"Are you Visiting the Right Doctor?
Julie Yoo, on September 09, 2013
"Are you Visiting the Right Doctor?
Kyruus CEO Graham Gardner amongst the healthcare innovators interviewed for this video.
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:
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:
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.
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!)
This is a post by Dr. Tim Crowley, Vice President of Physician Network Services at Kyruus.
How important is perception? Prioritization? Taking a step back? Incredibly.
I recently attended a conference where the moderator presented a famous video of a group of people passing basketballs to each other. The group was asked to count the number of times the basketballs were passed back and forth. In the middle of the exercise, a person in a gorilla suit walks through the room in the video. Afterwards, when the group was asked about the number of passes, one person raised their hand and asked, “What about the gorilla?”
Over two thirds of the group asked, “What gorilla?” Some insisted there was no gorilla at all, and even accused the moderator of showing two videos!
The point, of course, is that if you are too focused on one thing, you could be missing the real threat to your organization. That’s your gorilla.
Personally, I have seen at least three classic examples of this in Healthcare over the last five years:
1. Large Academic Medical Center in the Northeast proudly announces opening of $400 million, state of the art Cardiovascular tower. Meanwhile, 1,000-provider physician group responsible for 17% of their discharges announces change of affiliation to competitor across the street.
2. Large National For Profit Hospital Management Company gathers its senior management to review 700 hours of physician interviews about “how they are regarded by their employed physicians.” Consulting firm opens the conference with the following statement to the eager crowd: “Let me give you the Executive Summary. Your physicians hate you and they think you suck.” If I hadn’t been in the room to hear it myself, I’m not sure I would have believed it.
3. Faith Based System in the Northeast turns around $50 million operating loss into $30 million operating gain in one year. Market crashes and old Defined Benefit Retirement Plan’s unfunded liability triples. Game over. Private Equity Firm buys system.
So, while you, the hospital administrator, are totally consumed by the installation of your new EMR, or your brilliant new E.D or your aggressive new quality improvement and cost containment projects, you might want to look around and see if there any gorillas are in the room.
Here are two “gorillas” that can pose an existential threat to your organization:
1. Lack of a dynamic, effective ONGOING Physician Network Development program. Our proprietary physician tracking data shows that over 1% of physicians move EVERY MONTH. 12-15% change location, leave their practice or move to a different system every year. In addition, a whole generation of Primary Care Physicians is approaching retirement in the next 5-10 years. Without the information to identify those likely to leave and a comprehensive succession plan to help recruit new physicians to care for those patients, you could lose significant market share. If you are not actively engaged with your physicians to build your physician network, you are probably already losing more than you are gaining.
2. Patient outmigration, or "leakage". There is nothing more exasperating to the senior management teams at healthcare organizations than to see huge numbers of referrals go out to other organizations by their own physicians. What’s the point of creating and supporting a physician network if they aren’t willing to support your organizations and keep the care of their patients at the hospitals where they practice? Understanding why they are referring out is critical to fixing the problem.
Kyruus Physician Network Services can help your organization with both of these challenges. We have the tools and services to help you build, train and operate an effective Physician Network Development program and a Referral Management System that will help you promote patient retention.
This is a guest post by Jeff Gold, Solutions Architect at Kyruus
As the costs of health care continue to rise, demand for transparency and better oversight of physician interactions with industry is mounting. Transparent Innovations has closely covered progress on the Sunshine Act and recently, Iowa Senator Chuck Grassley challenged the National Institutes of Health (NIH) over the award of a research grant to a physician who had previously been identified for failing to disclose an industry relationship while working on a federal study. As we’ve reported before, institutions applying for or receiving NIH funding must be in compliance with more stringent financial conflict of interest requirements no later than August 24, 2012.
For institutions, complying with new regulations is costly. According to Doctor Kristy Weber, chair of the Council on Research and Quality at Johns Hopkins, lowering the NIH monetary thresholds from $10K to $5K, “will greatly increase paperwork for many individuals and institutions.” There certainly isn’t a shortage of viewpoints on the Sunshine Act either. Proponents say any transparency is a good thing, regardless of cost while others believe the high price of compliance outweighs the usefulness of the data.
