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GEN i - The Integration Generation in Healthcare

05.09.2012

Are ACOs Just 21st Century HMOs?

by Chad Johnson

It’s impossible to avoid the ongoing debate over the changes that Accountable Care Organizations (ACOs) will bring to the industry. Much like the political rancor over the Affordable Care Act (aka “Obamacare”) that first mentioned ACOs, the new model of care has hopeful supporters and a number of detractors within the health care industry.

An ACO is a network of health care providers and hospitals that share responsibility for providing care to patients. According to the Centers for Medicare and Medicaid Services, an ACO "agrees to be accountable for the quality, cost and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to it."

The rationale behind this new model of care is that the current delivery of health care in the United States is fragmented. It’s not unusual for a patient to visit different hospitals, doctors and other health care organizations for the same medical condition, with very little or no communication between the caregivers. As a result, there often are too many expensive tests and diagnostic procedures performed, repeated procedures and a lack of follow-up with the patient.

The government is encouraging health organizations to participate in the ACO model of care by financially rewarding caregivers for meeting certain quality of care benchmarks that include fewer repeat visits or readmissions and patient adherence to standard, preventative care visits, such as an annual physical or a mammogram.

Supporters argue that the introduction of ACOs will bring long-overdue change to patient care, shifting the focus back to the quality of care the patient receives. Health care providers will be encouraged to coordinate care throughout the ACO to the benefit of the patient’s health, otherwise they won’t qualify for certain rewards that are given if quality benchmarks are achieved.

The detractors of ACOs believe they are a utopian big-government dream destined to fail. Some even argue that ACOs are simply the 21st Century version of HMOs – which were almost universally disliked by patients – that will produce lower-quality care with fewer choices and higher prices.

In the 1990s, HMOs, or health maintenance organizations, were common health insurance plans that restricted patients to receive care from designated in-network physicians and refused to pay for procedures they deemed unnecessary. HMOs still exist today, but aren’t nearly as common; however, the near universal dislike of HMOs led to insurance plans easing the restrictions they place on patients in regards to treatment and choice of physician.
There are key differences between the proposed ACO model of care and the care patients received from HMOs in the 1990s. The main difference is in the accountability of care – in an ACO, health care providers for the first time will be rewarding for providing care based on their success rate, not based on the number of procedures or tests that they can perform (i.e., fee for service).

Caregivers within an ACO will have the flexibility to contract with other affiliated ACO caregivers or organizations without the reliance on an HMO insurance representative who were frequently accused of making care decisions that were not in the patient’s best interest.

Another key difference between the two models is that patients will not initially realize they are receiving care in an ACO. HMOs are insurance plans, so patients were acutely aware of their existence, from the limited choice of physicians they were given to the insurance cards they were required to present for payment. Patients in an ACO can choose the physician of their choice, and that physician will refer patients to other caregivers within the large network of affiliated ACO organizations. Patients may only become aware of the ACO after care is complete and their provider asks for permission to allow Medicare to share their claims data with the ACO for shared savings determination.

Regardless of how the Supreme Court will rule on the Affordable Care Act next month, health care organizations have been taking huge steps, at significant financial cost, to qualify to become an ACO – such as implementing electronic health records and creating seamless interoperability between affiliated organizations. Forward-thinking organizations are determined to remain profitable and at the forefront of patient care, regardless of the requirements.

There is little doubt that ACOs will alter the health care landscape by changing the way providers measure success. Patient care and preventative health measures will become the primary focus, putting the current fee-for-service model in the past, alongside HMOs.

Will the ACO model be successful? A large component of their success depends on their patient population proactively taking care of their health – a feat that would truly be a welcome medical revolution.

For more information on ACOs, see:

 

 

Tags: Health Information Exchange, Healthcare Interoperability, Health IT Matters

05.03.2012

HL7 v2 Remains the Foundation For Interoperability Initiatives

by Chad Johnson

With the steady stream of updates about Meaningful Use Stage 2 requirements, health information exchanges, the Supreme Court’s pending decision on the Affordable Care Act and associated Accountable Care Organizations, it’s easy to forget that there is still plenty to learn about current health data standards.

HL7 standards are the foundation from which all new standards are derived. CMS announced February 23, 2012, that the future healthcare standard for the exchange for clinical data information will be Consolidated CDA, which consists of a set of templates that are derived from HL7 v3. While HL7 v3 has absolutely nothing in common with HL7 v2, practically all medical systems and devices operating inside modern healthcare facilities produce patient data using HL7 v2.

