Wednesday, December 21, 2016

Cloud or No Cloud for Your Provider Credentialing?

What exactly is the Cloud? Well, it’s another way to say internet. Chances are you are already using the “Cloud”. When you update your Facebook status, you’re using the Cloud. Checking your bank balance online? You’re in the Cloud again. You are using the Cloud whenever you store and access data or programs over the Internet instead of using your computer’s hard drive.

When it comes to IT solutions in healthcare systems, moving to the Cloud delivers a host of benefits to clinical and non-clinical staff alike.

It used to be the norm that healthcare IT systems required data to be stored and managed on-site. Fast-forward to 2016 and now more than 80% of healthcare organizations are using cloud-based applications of some kind, according to HIMSS Analytics.  Companies that adopted cloud services have experienced 18.80% average increase in process efficiency, and 15.07% reduction in IT spending.

Wondering if it’s time to move your provider credentialing processes to the Cloud? Consider these 4 key questions.

Is it slow or difficult to get new providers up and running on your current system?

Capturing and retaining the best providers is a challenging task in today’s healthcare environment. A recent study by the Association of American Medical Colleges reveals that, by 2025, the US will face a shortage of up to 90,000+ physicians. Onboarding cannot be an arduous task for providers if you expect to retain the best of the best.

How long does it typically take you to get new providers onboarded? Most facilities report a 90 day to 180 day time frame to complete the onboarding process, which starts when an initial application is filled out to when the provider’s file is reviewed by the credentialing committee.  Many facilities have trouble with adopting new tools and are dealing with outdated technology. More than 1500 hospital CEOs say that their number one concern for potential crisis management was technology, system and data-related issues. The end result is slower onboarding and provider data management.

Implementing a cloud-based credentialing system allows providers, hospital administration and credential specialists to access information from any device anytime, markedly improving the provider onboarding time.  Cloud-based credentialing speeds-up your processes, tightens your security, improves your workflow, reduce your paper burden, but above all accelerate your revenue generation from these new providers.

Do you currently have to download and install system updates from your vendor?

The beauty of using a cloud-based credentialing system is that the servers are maintained off-site by the vendor and they take care of them for you freeing up your IT resources for other critical areas. Cloud-based credentialing allows for regular software updates – including security updates – so you don’t have to worry about wasting time maintaining the system yourself.

Upgrades and maintenance are automatic. This is especially helpful when you have neither the time nor the inclination to spend potentially hours upgrading to new software. Data is backed up automatically, and accessibility via the web is usually platform agnostic. Whether you’re on a Mac®, P.C., smartphone, or tablet, you have access to your facility’s information.

Are you behind in maintaining your database, getting the latest software updates and critical functionality because your IT department is too busy?

Save additional time and money by reducing the need for your IT personnel to spend days working on software or server upgrades. Many cloud-based solutions push out automatic updates, freeing up your staff for other projects.

What do you do when your credentialing processes go down, or you can’t access your data? Cloud-based software provides the ability for application monitoring services. AMS monitors availability, uptime and response time for cloud-based credentialing applications. By simulating real-user experience, AMS provide realistic insight into what end-users are experiencing when using the credentialing software. It detects and flags problem(s) immediately, and doesn’t wait for a client to call to indicate they are “down”. This keep you up and running, saving time and money.

For quality purpose and compliance, it is imperative to have the latest software versions for tracking your providers performance and for monitoring any sanctions or exclusion changes that could pose a risk to your patients.

Echo Cloud customers see 60% faster implementation, greater than 99% uptime, and up to 18 months of more current software versions than non-cloud customers.

Do you need a way to centralize your credentialing efforts across many facilities?

Many cloud-based programs allow for, and even encourage, collaboration between departments and employees. By utilizing a shared service, teams can interact, engage and collaborate within different areas of your company. Using the Cloud you can centralize your credentialing across your healthcare system, allowing your organization to work towards enterprise-wide credentialing and universal privileging.

With the rapid pace of change in the healthcare industry bringing both new challenges and opportunities, it’s a great time to evaluate what a move to the Cloud could mean for your organization, patients, and staff – today and in the future. To learn more about Echo’s cloud-based credentialing services, click here.

Wednesday, December 14, 2016

Credentialing and Privileging for Telehealth

This article was originally posted by The Center for Connected Health Policy

Before a practitioner may provide services in a hospital, he or she must have their qualifications evaluated and verified.  This process, known as credentialing, ensures an individual possesses the necessary qualifications to provide medical services to patients. Once a practitioner is credentialed, the hospital engages in the privileging process, which will assess the practitioner’s competence in a specific area of care.

Telehealth providers, despite not being physically located at the hospital they are providing services to, must also go through the credentialing and privileging process for that distantly located institution.  To credential and privilege a physician can be lengthy and expensive, utilizing a good amount of resources.  However, hospitals that have limited access to specialists need to contract with practitioners in other locations to provide virtual care to their patients.  The alternative is that their patients have to travel to receive that care or go without.  Telehealth has helped these institutions provide such services while allowing a patient to remain in his or her community.  In the past, hospitals relied on “privileging by proxy” standards that The Joint Commission (TJC), a hospital accrediting organization, have utilized to make the credentialing and privileging process less burdensome on facilities utilizing telehealth.  The process allowed the hospital receiving services to accept the distant site (where the telehealth provider is located) hospital’s credentialing and privileging decisions.  It cut down on duplicative work and expense.

The Centers for Medicare & Medicaid Services (CMS) identified TJC’s privileging by proxy standards as being in conflict with their Medicare Conditions of Participation (CoPs). In order to participate in and receive reimbursement from the Medicare or Medicaid programs, a hospital must be certified as complying with the Medicare CoPs.  Therefore, TJC’s process was rendered invalid. This created a difficult situation for many hospitals, particularly small and rural entities who could not afford to hire exclusively on-site specialists to service their communities’ needs.

To resolve this conflict while still maintaining safeguards on quality and safety, CMS approved regulations in July 2011 that would allow hospitals (and other health care organizations) to use a similar credentialing-by-proxy process that the TJC had once utilized.  TJC followed suit with similar standards that were approved in December 2011. The approved process is optional for hospitals to use.  Should an institution chose, it may still go through the complete credentialing and privileging process of verifying a practitioner’s qualifications.

However, if a hospital wished to utilize the credentialing by proxy process, certain requirements must be met:

  • There must be a written agreement between the two parties;
  • The distant-site hospital is a Medicare-participating hospital or telemedicine entity;
  • The telehealth provider is privileged at the distant-site hospital;
  • A current list of the telehealth provider’s privileges is given to the originating-site hospital;
  • The telehealth provider holds a license issued or is recognized by the state in which the originating-site hospital is located;
  • The originating-site hospital has an internal review of the telehealth provider’s performance and provides this information to the distant-site hospital;
  • The originating-site hospital must inform the distant-site hospital of all adverse events and complaints regarding the services provided by the telehealth provider.

Many hospitals will likely need to change their bylaws in order to meet the requirements of this process. Some organizations may find meeting these necessary requirements prohibitive in time and resources and choose not to utilize this optional process.

