I had the privilege of attending this year’s ASHHRA conference and was just blown away by the caliber of programs presented. The theme “Strength through Inclusion” truly resonated throughout the meeting as each presenter shared knowledge and experience with more than 950 attendees.
Stimulating perspectives were presented on such topics as diversity, engagement and inclusion, to name a few. Below are a few of the topic highlights rover three days:
• Thought Leader Forum: Envisioning Tomorrow’s Health Care Workplace
• Health Care’s New Landscape: Leading a Generationally Diverse Workplace
• Taming Abrasive Leaders in the Workplace
• Diversity Panel: Culture of Diversity, Navigating Our Future
• Inspiring Others During Times of Change
• Meeting Workforce Needs Through Collaboration
Rosanna Durruthy, chief diversity officer of Cigna, presented “Inspiring Others During Times of Change.” She closed her discourse with “We have to understand that diversity is the mix and inclusion is making the mix work. As human resource professionals, we create the future for our organizations. We are the alchemists of possibility and the source of all things extraordinary!”
I was lucky enough to be one of three attendees interviewed during the conference. The article ran in the daily electronic newsletter. Below is the result.
HR Workforce Analyst
Dallas-Fort Worth Hospital Council Foundation
My path to HR was not typical. While I’m not in the clinical aspect of care, I wanted to be able to impact others. The work I was doing made a difference, but not exactly in the way that I it wanted to. I moved into the DFWHC Foundation, which basically brings many hospitals together; so in that capacity, I was able then to impact what’s going on in hospitals. As an analyst, I take workforce data for about 70-75 percent of the entire Dallas-Fort Worth area and compile it to push out benchmarks to the hospital systems so they know where they stand. What we’re doing is really innovative and new to health care.
The DFWHC Foundation allows me to touch many different organizations in my community, so I see and hear a lot of what’s going on in these different hospital systems.
The biggest challenge in our area is scarcity—not only in our area, but across the U.S. Inexperienced nurses are finding it harder to find work because hospitals want to hire those with experience, and on the other hand, many who have been in the workforce for 20-30 years want to retire. Not only are we going to lose physically having them in the hospital, but we’re also losing their intellectual property and all the experience they’ve gained over the years.
Before our nurses want to retire, we need to use them in a different way to demonstrate their value before they leave the workforce by mentoring new nurses. Then at that point, we can’t argue that we have a deficit because of not having experienced nurses, because we’re allowing those moving out of the workforce to mentor those with less experience and show that we value both our new and experienced nurses on both ends—by bridging the gap and sharing knowledge.
This is my very first ASHHRA conference, and I’ve been very impressed from the start. This conference has been so impactful because of the consistent messaging of knowing and acknowledging what we can give back to others. I lift my hat to the HR folks who are faced with the issues every single day. They’re the fix-it for everything and have to be able to balance it all. The knowledge we’ve gained at this year’s conference is something that can be used and applied every day to those who walk through our doors and count on us.
Culture is an integrated pattern of human behavior including these characteristics:
These involve racial, ethnic, religious, social and political groups with the ability to transmit these characteristics to succeeding generations (National Center for Cultural Competence, 2011).
Cultural and linguistic competence is widely recognized as the fundamental aspect of quality health care (including mental health), particularly for the diverse patient population. It acts as an essential strategy for reducing disparities by improving access, utilization and quality of care. Studies have documented the impact of a patient’s language deficiency (e.g. limited English proficiency) and racial and ethnic background in accessing and receiving safe and quality care. Research shows that the racial and ethnic minorities often receive lower quality of care.
Anecdotally, it is clear that many hospitals are addressing language and culture needs as part of the efforts to improve quality. There is little information available to gauge the extent and depth of these efforts within North Texas. Several key drivers are instrumental in advancing cultural competence in health care that directly impacts our hospitals including:
• Title VI of the Civil Rights Act of 1964;
• National Standards on Culturally and Linguistically Appropriate Services (CLAS) of the Office of Minority Health, US Department of Health and Human Services;
• The Joint Commission Accreditation Standards and processes on Advancing Effective Communication, Cultural Competence and Patient-and-Family-Centered Care for 2012;
• The Affordable Care Act and focus on action plan and strategy for achieving Health Equity.
In order to achieve cultural competence and proficiency, organizations need to develop a systematic framework based on sustainable models and theories. Theoretically, competence requires cross-cultural values, attributes, knowledge and skill set to work effectively.
The key steps in implementing cultural competence are evaluating diversity and conducting cultural self-assessment. You must manage the dynamics of difference and institutionalize cultural knowledge. Finally, you must adapt to the diversity of communities through policies, structures, values and services.
In a culturally competent health care organization, five elements must be manifested at every level including:
• policy making;
• practice/service/care delivery;
• consumer/family as well as the community;
• attitude, structure, policies and services.
A linguistic competent health care organization should facilitate:
• understanding of language disparity;
• bilingual/bicultural staff;
• cultural peer leaders;
• multilingual health information and communication systems ;
• foreign language interpretation services;
• sign language interpretation services;
• ethnic media in most common languages of the region;
• print materials in easy to read and low literacy formats (e.g. picture and symbol formats);
• materials in alternative formats (e.g. audiotape, Braille, enlarged print);
• approaches to share information with individuals who experience cognitive disabilities and patients from MHMR organizations;
• translation of documents (consent forms, confidentiality and patient rights statements, release of information, discharge information, prescriptions , applications, signage, health education materials, public awareness materials and campaigns);
• assistance in completing paper work;
• professional interpreters for surgical and intensive care procedures;
• assistance in post surgical aftercare and with prescriptions;
• coordination with pharmacies for prescription delivery and compliance.
