Posts in Category: best practices

AUC and the CVIS 

Leveraging Appropriate Use Criteria for Better Outcomes—and Collateral Benefits

Appropriate Use Criteria (AUC) is intended to help physicians achieve the best outcomes using the most appropriate treatment plan for any situation. Ensuring that physicians comply with established AUC guidelines is crucial to the overall success of a facility. Demonstrated AUC excellence can impact: 

  • Patient outcomes and satisfaction
  • Hospital reputation
  • Reimbursement in the value-based care era

While the goal of all physicians is to provide best-quality, appropriate care for their patients, in the real world this can be challenging to accomplish—and to document—because of the lack of point-of-care access to complete, longitudinal patient information. Providing physicians with access to relevant patient data, and ensuring they have a clear understanding of AUC guidelines, can lead to improved outcomes—and cost savings as well. 


Rachanee Curry, LUMEDX Service Line & Analytics Consultant, explains how LUMEDX solutions help physicians access the patient data they need to comply with Appropriate Use Criteria.

Leveraging Appropriate Use for Cost Savings & More

With the shift to value-based care, service line leaders must seek out every cost-control opportunity. The good news is that there are collateral benefits to AUC compliance: In addition to improved clinical outcomes, collecting and serving up data so physicians can provide appropriate care helps heart and vascular centers improve their financial performance by:

  • Providing the right information, at the right time, to support appropriate clinical decision-making and best-quality care. When you deliver best-quality care, you are avoiding redundant or excessive treatment that can drive up costs; 
  • Delivering clinical workflows wherein quality data can be captured at or as close to the point of care as possible, optimizing efficiency and minimizing redundant manual work. This saves labor costs because clinicians spend more time on direct patient care rather than administrative tasks; 
  • Providing integrated clinical and operational data in near-real time so service line leaders can monitor their programs' performance and take action to improve.

In addition, when you demonstrate that your facility is consistently AUC-compliant, you are better positioned to work with payers on providing best-value care for that patient population. 

LUMEDX HealthView CVIS: Serving Up the Right Data at the Right Time 

HealthView CVIS helps heart hospitals navigate AUC and value-based care standards. The system collects point-of-care data and delivers actionable insights, facilitating better clinical decision-making and helping to improve business operations through increased efficiency and cost savings. 
HealthView CVIS can play a critical role in any hospital's move toward better patient care, greater efficiency, and improved fiscal performance. 


Early Reaction to MACRA Rule Mostly Positive 

Last weekend was a busy one for those trying to parse the new MACRA rule released on Friday. At 2,202 pages, the Medicare Access and CHIP Reauthorization Act rule wasn't exactly beach reading, and it gave the health IT community plenty to talk about on social media and in policy statements.

The dust is still settling, but it appears that early reaction to the rule was mostly positive. Healthcare organizations praised the CMS for being responsive to concerns they had raised during the comment period leading up to the rule's finalization. In fact, about 80 percent of the 2,000+ pages are comments CMS received and its responses.
The American Medical Association was pleased with the permanent elimination of the Sustainable Growth Rate (SGR) formula. "The new law," according to the AMA's press release, "gives many physicians the opportunity to be rewarded for the improvements they make to their practices and for delivering high-quality, high-value care to Medicare patients."
Other features that drew favorable reactions included:

  • The rule's overarching theme that improving the organization and payment models for medical care must stress quality over quantity.
  • Greater reporting flexibility for clinicians, as well as support for innovation in the delivery of care.
  • The formal adoption of a transition year during 2017, which makes major changes to the Quality Payment Program (QPP) reporting requirements, and provides a longer time frame for those transitioning to the QPP.
  • Emphasis on helping clinicians educate themselves about the rule.
  • Easing of the policy defining the Advanced Alternative Payment Model (APM), which will allow additional programs to quality.

But the rule is not without its detractors. "It's disappointing that the flexibility provided for quality reporting in 2017 largely disappears in 2018 and beyond," the Medical Group Management Association said in a policy statement.
Other organizations complained that the nominal risk standard defining the Advanced APM remains too high.

Want to know more? Healthcare Dive has a great breakdown of the rule changes you need to know. And for even more information on the new rule, click here. 
What's your take on the final MACRA rule? Share your thoughts in our comment section below.