For more information on Echo's credentialing and privileging applications, click here.

Wednesday, December 7, 2016

7 Ways to Support Population Health Management with Contact Centers

Healthcare call centers are profoundly relevant to today’s healthcare challenges. They are a vital tool in meeting the triple aim objectives of improving the experience of care, reducing costs and managing population health.  Call centers are assuming a critical role as patient experience hubs at the center of the healthcare continuum.

Our research shows that call centers are moving from a siloed support function to a critical role as a patient experience hub at the center of the healthcare continuum. Download this Article from AnswerStat The Contact Center’s Revitalized Role for Population Health Improvement, and we will walk you through 7 ways your call center can be at the forefront in supporting population health management.

#1 Integrate First Point of Contact Functions

Consolidate first point of access functions such as scheduling, transfers, physician referral, class registration, physician-to-physician referral, nurse triage, and switchboard into a central contact center communication hub. This will assist the newly insured, support ACO and medical home physicians and create economies of scale.

#2 Make Post-Discharge Calls to Reduce Preventable Readmissions

Your call center can assist in preventing avoidable readmissions by scheduling follow up appointments with a patient’s primary care physician prior to discharge. Enrich the patient experience even more by making outbound calls to recently discharged patients to clarify follow up care instructions, make certain prescriptions have been filled, or to discuss dosage amounts and frequency. The call center and also be used to confirm follow up physician appointments with family members and/or caregivers.  These actions can significantly increase kept appointment rates and potentially alleviate another a return trip to the hospital for the patient.

#3 Re-deploy Your Contact Center as a Trust-Building Resource for Participating Physicians

Ask physicians how you can help them succeed in your network. Ask them how the contact center can provide greater support for their practice. They might just tell you, and create a beginning to a long lasting relationship.

Provide navigation support by coordinating follow up appointments, referrals to specialists or to appropriate classes.  Make referrals and confirm appointments for patients in your Emergency Department who don’t have a primary care physician.  Facilitate physician consults for referring physicians with one-call access to specialists. All of these activities can be coordinated through your call center communication hub.

#4 Become the Communication Conduit to Direct Referrals for Reference Pricing

Employers across the country are taking note of reference pricing; where employer groups are identifying the average price charged for a particular procedure in a given service area and agree to pay only that amount with any overage paid by the insured.

Research and understand reference pricing for each plan in your service area, and enter the participating hospitals into your contact center software. When a patient calls in for a specialty procedure like knee replacement, your call center can refer them to an appropriate physician or hospital covered by their employer’s plan.

#5 Deploy Clinical Triage and Advice to Reduce Emergency Department Utilization

Clinical triage manages emergency department utilization by directing callers to the most clinically appropriate and cost-effective care – whether you’re trying to moderate cost for a hospital, a health plan, a managed care organization, or an ACO. Clinical triage directs the truly “at risk” to immediate emergency care, and redirects the inappropriate use of high acuity clinical services to primary care or homecare. Evidence-based clinical guideline protocols address ACO requirements for evidence-based medicine, patient engagement, and coordination of care.

#6 Shift Your Call Center’s Focus from Transactions to Transformative Experiences

The healthcare contact center is frequently a patient’s first experience with a hospital or health system.  The first three seconds of that interaction are important because they are a strong indicator of patient preference and subsequent hospital selection.

But think about it.  If your goal is to improve transactions, you’ve already lost. The future is about delivering transformative experiences at the first point of contact. It is like the comparison of just serving coffee to the experience you get at Starbucks. Population Health Management requires providers to connect with patients where they are. Think of your contact center as an ongoing connection, a running dialogue with key stakeholders (the patients!) your organization needs you to engage with.

#7 Build or Implement a Plan to Leverage Personalized Social and Mobile Media Opportunities

In addition to strengthening relationships with key stakeholders, the contact center communication hub must integrate with and personalize communications on social media and mobile devices. Social media, geo-location targeting, and mobile communications enable contact center communication hubs to connect with key stakeholders where they already are. With new demographics emerging, Millennials for example, are more likely to communicate via text than are older patient populations.

Now that you know some of the ways your call center can play a vital role in the continuum of care, standardizing on these best practices can transform your call center into a patient experience hub. What to learn more? Click here.

Friday, December 2, 2016

How to Educate Your Providers About MACRA

Guest Post by Dawn Anderson, Product Manager - Medical Group Credentialing & Provider Enrollment; Echo, A HealthStream Company

CMS estimates that between 592,119 to 642,119 clinicians will be affected by MACRA (The Medicare Access and CHIP Reauthorization Act) rule changes that go into effect in 2017. Despite this fact a recent Medscape study found that 28.6% of the physicians that responded to their recent survey said they had not heard of MACRA and an additional 39.2% said they did not know a lot about it. Providers need to be educated about MACRA.

Download our latest whitepaper - HOW WILL YOU RESPOND TO MACRA? Sweeping Changes to Physician Reimbursement and we will walk you through a few things that your providers should know.

The Medicare Access and CHIP Reauthorization Act (MACRA) rule changes go into effect in 2017 with the first payment adjustments taking place in 2019. MACRA has two tracks: Advanced Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS); CMS estimates that only 4 to 11 percent of clinicians will qualify for advanced APMS according to a recent report by the Brookings Institute. This means that most clinicians will fall under the Merit-Based Incentive Payment System (MIPS). MIPs does not apply to hospitals or facilities. CMS recently announced that it will give physicians 4 MACRA options for 2017 that would let them choose how quickly they want to implement MACRA and each option would avoid a penalty in 2019.

MACRA Options

Option #1 allows physicians in the Merit-Based Incentive Payment System (MIPS) to avoid a penalty in 2019 by reporting “some” quality and cost data in 2017, rather than all the data required under MACRA’s Quality Payment Program (QPP).

Option #2 allows physicians in MIPSS to submit the required quality and cost data for just part of 2017. The performance period would not need to begin on January 1, 2017. Physicians exercising this option not only avoid a penalty, but also could potentially earn a modest bonus in 2019.

Option #3 involves submitting performance data for the entire calendar year of 2017, which was the original goal of MACRA. This option allows for the potential of earning a higher bonus in 2019.

Option #4 is to join an Advanced Alternative Payment Model (APM), such as an Accountable Care Organization (ACO).

How will MACRA Affect Your Providers?

MACRA applies to clinicians, not just physicians. MACRA will apply to nurse practitioners, physician assistants, clinical nurse specialists and nurse anesthetists including those in your practice. In the third year, the list will expand to include physical and occupational therapists, nurse-midwives, clinical social workers and clinical psychologists.

MACRA will require outcome reporting. At least one outcome measurement must be tracked for MIPS. Being held accounting for outcomes is becoming an important part in quality assessments. Medicare’s Physician Quality Reporting System (PQRS) already requires doctors to report process measures, for example the percentage of patients with coronary artery disease for whom the physician has prescribed aspirin. The PQRS also allows physicians to select from a small number of outcome measures, but they are not required to select or report on outcome measures.

