Extended COBRA subsidy could be extended again

The COBRA subsidy for laid off workers has been extended and expanded. On Dec. 19, 2009, President Obama signed the Department of Defense Appropriations Act for Fiscal Year 2010, which includes an extension of the government-funded COBRA premium subsidy provided in the American Recovery and Reinvestment Act of 2009 (ARRA).

The original subsidy program under ARRA provided a nine-month 65% premium subsidy for COBRA coverage to eligible individuals who were involuntarily terminated from their job and who also lost coverage as a result of the termination on or after Sept. 1, 2008 through Dec. 31, 2009.

The new legislation preserves the amount of the subsidy at 65%, but it alters the original subsidy in several ways, including: extending the period during which an eligible individual may qualify to receive the subsidy; extending the length of time eligible individuals may receive the subsidy; and providing new notice requirements.

The legislation extends the period of eligibility by replacing the original Dec. 31, 2009, cutoff date with a Feb. 28, 2010, cutoff. The subsidy is, therefore, now available to eligible individuals who are involuntarily terminated on or before Feb. 28, 2010. The new legislation also provides that the involuntary termination must occur on or before the cutoff, which differs from the previous version of the subsidy that required both the termination and the loss of coverage to occur on or before the cutoff date.

For example, an eligible individual who is terminated as of Feb. 1, 2010, and has coverage through the end of February is eligible for the subsidy under the new legislation even though the loss of coverage would occur after Feb. 28, 2010.

The new legislation also increases the maximum period to receive the subsidy from nine to fifteen months. Because that increase is also retroactive, employees involuntarily terminated between Sept. 1, 2008 and Dec. 31, 2009, who exhausted their entitlement will now have an additional six-month period. Eligible individuals whose maximum subsidized period already expired will be permitted to reinstate their coverage by paying the retroactive subsidized premiums.

Further, depending on the particular circumstances, an eligible individual may also be entitled under the new legislation to receive a refund (or credit) for any overpaid premiums that were made after exhausting the nine-month premium subsidy.

MUST GIVE NOTICE

There are also a number of new notice requirements provided in the recent legislation. For example, the recent legislation requires plan administrators to provide notice regarding these changes to individuals who were eligible for the subsidy on or after Oct. 31, 2009, or who experience a qualifying event (consisting of termination of employment) relating to COBRA coverage on or after this date. The notice must be given no later than Feb. 17, 2010; however, for individuals eligible for the subsidy on or after Dec. 19, 2009, the notice must comply with the COBRA general notification requirements.

One final point: The COBRA subsidy may be extended again. An extension to June 30, 2010, has been proposed in legislation known as the Jobs for Main Street Act, which is currently before Congress.

This column is written for informational purposes only and should not be construed as legal advice.

Barry Senterfitt is a managing shareholder at Greenberg Traurig, LLP, Austin, Texas.

Janet Farrer is an associate at Greenberg Traurig LLP, Austin, Texas.

Barry Senterfitt
Janet Farrer

The height of health IT

Even health insurance giant WellPoint—with more than 35 million members and arguably enough reach to change the system with sheer volume alone—is taking few chances on the future of healthcare delivery. Like most plans, it’s testing new programs with cautious optimism, while aiming for large-scale implementation.

Charles Kennedy, MD, WellPoint’s vice president for health information technology, has a vital role in the plan’s innovation because few initiatives these days can be accomplished without the backbone of health IT.

Specifically, WellPoint’s emerging Individual Health Record—a simultaneously patient-facing and physician-facing electronic record—is “almost an air traffic control system to manage disease,” according to Dr. Kennedy. It’s probably one of the most promising efforts to control costs among members with chronic conditions. Pulling claims and clinical data through complex algorithms to arrive at a functional health summary differentiates the Individual Health Record from the typical EMR system.

“If you’re a hospital or institution, you have a variety of clinical data sources that have information on the patients that you see,” he says. “If you haven’t deployed an interface engine or some way of pulling those various clinical data sources together, you’re late to the party, and you need to do that ASAP.”