To exchange data with external providers using Consolidated CDA, health providers must first be able to easily exchange HL7 v2 data internally.

Corepoint Health Product Manager Rob Brull, instructor of our CDA & CCD: First Steps course, was recently interviewed by Healthcare IT News in an article titled “8 common questions about HL7.” To prepare for the article, Rob first polled Corepoint Health support and implementation specialists to discover the most common questions they receive from customers. Here are the winners:

We receive many other questions about HL7 health data standards from customers and from attendees at our HL7 training offerings. The fact that there are so many questions is no surprise – health data exchange is no cake walk, and it takes a lifetime of learning to keep skills sharp and to stay on top of the always changing field of health IT.

In addition to the above Healthcare IT News article, I recommend browsing our Healthcare Interoperability Glossary, where we offer an always-evolving A-Z list of terms and their definitions. We have also posted an extremely helpful HL7 Resources page that provides more in-depth information regarding specific HL7 v2 segments and terms.

Lastly, I encourage everyone to use their social media channels to connect with pubications, organizations and individuals who produce good information. I, personally, have benefitted greatly from maintaining an online dialogue with health IT professionals to learn how they are meeting unique interoperability challenges and how they are preparing for future changes.

Several of us on the Corepoint Health team have found that Twitter is a great way to learn more daily about health IT. Connect with us there, and feel free to “pick our brains” about HL7:

Tags: Health Information Exchange, Healthcare Interoperability, Health IT Matters

04.25.2012

Accountable Care Organizations and Radiology: Communication Key to Opening New Doors

by Chad Johnson

It’s no secret that Radiologists and Radiology practices have been skeptical of Accountable Care Organizations, and who can blame them? One of the touted benefits of ACOs is their ability to reduce costs by way of limiting medical imaging procedures.

Regardless of initial radiology concerns, hospitals and healthcare systems are making plans and taking significant steps toward moving away from the traditional fee-for-service healthcare model and more toward a lower-cost model that places patient outcomes as the top organizational priority, whether it be forming an ACO or connecting to a local health information exchange.

Many radiology department and practices are proactively embracing the change toward accountable care and realize that if they don’t voice their concerns now, their financial futures will truly be left for someone else to decide. Improving communication and beginning an active dialogue with the hospital community are key first steps to securing radiology’s position within the new model.

An article published last month in Diagnostic Imaging, titled “How to Improve Radiology-Hospital Relations — and Why it Matters,” provided great information on how radiology practices can repair relations with referring hospitals. In the article, Cynthia Sherry, MD, chair of Texas Health Dallas Presbyterian Hospital’s radiology department, said the number-one barrier to improving relationships is the breakdown in understanding the expectations of both sides.

The onus to improve relationships doesn’t solely rest with the radiology department, however, and the article says that assigning a radiology department liaison could help open communication channels and broker partnerships that will help when finalizing an ACO relationship.

Another good ACO resource for radiology is the Journal of the American College of Radiology’s comprehensive and well written “A Radiologist's Primer on Accountable Care Organizations.” The primer provides detailed ACO methods of care and reimbursement, all from a radiologist’s perspective. Much like the Diagnostic Imaging article, the primer advocates for open communication with referring hospitals when planning for ACOs and concluded with the following:

“Radiologists have a lot to contribute, including test selection expertise that is not used often enough and that may have atrophied. …Although strong guidelines may be in place, it is important for radiologists to act as patient advocates to prevent undue restrictions on well-indicated imaging. In addition, radiology must develop a leadership role in research that supports appropriate imaging.”

Further encouragement for radiology to fully participate in ACO discussion came in a CMIO article, titled “AJR: How to stop worrying and love the ACO model.” The article recapped a transcript of a roundtable discussion on ACOs that appeared in the American Journal of Roentgenology (fee required). The CMIO experts on the roundtable emphasized the need of radiologists to emphasize their roles as consultants, not merely interpreters of images – a development that should be welcomed and embraced by radiologists because it has the potential to elevate their expertise within the caregiver team.

