Cerner, Epic’s analytics tools prove most popular in clinical surveillance market

https://www.beckershospitalreview.com/healthcare-information-technology/cerner-epic-s-analytics-tools-prove-most-popular-in-clinical-surveillance-market.html?origin=cioe&utm_source=cioe

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Cerner and Epic offer the most frequently adopted clinical surveillance tools in the provider market, according to a KLAS Research report.

KLAS interviewed providers about their experiences with vendors offering popular clinical surveillance tools for its report. These tools review information from data sources such as EMRs to alert clinicians about a range of patient care activities that decrease readmissions and mortality. The most common use case for clinical surveillance tools today is sepsis detection, according to KLAS.

Cerner and Epic were the only vendors KLAS validated as having “extensive adoption” for their clinical surveillance tools. Of the 17 Cerner customers surveyed, most were using the vendor’s clinical surveillance for sepsis detection. The 18 Epic customers KLAS surveyed tended to use the vendor’s functionalities for sepsis detection, orders checking and floorwide alerts, among a few other less-common use cases.

KLAS noted that although Cerner and Epic were the most widely adopted clinical surveillance vendors, customers of these two vendors tended to be “less satisfied than customers of the other charted vendors in this report,” which included companies like Bernoulli and Stanson Health.

Cerner customers told KLAS they felt the system needed to better integrate with physician workflows and lacked customization options. Epic customers said that the vendor’s alerts were difficult to set up, but were pleased with its ease of use after implementation. KLAS noted Epic does not have a dedicated clinical surveillance modality, but customers have adapted its EMR to provide similar features.

 

Hospital Operating Income Falls for Two-Thirds of Health Systems

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Hospital operating income and health systems

Hospital expenses are rising faster than revenue growth for health systems, resulting in declining operating income.

Health system operating income is deteriorating as hospital expenses continue to grow, according to a recent Navigant analysis.

In the three-year analysis of the financial disclosures for 104 prominent health systems that operate almost one-half of US hospitals, the healthcare consulting firm found that two-thirds of the organization saw operating income fall from FY 2015 to FY 2017. Twenty-two of these health systems had three-year operating income reductions of over $100 million each.

Furthermore, 27 percent of the health systems analyzes lost revenue on operations in at least one of the three years analyzed and 11 percent reported negative margins all three years.

In total, health systems facing operating earnings reductions lost $6.8 billion during the period, representing a 44 percent reduction.

Rapidly growing hospital expenses as the primary driver of declining operating margins, Navigant reported. Hospital expenses increased three percentage points faster hospital revenue from 2015 to 2017. Top-line operating revenue growth decreased from seven percent in 2015 to 5.5 percent by 2017.

Hospital revenue growth slowed during the period because demand went down for key hospital services, like surgery and inpatient admissions, Navigant explained.

Many of the revenue-generating services hospitals rely on are under the microscope. Policymakers and healthcare leaders are particularly looking to decrease the number of hospital admissions and safely shift inpatient surgeries to less expensive outpatient settings.

In exchange, Medicare and other leading payers are reimbursing hospitals for decreasing admissions or readmissions and their performance on other value-based metrics.

The shift to value-based reimbursement, however, is slow and steady, with just over one-third of healthcare payments currently linked to an alternative payment model. Hospitals and health systems are still learning to navigate the new payment landscape while keeping their revenue growing.

Value-based contracts also failed to deliver sufficient patient volume to counteract the discounts given to payers, Navigant added.

According to the firm, other factors contributing to a slowdown in hospital revenue growth included a decline in collection rates for private accounts and reductions in Medicare reimbursement updates because of the Affordable Care Act and the 2012 federal budget sequester.

“Because of reductions in Medicare updates from ACA and the sequester, hospital losses in treating Medicare patients rose from $20.1 billion in 2010 to $48.8 billion in 2016, according to American Hospital Association analyses,” the report stated. “The sharp $7.2 billion deterioration in Medicare margins that occurred from 2015 to 2016 surely contributed to the reduction in hospital operating margins in the same year of this analysis.”

