Category: Industry Updates

31 Dec 2018

Uber and Lyft ride into healthcare. What to expect (and what not to)

Here’s the premise.

36 million American patients miss their medical appointments. If only they had a ride waiting outside, they’d make it to the doctor’s office.

Uber and Lyft have both made announcements in healthcare this month. And why not? In recent months, Apple, Amazon, Google, Berkshire Hathaway have all plugged into healthcare.

Here are a few headlines that recap this ride-sharing story.

Uber wants your doctor to call you a ride to your next checkup

Know the Risks When Using Uber Health, Lyft

Whoa, Uber’s New Service Will Drive You to the Doctor for Free

New BCBS Institute working with Lyft, CVS, Walgreens to tackle social determinants

Lyft announces integration with Allscripts EHR system, allowing 180,000 doctors to hail rides for patients

Five Things to Know About the Uber and Lyft Provider Partnerships

Basically, the doctor’s office or the hospital would hail a ride. A patient would hop in, possibly share the ride with other patients. Helping providers not lose money in missed appointments ($150 billion per year). Helping patients not fall sicker by skipping those appointments. Further, sick patients end up in acute care burdening the system more and more.

I get the logic.

Just that I see a few bugs in it. More so because we are practically in the trenches with doctors everyday.

Why patients don’t show up (really)

JAMA just published findings from a clinical trial of 786 adults with Medicaid. This is what they found:

“Offering a rideshare-based transportation service may not decrease missed primary care appointments.”

The Annals of Family Medicine published this study in 2004. Why We Don’t Come: Patient Perceptions on No-Shows. Before Uber or Lyft existed.

Patient “no-shows” is a big problem for doctors. But you rarely hear that they didn’t show up because they couldn’t get a ride.

The 3 big reasons that the Annals of Family Medicine study found were:

  • Emotions
  • Perceived disrespect
  • Not understanding the scheduling system

Here’s quoting from the study:

“Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants’ lack of understanding of the scheduling system.”

This does sound right.

There’s another study, Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. The findings:

“Forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments.”

In our experience, this sounds perfectly reasonable. More than a quarter of them cited “no reason”!

There are also unexpressed financial reasons. By showing up, patients need to face up to deductibles and co-pays. It’s not always that they want to pay up.

Several articles talked about how the rides would help lower income populations.

The reality is doctors struggle to get paid by Medicaid (insurance that covers lower income). They never know if they’d get paid for the service they are about to provide. They do it anyways.

It seems unreasonable to expect that over-stretched doctors and staff would now hail a ride for patients via the EHR.

EVEN IF we do call Uber from the EHR

I was recently in a meeting at a large hospital in the east coast of US. It’s easily considered one of the world’s best. The doctors don’t really have a problem patients showing up. It’s what happens after they do.

Here’s where they are stuck.

They see a patient. Order a test. Or schedule a procedure. The billing office calls the insurance to get “prior authorization” for the procedure. Insurances make it difficult to provide prior auths. The game goes on for several days. The billing office is overwhelmed by the many prior auth requests. Finally after 30+ days (on average), the patient ends up on the procedure table. Getting the care she rode in for.

Now imagine in the above everyday scenario, the doctor or her staff does call Uber for their patient. Possibly via their EHR. Of course, the integration is cool (for tech folks, not necessarily for doctors). It won’t necessarily help the patient get care faster. It won’t help doctors get paid for that care or service.

In fact, what it is is this. It’s convenient. Like ordering food online. It may not really solve our clinical or economic burden in healthcare. It adds a layer of easy. And that’s a good thing too.

May be we should say just that.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Pexels

31 Dec 2018

4 Takeaways from Practice Fusion EHR’s $100M sale to Allscripts

Two years ago, Practice Fusion, an electronics health record company was rumored to be valued at more than a billion dollars.

Last month, the company sold for a fire sale price of $100 million.

Having raised $157 million, you can imagine that most people didn’t make any money. Apparently parachute deals help senior executives and the board make a few million (including $2million for the company lawyer).

But nothing really for employees who stayed on and ordinary shareholders. Few who exercised options earlier will even lose money via taxes.

Read: Employees at Practice Fusion expected IPO riches, but got nothing as execs pocketed millions (CNBC)

Apparently, the company has been looking for a buyer for 2+ years. And got offers ranging from $50-$250M. Allscripts, an EHR giant that recently acquired McKesson’s Health IT portfolio, initially offered $250M. But got nervous after a Department of Justice investigation last year (of another company – eClinicalworks which settled with prosecutors for $155million).

Read: Allscripts offered to buy Practice Fusion for $250M. A DOJ investigation changed everything

That’s the story. What does it all mean?

