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Reporting’s Rising Role in Healthcare Success 

Reporting’s Rising Role in Healthcare Success  | Healthcare and Technology news | Scoop.it

Today’s healthcare market is saturated with hospitals, health systems, and physician practices tackling EHR optimization, cost analytics, and other data-related projects. The industry has made great strides to establish a digital, real-time record of patient care. As that clinical, operational, and financial data piles up, one of the industry’s latest challenges is identifying ways to make that valuable information actionable.

When viewed collectively, data tells a story of what has happened over time. In the healthcare setting, effective data capture helps providers easily assess a myriad of pertinent business metrics, including (but by no means limited to):

How many patients were seen today?

Which patients presented with co-morbidities?

On average, how long was the reimbursement process by payer?

What is the Accounts Receivable impact?

By monitoring business performance, healthcare stakeholders can understand where they stand today relative to past periods and peer organizations. Analysis of that data illuminates areas for improvement and the progress the healthcare organization is making in pursuit of long-term goals. As value-based care initiatives continue to take root, performance reporting also fuels reimbursement under quality payment programs like the Merit-based Incentive Payment System and Meaningful Use.

Hospitals working towards the triple aim of improving population health and patient experience while reducing the cost of care will have to leverage analytics to trend patient outcomes and identify improvement opportunities. With patient health, regulatory compliance, and reimbursement on the line, reporting stakes have never been higher. Amid the proliferation of data-oriented business processes and payment models, reporting expertise and analysts will be among healthcare’s greatest assets.

As your healthcare organization undertakes the complex process of broader clinical and financial reporting, build a successful data management strategy by keeping the following reporting considerations in mind.

Start with your current process.

How are you capturing relevant data now? Analysts should shadow staff members to see what information they are trying to get and how they are presently documenting those details. This can help you identify points in the data capture process that can be improved upon, or are perhaps being overlooked. Help employees understand the “why” behind data capture requirements. Demonstrate how current practices impact the data staff members see in reporting results.

Avoid knowledge gaps by involving reporting stakeholders early on.

In almost every healthcare setting there are gaps in the data being captured. Involve reporting in all implementation initiatives to make sure your organization is consistently capturing the right variables. This is particularly true among clinicians preparing to report on new metrics under MACRA’s inaugural Quality Payment Program period. Set field requirements in your EHR or other healthcare IT platform to ensure the necessary data makes it into the system.

Format reporting data in a manner that highlights actionable insights.

How do you want to see reporting data portrayed? Data may need to be sourced as a dashboard, manipulated in Excel, or sent to a third party, depending on the project at hand. In most use cases, a visual representation of data can help administrators more easily:

  • Compare performance data to other hospitals.
  • Track metric performance over time.
  • Visualize outliers, high-performance areas, and low-performance areas.

Armed with that insight, stakeholders can quickly identify downward trending financial KPIs, clinical quality measures that best support the organizations value-based reporting endeavors, and more.

Develop a data governance strategy.

Avoid common data quality “gotchas” by developing a data governance plan that cultivates consistency in how data is documented. Implement EHR rules that bar duplicate data entry and support field normalization. Establish a data source hierarchy to defer to the highest quality data source in cases where fields may come from multiple sources.

End-users often have not considered the impact that data documentation has on the reporting perspective. Data quality issues revealed during reporting often drive process or policy changes and can shed light on training opportunities. Reporting is a data mining process that supports more effective decision making on behalf of the organization. With reporting and analytics poised to play an expanding role in healthcare initiatives like population health management and improved utilization management, now is an ideal time for healthcare organizations to engage reporting expertise to establish a strong foundation for data-driven success.

Technical Dr. Inc.'s insight:
Contact Details :

inquiry@technicaldr.com or 877-910-0004
www.technicaldr.com

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Many docs come to work sick

Many docs come to work sick | Healthcare and Technology news | Scoop.it

Many doctors, nurses, midwives and physicians assistants come to work sick even through they know it puts patients at risk, a new survey suggests.


Many said they don’t call in sick because they don’t want to let colleagues or patients down by taking a sick day, and they were concerned about finding staff to cover their absence.


At the Children’s Hospital of Philadelphia, Julia E. Szymczak and colleagues analyzed survey responses collected last year from 536 doctors and advanced practice clinicians at their institution.