While hospital revenue growth slowed, hospital expenses sharply rose as healthcare organizations invested in new technologies. Value-based reimbursement, federal requirements, and other components of the Affordable Care Act prompted hospitals to make strategic investments in EHRs, physicians, and population health management, causing expenses to increase, Navigant stated.

Key strategic investments made by hospitals and health systems included:

  • Compliance with the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which requires certified EHR implementation in hospitals and affiliated physician practices
  • Compliance with Medicare payment reform initiatives, such as accountable care organizations (ACOs) or pay-for-performance programs
  • Participation in new value-based contracts with payers
  • Establishment of employed physician groups or clinically integrated networks to develop the capabilities needed for compliance with performance- or value-based initiatives

“In addition to these strategic investments, other factors drove up routine patient care expenses, including a nursing shortage that increased nursing wages and agency expenses; specialty drug costs, particularly for chemotherapeutic agents; and, for some systems, recalibration of retirement fund costs,” the report stated.

The shift to value-based reimbursement and all of its accompanying policies will be the “new normal,” and hospitals should expect the low rate of revenue growth to persist, Navigant stated.

But hospitals and health systems can withstand the economic downturn by achieving strategic discipline and operational excellence, the firm advised.

“Systems must be disciplined to invest their growth capital in areas of actual reachable demand; that is, matched to the growth potential in the specific local markets the system serves,” the report stated. For example, creating a Kaiser-like closed panel capitated health offering in markets where there is no employer or health plan interest in buying such a product is a waste of scarce capital and management bandwidth.”

In line with strategic discipline, organizations will need to “prune” their owned assets portfolio by improving the utilization of their clinical capacity and growing patient throughput. Health systems can achieve this by focusing on scheduling and staffing, ensuring adherence to clinical pathways, streamlining discharges and care transitions, and adjusting physical capacity to actual demand.

The tools used to succeed in value-based contracts should also be applied to Medicare lines of business to reduce Medicare operating losses.

Additionally, vertical alignment will be key to weathering falling operating earnings, Navigant explained.

“Revenue growth is more likely to occur around the edges of the hospital’s core services — inpatient care, surgery, and imaging — rather than from those services themselves,” the report stated. “Creatively repackaging services like care management that is presently imbedded in every aspect of clinical operations, and finding retail demand for services presently bundled as part of the hospital’s traditional service offerings, represent such edge opportunities.”

Reducing patient leakage in multi-specialty groups and systems through improved referral patterns, scheduling, or care coordination will help to grow revenue and keep it within the system.

“To achieve better performance, health system management and boards must take a fresh look at their strategy considering local market realities. They need to look closely at the markets they serve, and size and target their offerings to actual market demand,” the report concluded. “They must re-examine and rationalize their portfolio of assets and demand marked improvements in efficiency and effectiveness, and measurable value creation for those who pay for care, particularly their patients. Since much of this should have been done five years ago, time is of the essence.”

Hospitals look to value-based contracting in healthcare supply chain

https://www.healthcarefinancenews.com/news/hospitals-look-value-based-contracting-healthcare-supply-chain?mkt_tok=eyJpIjoiWVdZeU9ETTJaR1ZqWWpJNSIsInQiOiJZYWlKXC9DcnN5YitocXRMMXIxb1VJdXdLVGNoRWgwXC83cm15ZzlGbmR5SGNRZ3A5MHRaVHl4OXZCbUVRWHdLcXhUOU45bU5KVXhzMVFTV3Qyd3RkS1pZWGFRNzFlbVEzaFNvVHZHQ2I2VmhUY0NQeWdUR0dHZTBjbkpMZm9nQ05HIn0%3D

Almost three-quarters of C-suite and supply chain leaders say their health systems prioritize value-based contracting, although barriers remain.

Most hospital and health system leaders are interested in value-based contracting when it comes to their supply chains, but a new Premier survey shows a lack of opportunities to lock down contracts with suppliers.

Among 200 C-suite executives and supply chain leaders, 73 percent said their health systems prioritize value-based contracting when looking to improve their return on investment.

IMPACT

In perhaps another sign of the inevitability of value-based care, 81 percent of respondents said they would be interested in more suppliers offering value-based contracting options.