After implementing a system, health care organizations should focus on utilizing these innovations in every sector of patient care. They need to ensure efficient coordination between the elements in order to deliver the best possible patient care. In order to develop new strategies for adapting to continuously changing needs, frequent evaluation is crucial. This also gives an opportunity to health care organizations to work collaboratively on regional strategies to meet the needs of our diverse population.
Cultural and linguistic competence is a life’s journey…not a destination. Safe travels! (National Center for Cultural Competence, 2011)
Last month, I discussed three key benefits of data analytics in a physician practice. So, how does this relate to Meaningful Use (MU)?
Over the past few years, the Centers for Medicare & Medicaid Services (CMS) has been promoting the adoption of electronic health records (EHRs) by hospitals and physicians, along with the “meaningful use” of these systems.
Through the 2009 ARRA Stimulus Act, CMS established a MU incentive program that would pay providers for the adoption and use of an EHR. The CMS incentive payment was up to $44,000 for Medicare providers and $63,750 for Medicaid providers.
So, what does this have to do with physician data analytics? If your practice group is already in the process of meeting the CMS MU Stage 1 criteria, you are already on the beginning pathway for data analytics.
For example, some of the MU criteria include:
• Use of COPE for medication orders
• Drug-drug and drug-allergy checking
• H&P data (height, weight, BMI, BP, etc.)
• Problem lists
• Medication lists
Some of the clinical quality measures (CQMs) include:
• Controlling high blood pressure
• Use of high risk medications in the elderly
• Tobacco use screening and cessation intervention
• Documentation of all medications, including over-the-counter meds.
• BMI screening
When you look at the data necessary to collect the MU Stage 1 criteria and the CQM measures, you have already begun to develop a clinical database that can be used for data analytics.
For example, if you want to analyze your patient data by BMI, age, and blood pressure, the analytics tools can sort and chart the data and then present you with a graph of those patients with the highest combined risk of potential medical problems. You can then use this list to pro-actively improve the treatment, care and outcomes for these patients.
The benefits of MU, CQMs and data analytics go hand in hand. This truly is a win-win for your patients and your practice group!
Healthcare providers, public health agencies and state health programs all collect data. For example, county hospitals have data about a patient’s diagnosis and procedure. Public health agencies have many programs such as WIC, immunizations, mental health and HIV in which they collect and maintain data. Meanwhile, social service agencies collect information on families while enrolling them in Medicaid. Many programs serve the same clients with considerable overlays in data collected and databases maintained. There is no communication between these different entities.
Today’s technology allows for sophisticated linkage of databases with well-designed warehouses and information systems. There is growing recognition of the power of such public health information when making decisions. Hospital Administrative Discharge Data, similar to the Dallas-Fort Worth Hospital Council (DFWHC) Foundation’s data warehouses, can be cultivated and linked to different databases offering powerful insights into the health of the DFW population. Below is an example of research regarding available healthcare options for zip codes with high emergency room use.
We found that 11 percent of the population living in the hot blocks — the red circles on the map — have pre-existing conditions of diabetes. You can also see the major highway separating these patients from physician offices or clinics that could help treat their diabetes. Recently, the National Institutes of Health did research and discovered the average cost of an emergency room (ER) visit is $1233.00. If we focus on keeping the diabetic patients within these hot blocks healthy and out of the ER, we could save more than $2 million dollars.
The DFWHC Foundation will continue to provide innovation in data integration. We hope to continue to work with our partners as we focus on improving community health. For information, please contact me at firstname.lastname@example.org.
It’s getting late. Healthcare providers must begin Meaningful Use (MU) 90-day reporting for 2013 no later than Oct 3, 2013. By now, you may be considering to wait until next year. Hang on. Is that really the best decision? Please consider the following.
For Medicare participants, delaying first-time MU attestation until 2014 reduces total available incentives by $15K (from $39K to $24K) per provider. Likely to purchase an EHR eventually? Can you stand to forego $15K?
Federal funding for Regional Extension Center (REC) technical assistance runs out in April, 2014. Assistance will still be around, but it won’t be as cheap!
All 2014 MU attestations require 2014 Certified EHR Technology, regardless what MU stage applies (first and second timers – under Stage 1). Can you say “upgrade?” But if your current certified EHR is live, you could already be close, with a little more work. Wouldn’t $15K (from 2013 attestation) help with that 2014 required upgrade?
Consider timing. Most EHRs aren’t 2014 certified yet, and won’t be until well into the year. Once they are, you’ll need time to upgrade, master new features, learn workflows and begin MU reporting. By then you’ll be pushing the 2014 attestation deadline. Miss that deadline and forfeit the remaining $24K, and incur penalties.
Lastly, 2014 will already be challenging. There will be ICD-10 plus the 2014 EHR upgrade. Providers have only until Oct. 1, 2014 to attest to MU to avoid 1 percent Medicare claims adjustments beginning 2015. This means the 90-day reporting period starts in July rather than October.
Who needs the extra pressure? Do it now.
Admittedly, Medicaid EHR Incentive participants risk no incentive reductions or Medicaid penalties, but money today is still better than money later on.