The evolving healthcare industry landscape will show what it eventually means. But here are a few takeaways.

1) A nod to the cloud

The EHR world’s market leaders are Cerner, Epic and Allscripts. All of them are client-server based. Epic is based on 52-year old MUMPS technology.

In a world of client-server dominance, Allscripts acquisition of Practice Fusion is a nod to the cloud. That’s clearly where the industry is going. Or, will be compelled to go.

Here’s what the company’s president Rick Poulton said: “Plus, Practice Fusion’s affordable EHR technology supports traditionally hard-to-reach independent physician practices, and its cloud-based infrastructure aligns with Allscripts forward vision for solution delivery.”

2) It’s tough to make ‘free’ a sustainable business model in healthcare

Practice Fusion started on the premise of offering a free EHR to physicians. And in turn, monetizing de-identified healthcare data. Supported by ads etc.

Investors bought into it. Including Peter Thiel (he wrote the founder a check of $1million in 2011 before leading that round).

Then the valuation game caught up with itself. Investors put in money assuming someone else is going to put in at a higher valuation. Later. But when the company isn’t making real cash, the valuation cycle eventually catches up.

Someone says, I can’t agree to that valuation – it makes no sense. And then everything goes down-hill. Down rounds begin. Terms change. Dilution for earlier investors happens. People get fired. CEOs get ousted.

The problem with healthcare is that regardless of how fast the world moves, the industry moves at its own pace. Like life and death, the industry whiffs of a certain permanence.

You can’t do a Google or Facebook here by offering free service and making money via ads or data. At least, not yet.

3) The landscape is freezing

Industry changes happen like lakes freezing and unfreezing.

Rules of the game shrink. Consolidate. Big boys dominate. They make it harder for each other and others to change rules.

In US, Meaningful Use incentive dollars that spurred the industry have dried up. Tech giants like Apple have made healthcare announcements (“effortless solution to bring health records to iPhone”).

Companies like Allscripts bought McKesson (to go after smaller markets), now Practice Fusion. They’ll keep looking for more deals to spread their reach.

Tired of their healthcare costs, Amazon, Berkshire Hathaway, and J.P. Morgan announced that they are teaming up to disrupt the industry.

When industry landscapes freeze, it’ll take time before it melts again. But because it’s healthcare, the freezing – while it’s definitely begun – will happen slowly, slowly.

This leaves doors open for specialty and niche opportunities that are small for the big boys to focus on. That means there’s no point building a new plain vanilla EHR. But there’ll be strong needs for EHRs and products that go a mile deep in specific areas. That naturally plug into the new rules that are bubbling to the surface.

4) Practice Fusion’s real asset is its data. But no one’s talking about it

Practice Fusion has a dataset of 81 million patient records. Imagine applying AI on that data. Creating newer products for the same target group based on their data.

It may be tough for Allscripts because market commands their vision to focus on getting bigger faster. Not develop cool technology tools.

Practice Fusion’s idea was a good one. To build a company around data. But their business couldn’t sustain itself until that point where the industry is mature enough to make that data useful.

What’s the moral of the story?

Practice Fusion’s founder Ryan Howard moved on to build a heart-activity wearable device called iBeat (after differences with the board).

Is there a lesson here? That the healthcare industry is trying to tell us. Perhaps it’s this.

It’ll be slow. You can disrupt but not quickly or suddenly. You’ll need stable, sustainable business models. The boring stuff makes money. Regulations can disrupt your life. And yes, it’ll all be up in the cloud. Eventually.

 

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Pixabay

13 Dec 2018

Healthcare: Disruption at a scale we haven’t seen before

Just like you, I’m trying to make sense of the world around me. But there are no templates for the bridge that healthcare’s building for its future.

All we can do is listen to weak signals and amplify them.

Last week, CVS finally bought Aetna for $69 billion (must we say almost bought because a judge is still questioning them). I spoke to someone closely familiar with the deal. He called it “vertical stacking” – to expand what CVS customers can get – from drugs to MinuteClinic consultations to now insurance.

But it seems more like CVS disrupting itself before Amazon does. Earlier in the year, Amazon bought PillPack, an online pharmacy (CVS and others lost $11 billion in market value on the day of the announcement).

Market is rife with speculation that Amazon is going to be biggest company in healthcare (fancy signing up for Amazon Prime Health?).

After such buzz, do you think other insurances or pharmacies will stay quiet? In the M&A world, more begets more.

In fact, the entire healthcare industry is in an M&A frenzy. As of June 2018, healthcare was only third in line (#1 is Energy, #2 is Media) in terms of size of deals. See below.

Zooming in and out. From the forest to the trees

Healthcare is so big ($8.7 trillion by 2020) that it nurtures mini-industries within itself. Like the space I’m most familiar with: gastroenterology, a medical specialty in high demand.

