Industry Watch – September 2017

Imagine walking into the ER seeking medical attention. Maybe you’ve been in an accident or are having an allergic reaction, but either way the situation is urgent. A healthcare provider approaches you to ask what’s wrong … but they speak a language you don’t understand. Emotions run high as fear takes over, and care becomes increasingly difficult for the medical team trying to help you.

That situation might sound like a bad dream, but it is an unfortunate reality for the millions of limited English proficiency patients seeking care in the American healthcare system. With more than 25.9 million people reporting that they speak English less than “very well,” and with more than 300 spoken languages reported in U.S. homes, healthcare facilities are facing a significant challenge when it comes to providing equal treatment to every patient. Fortunately, there are several solutions available.

There are three essential interpretation modalities that healthcare facilities can rely on when treating a patient with limited English proficiency: onsite interpreting, video remote interpreting, and over-the-phone interpreting. There are pros and cons to each solution. Most often, a combined use of all three is required to establish a strong language access
solution.

Onsite interpretation is largely considered the industry ideal. Bringing an interpreter into the room with your limited English proficiency patient allows for verbal and nonverbal communication to take place (in the form of body language and facial expression). Onsite interpreters also can make empathetic connections with patients and often alleviate fear within patients. The downside to onsite interpretation is that it can be slow and costly. In an emergent situation, the time it takes for an interpreter to arrive onsite is time wasted. Also, onsite interpreters are the most costly, so for brief interactions, it can be difficult for healthcare facilities to justify the expense.

Another popular modality is video remote interpretation (VRI). VRI allows for nonverbal communication to take place since the patient and the interpreter are connected over video call. VRI has the added benefit of immediate availability. With most VRI systems, the healthcare provider can summon a video remote interpreter in less than a minute, quickly establishing a communication bridge. VRI also is less costly than onsite interpretation, with healthcare providers paying by the minute for the minutes they use.

Lastly, there is over-the-phone interpretation (OPI). OPI is inexpensive and immediate but suffers from lack of visual connection. OPI still is a crucial component to any language access solution, however, because it allows healthcare providers to communicate with patients at home for follow-up conversations.

Let’s look at an example in which a patient may benefit from all three interpretation modalities. Maria burns herself while cooking and heads to the ER. She primarily speaks Spanish, so the check-in desk calls a video remote interpreter to get her through triage. Once she is admitted, the healthcare team realizes that she will need skin grafts. At this point, they call an onsite interpreter to explain the procedure to Maria and to help alleviate any fear she is experiencing. They utilize a video remote interpreter until the onsite interpreter arrives so to not delay care. Once Maria has been treated and discharged from the hospital, her care team calls her at home to schedule follow-up appointments using an over-the-phone interpreter. Maria receives the same level of care as her English-speaking counterpart, and the healthcare facility doesn’t wastes any time.

Effective patient/provider communication is the cornerstone of good medical care, making language access services crucial in our diverse society. Fortunately, there are various options available, making communication with limited English proficiency patients easier than ever before.

ICD-10

FY2018 ICD-10 code update courses available

To help coders and facilities prepare for the Oct. 1 ICD-10 coding updates, Libman Education has released the FY2018 ICD-10 Code Updates courses authored by Lynn Kuehn, M.S., RHIA, CCS-P, FAHIMA.

According to Kuehn, coders will see more than 700 changes to the ICD-10-CM code set and over 6,000 changes to the ICD-10-PCS code set. Changes include additions, deletions, and revisions to maintain and improve the accuracy of code assignment.

The ICD-10 changes for FY2018 represent a significant effort on the part of CMS to ensure both the ICD-10-CM and ICD-10-PCS code sets truly represent diagnoses and procedures documented for discharges and patient encounters.

Kuehn continued, “While the ICD-10-CM and ICD-10-PCS code sets are officially only two years old, their first two years of ‘life’ were spent in a four-year code set ‘freeze’ while we prepared for implementation. During the freeze, no major changes were allowed. The 2017 update was extensive but still contained only the most important updates necessary for code set use. For 2018, we’ll see the remainder of the approved changes.”

The courses are interactive and contain audio and video clips along with activities and quizzes. The ICD-10-PCS Code Updates course is available now; the ICD-10-CM Code Updates course, slated to be available mid-August, is available for prepublication purchase. Libman Education

POPULATION HEALTH

Q&A with Jon Porter

Q: What are athenahealth’s population health initiatives?