Next year, under MACRA, PQRS will be replaced by the quality performance (QP) category of the Merit-Based Incentive Payment System, MIPS and physicians will have to choose one quality measure out of a total of six measures to report.

Under MACRA payment is related to patient outcomes. MACRA represents a new way of allotting Medicare Part B payments to clinicians based on patient outcomes rather than quality of services. The MIPS model is budget-neutral with penalty payments for low performers paying for the bonuses for high performers. This means that about half of the participants in MIPs will get a penalty and the other half will get a bonus, and it also means that some clinicians could pay a penalty even if their performance is good, but not exceptional.

A New Toolkit for Educating Providers

The American Medical Association (AMA) has created new online tools for MACRA that walk clinicians and their staff through the details of MACRA, called StepsForward. These tools include a payment model evaluator that projects whether the clinicians will default to the MIPS program and can estimate if they will receive a bonus or a penalty in 2019. The tool points them to educational tools and resources to help them improve those predicted outcomes.

According to the AMA, StepsForward is a practice-based initiative with a goal to provide proven strategies that can improve practice efficiency and help clinicians reach better patient experience, better population health and lower overall cost with improved professional satisfaction.

At a press conference on October 5, AMA President Andrew Gurman, MD, said some modules could even satisfy practice-improvement requirements in MIPS.

The AMA is also offering a podcast series on ReachMD titled “Inside Medicare's New Payment System”. Speakers include none other than CMS Administrator Andy Slavitt. Future episodes will keep providers apprised of changes to MACRA as the program goes forward.

MACRA is rapidly moving forward, so why not take the necessary steps to educate yourself and your providers to prepare for the coming changes. What to learn more about our Revenue Cycle Management solutions? Click here.

Wednesday, November 30, 2016

Quality Onboarding = Quality Outcomes: 5 Tips to Build Strong Physician Retention

While most discussions today are around healthcare reform and value-based outcomes and reimbursements, what the industry is not really talking about is the shrinking physician population. There are approximately 2.5 physicians per 1000 people in the US. It is projected that there will be a physician shortage of 130,600 by the year 2025. With more physicians leaving private practice for hospital-based employment, how can a hospital continue to be competitive and retain its share of this shrinking physician population? With quality onboarding.

According to Cejka Search, 54% of physicians who leave a practice do so in the first five years, with many making the decision in the first three months. This emphasizes the crucial role of the physician onboarding process. Employers need to be sure that their physicians are happy with the hospital’s services and put the physician in the best position to be successful. Here are five tips for successful onboarding and building strong physician retention.

Tip 1: Create an Onboarding Committee

Forming an official onboarding committee is crucial piece of the puzzle. All players who fully or remotely touch activities related bringing the physician onboard should have a seat at the table. This includes, but is not limited to Hospital Leadership, HR, Credentialing, IT, clinical, marketing, scheduling services, finance among others. Every hospital is different in the number of tasks that a physician has to complete and the number of departments that are involved. The more collaboration and coordination there is, the more seamless and efficient the entire process can be. Read how Penn Medicine’s Office of Medical Affairs’ decision to create a multidisciplinary onboarding task force greatly improved efficiency and saved the health system hundreds of thousands of dollars.

Tip 2: Facilitate Communication Anywhere, Anytime, and All in One Place

In today’s world it’s important to be able to have flexible mobile communication. Physicians want to be able to access their professional profile, credentialing information and other pertinent employee data easily and quickly, not to mention having to enter this data only once. Too many times onboarding processes are redundant requiring the physician to enter or submit his or her information more than once, which leads to frustration. Some processes are still paper-based. Even more frustrating!

Providing mobile responsive access where they can enter all their information at once from their initial application to periodically updating their professional profile, and being able to view any pending tasks (medical licenses renewal, CMEs, etc.) helps physicians manage their professional data in meaningful way so that they can concentrate on their real purpose – delivering quality patient care.

Tip 3: Centralize Enterprise Onboarding

As mentioned before, onboarding touches many departments throughout the hospital system. Having a centralized system in place where all dependent departments can view, be notified of tasks and take any actions required is key to shortening the onboarding time and getting the physician up and running faster so that he or she can start seeing patients.

Research from The New England Journal of Medicine confirms that hospitals typically lose $150,000 to $250, 000 per provider per year during the first three years of employing a physician. A significant portion of this revenue is lost in the onboarding process with lengthy delays in credentialing approvals, payer enrollment, EHR access initiation, photos, access badges, website directories and other activities that prevents hospitals from receiving revenue from actual patient appointments.

An online portal can be used throughout the enterprise to consolidate tasks and centralize communication for all onboarding activities. Connected departments can view workflows and quickly manage their required onboarding steps and provide supporting information such as task completed, due dates and other comments. This enterprise view of the onboarding process facilitates cross-departmental collaboration and accelerates a hospital’s the time to revenue.

Tip 4: Develop a Physician Liaison Program

The role of a Physician Liaison has emerged as a vital marketing position for many specialty practices. It is also a vital role for hospital organizations to have in order to drive referrals to their employed specialists. A physician liaison program is designed to increase patient referrals, strengthen relationships with providers and staff, and provide valuable customer service. In a recent Clinical Advisory Board Physician Survey, 66% of physicians said they were "very unlikely" to change their current referral pattern without a physician liaison actively communicating and building relationships with them. A strong liaison program builds a foundation of strong referring relationships driving revenue and market growth, and keeps your pool of physicians happy and engaged.

Make sure your hospital has a good physician liaison customer relationship management system (PL-CRM). Such a system should allow for quick access to physician profiles, be able to target specific physicians with membership tools, and easily track and document visits with potential referring physicians. Engage potential referrals with welcome letters and visit follow-up letters and generate reports for hospital leadership that track the success of your referral program, all automated with a PL-CRM.

Tip 5: Promote Physician Engagement

Finally, it is important to ask for and receive feedback from your physicians to keep them engaged in the process. Continuing to survey your staff regarding their onboarding experience, hospital services, clinical practices, and other touchpoints is vital to ensure your organization knows about potential issues to quickly address any problems. Physician retention, as well as employee retention in general, is directly connected to how well staff feels you listen to them and that their feedback is used to create a better working environment.

Setting your physician up for success means success and continued growth for your healthcare organization. This ultimately translates into better patient care and quality outcomes as physicians are in an environment where they can more readily focus on delivering patient care rather than taking care of administrative needs. It all starts with quality onboarding. Following these five tips will ensure your hospital continues to be competitive and can retain its share of quality physicians.

Want to learn more? Click here.

Wednesday, November 23, 2016

Top 3 Reasons for Hospitals to Include Online Patient Ratings in their Provider Directory

Most people go online to do research for just about every aspect of their lives, from finding a reputable contractor for home improvements, to which restaurants to eat at or which hotels to stay in while on vacation. We all use the Internet to see what others suggest. Think Yelp or TripAdvisor.

Why let other third party sites be your voice to the customer? Why not have your own voice?

