Friday, March 31, 2017

Pushing Provider Data Management To The Next Level

An Interview with BJC Healthcare’s Christy Treacy, Director, Provider Data Management Center Team 

Article was first Published in Provider Advisor Magazine, Winter 2017

About BJC 

BJC HealthCare is one of the largest nonprofit healthcare organizations in the United States, focused on delivering services to residents primarily in the greater St. Louis, southern Illinois, and mid-Missouri regions. With net revenues of $4.3 billion, BJC serves the healthcare needs of urban, suburban, and rural communities and includes 15 hospitals and multiple community health locations, 27,283 employees, and 3,964 physicians.

BJC stands out among large healthcare organizations in that their data management operations are extremely advanced. In this post Christy Treacy and her team provide a deeper look into their data management system, progress they have made by using a master provider database, and goals for continued program growth.

BJC’s Provider Data Management Center

In 2006, BJC began to use Echo as the source of truth for provider data and information. BJC operates a Centralized Verification Organization (CVO) integrated with the PDMC. The CVO does the credentialing and primary source verification for all active physicians and allied health practitioners, and the PDMC processes referring providers, including residents, fellows, and employed nurses. Treacy leads both the CVO and the PDMC, and she and her team manage the provider information for the entire health system and feed dozens of other systems within BJC. The PDMC staff is currently made up of three analysts and one system administrator, and they are currently tracking more than 41,000 active and referring providers.

Tracy and her team started a single database effort in 2006 in order to have a central repository to house all of their providers’ NPI numbers, as the CVO was collecting this information during the credentialing process. After experiencing success for that purpose, they began to move all of the provider information to be stored into the one location rather than in 15 different entities. Some of the services PDMC offers to the BJC Healthcare system include employed nurses, tracking of residents and fellows, verifying referring providers, upkeep of provider records, licensure expirables and more.

One of the big components that the PDMC has implemented with tremendous success is the ability to feed the hundreds of downstream systems throughout the BJC health system. Typically, large organizations create a separate export map for each of the systems they are feeding downstream, but BJC created one master file to export that contains 98 different data fields (i.e. address, licenses, specialty, demographics, id number, facility ID number, etc.). The export goes to BJC’s interface engine, IIG, which does the manipulation and cross walking to get the data in the appropriate format for the downstream system.

Success of Utilizing a Master Provider Database

When reflecting on the successes of the PDMC, Treacy and her team cite the significant reductions in inaccuracies in data, delayed claims, delays of patient care, duplication of provider information, and increased identity protection. Additionally, they emphasize the significant alleviation of manual work since the creation of the PDMC and the Enterprise Export.

Another success that has gradually come with the implementation of the PDMC is a more efficient process for requesting data. Now an IT ticket must be submitted and approved that has the specific details of what data is needed, why, and how often. This process has eliminated a significant portion of phone calls with questions about obtaining information.

One of the biggest improvements has been with provider satisfaction, due to an easier process and having regularly updated provider information. The ever-increasing requests for information signals to the PDMC that the word is being spread among providers that they are available to help. Treacy comments on the drastic improvement with providers, “Sometimes it seems like something small, but if it’s something our providers need and we can help them with it, it’s nice to be a part of the solution.”

Goals for Future Growth – 24/7

In discussing the future of BJC’s PDMC, Treacy explains her vision to continue to grow the provider master management data set and to eventually become a 24/7 operation. She explains that providers often run into trouble after-hours and on the weekends, and she adds, “With so much activity surrounding this whole concept of provider data, with so many different sources needing access to it, and with how often we are going to have to update it to keep it clean and available, we are envisioning we’ll soon be available twenty-four hours a day, seven days a week.”

Wednesday, March 22, 2017

The Inefficiency of Manual Provider Enrollment - How You Can Start Saving Today

Today’s payer applications are very complex, lengthy, and redundant. The sheer amount of forms to be completed for each provider can be overwhelming and time-consuming for enrollment professionals. A recent New England Journal of Medicine editorial claims that a coordinated national system of credentialing would save providers nearly $1 billion in administrative costs, and further savings could be achieved if processes for establishing payer–provider contracts were also standardized and conducted electronically.

The average healthcare organization processes 4500 enrollment applications annually with at least 18 applications per physician on staff. Provider enrollment professionals tell us that their biggest challenge is the volume and length of enrollment forms. In addition, complexity of the forms and collecting all the necessary provider data create barriers to timely provider enrollment.

