Harvey Jenner is Principal of IQVIA Healthcare Solutions

Jessica Preston, MPH, is Associate Consultant at IQVIA Healthcare Solutions.

Not-for-profit healthcare organizations such as medical special societies (MSSs) and patient advocacy organizations manage vital data registries about patients and providers for specific research, quality, and educational purposes. However, given the limited scope of their registries, they often fail to fully address broader organizational and research needs.

Shifting market conditions, particularly a changing regulatory environment and a movement towards patient centric data ownership, are driving an increased supply and demand for health data that can provide more comprehensive views of complex patient pathways. Increased access to patient-centric data sources such as electronic health records, patient reported outcomes, claims data, and genomic data is driving a renewed interest in patient registries as a potential nexus for a more holistic view of the patient experience.

MSSs and patient advocacy organizations are ideally positioned to take advantage of these market shifts and become the go-to data resource for their specialty area. Embracing new data sources and acting as a trusted data steward can bolster these organization’s convening powers, strengthen their collaborations with other health care stakeholders, and drive collective insights that will benefit patients and providers alike.

What is the value of acquiring new types of real world data

Augmenting registries with additional types of data can provide a more comprehensive understanding of patient journeys across the continuum of care. Additionally, acquiring new data sources can support an organization’s mission and long-term financial sustainability by addressing critical research questions and by enabling new use cases and market offerings. While the research questions supported will vary widely based on current scientific and care paradigms, market offerings generally include: real word research, trial recruitment and support, QI and implementation science programs, development of new digital quality measures, patient preference and satisfaction research, utilization management, and/or provider and patient-centric benchmarking.

What are the challenges to identifying, evaluating, and integrating real world data sources

Data landscapes are growing progressively more crowded as the supply and demand for data continues to expand. However, despite this growing availability of data, there is huge variation in the quality, coverage, and value of each data source. The process of selecting the most appropriate data source(s) can be an overwhelming task. Organizations need a systematic way of identifying, assessing, prioritizing, and partnering with relevant data source owners best suited to address current and future organizational and research needs.

How to set up a data landscaping and sourcing process

Successful organizations follow a methodical process to identify and prioritize third-party data sources. This three-step process includes:

Step 1: Data needs prioritization and qualitative data source assessment: 

To start organizations need to define and prioritize their unmet needs and existing data gaps. Once these are identified, a thorough review of the existing data landscape should be conducted through literature reviews and internal knowledge gathering. This list is then further refined through interviews with data source owners to better understand the data variables, quality, access requirements, and permitted data uses.

Step 2: Quantitatively evaluate datasets: 

Based on the qualitative assessment, a small number of highly promising datasets are then selected for a more intensive quantitative pilot. The goal of this stage is to work directly with the database owners to understand the presence, completeness, and quality of key variables required to address your organizational needs, in addition to the feasibility of linking the new data to an existing registry.

Step 3: Partner with the best data sources for your organization: 

 the quantitative evaluation, you will be ready to select the most promising dataset(s) to formally partner with.

No “one-size fits all” approach to assessing value of new data sources

It is important to note that the most appropriate data sources to assess and partner with will also vary significantly based on current data and capabilities. For example, an MSS may find less value in EHR data if they already obtain this data from providers in their quality registries. Instead, they may prefer to link claims data to help them obtain a more complete view of the patient pathway, enabling the capture and characterizing of the outcomes and risk factors that occur along each patient’s journey more accurately. On the flipside, patient advocacy organizations may find EHR data particularly valuable for gaining a fuller understanding of the patient journey for their unique populations.

The need to transform data into insights will continue to grow

As the amount of real world data continues to grow, so too will the need to turn that data into meaningful insights that can advance knowledge, support providers, and improve patient care. Patient advocacy organizations and MSSs who can successfully leverage and augment their existing registries with new sources of data will be well positioned to fulfill their missions and support their members now and well into the future.

Harvey Jenner is Principal of IQVIA Healthcare Solutions and Jessica Preston, MPH, is Associate Consultant at IQVIA Healthcare Solutions.

Articles

Increased access to patient-centric data sources such as electronic health records, patient reported outcomes, claims data, and genomic data is driving a renewed interest in patient registries as a potential nexus for a more holistic view of the patient experience.

The benefits of acquiring new real world data for medical special societies and patient advocacy organizations 

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. 

Asset protection trusts for physicians can be domestic, offshore, or may utilize the best aspects of both structures. We examine the question of 

 on the trust law basics every doctor should understand we introduced some of the features common to most asset protection trusts, regardless of whether they are domestic asset protection trusts, commonly referred to as 

 or offshore or foreign asset protection trusts, or 

There are currently about 19 states that have legislation that allow the formation of a DAPT in their jurisdiction. This number has grown over the last few years due to both consumer demand and the jurisdictions’ realization that the trust business can generate significant fees and draw wealth to their states. Among the most popular of the DAPT jurisdictions are Nevada, Montana, Delaware, and Wyoming but there are many others that have similar or even better statutes.

Experienced planners have strong opinions about which domestic jurisdictions are best and why and should be able to explain the benefits of the DAPT state they use and how they effectively protect you and your assets well beyond just, “Because we are in state X”. Among the best analysis of the various state DAPT statues is a 

 created by Las Vegas estate planning attorney Steve Oshins.