Long time ago, gastroenterologists (GIs) ran smaller solo or group practices. Despite the myriad challenges of running a medical business, doctors enjoyed the independence that private practices offered.

But over the years, everything got too complicated. From insurance reimbursements to regulatory compliance to even patient behavior. It just became tougher to stand alone. (Younger physicians hardly go solo today. Most join groups or hospitals.)

Smaller groups became bigger. Demand for colonoscopies (the main procedure that GIs perform) fueled the growth of free-standing ambulatory surgery centers.

Hospitals sensed the opportunity. And began luring gastroenterologists to gain access to their patients and bring home revenues from GI procedures. Under the thumbs of hospital administration doctors lost their independence. It didn’t help that they were forced to use monolithic hospital EHRs.

Well, the market’s now shifting again.

Private equity companies are fueling consolidation of GI groups. By providing capital for recruiting other groups, buying new medical equipment, removing administrative burdens and inefficiencies, streamlining technology and so on. They are courting doctors by offering them independence in a way that hospitals can’t.

Small groups (e.g. 4-8 doctors) and mid-size groups (e.g. 8-20 doctors) are merging to become large groups (e.g. 25-50+). Large groups are becoming super-sized groups (80-200+ gastroenterologists).

And the super groups? I learnt that the pipeline goes all the way to 1,000 GIs operating under a single entity.

Private equity (PE) companies refer to this as a “roll up” strategy. These roll ups will create a different kind of market dynamic that doesn’t exist today. A tailwind of ancillary opportunities (imaging, pathology labs, nutrition counseling, administrative consolidation, EHR and billing systems unification, analytics and so on).

There are approximately 12,000 GIs in the US today. Present consolidation trends indicate that these deals would cover at least half that number over the next few years. The rest might continue to operate like they do today – finding ways to not buckle under market pressure.

Depending on where they are in their career, gastroenterologists welcome this trend or are cynical about it. Older doctors see it as a way to capitalize on what they’ve built so far. Younger doctors see it as selling out too soon. And then there are doctors who are more entrepreneurial – they see it as a way to shape what’s to follow.

Gastroenterology offers an insightful window into other specialties such as dermatology (booming these days), orthopedics, ophthalmology and others.

Larger private equity companies will eventually want to combine super groups across specialties and regions. If that makes no sense, think “vertical stacking” that my friend said as a reason for the CVS and Aetna merger. Or even think of Kaiser Permanante – a non-profit with 22,000 doctors on staff – with a PE twist.

Welcome to the new world!

Where do we go from here?

Just the other day, a doctor reached out to us (after reading our monthly newsletter). Saying it’s confusing out there. He runs a solo private practice but owns a surgery center with other doctors.

He hates all these things that he’s had to do in order to stay in practice. Like EHRs and MACRA, he said. So he stopped doing those things. But worries that he can’t keep ignoring them forever. It’ll catch up with him and then it’ll be too late.

In the end, he wondered if he should find a way to merge with somebody. But then his operations weren’t so clean. Wouldn’t PE investors want a cleaner practice?

And so the conversation went.

The sooner you accept the new reality, the better positioned you’ll be to shape that reality. Before it begins to shape you.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image Credit: Álvaro Reguly @ Flickr (https://www.flickr.com/photos/alvaroreguly)

17 May 2018

Doc = Drop Out Club? 5 baffling things in healthcare

Say we met 10 years ago during the early stages of our business. And you asked me this: would healthcare delivery be more complicated in the future?

I would’ve shaken my head animatedly and said “no, it would be simpler!”.

I would’ve shown you technology trends. And told you that healthcare transactions will indeed become more automated, much simpler. Repeatable administrative tasks would be tech-enabled, algorithm driven.

As a company, we started life in billing claims for doctors. Back then I was quite sure billing would be way less complicated in the future. Insurances and hospitals would make sure that happens.

In fact, I would often urge our people to learn and upgrade their skills faster because their jobs would disappear soon.

I was wrong. Actually, very wrong.

I would’ve never guessed any of these things that baffle me about our industry today.

Baffling thing #1: It would cost more for doctors to make the same money

We never used to spend so much time obtaining prior authorizations (PA) before doctors perform procedures. Now we do. On an average, doctors today spend 16.4 hours per week or 853 hours every year on prior authorizations. Average wait time of response is 1-2 days.

I recently visited a hospital that houses some of the world’s best doctors. They can’t handle the PA burden. Their gastroenterology division spends 30+ days on average. Imagine what that means for a patient who urgently needs a procedure.

While PAs represent a bulk of the burden, there are many costs that add up. What’s worse is doctors are left with no choice but to meet these expenses. If they don’t, they don’t get paid.

