemented.”

During implementation, providers make a number of decisions about how they want their health IT system set up, though they may not have the time or knowledge to make those decisions. This can result in “potentially dangerous” flaws in a system that may not meet a provider’s workflow needs, Ratwani said.

Ratwani, who is also an assistant professor of emergency medicine at Georgetown University, pointed out a second challenge: vendor organizations’ inability to clearly communicate the best implementation practices for a specific healthcare organization, as well as sacrificing usability to the demands of a (potentially uninformed) customer.

A confluence of these challenges among the hospitals’ Epic and Cerner systems likely contributed to the high error rate, the study concluded. That has far-reaching consequences, as the two companies together make up more than 50% of EHRs within U.S. hospital systems.

The Office of the National Coordinator of Health Information Technology put requirements in place in 2010 to promote EHR usability and has continued to expand the program. Vendors must attest they are putting the needs of end users at the forefront of software development and third-party certification bodies must approve their products. Still, usability challenges persist.

In a 2015 research letter, Ratwani found a lack of adherence to ONC certification requirements and usability testing standards among several widely used — and certified — EHR products. Other extraneous factors can shape the final manifestation of the EHR. During local site implementation, for example, configuration and customization impact layout and and information accessibility and account for some of the variability across healthcare systems.

The latest study’s authors suggest stakeholders should consider basic performance standards for all implemented EHRs to ensure usable and safe systems, and Ratwani stressed the need for follow-through.

“Many vendors [have] their products certified as having met that requirement” even if they don’t, he said. “The ONC could modify that to say: Show us evidence of your user-centered design process. And if vendors are doing this, showing evidence is easy because if you’re doing it there are natural byproducts of it.”

All of the health information products examined in the study were usability tested by either Cerner or Epic and were certified by the ONC’s accrediting bodies.

Similarly, Ratwani believes that “rethinking [physician] training is going to be important.” That includes revamping the copious training physicians are bombarded with in a clinical setting, especially because clinicians sometimes get their health IT training on a product that “doesn’t even resemble the real product they’re going to be using.”

Rawani urges that multiple stakeholders be involved, noting that solutions can come from both vendors and providers.

DAS Health Announces Health IT Career Fair, Welcomes Former CareSync Team Members

TAMPA, Fla., June 22, 2018 – DAS Health, a leading provider of health IT and management solutions headquartered in Tampa Bay, has announced a career fair this coming Thursday, June 28th, open to the public. The event comes in light of recent local layoffs by healthcare technology company CareSync, offering industry workers the opportunity to learn more about open roles at DAS Health.

DAS Health recently completed its fifth acquisition in less than three years and secured an additional $6 million facility through Fifth Third Bank for further growth and expansion. As a result of continued rapid growth, DAS has current openings for up to 20 individuals with the right skill sets. Open positions include roles in sales, account management, revenue cycle management (RCM), billing, accounting, EHR technical and billing support staff, care coordination, and more.

“As a local small business owner, our people are our heart – DAS knows the importance of providing opportunities and stable roles for the individuals we work with day in and day out,” said David Schlaifer, President & CEO of DAS Health. “We hope to give back through this career fair and ultimately welcome talented team members to the DAS family. I encourage other business owners to do the same and open their doors to a community in need.”

The DAS career fair will take place Thursday, June 28th from 11-1pm at the DAS Health downtown Tampa headquarters, 1000 N. Ashley Drive. Former CareSync employees and all health IT and related job seekers are encouraged to attend. You can view more on DAS’ current openings at DAShealth.com/careers.


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