DAPTs are typically less expensive to set up and maintain than their offshore counterparts but are not as well tested and long proven on any wide scale and rely on the hope that, for instance, a judge in California with jurisdiction over a California defendant will refrain from trying to grab that defendant’s assets in Nevada because Nevada says they are in a special trust. DAPTs also unfortunately face “full faith and credit” challenges. Legally, a judgment in any state is good and enforceable against a defendant and their assets in every other state. As such, the main issue or flaw with DAPTs is that the trust’s assets remain in the jurisdiction and a the subjective judgment and control of the U.S. court system, regardless of the validity of the threat you may face.

The laws in these states the level of protection they provide vary widely as do many of the other details, so professional guidance by experienced asset protection attorneys is highly recommended. This provides both guidance on the correct usage and operation of the tool itself and the protection of a “privileged” relationship with a licensed professional. Your communications with various non-attorney promoters and document preparers are not confidential, are discoverable in a lawsuit and they do not have professional liability for any malpractice. There are significant ramifications for making transfers to these kinds of vehicles including tax, estate, and fraudulent conveyance issues that you must understand or have counsel that does. Some DAPT promoters may apply form documents without a full understanding of their use and how it will affect your future defense, control, and use of those assets. Get personalized help from an experienced attorney who can help make sure that you are following the letter of the law to get any and every possible benefit the trust may provide.

Large numbers of DAPTS have been established over the last few years in various jurisdictions by planners of widely varying skill for clients with questionable timing. Unfortunately, “bad facts make bad law” and given the number of bad fact-planning cases that have been executed in the last few years, we may see many of these structures pierced. Although these cases should be judged individually on their merits, human nature makes it more likely that they will begin to be viewed as a group by the courts and either generally upheld or viewed as ineffective. Until that drama plays out, I advise against participating in the legal equivalent of a clinical trial.

In short, if you live in a DAPT state and fund a fully compliant DAPT with the right assets, and the legal challenge you face never leaves a state court, it may very well work. Outside that specific fact pattern, consider using multiple layers of proven legal tools, and for the highest level of protection for those who are financially qualified, offshore trusts and hybrid ‘Bridge Trust’ structures that will be the focus of our next installment.

JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. 

Trusts 101 part 10: Domestic vs. offshore trusts

Jeff Bendix is the senior editor of Medical Economics.

Editor's note: The information is this story was taken from a recent Medical Economics Bootcamp session. You can find the full video of the session 

Electronic health records (EHRs), clinical documentation for billing and meeting administrative and regulatory requirements are among the major sources of frustration for primary care doctors. A 2018 study in 

 found that physicians spend an average of 90 minutes per day outside of work hours on EHR-related tasks. For growing numbers of clinicians, these are the reasons for giving up the practice of medicine entirely.

Fortunately, there is now a wide array of technological tools and services physicians can use to ease the burden of documentation and other billing and administrative tasks while also improving practice workflow and clinical decision-making. However, obtaining the right tools and maximizing their benefits requires planning and understanding what technology can and can’t do for your practice.

Identify best practices to alleviate the most common clinical and administrative burdens in your practice.

Understand the role of technology in building an optimized clinical workflow and delivering more effective patient care.

Discuss with Robert Wolf, M.D., at Wolf Medical Group how his practice reduced administrative burden and achieved a more effective clinical workflow by leveraging a clinical-first EHR and associated technology.


, director, primary care advancement, Elation Health

, Wolf Medical Group, Rising Sun, Maryland

From billing and documentation to responding to messages in patient portals, doctors today — especially those practicing primary care — face an avalanche of paperwork, and much of it is tied to EHRs. A technology that was supposed to make clinicians’ lives easier instead has created frustration and feelings of alienation from the practice of medicine and contributed to worrisome levels of burnout.

® survey, 31% of respondents cited paperwork as the leading cause of their feelings of burnout, which is more than twice the percentage of the second-leading cause. A 2016 survey of 6,375 primary care physicians that was published in Mayo Clinic Proceedings found that EHR users faced a higher risk of burnout than nonusers.

However, even as one new technology has heightened professional dissatisfaction among clinicians, other tools are emerging to help alleviate it. Family physician Robert Wolf, M.D., described how he uses some of these tools in his practice during a discussion with Sarah Pastoor, M.D., director of primary care advancement for EHR manufacturer Elation Health.

“I’m obsessed with efficiency. (I’m) always asking: How can we do this faster? How can we pare this process down?” Wolf said. One of the most important steps he’s taken to become more efficient has been to automate the clinical note-taking process.

“With computers, anything you have to do repeatedly can be automated, and I realized I was repeating the same instructions for simple things like urinary tract or upper respiratory infections,” he said. “If I could find a way to insert text explaining what I’ve done for a patient into the progress notes, I’d get credit for it and not have to keep retyping it.”

To achieve those ends, Wolf has developed templates in his EHR for common conditions and automated elements of the text software with tools such as dictation and text expansion software. “When patients come to see me, I’m already thinking about what template I’m going to use and what text I’ll put in there,” he said. “The software is set up so I can document quickly and for maximum reimbursement. In many cases, I can meet the criteria for a 99214-level visit, even for something simple.” Doing so, he adds, has led to “a significant improvement in the quality of my life. I no longer feel like I’m on that hamster wheel, where I have to see more and more patients.”