With more than 20 years of experience comprised of clinical practice and health IT implementation, Dr. Kennedy began his career in internal medicine. When he was a resident at Highland General Hospital in Oakland, Calif., he noticed how the patients’ needs far outstripped the hospital’s resources, and that experience solidified his vision of where medical care and information should meet.

“We tried to treat each patient regardless of who they were or their ability to pay,” he says. “It had the unfortunate side effect that we never thought about cost. We only thought about what was right for a patient. But that created a system where people are actually being hurt because they can’t afford care. I began to realize that the very laudable and applaudable approach of not caring about cost—only the patient—is right, but that doesn’t mean you can become cost unconscious. Cost unconsciousness has its own set of bad outcomes. That’s what’s led me into thinking we need to be more efficient. We need health IT.”

Earlier this year, Dr. Kennedy was named by the Government Accountability Office as a member of the new Health Information Policy Committee, which was established by the American Recovery and Reinvestment Act. Serving a three-year term, he and other committee members are creating policy framework for the development and adoption of a nationwide health IT infrastructure, including standards for the exchange of patient information. The committee will also make recommendations for handing out the $38 billion in health IT funding earmarked in the reinvestment act.

WHAT ARE SOME OF THE HEALTH INFORMATION POLICY COMMITTEE’S GOALS?

A:We’re trying to make sure the Obama health reform strategy becomes real. What people don’t realize is the number of things the industry and the government agree on. For instance, the government invested $1.1 billion in comparative effectiveness research.

The stimulus bill has $38 billion in it for health IT, and we’re trying to help the government develop policies to spend that money wisely. Our function is to say, ‘How do we take this incredible resource that Congress and the President have given us, and how do we turn it into an investment that creates healthcare value for the whole country?’ It’s a massive undertaking.

Our first objective was to ensure that the money from the stimulus package paid out over five years created value. We asked ourselves where we wanted to be five years from now, and then we worked backwards from there.

Deploying computers is not the goal. Having physicians and patients use computers to create better care at a lower cost is the goal. To do that, we have to set the bar high for the care system. Not only must you use the computer, you must use it in a meaningful way for better care. These are the ‘meaningful use’ criteria that we’ve published.

If we distribute a substantial number of computers, and physicians don’t use them, we won’t be successful. We didn’t want to focus on technical measures. We created the meaningful use criteria, and every single one is clinical.

We want physicians to achieve a clinical result, and we want information technology and the money in the stimulus package to be a contributor to that improved clinical result. For instance, one of the criteria is to avoid 1 million heart attacks and strokes by 2015. Another is to make cardiac disease no longer the leading cause of death in the United States. Those are stretch goals. That is not something simple and trivial.

It would have been much easier to say, ‘Our goal is to make sure 90% of physicians have computers.’ But we consciously didn’t do that because we recognize that health IT is a tool and that other changes need to happen.

HOW WILL THE INDUSTRY ACTUALLY ACHIEVE MEANINGFUL USE AND OTHER MILESTONES?

A:The law is actually quite specific in defining what a qualified system is, and we have a subcommittee that’s identifying the actual entity—such as the Certification Commission for Healthcare Information Technology (CCHIT)—that will assess systems as to whether they qualify or not. The bigger challenge is data integration.

Everyone recognizes that healthcare is horribly fragmented, that there are silos of care. We know that there’s massive inefficiencies, and there are significant quality concerns because information is not shared as people move across silos.

The challenge with data integration is that we really haven’t figured out how to do it correctly. If you’re an integrated delivery system and you buy one EMR, that’s fine, and that works. But 70% of physicians practice in a community setting, solo and small group practice. You have this tremendous problem that all of these systems are different. They call things by different names, and they even capture different sets of data.

WELLPOINT HAS CREATED THE INDIVIDUAL HEALTH RECORD SYSTEM THAT USES ALGORITHMS. HOW WILL THAT MAKE A DIFFERENCE?

A:Algorithms, also known as decision support, are going to be the key to getting value out of these systems. Let’s say the federal government funds a comparative-effectiveness study that identifies a new drug is great for certain people. In today’s world, we know it can take up to 17 years for that to be commonly found in a physician’s paper record. With this approach, you can create an algorithm as soon as physicians or specialty societies have decided on certain best practices. Now you’ve created an infrastructure to get that message to every doctor, but only when there’s an appropriate situation for that rule to be applied. That will take that 17 years down to 17 days. That’s a huge advance.

