Jay Desai, MBA is co-founder and CEO of PatientPing of Boston, MA.
Tell me about yourself and the company.
I’m CEO and co-founder of PatientPing. Prior to starting this company, I worked at Medicare at the Innovation Center and helped support many of the value-based care initiatives there – ACOs, bundled payments, and a number of the new payment models.
I started this company in September 2013. PatientPing is a care coordination platform. We have a number of products. Our flagship product, Pings, delivers real-time event notification when patients have admissions, discharges, and transfers at emergency rooms, hospitals, skilled nursing facilities, home health agencies, and a number of other sites of care.
How widely are ADT notifications being used?
It has really matured as an industry and as a problem that is being solved across the country. For several types of organizations, ADT notifications are becoming a critical part of their infrastructure to do their work. Accountable care organizations, in particular, those that serve Medicare and Medicaid patients that have frequent visits to the emergency room or the hospital. On the Medicare side, skilled nursing facilities, home health agencies, and other post-acute care providers. I don’t know if I could say explicitly the majority, but a large number of ACOs are using event notifications to do their care coordination activities.
A lot of the opportunities for medical management, improvement of quality, and cost savings tends to be when patients are repeat visitors to the emergency room. That’s an opportunity to prevent a subsequent ED visit by engaging them in after-hours primary care, urgent care, and things like that. At least informing them that that’s available to them to avoid a future visit.
Then on the post-acute care side, there are opportunities to reduce skilled nursing length of stay and have patients treated in home care as opposed to skilled nursing. Those are cost savings opportunities in lower-acuity settings for patients to get the same amount of recovery or hopefully the same speed to recovery. Those alerts are important to be able to trigger those workflows that drive the care coordination that ultimately drives the outcomes.
That’s on the ACO side. More broadly than that, health plans are using notifications. Primary care groups often are doing it for their transition of care activities. Hospitals are using it for their readmission reduction activities. Bundled payment organizations are using it for some of their initiatives. But I think we’re seeing the most widespread adoption among ACOs.
How has your solution avoided being bogged down in the competitive, technical, and cost issues that have hampered interoperability in general?
The need was apparent to me seven or eight years ago. ACOs that we were supporting were very keen to know when their patients went to different providers. I wouldn’t say that it was widespread, commonly accepted, or appreciated that hospitals didn’t feel that it was competitive information that they were sharing, say, with a competitor hospital that had a value-based care program.
Say you’re a big health system within a region. Your patient goes to your #1 competitor within the region. Then that competitor has patients that come to your hospital. In the early days of trying to build this organization, it wasn’t the easiest conversation to convince both of them to share ADT feeds, even though it is just ADT feeds and it’s a pretty lightweight set of information. That kind of notification is already happening, often between hospitals and primary care providers. But it wasn’t that easy.
It has gotten easier over time, where people say, I’m OK with sharing ADT because I need to receive that information, recognizing that I probably need to give it up if I’m going to receive it. We’ve had this conversation with thousands of hospitals many, many, many times over the years. The industry has evolved to the place where there’s more comfort doing it.
Some groups in many parts of the country still aren’t that excited or comfortable with notifying the community PCP, their competitors’ PCPs, or value-based care organizations that they have one of their patients. But it’s a lot more common and folks are more willing to do it.
You had a limited rollout the last time we spoke three years ago. Now that you have established the network and created trust, will you wrap more services around that same connectivity that you use for Pings?
The business has matured quite a bit. We have ADT feeds from over 1,000 hospitals across the country of a denominator of 4,000 to 5,000. We have about 4,000 to 5,000 post-acute care providers that are providing us their ADTs, skilled nursing and home health. That’s the senders of ADT.
We have close to 1,000 provider organizations receiving electronic notifications. That includes ACOs, health plans, Federally Qualified Health Centers, and post-acute providers that have an interest in knowing when the patients go to those 1,000 hospitals and 4,000 to 5,000 post-acute providers. They represent over 10 million patients. The business has scaled quite a bit. We have encounters that are being tracked by providers across the country, at sites across the country. It’s kind of neat to see the network grow.
We think about the future as this. ADT is a really great data source. Every ADT is an opportunity to help a patient who is having an emergency room visit, is being hospitalized or discharged, or is being transitioned to a skilled nursing facility. Every one of those encounters is an opportunity to wrap around products and services to ensure that the care transition is happening more safely and smoothly.
