HIMSS18 Pushes Immediate Patient-Centered Change

We have all heard the saying, “the customer is always right.” Consumers should drive how a business functions, next steps and where the industry is headed. In healthcare, it is no different. Patients expectations are raising higher standards in technology, experience and outcomes. The providers who fail to recognize the patient-centric culture forming will struggle to stay competitive.

HIMSS18 brought a multitude of insights to over 45,000 healthcare IT professionals on how to provide better patient outcomes. Technology is booming in healthcare, but adoption still lags behind other industries. Here are four themes from HIMSS18 to competitively propel healthcare providers:

  • Consumerism is here to stay. Patients are looking for a patient experience built on consumer preferences, personalization, flexibility and clear communication. This can include digital options for registration and billing, better ways to share EHRs digitally and personalized physician-to-patient interactions. Providers must use patient communities as an eye toward the next direction of their organizations.
  • Healthcare is moving from diagnosis and treatment to anticipation and prevention. Start looking at technology abilities not only as a tool or data storage, but to analyze and predict. Smart data enables insights toward physician care decision making, patient experience improvement, readmission reduction, population health management and prescription monitoring. The latter comes into play with the country’s opioid crisis, as prescribing systems are now working to flag addiction patterns and medication discrepancies.
  • Artificial Intelligence is the name of the game. AI has been introduced before, but its presence is finally in practical application in healthcare. Artificial intelligence will allow healthcare professionals to analyze the healthcare data they already have stored, alarm physicians of things that should be noted and let physicians better focus on patient experience while the machines look for gaps in data. The next step though is to make the technology accessible in practice at the point of care without adding workflow burden to end users.
  • Disruption is key. Healthcare organizations must focus on the consumer and how technology will evolve their abilities. Some say that health systems will be known as tech companies with a healthcare focus considering all of the technology advances leading to the future of healthcare.

Here’s a look at how several CHIME provider organizations are staying ahead with these themes: http://bit.ly/2Fs5dNU

HIMSS18 elicited many insights for the future of health IT. After all, it is not every day that you get to talk about machine learning detecting cancerous tissue. Then again, HIMSS brought up many tactics applicable to any healthcare organization despite differences in budget, patient communities, region or specific EHR. The conference teases what’s on the horizon for care possibilities but also grounds us with consideration of where reporting, CIO pain points, physician burnout and standardization need to be addressed.

Defining MACRA: What Is It, and How Will It Impact Your Organization?

(Updated June 21, 2017)

The first reporting year of the Medicare Access and CHIP Reauthorization Act (MACRA) is officially underway, but many physicians and healthcare organizations across the country still struggle with comprehending where they stand. Providers no longer have time for guessing. Instead, healthcare organizations must create and maintain strategic plans for reimbursement, covering everything from who will head MACRA initiatives to what reporting measures best match organizational strengths. Let’s begin by answering some key questions about the final rule.

What is it?
MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, transitioning focus from fee-for-service to value-based care. Clinicians now need to pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).


APM versus MIPS
A lot of confusion can arise when physicians try to understand what path under MACRA is best suited to their business. With the initial reporting year already underway, if you’re unsure of your path, you’re likely not reporting under APMs. The Advanced APM track offers practices the opportunity to earn more in exchange for taking on some risk related to patient outcomes. Models qualifying for 2017 reporting include the Comprehensive ESRD Care Model (Large Dialysis Organization arrangement), Medicare Shared Savings Program (Track 2), Medicare Shared Savings Program (Track 3), Next Generation ACO Model, Comprehensive Primary Care Plus (CPC+) and Oncology Care Model Two-Sided Risk Arrangement. In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through participation in these Advanced APMs.

The other option, MIPS, is based on reporting quality metrics, resource use, clinical practice improvement and advancing care information categories. Performance tracking for MIPS began January 1, 2017, with reported data submission due by March 31, 2018, for the 2019 adjustment payment period. In this initial 2017 performance year, physicians can earn or lose a potential 4 percent of their reimbursement. Those exempt from MIPS reporting are providers who do not generate at least $30,000 in Medicare Part B billing, and those who do not provide service to at least 100 Medicare patients per year. For the 2018 reporting year, CMS is now proposing to amend exemption threshold to $90,000 and 200 Medicare patients per year to help small practices.

The difficulty with MIPS is determining the metrics for reporting that best align with physician care and organizational strengths. Also, physicians have options within this first year toward what reporting pace they’re utilizing.

