Archive for December, 2017

Infographic: 2018 Healthcare Outlook

December 29th, 2017 by Melanie Matthews

Hospitals have experienced improvements in uncompensated care revenue due to the Affordable Care Act. But reform and economic uncertainty are creating a perfect storm that could erase this momentum, according to a new infographic by Navigant.

The infographic examines the factors that could reverse the improvements in uncompensated care and what this means for hospitals and health systems.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

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Infographic: Coded Severity and Readmission Reduction

December 27th, 2017 by Melanie Matthews

A federal program that has been shown to reduce hospital readmissions may not have been as successful as it appears, according to a new infographic based on a study by University of Michigan researchers.

The infographic examines how the reduction in patients heading back to the hospital could be attributed to how the diagnoses were coded.

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics
Concerned about escalating hospital readmissions from skilled nursing facilities (SNFs) and the accompanying pinch of Medicare readmissions penalties, three Michigan healthcare organizations set competition aside to collaborate and reduce rehospitalizations from SNFs.

To solidify their coordinated approach, Henry Ford Health System (HFHS), the Detroit Medical Center and St. John’s Providence Health System formed the Tri-County SNF Collaborative with support from the Michigan Quality Improvement Organization (MPRO).

A Collaborative Blueprint for Reducing SNF Readmissions: Driving Results with Quality Reporting and Performance Metrics examines the evolution of the Tri-County SNF Collaborative, as well as the set of clinical and quality targets and metrics with which it operates.

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Infographic: Spotlight on Hospitalists

December 25th, 2017 by Melanie Matthews

With the rising focus on value-based care, health systems are increasingly relying on the expertise of hospitalists as care coordinators to ensure positive patient experience and improve safety and quality of care, according to a new infographic by Pershing Yoakley & Associates.

The infographic explores the demand for hospitalist services, hospitalist supply, and clinical compensation.

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare IndustryGiven the powerful patterns disrupting healthcare, what will it take to succeed as a high-velocity healthcare organization in 2018?

Healthcare Trends & Forecasts in 2018: Performance Expectations for the Healthcare Industry, HIN’s 14th annual business forecast, is designed to support healthcare C-suite planning as leaders react to presidential priorities and seek new strategies for engaging providers, patients and health plan members in value-based care.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

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Infographic: BUILDing Together for Healthier Communities

December 22nd, 2017 by Melanie Matthews

The BUILD Health Challenge (BUILD) is a national initiative working to create multi-sector, community-driven partnerships to improve healthcare. BUILD awardees apply Bold, Upstream, Integrated, Local, and Data-driven approaches to transform healthcare in vulnerable neighborhoods across the United States.

A new infographic profiles the first cohort of BUILD Health Challenge awardees (2015-2017), lessons learned from these programs and results.

2017 Healthcare Benchmarks: Social Determinants of HealthInitiatives such as CMS’ Accountable Health Communities Model and other population health platforms encourage healthcare organizations to tackle the broad range of social, economic and environmental factors that shape an individual’s health. To underscore the need to address social determinants of health, Healthy People 2020 included “Create social and physical environments that promote good health for all” among its four overarching goals for the decade.

In one measure of their impact, 2015 research by Brigham Young University found that the social determinants of loneliness and social isolation are just as much a threat to longevity as obesity.

2017 Healthcare Benchmarks: Social Determinants of Health documents the efforts of more than 140 healthcare organizations to assess social, economic and environmental factors in patients and to begin to redesign care management to account for these factors.

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Infographic: Assessing the Value of Telemedicine Devices

December 20th, 2017 by Melanie Matthews

Telemedicine is a high priority and a critical technology initiative for many healthcare organizations, according to a new infographic by Aeris.

The infographic examines whether healthcare organizations consider telemedicine as mission-critical to their organization and telemedicine barriers, drivers and promising applications.

Real-time remote management of high-risk populations curbed hospitalizations, hospital readmissions and ER visits for more than 80 percent of respondents and boosted self-management levels for nearly all remotely monitored patients, according to 2014 market data from the Healthcare Intelligence Network (HIN).

Remote Monitoring of High-Risk Patients: Telehealth Protocols for Chronic Care Management profiles a successful eight-year initiative by New York City Health and Hospitals Corporation’s (NYCHHC) House Calls Telehealth Program that significantly lowered patients’ A1C blood glucose levels.

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Guest Post: Are You Preparing to Fail Healthcare Compliance in 2018?

December 19th, 2017 by Tim Feldman and Darci L. Friedman

A 2018 roadmap to healthcare compliance should focus on cybersecurity, vendor management and telehealth.

As the year winds down, we see numerous lists of priorities healthcare organizations should focus on in the coming year. However, if you are looking to those end-of-year lists for guidance on what your organization should pay attention to in 2018, you are already behind. If you do find yourself playing catch-up, drafting your 2018 compliance work plan is the best place to start.

