DIVURGENT

By:  Colin Konschak, MBA, FACHE, FHIMSS, Managing Partner, DIVURGENT

As an author of a book focused on planning for Accountable Care Organizations, I’ve heard from all too many providers and consultants who believe the concept will never take off.

Although I remain cautiously optimistic about this new care delivery model, I am very much looking forward to the results of the Pioneer ACO program.

As you may be aware, the Pioneer ACO program is the latest initiative from CMS’s Innovation Center. The goal is to assess the impact of different payment mechanisms within organizations that have already proven they can accept risk and act as an ACO. More to the point, the goal is to provide better care to Medicare beneficiaries and reduce Medicare’s costs.

The participants have been selected and the program has begun as of January 1 of this year. CMS was looking for up to 30 provider organizations to start the program and they ended up selecting 32 (out of more than 80 applicants) from 18 states. They estimate that, if successful, the program will save $1.1 billion over the next five years.

The first two years of the Pioneer ACO Model will test the shared savings payment policy with generally higher levels of shared savings and risk for Pioneer ACOs than the current levels in the Medicare Shared Savings Program.

In year three of the program, participating ACOs that have shown a specified level of savings over the first two years will be eligible to move a substantial portion of their payments to a population-based model, which is designed to financially reward patient care when specific quality-of-care benchmarks have been met.

So, why am I excited? Because it won’t be too long now before CMS answers the question many have been asking: “Are we chasing unicorns?” Until then, we only know that more than 80 provider organizations don’t believe so, and 32 have been charged with answering the question once and for all.

By: Colin Konschak, MBA, FACHE, FHIMSS, Managing Partner, DIVURGENT

The Beacon Community Cooperative Agreement Program will provide new health information technology (HIT) roadmaps, lessons learned, and a multitude of best practices for ACOs to grow their HIT infrastructure and capabilities. The Beacon Program supports awardees in helping them build and strengthen their health information technology infrastructure and exchange capabilities to improve care coordination, increase the quality of care, and slow the growth of health care spending.  This is in direct support to the Triple Aim of the Medicare Shared Savings program.

ACOs will face numerous challenges associated with the development of an effective HIT infrastructure. These challenges include: implementation of an electronic health record across the organization, health information exchange across a diverse group of stakeholders and the successful achievement of meaningful use by at least 50% of the ACO’s primary care physicians.

The results and lessons learned from the Beacon communities will be integral to overcoming these challenges. Beacon communities must define, track, and report on their progress toward measurable health and efficiency goals. The resulting experience will inform ACO efforts to support the meaningful use of EHRs and the use of other health information technologies

How ACOs will benefit from the experience of the Beacon communities can best be showb by looking at the stated goals of a select few Beacon communities:

Community – Bangor Beacon Community

Goal – Improve the health of patients with diabetes, lung disease, heart disease, and asthma by enhancing care management; improving access to, and use of, adult immunization data; preventing unnecessary ED visits and re-admissions to hospitals; and facilitating access to patient records using health information technology.

Community – Beacon Community of the Inland Northwest

Goal-  Increase care coordination for patients with diabetes in rural areas and expand the existing health information exchange to provide a higher level of connectivity throughout the region.

Community – Southern Piedmont Beacon Community

Goal – Increase use health information technology, including health information exchange among providers and increased patient access to health records to improve coordination of care, encourage patient involvement in their own medical care, and improve health outcomes while controlling cost.

Community – Central Indiana Beacon Community

Goal –  Expand the country’s largest Health Information Exchange to new community providers in order to improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions through telemonitoring of high-risk chronic disease patients after hospital discharge.

Community – Delta BLUES Beacon Community

Goal – Improve access to care for diabetic patients through the meaningful use of electronic health records and health information exchange by primary care providers in the Mississippi Delta, and increase the efficiency of health care in the area by reducing excess health care costs for patients with diabetes through the use of electronic health record.

Sources: http://healthit.hhs.gov/portal/server.pt?open=512&objID=1805&parentname=CommunityPage&parentid=2&mode=2&cached=true

 http://healthit.hhs.gov/portal/server.pt?open=512&objID=1805&parentname=CommunityPage&parentid=2&mode=2&cached=true

By: Joe Bohn, MBA, Founder Clinical Horizons

In 2010 the Patient Protection and Affordable Care Act provided the initial legislation that introduced Accountable Care Organizations (ACO) through the new Center for Medicare and Medicaid Services (CMS) Shared Savings Program (Section 3022). Dr. Elliott Fisher is originally credited with introducing the concept to the Medicare Payment Advisory Commission (MedPAC) in 2006 as benefits were being realized from the CMS Physician Group Practice Demonstration Project by 10 leading health systems and physician groups from across the country that were documenting savings and validating proof of some of the underpinning concepts that would set the stage for the beginning of the ACO movement. In 2009 Dr. Fisher, Dr. McClellan and colleagues also identified three key principles to guide reform efforts with a focus on accountability, performance measurement and transparency, and payment reform. Today we have new draft federal legislation being commented on by physicians, clinicians, health information management (HIM) professionals, and educators across the country that will help shape the final legislation for the January 1, 2012 launch of the CMS Shared Savings Program. While many private payer focused ACO models and Medicaid ACO models are also being developed and tested across the nation, key to each ACO’s success will be collaboration and teamwork not just within health systems, physician practices and government agencies, but also across multi-disciplinary teams that HIM leaders will and should be engaged in across the country. 

