An interesting opinion piece titled "Report Card on Healthcare Reform" appeared in the Sunday Review of the NY Times in March, written by the Editorial Board. The answer to the title of this post, "Are Avoidable Readmission Improving Already?" may, in fact, be "Yes." There is early evidence of success that is discussed in the NYT article and that I'll share below.
I'll skip the opening political commentary in the piece because, frankly, it's old news. That ship has sailed, both sides of the aisle in Washington agree that it has sailed, and health care providers of all types are already moving on to reform their businesses for this new era of healthcare. The new era is one that is focused on the triple aim, which seeks to
- Improve the patient experience of care (including quality and satisfaction);
- Improve the health of populations; and
- Reduce the per capita cost of health care.
The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. IHI’s imperitive directs that new models be developed to simultaneously pursue the three primary elements listed above, which are commonly referred to as the “Triple Aim.” Read more about the Tiple Aim by visiting the IHI web page or clicking on the IHI image above.
It should be noted that Accountable Care models, Population Health and Care Transition intiatives, Avoidable Readmissions programs, along with many other approaches, all seek to incorporate "best practices" approaches to healthcare with this Triple Aim in mind.
With that in mind, and with the first stage of Readmission penalities enacted in 2012 --already a whopping 1% of TOTAL Medicare reimbursements if a hospital fails to meet new readmissions standards on certain patients--hospitals have are already focusing intensely on mitigating these costly readmissions.
So has there already been improvement? Early data suggests that, yes, just the very existence of the first round of penalties is already improving focus and quality.
"One of the most promising aspects of the health reform act is its focus on improving quality," says the NYT. "The percentage of Medicare patients requiring readmission to the hospital within 30 days of discharge dropped from an average of 19 percent over the past five years to 17.8 percent in the last half of 2012, an improvement due in large part to penalties imposed by Medicare for poor performance and financial incentives paid by Medicare to providers to encourage better coordination of care after a patient leaves the hospital."
Continuing, "A number of pilot programs in Medicare and Medicaid have been started to reward quality, to encourage doctors and hospitals to coordinate care, and to lower costs. If enough of these experiments pan out, they could transform not only Medicare but the entire health care system."
Even as we speak, Congress appears to be planning to both increase and accelerate the penalties, a "doubling down" on reducing costs and improving outcomes. With early programs demonstrating success and ever increasing penalties for poor quality and readmission rates, providers are under severe mandate to take care of patients better after they are discharged, and provide care in the community that assures fewer need to be hospitalizeed in the first place.
Ankota's technology is used by providers of all sorts to Plan, Coordinate, and Deliver that care.
Cheri Lattimer is one of most widely recognized leaders in Care Coordination today. Many of Ankota's readers recognize Cheri from her pioneering role as the Chair of the National Transitions of Care Coalition (NTOCC) and Executive Director of the Case Management Society of America (CMSA). This is an exerpt of a recent interview with Cheri about the new care coordination payments enacted by CMS and the opportunities that they present to providers.
Ankota's technology is used by Hospitals, ACOs, and post acute providers to better manage Care Transitions, reduce readmissions, and improve outcomes. Providers of all types use Ankota's technology to better Plan, Coordinate, and Deliver care. Click on any of the blue buttons to contact Ankota and learn more.
The field of care coordination, which spans the healthcare continuum, took a tremendous leap forward in 2013, when the Centers for Medicare and Medicaid Services (CMS) began reimbursing for care coordination-specific activities, chiefly centered around “transitional care management” performed in post-acute settings.
Two new codes – 99495 and 99496 – now allow physicians and qualified staff to achieve payment incentives for performing post-hospital follow-up services that aim to keep patients safe, on track with discharge plans, and ultimately out of the hospital.
Recently, Case In Point Weekly sat down with Cheri Lattimer, executive director of the Case Management Society of America (CMSA) and project director of the National Transitions of Care Coalition (NTOCC), to gain an industry perspective of these groundbreaking new codes.
According to Lattimer, both CMSA and NTOCC were influential in CMS’ creation of the reimbursement codes, and they will continue to work for the healthcare industry to “go even further” in recognizing – and reimbursing – care coordination pursuits.
In the article below, Lattimer shares her perspective on care coordination, case management and the wider impact on the industry.
Q: What is the significance of the new codes focused on transitions of care?
A: The first thing is to recognize and applaud CMS, because it really is the very first time that they have recognized the need to align the incentives with the services around care coordination and transitions.
It also creates excellent support that it’s just not physicians but physician assistants (PAs) and advanced practice nurses (APNs) that are also able to utilize these codes. And, under those codes, the physicians are able to use nonphysician staff in their offices to be able to provide certain levels of codes.