Healthcare Cybersecurity Failings Draw the Ire of Accountability Office 

GAO Recommends Corrective Action by Department of Health and Human Services

More than 113 million electronic health records were breached in 2015, a year that saw a total of 56 cybersecurity attacks in healthcare alone. That's a 13-fold increase from 2006 to 2015.
The Government Accountability Office isn't going to let those cybersecurity failures go unremarked upon. The GAO last week came down hard on the Department of Health and Human Services, pointing out a number of weaknesses in efforts by HHS to help health plans and other providers protect data.
"HHS has established an oversight program for compliance with privacy and security regulations, but its actions did not always fully verify that the regulations were implemented," wrote the GAO in a report released Sept. 26. The report also called out HHS for giving technical assistance "that was not pertinent to identified problems" in cybersecurity, and for failing to follow up on cases it investigated. 
In short, the GAO found, loss or misuse of health information is not being adequately addressed by HHS. To help healthcare organizations comply with HIPAA and prevent further data breaches, the Office said, HHS should take the following corrective actions:

  • Update its guidance for protecting electronic health information to address key security elements.
  • Improve technical assistance it provides to covered entities.
  • Follow up on corrective actions.
  • Establish metrics for gauging the effectiveness of its audit program. 

HHS generally concurred with the recommendations and stated it would take actions to implement them.

UPDATE: On Oct. 4, HHS announced that it had awarded funding to help protect the health sector against cyber threats. Learn who received the funding, and how it is intended to help healthcare organizations.

Medical Errors Are Made at an Alarming Rate 

How Integrated Systems Can Help 

Medical errors are dangerous, deadly, and all too common. Research published in The Journal of Health Care Finance found that these mistakes cost the United States $19.5 billion in 2008 alone. A 2016 study estimated that medical errors cause 251,000 deaths a year in the U.S., where they are the third-leading cause of death (after heart disease and cancer). 

To Err is Human, the groundbreaking report by the Institute of Medicine, found that nearly half of all deaths attributed to medical errors were preventable. What's even more disturbing is the limited improvement that has occurred since the publication of that 1999 report. "The overall numbers haven't changed, and that's discouraging and alarming," Kenneth Sands of Beth Israel Deaconess Medical Center told the Washington Post.


Mickey Norris, National Vice President of Sales for LUMEDX, discusses how a CVIS can help reduce medical errors.

Medical errors can obviously result from many factors. Some relate to process or people issues, such as the inability to read another physician's handwritten notes, verbal communication breakdowns between medical professionals, or delays in adding notes to a case after treatment occurs.

But many errors stem from the lack of having accurate, up-to-date, or complete information about a patient readily available to clinicians at the point of care. In most cases this is a technology problem, yet technology can also be the solution.

Technology Can Help Reduce Medical Errors

The best technology solutions take an analog process and make it more efficient and accurate through a digital solution. The same is true in healthcare. The effectiveness of patient treatment hinges on getting the right information in front of the right caregivers at the right time. And historically that has been a challenge because the data physicians need is often located in multiple systems. These systems don't always communicate with each other.

For example, a physician may check a pharmacy log to determine which medications have been administered to a patient. But the patient may have been given additional medications in the cath lab, which weren't documented in the same log. This lack of complete information could result in drug interactions or overdoses, or in simply repeating tests. Similarly, the results of tests conducted outside a hospital may not be immediately available to a physician in a hospital. 

Integrating critical patient data from multiple systems automatically, and making it accessible to physicians and clinicians where and when they need it, helps reduce medical errors and improve care overall. Indeed, by minimizing the "number of hands" and number of times information is entered into a system, data quality improves, as there are fewer chances of error. 

Integrating data also reduces costs, because integration minimizes duplicative manual work. Clinicians can spend less time entering redundant data into silo'd systems and more time working with patients. Complete, accessible, high-quality data and improved operational efficiency in CV care are critical to the financial success of a facility.

LUMEDX HealthView CVIS: Increase Efficiencies, Reduce Errors

LUMEDX HealthView CVIS has the ability to interface digitally with almost every point-of-care device in use, and is completely vendor-neutral. Our suite of clinical interfaces allows device and clinical system data-ECG, hemodynamic systems, PACS, cardiac ultrasounds and more-to be captured automatically so that physicians and clinicians always have the most up-to-date information at their fingertips. And our structured reporting applications and registry modules support improved workflow efficiency and clinical quality, while minimizing redundant data entry and the potential for human error. 

HealthView CVIS also complements established workflows. It collects more than 30,000 discrete data points-from point-of-care devices to physician reporting. The robust analysis and reporting engine provides meaningful insights in the areas of treatment options, clinical evaluation and training, and service-line optimization. It's an important addition to any heart hospital's electronic records system, turning it into a robust and dynamic dataset where new information is added in near real-time. Fresh, relevant data that enables better medical care is a critical step in reducing medical errors. 