Our research shows that 67% of adults wish they could find more comprehensive information about doctors online and 5 out of 9 patients consider an online review to be important when evaluating a new physician. As reimbursement models evolve patient experience metrics will continue to be an important performance indicator.

Why not take the lead in engaging with patients to make sure they feel confident about the healthcare choices they make? Listen to our webinar recording “Enhance Your Provider Directory with Online Patient Ratings” for a research-based summary of why online patient ratings are so important to make available to prospective patients.

Here are our top three reasons to include online patient ratings in your physician finder or Provider Directory.

#3 Improve Online Visibility of Services 

Search engine optimization (SEO) experts agree that user-generated content, such as reviews, is heavily weighted by search engines. This means reviews are often the first impression a patient will get of a medical provider or hospital when they search online.

Simply put - search engines love online reviews because their users do.

According to Google, they exist to serve up the most useful and relevant information. In a local search, health consumers are often seeking providers and services nearby and are ready to take action. An online search drives nearly 3x as many visitors to hospital sites compared to non-search visitors, and 44% of patients who research hospitals on a mobile device scheduled an appointment.

Naturally, then, search engines like Google reward websites that provide online reviews and other valuable information to empower those decisions. Make sure your hospital and your providers are found at the top of this list when patients are making important healthcare choices.

#2 Increase Referrals and Grow Practices

Hospitals are acquiring medical practices at an increasing rate and concurrently, about 60% of family doctors and pediatricians, 50% of surgeons, and 25% of surgical subspecialists—such as ophthalmologists and ENTs—are employed (Rosenthal, 2014). Increasingly, to assure the financial health of owned practices is to nurture the fiscal well-being of the entire healthcare enterprise.

In days past, the reputation of the doctor was assumed. No one questioned it. Doctors were esteemed members of our community, society, and local culture. If you had an issue, you went to the family doctor. It was an expectation, just like getting married in your mid- to late-20s and having 2.5 children.

One of the biggest changes in the healthcare business is the consumerization of healthcare. Before, healthcare practitioners did not have to think of how the public viewed them, other than internally in their practice or at the hospital with surveys sent out to patients about the care they received. The new reality is that people have more freedom to choose – their plans, doctors and how they spend allocated healthcare and wellness funds. So why not maximize your piece of this consumer healthcare pie?

More than a quarter of survey responders said they would be willing to go “out of network” for a physician based on favorable information from Internet websites and online referrals. Online resources are especially important for elective and specialized healthcare services.

A referral by a primary care physician is important, but consumers are increasingly interested in third-party recommendations available via the Internet. That’s why online patient ratings are so important to a hospital or doctor. Online patient ratings provide an independent “consumer” validation about a provider, services provided and overall experience.

#1 Delight Patients at the First Touchpoint 

Anyone can provide a generic transaction. It requires "intentionality" to deliver a transformative experience.

The number one reason hospitals should incorporate online patient ratings into their provider directories is to create a memorable patient experience. Delighting patients by allowing them to see the comments of other patients is key to them choosing a provider or which hospital to go to. Sometimes it’s the simple feedback like did the patient feel comfortable in the waiting area, did they feel welcomed and safe in the exam room and did the staff and provider show kindness and consideration during the appointment. Did the physician sit down with them and really connect? Did they feel heard and understood? 

Patient satisfaction is not about bending to every patient’s every desire. It is about making a sustained and genuine effort to provide skilled and compassionate care. Providing transformative experiences care is not all about one provider, but it is the sum of every interaction a patient has with the healthcare organization.

Allowing patients to see reviews about the provider and his or her facility is one important way to make a patient feel welcomed and that you sincerely care about their experiences and their opinions. Providing online reviews and the ability for patients to write a review is a way to engage the patient at the beginning of the continuum of care.

Now you know three very important reasons why you should include online patient ratings in your provider directories. By engaging your patients from that first touchpoint, you can strengthen your online visibility; deliver a stream of patients to your participating providers, who are increasingly employees; and deliver the first part of a transformative, memorable experience that will delight patients and strengthen preference for your organization. All the while, you are increasing patient satisfaction scores — a key performance indicator that impacts your organization’s compensation.

Want to learn more? Click here.

Wednesday, November 16, 2016

3 Ways to Reduce Avoidable Hospital Readmissions with a Patient Experience Contact Center

During 2015, one in five elderly patients was back in the hospital within 30 days.  Some 78% of acute care hospitals — 2,610 of them — were assessed a penalty for excessive avoidable readmissions. Those penalties totaled $428 million. (Robert Wood Johnson Foundation, 2013)

Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Healthcare Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion — $17 billion of which is considered avoidable.

The Readmission Reduction Program, created under the Affordable Care Act in 2012, initially targeted readmissions for patients with acute myocardial infarction, heart failure and pneumonia. In 2016, CMS expanded the target conditions to include chronic obstructive pulmonary disease, total hip arthroplasty, total knee arthroplasty, coronary artery bypass graft and additional pneumonia diagnoses.

In addition to the readmission penalties, hospital reimbursements from CMS are determined by how well the hospital is meeting certain quality criteria including clinical care, safety and patient/caregiver experience. How a hospital handles a patient after discharge can have a dramatic effect on their overall reimbursement.

Enter the patient experience contact center. Yesterday’s call centers processed transactions. Today’s patient experience contact centers are the new communications nerve center. They deliver intentionally memorable experiences that mitigate risk, solidify loyalty and reduce unnecessary readmissions.

Download our case study on how St. John Providence Health System reduced preventable readmissions.  It summarizes how their contact center was central to their solution for reducing avoidable readmissions.

  • Readmission rate declined from 25% to 15%
  • $2.5 million fine from CMS was reduced by $1.9 million over two years
  • Their percentage of primary care physicians with patient follow-up appointments within 7 days of discharge climbed from 30% to 85%. 

The St. John Providence Health System case study includes 4 action steps, 6 success secrets, and 5 lessons learned. Here are three actions you can take now.

# 1 - Create a Centralized Communication Hub 

A key component of discharge care management is scheduling patients' follow-up appointments with primary care physicians within 24 hours of the time they leave the hospital. Hospitals shouldn’t leave that important follow-up visit to chance. Follow-up appointments occur within 7 days of discharge to catch any medical problems before they require acute-care services.

Hospitals should do everything they can to ensure discharged patients keep that first follow-up appointment, including reviewing patients' insurance benefits for appointments and arranging transportation to and from appointments.

It is no longer just about the phone. Call Centers have become Contact Centers, using multiple communication modalities including phone, email, Web-response, and text, to enable patients to ensure that they have engaged the patient in the next steps of care.

#2 - Engage the Caregiver in addition to the Patient

Discharge from hospital to home requires the successful transfer of information from clinicians to the patient and family to reduce adverse events and prevent readmissions. Engaging patients and families in the discharge planning process makes this transition in care safe and effective.