The Trade Off Between Productivity and Transparency
Using a traditional manual process, an institution naturally faces a trade-off between productivity and transparency. Why? Because the most productive environment is one where no time is spent on administrative tasks. That’s obviously not possible in this environment of increased transparency. Similar to a zero-sum game, the more time spent of transparency, the lower the productivity as shown in the graph below.
There is a better way
Complying with increased transparency and disclosure requirements while mitigating costs is possible with better technology. We know that stakeholders in the healthcare system will need to manage these relationships to allow for high productivity and high transparency. In the end, physicians and industry will need to work together to collaborate and preserve innovation. With technology, we can achieve both. We can shift the curve.
There has never been a better time for information technology to address these problems. Software development as a practice has been maturing and three changes offer reason for optimism.
First is the importance of user experience. Google, Apple and other companies have raised expectations. Design advice from experts like Steve Krugg and Jakob Nielsen is being embraced. Programmers are better equipped to eliminate the tedious parts of data entry and to provide intuitive applications that are easy to use.
Second, Big Data technology is breaking down previous silos and allowing better business insight than previously possible. Analytics provide meaningful results and business users are able to continuously refine results until the desired outcome is reached.
Third, companies that deliver software are more nimble and customer focused than ever. Large, inflexible corporations have given way to small, vibrant companies that delight their customers.
There will always be obstacles to adoption in a market as complex as health care. Many ideas and companies that seem promising will fail. But some may make health care more transparent without compromising its ability to learn from industry and grow. At Kyruus, we hope to be part of that.
This is a guest blog by Katie Dixon, Market Solutions Associate at Kyruus
The Obama Administration is investing big time in big data. On Friday, March 30, the Administration’s Office of Science and Technology Policy (OSTP) launched a $200 million, multi-agency effort titled the “Big Data Research and Development Initiative.” Fundamentally, the initiative’s mission is to highlight and create public-private partnerships in big data. The Administration is inviting industry, research universities, and non-profits to join forces and make the most of the opportunities created by big data. To view the announcement, click here or you can view the streaming video webcast.
While the initiative launches six new agency efforts, numerous agencies are already involved in the big data revolution including the: Department of Defense (DOD), Department of Homeland Security (DHS), Department of Energy (DOE), Department of Veterans Administration (VA), Department of Health and Human Services (HHS) and National Security Agency (NSA), among others. These agencies administer some of the most fundamental aspects of the American public’s life. For more detail, check out the official Big Data Fact Sheet.
What can we infer from the announcement? The initiative is an institutional precedent for big data as a discipline. In a sense, the federal government is legitimizing a practice that science and commercial companies have benefitted from for years. This is huge. One can extrapolate that big data is moving from an introductory/pioneering stage to a growth stage in its commercial life cycle. Big data is legit, it’s commercially viable and it can help the public live better.
A Call To Action
The announcement last week was designed to spur action. Now is the time for academia, corporations, NGOs, associations, foundations, governments and everything in between to step forward and make things happen. Collaboration is the key to identifying opportunities, inventing better products and systems, and reducing costs. The Administration knows that no one actor individually can address the biggest issues facing our citizenry. Together, however, possibilities are endless.
If you are interested in learning more about the announcement and big data initiatives, here are a few links.
Photo by James Vilija
I recently read a few articles published by Kaiser Health News that clearly articulate the push by hospitals and health systems to market themselves more aggressively to patients. The methods aren’t new to the marketing discipline; in fact, credit card companies, supermarkets and many other businesses have been using these practices for years. What’s new is that hospitals are using these tactics to recruit patients and establish loyalty to facilities in the event that medical services are needed. Some people see this as questionable behavior on the hospitals behalf. As a marketer, I think this is smart business. If it helps a patient receive preventative care to head off a medical problem in the future, or leads to an improvement of quality of life while also benefiting the hospital, I’m all for it.
Few need to be convinced that we live in a world today that is increasingly tracking, measuring and monitoring a broad spectrum of activities. This point was illustrated in a McKinsey report I read recently titled, "Big data: The next frontier for innovation, competition, and productivity". The introduction summarizes nicely why the amount of data is growing exponentially and how that can be a good thing for capturing value.