Let’s say we have noticed that there’s a lot of inappropriate use of PET scans. In today’s world, a doctor would have to call us for preauthorization every single time he orders a PET scan. In the future, the algorithms will be running, and they will only alert the doctor if there’s an issue with a PET scan. Today, they call 100% of the time, and we generally approve the scan more than 90% of the time. Algorithms will take hassles, administrative costs and bureaucratic burdens out of the system.

The right kind of health IT allows us to use new knowledge from our outcomes research subsidiary [HealthCore] and any gaps in a member’s care identified by our informatics company [Resolution Health] in much more effective ways. The right kind of health IT allows these advances to be applied real time at the point of care while the doctor is treating the patient or helping the patient at home.

IS WELLPOINT’S INDIVIDUAL HEALTH RECORD WORKING? HOW IS IT ANY BETTER THAN OTHER EMRS OR PHRS?

A:We’ve run a pilot in Dayton, Ohio. The idea was not just to create interoperability—don’t just allow System A to talk to System B. When you connect systems together, what you create is just a data dumpster. It’s like putting a jigsaw puzzle on a physician’s desk.

That information has to be organized to just the summarized information that the doctor needs…You don’t take all of the information out of these various systems, you only take the information necessary for the ongoing management of the patient.

Many EMR implementations have failed to show value. About 30% of the time, physicians will actually turn them off because they are incredibly time-intensive and will reduce a physician’s productivity. That will hit them in the pocketbook. We’ve looked for solutions that wouldn’t be so intensive from a physician’s data-entry perspective and would do more sorting of information and presentation of information.

Physicians are not data generators. They’re data consumers. Their orders create significant amounts of data, but the physicians themselves usually just scribble a relatively brief note. The problem with many EMRs is they will require physicians to become data-entry clerks.

In Dayton, Ohio, we have a very significant market share. We’re Anthem Blue Cross Blue Shield of Ohio, and we also have a strong partnership with Kettering Hospital Network.

Kettering had already installed an application integration solution, so even though they had 120 different clinical sources, many of those clinical sources could be accessed through infrastructure they had already built. That made it easy for us to collect all of the clinical data out of their systems. We built feeds to the application from Anthem’s claims systems. We were able to get this application up and running in a little over three months, which is incredibly rapid. We made it available to the patient in the form of a PHR and to the doctor in the form of a CCHIT-certified EMR with e-prescribing.

When we looked at who was using the tool, we found that patients who had a higher illness burden actually made preferential use of the tool. For many of the tools we’ve deployed, the ‘worried well’ have been the type of people who used it, not the people with the chronic disease that we really need to reach.

We noticed the people who used the tool and had the higher illness burden, their cost increase year over year was actually less than the people who didn’t use the tool, even though those people who didn’t use the tool were healthier.

We built algorithms in the system that exactly correlated with various HEDIS measures and every time the doctor or the patient logged on, they could see their exact compliance. By giving the patients and the doctor the same information in a simple red light, yellow light, green light format with algorithms enabled us to see quality improvement scores of anywhere from 10% to almost 40%.

WHAT’S THE BUSINESS CASE FOR A HEALTH PLAN TO CREATE A SYSTEM LIKE THAT?

A: Our strategy is maximizing healthcare value, and healthcare information technology is really a tool to get you there. But it has to be the right kind of health information technology. It has to influence doctor’s decisions, and you have to present sufficient clinical data—not mountains of data but the key things the doctor needs to know so that you can influence his decision to do something that’s consistent with the evidence base, or to prescribe a drug that will cost the patient less but has the same likelihood of creating a good patient outcome.

If you look at why healthcare spending is out of control, it’s chronic disease, not health plan profits and not health plan administrative costs. We are seeing an explosion of chronic disease in this country, and chronic disease is managed largely by the patient at home. They’re managing their diabetes 99% of the time at their home, not in the physician’s office. If you don’t make your health IT solutions patient-centric and if they don’t address chronic disease, I don’t think that you’re going to get the kind of value that you want.