We just expanded the reach of being able to provide the services, being reimbursed for the services, and the ability to improve the patient communication and care coordination.
Q: What does this mean for the case management community?
A: First, the independent case manager who is not an APN or a PA is not able to bill independently under the code. But the services they provide in the offices definitely are covered under the codes.
Q: How do the new codes relate to other dominant movements within healthcare, such as accountable care organizations and medical home?
A: Between accountable care and the patient-centered medical home, and even focused on reducing hospital readmissions, this focuses in on that transition from the hospital back to the community, to the skilled nursing facility, or into the primary care office. You now have the continuity of being able to share that information, review that information, and follow up on that information based on coding – which is really a significant improvement on what you have seen in the past.
In the past, if a patient was discharged from the hospital, other that [clinicians] were supposed to ensure that documents got somewhere, there really was no follow up – but you need to reconcile the medications, see if the treatment plan has changed, be able to ascertain if there’s a new diagnosis from the hospital stay, etc.
What we’re done is really kind of connected the dots that were somewhat disparate prior to this. We have aligned performance with the payment incentive and we have acknowledged that this is a collaborative effort of the clinical team. It’s just not payment for individuals; it is acknowledging the multidisciplinary team and the ability to be able to support that from multiple directions.
Q: Will the change in post-acute care affect working relationships between post-acute clinicians and acute staff?
A: I would absolutely hope so. Because if both parties do bidirectional sending and receiving and the patient is part of this equation, along with their family caregiver, we are closing many of the gaps that we have seen in the past for having a safe patient and family caregiver transition.
If the collaborative team from the hospital is transitioning appropriately out into the community (to primary care, a specialist, or a skilled nursing facility), and if in receiving that [the post-acute clinical team members] are also following the coordination and attributing those transitional care management services, we not only have provided a better experience fro the patient, we have improved patient safety. And, in fact, the reality is we probably have reduced a hospital readmission because we’re closing the gaps that often are related to that. This isn’t going to work if we don’t have good collaboration.
If you look at the codes and you look at the scope of which those codes actually cover, and then you go back and look at the services that can be provided in a non-face-to-face by a physician or qualified staff, you have to say there’s no way this should not improve.
Q: Why should physicians and staff be happy about these new codes?
A: On the outpatient side, where these codes have the impact and can be charged, many times the argument has been in the past that physicians in private practice, in clinical practice, cannot afford to have those services or have a nurse a case manager provide these services – just because they’re not reimbursed. This kind of shoots an arrow into that argument and there is funding that is available for that and, utilized appropriately, it does allow you to provide those services.
It helps to align not only the performance along with the payment initiative to be able to support the provider and the patients and the family caregivers in this process.
Q: Overall, where do you hope to see the industry go from here?
A: This is a great start, but it’s not far enough. Care coordination occurs at every part of our continuum. It isn’t just from the hospital to the community. It is within every aspect of what patients and family caregivers go through. The more medically complex they are, the more difficult those transitions become.
I applaud CMS and I think we can go even further and with that we can enhance patient safety and the healthcare experience for all of our patients and their family caregivers.
The upcoming webinar, Newsflash: CMS Now Reimbursing for Care Coordination: Everything You Need to Know About the New CMS Codes, will take place Wednesday, March 20, 2013.
The 5th Care Coordination Summit also covers the new CMS codes. Discover more about the agenda here. The Care Coordination Summit takes places May 7-8 in National Harbor, Md.
In 2012 and the beginning of 2013 ACOs have nearly tripled in number again, with growth coming among all types of sponsoring entities.
There are 428 ACOs now existing in 49 states, as ACO growth has also continued apart from the Medicare program.
David Muhlestein is an analyst at Leavitt Partners and writer for HealthAffairs Blog
On January 10, 2013 the Centers for Medicare & Medicaid Services (CMS) announced that 106Accountable Care Organizations (ACOs) will join the Medicare Shared Savings Program (MSSP). CMS reports that this brings the total number of MSSP ACOs to “more than 250” and that they cover up to 4 million Medicare beneficiaries.
These new Medicare ACOs, though, only tell part of the accountable care story. ACO growth has also continued apart from the Medicare program with 428 total ACOs now existing in 49 states. Additionally, physician groups have overtaken hospital systems and have now become the largest backer of ACOs.
Background Of The ACO Program
Public sector. ACOs are health care entities intended to lower health care costs, improve quality outcomes and improve the experience of care. The premise of the ACO is that each of these results can be obtained by moving away from volume-driven fee-for-service based reimbursement toward payment models that reward care coordination and quality outcomes.