Today we are seeing stronger recognition of the need to drive multi-payer coordination (both public and private) on the establishment, definition and activation of ACOs. Having a strong governance structure in place will be key and one that recognizes the importance of meeting Meaningful Use requirements as the industry progresses toward Stage 3 over the next four years, reporting transition to ASC X12Version 5010 by January 2012, and the looming deadline in 2013 for preparing for the industry wide cutover to International Classification of Diseases (ICD) ICD-10 CM and PCS by 2013. ACOs will be regional entities as they focus on providing care to specific population groups and as the ACO models grow in their multi-payer focus the emphasis on care for the entire population in their region will continue to strengthen. For HIM leaders there are a number of challenges to be addressed in supporting information needs in benchmarking, new importance placed on coding intensity, implications in risk models, meeting needs in health information exchange, new reporting to support goals for transparency, and other areas. However, they come with great opportunities to excel and help make these new models of care delivery an even greater success. Improving the health of the population and meeting the “three part aim” identified by CMS as strategic goals for participants in the shared savings program. Those three aims consist of: “(1) better care for individuals; (2) better health for populations; and (3) lower growth in expenditures.” This is the first of a four part series of articles dedicated to key topics of importance to HIM leaders. Next month’s article will focus on the implications of coding in its importance to benchmarking for the CMS shared savings program followed by July’s article on issues regarding health information exchange and involvement of HIM leadership in making it successful for ACOs.

About the Author: Joe Bohn, MBA, is CEO of Clinical Horizons, Inc. (www.clinicalhorizons.com) and co-author of Accountable Care Organizations: A Roadmap for Success. Guidance on First Steps. First Edition. Copies are available on Amazon.com or contact Joe for discounts available on multi-copy purchases. Joe can be reached at joebohn@clinicalhorizons.com.

References

[1] Centers for Medicare and Medicaid Services. Medicare Physician Group Practice Demonstration Project. Fact sheet available at https://www.cms.gov/DemoProjectsEvalRpts/downloads/PGP_Fact_Sheet.pdf.

[2] Fisher ES, McClellan MB, Bertko J, Lieberman SM, Lee JJ, Lewis JL, Skinner JS. Fostering accountable health care: moving

forward in Medicare. Health Aff (Millwood). 2009;28(2):w219-w231; Flareau B, Bohn J, Konschak C. Chapter 1: History and Case for Action.  In: Accountable Care Organizations: A Roadmap for Success. 2011. Virginia Beach, VA: Convurgent Publishing. 2011. p. 13.

[3] CMS-1345-P, Medicare Program; Medicare Shared Savings Program: Accountable Care Organizations. Proposed Rule. I(B)3. Statutory Basis for the Medicare Shared Savings Program. March 31, 2011.

By: Matt Curtin, Client Services Vice President

The Meaningful Use and Health Care Transformation Conference on May 20 featured morning and afternoon panelists discussing MU, ACOs, and the future of healthcare. The morning session, “Healthcare Transformation: Navigating the Road Ahead” focused on system redesign and quality improvement for taxpayers and recipients of care. David Groves, Director Ohio Governor’s Office of Health Transformation, said his office is committed to moving from instructional to community based care and talked about Ohio’s Medicaid rate (4% of OH’s budget). He pointed out fragmentations vs. coordination – it refers to multiple providers vs. accountable medical homes, provider vs. patient-centered care, institutional approach vs. continuum of care.

“What Lies Ahead for ONC Meaningful Use and Beyond” lunch session featured a panel of three healthcare executives covering: continuity of principles, strategy and approach; implementation; healthcare transformation; and patient-centered care. Trends to embrace according to the panel are: healthcare transformation – thinking about the plan and executing and in the next two years massively changing to consumer-based healthcare; moving from shared data to advanced care with DSS-based functionality to improved outcomes. The MU2 final rule is anticipated by mid 2012 by HHS and by June 8th slides will be posted on the ONC website. Overall, the panel is concerned about efficiency and workflow changes and notes that accountability is the next step and future goal. The greatest MU debate within the Office of the National Coordinator for Health Information Technology (members of the panel) centered around quality measures focusing on MU2 and broad, but meaningful measures that apply to most providers, e.g. patient engagements, getting and giving referrals, ordering tests, etc.

Q & A For Lunch Panel (Office of the National Coordinator for Health Information Technology, Children’s Hospital Research Foundation, Christ Hospital)

An audience member asked about upcoming pilots in e-prescribing regarding narcotics. Answer: Workflow duality is a major challenge and is a great opportunity for increasing RX monitoring and fighting abuse; will be able to track these usages regardless of cash or claims-based payment.

Patient-portal is vendor specific – should this be regional or community-based? Answer: This can and should be patient-driven. Demand can change this. Think of the “blue button” example; VA did a soft-launch of one-click ability to download one’s own patient data.

Is there potential harmonizing with MU and ACO rule making? Answer: This is the future, rewarding quality and value, and people need to get ready because no one knows what MU2 looks like.

Q & A For Afternoon Panel (TriHealth, Cincinnati Children’s Hospital, Community Initiatives of GE, Mercy Medical Associates)

The afternoon discussion panel discussed “Payment Reform and Accountable Care: How Will It Affect the Tri-State Region?”  The panelists defined ACO as a specific payment program, not a general term. All providers are responsible in the care continuum. On the payer side, view ACO as a status of organizational payment and must continually review performance. One panelist answered “What are we being accountable for and what population.” He said the payment reform design model should align with measurable outcomes – must start with premise of intent on increase quality within a community.

How does MU support payment reform? Answer: MU is using technology in a “meaningful” way, including the concept of the medical home, leading to clinical transformation. MU is essential for brining in EMRs – must have that data to understand population health information that allows for clinical transformation to take place. MU should drive positive clinical outcomes, not payment reform. MU is hard and criteria seems abstract. In order to be successful, providers must included end-users to communicate / demonstrate how this data can influence care improvement.