Baffling thing #2: Healthcare law would get more and more complicated

On Jan 1st, 2017, a new law to track physician performance went into first gear. It’s called Medicare Access and CHIP Reauthorization Act of 2015 (or simply MACRA).

MACRA adds to the long list of regulatory mandates that practices already need to comply with. The law is applicable to roughly 55 million clinicians. It’s 2,398 pages long. Check it out here.

MACRA measures are converted to a point-based system. Using points, doctors are compared to other doctors. A score is derived based on what they could’ve done vs what they did. That finally determines how much someone makes.

We find doctors struggling to interpret the law, leave alone moving in the direction of incorporating the mandates.

Baffling thing #3: Technology, intended to simplify life, would end up making doctors miserable

Technology in the form of poorly designed EHRs adds to the burden of practicing medicine today. Some doctors feel it hurts their relationship with their patients. Some quit medicine altogether unable to deal with the technology.

My company recently completed the third stage of our Meaningful Use certification (now bucketed under the MACRA law) for our own EHR. It took our team us 6 weeks plus. The first stage took us a week. The second possibly 2-3 weeks. It’s reflective of how complicated the qualifying criteria have become.

Mandates require that doctors use certified technology to document their cases. If they don’t, they’ll lose money in the future.

Baffling thing #4: Coding would be so complicated. Creating another avenue for insurances to delay payments

When ICD-10 arrived, clinical codes exploded to 155,000 from an earlier set of 17,000. Insurances have begun to demand greater specificity for codes that doctors submit.

For example, earlier you’d use 530.11 as ICD-9 code for Reflux esophagitis (a digestive disease). Under ICD-10, you have to get specific and code say K21.0 – Gastro-esophageal reflux disease without esophagitis.

Doctors aren’t used to documenting this way. So specifically. The result is more avenues for insurances to deny or delay claims.

Baffling thing #5: In a world of desperate medical need, many doctors would actually give up medicine

It’s called the “Drop Out Club” – a networking site where doctors counsel one another to leave medicine. Burnout. Lack of enthusiasm. Depression. Long work hours. Increasing burden of bureaucratic tasks.

Read: In “Drop Out Club” Doctors Counsel One Another on Quitting the Field

To become a specialist doctor, you have to spend four years in medical school and nine more years to train under a specialty. Imagine the kind of frustration a doctor must face in order to give it all up.

Our long, messy path to the future

Of course, I’m excited about the future. As a business, we keep developing a service or product to address the problems that we see. We figured that’s the best way to move forward in healthcare. Be more useful by solving problems that our clients face.

But I worry about the kind of long, messy path we keep traversing as an industry. A path that only gets murkier.

If we met today and you asked me the same question. Would healthcare be more complicated in the future?

I’d still shake my head and say “no, it’ll be simpler!” I’ll point you to today’s technology trends in artificial intelligence and machine learning. Without question, healthcare delivery will be simpler and more automated.

Of course, I’ve no idea what I’m talking about.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

 

04 May 2018

How do you get 5 star reviews from patients? Ask them

If you haven’t noticed already the popularity of doctor-review sites is on the rise. Healthgrades has over 3 million listed providers. Another review site Vitals claims to collect over 1.4 billion data points on doctors.

survey found 84% of patients use online reviews to evaluate physicians. 47% of them are willing to go out-of-network for a doctor with more favorable reviews.

Some doctors resist the trend. While some others take advantage of it.

Like Dr. M who seems to engage patients masterfully. Take a look.

Dr. M has over 5 pages of reviews of Vitals with an average rating of a stellar 4.8 on 5. Here’s a sample review.

 

If you took time to read the review, this patient’s problems aren’t “over” but s/he rated the doctor 5 stars.

Without question, Dr. M is a great doctor with sound clinical outcomes. Surely, patients must be treated compassionately. Possibly, the practice is also operationally efficient.

But there’s something more happening here. For patients to make the effort of going online and writing a review.

Making your best patients into powerful brand advocates

In today’s digital world, reviews have the power to significantly boost patient volume. Simply because patients trust other patients.

A high quality patient experience can instantly turn patients into powerful brand advocates.

The secret to making this work is this.

You ASK.

Yes it’s that simple. So obviously simple that I’m sure you wonder if there’s more to it.

But the reality is that it works.

Right after a patient receives great service and care, request a review. You’ll be surprised at the number of responses you’ll receive.

Getting patients to review you online. In 3 simple steps

Here’s everything you need to know.

1. Instruct your front-desk to capture the patient’s email address. Patients will be willing to share their email address if they know that they’ll be receiving their medical records digitally and securely.