HOW ARE THE PHYSICIANS EMBRACING THE INDIVIDUAL HEALTH RECORD?

A:We have 300 physicians using the system now. We’re planning for a broader rollout to the greater Dayton area in 2010 to virtually all primary care physicians.

What we’re focusing on is chronic disease management, and there’s not huge debate about many of the things that need to be done to take care of these patients. That’s not the problem. The problem is actually getting it done. The physicians in general have been positive and are beginning to see how their lives could be easier.

We also added all of our pay-for-performance rules. We pay physicians more if they practice medicine consistent with the evidence base, and we took the existing measures and turned them into algorithms in the system. As long as the physician follows all the alerts, he can be sure that he’s going to maximize his pay for performance incentive. That’s convenient for the doctors because what they usually have to do is identify the patients who haven’t had certain interventions and then reach out and call them.

We’re just starting to incorporate our utilization management rules. If we can begin to move those algorithms to the point of care, then physicians might not have to call except for when there’s a real reason to discuss something, which might be 5% of the time.

DETERMINING THE EFFECTIVENESS OF TREATMENTS IN ORDER TO BUILD THE ALGORITHMS IS AN EXPENSIVE PROCESS. HOW CAN IT BE DONE?

A:This is the beauty of health information technology…if you bring it together in a repository that’s reflective of the patient’s clinical condition and how they’re being managed, you can begin to do database-driven studies rather than very expensive prospective clinical trials where you’re enrolling patients and following them over time. You can begin to do database driven studies that are a fraction of the cost. No, they’re not the gold standard, which will always be a randomized perspective-controlled clinical trial, but there’s a lot of information we’re going to be able to glean out of database-driven studies that are more observational and more retrospective.

BE A VISIONARY. WHAT DO YOU SEE AS THE POTENTIAL FOR HEALTH IT?

A: I hope that every time a patient needs information when they’re home or need to take care of their chronic disease or want to stay well, that they have that information at their fingertips, it’s actionable, and they don’t even have to think about it. If we can make it that easy—and there is a path to get there—we could actually fix the healthcare system.

Charles Kennedy, MD, has held strategic health IT positions with a variety of organizations. He also served as the medical director of a California health center in addition to other clinical service. He earned an MBA from Stanford University, an MD from the University of California at Los Angeles, and a bachelor’s degree in genetics from the University of California at Berkeley.
” Physicians are not data generators. They’re data consumers.”

Information Technology Case Studies

President Obama stated that one central issue to the country’s future is healthcare. Within the American Recovery and Reinvestment Act of 2009, $19 billion has been invested in computerized medical records that will help to reduce costs and improve quality while insuring patients’ privacy.

The transition to electronic health records (EHRs), which Obama urges to be complete within the next five years, has united companies and healthcare facilities that are willing accept the challenge of change. The day for EHRs is here. Standards have been coordinated, structural design is planned, the only barrier is political. While some remain skeptical, others have embraced this change and present case studies to show IT implementation as a success, allowing care coordination, improvement, better healthcare value (reduced cost, enhanced quality) and create job revenue.

Transition from Paper to EHRs: A ProVation Medical Case Study

Problem
Facilitating the widespread adoption of health information technology – electronic health record (EHR) systems in particular – has become the battle cry in the quest to transform the nation’s healthcare system to improve access to and quality of care while reducing costs.

Solution
Thanks to recent market changes, the time for ambulatory surgery centers (ASCs) to begin making the transition to a paperless environment is now. More health information technology (HIT) vendors have introduced systems and applications tailored to the unique needs of the ASC. Subscription-based services are also growing in popularity, meaning ASCs can tap into the benefits of going paperless without making a sizable upfront capital investment.