By: Colin Konschak, MBA, FACHE, FHIMSS, Managing Partner, DIVURGENT

During a recent research expedition, I came across an interesting article in the December 2010 issue of Health Affairs. It provided a clear example of the issues surrounding a move from transaction-based reimbursement to value based reimbursement. As we all know, the US healthcare system is currently structured around transaction-based reimbursement. A provider provides items or services, creates a billing transaction and is then reimbursed by a payer. More transactions, greater reimbursement.

As we also know, the Accountable Care Organization movement is all about transitioning from this transaction-based approach to paying for value. Better outcomes, higher quality, efficiency equals greater reimbursement regardless of how many services are provided or how many claims are submitted. Seems quite logical. In any case, regardless of whether the future is the structure of the ACO or not, I firmly believe value based purchasing is the future.

Now for the interesting article I referred to. First, let me start by saying the physicians have one of the hardest jobs out there and one that is critically important as well. I respect the profession a lot. However, paying providers based on volume has inherent risks. This article took an interesting view of the situation. Basically, the premise was “What happens when physicians acquire MRI equipment in-office?

To answer this question, the researchers used Medicare claims data for approximately 11,000 orthopedic surgeons and 6,000 neurologists. The answer to the question, at least in this study was that the ability to bill for MRI in office led to substantial increases in MRI utilization. For example the orthopedists increased MRI usage by 38%. Of course there are several potential reasons why this might be, however it provides focus on one of the shortcomings of transaction based reimbursement. The economics behind it are flawed, hence the current push towards paying for quality, outcomes and efficiency, as is the case with value based purchasing.

By: Colin Konchak, MBA, FACHE, FHIMSS, Managing Partner, DIVURGENT

What one hospital charges for a particular procedure varies widely based on a host of factors. Understandably, many providers who are otherwise all for transparency when it comes to patient outcomes are reticent to disclose cost data. There are real reasons for concerns on the globalization of medicine. However, health care is largely a local phenomenon.

What are the compelling reasons for being as transparent with prices as with anything else? For one, increasingly, consumers are armed with price information today that exceeds anything they could have assembled even just a few years back. Also, in the mind of many consumers, price equals quality. Logical or not, this notion has become ingrained as a result of their consumer experience in other industries.

Wine under one label is deemed more expensive than wine under another label, even in the case where the wine has proved to be exactly the same, from the same source, processed and delivered in exactly the same manner.

Reputation Enhances Price – At the supermarket, branded merchandise still sells at a premium compared to store or generic brands that offer the same ingredients, molecule by molecule. Your hospital’s reputation could prove to be the deciding factor in whether or not a patient will plunk down more money to be treated by you over others who, based on all comparison measures, offer exactly the same care and service.

Suppose a consumer does his homework and finds that you and a competitor have entirely equal success rates for particular procedure, and you charge 15% more. Is this a reason to fear price transparency? No, because with all the data available for a consumer to peruse to his heart’s content, the decision to choose one provider over another is multifaceted. Price is one factor, albeit an important one, among several.

Many consumers will go with the lowest price. Many will choose the best value – a blend of price and quality. Short term, there is not much you can do about the prices for some of the procedures you charge. In the long run, everything is up for grabs.

More Business, Lower Prices – The more often a hospital performs a particular procedure, and the more experience its doctors accrue, the better it is able to offer that procedure at a lower price. Even in health care, greater business volumes contribute to economies of scale. In the short run, you can’t do that much about the volume you handle for any particular procedure. In the long run, you could seek dominance in your local or regional area by publicizing your experience in a given procedure. Thus economies of scale could result and price transparency would work to your favor.

At Alegent Health, based in Omaha NE, the prevailing attitude is that consumers have a right and ought to be able to easily know how much a provider charges. Three years ago, Alegent launched My Cost, found at www.alegent.com, an consumer-friendly feature that offers cost estimates for a variety of tests, procedures, appointments, and services.

So, You Want Cost Data – Visitors can simply enter the name of their insurance providers and any co-payment or deductible information. The system then presents a cost estimate that is useful in personal health care decisions.http://www.alegent.com, The visitor is also treated to financial assistance information via links provided, and a phone number in case their anticipated procedure is not listed on the site. Now up and running for nearly three years, more than 50,000 cost estimates have been generated at My Cost.

Alegent’s experience in promoting price transparency has been that consumers appreciate the honesty and openness of the organization. Instead of price transparency scaring away potential business, in this case it has led to stronger provider-patient relationships. Alegent’s CEO says transparency “isn’t necessarily easy, and it does take courage, but in the end it is the right thing to do for consumers and the community.”

Make the Commitment – Commitment to transparency takes guts. Yet, what other choice is there? Fortunately, as we’ll see, there is room for creativity and initiative.

Providing information on the results that your hospital achieves for patients, at the medical condition level, is vital. Your data needs to include patient outcomes with an adjustment for risk based on prior conditions, the overall cost of care, and measurements for both extending through the care cycle.

Transparency also encompasses offering the experience your hospital has in treating specific medical conditions, by volume of patients, coupled with delineation of such treatments based on methods of care offered. Your processes, in the long run, can be improved only by understanding how results are achieved, which methods are most effective, how they might be refined to make critical differences, and what the actual outcome of such refinements have been.

Details Count – Outcomes for a specific medical condition can and should be expressed many ways. For, say, shoulder surgery several validated measures exist such as range of movement, reduction of pain, and ability to function. Still other outcome measures for shoulder surgery include the interval between the initiation of care and return to normal activity such returning to work or playing tennis again.

Data related to the particulars of patients, known as patient attributes, such as gender, age, genetic factors, and prevailing conditions, are vital elements of transparency and are essential for assessing risk. Accurate diagnoses is vital for both the patient and the provider. A transparent provider will publish measures of diagnostic accuracy including cost, timeliness, and completeness.

Outcome measures that only address episodic interventions fall short because they fail to yield results meaningful to the patient. Such short-sited reporting and consequence scoring can be counterproductive and lead to the publication of misleading data.