2. Remind patients. At the end of the visit, remind patients that you’ll be sharing their medical records by email.

3. Use this email script when you share medical records. Setup your electronic health record (EHR) software to automatically send the following email when you share medical records.

 

The mindset of ASK

Most people (including patients) respond well to a request when asked. Here are 4 strategies that’ll help you and your staff get into the mindset of asking reviews.

1. Provide quality services, actually.

2. Even a few reviews matter. Start small

3. Don’t bribe patients. Feel clean

4. Make patient engagement a team effort.

The world of healthcare is changing. Transforming into a more customer-centric arena. Reviews play a crucial role in engaging patients online. With one review building over the other.

Now, over to you.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

 

03 May 2018

In healthcare, some thrive. But some struggle to survive

I’m sitting in the waiting area across the endoscopy room of a major hospital. Mindless talkshow TV runs in the background. Patients are waiting. Patiently. Looking up anxiously every now and then from their phones. Towards the reception desk.

It’s a scene I’ve experienced for years while working in healthcare. While waiting for doctors.

But there’s something different in the air now.

Patients like those around me will encounter a doctor who’s excited and enthusiastic. But some will meet another who’s dreading her career.

Healthcare is changing faster than ever before.

It’s just not about technology disruption. There are many forces at play. Change in patient and societal behavior. Challenging finances. Evolving policy. Dichotomy of unmet supply and unmet demand for care.

Why some thrive and some struggle to survive

The doctor I’m about to meet is in the thriving category. He and his colleagues are excited about creating a new field. In endoscopic surgery. Yes, it’s what you think it is. Surgery while inserting a tube into your gut. Complex. New. Innovative.

And just the other day, I was scheduled for a video chat with a group of doctors at another hospital. A couple of days prior to the call, I learnt that the hospital suddenly terminated their contract. It’s possible that they are being replaced by nurse practitioners to save money.

I come across doctors from both ends of the spectrum. Excited on one end. Depressed on the other. Some even leave medicine for good.

How does this happen?

Doctors start making real money only in their mid 30s. After accumulating significant student loans. At that point in their career, they either choose to join private practice or find a job at a hospital.

The problem of being employed

Earlier, more doctors were inclined to go solo by developing their own practice. Newer generations of doctors increasingly want the comfort of a regular pay check and life-style.

However, being employed doesn’t take away from the fact that doctors are fiercely independent. While they are taught to give instructions in residency, they end up taking instructions from hospital administration. On the number of clinical procedures they must perform, the number of patients they must see and so on.

Eventually, they are disillusioned with the system. Medicine’s not what they had signed up for. However, they are stuck because they need the money (think student loan, mortgage, car loan, kids’ college fund etc.).

The problem of private practice

When in private practice, doctors are overwhelmed by the many, many balls that they need to juggle. Often to stay in the same place. They need to worry about getting paid correctly from insurance companies. Hiring and training staff. Getting their clinical codes right. Credentialing themselves with insurance panels. Fighting denials. Guarding themselves from law suits and audits. Interpreting long-winded healthcare laws (like MACRA). Dealing with complex technology.

It’s a tough life to go it alone.

Forgetting to unlearn. And re-learn

Eventually, doctors find a certain area within a specialty where they can make a predictable income. For example, there was a time when cardiologists made money from imaging. Despite an environment of declining cardiology reimbursements, some doctors continue to rely on income from reading EKGs.

Imagine what would they do when technology like AliveCor becomes mainstream. People with heart conditions might wear a personal EKG band. Further, the company recently announced that their technology can accurately interpret atrial fibrillation.

There’s more. Through big data analysis, they can even recognize patterns for hyperkalemia (or higher potassium levels) from the spikes and troughs of EKGs.

It’s all changing too fast.

The entire healthcare industry is in for a massive disruption. The key to ride such a wave is to forget fast. Because if you hang on to the past, you’ll be run over.

Losing meaning and purpose

After working hard to become doctors, many lose their way. There are many challenges that the healthcare industry poses before a doctor gets to simply see her patient. In navigating those challenges, doctors figure out ways to survive. And in surviving, they sometimes forget why they became doctors in the first place.

The relationship with patients becomes a routine, near commercial transaction. Not laced with the purity they had imagined in college. They adapt to circumstances. Medicine becomes a vocation. Not intellectually stimulating or challenging. And they enter a long tunnel of career stagnation. Only to be shaken up rudely by industry changes. Sometimes it’s technology. Sometimes it’s financial. Sometimes it’s regulatory or legal.

*

The other day, I was catching up with a friend on the west coast. She’s not in healthcare. She works at a large company that hasn’t kept up with the many changes in their industry.