Wolf stressed the importance of using the latest technology and obtaining devices from the same vendor so they integrate seamlessly. His vendor of choice is Apple, because its products work well with each other and with his EHR. Among other advantages, Apple enables him to take notes on an iPad rather than a computer during patient visits. “It’s important to me not to have a computer monitor and keyboard between me and the patient,” he said.

Before he sees patients, a medical assistant gathers and enters the patient’s vitals and other basic information in the EHR. “That means when I come in the room, I basically just have to make the clinical decisions that only I, as the physician, can make,” he said. In addition, rather than have patients wait for any follow-up handouts, he emails them or communicates via the patient portal.

“I try to keep things as simple as possible, because simplicity is good for patients and for me. I feel like I’m doing things that really matter,” he said.

The practice uses Slack for internal communication. Wolf says his staff uses this platform to notify him of tasks he needs to accomplish before the end of the day, which is something they formerly did using paper slips. Using Slack makes it easier to prioritize and track the tasks so none of them get overlooked or forgotten.

Wolf said his focus on technology for streamlining and simplifying his practice has changed his attitude about practicing medicine. “I know people get discouraged and feel like medicine is set so it’s impossible to both make a living and enjoy what you’re doing,” he said. “But now, at age 55, I’m finding there are ways to use technology so you can restore joy to what you’re doing.”

 Summer Bootcamp: Reducing administrative burdens at your practice through clinical-first technology

Travis Schneider is Co-founder and Chief Corporate Development Officer for Tebra, a leading cloud-based healthcare technology platform. In his role, Travis oversees M&A and strategic partnerships for the organization.

In 2021, PatientPop, a leader in practice growth technology, merged with Kareo, a leader in cloud-based clinical and financial software. Travis was Co-founder and Co-CEO of PatientPop, where he oversaw all aspects of strategy, sales, and business development. He is enthusiastic about leading the integrated corporate development for Tebra.

Before co-founding the company, Travis co-founded and served as CEO of ShopNation. He also co-founded and served as CEO of StarBrand Media. The businesses were acquired by Meredith Corporation and POPSUGAR, respectively.

Travis holds an honors degree in business and economics from Wilfrid Laurier University. He is also a two-time recipient of the KPMG Enterprise Entrepreneur Award.

Last year, hospitals and other corporate-owned entities overtook nearly 

 independent practices nationwide. This influx in acquisitions is primarily attributed to the economic struggles independent practices were experiencing as a result of the Covid-19 pandemic. New data indicates that nearly 

 of doctors in the U.S. now work for hospitals and large-scale health facilities, a number that is up from 69 percent a year ago.

The benefits that stem from independent practices include access to care in rural communities, lower care costs, and better patient experiences. However, for independent practices to thrive, it will largely depend on how well they can adapt and implement emerging technology to streamline practice operations and bring patients a better overall experience.

Since the pandemic, many medical providers have faced severe burnout and strain, working around-the-clock hours under hazardous conditions. Consolidation is often forced by burnout and exhaustion of providers. Doctors went to school to provide care to patients. However, they become small business owners and face challenges of managing all operations, HR, IT, practice growth, reputation management, and revenue management.

With so many providers considering consolidation, the opportunity to receive fair and quality medical care from independent practices as opposed to large-scale hospital corporations is diminishing, dampening patient trust in the healthcare system.

The consumerization of healthcare is a broad shift from the healthcare market to individual healthcare consumers, meaning individuals are asserting more influence over their medical and wellness care. Healthcare consumers want a convenient and digitally-enabled experience from the time they submit an inquiry to the treatment and subsequent follow-ups. Convenience and customized experiences drive consumer behavior. The pandemic accelerated the adoption of consumer-centric healthcare, starting with telehealth services.

Right now, the consumerization of healthcare is one of the biggest challenges, and opportunity providers face. By adopting digital tools and software, they can easily respond, putting the focus back on patient care. To do so, practices must be willing to embrace a new model with technology that delivers the digital experience that patients encounter every day across every other industry without slowing down providers and their staff.

Digital technology is key to a thriving practice

 and customer of Tebra, left a large medical group to start his practice in a rural community. As a small practice with four employees, implementing the right technology has been imperative in building an online presence to acquire new patients, streamlining administrative tasks that detract from patient care, and having the virtual tools to treat patients who can not visit his practice in person.

“Independent practices are crucial to the healthcare ecosystem and providing accessible care to patients when and where they need it. As a provider, I want to focus on my patients, and by implementing the right technology that mimics my workflows, I have the resources I need to remain independent, so I can serve the patients who depend on me,” said Dr. Spriggs.

For practices implementing technology to meet consumer demands and provide a competitive edge, key considerations include:

 Often, providers end up with fragmented software solutions due to the complexity of the shopping experience. Disparate software solutions require duplicating workflows from scheduling and intake forms to clinical documentation and medical billing. By identifying each area of your practice that technology would benefit from, you can find the right solution to integrate into one platform. Moreover, the right solution will relieve staff from administrative tasks.

The right technology partner will provide support beyond the implementation process and evolve with the constantly changing healthcare system. As regulatory requirements often change and can significantly impact how you submit and receive reimbursements, your technology partner should provide software updates to account for such changes and provide the education you need on changing regulations.

 Technology for your practice should equally serve your patients and improve the experience and care they receive. Patients want digital touchpoints at every stage of their journey, from doctor discovery to payment and scheduling follow-ups. Ensure your technology stack serves your practice and your patient with an easy and streamlined experience.