Often, the most significant savings from an EHR are realized from the elimination of costs related to paper charts. Other savings are derived from the elimination of paper supplies, costs associated with off-site storage and retrieval fees, as well as a redirection of clerical staff. The workflow and process improvements made possible by EHRs can have a direct impact on an ASC’s bottom line, including increased patient throughput, faster revenue cycles and increased revenues. At one ProVation client site, the elimination of paper and printing costs netted an annual cost savings of more than $26,000, while a reduction in off-site storage fees created an additional ongoing annual savings of $12,000. The site also saves up to two hours per day previously lost to pulling, copying and managing patient charts, and an additional three hours per day previously spent entering registration information. While financial benefits are a critical factor in any IT investment, achieving compliance in documentation and clinical practice is equally important. As Joint Commission and Accreditation Association for Ambulatory Health Care (AAAHC) standards become more stringent, the EHR becomes an important tool in achieving and proving compliance and standards of care. EHRs can generate safety alerts, record safety measures taken, and significantly streamline the gathering of data and documentation should an audit occur.

Conclusion
In the past, a lack of appropriate EHR offerings and high upfront costs left many ASCs cold to the idea of transitioning to a paperless environment. However, with more vendor offerings specifically addressing their unique needs and more attention being paid to the benefits of broader HIT adoption, the time to eliminate paper from the care process is now.

www.provationmedical.com or (612) 313-1500

IT Implementation in Start-up or Retro-fitted ASCs: A Binovia Case Study

Problem
The IT implementation process in start-up or retrofitted ASCs presents a unique situation where IT and biomedical engineering merge. Roadblocks can arise in the implementation process from a lack of cross-training and understanding of both viewpoints.

Solution
The most important start to implementing IT is planning. Many problems arise during IT implementation and the proper way to avoid those is through detailed planning. It is also important to understand the difference between simply placing computers and a network in a facility and having trained technicians who not only understand how to install equipment, but also understand how to use and design equipment for a facility’s needs. Choosing an IT firm with medical training will ensure that you have the proper equipment to meet your unique needs.

During the planning phase, IT consultants will conduct a comprehensive overview of your infrastructure needs. From there, your team can begin designing a network infrastructure that works for you by planning servers with environment control, Internet connectivity with bandwidth usage for efficiency, disaster recovery and plans that avoid disruption of workflow. Disaster recovery should be off-site to avoid any problems that could arise from physical damages.

After the planning phase is complete, the Internet connection and firewall can be set up and equipment can be ordered.

Finally, software can be installed and tested. Cross-training and understanding the needs unique to a particular ASC come into play here. Your consultant not only installs the software, he or she tests functionality before training to ensure it does not disrupt workflow. Once staff is trained on new IT, continuous maintenance is performed to ensure that updates are made to windows and antivirus software, data is backed up, server logs and work stations are functioning properly and updates are tested and functioning properly.

Conclusion
Proper planning and consultants who understand the medical uses for equipment as well as the functionality requirements on the IT side of the equation, results in a smooth implementation of IT in any center. By planning for problems and working around those on the front-end, you can avoid delays and major setbacks.

www.binovia.com or (877) 331-0282

Back Office Efficiency: A SourceMed Case Study

Problem
CARES Surgicenter, a joint venture with Saint Peter’s University Hospital, is a multi-specialty ambulatory surgery center (ASC) providing outpatient surgical service for cosmetic surgery, ENT, general surgery, gynecology, orthopedics, ophthalmology, podiatry, urology and GI. The facility’s 150 doctors treat more than 10,000 patients a year with an average case load of 50 surgeries a day.

Like most ASCs, the pre-op process at CARES was inadequate, as they relied on the antiquated, yet common practice of phoning patients in advance of their surgical procedure to perform a preoperative screening. In addition to being inconvenient for patients and labor intensive for staff, the preop process was costly and time-consuming.

Solution
In a highly competitive market, CARES needed a way to separate itself from the competition with a more efficient, patient-friendly preop process. A discussion with their partner, SourceMedical, led them to One Medical Passport, developed by Medical Web Technologies.

Sold by SourceMedical as SourcePlus Passport, the perioperative workflow solution allows patients to complete their own preoperative medical history online from the privacy and comfort of their own homes. The program is intuitive and user-friendly, and takes the average patient less than 30 minutes to complete.

Prior to implementing the system, Marjorie Romano, administrator of CARES, called 50 patients to inquire about their interest in an online preop solution. Patient feedback was extremely positive. The idea of having continued access to an online personal health record which patients themselves can easily update whenever needed was very appealing.