Population health is such a broad, all-encompassing term; even vendors specialize in a few different ways. First, there are vendors that concentrate on the analytics of population health management, i.e., analyzing a population of data and slicing it so focus areas can be found and targeted. Second, we have those who specialize in clinical interoperability—who extract data out of systems and provide a single view of a patient. And third, there are the workflow-oriented vendors, who concentrate on performance and driving results. athenahealth does all of these, but we do the workflow extremely well.

We are 100,000 providers on a national network and we’ve taken on the responsibility of helping providers make the shift from managing episodes of care to managing the entire patient journey across the full ecosystem of care.

Care management is moving beyond the hospital into outpatient resources like urgent care centers and virtual consults. With so much of what matters occurring between visits, care managers need that full, 360-degree view of patients and an ability to engage them and coordinate care at every step.

We have an outreach manager service within our population health solution that allows providers to connect with patients via phone/email campaigns. We take on much of the work of identifying and addressing gaps in care by aggregating the data, determining the gaps, and launching outreach campaigns on our clients’ behalf. Live athena operators schedule appointments freeing staff from time-consuming manual outreach to concentrate on higher priority duties. To date, the campaigns average a 40% patient schedule rate.

We’ve also invested big time in the patient space, equipping patients (and caregivers) with the tools and resources to become capable, empowered, and active participants in their own care.

We have a patient self-management app (athenaWell) that works on any device and provides patients with care plans their can engage with on their own time. A typical approach would be to enroll the top 5% of the riskiest Congestive Heart Failure (CHF) patients in care plans supported by care managers. However, the predictors aren’t always accurate and the health system doesn’t always follow the “right” 5%. Instead, athenawell puts all CHF patients on a care plan—not just the top 5%. We know care managers can only monitor a small subset of patients, so the idea is to lever them up. Every day when a CHF patient steps on a smart scale, it syncs with athenaWell. The care manager will only get an alert if the patient’s weight is out of range and can reach out immediately to touch base. Using athena technology, we surface the most at-risk patients while monitoring the entire population, thereby making care managers more efficient and taking work off their plate. We just launched athenawell a few months ago and have about 1,000 patients who are self-managing.

Q: Where is the future of population health going?

Everything is moving toward the consumer. We’re seeing is an uptick in patient engagement tools to help manage populations.

To be frank, it can be difficult to establish and support the free flow of patient information across settings and get that 360-degree view, particularly when 50% or more of care is considered “out-of-network.” By building a healthcare network that seamlessly interoperates, athena has taken a crucial first step toward overcoming this challenge to connectivity and sharing data critical to successful health outcomes. Population health programs must move beyond the single health system to be truly patient-centric.

In the near future, when we partner with an organization to drive outcomes, anyone involved in the patient’s care—in or out of network—will be able to use our tools. No organization can be an island, nor can vendors be stingy about access. Industry-wide, I predict a lot more of this. Healthcare systems must realize even though there’s stiff competition in market, they must work together to be successful in their population health goals.

VALUE-BASED CARE

Edifecs updates Tennessee Medicaid program with payment reform solutions

Edifecs announced it has been selected by the Tennessee Medicaid Program (TennCare) to support the agency’s payment reform and clinical quality initiatives. One of the longest standing Medicaid managed care programs, TennCare provides healthcare for approximately 1.5 million Tennesseans, covering approximately 20% of the state’s population, 50% of the state’s births, and 50% of the state’s children.

As part of a larger effort to change the way healthcare is paid for in Tennessee—away from paying for volume and toward paying for value—Edifecs has partnered with the state Medicaid agency to help align its payment model with the Centers for Medicare and Medicaid Services’ national payment reform initiatives. Edifecs’ Payment Reform and Value-Based Care solutions bring scalability to TennCare’s initiatives by providing near-time quality calculations, ongoing visibility into performance, and the capability to apply non-claims based measurement data to performance goals.

Top features of the payment reform and value-based care solutions include the following:

• centralized and consolidated platform for all program quality data entry and submissions;
• near real-time visibility of program metrics via role-specific dashboards, reports, and notifications;
• flexible quality engine for calculation of program-specific customized clinical and outcomes based-measures;
• capability to configure, group, monitor, and associate clinical quality values to all episodes in TennCare’s eight Phase episode of care initiative; and
• partnership with CNSI, a firm specializing in large-scale, mission-critical IT implementations for many state and federal agencies, to integrate MC-Track for provider compliance and collaboration.

Source: BusinessWire