Failure is not pretty and human beings instinctively want to avoid reporting their own shortcomings, much like organizations. Still, ineffective treatments – errors in procedure, medication, or treatment – and complications following a procedure need to be identified and scored. As unpleasant as this task may be, it is a step on the path to improved levels of treatment and overall service. You cannot fix a problem that you refuse to acknowledge.

Expand Your Measures – A traditional core measure, “the 30-day readmission rate,” tracked by the government, is of course a potential indicator of poor quality. Who wants too many patients are readmitted within 30 days for the same problem.

You may be able to devise your own kind of data measures by tinkering with traditional data measures. For example, you could align your total quality management efforts, such as your Six Sigma Performance Improvement initiatives, around improving the 30-day readmission rate and devote resources to that. In turn, for each of the core measures which need to be fully transparent, you may wish to devise two, three, four or more strategies to ensure that your scores improve over time. Rest assured, other providers will be doing the same.

Costs Mysteries No More – Unlike most businesses, many hospitals, to this day, don’t know what their actual charges ought to be. They charge for this procedure or that based on tradition, competition, payer contracts, or whatever cost data they can scrape together. A comprehensive understanding of true cost is often lacking. If and when the government mandates that hospitals publish price and quality information, they will need the technical ability to do so.

In almost all cases, some web restructuring proves to be vital. There needs to be a huge consumer section that is highly inviting. Take the bull by the horns and invite the consumer to go patrolling through your data. Just as industrial companies publish annual reports with a profit and loss statement, balance sheet, and cash flow analyses, you might choose to offer a five-year projection as to the life cycle cost of a procedure and its follow up.

Implications for Your Hospital – Is transparency part of your agenda for your weekly and monthly meetings?
* Has your hospital developed policies and procedures in relation to transparency?
* Within your own office or division, are top officers involved in the transparency discussion?
* Have you attended any conferences and symposiums on transparency?
* Are you monitoring other providers who have already made the conversion to transparency?
* Are you devising plans to capitalize on the inherent opportunities in offering transparent data?

By: Colin Konschak, MBA, FACHE, FHIMSS, Managing Partner, DIVURGENT

Hospitals today can harness IT to redefine their relationship with customers and perhaps, equally important, redefine the quality perception of the hospital. The dilemma is that hospital executives invariably believe that they understand what quality is and will point to an impressive array of clinical indicators and outcomes. Results count, but what counts far more is how the consumer defines quality.

The consumer’s perception of quality is likely to differ vastly from that of hospital executives.

How does quality “show up” to the consumer? For many, through their phones.
Many providers have yet to fully embrace the reality that people have cell phones today, that more than 141,000 applications are available for download just on the iPhone, and that people are becoming less reliant on their desktop computers. The explosion of personalized information enables any individual to be in the driver seat, call the shots, and make better decisions about ones own health care.

The Options are Multiplying – The options for contacting, staying in touch, and sending reminders to patients are more diverse and hold more potential than ever before, especially for the provider with systematic IT capabilities designed to connect with the personal technologies that people carry in their pockets.

Consumers will make treatments and provider choices consistent with their personal values and based on anticipated results. Surely delivering expert medical services must be part of the mix? Yes and no. The delivery of expert health care and service is taken as a given – table stakes that you need to have, to be in the game.

Quality is always a moving target and always defined by the recipient, as much as providers wish it was stationary and always defined by them. Consumers will make their choices based on perceived quality, not necessarily on proximity or past relationships. To illustrate: smartphone users tend to invest their time and energy to running their lives more smoothly as a result of this pocket technology. “My life is that phone,” they will exclaim. The hospital system that sends them a text reminder about a “1:30 imaging appointment tomorrow, on Ridge Road,” confirms in the minds of these consumers that their health care institution is in tune with the times.

Me and My Phone – It’s a simple gesture, but a text or voice mail message about a scheduled appointment conveys to the consumer that this provider understands me or at least the way I schedule my time, arrange my affairs, and run my life.

This type of consumer downloads applications for his smartphone, health related applications among them. The variety of apps your hospital could develop for patients knows no bounds: apps on the seven tests for cancer, the first signs of a heart attack, how to perform CPR, what to do in the case of stroke, how to handle fainting or dizzy spells, what to do if someone has suffered a concussion.

A good app can help cement in the minds of consumers the quality of care that your hospital is capable of providing, hints that you are on their wavelength, and helps establish you as the go-to source when “something is wrong.” You could develop apps that accent your strengths, be it oncology, Ob-Gyn, or pediatrics. So, what apps does your hospital offer? Exercise regimens? Nutrition guides? Ailment-specific guides? Medication instructions and compliance assistance? Or none of the above?

Reminders and Amusements – Such patients want reminder pings asking, “Have you remembered to take your medication today?” maybe even three times a day, if that’s the daily pill regimen. For all of human history prior to this age, people either remembered on their own, or didn’t, without the aid of technology. Contemporary human reliance on pocket technology, however, cannot be denied or ignored.

So ingrained is the notion of turning to smartphones for instructions, reminders, updates, cues, formulas, and recipes, that it’s becoming second nature. People are now less reliant on their desktop computers and more reliant on their phone for everything. At the gym, you might see people working with an app-based workout routine that offers 20 different photos in sequence of the exercise that they want to be doing that day.

As the phones grow more powerful, more of the world is connected, more apps of greater utility become available, and life gets more hectic, using IT to support the consumer in ways they want to be supported likely will not be optional.

Ping to Me – Suppose each timed reminder, a “ping” in geek lingo, merits a response from the consumer and the response doesn’t come? With the right system, someone at the hospital will be able to call and say, “Mr. Williams, you haven’t pinged us back to indicate that you’ve taken your heart medication this afternoon. We don’t want you to have to return to the heart center, so please make sure to take your medication and let us know that you have.”

