Dallas-based Baylor Scott & White Health will outsource, lay off or retrain 1,700 employees who work in information technology, billing, revenue cycle management and other support services, according to The Dallas Morning News.
The health system said outsourcing the finance and IT jobs and other support services will help it improve efficiencies and focus on reducing costs in noncore business areas.
About two-thirds of the 1,700 employees will be joining third-party RCM, IT, billing or support staff vendors. About 600 to 650 positions will be eliminated.
Baylor Scott & White said that employees whose positions are being eliminated will be invited to participate in retraining programs.
The retraining program would allow the employees to remain employed at the health system and receive the same pay or higher, depending on their role, according to the report. Some of the retraining programs that will be available are learning to become a certified medical assistant or learning a job in patient support services.
“In no case — in no case — is anyone going to miss a paycheck,” Baylor Scott & White CEO Jim Hinton, told The Dallas Morning News. “We can afford to make these commitments, and we want to do the right thing for the great employees of Baylor, Scott & White. They’ve really done everything we’ve asked and more during this last year.”
This is the third time Baylor Scott & White has announced cost-cutting initiatives related to its workforce since the pandemic began. Last May, 930 Baylor Scott & White employees were laid off, and in December the health system said it would lay off employees and outsource 102 corporate finance jobs.
Mr. Hinton said that Baylor Scott & White has 2,000 clinical positions open, and it is investing in a new regional medical school campus and a joint venture to improve care for the underinsured.
“This is a transition to a new business model, a transition to a new way of working,” Mr. Hinton told The Dallas Morning News.
Alignment between CEOs and CFOs has become even more essential during the pandemic.
Many health systems halted elective surgeries earlier this year at the height of the pandemic to conserve resources while caring for COVID-19 patients. Now, in many areas, those procedures are returning and hospitals are slowly resuming more normal operations. But damage has been done to the hospital’s bottom line. Moving forward, the relationship between top executives will be crucial to make the right decisions for patients and the overall health of their organizations.
During the Becker’s Healthcare CEO+CFO Virtual Forum on Aug. 11, CEOs and CFOs for top hospitals and health systems gathered virtually to share insights and strategies as well as discuss the biggest challenges ahead for their institutions. Click here to view the panels on-demand.
Here are six takeaways from the event:
1. The three keys to a strong CEO and CFO partnership are trust, transparency and communication.
2. It’s common for a health system CEO and CFO to have different priorities and different opinions about where investments should be made. To help come to an agreement, they should look at every decision as if it’s a decision being made by the organization as a whole and not an individual executive. For example, there are no decisions by the CFO. There are only decisions by the health system. The CFOs said it’s important to remember that the patient comes first and that health systems don’t exist to make money.
3. Technology has of course been paramount during the pandemic in terms of telehealth. But so are nontraditional partnerships with other health systems that have allowed providers to share research and education.
4. When it comes to evaluating technology, there’s a difference between being on the cutting edge versus the bleeding edge. Investing in new technology requires firm exit strategies. If warning signs show an investment is not going to give the return a health system hoped for, they need to let go of ideals and stick to the exit strategy.
5. Communication and transparency with staff and the public is key while making challenging decisions. Many hard decisions, including furloughs or personnel reductions, were made this spring to protect the financial viability of healthcare organizations. These decisions, which were not made lightly, were critiqued highly by the public. One of the best ways to ensure the message was not getting lost in translation and to help navigate the criticism included creating a communication plan and sharing that with employees, physicians and the public.
6. The pandemic required hospitals to think on their feet and innovate quickly. Many of the usual ways to solve a problem could not be used during that time. For example, large systems had to rethink how to acquire personal protective gear. Typically, in a large health system amid a disaster, when a supply item is running low, organizations can call up another hospital in the network and ask them to send some supplies. However, everyone in the pandemic was running low on the same items, which required innovation and problem-solving that is outside of the norm.
Hackensack (N.J.) Meridian Health and New York City-based Maimonides Medical Center are partnering with remote monitoring platform Nanowear to pilot cloth-based wearable tech that monitors coronavirus patients.
Nanowear’s undergarment wearable comprises nanosensors, which detect physiological and biomarker changes that indicate when a patient’s condition is worsening and the hospitals need to further intervene. When a patient wears the garment, physicians can remotely capture and assess vitals including real-time ECH, systolic and diastolic blood pressure, temperature trends, respiration and lung volume.
The garment can collect 120 million data points per patient per day across cardiac, pulmonary and circulatory biomarker data, which is then transmitted to clinical staff.
“Nanowear’s SimpleSENSE is giving us an exponential amount of relevant data metrics about the heart and lungs from an all-in-one product that should ultimately enable us to triage lower risk patients and stratify high risk patients,” said Sameer Jamal, MD, principal investigator of the collaboration and cardiologist at Hackensack Meridian Health, according to the July 22 news release.
