DFWHC Foundation

Physician Data Analytics – Key to a New Payment Model

Richard Howe — Fri, 14 Jun 2013 21:14:28 +0000

Physician data analytics is thought of by many physicians as something that I may do “sometime” in the future. We hear comments like “it is too hard,” “too complex,” or “this will take away time from my patients.” Even though these thoughts are valid, it is easier than one may expect to get into data analytics.

The current volume-based payment model is rapidly changing to a quality base/total cost of care model where, as a provider, you will get paid for improving the quality of patient care while reducing volume-based activities/payments. In this new model, the patient “wins” via improved care and outcomes, the insurance company “wins” in less claims/costs, and the physician “wins” by sharing in that cost savings with the payers. This creates a win-win scenario.

So, let me describe a potential patient care situation that will give you an idea of how easy it might be to get into physician data analytics. A sample scenario could be:

• Determine the highest frequency of patient diagnosis seen in your office;
• Determine which of these diagnoses is related to more “chronic” conditions, i.e. do not pick the “one time” visit for a sore throat in a group of patients that you may see only once;
• Then sort the diagnosis by age, body weight, sex, a lab value or some other key factor related to this chronic condition;
• Determine any common contributing factor(s), such as a lifestyle behavior, related to this chronic condition;
• Determine what would be the most obvious change in behavioral lifestyle of that patient group that could most significantly improve (i.e. reduce) the chronic condition;
• Have a member of the patient care team contact each patient in this group to schedule a “preventive medicine” call or appointment (It is important to note that the physician does not have to be the person doing this and the steps described below);
• Talk/meet with each patient to discuss and get agreement on the life style change.
• Follow up on a monthly time basis to “measure,” i.e. document and record, the life change factor(s);
• Use the physician data analytics to analyze the same patient group on a regular basis and document the results – both from an individual patient and a group point of view – and repeat the cycle as noted above.

You have now used physician data analytics to move from a volume-based model into a new preventive care-based model.

The benefits of using data analytics in practice include:
• Improved health and outcomes for your patients;
• Lower overall costs of treating these patients;
• Ability to move into a “cost sharing” arrangement with your payers (PCMH-like model);
• Having more personal time to spend with your family and friends.

All of these benefits come from taking a relatively simple data analytics approach to your current patients!

North Texas Preceptor Academy set for June 27-28

Sally Williams — Fri, 14 Jun 2013 20:37:06 +0000

Nurse Preceptors serve a vital role by promoting competence, familiarity and confidence. The upcoming North Texas Preceptor Academy, June 27-28, is an educational event for registered nurses interested in learning more. Sessions are designed to help the beginner as well as the experienced preceptor.

The Preceptor Academy was first held in 2012, with VA North Texas Health Care System and Texas Woman’s University serving as hosts. Today, it has evolved into a community-wide event open to hospitals, healthcare facilities and schools through the North Texas Nursing Consortium and the North Texas Nursing Resource Center.

Continuing education of 6.5 CEU hours will be offered each day. The event will be held in Dallas at Texas Woman’s University in the T. Boone Pickens Institute of Health Sciences.

The Preceptor Academy is presented in partnership with the North Texas Nursing Consortium, Dallas-Fort Worth Hospital Council Foundation, North Texas Nursing Resource Center, Texas Health Resources, Texas Woman’s University and VA North Texas Health Care System.

You must pre-register as seating is limited. Registration deadline is June 21 and you can register online at http://dfwhcfoundationjune27.eventbrite.com.

For more information, please contact Sally Williams or Danette Tidwell at 972-717-4279 or e-mail workforce@dfwhcfoundation.org.

ICD-10 transition is coming

Theresa Mendoza — Thu, 13 Jun 2013 18:20:50 +0000

It is summer again and although many of us breathed a sigh of relief last year when the IC-D10 implementation was postponed until October, 2014—it is still coming.

It has now been more than year since the announcement to postpone ICD-10 and it still feels like last month as time has flown by. If you are like many providers, everything was placed on the back burner for a little while. This is just a friendly reminder that if you have not moved it back up to the top of your priority list—now might be a good time as 2013 will be gone before you know it.

The conversion to ICD-10 is a sizable undertaking. The change will drive business and systems changes throughout the healthcare industry and now is not the time to be comfortable or put it off. Presently, we have 16 months to put a plan in motion. To ensure a smooth transition, organizations will need to devote staff time and financial resources to conversion activities.

There are many great resources available via the American Health Information Management Association (AHIMA) and other healthcare consultants. Below are a couple of links to tools that are available for providers to download and utilize in assessing and prioritizing your “To Do” list:

http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046262.pdf

http://www.hcim.com/2011/03/free-icd-10-implementation-tools/

Meaningful Use Stage 2 is coming…or is it?

Patrick Casey — Wed, 12 Jun 2013 16:28:28 +0000

While it’s true Meaningful Use (MU) Stage 2 requirements are scheduled to take effect in 2014, they may not apply to you as a Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program participant. Here’s why…

If by 2014 you will be in the third year of MU attestation, you are indeed staring down the barrel of Stage 2 requirements. Even then, you will be required to do so only for a 90-day reporting period. This gives you until Oct. 3, 2014 to begin reporting. If you are ready by January 1, you may certainly start, the benefit being you will be first in line for incentive payments.