Does this sound like hand-holding? Is it seemingly an inordinate task? Based on the level of personal services provided in other industries, such as home security, the day when hospitals provide personalized updates, reminders, and custom monitoring might not be far off. Indeed to remain competitive, providing such customized attention might become mandatory as well as vital in reducing hospital readmission rates.

At the Women’s Center in the Tampa Bay Hospital, in Tampa, FL, when a patient arrives, she is given a Verizon cell phone. The phone only functions inside the hospital. She can take the phone to the cafeteria, gift shop, or anywhere else in the complex, knowing that she will receive a call only when the Center is minutes away from being ready for her appointment. A friendly caller will say, “Please make your way back. We’ll be ready to begin with you in exactly 10 minutes.”

Not a huge innovation, or is it? Restaurants have employed this technique for years. In hospitals, use of technology for such purposes greatly reduces anxiety. After all, does anyone enjoys sitting around in a waiting room where the minutes hang like hours? Especially when a patient is vitally concerned about some health issue, the ability to walk around versus sitting in a waiting room with other, equally anxious, patients can spell the difference between a pleasant visit and something else.

Among most patients, the perception of quality at the Women’s Center rises, independent of the medical services rendered.

Implications for your Hospital – What are you doing this moment to harness IT in ways that both serve consumers and help to raise their perception of the quality of your services?
* Do you have an appointment reminder system in place?
* Have you captured the requisite data to electronically connect with your customers? For example, do you have their cell phone numbers and email addresses?
* Do you have their permission to initiate such contact?
* Have you harnessed IT to make the patient’s experience more pleasant from the time he or she makes an appointment?

Preregistration, so basic, is more comfortable for people to complete at home rather than in the hospital or in a waiting room.

Duplicate and Triplicate – Time and time again patients complete the pre-registration forms in advance and mail or fax them in, or complete them online. That way, darn it, they don’t have to go through it all again when they arrive! Or do they?

The typical patient is thinking, “I appreciate that you’re letting me pre-register and submit all my medical history to you from the comfort of my home, but let it count for something. Enable this data to actually enter your system and be accessible so that I don’t have to go through this all again when I arrive.” It is anxiety-provoking to have to submit information that you know you have already submitted.

Once they’re inside the hospital doors, what do you do to ensure a patient’s comfort and ease? Do you provide in-house cell phones so that individuals are free to walk versus sit in a lounge chair? Have you scanned a photo of the patient so that your reception people have a fighting chance of greeting him or her upon recognition?

Are your IT systems configured so that the greeter can lookup whether or not the patient was here last week, or hasn’t been here for a year? Such knowledge would impact how the patient ought to be greeted.

Person to Person Connections – Larger questions loom. Does your hospital want patients to communicate directly with their doctors? By phone? By email? Does it make sense to establish doctor’s hours for addressing email? Are the same kinds of considerations being contemplated for nurses and technical specialists? Yes, this is a brave new world in terms of patient accessibility. Still, configuring your IT system so that your staff, from top to bottom, can communicate with patients one-to-one could prove to be mandatory in this ultra competitive industry.
* Is your hospital developing its own apps?
* Are you offering easily accessible frequently answered questions (FAQs)?

Are you using YouTube and Google Video to provide basic instructions such as: here’s how to check in, here’s how to care for yourself following your visit, here are the options if you have this type of ailment? If not, it’s time to get started.

By: Colin Konschak, MBA, FACHE, FHIMSS
Managing Partner, DIVURGENT

Customers to your hospital are the future kings and queens who, through their behaviors, actions, and choices, will impact every aspect of your operations. Consumer needs and demands will largely dictate which health care providers flourish, which merely remain viable, and which cling for survival.

Rather than become paralyzed by the notion that 10,000 years of streamlined medical dispensation is about to be turned on its head, there is another way to proceed: recognize that with great tumult comes great opportunity.

Forward Thinking Leadership Required
There has perhaps never been a time in which effective, forward-thinking leadership has become so vital. While much of the data you need to make publically available is a given, there is still wide leeway in terms of how else you can support the consumer. This can mean providing research data, meaningful comparisons, or up-to-the-minute information.

The role of information technology and the ubiquity of personal health records will ultimately help to streamline and remake operations, flow of information, availability of data, profitability, and, most importantly, quality of care. As consumer-driven health plans (CDHP) predominate in the health care marketplace, your patient constituencies’ health plan choices will serve as beacons as to what services to provide, which ones to accent in major ways, and which to merely have available.

Preferences Count – Paying attention to the preferences of consumers (stratified by generation or age) yields the potential for enjoying an extraordinary competitive edge. Knowing the propensity of younger consumers to embrace smartphone technology, social media, and all the disparate ways of gathering information – video, photo, audio, text, instant messages, real time conversation, etc. – virtually serves as a blueprint for meeting the needs of this huge patient segment.

Understand the retail medicine phenomenon: the rise of convenience care, boutique medicine, and other variations that are likely to develop. Embrace this movement as opposed to cringing at the thought of it. Doing so will yield a panoply of new ideas and opportunities. Since, in the end, your hospital’s longstanding reputation, brand, and specific services will represent the aces in the deck of medical care.

While the market for global tourism and its near cousin, regional tourism, continues to heat up, accenting the features and benefits of staying home for elaborate medical procedures and strategically establishing niches in those areas where distant competitors can not compete with you can secure your hospital’s position into the foreseeable future.

As with other developments in the quickly churning health care industry, meeting the challenge of globalization head on is far more adaptive and productive than throwing up one’s hands and lamenting, “What’s the use?”

Customers Have Choices – All of these developments point to the ever-present need to bolster existing direct-marketing efforts to consumers while establishing new approaches, new campaigns, and new channels to reach consumers in ways that are attractive, consistent with the times, ethical, appropriate, and ultimately compelling.

