Healthcare Boardroom | SEERhealth

The Silver Linings Playbook of Healthcare Technology

Matt Gretczko — Wed, 15 May 2013 13:45:00 GMT

Great Movie. Yes, there is a silver lining out there in all situations, even in the realm of healthcare technology.

Every day, throughout the world, new companies are emerging. To the standard participant in society, the impact and intent of these companies is often ignored unless it directly impacts their lives on a daily basis.

In an article by TechCrunch, Chamath Palihapitiya, a former Facebook executive recently expressed that the quality of new ventures was disappointing– not from a technology or utilization standpoint, but mainly because people are creating alternative or improved versions of current ideas, as opposed to solving problems with new ideas. Mr. Palihapitiya stated that people should be focused on “the big ideas,” especially in specific sectors like healthcare.

The moniker, “Healthcare is Broken,” is no longer helpful in progressing the conversation.

We, as in the collective population of the United States (including all political affiliations, ethnic groups, and financial standings) take this as a given. Therefore, we have reached the point where we need to reach consensus on what the issues are. If we can agree on these, then we may have an opportunity to develop and implement solutions to address the problems.

From my perspective, some of the biggest issues facing healthcare today, which we already have consensus on, are the following:

High admissions rates
Increasing costs
Provider burden
Decreasing patient satisfaction
Lack of information transparency
Lack of technology adoption
Unwillingness or confusion on how to adapt to changing regulations
Disparate data sources
Lack of standardization

Over the past decade or two, the majority of new companies in healthcare did not specifically focus on addressing the problem areas mentioned above. The market often assumed that the big problems can only be solved through regulation, policy, and processes as opposed to new ideas. Therefore, high-profile healthcare technology firms focused their innovation efforts on the development of medical devices to drive more efficient and effective “care.” While this is critically important and must continue, as stated above, we also need to dedicate resources to innovate and create big ideas to solve the issues that also have a broad and profound impact on the healthcare market. This shift has started.

There is a silver lining here…with a playbook that can work.

In order for these companies to succeed, it is critical that healthcare stakeholders effectively illuminate the advantages of their solutions to help drive adoption in the marketplace. This will be the basis for a series of market plays that will fix healthcare.

Areas where companies are finding success in addressing the aforementioned issues are the following:

Cloud Computing

Companies are recognizing that services brought to the healthcare industry must eliminate the intricacies, cost, and complexity of maintaining a complex IT infrastructure. Instead, technology can be hosted in the cloud and drive significant advantages from a flexibility and scalability perspective.

Problem Addressed: Lack of Technology Adoption

Health Plan Selection/Management

A wide variety of companies are developing “marketplaces” whereby individuals and companies can more effectively review, compare, and choose the best health plans for themselves or their employees. Such marketplaces ensure the selection of the right benefit mix at the ideal cost for the consumer.

Problem Addressed: Increasing Cost

Data Tools

Many companies have recognized that the problem in most industries, not excluding healthcare, is not the acquisition of data rather the ability to effectively use it. Therefore, new tools are being imbedded into products to ensure that the right information can be accessed in the right format, at the right time – this includes flexibility, visibility, and adaptability within the growing mobile environment (i.e. smartphones and tablets).

Problem Addressed: Disparate Data

Platforms

Point solutions will eventually be a thing of the past. As cloud computing matures, organizations also want a platform that consolidates a variety of applications/modules to address their business needs without complex integration. This includes coordinating data and processes across multiple business units within an organization to improve its operations, interactions with employees, and relationships with clients (patients).

Problem Addressed: Lack of Technology Adoption

Access to Accurate Diagnosis Information

A major cost in the healthcare market is the unnecessary utilization of services by patients (i.e. going to ERs for a cold). Instead, new technology is being developed to help the patient diagnose issues in advance, with and often without the support of a doctor. For example, applications that allow patients direct access to vetted doctor provided responses to questions. In addition, medical devices that sync local data regarding epidemics, or can track personal symptoms to provide a more accurate assessment of what a patient’s diagnosis may be.

Problem Addressed: Increasing Costs of Care and Decreasing Patient Satisfaction

Doctor Databases

It seems like this is a no brainer, but only recently have companies started to develop robust databases that provide patients with the exact information that they need in order to select a provider. No longer is the address, schooling, and board certification status of a provider acceptable. Patients want to see more detailed quality statistics about a doctor in order to make a more informed decision and regulation tying pay to performance is forcing provides to comply.

Problem Addressed: Increasing Costs and Decreasing Patient Satisfaction

Doctor Concierges

Similar to provider groups, many “boutique” offices are opening that combine the expertise of a variety of specialty providers in one location. The delivery of care is not different; however, for a small fee patients are assured high levels of customer service, immediate appointments, and new methods to openly and effectively communicate with their providers on an ongoing basis – pre, during, and after a visit.

Problem Addressed: Decreasing Patient Satisfaction and Provider Burden

Whether due to overly complex and archaic technology, the inability to effectively manage change, or lack of understanding about the right solutions for the problems healthcare faces, by starting to socialize the technology that is being developed, the marketplace will experience enhanced momentum to fix itself, rather than being engrossed in an ongoing cycle of disarray.

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Innovation To Drive The Future of Healthcare
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About the Author

Matt Gretczko is a Founding Partner of SEERhealth primarily responsible for leading the development of the SEERhealth platform, initial client roll-out strategy, and ongoing implementation methodology. Matt has nine years of consulting experience, previously working at Deloitte where he provided global process redesign, technology implementation, workforce analytics, and change management services. VIEW FULL PROFILE

Background Screening & Credentialing: Similar Disciplines, Notable Differences

Melissa Outlaw — Fri, 10 May 2013 14:33:00 GMT

As a person who spent nearly fifteen years in pre-employment investigations for a top tier provider, Kroll, I’m very familiar with the nuances of the background screening industry. Now that I’ve been in the credentialing world for almost 3 years, I often find myself continually explaining the nuances and disparities between the two. Although similar, there are some distinct differences between background screening and credentialing.

Let's first establish one key point: not all background checks are created equal as not every organization is required to verify everything about an applicant.

A pizza company hiring a delivery person has the flexibility to choose what they feel is important. For example, the pizza company may limit screening to verifying who the person is, if that person has an existing criminal record, and that the applicant has an active driver's license. Some businesses have discretion when it comes to the type of background check they perform; healthcare is indeed different. Healthcare is heavily regulated by state and federal government, requiring specific screening/credentialing prior to bringing a provider on staff.

In comparing background screening and provider credentialing, one can draw the following similarities and differences:

Similarities

Validating the person applying is in fact the person they say they are
Verification of past employment, education, licenses, certifications, references, etc.
Identifying sanctions in licensure, Medicare, Medicaid, etc.
Discovering criminal convictions, civil litigations, and/or bankruptcies
Ensuring that information obtained is from the primary source and it validates provider supplied information
Policies and procedures must adhere to industry rules and regulations

Differences

Generally, background screening is housed in the Human Resource (HR) department, while credentialing is performed in the Medical Staff Office (MSO)
Most organizations only perform background checks upon hiring an applicant. Credentialing must be performed, at a minimum, every two years and must contain quality metrics such as the number of procedures performed, readmission rates, infection rates, average length of stay, mortality rate, etc.
Providers who hold privileges are granted those privileges as part of the credentialing process; and a detailed review of a provider’s education and experience determine what procedures a provider can perform at a facility

After reviewing both processes from beginning to end, it is evident that background screening and credentialing share many of the same concepts, verify the same services, and have a high degree of liability and risk. The initial verification of information is indeed almost identical. The biggest difference arises after the initial verification of information; whereas, the background screening process is complete but credentialing continues in perpetuity, has several more key steps and is coupled with the mandatory two year re-credentialing standard.

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About the Author

Melissa Outlaw is a Founding Partner of SEERhealth and a Senior Vice President with Medkinetics, LLC. Melissa supports clients in benchmarking current internal practices, identifying potential efficiencies then driving the integration of technology with process improvement to reduce time of service and operating expenses. Melissa’s more than 11 years of experience with Kroll managing North American Operations of pre-employment investigations and business intelligence, where much of their business was healthcare related, have been welcomed by our clients in the US and abroad. VIEW FULL PROFILE

Reduce, Reuse, Recycle...Continuous Credentialing

Matt Gretczko — Wed, 17 Apr 2013 13:45:00 GMT

Reduce, Reuse, and Recycle may be one of the oldest and most consistent themes we associate with the ‘green revolution’. Regardless of your political affiliation, over the past 30 years, there has been an intentional and often comprehensive focus on this effort. More importantly though, it is a great example of a mantra that was conceived, instituted, and adopted across an industry.

How can credentialing and quality assurance follow a similar model?

The reality is that the intent and approach to the above mantra align well to one future goal of credentialing – making it continuous. Continuous credentialing will save cost, energy (effort), and resources to help the healthcare industry undergo unprecedented change through technology innovation, regulatory changes, and market preferences.

Let’s further discuss continuous credentialing.

