February, 2012

Summary of my week at HIMSS 2012

After attending HIMSS 2012 this year in Vegas, I could not wait to get back and share some of the knowledge and innovations I learned about from the conference. I sat through some incredible sessions, as well as viewed some exciting technologies and products that are bound to play a significant role in assisting with improving quality of care, safety and populations health.

In my walks through the different booths, I took the time to review some of the products being showcased. And this year there were several areas where I spent time evaluating and discussing the products and solutions with the vendors.

RTLS vendors:

This year I have seen a significant surge in the number of RTLS vendors. This was expected, as RFID products have seen a decrease in cost, and several bed management, asset management and patient flow software vendors incorporated that technology with their solution. But as I reviewed some of the products, I realized that only few stood out. Some of the vendors offered web view as part of their product, which made it accessible from any platform. Others provided a flexible workflow engine with custom workflow design tools. This functionality is extremely important, as it will allow the hospitals to implement specific workflows that will help resolve their specific challenges. These workflows consist of system actions when certain criteria are met (such as a device, staff, patient, temperature) or behave a certain way.

Business Intelligence: I had the opportunity to visit several booths that offered some incredible BI tools, from IBM to MicroStrategy. I was hoping to review and discuss mobile BI as well, but unfortunately I did not see examples of this product offering or vendors available.  

EMR vendors: As always, there was a enormous presence of EMR vendors and I was able to check out many of the products out there. I saw NextGen, Greenway, eCW (eClinicalWorks), GE, EPIC and Cerner and had the opportunity to view many of the new solutions and updated modules they are currently offering.

Knowledge Centers: This was something new to the HIMSS attendees. Inside the exhibit hall, knowledge centers are the areas where speakers and domain experts discussed specific subjects. Some of the topics were: Accountable Care Organizations, Cloud Computing to name a few.

Social Media Meet Up: This year, many of the bloggersfrom the #HITsm (health care IT social media) crowd got to meet and discuss the entire HIMSS event as well as the topic of health IT. I personally enjoyed meeting with some of the talented and healthIT experts out there such as @TechGuy, @ShahidShah, as well as @JennyLaurello (@HITExchange). We had the opportunity to discuss some of the sessions and innovations we were looking forward to seeing at HIMSS as well as some of the current federal initiatives, such as the stage 2 meaningful use changes.

Managed IT Service Providers: During my visits to the exhibit hall, I identified many vendors who provided IT services combined with health specific PM and expertise. This continues to be a very important area that can help many of the health organizations who are looking to fill their gap in IT support. While more clinical and technology folks are attending certification and accelerated programs in health care IT, the shortage is significant. Many hospitals are looking to implement initiatives right away and are in need of the appropriate resources to accomplish that.

As with every year I attend the HIMSS conference, I am introduced to so many new, thought provoking innovations, challenges and successes. This helps refuel my drive to continue to provide technologies and solutions that will yield to meaningful health outcomes and workflow efficiencies.

Highlights from Dr. Mostashari at the HIMSS 2012

On Thursday Feb. 23, 2012 during Dr. Farzad Mostashari’s keynote session, the ONC leader discussed his experience prior to coming into his current position. He went over some of the challenges faced implementing new programs, processes and technologies to assist physicians with improving population health in three different areas of NY. This was during his time with the New York City Department of Health and Mental Hygiene.

The results from the initiatives he piloted with physicians were positive, and this encouraged him to push for the similar adoption of HIT to assist with improving our nation’s health care. One of the areas he emphasized as part of the next stage in health IT adoption was the need for more interoperability, an area that will prove to have the most significant impact on improving patient health.

He repeated a few key phase several times, one of which being the need to achieve the “meaningful use of meaningful use”. He also outlined that technology will be a significant player in helping to improve a patient’s health and outcomes. “Tomorrow will be better, cheaper and easier”with technology”, Dr. Mostashari stated.

The Office of the National Coordinator for Health Information Technology’s NPRM was delivered to the Federal Register on Feb. 22, 2012. This was announced during the HIMSS 2012 town hall meeting. A day later, Dr. Mostashari outlined the overall underlining goals for this stage during his keynote session, highlighting that physicians will have the ability to send and receive documentation, images, and labs electronically.

After his talk, Dr. Mostashari answered several questions submitted to the LinkedIn HIMSS group, with one of the questions being around cloud computing. Dr. Mostashari took the opportunity to discuss how having cloud computing for health organizations will provide scalability and cost reduction industry wide, showing his clear support for and the validity of cloud computing in the health care arena.

A new breed of revenue cycle management business models to assist independent physicians

As many independent physician groups face the threat of reimbursement cuts, the high costs of software solutions and dwindling referrals, a new generation of billing service providers is offering creative packages and solutions to help these private organizations sustain profitability through new kinds of offerings.