The North Texas Regional Extension Center is not encouraging procrastination. We ask you to plan for Stage 2. We expect the cogs in the system (i.e., CMS, Office of the National Coordinator for Health Information Technology, EHR vendors, Health Information Exchange’s, etc.) to go through a period of working out the “kinks.” If Stage 1 taught us anything, we expect Stage 2 to exhibit a learning curve.

However, if you are attesting in 2013 or 2014 for the first time, then Stage 2 requirements won’t apply to you at all this upcoming year. That’s because every MU participant has two years of participation under Stage 1, regardless of when you begin. You will not need to upgrade your Certified EHR to the 2014 version because you won’t need that additional functionality until 2016, postponing a big upgrade (and expenditure) until later. It could also give EHR “version 2.xx” some time to work out its bugs – always a good thing.

Next time we’ll talk about what every MU participant should do to prepare for Stage 2. For additional information, please do not hesitate to contact me at pcasey@ntrec.org.

Thank you N-THICK!

Theresa Mendoza — Wed, 12 Jun 2013 15:16:58 +0000

There is an acronym in North Texas not many are familiar with unless you are a participant in the Dallas-Fort Worth Hospital Council Foundation (DFWHC Foundation). It is pronounced “N-THICK,” and it stands for the North Texas Healthcare Information and Quality Collaborative (NTHIQC).

This collaborative is made up of volunteers from our hospitals who contribute data for education and research. The group is diverse and brings an impressive variety of skills, knowledge and strategies to the table. The committee was established to provide the DFWHC Foundation Board, president and staff with expertise related to quality, patient safety and the development of the data assets of the Information and Quality Services Center (IQSC).

Every year this collaborative works to identify high priority and leverage gaps in health care. These dedicated professionals work with the DFWHC Foundation to develop opportunities for patient care quality and community health. In 2012, they focused on the development of meaningful analytic tools supporting education. They have taken on the task of putting hospital discharge data to work. The DFWHC Foundation is following their lead. The graphic below details the accomplishments:

We want to say “Thank you” to the NTHIQC and IQSC Staff for their dedicated work in 2012. We look forward to new accomplishments in 2013! For information, please contact Theresa Mendoza at tmendoza@dfwhcfoundation.org.

The Massachusetts Experience – Reform and the Workforce

Neguiel Francis — Mon, 03 Jun 2013 15:22:19 +0000

One of the most revealing impacts of health care reform on the workforce is the “Massachusetts Experience.” With implementation of the 2006 Massachusetts Health Care Reform Plan, including insurance subsidies for low-income individuals, pay-or-play requirements for employers and a state insurance exchange, the effect upon the health workforce was yet to be seen. The unanswered question was whether greater numbers of health care professionals were needed to ensure a successful reform with increasing access to care.

A study conducted by Douglas O. Staiger, PhD, and reported in the September 2011 issue of The New England Journal of Medicine, points out that “from January 2001 to December 2005, employment per capita grew by just over 8 percent in both Massachusetts and rest of the country. Subsequently, health care employment grew faster in Massachusetts, increasing by 9.5 percent from December 2005 through September 2010, while the rate of growth in the rest of the country was 5.5 percent. Most of the divergence in employment growth between Massachusetts and the rest of the country occurred in 2006 and 2007, when the Massachusetts reforms were being phased in. Had health care employment in Massachusetts grown at the same rate as in the rest of the country, approximately 18,000 fewer people would have been employed in health care by 2010.”

This study suggests there is a direct association between the implementation of the state’s health care reform plan and increase health care employment, especially in areas of administration and patient care support. The increase was not as dramatic among physicians and nurses. Further analysis suggests the impact to Massachusetts health care reform had other factors different from other states including “the numbers of physicians and nurses per capita in Massachusetts were already among the highest in the country, and this ample workforce may have facilitated absorption of large numbers of newly insured people without compromising access.” The entire article can be found here.

Another study can be found in the Baker Institute Policy Report for March 2012. This report detailed workforce programs, impacts of the Affordable Care Act (ACA) and workforce shortages. Accordingly, expanding the health workforce is one way to take full advantage of the ACA’s focus on preventive care.

Spring E-Newsletter is now available

DFWHC Staff — Fri, 24 May 2013 19:38:22 +0000

The spring edition of the Dallas-Fort Worth Hospital Council Foundation’s E-Newsletter was released to business associates this week. The issue highlights recipients during the DFWHC Foundation’s Employee of the Year Luncheon, April 18 at the Irving Convention Center. The upcoming Nurse Preceptor Academy and a recent study on obesity are also detailed.

For more information, please click the graphic below.

Physician Data Analytics: The KIS Principle

Richard Howe — Fri, 24 May 2013 15:34:49 +0000

In my previous blog, I discussed the value of physician data analytics. As noted, data analytics will be essential to effectively operate a physician practice group and provide the most efficient and effective patient care.