The notion of continuous credentialing seeks to transition the industry from focusing on two-year cycles to instead a constant state of privilegeability for providers. This state would lead to many benefits, including:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization
Greater information sharing across internal business units

If we dissect the benefits, they have an eerie alignment to the goals of the “green revolution” as well:

Reduce

From an environmental standpoint, reduction is avoiding the creation of waste in the first place. In credentialing, we can avoid this same waste technically, operationally, and even physically. From a technical standpoint, by implementing and adopting new technology platforms, organizations can have better insight into their organization and thus more appropriately vet providers in advance of moving through the onboarding continuum. If a provider is systematically passed from recruiting to the medical staff office for credentialing, an organization can drive more operational efficiency by leveraging previous information and efforts without restarting the process. From a purely physical standpoint, eliminating the “paper” in the process actually does reduce the environmental waste – clearly not a priority for most healthcare organizations, but if the introduction of new processes has a side benefit, it never hurts.

Reuse

We think of this as purchasing products that can be reused (i.e. coffee mug or water bottle rather than plastic/paper), or repurposing discarded items for a new use. Within the realm of credentialing, once a provider’s credentials have been verified and stored in a system, why wouldn’t they be leveraged by other facilities within your healthcare organization? This would significantly decrease provider burden, reduce the onboarding timeframe, and provide the framework for consolidating these types of activities into a shared service model; a group of dedicated quality assurance experts working to perform activities in an efficient and standardized manner while delivering high customer service to its clients. Unfortunately, many healthcare organizations are not able to avoid an even more simple hassle - the transfer of paper files. Those organizations that have transitioned from paper files still struggle with internal politics and inefficiencies that do not allow the state of a provider’s credentials to be consistent across all facilities. Of course, privileges will still need to be facility specific, but the data utilized to make those decisions should be standardized and shared.

Recycle

We may consider recycling as the process by which objects that are considered waste are brought back to their native components or raw materials, and then used for another purpose. This is when continuous credentialing really comes to fruition. Shouldn’t we be able to break a provider’s record into its raw materials – credentials – and then determine how this information can be recycled for future activities? What if organizations continued to perform their qualitative review of an individual provider holistically, but the tactical processing of credentials and verifications were completed across all providers in a much more efficient manner? A large volume processing capability can leverage an assembly line approach to completing the aforementioned tasks. Both the holistic review, and the processing, occur directly in one system that is capable of driving all activities within the onboarding continuum – recruiting, credentialing, privileging, outcomes, performance reviews, and enrollment. The information, or raw materials, are tweaked and packaged in order to meet the unique demands of each activity. Thus, a large-scale recycling process for data that at all times presents a complete picture of the actual state of a provider, all based upon the appropriate regulatory guidelines and bylaws.

A green revolution may not be occurring in healthcare, but it seems apparent that reduce, reuse, and recycle may be analogous to the goals of some of the main trends in healthcare quality assurance. Healthcare organizations now recognize that a fundamental shift must occur in order to stay competitive while delivering high-quality patient care. The most successful organizations don’t just listen and learn – they step outside the box and seek to employ tactics, lessons learned, and technology from other industries and efforts to build a business case for the desired change. Once the business case is conceived, then the correct resources and strategy can be instituted to be successful.

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New Provider Privileges Require New Evaluations

Melissa Outlaw — Mon, 25 Mar 2013 13:14:00 GMT

In healthcare, one thing is constant - change. It can be a daunting task to keep track of changing policies, yet even more difficult to implement solutions to address those changes! A glimmer of respite in the murky world of healthcare change is a standard that has remained constant like the Focused Professional Practice Evaluation (FPPE). According to The Joint Commission all providers who want to perform a new privilege must have a focused review, period.

Been There, Done That!

Provider history does not exempt a provider from a focused review for a new privilege. It doesn't matter if that provider performed a thousand procedures at a prior organization, helped create the device, and wrote the book on the procedure, they must undergo the review at your facility according to your defined process.

But How?

The standards do allow for flexibility in the way your organization performs the review. Your organization may wish to have direct observation for some procedures, while chart reviews may be better suited for others. Regardless of the how, your organization must have the process clearly defined. It doesn't need to be in the medical staff by-laws or even documented in writing; however, it must be consistently applied to all providers performing the same procedure. Often, organizations leverage technology to define this process and ensure standardization and replication.

Duration or Number

There is also flexibility in whether your organization reviews by duration or by number - as long as it follows a defined process. Some organizations with large procedure volumes may define the competency with a set number of procedures (i.e. must have focused review on fifteen procedures). Whereas some low volume organizations may otherwise decide to review by duration (i.e. must have focused review on all procedures for five months).

New vs. Performance Issue vs. Trigger

In addition to a FPPE policy for when a provider requests new privileges, it is important to define processes for when a focused review is needed due to one of the following reasons:

A provider has a performance issue
A provider triggers a review

Additionally, it is important to ensure that the defined process includes what constitutes a trigger (i.e. sentinel events, complaints, etc.) and what constitutes a performance issue (i.e. returns to surgery, longer length of stays that other providers, etc.).

Having a defined process in place that outlines the criteria for conducting focused professional practice evaluations is a must. How you choose to perform these reviews is discretionary as long as your organization is consistent. Be sure to assess how your organization will handle Ongoing Professional Practice Evaluations (OPPE) on each privilege as it will directly impact your FPPE.

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About the Author

Three Benefits of Improving the Patient Experience

John Damouni — Tue, 19 Mar 2013 14:00:00 GMT

Improving the patient experience has been among healthcare executives’ top priorities for the last several years. In an effort to infuse further urgency, the government recently instituted Medicare’s Value Based Purchasing program to tie 1% of Medicare payments to patient satisfaction scores. For the first time in history, patient satisfaction is being directly linked to revenue on a national scale.

The benefits of improving the patient experience are manifold and can positively impact multiple areas within a healthcare system. Building a strong service culture that is based on improving the patient experience will assist healthcare systems in improving the following three areas:

Revenue

Customer retention is perhaps the most visible aspect of customer satisfaction. If the customer is not satisfied, he or she simply won’t return; more importantly, the money he or she spent earlier on a business that did not meet expectations will now go to a business that does. Therefore, it is in the interest of every member of the organization to keep the patient satisfied.

One aspect of customer satisfaction that is not easily tracked is the value of customer referrals. It is human nature to listen to others for advice and suggestions, especially from friends, family and colleagues. A patient satisfied with a healthcare organization will recommend it to others they know. This chain will continue to spread as long as patients remain satisfied. All this translates to increased revenue and profitability. Customers and medical personnel will wholeheartedly recommend a facility that they feel provides exemplary service to patients.

Risk Mitigation

According to the National Center for State Courts, the median damages awarded in malpractice lawsuits is $400,000, which is twenty times higher than the median awarded in personal injury lawsuits. While improving an organization’s overall quality assurance practices will inherently lower the probability of medical malpractice, patient experience also plays a considerable role. While malpractice costs are astonishing and will not be fully mitigated by increasing patient satisfaction, if the patient believes that the healthcare provider is genuinely interested in his welfare and all his needs have been taken care of, then even in the occasional case of health complications, the propensity to sue will be considerably lessened. Study after study elicits the clear correlation between time spent with patients and risk of lawsuits. The more time a provider spends with a patient, then the lower the chance of a patient filing a lawsuit.

Talent Retention

In a service industry such as healthcare, employees are an organization’s greatest asset. While a healthcare facility may have the most advanced medical equipment, without skilled and suitably trained staff, achieving service excellence would be difficult. Unfortunately, retaining talented employees is not an easy task even in less than stellar economic climates. Talented individuals thrive on working in an excellence-driven business environment. By nature, service-focused organizations provide an environment that rewards performance, thus appealing to skilled and talented providers and staff. Satisfied providers will naturally promote their organization and recruit additional qualified healthcare professionals, fostering an ecosystem that continuously improves the overall organization.

Improving the patient experience requires more than instituting robust training programs, updating facilities, and tweaking a few standard operating procedures. Improving the patient experience is, at its core, about creating a culture of excellence to promote an unparalleled commitment to providing quality care, measuring results, and continuously raising the bar higher.

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About the Author

John Damouni is a Client Partner at SEERhealth with responsibility for supporting the client relationship management implementation and marketing initiatives. Prior to joining the SEERhealth team, John held leadership positions at world-class service organizations including the Ritz-Carlton Hotel Company.

John is noted for his expertise in implementing successful customer relationship management processes, as well as developing and sustaining strong client relations teams. VIEW FULL PROFILE

Expanding on the Future of Credentialing - A Deeper Look at the Trends

Matt Gretczko — Wed, 13 Mar 2013 20:26:00 GMT

In my article, the “Art and Future of Credentialing,” I discussed the complexity of credentialing and also emphasized that credentialing must undergo a modernization due to regulation, technology, and the changing landscape of delivering care.

Within healthcare, like any other industry, in order for change and innovation to occur, communication and education must be forefront. Therefore, the intent of this article is to outline in more detail the intricacies of the trends that may help drive the modernization of credentialing.