Provider enrollment personnel indicate they spend most of their time on initial enrollment and subsequent revalidation of the providers they represent. Unfortunately, most provider enrollment offices receive less than a 2-month notice to begin enrolling a provider prior to his or her start date. The problem with this is that is typically takes 3 to 6 months to complete the enrollment process so it is very likely that the healthcare organization will lose revenue during this onboarding time. Providers will not be allowed to charge patients and receive reimbursement until the enrollment process in complete.

Our research shows that 56% of provider enrollment professionals use some type of software solutions to help automate their processes (ref), but a high number of provider enrollment professionals are still relying on spreadsheets and other manual processes to do the job. Why risk losing significant amounts of time and money from inefficient processes?

Given the new payment reforms that are coming with downward pressure on revenues, upcoming changes in physician reimbursement, revalidation, and many other initiatives, is your hospital, healthcare organization, or medical group ready to thrive in this new environment?

Utilizing a software program that allows you to have access to preformatted payer forms, and direct integration to CAQH, PECOS and other state enrollment sites can save you both time and money. As an example, with an organization of 250 providers and 18 applications per provider to submit, Echo can help you save over $200,000* in annual costs to complete the application process.

Why not get started today in improving the efficiency of your provider enrollment processes. Contact us today to learn how.

Reference - PROVIDER ENROLLMENT: Revenue Cycle Impact and Woeful Inefficiency Make It a High Priority (DecisionHealth – HealthStream 2016 report)

*Will vary by organization

Wednesday, March 15, 2017

Are Your Patient Care Areas Receiving Timely Provider Clinical Privileging Information?

Industry practice is to make information about what practitioners have been granted privileges - and the specific privileges that have been granted – available to patient care providers. When necessary, nurses’ stations, surgery scheduling and other patient care areas need to confirm a practitioner's privileges.  In the past, paper copies of privileges for each practitioner where sent to these patient care areas. Inevitability, these hard copies ended up being filed in big clunky binders.  A common problem that arises is how do you know that this is the most up to date privileging information?

Today, credentialing software exists that easily enables patient care providers to look up privileges electronically. It is the responsibility of the credentialing/privileging department is to make sure that the privileging information is current. When privileges are granted, the provider’s information should be updated so that current privileging data is available.

The responsibility of patient care areas is to access the privileging information as appropriate.  There should be a patient care policy that identifies how privileging information is accessed, when it should be accessed and what a patient care provider should do if it is identified that a practitioner intends to exercise privileges that have not been granted.  All of this should be covered during orientation for new patient care employees and as well as during annual updates.

In addition, it is likely that during and accreditation survey a surveyor will ask a nurse or surgery scheduler to demonstrate the method for accessing privileges and that is how the system will be determined to be effective - or not. Don’t get caught trying to explain the effectiveness of your privileging look up process. Make sure you have a robust system that is updated on a regular basis and tied to your organization’s credentialing system.

Echo’s Provider Privilege Lookup portal can eliminate the time-consuming copying and distribution of paper clinical privilege lists. Share real-time clinical privilege information with others in your organization that need access. Pages can be created with easy-to-use search capabilities (i.e. by physician or privilege). The information displayed is tailored to your exact specifications and may include physician photos, staff status or department.

Don’t get caught in an accreditation nightmare. Click here to learn more about updating access to your clinical privileging information.

Wednesday, March 8, 2017

7 Reasons Why Health System Contact Centers Need an Event Management Solution

Guest Post by Kay Lynn Akers, Director of Client Experience; Echo, A HealthStream Company.

Today healthcare organizations are holding classes, screenings and programs for a wide range of people.  Whether the target audience is the community, patients, employees or providers the expectation is that the events are well managed and often that responsibility falls to the organization’s contact center.

Keeping track of all the courses, their details, enrollees, payments and correspondence is a challenge. Here are 7 reasons why health system contact centers need an event management solution:

Volume - It’s difficult to enroll a large volume of people using pen and paper.  No matter how many staff are involved it’s virtually impossible to keep a good master list of registrants if multiple people are taking names on multiple tracking systems.

Payments - When dealing with payments there are security considerations as well as process.  It’s important to use a solution that is PCI compliant in addition to having other features such as ability to pay for all classes in one transaction, document payments, and produce receipts.

Communications -  Sending out confirmation and reminder emails to event registrants would be an enormous job manually.  Healthcare contact centers need a solution that can automate these important tasks.  Another important communication is event lists or class rosters for the assigned speakers, facilitators and instructors.  Event management systems offer automated rosters and lists that can be emailed to these contacts and organizers starting at the preferred date for that event.

Reporting -  Paper-based event management doesn’t result in easy reporting.  After an event, it’s important to know the total fees collected, number of registrants among other metrics.  Software can generate these reports for classes individually and aggregated.  It’s easy to slice and dice the data for a variety of perspectives when it’s in an event management system.