As the roadmap for your compliance efforts throughout the year, your annual work plan should indicate key high-risk areas. The Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) has indicated that developing an annual compliance work plan is integral to the administration of an effective compliance program (Measuring Compliance Program Effectiveness – A Resource Guide).

The annual work plan and compliance program administration are but one portion of what is required for an organization to have a robust and effective compliance program. The required elements of a compliance program are the following:

  • Standards, Policies and Procedures;
  • Compliance Program Administration;
  • Screening and Evaluation of Employees, Physicians, Vendors and Other Agents;
  • Communication, Education and Training;
  • Monitoring, Auditing and Internal Reporting Systems;
  • Discipline for Non-Compliance; and
  • Investigations and Remedial Measures.

These elements provide a broad framework for your organization to identify risk, proactively remediate and provide a response mechanism to mitigate when there is an exposure. Working the plan and program throughout the year helps your organization achieve a state of ongoing readiness.

Cybersecurity

Cybersecurity is one item that will likely factor more heavily in your work plan, and appropriately so. Last June, the HHS Health Care Industry Cybersecurity Task Force released a report on improving cybersecurity in the industry. The Task Force concluded that cybersecurity, at its core, is a patient safety issue and a “public health concern that needs immediate and aggressive attention.”

Some of the areas to address in the broader realm of cybersecurity include:

  • Ransomware;
  • Email security, including phishing;
  • Internet of Things (IoT) and devices;
  • Bring your own device (BYOD); and
  • Medical identity theft.

As the Task Force report notes, cybersecurity must be thought about across the continuum of care in your organization. Work to shift the culture and thinking that cybersecurity is simply a technology issue, of concern only to the IT department.

Do this by implementing policies and procedures for key cybersecurity issues and then communicating them across the organization. Follow that with training, including everyone in your organization, from staff to board members. The training should: define cybersecurity; explain how it may manifest in the organization, and address your policies and procedures, making it evident to all what they can and cannot do and how to respond.

Third-Party Vendor Management

The outsourcing of services to third-party vendors is increasingly common and for good reason. Such relationships offer great benefits, but at the same time, these relationships also carry legal, financial, reputational and compliance-related risks. Here are seven questions to evaluate your third-party vendor relationships:

  • Does your organization, as a covered entity (CE) under HIPAA, have a vendor compliance program to help you identify, manage and report on these risks?
  • Do you review and assess your vendors’ risk profile?
  • Are you familiar with each vendor’s hiring practices?
  • Do you know which vendors’ products connect to other IT systems that contain critical data, including protected health information (PHI)?
  • Do you have insight into each vendor’s information security and data privacy capabilities?
  • Do you know with which vendors you have a business associate agreement (BAA)?

For many healthcare organizations, the answer to several of these questions is likely “no,” which creates risk for those organizations. The OIG’s position is clear: healthcare entities have a responsibility to proactively identify, assess and manage the risks associated with their vendor relationships.

All vendors are NOT created equal. A good starting point in managing an effective and efficient third-party compliance program is to perform a risk-ranking of vendors based on their access to critical assets or information. By segmenting your vendor population into “risk tiers” you can focus limited resources on the most serious exposures.

Components of third-party compliance assessment should include, among other things:

  • Due diligence (background, reputation, strategy);
  • Knowledge of, and compliance with, security and privacy requirements;
  • Operations and internal controls (policies and procedures);
  • Workforce controls, background and exclusion checks; and
  • Training and education.

And, of course, with every vendor that meets the criteria of a Business Associate, ensure that a written BAA is in place. BAAs can be complex and are often daunting, but they must be carefully negotiated and acknowledged by both parties.

By ensuring your vendors have strong compliance programs in place and that they are following through on the BAA requirements, your organization is meeting its compliance obligations and doing its best to minimize its risks.

Telehealth

The compliance concerns related to the delivery of care via telehealth are numerous and include the following:

  • Licensing;
  • Credentialing;
  • Security;
  • Regulatory requirements for billing; and
  • Fraud and abuse.

An area to focus some attention on is payment under federal healthcare programs. The OIG currently has two active work items on telehealth, one for Medicaid and one for Medicare. Both of the items relate to the propriety of payment for telehealth services.

If your organization provides telehealth services, consider conducting a risk assessment to determine if you have any exposure in the area. Risk assessments are not strictly one of the 7 required elements of a compliance program, but they are often referred to as the “8th Element” given the focus on them in the Federal Sentencing Guidelines and OIG documents.
Risk assessments, along with the other elements of a compliance program, provide your organization the means to identify, prioritize, remediate and/or mitigate the myriad on-going risks it will encounter. If you are not working your compliance program and specific risk areas throughout the year, you are failing to adequately prepare for an event. By failing to prepare, as one wise man said, you are preparing to fail.