I asked, “The bay area seems desperate for talent in machine learning. Why not take up an online course and get up to speed?” She’s those brainy ones. This would be right up her alley.

“Oh, I don’t get time from family, work, and myself,” she said.

“Don’t mind me saying this…but what’ll you do if they start lay-offs?” I asked with concern.

“May be, I’ll take a break from everything and learn stuff. May be like machine learning.”

“Why not do it now? Before that desperate point comes.”

“I don’t know. No time I guess…”

And that’s how it goes. Even in healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

 

08 Jan 2018

SPARCS compliance reporting is changing. Here’s what you need to know now

The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all payer data reporting system established by the New York State Department Of Health (NYSDOH).

The system is designed to collect patient level details such as patient demographics, diagnoses and treatments and charges for hospital inpatient stays and outpatient (ambulatory surgery, emergency department, and outpatient services) visits.

Facilities in New York are required to report data to SPARCS monthly to demonstrate compliance and avoid penalties.

Current data submission process

Under the current submission process, facilities submit SPARCS compliance data in an electronic, computer readable x12 837R format unique to requirements of the New York State. The data is transmitted to Department of Health’s Health Commerce System (HCS), where it is analyzed and response files are generated.

Revised data submission process

With the goal of standardizing data, the New York State Department Of Health (NYSDOH) will be using x225 837R format going forward. This is essentially x12 837I (standard used for submitting institutional claims) format with additional segment for race/ethnicity and NTE segment to collect source of payment and cardiac data elements.

NYSDOH has also partnered with Optum Government Solutions, Inc. for redesigning the processing system required for SPARCS.

Key points to consider:

            • Legacy system lack the utility to export data in 837I format. Facilities will need to check if their system provides data in the compatible format. If not, find a way to convert data into SPARCS compliant format.
            • The redesign of processing system may pose challenges with respect to the interface of the portal and method of submission within the portal.
            • NYSDOH is targeting complete implementation of the new system within 12 months.
            • Testing phase of SPARCS data submission in the new system begins on January 23rd 2018. Facilities can begin submitting test data to get comfortable with the nuances of the new submission method.
            • New format is applicable for Q4 2017 submissions and facilities are required to have at least one accepted claim for each claim type by April 30, 2018.
            • NYSDOH also requires 95% of the facility’s Q4 2017 data to be submitted as per the new format by June 30, 2018 and 100% of the facility’s Q4 2017 data to be submitted by Sep 30, 2018.

 

*Timelines are representative of current plan and are subject to change.

References:

New York State Department Of Health

SPARCS Operations Guide

Redesign of the SPARCS Submission Process

Statewide Planning and Research Cooperative System (SPARCS) Translation Project Stakeholder Meeting

We have been working with several clients and helping them comply with Meaningful Use, PQRS, ASCQR, SPARCS, HCRA and THCIC compliance programs. We have already developed technology to convert data into new SPARCS compliant format. Click here to get in touch and explore further.

 

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27 Jun 2017

How to grow your startup…even if VCs don’t love you

 

Big meeting rooms with shiny tables make me uncomfortable. Like that room inside the offices of that big-name VC firm.

Even as I waited, I lusted after the logos of many a known startup. They were displayed on plaques outside the room.

(Some of them are bust today. But back then it didn’t matter.)

Then he came. The investor. Eating something. Crumbs.

“Show me something that you have that no one else has!”

That was almost the opening line.

Right, I thought. Imagine hearing something like that on a first date.

My next thought was to recall the cost of the flight tickets that brought us to this meeting. Then my time. I could’ve met clients. Trained our people.

Or, I could’ve at least gone for a movie.

Ouch, I thought. But decided to go along since I was already there.

“Look,” he said midway through the demo. He was staring into his phone. “We would want you to get to a $500 million valuation. Or, go bust!”

Go bust? But what about our clients? And our people?

(Wasn’t it a 50 Cent movie? Get Rich or Die Tryin’)

Just valuation.

Not real money. Like profits. Or even revenues.

“But that’s our model,” the investor said. He was looking at me now.

“Oh,” I responded.

A day later, to close the loop I told him we weren’t a fit.

Well, he already knew that.

Thinking about growth differently

No meeting really is futile. Those kind of meetings (yes, there were a few) helped me discover the Healthcare Footprint Finder. A practical strategy to grow your business in healthcare.

Another VC-friend-of-a-friend told me this in confidence:

In reality, most of us don’t understand healthcare. Or, how to sell to businesses within healthcare. The industry is too complicated. That’s why we ask for traction. If there’s demand then it reduces the risk for us.

I know. Healthcare is complex.

Everything takes time. Your first product is often the means to your next one or the one after that.

If you can’t stay put, you’ll surely go bust.