Transaction Speed -  Looking up a class or program, finding the right date and then getting on the information needed for registration takes time.  Having a system that can quickly pull up the right event and day is essential and saves time.  Plus, if someone has registered previously, verifying their demographic information is going to be much quicker than capturing it all over again which would be necessary with a manual system.

Self-service - Event management systems offering online registration enable target audiences to register at their convenience versus having to work around your staffing hours. It’s a win-win because a higher volume can be managed with fewer team members by offering web enrollments.

Follow-up - In today’s world people expect emails within minutes of registering for an event.  An event management system can automatically send out these confirmations and receipts without human intervention.  They appreciate reminder emails a few days in advance of the event.  After the event send a link to an online survey via email to close the circle of communication.

These are just a few key operational and patient experience reasons health care organizations should use an automated event management process for their program offerings.

Now that you know some of the ways your call center can more efficiently promote and conduct events with the right event management tools, standardizing on these best practices can transform your call center into a patient experience hub. What to learn more? Click here.


Wednesday, March 1, 2017

29% Failure Rate in Patient Experiences

Guest Post by Rick Stier, Vice-President of Marketing; Echo, A HealthStream Company.

This post is an excerpt from an article that appeared in Connections Magazine.

Patient experience failure, the incentivized reduction of avoidable readmissions, increasing rates of physician burnout, and the escalating priority of revenue cycle management, have all combined to incubate an unexpected solution: Exit the call center.

Enter the era of thoughtfully deployed patient experiences, beginning with the first point of contact. In contrast to yesterday’s call centers, which processed physician referrals and class enrollments, today’s patient experience contact centers are a health network’s communications nerve center. They deliver intentionally memorable experiences that strengthen preferences, mitigate risk, reduce unnecessary readmissions, serve as physician practice extenders, and solidify patient loyalty.

Patient Experience Failure

Currently healthcare has a 29 percent patient experience failure rate, according to research by Hospital Compare. Only 71 percent of inpatient patients receiving care report that they received the “Best Possible Care.” That first touchpoint is critical. According to SHSMD (2012), the first three seconds of that initial interaction influences hospital selection and preference. Whether on the phone or online, healthcare contact centers can intentionally deliver a transformative first patient experience.

Incentivized Reduction of Avoidable Readmissions

One-half of all hospitals in the United States (2,597) will be penalized by the Centers for Medicare & Medicaid Services (CMS) for unnecessary readmissions in FY 2017. Preventable readmissions represent a substantial portion of unnecessary medical spending. According to data from the Center for Health Information and Analysis (CHIA), the estimated annual cost of this problem for Medicare is $26 billion annually, $17 billion of which is considered avoidable (source: Provider Advisor 2016 Volume 2, Issue 2, p. 4).

Increasing Physician Burnout

Nine out of ten physicians discourage others from joining the profession. Currently about 300 physicians commit suicide every year (source: Daniela Drake, The Daily Beast, 2014). Physicians face increasing burdens, including the complexities of ICD-10 coding; new billing models; responding to new government regulations; dealing with a changing landscape of health plans; and here comes MACRA (Medicare Access and CHIP Reauthorization Act). 
Beginning in 2019 physicians will be reimbursed on various performance metrics such as quality, advancing care quality, resource use, and clinical practice improvement. According to Deloitte, “Providers are in for a notable awakening when the law takes place in 2017.”

On top of this avalanche of stressors, physicians must keep up-to-date clinically, build practice volume, and improve their patients’ experiences. Are you exhausted yet?

Growing Focus on Revenue Cycle Management

The Affordable Care Act (ACA) and Medicaid expansion has created an influx of previously uninsured patients that has left healthcare organizations scrambling to accommodate increased demand while simultaneously experiencing lower margins. Because consumers are assuming greater financial responsibility for their own healthcare, healthcare delivery networks must shift from a wholesale to a retail environment where they interact directly with patients on issues such as pricing, billing, and payment. 

Concurrently, few healthcare organizations have taken the steps necessary to integrate the many information systems that support revenue cycle management. As the industry migrates toward value-based care, healthcare organizations are entering new collaborations, taking on risk contracts, exploring alternative sources of revenue, and being pressured to document outcomes.

Patient experience contact centers are a timely response to these industry pressures and many others. Redeploying a legacy transaction-focused call center as a patient experience contact center can strengthen preference for your organization, mitigate risk, reduce unnecessary readmissions, serve as a physician practice extender, and solidify patient loyalty.

For more information on patient experience contact centers, click here.