As the North Texas Regional Extension Center is in the process of launching a physician data analytics service, I felt it was important to discuss the basic problems with data analytics in health care.

• Lack of clinical structured data elements

Rather than structured data, many of the clinical data elements in a medical chart may be “free text.” The free text approach is personalized to a physician’s training and preferences. While this works for that physician, it does not lend itself to comparing clinical data across different physicians and national clinical databases. Use of an electronic medical record can lend itself to the use of standardized clinical charting components and thus, significantly help in moving away from free text into a standardized format.

• Lack of a standard clinical vocabulary with common terms

Even if a physician is using standardized charting and not free text, there are still many clinical names to describe the same condition. The use of a standardized clinical vocabulary is becoming more readily available and some are embedded into the electronic medical record. Physicians in a practice group have to agree to use standard terminology instead of their personal preference.

• Clinical data being collected in multiple formats

Today, clinical data is being collected in multiple data formats including free text, numeric data, structured data, video files, audio files, scanned images, etc. The multitude of diagnostics devices with variations in data output increases the complexity of clinical data. Most industries do not have this complexity with differing data formats. Over time, we must find a way to extract clinical information from different formats into structured data that can be used in data analytics.

The ideal situation is to have structured, highly specific data. This leads directly to the KIS principle (Keep IT Simple). The key message is to get the data you can “easily” get and build from there. So, start simple and then add the more complex data at a later time.

That is why we are starting with physician claims data. It is in a standard format and easy to obtain!

Engaging and Retaining the Health Workforce

Neguiel Francis — Wed, 15 May 2013 16:13:26 +0000

A note of encouragement to those concerned about the health workforce. With health care reform and the aging population, the future has never been brighter. As the backbone of the health care system, the health workforce is receiving well-deserved focus. Title V. of the Health Care Reform reinforces this fact. Here is an excerpt from the White House’s own website:

By funding scholarships and loan repayment programs, the number of primary care physicians, nurses, physician assistants, mental health providers, and dentists will increase in the areas of the country that need them most. With a comprehensive approach focusing on retention and enhanced educational opportunities, the Act combats the critical nursing shortage. And through new incentives and recruitment, the Act increases the supply of public health professionals so that the United States is prepared for health emergencies.

The Act provides state and local governments flexibility and resources to develop health workforce recruitment strategies. And it helps to expand critical and timely access to care by funding the expansion, construction, and operation of community health centers throughout the United States.

This act not only supports the nation’s health workforce, it expands it. These provisions should dispel doubt about the strength of the health workforce and provide hope for the future. As the excerpt confirms, retention continues to be a primary focus throughout the recruiting process. These strategies are moving away from individual facility orientations towards developing centralized system orientations to provide a lasting impression upon new hires. The hope is new employees will feel valued and have a sense of belonging. Equally important is promoting inclusion and team building following orientation as this is the period that could prove most overwhelming for new hires. This strategy will establish trust and reduce the challenges of frequent turnover faced by so many health care employers.

The other area receiving attention is creating educational opportunities. Benefit packages attracting and retaining employees include tuition reimbursement. New hires usually need to be on the job for six months to become eligible. The commitment to return to school establishes employees with potential, and retention is a natural result. Another tool promoting educational opportunities is convenient online educational programs.

With a comprehensive approach focusing on retention and enhanced educational opportunities, the health care workforce will continue to be strong for years to come.

Employer-sponsored Health Coverage – Big Impact

Neguiel Francis — Wed, 15 May 2013 15:10:51 +0000

As more employers consider the increased cost of employee health insurance, the looming decision is whether or not to continue to offer coverage. “Between 2000 and 2011, the average annual employee-only premium more than doubled to $5,081 from $2,490. And during that period, the amount employees contributed toward premiums also skyrocketed, to $1,056 from $435,” according to an April 11 study published in Modern Healthcare entitled, “More employers dropping insurance.”

The study reveals employer-sponsored insurance dropped 10 percent over the same period, 2000-2011. So the lingering question is, “Do you stand to lose your employer-sponsored coverage?” At least one demographic, adults between the ages of 19 and 25, continued to see a rise in employer-sponsored coverage. No surprise there as this represents the government provision allowing those under 26 to remain on their parents’ insurance policy. For the rest of us, these are sobering times.

The future of employer-sponsored coverage is anybody’s guess. Rising costs result in fewer employers offering insurance and as premiums increase, more employees are opting not to participate. To throw in a caveat, when employees do not participate in employer-sponsored coverage, they are not required to submit personal health information or participate in employer-required wellness programs. Overall, this is a “lose-lose” situation.

Employees become sick with no program to offset the cost for care, hence, they stay off work longer and employers lose productive hours due to absent employees. As more employers increase health insurance premiums or stop offering health insurance altogether, you will be impacted. Consider yourself and your love ones and adapt lifestyle changes allowing you to stay healthy for as long as you can. A healthy life may be your only option. It’s a no-brainer! If you take the steps necessary to optimize your health, your dependence and reliance on a program that may cease to exist will be greatly diminished. Your quality of life and of those you care for depend on it.