More than 95 percent believed that working while sick puts patients at risk, but 83 percent still said they had come to work with symptoms like diarrhea, fever and respiratory complaints during the previous year.


About 9 percent had worked while sick at least five times over the previous year. Doctors were more likely than nurses or physicians assistants to work while sick.


Analyzing their comments, the researchers found that many report extreme difficulty finding coverage when they’re sick, and there is a strong cultural norm to come in to work unless extraordinarily ill.

The findings are reported in JAMA Pediatrics. The researchers were not able to respond to a request for comment by press time.


Sick health care workers present a real risk for patients, especially ones who are immunocompromised, like cancer patients or transplant patients, said Dr. Jeffrey R. Starke of the Baylor College of Medicine in Houston, who coauthored a commentary on the new study.


“Most of us have policies restricting visitation by visitors who are ill, we screen them for signs or symptoms,” Starke told Reuters Health by phone. “Yet we don’t do the same thing for ourselves.”


Most hospitals do not have a specific policy restricting ill healthcare workers, and developing and enforcing these policies may help address the issue, he said.


These policies should put the decision about who is well enough to come into work into someone else’s hands, not the doctor’s, Starke said.


Aside from spreading illness in the hospital, sick doctors likely perform worse on the job than healthy ones, he said.

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How New Jersey Public Policy Fails Primary-Care Physicians

How New Jersey Public Policy Fails Primary-Care Physicians | Healthcare and Technology news | Scoop.it

We live in a very exciting time in the healthcare industry. Regardless of how you feel or think about decisions that are made on the government level, healthcare is in a period of controlled chaos right now.


With the potential merger of Anthem and Cigna and Aetna and Humana, or Assurant closing its doors on its health insurance business, things are about to get really interesting for medical practices. Arming yourself with as much information as possible is key to not just surviving financially, but thriving in this new environment.

Let's take Assurant, for example. They've decided that doing business in the healthcare arena and competing against the dominant healthcare insurance companies was far more expensive than expected. What does this mean for your practice? If you have patients that use Assurant as their medical insurance, it's a great idea to step in and take control of those accounts, now. Create a waiver for Assurant patients that explains what is going on, what to expect from their plan, and how they can still see you with a new insurance plan. The waiver should also state that in the event Assurant does not pay the medical claim, patients will be responsible for the allowed amount, and they will have to pay out of pocket if it is a PPO Plan. If the plan is an HMO, and Assurant does not pay, the practice is not allowed to place a PR (patient responsibility) to the patient and will lose that money.


Aetna and Assurant have similar fee schedules, so suggest to your patients to look into individual Aetna plans, to ensure that you will retain those patients and not lose revenue if you are contracted with Aetna. You will also need to really follow up with those claims and make sure that Assurant is paying you. I have seen them use a delaying tactic of denying a claim with the code CO95 (plan procedures not followed), which basically means they are sending your claim to a different claim address than what was provided to you at the time of benefit verification.  


As far as the pending mergers, I really love it when this happens. I'm particularly fond of the companies that have been courting each other lately. With the possible Aetna/Humana merger, Aetna will be able to add a lot more patients to their network. It will position them as a real player and earn them much needed respect within the market. I still have some overall issues with both Aetna and Humana, but merging them together should ease some of those issues.


The Anthem/Cigna cat-and-mouse game going on is particularly interesting. Cigna claims they're worth more than $184/share, and said no to Anthem's last purchase attempt. But Anthem is not giving up. Cigna used to be a premium plan until they teamed up with American Specialty Health. They have basically cut reimbursements to providers in half (if you signed up under their new network, otherwise you are seeing Cigna patients out of network), and implemented a time-consuming authorization process that eats away at whatever profit your practice may have left over from the reimbursement cuts. They implemented this over the course of the last year, or so. Working with Anthem is pretty cut and dried: What you see is what you get, with no hidden agendas. Anthem requires few to no pre-authorizations, allowing you to see your patient and maybe make a few bucks.


Just taking a few moments and reading up on what is going on in the healthcare industry today is really key to insuring your practice is not caught off guard. Always be learning, always be aware. There are multiple newsletters you can sign up for that will drop a daily or weekly e-mail into your inbox that will help you keep up.

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