Patients are truly becoming customers, and customers of the health care industry, as in all other industries, quickly become aware that they have choices (most of the time, far too many choices). So, when an outstanding local option appears, why wouldn’t they capitulate?

Health care needs are not going to go away, but they are going to shift. As it has been done in the U.S. for the last decade or so, opportunities for you and your hospital will probably stay at the forefront of health care as it’s dispensed in your community.

A Five to Seven Year Outlook
Let’s take a near-term look at high-probability scenarios with an eye on identifying the opportunities that lie within.

Even with legislation and reform, health care costs, the ever-diminishing dollar, and increased consumer expectations as to what is possible and achievable will continue to keep expenses on an upward trajectory. Insurance reforms, in one manner or another, are likely to increase the pool of customers who are, at present, “priced out of the market” that would otherwise become long-term loyal patients of your facility. Efficiency in the use of information (as well as in personal technologies) will have somewhat of a counter-balancing effect in keeping costs in check or, at least, not rising quite as steeply as they have in the first decade of the 21st century.

Those who will prevail are the providers adept at harnessing technology and basking in the accrued benefits of doing so, unlike those competitors who are still trying to figure out where to put the plug into the wall. As Doctor David Blumenthal, national coordinator of Health Information Technology, remarks, “There’s no way to transform the health care system without information technology.” The corollary to that statement is there is no way to transform your hospital without information technology.

According to the Computer Science Corporation, integration of information technology will in essence mean “one database across clinical and financial, ambulatory and in-patient data [that] will ensure that care can be coordinated, standards met, and reporting and billing be a by-product of care.”

Perhaps the biggest visible shift apparent on a daily basis will be your hospital’s proactive efforts to meet the needs of consumers by employing what you know about them coupled with understanding the health care life cycle. You’ll want to keep them finely tuned, much as an auto-mechanic does with a car. Rather than responding in episodic fashion to singular health care needs, a holistic, systematic approach to customer care will rule the day.

Supply and Demand – It’s likely that the demand for high-quality health care will exceed the available supply, at least domestically. Impending reforms in health care insurance, in whatever form they take, will result in provider supply constraints that show up as delays in getting appointments, receiving care, and attaining followup visits. This might result in customers feeling as if appointments are being rationed.

HealthLeaders Media, in mid 2009, featured an article with the observation that “one year after Massachusetts mandated health insurance, the number of adults unable to find a primary care provider rose by 75% and waits for referral appointments increased to as long as 50 days.” This might not be the norm, but it is an indicator of the potential disruptions in supply.

Basic math indicates that with a decreasing ratio of primary care providers to customers, customer frustration is bound to boil over. This will fuel the growth of retail and boutique medicine and exacerbate the frustrations of hospital executives who will bemoan the Wal-Martization of bread and butter services.

Years Before Profitability Gains – In their report, “U.S. Healthcare in the Year 2015,” authors Jordan Battni and Walt Zywiak noted that acceleration of cost-cutting and reimbursement reform efforts will place continuing pressure on healthcare-delivering organizations to reduce waste and eliminate fraud as well as reform billing and recovery practices.

Still, it will be years before such measures will make a notable impact on a hospital’s profitability. The introduction of new systems, new procedures, and new models for administration virtually all go through an initial phase where it appears the massive effort of adopting such procedures was all for naught.

Consider the rise of the PC in the early 1990s. There was a swing economic analysis that showed no increases in worker productivity for many years thereafter. Eventually, a break-even point of sorts was reached, and the intended benefits began to accrue. The decade after, and certainly two decades after, the productivity gains are widely visible.

The real gains in profitability that hospitals may collect over the next five to seven years are likely to come as a result of eliminating waste, redundancy, and misdirected efforts. Doing more with less, in the near term, is likely to yield quicker, more discernable results than the industry-pervasive, system-wide measures being adopted and applied during this time.

One way or the other, health reform is going to impact the industry in unprecedented ways. While no one can say exactly how this will all shake out by the middle of the coming decade, it is safe to say that leaner, more efficient hospital systems will have strategic advantages while lesser providers everywhere have to cope with tidal wave-sized challenges.

Population Shifts
Along with consumers taking greater control and management of their personal health (and that of their families), the increased expectations as to what health care can provide, and perhaps a propensity to opt for select procedures, another trend by mid-decade has become highly observable and irrefutable: the aging of the population.

By 2015 or so, those 65 and over will account for nearly 1/5 of the U.S. population (18%). It is known that this segment employs double the number of physician resources compared to those under age 65. While the demographics for your local area may vary from the norm, one can predict that virtually across the board, the median age of the U.S. will continue to increase.

Accompanying this shift in demographics comes the onset of customers seeking care for chronic conditions. By some estimates, 70% of all doctor visits will be for treatments of chronic or recurring conditions, and it is not only because of the aging of the population. For the foreseeable future, health issues related to an overweight and obese population, despite massive public awareness campaigns, will continue to ratchet upwards.

A Public Health Paradox – On a parallel track, more people than ever are maintaining highly active lifestyles far into their senior years. The development will require demands for unprecedented levels of specific care. For example, knee and hip replacements and various orthopaedic surgeries will see a marked increase before the decade is over, and they will increase manyfold in the decade thereafter.

At the same time, the supply of general practitioners throughout the U.S. is holding steady, not increasing with the population. More doctors are specializing. Fewer see primary care as an attractive career choice. The availability of qualified nurses, an issue for several years running, will continue to be a challenge. This may be offset by the immigration of doctors and nurses from other countries to the U.S. as the globalization of medicine prompts shifts in perceptions, aspirations, and choices of the human resources that populate the health care industry.