The Agency for Healthcare Research and Quality in their IDEAL Discharge Planning Guide lists five key areas of discussion with the patient and caregiver during discharge to prevent problems at home:

  • Describe what life at home will be like
  • Review medications
  • Highlight warning signs and problems
  • Explain test results
  • Make follow-up appointments

Before the patient is discharged, get the patient’s permission to also contact their caregivers. These are family members, loved ones, neighbors, friends or other trusted individuals whom the patient identifies as appropriate to help them confirm follow-up appointments and if necessary to transport them to medical appointments.

St. John Providence Health System implemented this approach. The result was an increase in their post-discharge kept appointment rate to an enviable 87%. 

#3 - Follow-up with the Patient’s Physician

Not only is it important to make and confirm a patient’s follow-up appointment, you should close the loop by contacting the physician’s office to make sure the patient kept their appointment. If the patient failed to make his or her follow-up appointment, then another round of communication with the patient and/or caregiver is necessary.

Perhaps they didn’t have transportation; perhaps they were confused about the date, or perhaps they simply forgot the appointment. The key is to try to eliminate these obstacles, so that the patient receives the care they need to prevent them from being readmitted to the hospital.

Now you have three initial steps you can take to begin to reduce avoidable readmissions with your patient experience contact center. By standardizing on best practices, you can significantly reduce or eliminate readmission penalties and can concurrently increase your quality scores to earn higher reimbursements. Want to learn more? Click here.

Wednesday, November 9, 2016

3 Facts About Provider Enrollment That Can Affect Your Credentialing Process

Guest Post by Meg Terry, Senior Vice-President of Corporate Strategy; Echo, A HealthStream Company

Change is inevitable, progress is not.  Healthcare organizations are certainly not immune to change and doing business the “old” way makes it harder to progress. Traditionally, provider credentialing and provider enrollment have operated as separate functions within a hospital or health system. Organizations that are successful have integrated these two processes in order to more efficiently manage the organization’s revenue cycle for continued growth.

Listen to our webinar – Top 10 Provider Enrollment Survey Result Discoveries, and we’ll walk you through the facts about provider enrollment that can affect your credentialing process and why change is necessary.

Fact #1 – Provider Enrollment is a Critical Component of Provider Onboarding

A growing number of U.S. doctors are leaving private practice for hospital employment and only one-in-three will remain independent  by the end of 2016. This industry shift has placed a new burden on credentialing and enrollment professionals to integrate their activities and streamline the process. While the hospital may be paying a salary to a new physician beginning on Day One of employment, it cannot start billing and receiving reimbursements for services until the physician has been completely onboarded. This includes both finalizing his or her credentialing as well as enrolling the provider in commercial and government health plans.

Regardless of when a provider starts working at a hospital or medical group, until the health plan awards the provider an effective date of participation claims may be denied or held. Lost revenue can result in hundreds of thousands of dollars in a matter of weeks.

To avoid payment interruptions, it’s important that you have a system in place that can initiate both the credentialing process and enrollment process at the same time so there is minimal time delay between approving a provider’s credentials and completing the enrollment process.

Fact # 2 – Efficient Revenue Cycle Management Depends on an Integrated Enrollment and Credentialing Process

Echo's latest research conducted in conjunction with Decision Health indicates that provider enrollment professionals are realizing the financial impacts and inefficiency of manual provider enrollment processes. One of the biggest challenges faced is collecting all the provider data necessary to submit payer applications. For example, manually submitting a Medicare application can take up to 90 days to process. Using an automated online process that integrates with your credentialing database can accelerate the enrollment application process saving you time and money.

On average, about 18 payer applications need to be processed for every provider. If your facility has 20 providers and you spend about one day each collecting data and processing their enrollment applications, you spend roughly 3000 hours a year just processing paperwork! Let’s say that a busy provider bills around $5000 a day. So for the 90 days that this provider is not fully enrolled, you are potentially losing $450,000 in billable revenue.

In contrast, working in tandem with your credentialing system, the pertinent provider data is already collected and the 90-day process can be cut to 10 days or less, reducing your lost billable revenue significantly and saving you time.

Fact # 3 – Happy Providers, Happy Life!

Seriously, physician retention is another important topic. Physician satisfaction equates to success and continued growth for your healthcare organization. This ultimately translates into better patient care and quality outcomes as physicians are in an environment where they can more readily focus on delivering patient care rather than taking care of administrative needs. What better way to promote strong physician retention that to make “standard” employee practices simple and easy?

With regards to enrollment and credentialing, providers need a streamlined, turn-key system where they are only asked for information one time. Collecting all data required once and entering it in one place makes the pre-employment process go smoothly; less time asking for and handling duplicate information and mitigating the chances of entering incorrect data with a second process. Having a centralized “portal” for providers gives them a set place to view all of their activities and see where they are in the credentialing and enrollment process.

Hopefully you can see from these 3 facts of just how interconnected provider enrollment and credentialing are. Progress can be made by integrating both functions into one automated system, so you can make your provider enrollment process less time consuming, maximize resources, and better control your revenue cycle. What to learn more? Click here.

Wednesday, November 2, 2016

The PSI Profile - 3 Ways to Utilize Consumer Feedback From Social Media for Provider Assessment

How many of you know your credit score, or even check to see what it is?  Ever wonder what is a good credit score, and why this little three-digit number is so crucial to your financial well-being?

Having a less than stellar credit score can impact whether or not you qualify for a loan, get a lower interest rate or insurance premium, get that job offer you have been wanting, and even have an effect on whether or not you can get your utilities turned on.  Your credit score defines how trustworthy you are from a financial perspective, but also from a personal one too. The more responsible you are in paying your bills on time the higher your credit score. Wouldn’t it be interesting if you had a score by which you could judge the “responsibility-ness” of a Provider?

Consumers are increasingly voicing their patient-physician experience online – and they’re being heard by providers nationwide. Our partners at Binary Fountain have created the first-ever standardized, real-time physician social index (PSI) score based on attributes patients consider when choosing a physician. Binary Fountain collects data from over 100+ online sources, including social media, review sites, advocacy forums, blogs and other sources. PSI Scores like credit scores are scaled from 100 to 999. Scores are weighted against the author’s rating, volume of feedback, richness of source content, and the source’s influence on online audiences.

Listen to our Webinar EchoPSI Profiles: Monitoring Patient Feedback on Providers to discover how PSI shares the patient’s experience and adds their voice to support your organization’s provider analytics activities, and we will walk you through how best to utilize the data from your providers’ social indexes.

First and foremost, a PSI can be used as progressive benchmarking tool. You can employ the information to do comparative reporting between providers of similar specialties to identify best practices and thresholds. This data can be included in initial and re-credentialing activities, as well as Ongoing and Focused Professional Practice evaluations (OPPE and FPPE). Compare patient experience metrics across locations within your organization, and against local and national healthcare groups can help your organization gain a competitive advantage.

Second, data can be used in finding areas for improvement to take action on that can increase patient satisfaction. Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys ask consumers and patients to report on and evaluate their experiences with health care. These surveys cover topics that are important to consumers and focus on aspects of quality that consumers are best qualified to assess, such as the communication skills of providers and ease of access to health care services. Results from the CAHPS surveys are used by Center for Medicare and Medicaid Services (CMS) in determining Diagnostic Related Group payment for each hospital.