Despite that, only 38 percent said they had participated in value-added or risk-based contracting with suppliers or pharmaceutical companies.

There are some barriers. When asked if they had considered participating in value-based contracts with suppliers with both up- and downside risk/reward, 55 percent said they didn’t know enough about shared risk contracts. Another 20 percent said they’re actively considering such contracts; 16 percent are already participating in them.

As for why many providers haven’t yet taken part in value-based or risk-based contracting with suppliers, 67 percent said it’s due to not having been engaged by a supplier. About 11 percent said it doesn’t align with the organization’s strategy.

WHAT ELSE YOU SHOULD KNOW

Respondents provided some examples of value-based contracts they had implemented, and at the top of the list was surgical services at 13 percent.

Following that was purchased services (11 percent); cardiovascular (11 percent); pharmacy and materials management (9 percent); nursing (8 percent), imaging and lab (6 percent); and facilities (5 percent).

Data was the most common challenge, cited by 22 percent of respondents. That was followed by internal communications (14 percent); coordination with suppliers (12 percent); infrastructure support (11 percent); and physician buy-in (10 percent).

THE TREND

Research this year from Sage Growth Partners highlighted the challenges providers face in succeeding under value-based contracting. Slightly more than two-thirds of the survey’s 100 respondents said value-based care has provided them with a return on investment, but many have had to supplement their electronic health records with third-party population health management solutions to get the most bang for their buck.

Health care startup aims to eliminate hospital and doctor bills

https://www.axios.com/startup-ooda-health-aims-to-eliminate-hospital-doctor-bills-e1fc6bdc-6755-4627-b954-59fc35326d3e.html?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top

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New payment startup Ooda Health has raised $40.5 million on the premise that its technology will make sure patients never get another bill from a hospital or doctor.

Why it matters: Ooda Health not only has big-name venture capitalists on board (Oak HC/FT and DFJ led the funding round), but also has large health insurers and providers as investors. However, while the company attempts to cut administrative waste, it won’t address the health care system’s underlying pricing and spending habits.

The details: Anthem, Blue Cross Blue Shield of Arizona, Blue Shield of California, Blue Cross Blue Shield of Massachusetts, Dignity Health and Hill Physicians are the initial industry investors.

  • Ooda Health would not disclose their investments. Seth Cohen, Ooda Health’s co-founder and president, said the company got its start after Blue Shield of California CEO Paul Markovich recommended a meeting with Dignity Health CEO Lloyd Dean.

How it works: Health insurance companies pay Ooda Health an administrative fee and a risk-sharing payment. Ooda Health then connects with hospitals and doctors and pays them instantly based on what is in the electronic health record instead of a traditional medical claim. Any outstanding payment issues would be handled through the insurance company, rather than directly by providers.

  • Cohen made this analogy: If you’re at a restaurant and you use your credit card for the meal, the restaurant gets paid immediately. The credit card company, not the restaurant, then follows up with you about how to pay off what you owe.
  • Health insurers would avoid late fees and penalties for missing payment deadlines, patients who are encountering higher deductibles and out-of-pocket costs wouldn’t have to pay providers directly, hospitals wouldn’t have to chase outstanding balances, and providers would get paid quickly.
  • “It is a bad model for providers to collect from patients,” Cohen said, noting that collection agencies are cut out in this scenario.

Yes, but: Out-of-network hospitals and doctors would still charge exorbitant fees on their own, and administrative work wouldn’t be completely eradicated. This also makes the electronic health record a de facto tool for billing instead of solely a repository for patient medical information.

 

CHS faces investigation related to EHR incentive program

https://www.beckershospitalreview.com/legal-regulatory-issues/chs-faces-investigation-related-to-ehr-incentive-program.html

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Franklin, Tenn.-based Community Health Systems has received a civil investigative demand related to the company’s adoption of EHRs and adherence to the meaningful use program, according to CHS’ latest financial filing.

Under the meaningful use program, now called the promoting interoperability program, CMS distributed incentive payments to eligible providers for installing EHR systems and using them to engage patients and families and to improve care coordination.