Enhancing the EHR 

Why Department-Level Systems Remain Critical to Quality 

The need for Electronic Health Records (EHRs) has become widely accepted, and methods to accelerate hospital adoption are proving to be successful, albeit resource-and cost-intensive. While EHRs are highly useful tools for collecting certain kinds of information and making that information available widely across services, cardiovascular care is complex; the data generated by this care is equally complex; and therefore cardiovascular service lines require systems that can match this complexity.


 

Chris Winquist, LUMEDX President and COO, explains how the CVIS augments the EHR to provide CV services with the deep data needed for clinical and business excellence.

Publicly Reported Measures & the Need for Deep Data

Even with the rapid pace of innovations in treatments and technologies, cardiovascular disease is the leading cause of death in the United States.(1) Unsurprisingly, today a large percentage of publicly reported quality measures are CV measures. Further, new value-based payment models are making up-to-date tracking and managing of performance ever more critical. Demonstrating quality of care delivered has never been more central to cardiac and vascular departments. 

How can a hospital best report, monitor internally and improve quality performance in key measures like Mortality, Complications, and Appropriate Use? With discrete, queryable data. This data must be:

  • Acquired at the point of care so workflow is efficient and data is of high quality 
  • Made accessible to providers across the care continuum so they can make fully informed treatment decisions
  • Reported to the registries
Getting Actionable Information

It's not enough to report to the registries once a quarter and then hope for the best. A high-performing facility must monitor and drill-down into its own data to investigate any problems and take action-as quickly as possible. For this, service lines need systems that can capture information as queryable data elements. And these systems need to integrate with all the devices and clinical systems at work in the service line (ECGs, Stress, Holters, cardiac ultrasounds, hemodynamic systems--to name just a few). 

A dedicated departmental system-one that integrates with clinical-modality systems and the EHR, and offers automated registry data collection and submission to the full suite of cardiac and vascular registries-is the only way for complex environments like cardiac and vascular services to get the data they need to measure and improve performance (clinical, operational) in a substantive way.   

LUMEDX HealthView CVIS Enhances the EHR and Supports Operational Efficiency

With more than 30,000 discrete, queryable data points, HealthView CVIS offers the depth cardiac and vascular departments need for optimal clinical and business excellence. We've developed a powerful data engine that brings insight to every aspect of CV suite operations by drilling into details and reporting on both trending and outlier situations. 

The HealthView CVIS also accepts and transmits relevant data from and to the EHR, so that the enterprise and the service line can operate at the highest levels of efficiency, facilitating best-quality care, improved performance and cost savings.

(1) Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics-2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28-e292.

Spotlight on Analytics, Part 5 

Q & A with Gus Gilbertson, Product Manager for LUMEDX

Predictive Analytics

Q: How much of the healthcare industry has adopted predictive analytics?

A: By definition, negotiations between providers and payers are a game of who can better predict patient outcomes. Win-win scenarios can certainly be devised, but a lack of predictive ability puts an organization at risk for poor contract structuring.

Clinical outcomes are increasingly a game of predicting outcomes and identifying the levers that affect those outcomes so providers are able to improve on future outcomes. Operational predictions are also important, as misunderstanding patient care needs can lead to expensive outlier care patterns or care variations that break capacity management efforts and budgets.

Q: How do you see predictive analytics having an impact on healthcare organizations, and specifically on heart hospitals?

A: Outcome prediction and risk profiling will increasingly guide care pathway selection and tailor care patterns to targeted patient profiles. Predicting and applying the care pathway that leads to the best health outcome at the lowest cost is the foundation of healthcare in the value-based purchasing era.

The dynamics of heart health are increasingly being researched and documented, leading to continued technical evolution and improved outcomes. Being able to predict which technology will lead to the best patient outcomes per dollar spent--whether it be a TVR, and VAD, or an aspirin—is a crucial skill for providers.

Q: What is the role of predictive analytics in affecting areas like heart failure readmissions?

A: Estimates continue to suggest that as much as 20 percent or more of care is wasted. Access to predictive models for identifying patients at risk for readmissions--and providing better targeted treatment up front--are the keys to reducing readmission. Those who best understand their care pathways and patient risk profiles will be the ones who can provide the best value in heart failure care. They will be the ones who can best explain the risk factors inherent in their readmission outcomes to stakeholders from patients to community groups and regulators.

Stay tuned for Part 6 of this series!

 

The Best of Cardio and Health IT News: 4/14/16 

News stories you won't want to miss!