Letter grades are assigned to key performance indicators such as amount of time spent with patient, clarity of instructions, thoroughness of examinations and more in the PSI profile based on online social feedback. Your hospital can utilize this information to identify trends, examine root causes and take action on those crucial items that can affect CAHPS scores and ultimately hospital reimbursements.

Finally, a provider’s social index can be used to promote positive feedback, and to turn satisfied patients into brand champions. What areas are your providers especially good at? Is it "a great bedside manner" or “takes time to explain things and puts patients at ease”? Then make sure their stories are told across the organization.

When Patients Use Online Reviews
Word-of-mouth marketing is still important to healthcare audiences. The informal conversations among family, friends and co-workers will continue to be an important driver of referrals. However online reviews of healthcare providers are even more important. In fact, the number of patients using online reviews jumped 68 percent from 2013 to 2014, one survey found. The reality is, however, online reviews are not only the accepted form of “informal referral” they actually are a driver of whether a patient will select your services.

Social media has a powerful presence.  Patients may not always tell you that they had a good or bad experience, but they will definitely tell their friends and family. Slow service and bad food reviews can definitely hurt a restaurant’s reputation online, so don’t get caught off guard with your hospital's reputation from your providers’ social index.

Now that you know what a PSI is and what you can do with it, why not take the necessary steps to ensure your providers’ “social credit” scores are a good as they can be. What to learn more? Click here.

Friday, October 28, 2016

Is Your Facility Ready for MACRA?

Yikes, another acronym! What is MACRA? It stands for Medicare Access and CHIP Re-authorization Act (MACRA) and is part of the Centers for Medicare sweeping payment reforms started in 2015. MACRA created the Quality Payment Program that rewards physicians and clinicians for giving better care, not just more care, and goes into effect in 2017.

How is MACRA different from Hospital Value-Based Purchasing?

The Hospital Value-Based Purchasing Program rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on quality of care. MACRA is focused on improving the way physicians and clinicians are paid, to incentivize quality and value of care over quantity of services. Simply put,  HVBP focuses on the payments hospitals receive from CMS and MACRA focuses on payments physicians can receive from CMS. How does this affect you? Well if the majority of your physicians are hospital employees, then your facility must manage and account for both payment incentives in order to optimize your overall reimbursements from CMS.

Download our latest whitepaper - HOW WILL YOU RESPOND TO MACRA? Sweeping Changes to Physician Reimbursement and we will walk you through 3 ways your facility can prepare for MACRA.

#1. Educate Your Providers

It’s important that not only is your administration aware of the details surrounding MACRA, your providers should be too. Take the time to sit down with them to discuss how MACRA will affect them and how you can work together to maximize any and all reimbursements. MACRA will be implemented through a framework called the Quality Payment Program, which offers clinicians two paths for participation: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). Most Medicare participating physicians will initially utilize MIPS. The MIPS breakdown is shown below:

Data from HealthStream/Decision Health Whitepaper

50% of the MIPS score is based on quality. How does your organization define quality? Best practice is to get your providers involved in defining and setting the Quality goals that they will be measured on. Buy-in from both the clinical and administration teams will ensure success in meeting these new CMS payment programs.

#2. Identify and Track High-Performance Areas in Quality 

First, it's important as we discussed earlier to identify those quality measures you want to define as your high-performance areas. To help you do this CMS has outlined how they will score the Quality Performance category:

  • Each quality measure will receive a score of 1-10 points compared to an historical benchmark (if available). Zero points for a measure that is not reported
  • A bonus will be rewarded for reporting outcomes, patient experience, appropriate use of technology, patient safety and EHR reporting
  • Measures will be averaged to get a score for the category

As you can see they are looking for much of the same “quality” areas that are currently tied to the HVBP program including clinical outcomes, and patient safety.

Second, since your facility already has to comply with the Joint Commission's Ongoing and Focused Professional Practice Evaluation (OPPE and FPPE) regulations why not utilize this same reporting to track your MACRA quality measures.  A good OPPE analysis should provide a summary of how your physicians are meeting the specified clinical/patient safety outcomes with benchmarking, a measure of patience experience including CAHPS survey scores and provide a provider's social index which is an indicator of how the provider is viewed online in social media.

Example of an OPPE Analysis and a Provider Performance Profile Report

#3.  Review your Quality Resource and Use Report (QRUR)

The Quality and Resource Use Report (QRUR) shows how your payments under Medicare Part B fee-for-service (FFS) will be adjusted based on quality and cost. The report includes performance information from measures reported through the Physician Quality Reporting System (PQRS) and uses Medicare claims to calculate additional quality outcome measures and cost measures. Performance is compared to benchmarks of similar peer groups. Data in the QRUR is used by CMS to calculate your Value Based Payment Modifier (VBPM) and subsequent payment adjustments (positive, negative, or neutral).

Past QRURs can identify opportunities for improvement and also help you point to performance indicators that should be monitored and tracked with your OPPE analysis. Having your OPPE analysis and QRUR in sync can help you optimize your reimbursement payments for your providers and for the hospital as a whole.

Now that you know what MACRA is and how your facility can prepare for the changes, why not take the necessary steps to ensure your providers are in sync with the quality goals desired and that you have a good performance monitoring plan is in place. What to learn more? Click here.

Wednesday, October 26, 2016

3 Ways a Proper OPPE Analysis Can Improve Performance and Impact Your Hospital Value-Based Purchasing Reimbursements

Guest Post by Lisa Rothmuller, Director of Corporate Strategy; Echo, A HealthStream Company

Dinner with family and lunch with co-workers are the breaks from our busy schedules that we all cherish. Good food, friendly company, and great service is what we all aim for during these outings. While we can generally pick a restaurant with good food and we mostly have a say in the friendly company that we invite, it is the third factor of great service that we often leave up to chance.

We all wish for great service but there is no doubt that we have all experienced both fantastic and poor service while dining out. Both of these experiences play a role in our decision to return to a restaurant. If we experience great service, we’ll continue our patronage to that restaurant; if we experience poor service, we’ll caution our family and friends about visiting that restaurant.

While excellent service is not always on the top of the list for why to re-visit a restaurant, it is these return visits that lead to consistent revenue and growth for a restaurant. The same rings true for healthcare facilities. Most of us hope that we don’t need to visit a doctor or hospital often, but during those trying times, we would like to know we will receive the best quality of service.

With quality in mind, The Center for Medicare and Medicaid Services (CMS) launched their Hospital Value-based Purchasing (HVBP) Program in order to set performance standards and reward acute-care hospitals for the quality of care they give patients. CMS is basing the level of reimbursements on measured performance scores as they relate to the quality of care.

Download our new infographic - Value-based Purchasing and OPPE: The Quality Connection and we will walk you through 3 ways you can utilize OPPE measurements to improve your hospital’s performance and ultimately your HVBP reimbursements.