When independent practices invest in the righttechnology, they will spend less time on operations and more time on personal, meaningful care. In addition, providers can restore work-life balance, reduce burnout and focus on why they became doctors - to deliver care.

For independent practices to thrive, it will largely depend on how well they can adapt and implement emerging technology.

Technology empowers private practices to sustain their role in the healthcare ecosystem

Liz Fobare is the Senior Director of Clinical Product at Kareo, 

. With over 15 years of experience in the healthcare technology industry, Liz is a strategy expert. She is highly trained in design thinking methodologies with a proven track record of achieving operational efficiencies in product development, marketing, and customer experience.

https://www.linkedin.com/in/elizabeth-fobare-91ba5a14/

Prior to COVID-19, telehealth was considered a niche or nice-to-have service for some specialties, while others were skeptical of its efficacy and slow to adopt. However, the pandemic changed perceptions nationwide when accessibility to care became a national imperative. Medical facilities across the country embraced telehealth to connect with patients near and far. Now, as medical providers ease into the new landscape, it’s clear that 

. New research suggests that telehealth drives positive health outcomes, increased access to care, and the ability for practices to meet evolving patient expectations. It is the primary tool for a modern patient experience.

, data from the first quarter of 2019 shows that telehealth visits were 50 percent lower than in the first quarter of 2020. At the time, reimbursement models for telehealth services were complicated and often restrictive; for example, only some rural areas were deemed eligible for telehealth treatment and reimbursement. Licensing was also confusing and both providers and patients were concerned about the security and effectiveness of a telehealth visit.

The disruptions to patient care caused by the COVID-19 pandemic forced healthcare providers to rapidly adopt telehealth. 

 for telehealth services and increased the number of fully reimbursable procedures. Platforms not compliant with the Health Insurance Portability and Accountability Act (HIPAA)like Skype, Facetime, and Zoom were temporarily permitted for telehealth so long as they were not public-facing. With many of its burdens lifted, by December of 2020 nearly 

 of independent practices had begun to offer telehealth.

Telehealth offered a solution to patient care that kept providers safe from exposure and extended access to care across various population groups. The equitability of telehealth support proved to be yet another benefit, with the 

 of American adults who own smartphones now having easier access to quality communication with their providers, resulting in better healthcare outcomes. The convenience of telehealth all but eliminates the barriers of distance and time. Moreover, telehealth has expanded access to quality care to some medically underserved communities.

Patients have also embraced telehealth, highlighting a 

. Patients appreciate the ability to connect with their providers from the comfort of their homes. No longer do they have to rush to and from appointments or waste time in physical waiting rooms. Yet while telehealth offers convenience, patients expect that their information is protected. Non-HIPAA compliant tools posed a number of challenges, including with security and continuity of care, in the early days of COVID-19. Providers did not have a seamless experience with clinical documentation and video management. The manual work that derived from these quick fixes was time-consuming for staff.

Telehealth has empowered practices to engage with patients across every step of the care journey to strengthen clinical outcomes and improve practice operations. From automated telehealth appointment reminders to digital intake forms to integrated note-taking, telehealth makes it easier for providers and patients to connect.

In the years since the COVID-19 pandemic began, telehealth has advanced to improve functionality for the needs of patients and providers. An integrated platform that offers secure communication channels where providers can access charts during telehealth visits is key for success and long-term usage. Features like provider-specific rooms, a virtual waiting room, and digital intake forms refine the patient experience by streamlining operational procedures. Practices that have integrated automated appointment reminders by text or email report up to 

 decrease in patient no-shows. Telehealth group appointments show great efficacy for support groups, mental health therapy, and parents needing to accompany their children.

Kareo’s latest telehealth data reveals that of the providers who offer such services, nearly 50 percent of their monthly appointments are telehealth visits. Independent practices have begun to implement strategic initiatives to enhance their telehealth services. By establishing execution strategies, outlining goals, and choosing the right technology partner, independent practices are 

. With access to customization capabilities, practices can improve internal documentation and patient-facing communications. These tools are foundational to establishing a modern practice that keeps patients coming back.

The future for telehealth and its impact on national healthcare is bright. The continued use of telehealth is projected to improve the nation’s clinical quality by 20 percent and reduce healthcare spending by 15 to 20 percent. For example, the advancement of at-home diagnostics and high-quality virtual visits are expected to improve health outcomes and reduce healthcare costs for individuals who manage chronic conditions. Every day the industry is uncovering new opportunities to leverage telemedicine. One such opportunity includes webinars to support proactive, preventative care and patient education. Perhaps most importantly, access to care will continue to expand by an estimated 

, including to unserved communities and populations across the country.

Care delivery will continue to evolve with patients at the forefront of the tools and offerings provided. Providers are encouraged to embrace telehealth medicine and its expanding practices to provide a modern patient experience that is demonstrating success across multiple facets of quality of care and patient engagement.

Liz Fobare is the VP of Product Management at Kareo, a 

company. With over 15 years of experience in the healthcare technology industry, Liz is a strategy expert. She is highly trained in design thinking methodologies with a proven track record of achieving operational efficiencies in product development, marketing, and customer experience.

It’s clear that telehealth is here to stay.

Telehealth: More than a pandemic trend

With all the useful information available on Physicians Practice, it is easy to become overwhelmed.