The COVID-19 pandemic has catapulted the telehealth industry forward by decades in a matter of months, according to Amwell’s Roy Schoenberg.
That not only benefits the Amwell’s business, but it’s a win for patients, said Schoenberg, who serves as the company’s president and co-CEO.
“We are going to see an enormous amount of change, nothing short of a revolution, going forward,” he told Fierce Healthcare.
Roy and his brother Ido Schoenberg have been telehealth advocates for more than a decade since launching Amwell, formerly American Well, in 2006. The Boston-based telehealth company works with more than 240 health systems comprised of 2,000 hospitals and 55 health plan partners with over 36,000 employers, reaching over 150 million lives.
Like other virtual care companies, Amwell has seen skyrocketing demand for its services during the COVID-19 pandemic as stay-at-home orders and social distancing guidelines prevented many patients from visiting doctors in person. Shares in public digital health companies like Teladoc and Livongo have grown by double digits during the health crisis.
The momentum around telehealth also has attracted investors. The company recently raised $194 million in a series C funding round.
Amwell also is gearing up to go public later this year, according to CNBC’s Christina Farr and Ari Levy. The company confidentially filed for an IPO earlier this week and has hired Goldman Sachs and Morgan Stanley to lead the deal, Farr and Levy reported last week, citing people who asked not to be named because the plans have not been announced.
The company declined to comment on the CNBC report.
Before the COVID-19 pandemic began, Amwell was providing an average of 5,000 telehealth visits a day. That has jumped to 45,000 to 50,000 virtual visits a day due to the coronavirus, said Ido Schoenberg, who serves as chairman and co-CEO.
“We saw 30 times, 40 times higher volumes and we have clients that had 2% to 3% of their patient volume online that now have 75% of visits online,” he said. “It’s truly incredible. The number of active providers on our platform grew seven times over in two months.”
As visits surged, technology companies struggled to keep up with demand, and patients reported long wait times for virtual visits on some platforms.
Roy Schoenberg acknowledged Amwell also faced challenges rapidly scaling its technology and services almost overnight as it was “thrown into the center stage of trying to save the world.”
The company leverages automation for processes such as onboarding physicians, credentialing, licensing, and working with health plans and that capability proved critical to scaling its services, the executives said.
“We needed to allow 40,000 to 50,000 physicians to come on to our system and begin to use it. If this was a manual process, it would have been broken,” Roy Schoenberg said.
Regulatory barriers to telehealth also quickly fell away, at least temporarily. The Centers for Medicare and Medicaid Services and commercial health plans have expanded access to telehealth by offering payment parity for many telehealth services for the first time.
While questions remain about what regulatory flexibilities will remain in place to support the ongoing demand for telehealth, Amwell executives believe virtual care has proven its value to providers, payers and patients.
CMS will likely tighten up some of the relaxed requirements around telehealth which is a “fiscally responsible approach,” Roy Schoenberg said.
“At the end of the day, even though the government tends to be a little bit slow, it gravitates to where the value is. How long will it take for the payment structure to retract and then expand, that’s anyone’s guess. We have an election year coming in. Who knows what that is going to do? There may be some changes, but I think overall, the genie is out of the bottle, the toothpaste is out of the tube, or whatever phrase you want to use,” he said.
The executives never doubted that telehealth would, at some point, reach the mainstream. Now that it’s happened, health systems and patients have become advocates for the technology and that will also put pressure on CMS and commercial payers to continue to support it, they said.
The executives now see an opportunity for Amwell to use its platform to expand the reach of healthcare to more patients. There is a growing industry of telehealth providers, device makers, and technology-enabled disease management companies that will enable digital home healthcare services, they said.
“What we built is something way bigger than a video conference between doctor and patient, which you can easily do using Zoom or FaceTime,” Ido Schoenberg said.
Digital connectivity will enable providers to gather health data on patients from wearables and devices to better understand gaps in care, get an overall picture of patients’ health and then provide more effective interventions, all without patients leaving their living rooms. The combination of telehealth and remote devices will enable elderly, frail patients to receive care at home, where they want to be, rather than being moved to a skilled nursing facility, they said.
“It’s about the ability to democratize healthcare and make great care available to many more people that today don’t always have access to it,” Ido Schoenberg said.
Roy Schoenberg added, “These are the opportunities opening fast and furious in front of us and the promise is to make healthcare less painful as an individual experience. That’s the value proposition.”
Geisinger Health System has inked a 10-year technology agreement with Siemens Healthineers to access diagnostic imaging equipment and artificial intelligence applications.
The Danville, Pennsylvania-based health system said the partnership will advance and support elements of its strategic priorities related to continually improving care for their patients, communities and the region.