It is difficult to determine how harshly near-term developments are likely to impact hospitals across the broad spectrum of services they provide, but this much is known: as in the past, the consuming public will be stratified. Some will take full charge of their personal health, aided and abetted by personal health records and information technology. At the other end of the spectrum, some will continue to play a passive role, preferring to follow the old model characterized by the questions, “Doctor, what’s wrong with me?” And, “Can you fix me?”

The middle ground will further stratify, with some taking charge of their health care periodically as illnesses, accidents, and personal wake-up calls prompt them to do so. Some will dutifully climb out for their annual checkup, flu shots, or whatever the issue “de jour” prompts them to do. Some, not quite in the “Help Doctor, tell me what to do!” camp will haphazardly apply wellness measures as the spirit moves them, or they perceive it is an element of “getting with the times.”

As the population ages on the political front, congressional representatives, especially those representing high median age populations, are likely to push for greater and greater measures of governmental control (or at least government meddling) despite the push-back from other legislators who are predisposed to maintain a laissez-faire approach to the nation’s health care.

IT is the Holy Grail
As with the introduction and installation of new systems in business and industry, the liability of reporting patient safety, security, and privacy issues are likely to loom large. Federal concern, especially about patient privacy, will prompt a new wave of regulation and compliance for the foreseeable future, adding to the cost of the widespread implementation of information technology, and not contributing to the holy grail of IT results: low costs.

The long-term future of hospital IT and its corroborated cousin, the electronic health record, is clear: it will predominate. Yet, over the next five to seven years, the picture is cloudy. John Glaser, CEO at Partners Healthcare in Boston, says that the adoption of electronic health records could be as high as 75% or as low as 25%.

Taking the midpoint of his prediction, 50%, equates to a still fragmented industry in which some hospitals have fully integrated electronically, most are striving to attain that practice, and some continue to straddle the fence with less vigorous adoption schedules. From a competitive and strategic standpoint, it makes no sense to be in either of the trailing groups, but the road to full integration is going to be rocky.

Over the next few years, as odd as it may be to witness, doctors still sporting pens and clipboards will make the same halls as those who wouldn’t think of proceeding without a smartphone, iPad, or whatever global, technological wonder will be available five to seven years hence.

In any case, information technology will likely be the make-or-break factor separating competitive providers from those who merely hang on. IT makes all other industry-wide developments possible: faster, more widespread adoption of electronic or personal health records and keeping the customer king, among the vital ones.

IT is not the cure-all or the end-all, but ,unquestionably, it will be the foundation upon which the future of health care and hospitals sit. The coming few years in U.S. health care will prove to be a time of innovation and experimentation matched by frustration and exasperation, ultimately leading to transformation. Progress is likely to be spotty because of the enormity of the task.

Two steps forward, one step back will be the norm rather than any uninterrupted progression. Trial and tribulation leading to resolution and exaltation is predictable.

Article Perspectives and Insights
* Forward-thinking leadership is vital to meet the challenges of the consumer driven health care; Nothing less will do.
* Paying attention to the consumers preferences, stratified by generation or age serves as a blueprint for meeting the needs of large patient segments.
* It will be years before vital measures such as accelerated cost-cutting and operational reform make a notable impact on a hospital’s profitability.
* The aging of the population along increased expectations across-the-board as to what health care can provide will profoundly impact the industry.
* IT and how you employ will be the make-or-break factor for your hospital in the coming decade.

Realistically, to understand the actual value of the services that you render to patients, you have to maintain a long-term relationship with them. This means periodically making contact to monitor how they’re doing, how they feel, what has transpired since the last contact, what new needs they may have, and what has worked best for them.

It is costly to develop and maintain such patient registries, yet the continuing display of care and concern for the patients and the development of longer-term relationships can lead to increased business (while not necessarily your first objective).

The day is coming when such monitoring can be done with less effort and lower cost. In addition, other parties who serve the patient such as medical device suppliers, drug stores, and health service firms can add to the breadth and scope of your data.

Patient feedback is a vital tool in the quest for transparency and in improving the overall quality and perceived value of the your services. The patient’s experience in terms of ease of appointment-making, waiting time, accessability to the doctor, attention to individual needs, amenities, discharge procedures, and follow-up are all valuable inputs that are over-ruled perhaps only by the patient’s ultimate perception of the quality and the outcome of his or her medical procedure.

Observe the Leaders, but Chart Your Own Path – Because many leading providers across the nation are already making core measures transparent, you have the opportunity to see what the early leaders are offering and potentially improve upon that. The more transparency measures you encounter in your perusal of progressive providers, the greater the opportunity you have to align the mix of measures in your transparency efforts.

Some of the measures you may wish to include, clearly, are beyond traditional. For example, while this may seem like an exceedingly small item for you, a consumer might want to know, “Does the hospital provide me an aspirin within so many minutes of my arriving at the emergency room if I complain of chest pain?”

Manage Perception – To consumers, perception is everything. If they feel like they’re being treated well and looked after, all other things being equal, that is an important feather in your cap. Conversely, if consumers are being treated well but their perception is that they are not, then they are going to feel somewhat agitated. Hospitals have to both treat the patient well and manage the perception that they are doing so. Ultimately patients’ view can be reflected in the transparency data that you generate.

Changing the value of perception can occur in other small ways. For example, if you simply passed out a card to patients during their stay that asks, “How are we doing today?” it’s a seemingly small inexpensive gesture, but it can greatly impact perceptions.
Why not give the patient the opportunity to log on and, as hotels currently do, make comments about the quality of their stay. “Was the desk reception friendly?” Through use of social media such as Twitter and Facebook, patients can easily be afforded the opportunity to offer updates in real time. These aren’t necessarily going to be all complaints, and someone at your hospital who has responsibility for quality control could monitor comments posted on social media, aggregate them, and provide real feedback to the executive staff.