Higher patient ratings equal fewer readmissions, lower mortality

The scores patients assign their hospitals appear to correspond with the quality of the hospitals' patient outcomes, according to a study published in JAMA Internal Medicine. Researchers analyzed the scores patients assigned to the Centers for Medicare & Medicaid Services' star-rating system for more than 3,000 hospitals. Hospitals' star ratings were inversely proportional to their rates of death within a month of discharge. 

Hospitals reap $1.6M from specialists, including cardiologists

While the average primary care physician is generating less income for hospitals ($1.4 million in 2016 versus $1.56 million in 2013), that’s offset by specialist doctors, whose contribution to hospital revenues jumped 14% to $1.6 million, compared with $1.42 million three years ago. Among specialists, orthopedic physicians bring in the most business ($2.75 million each), followed by invasive cardiologists ($2.45 million) and neurosurgeons ($2.44 million.

5 ways make employees happy in a healthcare workplace

Healthcare organizations named to Fortune's 20 Best Workplaces in Health Care share a sense of camaraderie and pride in their work, and offer lessons to other hospitals and systems that strive to create a positive work environment that can attract and retain the best talent. The winning organizations overcame the natural hierarchy of a healthcare organization to create a friendly, emotionally supportive workplace where coworkers feel as though everyone is equal and they can count on coworkers to support them.

Heart, vascular department at Aurora St. Luke’s receives top accreditations

Building on its rich history as the premier heart hospital in Wisconsin and a global destination for heart care, Aurora St. Luke’s Medical Center has received two prestigious accolades from the Accreditation for Cardiovascular Excellence (ACE). Both acknowledgments from ACE reinforce Aurora St. Luke’s positioning as a global leader in cardiovascular excellence.

Momentum building for national unique patient IDs

As digitization of the healthcare system increases, issues around data exchange and medical records exchange make patient identification more challenging than ever. In the absence of a unique patient identifier system, doctors use a patient’s name and birth dates to identify them, and there can be hundreds or thousands of identical or similar names and dates in EMR systems. Get it wrong, and a diagnosis or treatment may be missed — sometimes with dire consequences.

This Week in Cardio and Health IT News 

EHR developments, top hospitals list, and more

Here are some of this week's top stories in cardiology and health IT.

Big names in healthcare pledge to facilitate interoperability, EHR accessibility

The Obama administration has announced an agreement to increase interoperability by top U.S. health information technology developers and many of their larger customers. Signing on to the pledge--which requires signees to ease patient access to electronic health records--were Allscripts, Athenahealth, and Cerner Corp., among others. About 90 percent of U.S. hospitals use at least one of the vendors who signed on. 

Top 100 Hospital List released by Truven

Truven Health Analytics has released its list of the 100 top hospitals in the United States. In researching the hospitals, Truven discovered a trend toward reduced expense per patient among the majority of top-performing hospitals. This year's trend appeared for the first time in the awards' 23-year history. 

More patients survive when hospitals adhere to cardiac arrest protocol

Hospitals that closely followed recommended care protocols after in-hospital cardiac arrest (IHCA) had the highest survival rates. That's the conclusion of a new study published in JAMA Cardiology, which found that more than 24,000 lives could be saved annually if all hospitals operated at the level of the highest-scoring provider. 

Payer-provider collaborations called key to improved patient outcomes 

Payers and hospitals must overcome their differences to reduce readmissions, according to a special report by FierceHealthcare.com. "As providers increasingly move toward value-based care models, they must work with their counterparts in the payer sector to coordinate care and prevent readmissions," the report says. "But the transition is proving bumpy in some cases due in part to the historic mistrust between payers and providers."

Questioning whether readmission rates are a reliable care quality measure

Hospital readmission rates are not an outcome, but a measure of utilization, says one Harvard School of Public Health professor. He pointed to new federal research demonstrating that hospitals don't use observation status as a way to create the appearance of decreased readmissions, which had been a concern prior to the research. Readmission rates can decline for a number of reasons, including difficulty in being readmitted or better hospital-to-patient communication, he says.

The Best of HealthIT News: Week of 2/8/16  

Population health, Obamacare, and cost containment

Did you have a chance to check out the latest news from the healthIT community? Let us help keep you up to date on the stories you won't want to miss.

Companies Form New Alliance to Target Healthcare Costs

Hoping to hold down the cost of healthcare benefits, 20 large companies—including American Express, Macy’s  and Verizon—have come together to use their collective data and market power. Members of the new alliance will share data about employee healthcare spending and outcomes, possibly using the data to change how they contract for care. "Some members say they could even form a purchasing cooperative to negotiate for lower prices, or try to change their relationships with insurance administrators and drug-benefit managers," Yahoo news reports.