# 1. Identifying Best Practices 

Evaluating every provider is a hefty task. Especially if you work within a health system that employs thousands of health care providers. Capturing all of this data not only helps determine which of your doctors are performing well, it also allows you to track trends that may be used to create new practices within the organization. For example, if a provider, or group of providers, is consistently showing a lower ALOS than the group or national benchmark, exploring the reasoning behind this data can lead to having this practice adopted system wide as a new standard of care.

# 2. Uncovering Areas of Improvements 

While we may not like to admit it, we all have areas where we can improve and the same is true within health care organizations. The ongoing discovery of these areas needing improvement and developing improvement processes, demonstrates that your organization is dedicated to quality patient care and safety. Some of their performance measurements may be due to the need for additional training or mentoring. If a provider’s performance is showing increases in adverse outcomes, they may need additional proctoring in a certain clinical protocol to refine their skills. Having a system in place that can quickly identify these areas and put an action plan in place is crucial for success. Doing this ensures that your providers are delivering the highest quality of care. The result can have a major impact on your Clinical Care score for HVBP reimbursement.

Performance Profile Example

#3. Incorporating Patient and Caregiver Feedback

The patient’s opinion matters whether it is positive or negative. OPPE measurements capture provider’s clinical knowledge, patient care outcomes, professional skills, and areas of improvements. CMS is also looking to hold organizations accountable for patient and caregiver experience. To obtain this data, health systems need to make sure they are evaluating CAHPS scores and also using tools to evaluate online reviews for providers that can be obtained detailing how a patient felt about his or her experience and if they would recommend that provider or not. A good system can collect these performance indicators in a single dashboard for a comprehensive assessment.

Gathering and evaluating all of this data is daunting, but proper analysis and action plans can be the key to maximizing your Value-Based Purchasing reimbursements. Now you have the tools to know how to better integrate your OPPE measurements into the current CMS value-based scores. By creating best practices, continuing to make improvements in quality of care and listening to your patients you can make sure that your hospital is maximizing its monetary rewards.  Want to learn more? Click here.

Wednesday, October 19, 2016

4 Tips for Accelerating Provider Enrollment

Don’t let this happen to you…

You acquired a new 10-physician practice on January 1st. All 10 immediately began seeing patients on your behalf, and your hospital began paying these physicians their agreed-upon salaries and benefits. It is now April, and none of the physicians has yet completed the full Provider Enrollment process. The physicians have collectively generated almost $4 million in charges for which your hospital will never be reimbursed by payers, and you are facing a stunning write-off for the first half of the year.

Has a version of this scenario played out in your organization? If so, you are not alone.

For years, hospitals have considered Provider Enrollment a back-office function. It is separate from the provider credentialing process but shares many of the same characteristics - it is complicated, redundant, and time-consuming. The enrollment process may cause frustration to providers and administrative staff alike, but it is not traditionally considered a strategic function worthy of attention or added resources. However, a series of new industry developments has greatly escalated the importance of the enrollment process. Unfortunately, many healthcare leaders are only realizing this as they incur significant and surprising revenue losses, and the result is that hospital leaders are now scrambling for better solutions to this new administrative nightmare.

Our research shows that a high percentage of those who manage the Provider Enrollment function are struggling with the effectiveness and efficiency of their current process. Their top priority in this area is to reduce the time it takes to enroll providers. Download our new infographic - The Inefficiency of Manual Provider Enrollment Application Processes, and we will walk you through 4 ways your organization can accelerate your provider enrollment process.

#1.  Automate Your Application Forms

One way to speed up the process during the initial provider enrollment is to make sure that your enrollment applications can be automated with pre-formatted payer forms. Every payer has their own unique set of data required to enroll a provider. The more of this information that can be pre-populated when filling out the initial application the quicker the application can be submitted. An added bonus would be to have your enrollment process integrated with your credentialing process so that all of your individual provider information can also be uploaded to the enrollment application forms.

#2.  Integrate with PECOS 

What is PECOS? PECOS (Provider Enrollment, Chain and Ownership System) is an electronic portal sponsored by the Center for Medicare and Medicaid Services that supports the Medicare Provider and Supplier enrollment process by allowing registered users to securely and electronically submit and manage Medicare enrollment information. The PECOS submission can be automated with software functionally that allows for direct data exchange between your system and the PECOS electronic portal. A direct exchange will ensure data accuracy and faster billing.

#3. Integrate with CAQH

What is CAQH? CAQH (Council for Affordable Quality Health Care) is a non-profit alliance of health plans and trade associations, developing and leading initiatives that positively impact the business of They host a universal credentialing database for health care providers.

How does it work? A provider requests participation in a network that accepts the CAQH application. The health plan initiates an online account for the provider. The online application is completed and submitted to CAQH along with several other supporting documents.  Once the application is complete, any insurance company that accepts the CAQH application can access the provider’s information, expediting the enrollment process.  The provider information typically needs to be updated every 120 days.

Many health insurance plans today are signing on with CAQH. Having the ability to directly integrate with their database to submit and update provider data allows you access to multiple plans at once, submit ONE application, saving you time and significantly increasing the efficiency of your enrollment process.

#4. Automate Common Payer Transactions such as EDI, EFT, and ERA

The average healthcare provider works with 25 payers. That means a lot of paperwork just to get paid. As we discussed earlier, each payer requires a unique set of forms, procedures, and data to be submitted in order to enroll for Electronic Funds Transfer (EFT), Electronic Remittance Advice (ERA), Electronic Data Interchange for Claims (EDI) and other common provider-payer transactions. When providers make minor changes to their enrollment information, they must submit these forms again.

Traditionally, time is wasted dealing with paper forms, correcting manual errors, and tracking down the status of enrollments. By Streamlining your process with an automated payer transaction system, providers can fill out a simple online form once and the enrollment data is delivered to all payers from an online list with a single click. The result? Less paperwork, faster payment.

Now you have the tools to know how to significantly accelerate your provider enrollment. By standardizing on paperless best practices, you can make your provider enrollment process less time consuming, maximize resources, and better control your revenue cycle. What to learn more? Click here.

Wednesday, October 12, 2016

5 Things to Accelerate Your Credentialing Process

Please raise your hand if you feel like your credentialing process is a bit like applying for a new home loan!

When you start the home loan process you are hit with filling out a lengthy application with all your personal information since birth, having to verify your employment history, outstanding debts, provide copies of your bank statements, past tax filings, obtain a credit report, give a blood sample (not, but it feels that way) and more, killing any excitement you had about your potential new home. As a new home buyer its daunting enough to have to gather all this information – never mind knowing that your loan can take upwards of 45 days to process regardless of your good history and credit score, and you could be denied by an underwriter.

Well there is good news! Physician credentialing doesn’t have to be as daunting as the home loan process. With the right tools at your disposal you can quickly and easily finalize all the required data and approvals all without delays. Download our Ultimate Guide to Paperless Credentialing, to discover opportunities to expedite provider credentialing while we will walk you through 5 things to avoid. Here we go.