In 2012, 2,000+ electronic health record (EHR) companies went through the gate of Meaningful Use Stage 1 (part of the erstwhile Obamacare). By 2015 the time of Stage 2, only 200+ companies passed through the gate.

It’s now time for Stage 3. The game gets narrower.

Healthcare requires staying power. Where you need to make real money. Not just play the valuation game.

Because even if you get an investor onboard, they will lose patience in trying fuel you again and again.

But how do you stay on in healthcare? By finding your next big idea.

And how do you find your next big idea? By looking around your existing footprint.

Observe your clients in action. You will discover many unmet needs. They may not be able to verbalize them for you. But if you work closely with them, those needs will begin to leap out at you.

Our company started by selling billing services to gastroenterologists. Today we sell sophisticated endoscopy report writing software to the same clients. We also sell MACRA compliance services and a cloud-based EHR platform. To the same clients.

We got the idea of creating software by looking around our existing footprint. Looking for newer ways to be useful to people who already love us and our work. Observing what was bothering them. Solving their problems.

That’s how it happens. We use the Healthcare Footprint Finder model to grow.

When you approach growth this way, you will have a pipeline of services and products to develop. Because client needs become the starting point. Not random ideas. This way, your new product is likely to sell from Day 1.

Without hankering for funding, you would focus on the right things for your company.

So, VCs or not?

There’s no right answer. It depends on what you want and what the business wants. At that point of time. It also depends on finding the right investor. Does the person getting on your board understand you and your vision?

There are many fine examples of entrepreneurs who’ve ditched the elevator pitch altogether. Built fantastic companies.

Jason Fried from Basecamp. Ramit Sethi from IWT. Ben Chestnut from Mailchimp. Steve Rayson from BuzzSumo.

It’s the market that sustains them. Their business models are regenerative. Always alive. In tune with client needs.

They focus on quality vs quantity. User success vs user acquisition. Sustainable growth vs quick exits.

Mara Zepada of Switchboard and Jennifer Brandel of Hearken call these companies Zebras. An alternative to the Unicorn fantasy.

But such a strategy seems counterintuitive.

At a time when everybody wants to Uber-this and Uber-that.

Even when it all comes Uber-ing down.

 

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Photo by Ashley Bean on Unsplash

21 Jun 2017

Global convergence in the future of healthcare. Are you ready?

 

This wasn’t the usual South African clinic.

We were inside a high security prison for illegal immigrants. On the outskirts of Johannesburg.

Stroking his beard the doctor told me, “Some of them get arrested for a free ride home. First, the authorities bring them here for a few days. Then they drop them at the border. Our clinic has to make sure they don’t get sick.”

Then he began sounding so much like doctors in America.

“We must digitize. But it mustn’t slow us down.”

“Patients don’t listen to instructions.”

“Nothing integrates here. We need our systems talking to this, this and this.”

Global like your local Starbucks

Healthcare issues are so local that we fail to realize how global we’ve actually become.

South America. Africa. Asia. Middle-East. Whichever part of the world you look. Healthcare is looking more similar than dissimilar.

With increased sanitation, communicable diseases like malaria are on the decline. With increased prosperity, non-communicable diseases like diabetes are on the rise.

In a city like Mumbai or Johannesburg, you’ll find that both disease conditions co-exist often within walking distance.

4 pillars of healthcare delivery

Observe these four essential pillars of healthcare. These are applicable wherever healthcare is delivered. Notice the convergence.

  1. Disease: Types of diseases are more common (e.g. hypertension). Reasons of disease are also more common (e.g. stress). Country after country, disease burden is on the rise.
  2. Diagnosis. Our approach to arrive at a diagnosis is getting similar (e.g. via lab tests, examinations and consultations).
  3. Cure. Therapies are common (e.g. procedures are similar, guidelines are more common).
  4. Pay. Sometimes it’s the government or the individual that pays. But today it’s more likely that you have an insurance company covering you.

You will notice that everyone is moving in the same direction. Everywhere.

Future of healthcare needs a global mindset

Extrapolate these trends of disease and healthcare delivery. What do you think is going to happen in the future? Yes, a lot more convergence.

You could delve into a specific area such as in Health IT. You will hear the same language. Technology standards. Interoperability issues. Burdensome complexity.

Healthcare administrators fret about the same issues from Manama to Miami. Productivity of doctors and staff. Expensive technology. Lack of available skills.

In global healthcare, the good and bad news is the same: Whether we sink or sail, everyone is in this together.

So where do you begin?

Today’s business environment is unpredictable. Technological changes are wiping out old business models faster.

A global mindset reduces risk for business. Particularly in healthcare because things are changing quickly.

But where do you begin?