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a June 2021 story on 

five ways physicians can minimize interruptions

“ 1). Monitor, but do not respond - By monitoring the calls and text messages that come in, but not responding to them, they are able to turn back quickly to their work and make good progress

2). Increase your message monitoring interval - If you monitor your messages every five minutes to 10 minutes, increase the interval to 15 or 20. In the grand scope of things, that’s not a big deal in terms of staying informed, while at the same time it affords you the ability to stay focused and accomplish great things. In time, increase the interval to 25 minutes to 30 minutes.

3). Decide in advance which messages merit quick response - After hours when you’re attending a play, a movie, a dinner, or are at some other place where you do not need to be disturbed and, indeed, would disturb others if you were to check your cell phone, take it out of the equation. Don’t bring it with you.”

 for the rest of the tips. Be sure to come back next week for another Tip of the Week!

Your weekly dose of wisdom from the Physicians Practice experts.

Practice tip of the week: Five ways physicians can minimize interruptions

George Dealy is vice president of healthcare solutions at 

, an enterprise analytics company based in Burlington, Mass. You can follow Dimensional Insight on 

The long-term financial stability of any healthcare organization has always been directly correlated with the efficacy of its revenue cycle. Unfortunately, although healthcare providers have always faced challenges in maintaining an efficient and optimized financial operation, the COVID-19 pandemic has posed a particularly tumultuous period for the industry.

In order to better anticipate and respond to future obstacles, providers must implement data analytics tools that will allow them to quickly and reliably identify potential weaknesses and opportunities for improvement. In this whitepaper, we will evaluate some of the greatest revenue cycle challenges currently facing the healthcare industry and how data analytics can help.

Although the healthcare industry has a vast ocean of data at its disposal to leverage in garnering valuable insights, much of this is unusable due to poor organization and discrepancies between multiple sources. In order to foster collaboration and enable data-driven decision making, organizations need to ensure that all users are looking at the same information.

Consistent and reliable information is necessary for generating trust and fostering a data-friendly work environment. Access to a single and reliable platform increases user engagement and reduces the costs associated with training, and in turn, increases company-wide adoption. To put it simply, employees who trust their data use their data.

This is where a single, encompassing analytics platform becomes relevant. End-to-end solutions consolidate data from multiple heterogenous channels into one source, providing a usable and accountable resource for company-wide decision making.

Information isn’t democratized across the organization

In order to maximize your return on investment, you have to ensure your data is ending up in the right hands and is being used by the right people. Often, organizations limit their data applications to a select few departments or don’t take the steps necessary to encourage deeper adoption throughout the organization. Every level of a business presents opportunities for improvement that can benefit the entire company, but recognizing these opportunities requires staff who actually use the data in their decision-making.

One of the key factors behind democratizing your data is the implementation of software with self-service capabilities. Self-service analytics allows end-users without a technical background or in-depth understanding of analytics to access and use data. According to Howard Dresner’s 

2021 Self-Service Business Intelligence Market Study

, self-service analytics was ranked sixth out of 44 topics for the most important BI technologies and initiatives. With these features, you can provide staff from all departments with resources necessary to garner data-driven results.

Many companies are also held back by their own executives and administrators, who neglect the importance of fostering a data-friendly environment and generating support from other departments. Mid-level managers and other team leaders need to be inspired by their leadership in implementing data in their day-to-day operations.

One of the biggest obstacles facing healthcare revenue cycles is missing and denied charges. According to a report by the Kaiser Family Foundation, 

17% of in-network claims in 2019 and about 14% of in-network claims in 2018 were denied

. Due to the urgent nature of healthcare, denied charges can significantly impede operational efficiency and lead to increased administrative time and wasted resources.

Healthcare organizations need a way to quickly identify possible red flags in their revenue cycle and preemptively address any faulty claims before they’re submitted. Using data analytics, businesses can not only monitor the state of in-process claims, but also diagnose other roadblocks and inefficiencies in revenue cycle performance. By evaluating claims against pre-set conditions, analytics platforms can quickly alert staff to at-risk charges and allow organizations to make any necessary adjustments prior to submission. Ensuring that claims are accepted the first time around protects businesses from unnecessary time and resource expenditures further down the road.

The transition to value-based care reimbursement

The healthcare industry as a whole has been struggling to transition to value-based care amidst major payment reforms from the 

 (CMS). Prior to these reforms, many healthcare organizations relied on fee-for-service payment systems for their revenue cycles.

Now, the push for value-based-care has led to the development of new systems like bundled payment contracts and accountable care organizations, making financial operations increasingly complicated. Hiccups in patient processing can leave valuable funds tied up and unusable while also making it more difficult to properly evaluate the state of the revenue cycle.

However, with the implementation of the right tools, organizations can drastically reduce the pressure induced by a clumsy and burdensome transition. Data analytics platforms can leverage revenue cycle and outcomes-focused information in the same system, allowing you to manage the transition intelligently and responsibly from fee for service to value-based payment.

Furthermore, by combining population health management with analytics, organizations can adopt a cross-functional perspective that takes into account the day-to-day measures of clinical and operational teams. Now that frontline metrics play such a significant role in evaluating claims, organizations have to utilize data in adopting a cross-functional perspective.