Conclusion
Because of high patient utilization, CARES was able to reduce the number of preop nurses required to make preoperative calls. Two out of four nurses are no longer removed from patient care to make calls on a daily basis. Information being entered by patients is also more thorough because they have the necessary documents and prescriptions on hand to confirm. As a result, day-of-surgery cancellations due to medical history “surprises” have been eliminated. Furthermore, and most importantly, patient satisfaction is at an all time high.

www.sourcemed.net/sourceplus/ sourceplus-passport/ or www.mwtcorp.com

ROI on Hard Costs and More: A Surgical Notes Case Study

Problem
While the first factor for buying software applications is assurance in compatibility and implementation, return on investment (ROI) comes in at a close second. Some potential buyers are adamant about seeing cost-savings and ROI upfront. Finding a company that can give you both can be tough.

Solution
Surgical Notes extracted data from more than 50 ASCs and surgical hospitals, both large and small across the U.S., to develop a cost-savings matrix that outlines the monetary benefits of using Surgical Notes VMR Express, a forms generator and document imaging software application. We looked at facilities doing as few as 100 cases per month and as many as 850 cases per month. All showed savings with our new application in both time and money. Below are average statistics from our analysis:

• Average number of forms per patient chart: 22

• Number of minutes to prepare one chart: 10

• Average hourly wage of chart preparer: $15.10

• Average cost per sheet of “sticky labels”: 0.21

• Average number of sheets per patient: 3

• Average annual cost of pre-printed forms: $10,700

VMR Express allows facilities to print patient data information directly onto the forms of the patient chart. All patient data is directly retrieved from the facilities’ practice management system thus reducing errors associated with re-typing information and printing sticky labels. All forms are printed with a barcode for easy scanning back into the system for storage and easy retrieval. Each form is indexed properly according to the desired tabbing methodology chosen by the facility.

Conclusion
Utilizing VMR Express, ASC facilities saved an average of $24,300 per year in hard costs. Some of these annual savings are outlined below:

• Labor savings: $9,400

• Remote storage savings: $3,900

• “Sticky label” cost savings: $4,000

• Savings of pre-printed forms: $3,000

• Chart folder savings: $4,000

These savings do not include the intangible savings of reducing A/R by increasing speed with which reports can be sent to payors, the decrease in errors associated with re-typing sticky labels, reduction in time associated with changing pre-printed forms, and other benefits.

Sales@SurgicalNotes.com or (800) 459-5616

Dealing with Claims Denials: An Athena Case Study

Problem
In 2000, Thomas Mohr, MD, founded Pediatric Partners, a single-site practice with three physicians located northeast of San Diego. Like most small practices, the group found itself experiencing massive inefficiencies in its front and back office operations along with a steady spike in denials and days in accounts receivable (DAR) of more than 90 days. The medical group had installed a software-based EHR and was experiencing typical outcomes from the traditional clinical software.

“Our staff went through extensive training and we also hired outside consultants to help them utilize the software,” says Mohr. “It wasn’t long after it went live that the staff was experiencing growing frustrations, which only compounded as the new software versions required substantial capital investments in hardware and upgrades. As our practice grew, so did the cost of operating the system.” Mohr needed to find a solution that would deliver consistent results.

Solution
In 2001, Mohr implemented athenahealth Inc., and its Web-based practice management and billing service, athenaCollector. Upon switching to athenaCollector, the practice was able to leverage the collective billing and payor knowledge of thousands of providers using the system nationwide. The practice’s denials started decreasing and the practice saw more than a 40 percent reduction in DAR.

Conclusion
Pediatric Partners was now able to expand and acquire new practices, including four competing groups. Today, the medical group has 10 locations, 20-plus physicians, sees 86,000 patients a year, and has revenue approaching $10 million compared to $600,000 in 2000.

www.athenahealth.com or (800) 981.5084

Back Office Effectiveness

By Tom Hui

A good ambulatory surgery center (ASC)-specific information system will present an integrated data flow which is the key to both efficiency and quality. Much of the data that is processed and acted upon by the back office has its origins in scheduling and clinical modules. Incomplete and inaccurate data will cause delays in billing and collections, as well as cause division among departments. The ASC administrator and the information system champion have the greatest leadership, influence and impact in promoting a coherent and integrated team approach.

