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The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.
Epic’s “Rules of the Road”
By Frank Myeroff
Are you aware of the hiring guidelines from Epic entitled “Rules of the Road?” These rules are in place to protect Epic clients by ensuring that staff members do not negatively impact their implementation projects by leaving them.
The rules state that you are not able to recruit or hire any employee from an Epic customer until four months after the go-live, unless the individual is hired for a position that is not related to Epic. You are also not able to place or hire any individual who left employment from a customer’s Epic project before critical go-lives or rollouts are complete until one year after the individual’s last day at the customer.
The “Rules of the Road” no longer permit recruiters to acquire employees from an active install or rollout. With rollouts at hospitals continuing well into 2014, the Epic contracting staff are essentially locked in and prohibited from leaving and consulting before completion. Before these rules, recruiters were able to acquire HIT talent already working at hospitals but interested in entering the job market as an Epic consultant.
As a result, the demand will continue to grow, but the consulting pool will shrink. This increased competition for Epic consultants could increase hourly rates over 2013.
From time to time, I speak with Epic candidates who have quit their jobs in order to consult prior to knowing about the “Rules of the Road.” Unfortunately, these candidates are not eligible to consult on any Epic project for one year.
Please ask the question: is the Epic contractor I’m about to hire eligible to consult? Don’t find yourself in the situation where you’ve filled an open Epic consulting position with an ineligible candidate.
Infractions to Epic’s “Rules of the Road” will result in the loss of the consultant’s access to the Epic User-Web. Eligibility of the candidate to consult should be the first question you should ask any staffing firm submitting a candidate for consideration in order to avoid this costly situation.
To be sure that you are meeting Epic’s “Rules of the Road”, only work with firms that have a relationship with Epic and its consulting relations department. Reputable firms will work closely with that department to validate that your candidate(s) is eligible to consult.
Frank Myeroff is managing partner of Direct Consulting Associates of Solon, OH.
By Anil Kottoor
An Accountable Care Organization (ACO) is only as successful as the sum of its fundamental parts. Failure by just one participating provider to achieve a successful outcome on any of the 33 required quality measures could ultimately stand between the ACO and its eligibility for incentives under the Medicare Fee-for-Service Shared Savings Program.
So why not make those required metrics multi-task?
Every provider involved in an ACO should be leveraging the quality metrics they must already track to monitor internal performance and identify areas in need of improvement. From improved documentation to streamline care transitions to compliant coding and billing for more appropriate reimbursement levels to better utilization of resources for efficient patient throughput and reduced overhead costs, every aspect of a provider organization can be improved with internal benchmarking.
By repurposing data already collected to comply with reporting requirements, ACOs can easily perform effective internal benchmarking across the organization to identify gaps in care or areas of exposure before they affect the organization as a whole.
In particular, the metrics collected under the care coordination/patient safety and preventive care domains can reveal clinical outliers that may necessitate education, outreach, or process improvements. For example, by tracking the average HbA1c level across its diabetic population, an ACO can identify which if any patients run consistently higher than average after a one-year period. This could trigger a closer look at how individual physicians engage their diabetic patients to determine whether the outliers are a result of the treatment plan or the patient’s non-adherence to that plan.
Tracking and monitoring utilization rates and medical costs can also be useful to identify those providers who are managing care and costs more effectively compared to their peers. This information can then be leveraged to identify best practices which can be shared to align all providers within the ACO.
Further, by monitoring claims data, ACOs can identify the frequency of returned and rejected claims or missed filing deadlines. From there, the ACO can take a closer look at individual practice workflows and processes to determine how the situation can best be remedied.
The full benefits of ACO participation will only be realized when all providers are efficiently managing care and costs within the organization. One provider or practice can impact overall ACO performance. By utilizing the real-time information necessary to comply with external benchmarks for internal benchmarking purposes, providers can ensure that they are contributing to the good of the ACO and the organization is on track to meet the quality outcomes necessary to qualify for shared savings.
The successful ACO will partner with a technology company that can present data both retrospectively and in a real-time actionable manner to improve workflow and care outcomes. By focusing efforts on real-time reporting, ACOs will be more likely to demonstrate improvements in care and quality outcomes, thereby improving the likelihood of receiving financial incentives under the Shared Savings Program.
Anil Kottoor is president and CEO of MedHOK of Tampa, Fla.
Coordinated Care and the Changing Role of Payers
By Ashish Kachru
The result of the recent presidential election did more than return President Obama to the White House. His signature policy victory, the Affordable Care Act (ACA), looks like it’s here to stay as well.
Whether or not you agree with this policy politically, the ACA will introduce substantial changes to the US healthcare system. Millions more Americans will have an opportunity to purchase health insurance. The nature of that insurance is also changing. Lifetime limits on benefits and coverage of pre-existing conditions will be lifted.
