Industry Watch – March 2015

Dr. Michael James McCoy has joined the Office of the National Coordinator for Health Information Technology (ONC) as its first Chief Health Information Officer. The post announcement was made by the organization’s National Coordinator for Health Information Technology and Acting Assistant Secretary for Health, Karen B. DeSalvo, M.D., on Jan. 21, 2015, in a staff memo. McCoy’s position began Jan. 26.

In the memo, DeSalvo described McCoy as “a board-certified obstetrician/gynecologist who practiced clinically for more than 20 years and has over a decade of experience in health information technology, with special interests in interoperability, user experience and person-centered care. His background includes leadership roles in nearly all facets of the health IT domain – from use in small physician offices to large national health delivery systems, IT development and standards development organizations.”

DeSalvo said McCoy “will lead development of ONC clinical policy for standards and regulatory matters to help ensure ONC initiatives improve health beyond healthcare.” He will also be the lead clinical subject matter expert on interoperability.

Hardware

IBM unveils z13 mega mainframe

Interoperability

ONC releases draft interoperability plan

The U.S. Department of Health and Human Services’ (HHS)Office of the National Coordinator for Health Information Technology (ONC) released “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0” on Jan. 30. The draft roadmap is a proposal to deliver better care that results in healthier people through the safe and secure exchange and use of electronic health information. It identifies critical actions to achieve success in sharing information and interoperability and outlines a timeframe for implementation. The plan incorporates months of comment and feedback from hundreds of health and health IT experts from across the nation through ONC advisory group feedback, listening sessions and an online forum.

Designed in concert with the Federal Health IT Strategic Plan 2015 – 2020, the draft roadmap is based on a core set of building blocks needed to achieve interoperability:

1. Core technical standards and functions;
2. Certification to support adoption and optimization of health IT products and services;
3. Privacy and security protections for health information;
4. Supportive business, clinical, cultural and regulatory environments; and
5. Rules of engagement and governance.

The roadmap’s announcement is linked to the administration’s Precision Medicine Initiative to improve care and speed the development of new treatments with an eye on smarter spending. As part of this work, HHS is focused on three key areas:

1. Improving the way providers are paid;
2. Improving and innovating in care delivery; and
3. Sharing information more broadly to providers, consumers and others to support better decisions while maintaining privacy.

ONC also released the “Draft 2015 Interoperability Advisory: The best available standards and implementation specifications for interoperability of clinical health information (‘Standards Advisory’).” The Standards Advisory represents ONC’s assessment of the best available standards and implementation specifications for clinical health information interoperability as of December 2014.
The draft roadmap and Standards Advisory are available for viewing at www.healthit.gov/interoperability. The public comment period for the draft roadmap closes April 3, 2015. The public comment period for the Standards Advisory closes May 1, 2015.
Source: ONC

Revenue Cycle Management

Five end-to-end best practices for patient collections

By Jim Riley, General Manager, Revenue Cycle Management, Emdeon

A recent Black Book survey revealed that financially challenged hospitals are rapidly replacing their RCM solutions with end-to-end RCM service vendors. Among those who have made the switch, 82 percent said their main worry was the old solution’s inability to deliver meaningful analytics or operate outside fee-for-service payment models. Twenty-one percent said they switched to avoid bankruptcy or closure. Black Book also highlighted one main hospital RCM challenge: Outstanding patient balances now account for 57 percent of hospital bad debt.

RCM solutions promising to tackle this staggering amount of consumer debt must offer a more effective approach than traditional patient billing, including the following five best practices for patient collections.
Predetermine eligibility. Upon scheduling patient admission, determine what must be collected by verifying insurance coverage and deductibles and calculate an estimate of the patient’s responsibility for services to be rendered – the opening “end” in end-to-end RCM.

1. Assess ability to pay. When the patient’s portion of the bill will be substantial, use credit checking and tools that show propensity to pay as a means of identifying possible collection risks.
2. Discuss costs up front. After predetermining eligibility and ability to pay, head off “sticker shock” by having a conversation with the patient regarding cost and payment methods, including various financing options. Additionally, it is important to have processes in place to help determine if a patient is qualified to receive coverage from a charity care program and the ability to help enroll them as needed.
3. Collect at the time of pre-admission. Studies consistently show that patients are less likely to pay after leaving the hospital. Collection before care is administered not only increases collection percentages, but eliminates accounts receivable delays and decreases billing costs.
4. Communicate effectively regarding post-care amounts due. Billing after discharge will never be completely eliminated; make it easy for patients to close the account. The main reason patients don’t pay is that they simply don’t understand or believe their medical bills. Post-care billing should be timely and consistent with pre-admission statements that show the overall care cost, portion paid by insurance and the patient’s portion due clearly and concisely, as well as offer a few options for payment.

While hospitals don’t relish being involved in consumer finance and collections, shifting payer models have made it a necessity.

The alternative to traditional billing that’s increasingly pursued by a number of hospitals (end-to-end RCM in the spirit of communication and a well-understood transaction) can go a long way toward reducing patient balances from over 50 percent of bad debt to something far less financially threatening – and infinitely more manageable.

Rankings

Best In KLAS Awards 2014: Software and Services

Released Jan. 29, 2015, this highly anticipated annual report from KLAS Research reflects feedback from thousands of healthcare providers about the best-performing healthcare IT vendors for more than 100 market segments. Epic dominated the winner’s list this year (11 top awards, including two overall awards), followed by Cerner (three top awards), Impact Advisors (two top awards, including one overall award) and athenahealth (two top awards). KLAS added three new Global (Non-US) software categories this year: Acute EMR, PACS and Patient Administration Systems. Separately, KLAS also awarded more than 60 companies with the designation of KLAS Category Leader for their respective market niches. Learn more at www.klasresearch.com.