The medical technology company will provide Geisinger access to its latest digital health innovations, diagnostic imaging equipment and on-site staff to support improvements. Education and workflow resources will also be available, which will provide Geisinger staff with the ability to efficiently make decisions and continually optimize workflows, the companies said.
Siemens provides AI-based radiology software that analyzes chest CT scans, brain MRIs and other images as well as AI-based clinical decision support tools and services to help advance digitization.
Financial terms of the deal were not disclosed.
“By expanding our relationship with Geisinger, this becomes one of the largest value partnership relationships in North America and will allow us to work together to improve the patient experience for residents of Pennsylvania and the region,” said David Pacitti, president and head of the Americas for Siemens Healthineers, in a statement.
“Making better health easier by bringing world-class care close to home is central to everything we do at Geisinger,” said Matthew Walsh, chief operating officer at Geisinger. “This partnership will allow us to continue to equip our facilities with the most advanced diagnostic imaging technology in the market to care for our patients.”
Michael Haynes, associate vice president of operations, Geisinger Radiology, said the collaboration with Siemens will enable the health system to identify and respond to health concerns more quickly.
Geisinger operates 13 hospitals across Pennsylvania and New Jersey as well as a 600,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine.
Partnerships between health systems and tech companies are becoming fairly common as the healthcare industry pushes forward to use data analytics, AI and machine learning to improve clinical diagnosis and better predict disease.
Mayo Clinic announced a high-profile, 10-year strategic partnership with Google in September to use advanced cloud computing, data analytics, machine learning and AI to advance the diagnosis and treatment of disease.
Providence St. Joseph Health inked a multiyear strategic alliance with Microsoft to modernize its health IT infrastructure and leverage cloud and AI technologies.
- The biggest problem with electronic syndromic surveillance reporting isn’t that hospitals lack the capacity to send data — it’s that public health agencies lack the ability to receive it, according to a new report published in the Journal of the American Medical Informatics Association.
- More than four in 10 U.S. hospitals say their local, state and federal public health agencies are unable to receive data electronically, reflecting a decade-long investment in health IT infrastructure on the private sector side without a concomitant investment from its federal partners, researchers found.
- Hospitals in regions forecast to be some of the hardest hit from COVID-19 were more likely to say public health agencies were unable to receive health data electronically, implying areas of highest need were some of the least prepared to mount a coordinated, data-driven response going into the pandemic.
Effective pandemic response requires real-time, accurate data sharing between providers and public health agencies, allowing the government to track outbreaks and allocate resources as needed.
A lack of nationwide, interoperable reporting infrastructure has been one of the major criticisms of the Trump administration’s handling of the pandemic, which has infected almost 1.7 million and killed 99,000 people in the U.S. as of Wednesday.
CMS requires hospitals be able to electronically send and receive health information, including lab results and syndromic surveillance data, to and from public health agencies like their state’s department of health. For more than a decade, providers have funneled significant resources into their IT infrastructure due to a slurry of federal incentive programs, though EHR implementation remains piecemeal across the U.S. due to cost and other barriers.
The JAMIA study, one of the first looking at the state of health data reporting, analyzed 2018 American Hospital Association data to identify hospital-reported barriers to surveillance data reporting, and Harvard Global Health Institute data on the coronavirus pandemic’s projected impact on hospital capacity at the hospital referral region (HRR) level. Researchers assumed a 40% population infection rate over 12 months.
The group found 31 high-need HRRs, those in the top quartile of projected beds needed for COVID-19 patients, with more than half of the hospitals in the region saying the relevant public health agency couldn’t electronically receive data.
That suggests areas more likely to be overwhelmed by the pandemic had some of the least interoperable data-sharing capabilities going into it, hamstringing outbreak response.
Researchers found the most common barrier to data-sharing nationwide, reported by 41% of hospitals, was that public health agencies didn’t have the capacity to receive data electronically.
The next most common, reported by 32% of hospitals, was interface-related issues, such as costs or implementation complexity; followed by difficulty extracting data from the EHR (14% of hospitals reporting), different data standards (also 14%), hospitals lacking the capacity to send data (8%) and hospitals being unsure what public health agencies to send the data to (3%).
Researchers also found significant state variance in hospitals saying public health agencies couldn’t receive needed data electronically, running the gamut from 83% of hospitals saying so in Hawaii and Rhode Island to 40% in New Jersey and Virginia to none in Delaware.
Geographic variation is likely due to different funding priorities in different places, as some agencies may only be able to receive specific data elements or interface with a select number of EHRs. This spotty IT implementation results in a patchwork picture of disease progression across the U.S., though the Centers for Disease Control and Prevention is working to automate the COVID-19 reporting process.