Norman J. Beauchamp, Jr., MD, MHS, of the department of radiology at the University of Washington in Seattle, is quoted in the article:

“ACOs reward the radiologist for helping our clinical colleagues understand and embrace the rationale for the imaging recommendations we are providing so that they find our input essential in attaining the common goal of providing patient-centered cost-effective care.”

Regardless of how the Supreme Court rules on the Affordable Care Act, the fact remains that health organizations have invested significant money and time into transforming the way care is provided.

According to the above articles, many radiology departments are taking proactive steps to not only secure needed reimbursement, but also to reaffirm their position as key caregivers with knowledge and tools that consistently improve patient care.

 

Tags: Health Information Exchange, Meaningful Use & HITECH

04.11.2012

5 Questions with Joe Moore, CIO at Radiology Consultants of Iowa

by Erica V. Olenski

What changes do you see in radiology as ACOs unfold?

[Joe Moore] More confusion, turmoil and disruption. Imaging has a target on its back due to the increased utilization and skyrocketing costs. The sad part of that is radiologists are not the cause but will be the most affected. Between specialists making the most of the Stark in-office exemption and ER doctors practicing defensive medicine, they are killing a vital industry.

In the government’s usual fashion, they avoid dealing directly with the cause and instead have chosen the route of making imaging less profitable. This will have little impact on those responsible since they will just order more tests and imaging is not their core line of business. Radiologists on the other hand get all their revenue from imaging and will be affected significantly.

So, getting back to the original question of how ACOs will impact radiology, I think they will be incented to continue the assault on imaging and potentially destroy a once vibrant and vital industry.

What do you believe the radiology IT priorities are for 2012?

[Joe Moore] Position for survival. In my opinion the writing is on the wall for radiology and we can already see the changing landscape taking shape.

Radiology needs to be more flexible and embrace a service model that makes them more vital. The industry of radiology is partly to blame for current trends toward outsourcing imaging to large, national groups. Radiology is now a 24x7x365 service and hospital administrators are increasingly demanding more from their radiologists.

The trend to date has been to give away the night-time business as the volume of work isn’t enough to justify the cost of having a radiologist working a night shift. Groups around the country continue to be surprised when their long-time partnerships with hospitals and systems end abruptly as they hand the work over to national provider groups. IT can prepare the practice for the transition to a more complete service model by ensuring their systems can support multiple organizations, run on networks designed to distribute the workload across the enterprise, interoperate and integrate with many systems, and adapt to the changing landscape.

What technologies are exciting for radiology right now?

[Joe Moore] Radiology has always embraced technology and has never needed an artificial incentive to take advantage of the latest technology, that’s why I love working in the field of radiology IT. The most exciting technology today, for my money, is cloud services and virtualization. These technologies support the priorities I mention above and are critical to our operation.

We’ve made a fair amount of progress here at RCI virtualizing the data center and many of our desktops. We have what I think most would consider our own internal cloud.  I look forward to the day when we can virtualize our PACS workstations, which will provide great flexibility, customization, fault tolerance and efficiency. External cloud services can best be utilized to offload common IT tasks such as spam, virus and web filtering, backup and disaster recovery, web hosting, etc., thus allowing the internal IT to focus on technology that is unique to radiology.

I don’t see us going fully to external cloud services any time soon but certainly a hybrid model of both internal and external cloud services is the way to go, in my opinion. If I were starting a business from scratch I might look at that differently and consider a complete operation running in the external cloud.

Healthcare integration and interoperability have always been a strategic initiative for RCI. What new initiatives are you undertaking? Any health information exchange (HIE) involvement?

[Joe Moore] RCI is involved in a couple of HIE initiatives at the state and local level. We feel that to continue to add more value to our service it is critical that we participate in the efforts to make our information available to all who need it, when they need it, in an appropriately secure fashion. I think we’ll have to support numerous avenues of integration and interoperability whether it be with PHRs, EHRs, HIEs, or whatever else comes down the pike. This really leads back to our priority of being flexible and prepared for the known and unknown changes coming at us.

There are many new professionals joining the health IT profession. What advice would you give them?

[Joe Moore] Run away and don’t look back! Just kidding. The transition that health care is currently undertaking is immense and there is great opportunity with the challenges facing HIT today.

I would say the number one thing to focus on is the core business or core service you are supporting. Make sure you understand the point of view of the clinician.