One of the most significant systemic shifts introduced by the ACA is the expansion of integrated care delivery models. With millions more Americans now eligible to receive healthcare, hospitals and primary-care practitioners simply do not have the capacity to handle this new volume of patients. For RNs and other clinicians in a variety of care settings to effectively pick up the slack, patients must be assured they will receive seamless, consistent, high-quality care.
Of course, bringing millions of new patients into the healthcare system is unsustainable without to reducing the cost of care delivery. The ACA includes a host of cost containment and quality improvement initiatives that, collectively, are helping us migrate from a reactive, quantity-driven healthcare system to one that’s driven by quality, patient satisfaction and coordination among patients, physicians, providers, and payers.
It’s hard to overstate the importance of this migration. A reactive approach to care is one in which patients present symptoms to their healthcare providers. Treatment is focused on identifying the illness as presented and mitigating its effects on the overall health of the patient. Proactive care hinges on communication initiated by healthcare providers. The focus is not on treatment but prevention – identifying potentially negative health outcomes (and their associated costs) before they occur.
In a proactive care environment, physicians, hospitals, and other healthcare providers coordinate care for a population to improve the health of individual patients. With the right data, analytics tools, and workflow technology, coordinating population care can be streamlined, cost effective, and powerful.
The Center for Medicare and Medicaid Services (CMS) has taken a lead role in our migration to a proactive care environment by initiating and funding a variety of new payment and delivery models. At the federal level, more than 150 Accountable Care Organizations (ACO) have been launched since 2011. The CMS State Innovation Models Initiative provides competitive funding opportunities for states to implement and test their own payment and delivery improvement models.
Many safety-net health plans have existing population care management platforms that already enable them to coordinate care proactively with their provider community. These systems dovetail nicely with both the ACO mission and many state-specific care coordination initiatives. Many payers, in other words, are already up to speed on leveraging data – both internally-generated claims data as well as clinical data from provider EMR systems – to identify high-risk patients and actively engage them in their health.
The next few years will be crucial to ensuring our proactive, quality-driven healthcare system becomes successful. It’s a huge shift for everyone involved. But with the right technology solutions, widespread implementation of best practices and the removal of data barriers between patients, providers, and payers, the US healthcare system can successfully delivery higher-quality care to more people at a lower cost.
Ashish Kachru is CEO of Altruista Health of Reston, VA.
The Patient’s Point of View: Patient Centered Medical Homes (PCMH)
By Joe Crandall
About 10 years ago, I was hospitalized a few times for colon cancer. Because of this experience, I pursued a professional career in healthcare.
Most recently, I have seen a care provider about 10 times for myself or my kids. You could say I am an educated consumer of healthcare. I would like to offer a patient’s perspective on the PCMH being adopted as a new care delivery model for the primary care physicians (PCP) office.
First, the PCMH has a lot to offer patients and caregivers:
- Better access to healthcare
- Utilizing the right healthcare provider for the right problem
- Electronic medical records being shared to reduce tests and exams
- Better coordination for preventative medicine and long-term disease management
However, the PCMH has two problems:
- A marketing problem
- A change management problem
The term Patient Centered Medical Home is confusing to patients. The confusion arises because the name implies a physical location versus what is a change in the care process. For organizations implementing this solution, they should change the name to better reflect what they want to accomplish. A title suggestive of “centralized care coordination” would be better understood and adopted by all. Patients will be pleasantly surprised by the changes if they get past the poor naming convention.
The second problem the PCMH will have to overcome is resistance to change. Most organizations are slow to change because they don’t know where to start and/or they don’t know what they need to do to get certified. Luckily, the NCQA has specific guidelines on attaining designation as a PCMH along with some great tools to help with certification. Organizations are left on their own to conduct a comprehensive, unbiased, and objective assessment of their current capabilities. A good assessment will not only tell the organization where they are, but also why they are at that state of readiness.
With the starting point clearly identified and the 2011 NCQA standards as the goal, the organization can develop detailed courses of action. Even with excellent courses of action that clearly outline the steps to certification, organizations are reluctant to change. Each and every office worker needs to be educated on the PCMH model so they can articulate a clear message to each patient that visits the office. By involving and education everyone, the chances of success increase dramatically.
My PCP adopted the PCMH last year. His office appeared to run smoother. I got an appointment immediately and I waited less. Since then I have been treated, diagnosed, prescribed medications, had x-rays, and got the results all without seeing my PCP.
I didn’t feel like I received lesser treatment. I felt I received better, more focused care because the people I saw were available when I needed them and qualified for the level of care provided – all because of a centralized care model based out of my PCP’s office (not a home).
Joe Crandall is director of client engagement solutions of Greencastle Associates Consulting of Malvern, PA.