Low-quality data and poor data-governance

At the end of the day, data is only as good as the analytics platform you use to manage it. Many healthcare organizations fail to garner any meaningful insights from their data due to poor governance and a lack of any strong foundation. Without proper management and analytic capabilities, your data’s potential will never be realized.

The necessity for high quality and curated data has only become more apparent as businesses increasingly look to employ fact-based decision making in their revenue cycle operations. Opportunities for improvement and potential bottlenecks only become apparent when you can dive deep into the data and evaluate underlying trends.

This is where the advantages of an end-to-end analytics solution become evident. One comprehensive platform conducting integration, rules management, and analytics provides your organization with the resources necessary to optimize operations and substantially increases return on investment.

Fortunately, many of the challenges facing the healthcare revenue cycle can be remedied through the adoption of a data-friendly work environment and support from leadership. With proper education and a realistic yet ambitious business intelligence strategy, many providers can drive meaningful changes within their organization. A commitment to changing company culture and how data is viewed at all levels of operation is paramount to improving patient outcomes and increasing ROI.

Moving forward, providers must take a deliberate look at what their long-term objectives are and what pathways they need to forge to get there. Data analytics by itself won’t magically fix all the issues impeding revenue cycle goals, but when accompanied by a committed leadership and a willingness to learn, organizations can make substantial strides in growing and optimizing their enterprise.

In order to better anticipate and respond to future obstacles, providers must implement data analytics tools that will allow them to quickly and reliably identify potential weaknesses and opportunities for improvement.

How analytics can help address revenue cycle challenges

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, 

Marketing Your Medical Practice-Ethically, Effectively, and Economically,

 which has sold over 225,000 copies and has been translated into Spanish. He contributes a weekly video for 

 on practical ideas to enhance productivity and efficiency in medical practices.  His 5–7-minute videos and short articles provide practical ideas that can be easily implemented and incorporated into any medical practice. Dr. Baum can be reached at 

When s&*t hits the fan, most medical practices conduct damage control to identify the problem and, more importantly, to see that the problem does not occur again. When a patient complains and has a moment of misery with the practice, the investigation will reveal that an employee or even the physician did not perform to the patient's expectation. However, sometimes, the investigation will discover a problem in the system. If a patient waits on hold when calling the office for more than several minutes. Then when the caller does connect with the office, the caller is relegated to a phone tree. This is unacceptable, and most patients don't appreciate a long hold time or being required to listen to multiple options before they can speak to a human. This is a system problem that needs to be fixed. Suppose the practice conducts patient satisfaction surveys and hears this complaint multiple times. In that case, the process needs to be repaired.

On the other hand, when a moment of magic often occurs, hopefully, more frequently than moments of misery, the positive movement is not recognized and is seldom celebrated. I suggest that these magic moments be acknowledged with every intention that the action is repeated.

When an accolade is received by the practice, the compliment is buried or not celebrated at all. Let me provide examples of how a moment of magic is honored and shared with others in practice.

It is common for patients to share with the doctor in the exam room how helpful a staff member was and compliment the staff member. Rather than gloss over the compliment, the doctor might consider asking the patient "to hold that thought." Then go to the employee and invite him\her into the exam room and ask the patient to repeat the compliment so that the patient hears the remark directly from the patient. For example, a patient reports that the receptionist was so helpful in making an appointment so quickly for the patient. The receptionist comes to the room and hears from the patient that her effort is appreciated. The employee will likely break into a smile as they enjoy the recognition. This acknowledgment takes less than three minutes, but it is the best three minutes you can invest in staff motivation. Sharing the same story at a future staff meeting so that the remainder of the staff also hears the compliment. This informs the staff that their actions are recognized and celebrated by everyone. This approach motivates others to extend themselves to patients so everyone can have magic moments within the practice.

A second example is the thank you note sent by a patient to the office manager or to the treating doctors complimenting them on their expertise or outstanding care. Most of those notes are tossed out, placed in a drawer, or posted on the practice bulletin board in the employee lounge. I suggest you share the note with all the staff and send a copy to the patient's referring physician with a letter that mentions his\her patient's positive experience. Obtain permission from the patient and place the note in a scrapbook in the reception area for other patients to read about the positive experience others have had with the doctors and the practice.

Finally, our last example is the situation when a patient refers another patient, usually a family or friend, to the practice. Isn't a referral from a satisfied patient worth at least a thank you note? In most practices, if you consider the lifetime value of a patient, it is often equivalent to thousands of dollars. However, you can create a raving fan if you send the patient a meaningful gift in the $50-$100 range. This gift isn't necessary, nor is the referral expected, but a small gift is very appreciated. With a lovely, meaningful gift, you will likely find that the patient will continue the process and refer others to your practice.

Let me end this blog with the reality that healthcare is not like a trip to the Magic Kingdom. But just as Disney converts moments of misery to moments of magic, healthcare can do the same.

The bottom line: Of course, moments of misery must be addressed and corrected. However, it is just as important to recognize those moments of magic you want to see again. The take-home message is that moments of misery and magic are an opportunity to offer stellar services to our patients.

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish. He contributes a weekly video for Medical Economics on practical ideas to enhance productivity and efficiency in medical practices.  His 5–7-minute videos and short articles provide practical ideas that can be easily implemented and incorporated into any medical practice. Dr. Baum can be reached at 

When a moment of magic often occurs, hopefully, more frequently than moments of misery, the positive movement is not recognized and is seldom celebrated.