Perhaps more important, such feedback could help the floor staff to make real time improvements in the quality of care. “Ms. X in room 526 would prefer to have the newspaper delivered as the very first thing…” With some ingenuity you could create patient satisfaction scores to be compiled and included in your transparency efforts.

Learn from Other Industries – When the W brand from Westin Hotels was first launched, a button was installed on phones in the rooms with a W on it, which stood for, “Whatever, whenever.” Hotel guests could hit the W button and regardless of the type of assistance they were seeking, whether it was room service, housekeeping, or security, their request would quickly be handled.

Small personal touches can make a difference, literally. In a Tampa Bay area hospital, a new process was initiated. If a nurse or allied health professional is about to leave a patient’s room they have to turn, actually touch the patient (if conditions allows) and say, “Is there anything else I might do for you before I leave?” Consequently, a notable rise in patient satisfaction scores resulted. Increasingly patients indicated that the quality of care during their stay was higher than those patients who had not received “the touch” and the question, even when no other discernable measures of quality were provided to one group of the other.

The key in touching the patient is to offer an authentic person-to-person gesture, warm and friendly, and given with the complete intention to serve. You never want your people to get robotic, like a fast-food worker who mindlessly repeat a sales mantra, i.e., a guy walks into a fast food restaurant, orders apple pie and a milkshake, and the order taker says, “Do you want some desert to go with that?”

Doctors Can Work Miracles – Your doctors can go a long way in enhancing the perceived level of quality. If a doctor enters a room for as little as 30 seconds, as long as he or she sits down by the patients 10 seconds or so, no matter what else happens, the perception of the patient is that this person cares.

Suppose the doctor walks in, never sits down, then leaves. No matter how attentive and caring, the prevailing perception becomes, “Oh, the doctor was making rounds, and I’m merely one of many.”

Implications for Your Hospital – Have you implemented a campaign to identify all areas of “perception management”?
* Are you surveying patients or otherwise providing outlets for their expression?
* What possible measures are emerging as a results of your exploration?
* Are there guidelines for doctors, nurses, and medical staff for offering an added personal touch?
* How do you support these efforts, rewarding those who capitulate and correcting those who do not?
* Are you developing other strategies for delighting patients?

Your hospital is already in the retail business whether or not you know it.

With hospitals perpetually in a budget crunch, the opportunity to increase revenues by providing additional convenience to customers through retail medical services is growing more attractive all the time. An executive with the Paquin Group, at www.pacquinhealthcare.com, a health care retail consulting firm based Coeur d’Alene, Idaho, observes, “the average hospital that makes $500,000 annually from retail sales such as gift and coffee shops has the potential of 5 million to 15 million annually” by offering retail medicine.

Some of the services and specialty stores showing up in hospitals as independent firms that pay the hospital rent or as part of the hospital’s own operations include optical shops, pharmacies, health food markets, baby photography services, dental and orthodontic practices, contact lens stores, art and dance studios, prosthetic services, acupuncture, chiropractic, and massage services, cosmetic surgery centers, aromatherapy service shops, specialty cosmetic centers, health book stores, weight loss classes, specialty cancer shops (wigs, scarves, etc), smoking cessation courses, and gourmet food shops, among others.

The key to effective on-site retail sales is a keen focus on the consumer. How your stores are designed and arranged, along with the knowledge of the employees who staff, are the critical elements in a consumer’s inclination to pay for retail goods and services associated with your hospital.

Some hospitals have devised their own branded vitamin supplements and some have created a variety of retail notions to sell in their gift shop. For further exploration as to how your hospital might add retail business revenue, here are some resources:

* www.redlandshospitalstore.com – How a hospital is offering their store’s products online.
* www.hospitalbusinessdevelopment.com – How hospitals are increasing retail revenues.http://www.hospitalbusinessdevelopment.com
* Beyond the Gift Shop: Boost Revenue, Your Brand, and Patient Satisfaction with Strategic Hospital Retail by Mindy Thompson-Banko, published by the American Congress of Healthcare Executives, Chicago, IL.

Providing Medical Equipment and Supplies
Another alternative in retail medicine beyond establishing or affiliating with walk-in clinics or populating your facility with retail medical, is the provision of medical equipment and medical supplies.

Thus far in the evolution of U.S. health care, hospitals have played little or no part in providing needed equipment to patients for purposes of follow-up care. Drugstores sell such equipment as do wholesale medical suppliers and specialty retail suppliers. Increasingly, online vendors are capturing a sizable share of the market. In addition, resale of used equipment in good to excellent condition or refurbished equipment has been a growth sector, particularly with the advent of online sales.

Med Marketplace, online at www.medmarketplace.com, bills itself as the world’s “largest online marketplace for selling medical equipment.” Visitors to the site type in a product or keyword, the desired condition, and the desired location. They then receive a comprehensive list of what is available based on the criteria they have selected.

While hospitals have long sold their used equipment to brokers who then resell it at a profit, the ability today for hospitals to sell new equipment directly to patients and to sell their own used equipment facilitated by the Web has never been greater.

Implications for Your Hospital – Consider the annual number of patients that you treat, and the annual total of patient visits.
* What percentage require some type of equipment or medical supplies for follow-up treatment?
* What is the typical expenditure by patients who need to make such outlays?
* What is the total annual estimated outlay of the followup expenditures made by your patient population?
* What percentage of that revenue total could you potentially capture by entering this arena?

Long-term traditions, local restrictions, and other factors must be considered and handled adroitly before sales of new and used medical equipment and supplies can become a profit center. Still, the potential is intriguing and, in this era of hyper-competition, is not one to be overlooked.

To summarize: Your hospital is already in the retail business and other lucrative opportunities abound. What can you do to affiliate with retail operations at arm’s length or to or accommodate them within your own facilities?