<img height="1" width="1" style="display:none" src="https://www.facebook.com/tr?id=1225318787516564&amp;ev=PageView&amp;noscript=1">

Kyruus Blog

Docs in Translation: How Clinical Fluency and Volumes Affect Outcomes

This post was written by Dr. Lara Terry, Kyruus' Medical Director

Rapidly advancing technology is enabling the production and consumption of healthcare data in a way not previously possible. With so much at stake in medicine, can Big Data help us decide on the “right” doctor to meet our medical needs?

Topics: Analytics Patient Experience Provider Networks

Can’t Get No (Referral) Satisfaction

In the event of a medical illness, we all want to feel that we will get to the “right” doctor – someone expert in diagnosing and treating our specific condition using the best and latest in medical knowledge. Not surprisingly, there is a large and growing body of evidence suggesting that the “right” doctor for a given patient is the one with the appropriate training and clinical experience in that patient’s condition. This is particularly true in specialist care where procedures are more common and conditions more narrowly defined.

Topics: Referral Management Analytics Patient Access Provider Networks

The Data Puzzle: Industry Comments on Release of CMS Physician Data

Comment Letter Chart Link: KYRUUS COMMENT LETTER CHART

Topics: Analytics Provider Networks

A Patient A Day Keeps the Doctor In Play

[Originally posted on O'Reilly Strata Blog]

Topics: Analytics Provider Networks

Kyruus to speak at Hospital & Physician Relations Conference with Dr. Michael Nochomovitz of University Hospitals

Oct 13-15: Hospital & Physicians Relations Summit (Scottsdale, AZ)
Kyruus Chief Product Officer, Julie Yoo, to speak with Dr. Michael Nochomovitz, President of University Hospitals Physician Services, on "Bridging Patients & Physicians With Big Data"

Topics: Referral Management Healthcare Conferences Analytics Patient Access

Kyruus CTO to Speak at Brigham & Women's iHub Inaugural Hackathon

September 20-22, Boston, MA
Brigham & Women's Hospital iHub Hackathon
In partnership with MIT H@cking Medicine
http://disruptingmedicine.org/events/hackathon/

Topics: Analytics

Kyruus CTO, Vinay Seth Mohta, to speak at StrataRx

"Are you Visiting the Right Doctor?

Topics: Referral Management Healthcare Conferences Analytics Patient Access

Healthcare Innovators on Innovation

Kyruus CEO Graham Gardner amongst the healthcare innovators interviewed for this video.

Topics: Analytics

PPSA's Final Ruling is Here: Now What?

This interpretation was written by Leon Goldman, Kyruus' Chief Privacy Officer and former Chief Compliance Officer at Beth Israel Deaconess Medical Center

The final rule of the Physician Payment Sunshine Act, commonly called “PPSA”, has been published in the Federal Register as of today, February 8, 2013. Anxiously awaited by the healthcare industry and the public alike, the final ruling means applicable manufacturers and group purchasing organizations will be frantically reviewing it, trying to ensure their organization’s processes and systems are ready and able to report the data to CMS by the deadline of March 31, 2014.

While there is anxious activity among the manufactures and GPOs, it is certainly less clear to hospitals and physicians what the PPSA will mean to them, and what exactly they need to be doing to prepare. Aside from providing the opportunity to review the data posted about them, PPSA does not place any statutory obligations on hospitals or physicians - it will, however, reveal a great deal of information about them to the public.

The process by which hospitals have monitored financial relationships with industry has long relied on individual disclosure, either on an annual or transactional basis triggered by specific events, such as seeking permission to perform research studies. Proactive review of publicly available information has not been part of standard review for most institutions - often because the perceived benefit of implementing such a process has not outweighed the cost of review, in both dollars and time. PPSA mandates not only the collection of a vast amount of information about “covered recipients” but also the creation of a vast database that must be downloadable, easily searchable, and aggregated. How and to what extent this will actually change the playing field is yet to be known.