For years now we have seen IDNs and hospital systems joining forces with private physician practices. But for some independent docs, this is raising concerns, as it is affecting referrals and revenue. There are also concerns that they may not have the ability to compete with the marketing dollars, negotiating powers and technology budgets of these health systems and their member practices.

For some revenue cycle management service providers, this was the best opportunity to assist the concerned private physician. The services that are being offered are tailored to help eliminate some of the typical challenges that small to mid-size physician practices face. Some of these include:

Hosted practice management and EHRs: Some of the companies have eliminated the high up front capital costs associated with a purchase of EHR and PM. By offering a full platform with services, a physician group can pay a monthly fee or part of their reimbursement and receive a fully operational PM/EHR system.

Revenue cycle management (RCM): Many of the RCM firms offer as part of their services some of the following:

• Fully out sourced billing and collections
• Coding solutions to increase reimbursement
• Improved cash flow and collections
• Lower overhead
• Reduced bad debt

Technology: Technology has been a new territory for many of the billing service providers. By including hardware or infrastructure as a service (IaaS) options, many of their clients have the advantage of receiving support and services from one single group. This also provides a much more predictable cost and fee structure for an organization.

Consulting: For health care billing groups, their financial revenues are directly associated with the client’s reimbursements. This means that they are incentivized to get the highest reimbursements and are continuously working with physicians to assist them with coding challenges, as well as helping identify efficiencies and value-added solutions.

Portals: Payment and referral portals have been a new addition that many of the billing firms have started to adds to their offerings. This significantly improves cash flow as well as allows for all of their clients in a community to interact with each other and share patient information electronically.

Compliance: With all many of the pay for performance (P4P) programs available, as well as meaningful use and other federal programs, billing firms are helping physicians receive some of the incentives available.

It seems that in the past, most of what has been written about the revenue cycle sector has focused on the outsourced collections and billing aspect of services. There are many new RCM providers that are bundling additional services that bring tremendous value to independent physicians. Despite the current complexity and changing landscape of health care, many physicians are able to focus on patient care while having increased assistance in their revenue cycle management from the front to the back.

HIMSS 2012 and a week long full of education and discovery

Every year the HIMSS attendees get to take advantage of many educational activities and sessions offered during the yearly conference event. In addition, many can spend time visit the exhibit halls and learn about some of the latest products available out there.

This year, there are many events that I will be attending and looking forward to. For starters, I am very interested in seeing some of the sessions presented by the ONC, and HHS. These would be the presentations in which we are expecting some additional details on the Meaningful Use Stage 2 dates. I will also be spending sometime on some of the sessions about HIE, EHR best practices, business intelligence, and mhealth.

There are several vendors that I am interested in visiting and discussing some of the products being offered. Some of these range from EHR, RFID, cloud computing, robotics, medical equipment and others vendors.

During this week-long conference, I will also spend sometime meeting and networking with health professionals, fellow bloggers, technology enthusiasts and old friends.

What’s needed from tomorrow’s HIT talent?

As the health care landscape continues to change, hosptials, health systems and other provider organizations are faced with a growing number of increasingly complex projects –  ICD-10 conversion, HIPAA 5010, EHR implementations, meaningful use complaince and and IT system merges, just to name a few. Because of the new demand on IT innovations, several health IT leaders are finding it difficult to recruit and maintain staff with the appropriate skills to help lead and manage these challenging projects. 

Over the past 12 years that I have spent working in health care technology, I have had the opportunity to work with many talented health care IT individuals, coming from varied backgrounds — some clinical, some technical and others from engineering. This goes to show, once again, that sometimes the ideal candidates and health IT superstars do not necessarily come from IT backgrounds.

There are several traits that a top HIT pick would have, and out of many I will discuss the top six that I feel are most significant:

Personal skills: Most IT folks in health care recognize that there are continuously being challenged. In this complex environment, many of the rising stars are empowered through self-motivation and drive. These candidates tend to be the ones taking on projects and experimenting with new solutions that may be out of their comfort zone.

Clinical workflows knowledge: For IT directors, having a candidate with a clinical background provides an incredible value. In many cases, analysts and support specialists who have been in the front lines working with physicians and nurses during the implementation of an EHR and other projects have  learned about the processes and clinical workflows. And with the ability to understand how technology can help streamline and facilitate the care of patients, super stars are empowered. They bring the best of both worlds and become one of the organization’s strongest supporters. 

Strong communication skills: An important aspect of working in health care IT is the requirement to implement new products and support clinical and administrative staff on those endeavors. In those roles, strong communication skills becomes even more critical to ensure buy in from the group. Not only does it becomes critical for the IT candidate to have effective soft skills, but they also must have a positive attitude.

Technical skills: While having the technical background on specific products (EHR vendor products and other clinical tools) may not exist in many of the new candidates, it is very important for the top performers to be exposed to many of today’s technologies. Whether it is some sort of programming, mobility, or even other ERP systems, having that diversity in experience will help when dealing with different health care applications.