#1. Hard Copy Applications

Different from applying for a home loan, credentialing applications should be done online, not on paper. An online application will accelerate your operations, ensure accuracy and completeness, reduce errors, and requests for missing information. Eliminate time-consuming data entry with a secure portal to collect provider information, the ability to download the information directly to your database and automated data checks to assure complete and accurate data. An online application process will reduce the time it takes to get back applications during your biannual re-credentialing. Speaking of re-credentialing, the ability to pre-populate online applications with current provider data will improve response time and increase provider satisfaction.

#2. Inefficient Provider and Interdepartmental Communications

Another area that can delay the credentialing process is communicating with providers as to what their tasks are and how to complete them. One way to avoid delays in communication and time to complete tasks is to utilize a provider portal. A provider portal is a one-stop dashboard for a provider to view and act upon their multiple tasks through a smart phone, tablet or laptop. A portal enables providers to quickly view and manage all their information.

Full onboarding of providers includes interactions with different departments, not just credentialing. HR, IT, Marketing, Clinical, Scheduling and others all have tasks that are associated with getting the provider up and running and seeing patients. Being able to centralize communication with all of these departments will make the onboarding process more efficient. Facilitating interdepartmental communications with a system whereby each department can view workflows and quickly manage their respective onboarding steps will accelerate the enire onboarding process.

#3. Manually Verifying Data from Primary Data Sources

There are many credentialing data sources that need to be verified including licensing, state boards, NPDB, DEA, provider affiliations and more. Contacting each of these sources manually even with an email can be a slow process, especially waiting for a response. Why not access these sites automatically, query each site for the desired information and have the results returned to you almost immediately? Not only do you have to verify licensing and certifications, but you also have to check for sanctions, exclusions and disciplinary actions on your providers. Integrating with all of these sites automatically will prevent major delays in data acquisition and significantly decrease your credentialing completion time.

#4. Manually Tracking Privileging and Peer Review Activities

Are your department chairs review a manila folder full of credentialing papers? How much time does this take and how fast can they get this done with their busy schedules? What if you had an automated process to electronically assess the provider, review the initial and re-credentialing provider data, grant or comment on clinical privileges, and take immediate action on the file. How much time would that save?

Just like with provider assessment, peer review can be a lengthy process if one is required to physically write a report on every case. Why not provide a customizable form to track performance indicators? Online tracking mechanisms provide timely and more effective closure to open reviews, improve patient safety through the automatic generation of reviews, eliminate manual form errors by allowing for required fields, provide selection criteria and improve communication among participants of the peer review process, reviewers and the Quality Department.

#5. Not Proactively Tracking and Monitoring Appropriate Performance Measures

The Joint Commission requires hospitals to set OPPE standards. The value of OPPE depends on the measures selected by the medical staff, how well those measures represent activities that reflect the quality of care and performance, and how effectively the resulting information is used. Utilizing an online dashboard where all main performance indicators can be viewed is key to having visibility to the level of performance of your staff. Such a dashboard can be used to automatically track patient data such as admissions, mortality, and average length of stay, which can be used to address delivery of optimal care, and safeguard ongoing reimbursements. Collected data can be utilized to measure your practitioners against industry standards on the national, state and enterprise levels. Organizations that provide ongoing computerized access to data have found that practitioners will look at their own data and proactively implement changes to their practices especially when they are shown data that they are not performing to the same level as their peers.

Now you have the tools to know how to significantly speed up your credentialing process. By standardizing on paperless best practices, you can make your credentialing process less daunting, minimize delays, shorten your credentialing time and provide more value to your organization. What to learn more? Click here.

Monday, October 3, 2016

Where Is Provider Credentialing Headed?

An Interview with credentialing expert Meg Terry, Senior Vice President, Corporate Strategy at Echo,     

A HealthStream Company 

Article was first Published in Provider Advisor Magazine, Q4 2015

How do you see Physician Credentialing changing over the next 2-3 years?

I think we will continue to see an increased emphasis on reviewing and assessing clinical competency when making initial credentialing, re-credentialing, and privileging decisions. Clinical privileging will rely on evidence-based methodologies to demonstrate that the provider has received the appropriate education and training to diagnose and treat their patients.

Another area is the expansion and integration of new data sources, including national data such as the CMS open payments database and the Physician Quality Reporting System (PQRS). Particularly with PQRS tying reimbursement to quality measures,there will be a renewed emphasis to assess thequality of care being provided.

Finally, as hospitals and medical groups are being acquired and merged, the CVO (Centralized Verification/Credentialing Office) will continue to play an important role in streamlining credentialing for health systems, including those that cross state lines. Echo’s suite of solutions provide methodologies to automate and consolidate many of these processes so the medical staff services professionals and physician leadership can focus on the data rather than on the data collection process.

Currently, various aspects of physician onboarding (including credentialing) are being handled in multiple areas of a hospital or health system. What are some of these processes that could be consolidated under the umbrella of “physician onboarding?”

The provider onboarding process, which usually takes 90-180 days, includes several departments within a hospital or health system, including Human Resources, Credentialing Provider Enrollment/Contracting, IT, Compliance, Safety, Marketing, and more. With accelerating provider employment, there is a corresponding increase in the number of providers who need to be quickly brought onboard so they can begin seeing patients as quickly as possible, and can generate paid invoices as quickly as possible. Our solution enables a shortened revenue cycle.

At Echo, we look to automate each onboarding activity with onboarding workflows that include online credentialing applications, status portals, hands-free primary source verification, online credentials file review, and provider application generation for the various payer plans and networks. We’re also developing new tools to provide an easy method to quickly identify where providers are within the onboarding process to eliminate roadblocks and communicate with all stakeholders.

Can you share any specific customer experiences or outcome improvements when they adopt Echo?

Echo serves as the Master Provider Database, or a single source of truth, for many hospitals and health systems. Our clients are exchanging data with their legacy systems on a daily basis, eliminating redundancy and duplication. One client updates over 100 different provider databases in their health system each night!

In addition, several of our clients have moved to a paperless credentialing process. It’s like an Electronic Health Record (EHR) for provider data. By having an electronic record, other departments within the hospital can immediately access clinical privileges,licenses, photos, demographics, and other key provider data elements.

What have you learned from customers recently?

I’ve learned how forward-thinking clients are measuring clinical improvement using provider scorecards. To support objective and continuous privileging, the Joint Commission in 2007 began requiring Focused and Ongoing Professional Practice Evaluation (FPPE and OPPE). EchoAnalytics functionality provides the automation to acquire data from multiple sources, produce comparative data, and capture several different quality metrics.

About Meg

With nearly 30 years of experience in Provider Credentialing Automation, Meg Terry specializes in
empowering healthcare organizations to increase efficiency and reduce costs by streamlining processes, implementing automation strategies, and ensuring the integrity of provider data. Meg is Senior Vice President, Corporate Strategy at Echo, A HealthStream Company. She joined the organization (previously HealthLine Systems) in 1987 and is recognized as the guiding force behind the development of the company’s industry-leading medical staff management software systems.