Credentialing will no longer be largely paper-based

Historically, credentialing has largely been a paper-based process. Healthcare organizations across the country maintain hundreds, and even thousands, of “files” that contain the credentials of their providers. These files (many manila folders) contain copies of source documents, verifications, and a plethora of other materials organized into a variety of sections. Paper files require significant space to maintain, not to mention restrictions on sharing this information with multiple facilities (both within and external to an organization). Moreover, paper files limit an organization’s ability to quickly assess a provider’s credentials, and do not align to the growing need for information sharing and real time analytics.

Moving to an environment in which credentials are stored electronically helps maintain data integrity, promote “continuous” credentialing, and facilitate the sharing of information for credentialing and other activities. Ultimately, regulation will need to provide clarity on what is acceptable as a provider’s credentials as the landscape of healthcare technology shifts towards automation. Rather than maintaining a paper file, it should be acceptable to utilize a systematic, real time view of a provider’s actual information with all the supporting documentation easily accessible as needed.

Credentialing will be one “component” of a broad technology platform

Credentialing is often branded as an administrative burden as opposed to being considered a critical component of a successful onboarding program at an organization. Physician onboarding can be described as the series of sequential processes required to bring a prospective new member of the clinical staff to a fully-functioning and billable state. For most organizations, this involves recruitment, employment, credentialing, privileging, appointment, and payor enrollment

Multiple adjustments can occur to the credentialing process itself in order to decrease the burden and make it more efficient. However, to truly make credentialing an integral component of the onboarding continuum, the aforementioned onboarding activities must be operating on the same technology platform. Too often organizations tend to implement disparate technology solutions that do not integrate with each other which leads to data discrepancies, lack of aggregate analytics, and complex processes to align outcomes across these activities. Instead, by leveraging a platform that provides solutions for each of these components, seamless collaboration can occur across business units. Collaboration will help drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management – not to mention the elimination of redundant activities regarding data collection. Technology solutions exist in the marketplace today that have various modules to automate these capabilities while also restricting the visibility of certain information based upon roles within an organization.

In order to achieve this operational environment, healthcare executives must analyze the integration points of all initiatives and effectively research options in the marketplace that can meet their needs – this may include expanding or replacing current technologies.

Internal data sharing becomes a reality

If an organization can implement a platform to coordinate activities across the onboarding curriculum, this also leads to another strong benefit – data sharing.

While data sharing is a broad shift in mindset, it has tremendous benefits; especially when it occurs systematically. Not only will the organization develop much more efficient processes and greater visibility of information, but providers will also experience more seamless interactions that eliminate redundancies. Imagine if your organization could consistently derive a holistic picture of a provider in the following manner:

Recruiting shares basic demographics and application information with Human Resources
Human Resources uses this information to vet a provider and then passes this information along to the Medical Staff Office to drive credentialing
The same information is then leveraged to drive privileging and enrollment activities
Privileges granted to a provider are tied to ICD/CPT codes so that all procedures link directly to billing and quality data
Billing and quality data is reviewed and utilized to drive financial processing and focused and ongoing professional performance evaluations
Outcomes and quality data is also utilized to benchmark internally and externally to maintain a competitive edge

Today’s technology can make it a reality.

Continuous credentialing will be the new norm

Today, credentialing generally occurs on a two year cycle. In the near future, healthcare organizations and providers should interact in a symbiotic environment where “perpetual” or “continuous” credentialing is the norm, as opposed to meeting two-year cycles. This means that at any point, a provider would be “privilegable”.

Some of the potential benefits of perpetual credentialing may be:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization

This notion is further addressed in the article “Promoting the Future of 'Continuous' Credentialing – A Partner in FPPE/OPPE."

Where does that leave us?

Technology innovations in healthcare with the most publicity tend to be those related to devices or procedures. However, there is a growing trend of technologies dedicated to improving healthcare operations by focusing on the ability to drive high patient care, improve data access and reporting, increase patient and provider satisfaction, and facilitate proactive risk management.

These are the technologies we must start promoting and aligning to new processes within our organizations to drive these trends.

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Three Quality Metrics Hospitals Should Communicate to Providers

Melissa Outlaw — Mon, 11 Mar 2013 16:56:00 GMT

Frequent communication between an organization's leaders and their employees is a necessary practice regardless of organization type. Outside of standard operational communications, organizational leaders must also communicate their ongoing strategy to ensure that key stakeholders assist in achieving the desired results – for healthcare, it is maintaining the highest level of care. Within this environment, medical and allied health providers are the stakeholders that play a vital role in how the hospital functions and achieves this goal. Therefore, frequently communicating quality metrics that are focused on improving care results in a win/win for all parties.

Information is Key!

Whether your organization has five providers or 5000, it is important to track and communicate, at a minimum, the following three metrics: Procedures Performed, Provider Benchmarking, and Patient Statistics.

Procedures Performed

Knowing the types and the number of procedures performed is valuable information and beneficial to both the provider and the organization. It allows the provider time to adjust as needed to ensure they are meeting the organization’s minimum qualification for privilege retention. And, if billings do not align to procedures performed/granted it could save the organization time and money. To expedite the gathering of this information, the delineated privileges should be tied to ICD and CPT codes.

Benchmark Data

Benchmarking data displays individual provider performance as well as how they compare to their peers, other providers in their hospital, and if applicable across their health system. Generally, the benchmark metrics consist of the following data points:

Number of Cases
Case Mix Index
Number of Mortalities
Mortality Rate
Number of Readmissions
Readmission Rates
Average Length of Stay

Communicating benchmark data may identify outliers, such as higher readmission rates, which would facilitate conversations to determine cause. The solution may be as simple as prescribing a different antibiotic for the same procedure as other providers – a straightforward change that will improve provider performance, save the organization money and increase patient satisfaction.

Patient Statistics

Reviewing all procedures and understanding each provider's patient demographic and outcomes will help create a complete picture of a provider's performance. Once this picture is understood, communicating this information to providers fosters a collaborative environment between providers and the organization and eliminates the sole focus on events with negative outcomes. This data should include:

Inpatient

Counts by Physician Role (Admitting, Attending, Consultant, Secondary Surgeon, and Surgeon)
Top DRGs as Attending
Top Diagnosis Codes as Attending
Top Inpatient Discharge Statuses as Attending
Top Procedure Codes as Surgeon/Proceduralist
ICD-9 Complication Codes

Outpatient

Counts by Physician Role
Top CPT/HCPCS Procedure Codes as Surgeon/Proceduralist
Top Outpatient Discharge Statuses as Attending

Communicating these three metrics frequently will allow providers to adjust care as necessary resulting in a higher quality of care. And with new laws and regulations surrounding pay for performance and quality of care, hospitals that not only incorporate these metrics into their day to day operations, but also proactively communicate them out to their providers, may ultimately be rewarded with increased revenue and higher reimbursements. Now that’s something to talk about!

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Leveraging QA Shared Services Centers to Streamline Healthcare M&A Activities

Anthony Begando — Fri, 08 Mar 2013 16:07:00 GMT

Your firm spent the better part of a year courting and closing a strategic acquisition in a key metropolitan sub-market. The deal brought three hospitals, five clinics, and an outpatient surgery center into your system. As the deal team encountered a few difficult situations during contract negotiations, once the final terms and conditions were agreed to, all parties sought to close as quickly as possible. Shortly after the plates and glasses were cleared from the closing dinner, the realities of integrating the newly purchased operation and its clinical staff set in.

Three weeks after closing, over 35% of the privileged providers involved in the transaction had yet to complete enrollment with the 26 payers and managed care organizations contracted with your organization. In addition to creating a major disruption in cash flow and potential for lost revenues, this situation also prevented those providers from taking advantage of the more favorable billing terms available under your contracts. Providers themselves were disappointed by what appeared to be a disorganized and poorly planned integration process. Muddled training on systems, procedures, and professional performance evaluation programs directly contributed to a growing chorus of discontent across both the clinical and administrative staff. What had seemed only weeks earlier like an ideal and synergistic business combination was proving to be a major headache for all involved.

Sound familiar?

We have written at length on these pages about the benefits of consolidating and facilitating enterprise-wide quality assurance activities within Shared Services Centers. These operations consolidate a number of historically siloed and disintegrated administrative processes within a highly efficient internal business unit focused on managing provider relations and information from recruitment through retirement. Typically, these activities include initial credentialing, privileging, committee administration, staff appointment, payer enrollment, recredentialing, and facilitation of peer review & FPPE/OPPE programs. Furthermore, these centers can coordinate initial orientation, training, and CME administration for newly hired staff. The information gathered and managed by the center provides detailed, enterprise-wide managerial analytics and simplifies a number of compliance reporting mandates. The benefits stemming from these operations include accelerating new provider onboarding, strengthening provider engagement, and simplifying professional performance evaluation practices. These outcomes directly improve revenue and cash flow while reducing bad debt and redundant administrative costs.