Magic at Disney: It’s available in healthcare

Tom Cowen is the Head of Vertical Strategy, Healthcare & Life Sciences at Conga where he is responsible for institutionalizing Conga’s success in the HLS sector. He is a software industry executive who has worked for industry leaders and start-ups including Oracle, EMC, and Vendavo. Over the past 30 years, he has focused on bringing value to Healthcare & Life Sciences companies through applications including: CRM, ERP, quote to cash and price optimization. He has held roles in product & vertical strategy, finance, sales and sales engineering. While at Conga, Tom has had the privilege of working with top companies including Boston Scientific, AbbVie, Express Scripts, CVS Health, and McKesson.

Tom and his family founded Justin’s Smile Childhood Cancer Foundation in memory of his 13-year-old son, Justin, who passed away from Osteosarcoma. The foundation funds Childhood Cancer research and provides support for patients and parents.

I recall my first telehealth visit as one might remember a blind date. It started with the email that never arrived and finished with awkwardness as my video didn’t work and my doctor’s did. I recall how the doctor sighed and mouthed, “I’ll call you,” before he ended the session. It’s hard to believe, that was only four years ago, two years before Covid-19 changed everything.

Since Covid-19 began, telehealth usage has exploded, with approximately 80% of doctors now using telehealth, up from 20% at the beginning of the pandemic. McKinsey estimates that up to $250B of the U.S. healthcare spend could be potentially virtualized. *

While the technology wherewithal was available four years ago, many doctors, like my own, were dipping their toes in the cold ocean water. The reasons were consistent when I asked, “We don’t know if insurance will pay,” and “we don’t have a telehealth system.” Behind the responses, there were payment, inconvenience, and risk issues that slowed telehealth adoption. At this point in the pandemic, most telehealth adoption barriers have been cleared, and doctors now focus not only on bedside manner but website manner. But one key challenge has surfaced – managing the complexity of telehealth contracting efficiently with the appropriate protections and business terms in place, with the following three key areas to consider in telehealth contracting.

Telehealth offers payers and providers the ability to expand their services beyond the brick-and-mortar walls that previously defined where and how they provided service. We see this most in the mental health space, where a provider can practice remotely. As someone who lost a young son, I know that mental health workers with a child loss specialty are not always within driving distance. Telehealth opens new possibilities for grieving parents like me. A Facebook post with a recommendation and a phone call can lead to a new patient and provider relationship that was once impossible.

From a contracting perspective, this means that groups of providers often need to be credentialed, contracted, and onboarded in quick order. Healthcare players looking to expand to a new state, or a new set of specialties will need to onboard large practices or a list of doctors quickly. A large healthcare payer that uses Conga’s Contract Lifecycle Management system for its provider network has grown from operating in eight states to 20 in the last several years. Look for intelligent contracting solutions that enable automation, mass creation and amendments to handle the increased volume of provider contracts. Leading Contract Lifecycle Management solutions provide visibility into both in-flight and executed contracts allowing teams to identify bottlenecks and understand the status of a new telehealth expansion. Contract intelligence alerts users to provider contracts that have been sitting on a lawyer’s desk for days.

Telehealth offers an interesting case for price vs. value, which perhaps has not been resolved yet and may likely take several years for the industry to solve. Over the past several years, telehealth current procedural terminology (CPT) codes were created and amended. The current list is still small and non-specific with codes 99441-99443 being time-based (i.e. 5-10 minutes). Does one value a cardiologist’s time the same as a podiatrist? More fundamental price/value questions still exist, like do patients receive the same quality of care during a telehealth visit? How do they value convenience or access to specialists? Expect to see an increase in more specific codes and an evolution of the price/value of these services.

Look for Contract Lifecycle Management systems that handle fees natively and facilitate frequent changes to the fees and codes that will evolve in the coming years.

Oddly, one topic missing in the telehealth conversation is risk. Changes in healthcare can result in litigation as patients suffer from poor outcomes. How can providers protect themselves against a potential wave of litigation? Is the “Miranda right” saying at the beginning of the telehealth visit, “you are aware that this visit is virtual and therefore I cannot conduct a complete examination,” enough to protect providers?

As with pricing, expect a continuous wave of changes across all the contracts that cover Telehealth (Payer to Provider, Provider to Telehealth Platform, Provider to Patient, etc.). Look for Contract Lifecycle Management systems that support a robust and evolving clause library. Find systems that support the ability to amend language in executed contracts in mass. Intelligent Contract Management systems that utilize artificial intelligence (AI) identify clauses in existing contracts that may need amendment as state regulations evolve.

If you have a Contract Lifecycle Management system in place, take the influx of telehealth contracting issues to implement changes that will help avoid risk while operating more efficiently. If you are not currently using an Intelligent Contract Management system, now couldn’t be a better time to explore one that will support the growth in contracting volume and amendments that telehealth will require.

Tom Cowen is Head of Vertical Strategy – Healthcare & Life Sciences at Conga, the global leader in scalable Revenue Lifecycle Management solutions.

* McKinsey & Company - Telehealth: A quarter-trillion dollar post-COVID-19 reality? by Oleg Bestsennyy, Greg Gilbert, Alex Harris, and Jennifer Rost

Since Covid-19 began, telehealth usage has exploded, with approximately 80% of doctors now using the service.