Some ASCs have worked diligently to achieve efficiencies, only to lapse back into mediocre performance. In these surgery centers, quality, efficiency and effectiveness are not consistent and not replicable. Good results can be traced to unique individual efforts and when those key people depart, their replacements cannot reproduce their outcomes. Many facilities operate in a passive mode; they rely on people to remember to do certain tasks. An information system that captures the expertise and knowledge that comprise best practices can proactively prompt and remind back office personnel that certain targets and benchmarks are not being met. A good information system will provide proper metrics to management and staff so that they may focus on tasks that are truly the keys to success, as opposed to performing routine tasks.

Failure analysis, which should be a part of any quality improvement program, is rarely applied to the back office. As a result, back office personnel are typically remediating and responding to problems rather than preventing them in the first place.

The back office is the “nuts and bolts” of the business component of an ASC. It offers many opportunities for improvement and requires a careful and well- executed implementation of an information system.

Points to Remember

A good information system is a key component of a successful surgery center, but it is not a magic bullet to solve management problems and fix poor business processes.

Improving the back office needs the involvement of the front office and clinical personnel and their respective processes.

Banish any unwillingness to analyze and revise broken processes and their associated work-around solutions. This attitude often leads to rigid behaviors and poor habits which prevents improvements in the back office.

Be able to transfer expert knowledge of the ASC industry and the information system when there are personnel changes; without it, this can lead to degradation and misuse.

Turning Data Into Insights: The Power of a Centralized Data Warehouse

Have you ever asked your information technology (IT) group for the answer to a question, only to receive an inadequate response (or no response at all)? It’s hard to fault the personnel. IT departments in the healthcare world are all too often over-tasked and understaffed. Typically, they are too busy with daily operations and systems maintenance to deal with requests that fall outside their normal duties. Items found on the chopping block often include marketing initiatives and/or requests for business intelligence.

To remain competitive in an increasingly competitive healthcare industry, organizations need high-level answers and in-depth insights — about patients, about the physicians they work with or the physicians that refer to them. How can you get the information you need to make key decisions on a day-to-day basis?

For many healthcare providers, the solution is a centralized data warehouse that stores a wide range of electronic information, from patient records to marketing data. As providers throughout the country look for ways to optimize American Recovery and Reinvestment Act (ARRA) funds earmarked for healthcare IT, this is the perfect time to take a close look at data warehousing and the benefits it provides.

The components of a data warehouse

If your organization is like most, you compile massive amounts of data but do very little with the information. By centralizing all of your data in a single place, you’re in a position to extract insights that can be valuable in many areas, including patient retention, reactivation and acquisition. Most data warehouses include the following:

» Patient records

» Inbound marketing data, including call centers and Web sites

» Donor and fundraising data

» Physician information

Every day, healthcare professionals use science as the basis for medical care and treatment, yet the vast majority of organizations are only beginning to infuse science into marketing efforts, market planning processes and in driving answers to key business questions. Just as data can drive better medical decisions, it can lead to greater effectiveness and efficiency in other organizational functions.

Who are your patients?

One of the biggest benefits of a centralized warehouse of data is the incredibly accurate picture it provides of your patient base. Many healthcare executives presume that they have a clear view of their patient population, only to be surprised by what the data reveals.

By linking your patient records with information from external databases, you can develop a precise picture of who your patients really are, including the demographic, financial and behavioral characteristics that set them apart from other patients in a market that you currently serve. You can also understand the differences between your “best, average and worst” patients and “best, average and worst” referral sources, whether it be system-wide, facility specific or within targeted service lines/specialties.

In addition, by having all of your patient records in one place, you can capture information at every touch point — from pre-op visits to surgeries, from phone calls to Web interactions.