For healthcare organizations currently considering or actively involved in merger and acquisition activities, QA shared services centers can play an integral role in catalyzing deal flow and ensuring successful integration processes. By working directly with deal and integration teams, service centers can facilitate clinical staff alignment, credentialing, privileging, and payer enrollment activities well in advance of closing to ensure “Day 1” readiness for staff-wide appointment and reimbursement. Furthermore, the services center staff can provide consultative support to several key, but often overlooked integration activities such as QA policy harmonization, systems integration, risk management analytics, FPPE/OPPE transition, accreditation compliance & audit readiness, and compliance reporting continuity. Finally, by leveraging the services center’s intrinsic onboarding function, acquirers can expect new staff members to experience a well planned, efficient, and highly professional introduction to their new parent organization.

To learn more about best practices for developing a QA shared services center, please follow the link below.

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About the Author

Anthony Begando is the Co-founder and Chief Executive Officer of SEERhealth LLC. Anthony has 21 years of experience in the healthcare industry. Since 1995, he has held leadership positions within the healthcare field, as well as founded Tenon Consulting Solutions, Inc. and Military Credentialing Solutions, Inc. and is noted for providing practical, creative solutions that improve business performance. VIEW FULL PROFILE

Promoting the Future of "Continuous" Credentialing - A Partner in FPPE/OPPE

Matt Gretczko — Thu, 07 Mar 2013 16:43:00 GMT

I am a firm believer that within the next 3-5 years credentialing may follow less of a “two year cycle” and instead will seek to achieve “continuous” or “perpetual” credentialing – a state which allows a provider’s credentials to be fully up to date at all times, or completely privilegeable. This may seem like a big leap, but the reality is recent factors, some of which are outlined below, are actually supporting this trend. Unfortunately, gaps in communication and collaboration within the healthcare market often restrict the transparency of such benefits.

The institution of FPPE/OPPE reporting and process requirements supports perpetual credentialing

These two evaluation requirements help ensure that a provider is competent to perform the procedures and tasks they have been assigned within a particular institution. Whereas FPPE is a defined duration, OPPE is a defined frequency. According to a presentation by Harvard Medical School, OPPE is defined as: “Measurement of physician performance data to assess competency and approve privileges on an on-going, non-periodic basis to allow them to take steps to improve performance on a timelier basis.” In my application of that definition, if an organization is performing ongoing reviews (more than once a year) of a provider’s performance and competencies, it would make sense to also ensure that the provider’s credentials which support those capabilities are also maintained throughout the year. Moreover, FPPE drives a similar goal in that it is triggered when a provider is initially granted privileges, receives new privileges, or exceeds an OPPE threshold. At these points in time, wouldn’t you want credentials that are up to date and fully referenceable as well? Forcing institutions to institute processes, and hopefully technology, to drive these evaluations aligns to a vision of having a perpetual privilegeable state for a provider.

Technology is the catalyst for effortless data maintenance

In the past, most healthcare organizations stored their credentials information in paper files. Although many have transitioned to systems that help “maintain” this same information electronically, the reality is they still may not be leveraging these automated systems to fully replace paper documentation (i.e. view electronic information in place of an actual credentials file). This transition will take time and also requires regulatory changes. However, the ability for these systems to streamline data entry and more effectively store credentials information and the associated documentation, also provides a better mechanism for credentials maintenance. In addition, these systems can help drive two key areas of analytics – operational (completing the credentialing and verification work), and outcomes/quality (understanding the performance of individuals within your organization). Instituting policies and programs, whereby providers inherently seek to update their information as soon as a change occurs, or are notified when expired documentation is due, will also help drive this state of perpetual credentialing.

What are the benefits of perpetual credentialing?

Some of the potential benefits of perpetual credentialing may be:

Decreased timeframe to grant privileges
Broader ability to deliver care in local, community, and regional areas as it relates to the ACO model
Lessened burden of credentialing activities for providers, and other resources, through a more balanced and focused effort throughout the year
Alignment and integration of credentialing and privileging activities into the broader onboarding process at the organization

It is important that as organizations institute FPPE/OPPE processes and technology to drive it, these same organizations recognize the inherent tangential value of such policies, such as reshaping the manner in which credentialing is performed. In addition, the healthcare environment must continue to look towards other impending changes and determine how they may also drive new trends within the healthcare environment.

Of course, there are still challenges. One of the main ones being that regulatory bodies will ultimately need to collaborate with organizations to understand the trends and goals that their policies must seek to promote at market level scale.

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Patient Experience: Exceeding the Patient’s Expectations

John Damouni — Fri, 22 Feb 2013 14:02:00 GMT

The challenges of providing patients with a “positive experience” in healthcare are undeniable. Most healthcare organizations work hard to meet the basic level of service standards demanded by their patients, governmental regulations, and the marketplace. However, when it comes to patient experience, the difference between meeting the basic level of service, and delivering great, or even excellent service can be vast. Nevertheless, the patient experience can be improved by making simple changes to the current service delivery model in healthcare organizations.

While it is virtually impossible to exceed all patients’ expectations, most patients expect healthcare organizations to be clean, rooms to be comfortable, and providers to be competent. However, even when these basic expectations are met, the ability to satisfy patients’ concerns can determine whether a patient has a positive or negative experience at a hospital. Some of the common patient complaints include wait time, responsiveness of a timely manner of staff, and poor communication. Process redesign, rigorous employee selection processes, and intensive training programs are a few of the tactics utilized to combat some of the service symptoms patients experience.

The level of service delivery that healthcare organizations should strive for is exceeding expectations. In order to operate at this level, healthcare executives must make the following strategic objectives a top priority:

Create a culture of service; including strong service-oriented mission and vision statements
Select and recruit service-driven providers and healthcare professionals
Create an ongoing training program to support the changing needs of patients
Measure and evaluate service performance to continuously refine offerings

Once the aforementioned objectives are realized, the appropriate service infrastructure will be in place to drive a state-of-the-art service model. At this level of service standard, patients can expect that all interactions with healthcare professionals and the organization demonstrates a strong mission to deliver high quality service at each step in a patient’s wellness journey. Some of the noticeable enhancements patients would be able to discern include:

Personal Care

Patients will receive personalized care from empathetic providers and staff who are emotionally connected to patients’ concerns.

Anticipation of Needs

Healthcare organizations striving to exceed patients’ expectations are led by providers and staff who can “sense and respond” before being asked or prompted. The ability to anticipate needs will comfort patients and build trust and credibility quickly. Examples of anticipation of needs may include responding to non-verbal signs a patient has pain or discomfort, or perhaps body-language cues exhibiting frustration with wait-times for a particular service.

Family Engagement

One of the most glaring differences between healthcare and other service-oriented industries is family involvement. Frequent and consistent communication with family members can assist with easing a stressful experience. Furthermore, involving family members in the recovery process alleviates patient and family stress and enhances the chances of a speedy recovery.

Healthcare systems working to exceed their patients’ expectations understand the long term benefits to the patient and organization are manifold. Cutting-edge healthcare organizations start every initiative with the end (the patient) in mind. By building a culture of service, organizations would inherently improve the quality of care delivered, mitigate risk areas, retain talented individuals, and improve processes and procedures to increase operational efficiencies.

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Credentialing Without Borders

Matt Gretczko — Wed, 20 Feb 2013 20:50:00 GMT

Innovation and collaboration is at the heart of what we do at SEERhealth. In order to achieve these goals, we invest a large amount of time to become “experts” in the healthcare market. This dedication allows sufficient competency to drive the solutions, change, and thought leadership that we believe can define the future of the marketplace. Our team also recognizes that the many intricacies and components of the healthcare industry ensure that being an expert on all of its facets is impossible.

But what if we could examine one critical component of healthcare at a time and start to address it globally – and when I say globally, I mean globally.

In most industries, organizations tend to focus their attention on certain “markets.” They start rolling out a product or service regionally, then nationally, and maybe even internationally. As this expansion occurs, the products and/or services tend to evolve to meet the varying demands of it's customers. Some of this evolution is driven by revolutionary ideas, but the process is typically driven by a market need.

What if we were to think about credentialing as this type of need? Products designed to address issues in the United States could then be leveraged to drive efficiencies elsewhere – and maybe even vice versa.

In attending domestic healthcare conferences, one of the more noticeable non-topical themes is that international participation continues to grow – this includes attendees from Canada, Brazil, India, some Middle Eastern nations, and many other countries. Some may argue that this international presence is because the United States truly offers some of the best care in the world and other nations are trying to mimic it. Others may say it is to learn from our mistakes. Both may be true as we know the U.S. healthcare system is front and center with debate. What I do know is that this trend of participation is because many aspects of healthcare, domestic and foreign, are the same – not excluding credentialing.

Credentialing is global.

One of the most critically important yet negatively branded activities within the provider onboarding continuum is the process of credentialing. Credentialing is the process by which a provider’s skills, education, and training are verified. At this native level, credentialing is the same no matter where you practice in the world. Unfortunately, as an industry, healthcare has not yet capitalized on the similarities of the outcomes and instead focuses on the process intricacies that lead to differentiation.