As an example, a patient shows up in the ER. We may know that they have had several other ED visits, they may have had prior utilization of a skilled nursing facility, they’re currently on VNA, or they have an affiliation with an ACO care program. The care coordinator at the hospital or the emergency room is left with the decision of how to best support that transition of care. We think that with the historical context we have on that patient, some of the knowledge we know about their whereabouts, can support that care manager’s decision on what to do next. That could be supporting a care transition and linking that patient into the care program that is most beneficial to them. That could come through a range of products and services.
We are excited to be able to continue to make sure that every one of those admits and discharges and the subsequent care they receive is high quality and safe.
What are hospitals required to do with notifications under the new CMS rule?
The CMS rule contains a number of provisions. The one that we’re focused on is the conditions of participation for electronic notification. They are requiring all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. They are very specific in terms of what is considered the patient’s established care team. They are also very specific about the information that must be included in that notification.
One key provision is a six-month implementation timeline. Hospitals need to have a system to provide these notifications by September 9, 2020.
How would they meet the requirements without using PatientPing?
Hospitals will have two categories of notification recipients. One is the patient-identified practitioner. A patient comes to the hospital and says, “My doctor is Dr. Desai.” The hospital has the burden to send the notification to that particular provider. That typically happens through EHR workflows. The EHR will have an active directory where they can look up the email address or other provider contact information and then send the notification through.
That often happens at discharge through the transition of care document, the CCD. There are established workflows to send ADT alerts to the patient’s designated provider. Companies like ours don’t necessarily help with that. EHRs typically do a pretty good job with sending those notifications directly, as identified by the patient.
This rule includes a second category, recipients who have a need to receive the notifications for the purpose of treatment care coordination and quality improvement. They narrow it even further to say entities affiliated with the patient’s primary care practitioner as well as post-acute service providers and suppliers with whom the patient has an established care relationship. Entities affiliated with the patient’s primary care providers will include groups like their primary care practice. Their affiliated accountable care organization that is a function of their primary care relationship. It may include groups like their Federally Qualified Health Centers or the independent physician association that their primary care provider is a part of.
Hospitals will need the capability to deliver notifications to those groups. That is different than just sending a notification to the patient’s designated doctor. It’s more driven by a roster or a panel. If I’m the ACO, I may have a roster of patients and I want to watch the ADT notifications that are being rendered. I then want to do a match between those two and then send a notification.
To do that, a hospital probably will benefit from having essentially a router of those ADTs that can compare the list of patients against those ADT messages that are to be generated. They may need more than one router. They may send their data to their HIE that delivers data locally within their region. They may send their data to a national network like ours that provides notifications outside of their state. Or they may have their router point the data to wherever it needs to go. But there are a number of stakeholders that may be out there in the communities surrounding the hospital that have an interest in knowing when the patient shows up at that hospital, and they have a valid reason to do that.
This will be particularly relevant for some of the larger academic medical centers that are referral sites for many patients across the country. Cleveland Clinic, Mayo Clinic, and Hospital for Special Surgery receive patients from all over the country. There may be providers out there in the community who have an interest in knowing that the patient is presenting at that particular hospital. Service providers can help route that notification through to the various endpoints where it needs to go.
Do you have any final thoughts?
The CMS and ONC operability rules are totally groundbreaking. I’m excited about what they will do for patient care. CMS and ONC had a lot of hard decisions to make, and I’m impressed by their commitment to supporting patient care, care coordination, and quality improvement. Many hospitals have been thinking about this and putting solutions in place.
We think this will create a broader national framework under which this information is going to flow. We’re excited about that. We’re excited to support it and be part of the solution. Obviously we won’t be the only solution. We’re excited to be part of this solution and we think that there’s going to be a lot of good things that happen for patient care as a result.
We’ve been committed to this mission for a very long time. ACOs, provider groups, and health systems are doing a lot of really hard work to try to support patient care. Data is often at the center of that strategy, or is at least part of the strategy. Being able to facilitate these care transitions with more real-time data sharing across all the different places that patients might go will do a lot to support care. I’m excited to be part of the solution and the momentum that will come with it.