The significance of MACRA moving forward
No matter your health organization’s reporting path, MACRA requires physicians to properly capture, maintain and analyze data from both financial and clinical areas to maximize their reimbursement opportunity. In the transition to value-based care, MACRA pushes healthcare providers to be more strategic and stringent with their data to meet reporting requirements, prepare for future regulation changes and cater to today’s evolving patient needs.

Visualize Financial Performance with BI Dashboards

The combined use of financial analytics and business intelligence (BI) within a healthcare organization can considerably improve operational effectiveness if applied properly. Direct benefits include reduced costs, increased efficiency, optimized catchment areas and network management, improved pay for performance/accountability and better operating speed. 

Getting Underway
No financial analytics journey can start without a solid project roadmap identifying expectations and timelines. Appoint a project manager to oversee the team’s work and lead daily management, while assigning co-leads as well with one from IT and one as the champion of the financial analytics project. This champion needs to understand the vision and be able to work within the political climate and structure of the organization.

When creating a financial analytics project roadmap, consider additional ongoing IT projects that may serve as interdependencies or conflicts. Define the budget and overall timeline. This will drive follow-up steps and selection of team members who have the appropriate timeframe for their work involvement.

Initial project steps should also include distinctly defining the project’s ROI. Focus and specify what the financial analytics dashboard will achieve. With the expected ROI, budget, timeline and project management defined, select the project team. Keep in mind that everyone is not capable of doing analytical work. Attention to detail, perseverance, ability to critique one’s own work, troubleshooting skills, creativity and, most of all, the ability to work well with others are mandatory for healthcare business intelligence work.


Targeting the Right Metrics
Next, select the right metrics. Tailor analytics views to data recipients to be the most effective. Consider how many different definitions can be given to the same data element. For example, discharge time – is it when the patient physically leaves the facility, when the time is keyed into the EHR or when the discharge order was signed? Keep in mind the following:

  1. Understand what data is needed to support a given metric. Some metrics are based on data from one system. Consider percentage of cash collected. To calculate this, you need to know how much total monies were collected in a given time period and which of those monies were cash. While it sounds simple, does “cash” include checks or card payments?
  2. Select metrics defined by a national organization. HFMA has great materials on financial metrics, and other organizations offer definitions for operational metrics and clinical metrics. Using an organization’s definition from a national level will allow you to compare your values to other organizations similar in size and type to your own facility.

Data Selection
When determining source systems, consider how accessible data is, which may depend on its source. Data from a HR system may or may not be updated throughout the day, and that data may not easily match or align with data from your revenue system. Consider data feed schedules, since timely data is critical. Up-to-date data that is equally accurate is the winning combination. Your project team will need to structure testing and validation of selected data and its precise aggregation before presenting the analytics views to a wider audience.

Data Cleansing and Aggregation
Usually, data from different systems is not in the same format. For example, dates are formatted in a combination of ways, but your financial analytics view needs to use one standard way in all its visualizations. Good data aggregation achieves a single unified record made up of data from different systems. Though this sounds simple, most often it is not. The stronger the aggregation process is, the more usability the achieved data set will possess.   

We hope this serve as a helpful starting point for your financial analytics initiatives. Thank you for your time!

Tips for Negotiating with EHR Vendors

Before signing the contract with a new EHR vendor, think about the immediate and future implications on your healthcare organization, end users, workflow, business operations and the patient community. Be willing to consider the following questions when approaching this daunting IT decision:

  1. What is the main goal we are trying to achieve?

    Don’t buy or opt in for additional or added features when you don’t need them for your practice. Additional functionality and available modules can always be negotiated from a pricing standpoint (which you should be able to be lock in for at least two years) as an option exercised at a later date if the scope of the practice changes and there is a need for the additional product. Another thing to remember is, just like cars and furniture, software is always on sale. The level of discount you are able to achieve will depend on a number of factors, including success of the vendor, timing in the quarter or fiscal year and length of agreement you are willing to enter into.

  2. What’s the best way to achieve win-win outcomes in the negotiation with a new EHR vendor?

    Remember that the best executed software agreement is one that both the customer and the vendor feel good about. The goal is for the agreement to be a win-win result. It should provide a quality and supportable product for the medical practice in an agreement that the vendor feels good about to provide the appropriate support. With a win-win agreement, the vendor is much more likely to go the extra mile in assisting the customer when issues arise outside of the normal support process.