Turning raw data into marketing insights

Once you have all of this information, what can you do with it? A data warehouse provides benefits in many areas:

Acquire new patients and new referrers. Once you know the profile of your best patients and best referral sources, you can examine your markets of service (or future interest) for people that “look” just like them. As a result, you’ll know exactly who should receive your marketing messages and who should not. The more targeted your prospect list, the greater your return on investment (ROI).

Retain your best patients. You’ll know who your best patients are, based on metrics and evaluation methods that are important to you. This will allow you to optimize your efforts to have them come back when next they may need your services.

Maximize marketing dollars. By truly knowing the target patient population and the target referral sources that you are after, your media plans will have less waste and higher return.

Minimize patient churn. Analysis of data can be useful in predicting those patients that are likely to churn. This proactive information allows you to have strategies in place to communicate with these patients before you lose them.

Develop long-lasting patient relationships. Once you attract new patients into your network of care, it is critical to convert them to life-long patients. Data warehousing allows you to drill down and filter information to yield valuable “business intelligence.” For example, you’ll know how much you’re spending on patient acquisition, and how long it will take to break even on new patients. You’ll also know how much annual revenue comes from top-tier patients and the average patient value at different stages of the patient relationship.

Ease the burden on your IT department. In most healthcare organizations, the IT department is simply not equipped to perform the level of analytics needed to solve for marketing, market planning and business intelligence questions. By outsourcing this work to experts, you can enable your staff focus on what they do best while gaining the insights that you need.

For healthcare systems, the time is now.

As networks of all shapes and sizes continue their EMR conversions, the benefits of housing all pertinent information in a singular location will become increasingly evident. Those proactive providers that factor a data warehouse into their current and long-term processes will remain on the leading edge of the industry – and far ahead of the competition.

Ken Rabinoff-Goldman, DC, is vice president of Buxton – HealthCareID and is responsible for business planning, market development and sales focusing on superior site selection, targeted marketing and other strategic planning tools for the healthcare industry. Having served patients at his private practice in Albany, N.Y., for 22 years, Rabinoff-Goldman contributes greatly to Buxton’s executive medical experience by helping understand the needs of clients in the healthcare field.

HIPAA and the American Recovery and Reinvestment Act (“ARRA”)

When Congress passed ARRA on February 13, 2009, HIPAA regulations were expanded to protect patient health information. First of all, HIPAA privacy and security laws now apply directly to business associates of covered entities. Definitive actions must be taken when there is a breach of patient health information with one being that immediate notification to patient of such breach. In addition, personal health record (“PHR”) vendors are required to notify individuals of a breach of patient information.

The bill allows patients to pay out of their own pocket for any health care service in full and can request that their claim not be submitted to their health care plan. However, it prohibits the sale of patient health information without the patients’ written authorization.

The biggest change is the security rules as they apply to Business Associates (“BA”). Prior to this act, a BA only had to comply with the written business associates agreement. Now and for the first time, HIPAA privacy and security laws apply directly to Business Associates (“BA”) of covered entities. This requires every BA to make several changes, such as (1) having written policies and procedures on HIPAA and security, (2) appointing a security officer, and (3) providing adequate training for their staff with regard to protecting electronic health information. For non-covered HIPAA entities such as e-Prescribing or PHR vendors, they are required to have BA agreements with covered entities for the electronic exchange of patient health information. BA also need to follow HIPAA security laws with regard to locking computers and encrypting emails that contain electronic patient health information.

The civil monetary penalties have significantly increased with the passing of ARRA. The first time offense will result in civil monetary penalties and criminal penalties. The penalty was only $100 per violation. Now, the penalty is $1,000 per violation, if the violation is due to “reasonable cause and not to willful neglect” (with a maximum penalty of $100,000). If violation is due to willful neglect and is properly corrected, the penalty is $10,000 per violation (subject to a $250,000 maximum penalty). Finally, if violation is not corrected properly, the penalty is $50,000 per violation (subject to a maximum penalty of $1,500,000 during a calendar year).

The general effective date for this Act is February 17, 2010. However, there are varying effective dates for some provisions. For example, the civil monetary penalty provision is effective immediately. Therefore, it’s imperative that business associates and covered entities should examine each provision and make the necessary changes. For example, current HIPAA forms need to be reviewed and changed to be in accordance with the new law.