The study does have some significant limitations. It’s a relatively one-sided portrayal of the issue, as researchers did not have access to data or survey results from public health agencies. And, since AHA survey results were from two years ago, the EHR landscape could have shifted since 2018.
However, researchers called upon policymakers to build up public health agencies’ IT capabilities, especially as states begin to reopen despite an increasingly likely resurgence of the virus in the fall.
“Policymakers should prioritize investment in public health IT infrastructure along with broader health system information technology for both long-term COVID-19 monitoring as well as future pandemic preparedness,” authors A Jay Holmgren, a doctoral candidate at Harvard Business School; Nate Apathy, a doctoral candidate at Indiana University’s Richard M. Fairbanks School of Public Health; and Julia Adler-Milstein, a professor at University of San Francisco Department of Medicine, wrote.
Keys to achieving revenue integrity and compliance across your organization
It’s old news: Revenue cycle complexity continues to increase, exacerbating existing challenges. And as we tackle those, new ones arise to take their place.
Ever-changing regulations are a given, but adopting value-based reimbursement (VBR) models currently poses a major challenge. New payment models complicating revenue cycle activity become more difficult with additional quality reporting and other requirements. Add in the operational realities of siloed workflows, data proliferation, and disparate systems, and it’s clear why efficient collaboration can seem nearly impossible. Intelligent middle revenue cycle operations that manage to these challenges are vital to achieving revenue integrity and financial stability.
Use the right solutions at the right time
Today’s environment requires sharpening the way you ensure revenue integrity. Providers need an easy, seamless way to manage middle revenue cycle operations, and there are several effective strategies to accomplish that. Of course, it’s important to recognize and make use of your EMR system’s capabilities. It’s also essential to leverage complementary technologies with specific core competencies that will improve revenue cycle performance. For example, a solution that continuously monitors records in real time enables timely auditing, coding adjustments and case completion to reduce billing turnaround and reimbursement delays.
Take a smart approach to enabling technology
Augmenting your core systems with complementary technologies or capabilities on a single, integrated platform makes it much easier to support internal collaboration between different departments or teams. An integrated platform also enables you to seamlessly deploy additional capabilities onto that platform, ensuring speed to value. Instead of using multiple disparate tools, a shared platform enables interdepartmental communication and helps minimize inefficiency. A smart technology platform that crosses departmental siloes and brings transparency across teams is critical. Platforms that leverage clinically aware artificial intelligence and other automation enable staff to proactively focus on the areas where their expertise has the most impact. In addition, when leveraging an integrated platform, one expert team’s work will not get cancelled out by another team’s contributions.
Regardless of which core system you use, integrating technology with targeted competencies and connectivity adds value to the EMR. It can provide a depth of specialized expertise that drives better documentation, coding and real time audit interaction — keys to a high-performing revenue cycle.
Prioritize comprehensive, correct documentation and coding
Unfortunately, it seems the battle against claim denials is here to stay. You can’t overlook the importance of front-end data validation to eliminate rework and inefficiency. However, the ability to ensure complete and accurate clinical documentation for every case will significantly impact revenue capture and reduce the inefficiency of denials and rework.
Broaden the scope of your CDI program with technology that uses clinical intelligence to drive concurrent documentation review for all payers. Getting it right up front contributes to better coding, accurate reimbursement, and appropriate quality measures, all of which are vital to success under VBR.
Increase collaboration with payers
As long as payers and providers continue working at odds, the costly onslaught of denials will persist. In a perfect world, both sides would join forces to find mutually beneficial solutions for claim errors, denials and payment delays. Imagine the savings in administrative inefficiency alone. However, we’re not in that world yet. Therefore, it’s important to make a proactive effort to understand the specifics of each payer’s contract and adjust your internal processes and technology rules accordingly. As operating margins get smaller, organizations have no choice but to increase efficiency and accuracy, and working together with payers can contribute significantly to that goal.
Consolidate, collaborate, communicate
Industry pressures to improve performance are unrelenting, especially around smart solutions, innovation, and increasing both efficiency and the bottom line. Organizations are expected to improve these areas while, at the same time, enabling patient-centric operations. One way to achieve this is to leverage innovative, integrated tools to augment core systems and promote partnership, communication and efficiency across multiple related disciplines.
Consider clinical documentation, coding and auditing. Numerous departments need pieces of that information for different reasons, including utilization review, medical necessity determinations, chart audits and quality monitoring, in addition to bill preparation. A single repository containing up-to-date data in a real-time view driven by supporting workflow, rules and alerts provides consistent and reliable information when and where it’s needed.
As patient care becomes more complex, so does the middle revenue cycle. Seek solutions that will simplify and manage the complexity in an administratively efficient way. Consider your prospective vendor’s core competencies when evaluating solutions and look for integration and intelligent automation that will add the most value to your organization.