Take Canada for example – they have alternative regulatory bodies that govern the appropriate skills, education and training that a provider must have, they have unique payment methods due to their institution of national healthcare, and they have differing semantics for aspects of the process (even for providers themselves). However, the reality is that the resources responsible for performing credentialing in Canada, similar to the United States and many other countries, seek to ensure that they have providers who are competent to deliver the highest level of care to patients.

Focusing on the niche problem of credentialing, we can build dynamic technology that allows organizations to effectively vet a provider, but tweak the steps and approach to reach that goal based upon the standards and regulations of their country. As credentialing continues to evolve it will become part of a broad platform that drives the sharing of quality and outcomes data to build an integrated model of risk management (See – art and future of credentialing). Healthcare should not be held to physical barriers when there is enormous opportunity for collaboration and innovation across borders to drive efficiency and improvement.

Credentialing is one small, but key component that can help be a catalyst for this change in redefining how high patient care is delivered. We hope our solutions, and others, can make this a reality.

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[VIDEO] What is a Shared Services Center?

Anthony Begando — Thu, 14 Feb 2013 19:47:00 GMT

<00:00>	Hello, this is Anthony Begando with SEERhealth Corporation. Shared services centers is a concept that was developed about forty years ago in the industry to help large organizations consolidate functions that were typically being performed across multiple locations or divisions or subsidiaries or what have you in a common corporation or enterprise. The idea was, you could take a common function like human resources, personnel services, information technology,
<00:30>	logistics, supply etc. and build one organization that would provide and support those common functions to all members of an enterprise. Shared services have been a little slow to catch hold in healthcare, however over the last ten or fifteen years we have certainly seen IT and HR applications being utilized around shared services. One area, that we at SEERhealth, have been working hard to implement and been quite successful in implementing involves consolidating quality assurance practices
<01:00>	for providers that would typically involve the functions related to credentialing, privileging, committee and appointment processes, payor enrollment programs and also, performance monitoring and professional performance evaluation programs. Collectively, this sort of continuum of activities helps an organization truly manage their relationship that they have with their healthcare providers and clinical staff.
<01:30>	Within a healthcare organization, putting a quality assurance shared services center in place really can drive out several significant, short-term and compelling benefits. Fore mostly, provider onboarding, whether that’s your new hires, acquisitions, post-residency or fellowship employment situations and what have you, can be greatly simplified, supporting things like
<02:00>	multi-facility appointments, core privileging etc. With regard to onboarding and payor enrollment, simplifying and speeding up that enrollment life cycle in order to improve revenue recognition for new hires and finally, improving the relationships that exist between the healthcare organizations and the clinical work staff.
<02:30>	Simply stated, a well run shared services center helps providers make it easier to do business and work with a healthcare organization. This has been Anthony Begando with SEERhealth. If you’d like to learn more about how we may be able to assist your organization in developing a shared services center for quality assurance please feel free to contact us directly. Have a great day.
<02:42>	END

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Healthcare Continues to Benefit from Shared Services

Melissa Outlaw — Tue, 12 Feb 2013 15:29:00 GMT

In today's ever changing world of healthcare, there is an increased number of multi-facility organizations. It is the norm, especially with the expanding emphasis on ACOs, for an organization to encompass a mixture of hospitals, surgery centers, physician practices, and long-term facilities. Due to this environment, we are also seeing a fundamental shift in how these organizations collaborate to manage the credentialing of providers. This has resulted in significant benefits for both the organization and providers.

This is 'shared services' - identifying the services that are repeated at each or multiple facilities and then consolidating them into one, central location. Most are familiar with the centralization of Internet Technology (IT), and Human Resources (HR). Both HR and IT underwent a significant shift from being separate business units at multiple facilities to a single entity that performed activities for the entire organization. It has now become not only standard, but accepted as the most effective way to run a business.

Medical Staff Services - Shared?

Healthcare has now reached the point in which Medical Staff Services is being consolidated in order to eliminate redundancies across the organization. Verifying providers' credentials information in a central location not only allows large organizations greater efficiency through volume-based processing, but it also leads to greater sharing of information, higher visibility of key data and statistics, and creates an office within healthcare that drives best practices throughout the organization.

Provider Satisfaction - Win/Win!

As the creation of a centralized credentialing office becomes conventional, organizations will see a direct impact on provider satisfaction. Before, if a provider worked in three facilities, he or she would go through credentialing three separate times. This means the provider would have to review and update his or her information, and provide copies of all updated information, three separate times to three different medical staff personnel. Consolidating all this work to be completed only once and establishing one point of contact for the provider will eliminate excessive paperwork and allow the provider to do what he or she does best - see patients. Ultimately, this is a win-win for the organization and the provider.

Careful Consideration is Necessary...

It is important to note that the centralization of services, such as credentialing, does not mean that facilities are no longer supported. In fact, it is often commonplace to maintain some staff members, depending on the size of the organization, on-site to help facilitate tasks that are facility-specific, like privileging.

The shared service model has demonstrable positive results for both organizations and providers. However, it is important to do it accurately and methodically. If you do not have staff experienced in large organizational change initiatives and knowledge of the variety of factors that must be considered to create this solution, we recommend that you look outside your organization to help oversee this effort.

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Improving Patient Experience with Personalized Service

John Damouni — Sat, 09 Feb 2013 14:21:00 GMT

No doubt you have interacted with a warm and engaging healthcare provider that has impressed you with their advanced emotional intelligence skills, and was successful at establishing a strong brand perception for the organization they represented. While it may be obvious to service advocates in the healthcare industry that “service” is the primary objective of healthcare providers, how that service is delivered is what differentiates good healthcare providers from great healthcare providers.

The way in which a service is delivered can be just as important as the service itself. Take for example two different healthcare providers who can sense a patient’s fear of a certain procedure and take different approaches to easing the patient’s concerns. The first decides to go into details about the procedure, often speaking in complex medical terms that the patient cannot comprehend. The other, more empathetic, healthcare provider takes the time to communicate comforting and reassuring words to ease the patient’s concerns. To the patient, the actual medical service remains the same, but the experience is positively altered with the guidance of the more empathetic provider.

Industry leading healthcare organizations train their employees to personalize the delivery of a service based on the perceived preferences of a client. In order to properly “sense” an individual’s preference for service delivery method in healthcare, one must be able to watch for verbal and nonverbal cues, including:

Engagement level:

Healthcare providers should be able to detect a patient’s level of engagement and adjust their approach accordingly. Some patients may be hungry for information and want to be involved in the course of treatment, while others prefer to be comforted and assured of a quick recovery. Providers must be able to tailor and personalize their service approach to successfully meet every patient’s expectation

Body Language:

Most communication experts claim that over 90% of communication is non-verbal. Therefore, in order to personalize the delivery of healthcare related services, healthcare organizations must select and train healthcare professionals with high empathy, relationship-building, and emotional intelligence skills

Credibility and Competence:

Patients in need of care are often vulnerable and uncertain about their course of treatment. Behavioral cues can reveal someone’s degree of fear, uncertainty and doubt. Healthcare providers must be able to build a strong bond with patients leveraging their competence and experience in the medical field

The most successful healthcare organizations foster a work environment where providers and healthcare professionals are empowered to own and nurture personalized relationships with patients. In the current competitive landscape of the healthcare industry, personalized service delivery can be a strong differentiator that can separate the good healthcare systems from the great healthcare systems.

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The Art ... and Future of Credentialing

Matt Gretczko — Thu, 07 Feb 2013 15:51:00 GMT

I have been working in the healthcare industry for many years now. To me, credentialing is a pretty straightforward topic – I understand the intricacies, value the outcomes of the process, and recognize the complexity of not only doing it right, but well.

At its simplest level, credentialing is the process by which a provider’s skills, education, and training are verified. However, when one asks me to concisely define credentialing and its various components, it is a more complex explanation to those with limited interaction with this unique niche in the healthcare landscape. To them, credentialing is often seen as an amorphous activity – something proposed as a metaphoric cross between a background check, transcript review, security clearance, and an interview; potentially driven by a non-standardized, often burdensome, and paper-driven process.

Is this what credentialing is supposed to be?

No. The goal of credentialing has always been the same. Credentialing is meant to assess a provider’s skills, education, and training, but the manner in which the process occurs often clouds its definition and intent. Competing perspectives on the path forward for credentialing slows the ability to garner agreement to drive one key element of change: collaboration. In addition, providers see it as an unnecessary “administrative” burden as opposed to “value-add.”

Therefore, we must instead operate under the assumption that the healthcare industry has agreed that credentialing must undergo a modernization due to regulation, technology, and the changing landscape of delivering care. Many healthcare organizations struggle with determining the right solution to meet this modernization goal.

How many of you hear the following when considering a new strategic project or engagement at your organization:

Efficiency
Standardization
Technology
Cost
Training
Collaboration

I’d be shocked if you didn’t hear them all. Finding the right credentialing solution means developing one that ensures the perfect balance of the above criteria to drive your desired results. This must be tailored to your organization so that it promotes your organization’s credentialing goals, change management tolerance, and alignment to a strategic vision. In addition, the solution must be developed as an output of detailed analyses that strongly consider the role technology can, and should, play in the future credentialing framework.