In its financial filing, CHS said it is responding to a civil investigative demand related to its “adoption of electronic health records technology and the meaningful use program.”

Federal and state authorities issue these types of demands to collect records and information related to ongoing civil investigations, including False Claims Act cases.

CHS declined to comment on the investigative demand beyond what is included in the financial filing.

EHR incentive payments grabbed the attention of federal regulators after HHS’ Office of Inspector General released a report in 2017 that revealed Medicare made approximately $729.4 million in EHR incentive payments to medical providers who did not comply with federal requirements.

 

Trinity Health chooses Epic for integrated EHR, revenue cycle management

http://www.healthcarefinancenews.com/news/trinity-health-chooses-epic-integrated-ehr-revenue-cycle-management?mkt_tok=eyJpIjoiTXpGak1qTmhNbVUxWVRsaSIsInQiOiJwQlwvU1ZxcTU2bExreng4NXpEZ0Q2WkRYeldUbzlNM3kwWlJFeER5WlwvS3NqQ0lvMFwveHVNRExjdmVkdkRNMTBOb3FlZlwvOUJIMTYzR0tVWlNlcDJWMlRkMVM4TzZCK1I3XC9NSkFkc1U5QjhYaTZXKzhaUnY0M2RKNGNubTR5dk84In0%3D

St. Joseph Oakland is part of the Trinity Health system in Pontiac, Michigan. Credit: <a href="https://twitter.com/sjmo_hospital/status/988871404237086721" target="_blank">Twitter</a>

 

The Michigan health system, one of the largest in the U.S., says it wants to roll out a single, enterprise platform to deliver “people-centered care.

It’s a big week for Epic implementations in the Upper Midwest. The world-class Mayo Clinic is ready to go live with its newly-minted system on May 5, after more than three years of work. And today comes news that sprawling Trinity Health, based in Livonia, Michigan, has selected Epic to build out its own enterprise-wide electronic health record and revenue cycle management system.

It’s a process the Catholic health system expects will take four years to implement across its 94 hospitals and 109 continuing care locations. The expected cost of the deal was not disclosed.

Trinity officials said the integrated Epic platform will allow the health system to improve experiences for patients and clinicians across the board.

“People deserve customized and convenient healthcare experiences, including simple access to a complete health and billing record,” said Mike Slubowski, president and chief operating officer of Trinity Health.

“At the same time, physicians and clinicians need tools that make it easier to practice medicine,” he said. “We look forward to implementing a single, enterprise solution enabling us to deliver excellent, people-centered care.”

It’s the same appetite for a seamless and enterprise-wide system, across all locations and functionalities, that Mayo Clinic CIO Christopher Ross said was a factor in its choice of Epic back in 2015. That health system had been “steadily working toward a convergence of its practice” for several years, he said at the time, and best-of-breed would no longer suffice for achieving those goals.

At Trinity Health, the plan is to leverage Epic as a fully-integrated system for a single, comprehensive health record for every patient.

Trinity tapped Epic on the strength of the different products offered on that single, unified platform, officials said – not just enterprise EHR and revenue cycle, which will eventually go live at all of its hospitals, ambulatory centers, physician offices and continuing care programs, used by some 100,000 employee – but also online scheduling, e-visits and  online bill pay.

“We are confident a single platform will enable new levels of innovation, consumer focus, clinical and business integration and efficiency to help us build our people-centered health system,” said Slubowski. “It will also help align people, process and technology to create a culture in which people-centered care becomes the standard way we care for the communities we serve.”

Epic President says EHRs are not walled off, integrations are just hard

https://medcitynews.com/2018/03/epic-president-says-ehrs-not-walled-off-integrations-just-hard/?utm_campaign=MCN%20Daily%20Top%20Stories&utm_source=hs_email&utm_medium=email&utm_content=61259603&_hsenc=p2ANqtz-9KZbK2I0aYCjcH-L8_oANZXZSsq2K8jondsl8vHF0rHfcb8_zR65kRtQV-cDsnd_VomLuc-G2in5Y4wJcsFWrR8zgKJg