This database will provide (relatively) easy access to vast amounts of information to the public, regulators, or the media for the first time. While some information is already available today via select states reporting and approximately 50 companies currently disclosing, PPSA will significantly increase the amount of information available to the public. We project the following:

  • Over 3 million public industry payment disclosures amounting to over $4 billion
  • Over 700,000 healthcare professionals indicated with public industry payment disclosures
  • Over 1,500 companies disclosing payments

At Kyruus, we have little doubt that agencies, such as the National Institutes of Health, will use the information as a way to “verify” what they are told by their applicants. The media, too, will see the data as an interesting source of information for investigative reporting. Lastly, individual patients and families will likely use the data to become more informed about their physicians and the relationships those physicians have with industry. Given all who will likely use the data, it behooves hospitals and covered recipients to be aware of the data.

Nevertheless, the presence of such a database will not relieve institutions of the need to gather information on their own as they have been doing up to this point. Factors for consideration:

  1. The annual posting of the data may not provide adequate information for organizations to fulfill their transactional obligations for events such as accepting payment from PHS for funded research.
  2. The PPSA database will contain nothing about non-physicians receiving payments or transfers of value about which the organizational policies require disclosure.
  3. There may be payments to physicians that need to be disclosed under an organization's policies, but which are exempt from reporting under the PPSA and can only be discovered through an active disclosure process.
  4. Consolidation of reporting by manufactures may make the information that is reported less useful to the institution for their assessment need. Again - the institution will need to continue to monitor data internally to understand what PPSA will mean for them, and what they need to do.

Kyruus believes that best practices will move organizations to develop policies and procedures that actively collect disclosure information from affected individuals and actively monitor publicly available information. This allows organizations to be in control of the information, to reconcile discrepancies, identify and eliminate problem areas, and to respond quickly to both public and regulatory inquiries.

Topics: Analytics Provider Networks

Leakage: Aid and Comfort to the Enemy?

This is a post by Dr. Tim Crowley, Vice President of Physician Network Services at Kyruus.

 

Imagine you are a King in Medieval times, and your fortress is under siege by an invading force. You have planned for this by building up more provisions of food and water for your people than your opponent could possibly bring to the battle. As the height of the siege, you make a both terrifying and mystifying discovery: Your own people are sending food and water out to your enemy!

This is the situation many hospital CEOs face every day when they review data revealing their own physicians - for whom they provide enormous "support" (read subsidies to cover losses), and whose very own paycheck depends on the revenues that specific system was expecting their patients to generate - are referring out of network. This is leakage in its purest form.

So how do you manage this problem?

The first thing you need is data, something most systems possess (in varying degrees of accuracy and "actionability"). It can be gathered and tracked internally, acquired from payers, data vendors and some cases, directly from the states that monitor and sell Physician identified data (see accompanying list).

Once you’ve determined who is leaking, what they are leaking and where they are leaking to, the next task is to determine WHY these physicians are referring cases out of the system. Then, and only then, can the strategy for dealing with this incredibly exasperating problem be formulated and implemented.

Figuring out the “WHY” requires one-on-one, practice-by-practice, or direct meetings with small groups or "Physician Pods,” to ask why physicians are referring out of network.

Warning: This question needs to be posed in the right way so you don’t make the problem worse. Also, the answers to this question may be quite humbling…

Remember, this is not a time to investigate, castigate, regulate or humiliate. It is an opportunity to ENGAGE with your physician staff, to LEARN about your system and find out why they refer patients away from your facilities and specialists.

The answer(s) to the “why” will become immediately (if not painfully) clear. They may include:

1. Ignorance of services that you currently provide and assumed ALL knew about.

2. Ignorance of specialists who are on staff who provide services you assumed ALL knew about.

3. Ignorance of the quality and better outcomes of the services you provide and assumed ALL knew about

The current generation of Primary Care Physicians, who now or at some time in the past made rounds on their inpatients before hospitalists came along, knew SOMETHING about your hospital and your specialists. However, as this generation approaches retirement, replaced by the new generation of PCP's (who never darken your door), this problem will only get worse.

Unless you ACTIVELY PROMOTE, INTRODUCE and EDUCATE your referring physicians about the services and specialists in your market, THEY WILL HAVE NO WAY OF KNOWING WHAT YOU CAN DO FOR THEM AND THEIR PATIENTS. (IF IT SOUNDS LIKE I AM SCREAMING, IT IS BECAUSE I AM!)

Topics: Analytics Provider Networks