Leadership skills: Many times, there are opportunities to grow and expand your role within an organization. Having strong leadership skills will help advance the strong HIT candidate quickly.

Everyday is training day: Hospitals and other health organizations continue to face software upgrades, staff turnover and regulatory changes. The only constant for healthIT is, in fact, change. A superstar not only needs to maintain a finger on what changes are coming down the pike, but must also continue to attend trainings, conferences and educate themselves on the latest and greatest technologies and collaborative projects going on in the industry.

One of the best sources for raw talent is the candidate pool of graduating students from the new health IT specific certifications. Whether it’s a post graduate degree or college level certification, these individuals may be the superstars that will help a hospital accomplish its goals and stay ahead of the curve in the coming years.

AMA continues to oppose the implementation of ICD-10

On Feb. 2, the American Medical Association (AMA)’s CEO has urged HHS and congress once again, to halt the ICD-10 conversion. In a letter to secretary Kathleen Sebelius, James Madara, MD stated “On behalf of the physician and medical student members of the AMA, I am writing to urge you to immediately halt the Health Insurance Portability and Accountability Act (HIPAA) required implementation of ICD-10, and re-evaluate the penalty program timelines associated with the number of Medicare health IT programs underway today”.

In the letter address to congress in January, Dr. Madara also urged House Speaker John Boehner (R, Ohio) to block the mandate to ICD-10 scheduled for Oct. 1, 2013.

“Stopping the implementation of ICD-10, and calling on appropriate stakeholders including physicians, hospitals, payers, national and state medical and informatics associations, to assess an appropriate replacement for ICD-9 will help to keep adoption of EMRs and physician participation in quality and health IT programs on track and reduce costly burdens on physician practices,” Dr. Madara stated.

While the AMA has voiced clear opposition to the switch to ICD-10, highlighting the complexity and burden it puts on physicians, there are several groups who are proponents for the transition. For example, the American Health Information Management Association (AHIMA) has voiced strong support for the new code set as well as many of the areas it will benefit long term.

As the deadline for the switch gets closer, it is critical to ensure full organizational readiness for the switch. Since there are many areas affected by the transition  – including EHRs, clinical support tools, and administrative and billing function – all areas of the organization must come together and ensure that they are prepared, and that preparation must be underway now.

AMA offers free health and fitness app

On Jan. 30, 2012, the American Medical Association (AMA) released a mobile app called Weigh What Matters. Available for multiple platforms (Android, iPhone and iPad), the apt is just one initiative in the family obesity prevention program.

The purpose of the app is to help patients track their progress toward a healthier lifestyle. Health and fitness apps have become very popular and continue to grow amongst consumers. But in order to truly have more aggressive adoption rates, it would require some additional functionalities, offerings and overall innovation to truly spur patient engagement.

MGMA requesting delays on HIPAA 5010 from HHS

Being a member of the North Carolina Medical Group Managers (NCMGM), I’ve recently had direct exposure to the many challenges the industry is facing around the HIPAA 5010 transition. Through round table discussions and list serve feedback from health care administrators, it is very clear that despite much of the testing done in 2011, challenges abound since the passing of the implementation deadline last month.

Unfortunately, these challenges are not faced by North Carolina provider organizations alone. The Medical Group Management Association (MGMA) received feedback on 5010 obstacles and pitfalls from provider organizations around the country. In response, the MGMA sent a letter to HHS Sec. Kathleen Sebelius describing the problems and reimbursement issues faced by many of those who have gone through the transition.

The letter cited several challenges encountered since implementing, including:

• Issues with practice management and/or billing systems that showed no problems during the testing phase with their MAC, but once the practice moved into production phase, found their claims being rejected
• Issues with secondary payers
• Rejections due to various address issues (pay-to address being stripped/lost from claims; Pay to address can no longer be the same as billing address; no PO Box address)
• Crosswalk NPI numbers not being recognized
• “Lost” claims with MACs
• Old submitter validation information not being transferred
• Certain “not otherwise specified” claims being denied due to not having a description on the claim (CMS sent a notice of correction of this issue Jan. 27, 2012)
• Sporadic payment of re-submitted claims (with no explanation for rejections)
• Protracted call hold times (most typically 1-2 hours) when attempting to contact
• MACs for further explanation of unpaid and rejected claims (a problem that dates as far back as November 2011)
• Unsuccessful claims processing (with no reason cited for rejection) despite using a “submitter” that was approved after successful testing with CMS

In the letter, the MGMA requests that the HHS considers delaying the enforcement of the rule, as well as provides advanced payments for physician practices who are struggling to meet the deadline in lieu of the simultaneous EHR meaningful use mandates and the compounding stress on capital.