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  Many facilities have trouble with adopting new tools and are dealing with outdated technology.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.