    There doesn’t necessarily need to be a bad guy in the negotiating scenario if open and honest communication is on the table during the negotiation process. Both the customer and the vendor are going to having non-negotiable items that they cannot concede on for various reasons. These should be communicated at the appropriate time during the process. Good representation from the right individuals from both a financial and clinical perspective will help to ensure that expectations are communicated for what is required and what the vendor is offering to meet the needs.

  3. What else should you consider when working with a new EHR vendor?

    Reference checks are the key to making this very important decision for your practice. Ask for a minimum of three references and at least one of those references should be a “bad” reference provided by the vendor. Although it may not have necessarily completely been the vendors’ fault for the bad references, it will provide you, the potential customer, with some insight on why that reference failed with the implementation or has not been able to fully utilize the capabilities the vendor is proposing to your healthcare organization. Good references are just that, but take the time to learn as much as possible from them about how they feel they successfully implemented the product. What was their staffing model? How long did the implementation take? Did it stay within the budget parameters? What would they have done differently to make it an even better implementation? Exchange contact information with the good references in hopes of communicating with them further in the future.

Best of luck with your negotiations!

Share Your Voice in the Annual Health IT Industry Outlook Survey

With less than one week until the HIMSS16 Annual Conference begins in Las Vegas, thousands of healthcare IT professionals are finishing up last minute conference preparation. Last year’s show had over 43,000 registered attendees, but that’s not the only figure that stood out. Our HIT Annual Survey conducted at the conference showed noteworthy results regarding industry barriers related to healthcare data analytics.

Completed by project managers, CIOs, IT directors and consultants, last year’s survey revealed that most (51 percent) showed confusion toward what and how much healthcare data to actually collect in data analytics initiatives. A majority (34 percent) also felt that the lack of buy-in across their healthcare organizations was the largest barrier to IT initiatives, including data analytics and achieving meaningful use. The full results from 2015 can be found here.

This year for HIMSS16, we’re excited to gain industry insights again by launching the Fourth Annual Health IT Industry Outlook Survey. This year’s survey presents six questions focusing on healthcare leaders’ top initiatives and concerns for the remainder of 2016. By participating, individuals can enter into drawings for $200 Amazon gift cards. Survey responses will remain anonymous.

Can’t attend HIMSS16 or want to participate in advanced? Not to worry! Take the quick survey here.

Amazon Gift 2016 Outlook Survey

As always, for those headed to Vegas, stop by Stoltenberg’s booth #3621 for prizes, refreshments, meet ups with our executives, and survey live visual results. Plus, help us celebrate our 20 years as strategic health IT advisors on social media with the hashtag #20inHIT.

See you in Vegas!

Quick Tips for Medicaid/Medicare Compliance

Medicare and Medicaid compliance can be a tricky area to adhere to. As such, Senior Consultant, Dick Menard provides the following tips on navigating compliance issues:

Focus on creating process for understanding the requirements as best you can using the proposed rule.  The tricky part is predicting what will change in the final rule, so someone has to monitor the CMS (Centers for Medicare and Medicaid Services) website constantly for updates.  A Google alert works well for this, and there are many special interest blogs that are helpful in interpreting what CMS really intends.  Once the final rule is announced, there is not much time to modify systems.  Also, CMS will issue technical clarifications in publications such as MLN Matters after the final rule has been published.


I suggest making a business requirements document (BRD) using the proposed rule and passing that around to senior hospital management for review.  Sometimes a requirement is so vague that you will have to take a stance and let someone challenge you.  Once you get consensus on what the business requirements are, then you can assess the revenue impact and begin to scope out detail project plans and functional requirements. 

To facilitate moving from business requirements to functional requirements, I recommend creating a business vocabulary.  Make the vocabulary consistent and even color-coded.  This avoids misunderstanding  of what a concept means as more members become part of the team and details stop to emerge.


Stoltenberg Teams with Ohio Northern University on Senior Capstone Projects



Junior Consultant Program 2[1]

Through its Junior Consultant Program and recent participation in the Ohio Northern University James F. Dicke College of Business Administration senior capstone projects, Stoltenberg Consulting teams with ONU to provide business students with unique opportunities to learn the HIT industry.

Find out more about the ONU relationship here, and find out more about the Junior Consultant Program here .