1) Think differently about talent

Start by exploring new-age outsourcing tools like Fiverr or Freelancer or Upwork. From drawings of the anatomy to voice-overs, we’ve used these tools to reach global talent. It’s made our work richer.

A friend from a Fortune X company recently hired material science engineers in East Europe. These engineers reinvented a core product design for the company without really knowing who they were working for.

As head of R&D, my friend told his bosses only after he completed the pilot. It cost the company 1/20th the expense and brought about a shift in mindset.

Salim Ismael writes about this evolving exponential organizational mindset.

Today’s companies are built for a linear world – closed and topdown. They evolved more than a hundred years ago.

That world doesn’t exist anymore. Changes are exponential today.

2) Build partnerships with your global colleagues

Do this little experiment.

Go to LinkedIn and search for what you do in a completely different geography. Search for an industry-specific health IT standard like “HL7”. You’ll find people in UK, Australia, Egypt and elsewhere.

Reach out and build partnerships. You will find a need in the most unexpected places.

U.S. certifications are sought after in emerging markets. Like JCAHO, operated by Joint Commission, a non-profit body based in Chicago.

Brazil introduced ICD-10 in 1996. China in 2002. South Africa in 2005. U.S. shifted from ICD-9 to ICD-10 much later in 2015.

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Healthcare is changing.

To think differently, look beyond what you can see.

And ask this question: what’s not so different here?

Get healthcare insights more directly at redo/healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Facebook Connections by Michael Coghlan/Flickr

17 Jun 2017

4 steps to find your footprint in healthcare

 

Creating a business is fun. It’s also tedious.

It’s the tedious parts that are difficult. Because it takes patience to figure things out.

Building a product is fun. But when it doesn’t sell, do you add more features? Or, learn how to sell?

Like creating products, hiring is fun. When you are on the choosing end. But developing someone who’s not yet ready – that takes effort.

When new clients sign up, it’s fun. But when they complain about your support or when quality wobbles – that’s tedious.

It’s easy to gravitate towards the next shiny thing. And the next after that. But the magic lies in figuring the tedious things out.

To market and sell. To build stable operations. To develop people. To be responsive to clients. To manage cashflow. These take time and discipline.

How we found our focus in healthcare

There are more than 120 medical specialties and subspecialties in medicine. Each is an industry in its own right. But we found our center in the gut!

My company started by providing billing services. It so happened that one of our first clients was a gastroenterology practice.

We loved the David and Goliath fight with insurance reimbursements. In doing so, we learnt the business problems that GI doctors face.

When our clients struggled with old EHRs, we knew we could do something about it. With a lot of effort and of course money, we built our own cloud-based EHR called enki.

We didn’t stop there. We kept learning and digging the well of gastroenterology.

We noticed that clients had to deal with the complexity of compliance. We figured that out. Helped them win audits and incentive dollars.

We saw that our doctors lived with old endoscopy software. Expensive. Requiring frequent upgrades.

That prompted us to build endoscopy report writer software. We used our knowledge of building cloud-based products and compliance. Applied that to the endoscopy market.

Our clients continue to have many needs. Our company simply needs to make sure we meet those needs by being on top of the game.

That becomes our focus.

4 steps to find your healthcare footprint

If you are starting or growing your business in healthcare, find your footprint using these four steps. Here’s the Healthcare Footprint Finder.

Step 1: Find your market within the industry

Healthcare is too big. You need to find a market within the industry. Something with gaps and frustrations but also expanding. A specialty that’s branching into subspecialties.

Before you start developing anything, be clear (by testing) that someone is willing to pay you for it. How does it ultimately benefit a doctor or a patient?

(I’m not a fan of the user-volume game that certain startups play. It burns a lot of other people’s money. Doesn’t guarantee a method for profitability.)

Step 2: Find a footprint within your market

Once you know there’s a market need, find your footprint. If you can serve ONE client well enough for them to say, “We love what you do for us!” then you are in business. You can do this many times over.

If you can’t find even one to say so and pay you, then something is wrong.

Step 3: Learn how to sell your footprint

Several entrepreneurs abandon this step because it’s too difficult. Or they throw money on the problem by hiring more salespeople or paying for clicks.

Marketing forces you to deeply probe and ask yourself whom you wish to serve. Why? How? What differentiates you? How could you be better? What should you be doing to offer maximum value to your footprint?

Step 4: Look around your own footprint

Once you have a footprint and know how to sell, look around your footprint. What do your clients do before and after they use your product or service? How could you make their life better?

That becomes your next product or service. That’s how you grow.

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Get healthcare insights more directly at redo/healthcare.

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Originally published on LinkedIn,  by Praveen Suthrum, President & Co-Founder, NextServices. 

Image: Christopher Sardegna/Unsplash

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