This transformation isn’t similar to other industries. I laugh when people try to compare banking to healthcare and relate banking’s successful use of new technology to health care’s failure to use the same. You have to remember that clinicians work impacts people’s lives. While finances are important, no one ever died as a direct result of a banking foul up. When you put a new application or process in the hands of a clinician, understand many of them are horrified at the thought.

IT should be there to get them over their anxiety and provide the expertise to train them to use the new system to its fullest extent. Don’t take criticism personal and never assume you know what a clinician wants; most of the time the opposite is true.

Realize your success relies on their successful use of the applications and services you provide and support. If the end users are miserable, you’re going to be miserable. Take pride in being a service provider. Too many in HIT see themselves at some higher level of intelligence just because they work in a field that is a mystery to many. So what, at the end of the day what really matters is the core business and how well the technology supports that. You can have the greatest LAN, SAN or whatever AN you want, but if it doesn’t work for the end user and support the core business, it’s useless.

Don’t think of the technology as the most important thing. Think about the end result, take pride in being a service provider and have some patience and respect for your end users.

Tags: Health Information Exchange, Healthcare CIO, Healthcare Interoperability, Meaningful Use & HITECH

04.04.2012

HIE Physician and Patient Portals

by Chad Johnson

HIE Series. Part 6 of 6.

Up to this post, the discussion of health information exchanges in this series has focused on how they can be set up and utilized by a healthcare organization. While HIE architecture types and communication methods typically only involve IT staff, this post will briefly discuss portals, which brings the HIE to the more personal patient and physician levels.

Merriam-Webster defines portal in different ways, but this definition is most applicable to an HIE: “A site serving as a guide or point of entry to the World Wide Web [HIE] and usually including a search engine or a collection of links to other sites arranged especially by topic.”

So, what exactly do portals have to do with HIEs?

Not all physicians will be able to connect to a regional HIE for various reasons, such as lack of an advanced EMR or he or she may be a specialist not involved with routine or emergency care. These physicians will have the ability to access their regional HIE’s physician portal to view a specific patient’s treatment history, providing valuable health data that may be useful prior to performing a procedure.

For patients, portals link them to the process of health data exchange. In the future, the patient’s total health record – regardless of where the care was received – will be viewable in a patient portal. This is extremely valuable because patients will have the ability to correct errors in the health record if they exist, and be reminded of previous care they have received.

Additionally, a portal is an access point for both patients and health providers that provide a convenient platform to communicate through various methods, which differ among portal vendors. Some portals allow only basic communication in the form of offering patients the ability to schedule or reschedule appointments, request a prescription refill and complete paperwork prior to their next appointment.

Other, more robust portals – especially those built to meet Meaningful Use Sections 170.304(h) and 170.306(d) – allow patients to access clinical summaries and electronic copies of their health information. In terms of offering a true communication method between patient and physician, some portals give the patient the option to send a text (SMS) message or an email directly to his or her physician.

Let me try and personalize this one step further: My personal physician’s office offers a patient portal, which is accessible from their website. After entering my login and password, I can update personal information (address, insurance, etc.), request an appointment, request a prescription refill, request a referral, and submit a billing question. The portal offers two additional – rather valuable – services for an additional fee of $50 per patient, per year: the ability view my medical record and the ability to email my doctor.

While I don’t appreciate this fee, it’s important to put things in perspective because the available free options are tremendous advances in opening the doors of communication between patients and our caregivers. Giving patients the ability to bypass the patient calling tree and to directly communicate with the provider about billing questions or simple prescription refills will likely improve patient satisfaction.

Additionally, the portal will give the provider better access to the patient, with the ability to send email reminders that it is time to schedule an annual physical or information about valuable health resources for specific chronic diseases.

An accurate patient health record is vital for quality care because it can prevent repeat examinations and provide every provider with access to pre-existing medical conditions that may actually save a patient’s life in the event of an emergency or in the case of a patient’s faulty memory of his or her treatment history.

Portals truly have the potential to directly connect patients to their care, which is the true reason behind health information exchange.

Topics in this HIE series include:

Part 1: Health Information Exchange: What’s the Motivation?
Part 2: Architecture Types
Part 3: Despite Momentum, HIE Sustainability a Concern
Part 4: The Building Blocks of HIEs: A Glossary of Terms
Part 5: HIE Communication Methods
Part 6: HIE Physician and Patient Portals

Tags: Health Information Exchange