So how will you know if your organization is creating the right credentialing solution? Instead of pointing out what a “good” credentialing process looks like, let’s identify trends that we believe should be standard in credentialing within the next three to five years:

Credentialing will no longer be largely paper-based
Credentialing, and its associated activities and documentation, will be one part of a broad platform that drives high patient care, improved data access and reporting, increased patient and provider satisfaction, and proactive risk management
Healthcare organizations and providers will interact in a symbiotic environment where “perpetual or continuous” credentialing is the norm, as opposed to meeting two-year cycles. This means at any point, a provider could be granted privileges or work at an additional hospital
Credentialing data integrates with quality and outcomes data to create a complete picture of a provider
Credentialing is one key part of the onboarding process for providers, but the information is shared in other steps of the process

When assessing your current credentialing process to determine the path to “modernization,” don’t just focus on meeting regulation. Most credentialing processes meet this requirement. Instead, determine an approach that will play a vital role in your organization as it seeks to capitalize on technology to truly revolutionize the way providers interact with organizations, and the information shared internally and externally.

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Stay on the Cutting Edge: The Three A's of Data

Matt Gretczko — Tue, 05 Feb 2013 14:51:00 GMT

We live in a society where time is extremely valuable – whether you live your life by the adage “time is money”, or just value having free time to pursue your interests; ultimately we try to balance our time between competing priorities.

Within healthcare, providers must often balance their time between the actual delivery of care (performing procedures) and the administrative activities that promote that process – such as credentialing, privileging, and chart/EHR maintenance. These activities, often disregarded as insignificant, actually can have tremendous impacts on the immediate and future well-being of patients. Providers don’t actually “believe” these things are inconsequential, rather the process or technology driving them may be inefficient, or they have insufficient information to properly perform the requested activities. Couple that with a high-stress and profit-driven environment and it is not hard to imagine that providers would find a way to be more efficient (aka, save time).

Often these time saving activities are harmless, but what if they could be life threatening?

I read an article the other day (“Cloning Persistent Problem in EHR Data Entry” on hitechanswers.net) which described an upward trend amongst providers known as “Cloning” – this time though, we are not talking about goats or cells. Instead, according to the study in the article, there are some rather staggering statistics around providers and the practice of copy and pasting data when charting patient information:

Copy/paste was used by 82 percent of medical residents and 74 percent of attendings
Copy/paste was used more than 20 percent of the time by both groups
After a day off, copy/paste was used more often by attendings (94 percent) and less often by residents (66 percent)

Though an obvious time saver and benefit to transitioning to an electronic health record platform, the potential for erroneous information finding its way into a patient chart is significant when cloning is the norm. Any industry that is undergoing significant change, such as an EHR implementation or acquiring a new credentialing and privileging system, often struggles with ineffective adoption techniques. Many times organizations disregard the significant role that training and the communication of best practices can have on greatly improving the long-term success of that investment. Such training is one method being utilized to thwart the practice of cloning in an effort to decrease the risk of inaccurate information in patient charts. But what about protecting the integrity of other data?

EHRs are not the only data source at healthcare organizations.

As the healthcare industry shifts towards automation to replace paper-based processes and systems, we must start to evaluate three critical components of all data: accuracy, aggregation, and access. The practice of cloning has illuminated the risk of inaccuracy.

Accuracy is often dependent on user input. Therefore, it is critical that as your organization moves towards any new healthcare technology – EMR/EHR, credentialing and privileging, quality, incident reporting – it has the infrastructure in place to ensure the appropriate education and training. In order to address aggregation and access, many healthcare organizations are consolidating processes, systems, and activities into a single operation. This approach, often referred to as a “shared service”, creates an infrastructure by which data from various sources across the organization can be aggregated into meaningful reports and dashboards for the appropriate presentation to key stakeholders. In addition, this operation can now maximize the technology investment by segmenting access to this consolidated data by various user groups and entities.

Any system that is implemented should be seen as a pathway to maintaining high quality patient care, improving data, increasing patient and provider satisfaction, and eliminating excess time spent on various activities.

This includes ensuring that you are not sacrificing accuracy for efficiency, or disregarding the need to easily aggregate and access data across your organization.

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Designing a Successful Professional Practice Evaluation Program

John Damouni — Wed, 30 Jan 2013 15:33:00 GMT

Professional Practice Evaluation is a critical part of risk management within a healthcare system. According to The Joint Commission Standard, Professional Practice Evaluation encompasses Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE). OPPE is the process by which a healthcare organization reviews clinical data on privileged providers on an ongoing basis in order to afford these providers the opportunity to continuously improve performance. FPPE is a time-specific evaluation of a privileged provider’s competence in performing a specific privilege.

In order to successfully design and implement a Professional Practice Evaluation program, healthcare executives are encouraged to monitor the flow of information through various stages of the provider life-cycle to detect inefficiencies. Most Professional Practice Evaluation programs have systems that are decentralized and lack standardized processes, which impacts the level of efficiency in collecting, aggregating, and analyzing the information necessary to evaluate a provider’s performance. Signs of an ineffective Professional Practice Evaluation program may include:

Disparate collection and management of data
Lack of automation and analytics capabilities
Redundant processes due to lack of synergy with the organization’s quality assurance program
Delayed or ineffective incident reporting
Lack of compliance with claims reporting

Evaluating the processes and systems associated with an organization’s current Practice Evaluation program assists in defining the specific steps required to design and implement an effective OPPE/FPPE program. In order to do so, many healthcare organizations are leveraging a single, enterprise-wide platform that aggregates data points found across multiple systems, such as EHRs/EMRs and billing products.

This type of platform helps standardize the approach for performing Practice Evaluations to maintain high standards, ensure objectivity, and confirm the accuracy of the process. In addition, an enterprise-wide platform helps simplify compliance claims reporting, reduce administrative burden, and utilize performance data to propel the growth of the organization.

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Peer Evaluations: The Importance of Objectivity

Matt Gretczko — Tue, 22 Jan 2013 14:48:00 GMT

Being Objective – not influenced by personal feelings, interpretations, or prejudice; basing decisions solely on facts.

That seems like the obvious intent of a Peer Evaluation, but too often we find it is not the case. This begs the question - why? Interestingly enough, often Peer Evaluations (whether OPPE or FPPE) lose objectivity when the processes guiding them are unstructured.

The OPPE and FPPE processes at organizations must be formalized so that they can be shown to demonstrate a “clearly defined process, frequency, and duration,” as outlined by the Joint Commission. In addition, these processes must incorporate metrics, thresholds, outcomes, and policies to further define their approach. However, many organizations have struggled to make the leap from performing these activities on an ad hoc basis, to actually creating a process and infrastructure that supports their ongoing integration into standard business practices.

Before an organization can bridge this gap, it must ensure a clear understanding of what is being regulated. A quick refresher on terminology:

FPPE - Focused professional practice evaluation is a process whereby the organization evaluates the privilege-specific competence of the practitioner who does not have documented evidence of competently performing the requested privilege at the organization

OPPE - Measurement of physician performance data to assess competency and approve privileges on an on-going, non-periodic basis to allow them to take steps to improve performance on a timelier basis

After confirming the terminology and specific details of each evaluation, your organization must outline a process that is standard and repeatable, and whose underlying goal fosters objectivity. Factors that one must define, as outlined by NAMSS, include:

Measures
Reviewers
Indicators/triggers/issues

In addition, this process must ensure the results are utilized in credentialing activities and that FPPE/OPPE is applied to all privileged practitioners.

Organizations must also ensure that various data points (case review, malpractice suits, incident reports, outcomes) and evaluation methodologies (chart review, simulation, clinical practice patterns, proctoring) are incorporated into the process to ensure the most productive results.

Does it seem far-fetched to achieve this reality?

The good news is there is technology currently available in the marketplace that can assist in driving effective FPPE / OPPE processes into the standard operations of your organization, ensuring integration into other systems as necessary to meet the regulatory standards.

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The Link Between OPPE/FPPE and Provider Perceptions

Matt Gretczko — Fri, 18 Jan 2013 20:28:00 GMT

Judgments. Evaluations. Assessments – these are all words that most people associate with stressful, yet unavoidable components of their job. When one is being judged, evaluated, or assessed, the ideal outcome is a positive experience for the individuals involved and the organization. The issue is often that the intent of these interactions is not aligned to the outcomes.

So what if employees could begin seeing these activities not as a hindrance, but instead as an opportunity to improve their own professional skill-set and results?

It is believed that the pay-for-performance system that is prevalent in many other industries may be a solution to achieving this result in healthcare. In order to drive this shift, the regulatory bodies of the healthcare industry are mandating the implementation of processes and infrastructure to better track, define, and report on the performance of their providers.

One such mandate is instituting Professional Practice Evaluations processes. These evaluations currently come in two types - Ongoing Professional Practice Evaluations (OPPE) are performed on a cyclical basis. These activities use historic clinical and operational data to objectively provide healthcare practitioners with the information needed to continuously improve performance. Areas of evaluation include patient care, medical knowledge, communication skills, professionalism, and systems-based practices. In contrast, a Focused Professional Practice Evaluation (FPPE) is situational — evaluating a provider’s competence in performing a specific privilege. FPPE is often initiated when a provider requests new privileges, or when an event or condition supports a focused review.