Federal Insurance Marketplace Signs Up Millions of New Obamacare Users

The Obama administration reports that approximately 12.7 million new patients signed up for health insurance under the Affordable Care Act, or automatically renewed their policies during Obamacare's third annual open enrollment season. Sylvia Mathews Burwell, the secretary of the Department of Health and Human Services, told the New York Times that the signups show that “marketplace coverage is a product people want and need.” Most of the plan selections were for people in the 38 states—more than 9.6 million—who used the federal website, HealthCare.gov, the Times reported. The other 3.1 million people were enrolled in states that run their own marketplaces.

Healthcare Economics: Court Allows Some Hospitals to Save Money by Classifying Themselves as Both Rural and Urban

While an earlier Health and Human Services (HHS) rule had barred both urban and rural classifications at once, a new federal appeals court ruling removed the barrier for dual hospital classification. The recent court decision applies only to hospitals within the 2nd U.S. Circuit Court of Appeals, but some hope that—combined with an earlier similar decision in a different circuit—the 2nd Circuit Court's ruling will inspire HHS to change the regulation across the country. "The Center for Medicare & Medicaid Services allows hospitals to classify themselves as rural (which providers typically leverage for discounts on drug purchases) while also classifying themselves as urban, (an important factor to attract qualified clinicians)," according to Reuters. 

Population Health: Hospital-based Wellness Centers Are Changing the Healthcare Model

Wellness centers housed in hospitals are helping communities prioritize preventive care and management of chronic conditions. The centers are part of the population health management model that focuses on preventing illnesses rather than simply treating them when and if they occur. The idea is to get patients to seek treatment before their conditions worsen, thus easing the burden on emergency rooms and acute care centers—and saving money.

Cost Control: Surgical Safety Checklists Can Save Lives and Reduce Hospital Stays

Surgical safety checklists—if implemented correctly—can save time, lives, and money. After the checklists were implemented, one study found, the average length of a hospital stay dropped from 10.4 days to 9.6 days. In addition, the checklists led to a 27 percent drop in the risk of death following surgery. Proper and consistent implementation is critical, however, for the checklists to work.

The Best of Cardio and Healthcare News for the Week of 2/1/16 

Trending topics in HealthIT

Leave the researching to us! LUMEDX surveys the top healthcare and health IT stories of the week.

Healthcare economics: Basing healthcare decisions on Medicare data might not be best practice

A recent study found that the correlation between total spending per Medicare beneficiary and total spending per privately insured beneficiary was 0.14 in 2011, while the correlation for inpatient spending was 0.267. “What that suggests is that policy for Medicare doesn’t necessarily make better policy for the privately insured,” one researcher told Health Exec.

Reducing readmissions among minorities: 7 population health strategies

A new guide from Medicare gives hospitals methods for addressing ethnic and racial healthcare disparities in readmissions. The guide comes amid increasing concerns about racial and ethnic disparities in healthcare outcomes, and frustration about federal penalties that some say unfairly punish providers in high-risk communities. 

Sharing of medical-claim data would be allowed under proposed #CMS rule

"Some medical data miners may soon be allowed to share and sell Medicare and private-sector medical-claims data, as well as analyses of that data, under proposed regulations the CMS issued," Modern Healthcare reports. "Quality improvement organizations and other 'qualified entities' would be granted permission to perform data analytics work and share it with, or sell it, to others, under an 86-page proposed rule that carries out a provision of the Medicare Access and CHIP Reauthorization Act of 2015" (#MACRA). 

Federal gender pay equity rule: What will it mean for healthcare industry?

Nearly 80 percent of hospital employees are women. How might they be affected by President Obama's recent announcement that the Equal Employment Opportunity Commission will begin requiring companies that employ 100 or more people to report wage information that includes gender, race, and ethnicity?

The price of healthcare miscommunication: $1.7B and nearly 2,000 lives

New research shows that healthcare miscommunication has cost nearly 2,000 lives, and was a contributing  factor in 7,149 cases (30 percent) of 23,000 medical malpractice claims filed between 2009 and 2013. Communication failures were also to blame for 37 percent of all high-severity injury cases.

Physical fitness can decrease mortality risk following first heart attack

Being physically fit may not only help to reduce the risk of heart attacks, but may also decrease the risk of mortality following a first heart attack, according to a new study. The study used multivariable logistic regression models to assess how exercise affected the risk of mortality at 28, 90, and 365 days after a heart attack.

 

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