Ins and outs of telehealth contract management

Chris Mazzolini is the editorial director of Medical Economics

There are two crises in medicine that have converged in recent years, which include the aftereffects of the COVID-19 pandemic and an increase in burnout among physicians, but this overlap is not all negative. Many physicians, burned out from the administrative hassles that come with running a volume primary care practice, are using the upheaval caused by COVID-19 to reevaluate their careers and are considering a membership-based model.

A discussion about this reset opportunity was the focus of this bootcamp session, featuring a conversation with a burnout expert. The following transcript was edited for length and clarity.

Understand how burnout impacts physician work-life balance, mental health and medical errors.

Learn why now is the time for self-reflection and exploration of ways to improve physician career satisfaction.

Listen to an open discussion about the various strategies to alleviate burnout.

Discover why a membership-based model can help reduce burnout and enhance physician work-life balance.


Vice President of Physician Development
MDVIP


Professor of Industrial-Organizational Psychology
Davidson College

Burnout, COVID-19 and the ‘Great Reset’

 Do you think the psychological impact of COVID-19 will continue to affect physicians as they learn how to live in this next normal?

 Yes, the COVID-19 pandemic is not something that happened once, then went away. It is similar to the Great Depression. The Great Depression changed the people who grew up during that time, so we will not be the same people we were. We cannot just be carried along by the next fad or wait to deal with the next crisis; it’s up to us to design how we want our future to be in the remaining chapters of our lives. I’m going to sound like a psychologist here: The remaining chapters of our lives have not yet been written. Physicians should ask themselves, “What can I control? What can I do differently so I’m not, once again, dealing with all this bureaucratic work that’s impacting my autonomy?” Doctors need to take care of their body and mind, and that often requires rethinking their business model, rethinking how they do what they do.

 You brought up how physicians should consider recrafting their careers, but these days, physicians have been conditioned to be strong and persevere. Why is it so difficult for physicians to take care of themselves the same way they look to take care of their patients?

 It’s their sacred mission to take care of others. Physicians are the best of the best, but they’re susceptible to breaking down as much as anyone else. When that happens, it’s horrible for them, and it’s hard for their patients. Physicians tend to think they can tough it out. Nearly half of all the responding physicians in a national survey said, “My strategy for managing stress is to isolate myself and not burden others with it.” They would never advise this to one of their patients.

 In your presentation, you talked about how a crisis can be the right time for someone to explore something new, possibly a new business model. In the midst of ongoing uncertainty in healthcare, how is this applicable to physicians?

 You can experience a crisis and the aftermath of a crisis in a variety of ways. You can think, “Poor me. Life is bad. I lost two years of my life. I’m not happy.” Or you can say, “This is an opportunity.” Again, I would not have chosen this as the trigger for the Great Reset, but now physicians can be empowered to look at their own life and redefine how they want it to be. If you go back to the same version of your old normal, you’re missing a tremendous opportunity. This is your chance to take action and find a solution that allows you to have more control and autonomy over your life, in whatever form that is. Some physicians are leaving the profession. I am not recommending that, but we’re seeing a potential nurse and doctor shortage in several areas. I want physicians to recognize that they’ve been on the hamster wheel, running harder and faster, and running the risk of wearing themselves down and burning themselves out. Instead, doctors should be asking themselves, “How do I get back to providing quality care for my patients in a way that nurtures them, cares for them and allows me to have work-life balance?” It’s not out of reach.

 Let’s say you have a physician who’s recognizing some signs of burnout, recognizing that things need to change and recognizing that they are not practicing medicine the way they would want to because of stress. It’s human nature to avoid change. How can physicians get past barriers they set for themselves?

 Think about it like this: Change has been imposed on us by the pandemic, so it might be difficult for physicians to want to make a change if they feel they’ve been successful with their current strategy and believe their life is good and they’re okay. Maybe they don’t see reasons to change. But if you’re constantly running on the hamster wheel or the pandemic has increased your stress level dramatically, you don’t have a constructive choice. You’re on the burning platform, and you have to make a change. It’s time to self-reflect: What’s your vision if you make a change? Where does that take you? What are your goals? Maybe the answer is work-life balance, taking care of your family, having enough income and making a positive difference. So, now that you know what’s driving you to change and have directional clarity, how are you going to get started? What are your first few steps?

 With your research, you’ve had a unique opportunity to take an objective eye and observe what’s happening in the business of medicine and what’s influencing physicians both positively and negatively. In your professional opinion, do you recommend doctors explore other practice models that might better meet their needs?

 The short answer is yes. A lot of the physicians we interviewed, and some I have read opinion pieces from, have said they simply had to get out of a huge hospital practice or another gigantic system to get more control, manage their workload and be able to continue to deliver the kind of healthcare they want to provide. There are alternative business models available. Again, one of the primary culprits that impacts a lot of primary care physicians is the prevailing volume-based, fee-for-service business model. That’s not a business model anyone with a blank sheet of paper would have ever designed, but it’s now the standard for primary care, and it unfortunately keeps doctors in the cycle of having to see more patients with less time per patient to maintain their income. It is a chief underlying contributor to the stress everyone’s experiencing. So, while we’re waiting for the government to change regulations to make it easier for physicians to manage their load, physicians have to look at their own business model.

Many physicians, burned out from the administrative hassles that come with running a volume primary care practice, are using the upheaval caused by COVID-19 to reevaluate their careers and are considering a membership-based model.