But what do Providers think about these efforts?

The short answer is: It depends. Providers, like any employee, want to be compensated for the effort they exert in their daily jobs. However, they also have the unique need to manage, prevent, and treat illness — which means time spent not interacting with patients must be meaningful. If an organization implements these processes correctly, we find that it can lead to a variety of benefits that improve providers’ perceptions, such as: improved quality outcomes with patients, elimination of the perceived subjectivity within the evaluation process, and improved financial benefits for the organization and the provider.

So how do you implement it correctly?

Providers will ultimately view these efforts as a positive to their professional development as opposed to a “big brother” administrative burden when following the subsequent standards:

The practice evaluation program is implemented and operated as a common, transparent process, uniformly applied to all members of the clinical staff
Evaluations are based on objective, trusted measures, metrics, and data — free from individual biases, perceptions, or predilections
Evaluation programs leverage cost-effective information technologies to automate the entire process
Automated workflows, routing, and reminders facilitate evaluation procedures
Multi-facility organizations leverage a centralized administration and management function to govern the program across the enterprise
Evaluation systems are fully integrated with credentialing, privileging, and staff appointment systems and draw evaluation data from existing enterprise EMR, outcomes measures, and claims/billing applications
Enterprise-wide compliance reporting is a natural output of the systems supporting the program and do not require additional data gathering, formatting, or consolidation
Evaluation procedures are integrated with clinical event notification, incident reporting, risk management, and patient satisfaction functions
Key internal and external stakeholders are engaged to ensure the development of an objective appraisal process

Provider perceptions impact all interactions that they have with an organization. Therefore, it is critical that the aforementioned mandates are implemented in a manner in which providers recognize the benefit and integrate the goals into their everyday routine.

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Implementing an Effective Professional Practice Evaluation Program

Anthony Begando — Fri, 11 Jan 2013 15:26:00 GMT

The Business Case below is an excerpt from our White Paper Implementing an Effective Professional Practice Evaluation Program.

SEERhealth has responded to the business case below by publishing a white paper that clearly defines the attributes of an effective professional practice evaluation program, what the phased implementation approach should look like, and what outcomes can be anticipated related to healthcare quality assurance and financial objectives.

Business Case:

A Troubled Professional Practice Evaluation Program at Wellingud Health

Michelle Lucas and her General Counsel, Allen Lapore, were leaving a long Executive Committee meeting where the topic of discussion largely centered around the recent legal action brought against Wellingud Health by Dr. Vijay Aggarwal. In the suit, Dr. Aggarwal claimed that he was wrongfully terminated earlier in the year by the Chief of Radiology at Westside Hospital— one of Wellingud’s leading facilities. After the meeting, Michelle voiced considerable concern regarding the fact that this was the third case filed against Wellingud in the past year. While Michelle had personally chartered several business improvement initiatives following her appointment as Wellingud’s CEO three years earlier, a persistent problem with provider engagement and collaboration between administration and the medical staff continues to blight the organization.

In reviewing Dr. Aggarwal’s employment records, credentials, and privileges, Allen noted that while several issues emerged throughout Dr. Aggarwal’s tenure, and that his termination was performed in accordance with Wellingud’s policies and procedures, the nature of his working infractions were not uncommon for highly utilized radiologists. After speaking with Dr. Richmond, Chief Radiologist at Westside Hospital, it was clear to Allen that Dr. Aggarwal’s termination may have had as much to do with personality conflicts than simply performance problems. Furthermore, several other junior members of Dr. Richmond’s staff were noted to have had similar performance issues, which appeared to have been either largely ignored or resolved through varying approaches.

In discussing his findings with Michelle, Allen knew that the corporation would have a very difficult time defending itself against Dr. Aggarwal’s action. Unable to argue with Allen’s perspective, Michelle advised Allen to begin settlement negotiations with Dr. Aggarwal’s lawyers rather than risk a protracted dispute that would likely result in a decision favoring the terminated physician. Michelle also asked Allen to seek assistance from an outside firm to perform an independent assessment of Wellingud’s professional practice evaluation processes and to provide the Executive Committee with a slate of recommendations.

Following a 45-day assessment spanning the corporation and its facilities, Allen and members of the assessment team presented the following findings:

Virtually every facility was found to have redundant credentialing, privileging, and performance management practices.
Performance measures and criteria were often poorly defined and varied between departments clinical constituencies.
OPPE and FPPE practices appeared to have been largely developed as a stopgap measure for Medicare compliance. Furthermore, their application across the clinical staff and constituencies were highly inconsistent.
Practice evaluation procedures were performed using a host of paper forms, spreadsheets, and simple databases across the organization, making enterprise-wide analyses and reporting virtually impossible.
The corporation required two full-time employees to gather, sanitize, aggregate, and format the data necessary for submitting mandated OPPE/FPPE compliance reports.
Several examples of conflicts of interest were noted within the peer review process.
The lack of synergy and integration across the organization’s overall quality assurance process limited information sharing, analytics, and reporting.
Incident reporting practices were often delayed.
Due to a lack of information and reporting, risk assessments and mitigation practices were consistently performed in a reactive fashion.
Numerous members of the medical staff noted that professional practice evaluation standards were often performed inconsistently and influenced by personal relationships.

Following their presentation, Michelle and Allen proposed to the Executive Committee that Wellingud Health undertake an initiative to restructure and strengthen their professional practice evaluation program. Furthermore, Michelle suggested the formation of an enterprise-level function to oversee and facilitate practice evaluation programs across Wellingud’s operations. The success of this initiative would be measured not only by the ability to perform practice evaluation procedures in a compliant manner, but to also measurably improve provider satisfaction, procedural quality, patient satisfaction, and reduce administrative cost.

In an ever-changing healthcare environment, professional practice evaluations are a critical component of organizations' compliance and quality assurance programs. Not only will effective professional practice evaluation programs eliminate administrative redundancies and minimize subjectivity within the evaluation process, they can also directly and positively impact an organization’s operational performance. Click on the button below to download our comprehensive white paper regarding how to implement an effective professional practice evaluation program.

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[INFOGRAPHIC] Provider Onboarding: The Road to Revenue

Anthony Begando — Thu, 10 Jan 2013 19:22:00 GMT

In the current healthcare environment, many organizations are aggressively searching for ways to increase revenues, reduce cost and improve provider relations. Implementing an enterprise-wide initiative to streamline provider onboarding processes can aid an organization in directly realizing these objectives.

The infographic below demonstrates how healthcare organizations can derive substantial operational and financial benefits through streamlining and consolidating new provider onboarding activities.

Click the image below to enlarge

To embed this infographic on your site, copy and paste the code below:

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Healthcare Quality Assurance Glossary

Julie Peel — Wed, 12 Dec 2012 21:00:00 GMT

Navigating the complexities of the Healthcare Quality Assurance industry can be overwhelming at times, especially when considering the intricacies of the vernacular. In many cases, different organizations use similar terms in very different ways. In order to clear up some of the confusion, we've put together a basic list of definitions to help support a common understanding. Please feel free to comment with suggestions for improving or adding context to the definitions below, and for additional terms we would be well-served to include.

Healthcare Quality Assurance

The segment of the healthcare industry focused on ensuring patient care is consistently delivered at the highest levels of quality. Healthcare Quality Assurance includes a wide range of activities designed to identify, vet, and manage the people and processes necessary to deliver care, including provider recruiting, credentialing, privileging, risk management, payor enrollment, and reimbursement.

Provider Recruiting

The process of finding and hiring the best-qualified medical provider for a job opening, in a timely and cost effective manner. The recruitment process includes analyzing the requirements of a job, attracting providers to that job, and screening and selecting applicants. Effective provider recruiting ensures a good fit between the provider and the healthcare organization, and is the foundation for establishing a strong working relationship between the two moving forward.

Healthcare Credentialing

Collecting, verifying, and reviewing a healthcare provider’s education, training, experience, practice history, medical certifications, licenses, malpractice history, and additional qualifications to determine that provider's fitness to practice in a particular healthcare environment. In short, credentialing ensures the provider is competent to practice in his or her given specialty. Effective healthcare credentialing leverages information collected during provider recruiting, and supports downstream business processes thereby eliminating areas of redundant effort for both the provider and the credentialing entity.

Privileging

Granting a healthcare provider the authority to provide patient care in a clinical setting. Clinical privileges are limited by the individual's professional license, experience, and competence. Privileges are granted based on the provider's verified credentials, and outline the specific procedures the provider may perform in a given healthcare facility.

Payor Enrollment

Collecting, customizing, and submitting provider demographic and credentials information to payors to facilitate reimbursement for clinical services performed. Payors are entities other than the patient that finance or reimburse the cost of health services. On average, healthcare providers are enrolled with up to 20 unique payors, each with distinct enrollment forms and processes. Healthcare organizations can effectively streamline their payor enrollment practices by leveraging state of the art technology solutions to automate the form completion and submission processes using information collected throughout the provider onboarding life cycle.