About the Authors: Tim Feldman is Vice President and General Manager of Healthcare Compliance & Reimbursement at Wolters Kluwer Legal & Regulatory U.S. He oversees product development across a vast suite of practice tools and workflow solutions to help professionals stay ahead of regulatory developments and effectively manage compliance activities. Darci L. Friedman, JD, CHPC, CSPO, PMC-III, is the Director of Content Strategy & Author Acquisitions for Healthcare Compliance, Coding & Reimbursement at Wolters Kluwer Legal & Regulatory U.S. She is responsible for supporting the overall strategy for developing new content and features, innovating new product models, and recruiting top content contributors.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Infographic: Advancing Medicare and Medicaid Integration

December 18th, 2017 by Melanie Matthews

There are more than 11 million individuals who receive services from both Medicare and Medicaid. State policymakers and their federal and health plan partners are increasingly seeking opportunities to improve Medicare-Medicaid integration for these dually eligible beneficiaries, according to a new infographic by the Center for Health Care Strategies.

The infographic explores the reasons to integrate care for dually-eligible individuals; features of effective programs; and factors influencing state investment in integrated care.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid PopulationTo locate, stratify and engage dual eligibles, Health Care Services Corporation (HCSC) takes a creative approach, employing everything from home visits to ‘street case management’ to coordinate care for Medicare-Medicaid beneficiaries.

Dual Eligibles Care and Service Planning: Integrative Approaches for the Medicare-Medicaid Population describes HCSC’s innovative tactics to engage this largely older adult and disabled population in population health management with support from a range of community partners and services.

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Infographic: 5 Healthcare Social Media Facts You Should Know

December 15th, 2017 by Melanie Matthews

The role of social media in healthcare is continuing to increase as social media adoption grows.

A new infographic by Health Care Social Media Monitor examines 5 key healthcare social media trends.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System Encouraged by early success in coaching 23 patients to wellness at home via remote monitoring, CHRISTUS Health expanded its remote patient monitoring (RPM) enrollment to 170 high-risk, high-cost patients. At that scaling-up juncture, the challenge for CHRISTUS shifted to balancing its mission of keeping patients healthy and in their homes with maintaining revenue streams sufficient to keep its doors open in a largely fee-for-service environment.

Remote Patient Monitoring for Chronic Condition Management: Leveraging Technology in a Value-Based System chronicles the evolution of the CHRISTUS RPM pilot, which is framed around a Bluetooth®-enabled monitoring kit sent home with patients at hospital discharge.

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Infographic: The Pursuit of Healthcare Interoperability

December 13th, 2017 by Melanie Matthews

Healthcare organizations are working toward interoperability by investing in electronic health records, as a first step toward eventual data integration. However, the challenges to achieving interoperability go beyond EHR implementation, according to a new infographic by Transcend Insights.

The infographic examines five of the biggest interoperability challenges.

Trends Shaping the Healthcare Industry in 2018: A Strategic Planning SessionUncertainty regarding the future of the Affordable Care Act (ACA), combined with industry market forces, including consolidations and strategic partnerships, positioning for value-based healthcare, cost containment efforts, an emphasis on technology and efforts to understand and address the whole patient as part of population health management have been the key drivers in the healthcare industry this year.

With the efforts to repeal and replace the ACA now focused on the elimination of the cost-sharing reduction (CSR) payments to insurers and changes to regulations governing association health plans, short-term, limited-duration insurance and health reimbursement arrangements, the healthcare industry can put aside the uncertainty of this year and move forward with the market forces in play.

During Trends Shaping the Healthcare Industry in 2018: A Strategic Planning Session, a 60-minute webinar on December 7th, two industry thought leaders, David Buchanan, President, Buchanan Strategies, and Brian Sanderson, managing principal, healthcare services, Crowe Horwath, will provide a roadmap to the key issues, challenges and opportunities for healthcare organizations in 2018.

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Infographic: Payer-Provider Partnerships Continue to Deepen

December 11th, 2017 by Melanie Matthews

Payer-provider partnerships continue to deepen, with 68 percent of partnerships launched in 2017 being joint venture or fully co-branded insurance products, according to a new infographic by Oliver Wyman.

The infographic tracks the growth of partnerships since 2013 and how these partnerships support value-based healthcare models.

2017 Healthcare Benchmarks: Community Health PartnershipsIncreasingly, healthcare organizations are forging community partnerships to bridge care gaps and improve population health status. This alignment of care and resources ranges from providing transportation to doctors’ appointments to scheduling EMT visits to visit the homebound elderly following their hospitalization. Working in tandem with community groups addresses social determinants of health (SDOH) and produces clinical and financial benefits that are recognized and rewarded by today’s value-based healthcare reimbursement models.

2017 Healthcare Benchmarks: Community Health Partnerships documents the efforts of 81 healthcare organizations to align clinical interventions with neighborhood collaborations to improve health, wellness and socioeconomic factors in the populations they serve. These metrics are compiled from responses to the October 2017 Community Health Partnerships survey by the Healthcare Intelligence Network. Click here for more information.

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