Provider Onboarding

Includes all the steps necessary to bring a new healthcare provider on staff at a healthcare facility. Provider onboarding includes recruiting, credentialing, privileging, and payor enrollment. A successful provider onboarding process uses information gathered at each step to support subsequent steps in an efficient and effective manner. Sound provider onboarding most often leverages comprehensive business processes and technology solutions to streamline communications and sharing of critical information across the organization.

Risk Management

While risk management covers a wide range of scenarios, within healthcare quality assurance we consider risk management to be the clinical and administrative activities undertaken to identify, evaluate, and reduce the risk of injury to patients, as well as mitigating the risk of loss to the organization itself. Proactive risk management includes thoroughly vetting healthcare providers in a continuous manner throughout their association with the healthcare organization, tracking and managing adverse events, and institutionalizing best practices across the organization. As with other areas of the healthcare quality assurance spectrum, highly-evolved business processes and technology are keys in establishing and maintaining an effective risk management program.

Quality and Performance Improvement

Actively using performance data to improve patient outcomes. This involves the strategic use of performance standards, measures, progress reports, and ongoing quality improvement efforts to ensure an organization achieves its desired results. Leveraging quality and performance improvement data and metrics is a key component of an effective risk management program within a healthcare organization.

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About the Author

Julie Peel is a founding member of the SEERhealth team primarily responsible for developing client strategy and ensuring the delivery of comprehensive, highly successful solutions. Julie has 12 years of experience in the healthcare industry helping a variety of organizations achieve their strategic, operational, and technical objectives. Her strengths lie in strategy formation, program management, business process optimization, functional analysis, and change management. Julie possesses an outstanding record of leading and delivering highly successful business solutions within the public sector, health services, medical staffing, financial services, and high-tech industries. VIEW FULL PROFILE

[VIDEO] Considering Provider Burden in Healthcare Quality Assurance

Anthony Begando — Tue, 11 Dec 2012 14:23:00 GMT

<00:00>	This is Anthony Begando with SEERhealth. Sitting in front of me are 23 stacks of paper, and they represent information that a typical private practice physician would have to maintain with the various business entities that he or she does business with everyday. In this case, let’s say I was an internist and I worked at, had privileges I should say, at five separate hospitals, had 16 payor relationships that I dealt with
<00:30>	as well as, Medicare and Medicaid. Each one of these files contains all of my credentialing information and privilege histories etc., compliant with the specific standards that each organization that I work with needs. Hospital X’s file looks like this, hospital Y’s file looks like this, hospital Z’s file looks like this, so on and so forth. When you open up the files, the information is all pretty much the same but it's organized maybe a little differently,
<01:00>	has a little different standard here and there, but basically it’s the same stuff. On the payor side, there isn’t as much that needs to be collected but guess what, it’s pretty much the same stuff that the hospitals needed just in a little more summarized fashion and needs to be updated a little less often. So, when we sit around and talk about what’s wrong with the healthcare industry, this is a great example. I’m a doctor, I’m a busy person,
<01:30>	I need to be seeing patients everyday and a big part of my administrative burden is maintaining this stack of paper information that enables me to work at hospitals, get reimbursed by payors, and prove my overall competency of clinical capabilities. What we need to do in the healthcare industry is eliminate this kind of ridiculousness. First and foremostly, when we consider that the other side of each of these transactions, let’s say the hospitals and the payors and so forth, gather, verify and maintain this information in a
<02:00>	completely redundant fashion, is silly. What we need to do is create a simple platform for maintaining this information as data, make it easily accessible, low cost, and highly distributed so that if you were a hospital and needed to see my credentials I could pull down 95% of the information I need today, gather the little bits and pieces that I don’t have as standard information and complete that process as quickly as possible with the minimum of burden on the provider
<02:30>	and the rest of the healthcare organizations that participate in this process as well. We at SEERhealth are committed to creating these kinds of solutions and we appreciate the opportunity to work with your organization to help put these kinds of solutions in place not only for your firm but also for the industry as a whole. This has been Anthony Begando, have a great day!
<02:57>	END

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The Significant Impact of Improved Provider Onboarding

Anthony Begando — Thu, 06 Dec 2012 19:08:00 GMT

<00:00>	This is Anthony Begando with SEERhealth. In today's healthcare environment, many organizations are looking for ways to improve their revenue and reduce costs. An area that's often overlooked, in this regard, involves improving the provider onboarding process.
<00:30>	Onboarding can be thought of as those sequence of steps of taking a newly hired physician or advanced practice provider and getting them fully billable with the payors that serve and work with an organization. The process typically includes hiring, credentialing, committee review and approval, privileging, appointment, as well, and finally concluding with payor enrollment. For most organizations, that cycle takes about 140 to upwards of 180, 200 days to complete. If you're able to reduce that time frame down, organizations typically can recognize substantial return on that exercise.
<01:00>	Let me give you a quick example. To make things simple, let's say you have 100 billable day, provider onboarding cycle time. The average provider for most hospitals in the United States bills about $6,000 a day in services. If it takes 100 billable days to get that provider fully billable with payors, the organization is basically losing or forfeiting $600,000 in billings. If you hire 100 new physicians a year, your organization is forfeiting a total of $60 million of potential revenue.
<01:30>	If you put a provider onboarding process improvement initiative in place and that initiative is able to reduce that cycle time down by as little as 10%, if we use our previous example, you take that $60 million forfeiture, drive $6 million or 10% back down into the organization, and that money flows directly to the organization's bottom line. If you consider the modest costs that are typically involved in most provider onboarding improvement processes, that creates usually a significant and very expedient ROI.
<02:00>	Our organization focuses on a couple of different solutions around provider onboarding. Some solutions focus on just doing simple process streamlining and automation initiatives that drive modest to significant improvements to that cycle time.
<02:30>	We also work with organizations to put in place shared services centers, that really consolidate and centralize that onboarding process. Often, with larger health care quality assurance programs, it's really great substantial improvements in that cycle time. We have a lot of great content on our website about how your organization can take advantage of these kinds of programs. We'd be happy to share this information with you (Please, take a look at our case study, Modernizing Healthcare Quality Assurance in The Army National Guard, demonstrating the success gained by the initiaves set). Certainly, if you have any questions or would like more information about how we may bill this issue, please feel free to contact us directly. This has been Anthony Begando with SEERhealth. Have a great day.
<02:57>	END

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Improving Automation to Alleviate Provider Burden

Matt Gretczko — Tue, 27 Nov 2012 16:33:00 GMT

From Archaic to Cutting-edge

Believe it or not, semantics should not play a large role in your organization’s ability to be successful. Cutting-edge may be referred to as electronic or automated whereas archaic may be synonymous with manual or paper-based. The important item to decipher is that all organizations want to replace archaic with cutting-edge, despite the terminology considerations.

The good news is that due to regulation changes, vast investment, and a plethora of really smart people, healthcare finally has a large influx of new technology that can drive the vision of state-of-the-art healthcare systems without many sacrifices.

The Benefits of Automation

So, why is “cutting-edge” so desirable? Mainly because it forces healthcare to adapt and evolve to ensure it is sustainable for future generations. Automated (or electronic) processes lead to many benefits, including:

Economies of scale – ability to quickly and easily scale operations during times of growth
Reliability – new platforms that are cloud-based allow your organization, and its resources, to access and operate in more global circumstances and environments
Risk Mitigation – by eliminating many paper-based processes, it also removes the tangential risk associated with the ongoing maintenance and storage of that information. Not to mention that paper is generally bad for the environment and often leads to stagnant data
Efficiency – leveraging technology to drive operational components of your business allows your organization to assess and develop the most effective processes to run your business through standardization and optimization
Flexibility – automation allows your organization to develop unique and creative solutions which ensures high-levels of engagement and satisfaction for key stakeholder groups – patients, providers, and employees

The healthcare industry, although inherently resistant to change, is not actually against these drastic improvements to the way they operate. Most organizations, and their executives, have recognized that it is unavoidable; despite sometimes struggling with budgetary constraints or prioritization issues.

Unfortunately, the real barrier is that organizations tend to not know how to move forward. It is critical for organizations to assess their strategic priorities, recognize the gaps or limitations in their current technology, and then select a “solution” that will help them meet their goals. The solution may combine technology, process design, change management, talent management, and a wide variety of other business units and activities to meet the identified goals.

Too often, large healthcare organizations implement technology in order to meet a requirement, but do not perform the subsequent analysis of what they are trying to achieve to drive true strategic value. For example, many organizations are implementing EMRs to achieve meaningful use, but do not think about how EMR data can be leveraged to drive quality statistics. Or an organization may implement a credentialing system that is not coordinated with the technology driving quality or risk processes, resulting in valuable data remaining under-utilized across the spectrum.

Your organization must first agree that you are willing to become cutting-edge through automation. Once this is confirmed, you can then focus on determining the right engagement lifecycle and resources to be successful, which will ultimately pay for the initial investment through efficiency gains.

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