While the ACO title is relatively new, the general accountable care framework was previously tested in the Medicare Physician Group Practice Demonstration (PGP), which was enacted in 2000 and ran, with ten participating organizations, from 2005-2010. After the PGP showed modest success, the Federal Government formally embraced this approach to delivering care through the passage of the Patient Protection and Affordable Care Act in 2010.
The health reform law and subsequent regulations establish a framework where provider groups agree to care for a population of patients with the goal of reaching or surpassing predetermined cost and quality benchmarks. If the ACO manages to meet all the quality benchmarks and the population’s cost of care is below the established threshold, the ACO is able to share in the “savings” (the difference between the actual cost and benchmark cost). The first 32 Medicare ACOs, called “Pioneer ACOs” were announced in late 2011. In 2012, 27 shared savings ACOs were announced in April and 89 more (later decreased to 87 due to attrition) joined in July.
Private sector. Simultaneous to the CMS-backed plan, private sector ACOs were also forming. Prior to the first Pioneers joining the CMS program, over 150 private sector ACOs were already operating or announced and that growth continued through 2012. Due to the legislative nature of the program, MSSP ACOs are structurally similar with common payment arrangements, while private ACOs have more flexibility in designing accountable care contracts. Many private sector ACOs do mimic the shared savings model of the MSSP, but others have moved to full or partial capitation models, bundled payments, retainer agreements, in-kind services and subsidies provided by payers, and pay-for-performance incentives.
Similar to the MSSP, most of these arrangements also require some form of quality benchmarking to achieve full payment. Operating as a MSSP or working with private payers does not require an exclusivity agreement, and many ACOs simultaneously contract with private payers and CMS. Additionally, many state Medicaid programs, either directly through the state Medicaid office or via a Medicaid managed care plan, are actively negotiating accountable care agreements with providers.
How Many ACOs Are There?
I am part of a team that has been actively tracking and studying ACOs, both Medicare and private sector, since 2010. We identify ACOs from press reports, news articles, government announcements, news releases, conferences, personal and industry interviews, and other public records. We collect general information on ACOs from public sources and then interview ACOs to learn more about specific payment arrangements, approaches to coordinating care, and plans for the future.
To date we have interviewed approximately 80 different ACOs and will continue to interview more. We include on our list of ACOs entities that self-identify as being an ACO, are part of the formal MSSP, or that mimic ACOs in objectives but have decided to not use the ACO name (such as Community Care Organizations).
As of the end of January 2013, we have identified 428 different ACOs throughout the country. (See exhibit 1 below, click to enlarge.) In mapping ACO growth and dispersion, we identify hospitals that are owned by, or affiliated with, the ACO and use their location as a representation of the ACO’s geographic location, so a single ACO may exist in multiple states. If an ACO does not directly affiliate with hospitals, such as with some ACOs led by physician groups, then the office of the ACO was used to define its location. Three insurer-led ACOs with a national footprint were not mapped.
The continued growth of the accountable care movement is apparent, as ACOs have spread to 49 states, Washington DC and Puerto Rico. The only state without an ACO is Delaware, though there have been discussions about forming an ACO in the state and ACOs in neighboring states may cover some Medicare patients there. California, Florida and Texas lead the nation with 46, 42 and 33 ACOs respectively.
Generally, higher-population states also have higher numbers of ACOs, and extensive ACO growth has continued throughout the Midwest and on the West Coast. The least amount of growth has occurred in a band running from the Deep South, through the Great Plains and toward the Mountain West.
State estimates provide insight into broad trends, but any potential competition among ACOs will occur at the market level. Hospital Referral Regions (HRRs) are geographic regions defined by the Dartmouth Institute for Health Policy and represent markets where patients are likely to be referred for tertiary care. (See exhibit 2 below, click to enlarge.) They represent a good proxy for areas where ACOs are most likely to compete for patients.
ACOs are expanding their market coverage, as now only 64 (21 percent) of the 306 HRRs do not have an ACO present. Growth is still focused around population centers, particularly along the West Coast and the Northeast. In the past year ACO, growth has increased dramatically around Phoenix, Baltimore/Washington DC, Indianapolis, Omaha, and Portland Maine. Minneapolis, Central Ohio and the large Texas cities continue to have high numbers of ACOs. Boston and Los Angeles have the highest concentration of ACOs with 19 apiece, followed by Orlando with 13. Rural areas, particularly in the South and Appalachia, continue to have a paucity of ACO activity.
Who Is Involved In The Movement?
A major part of the ACO design is that health care providers are more involved managing the health and care of a population with some level of attendant risk for the amount of care provided. That does not mean, though, that providers are the only people that are encouraging ACO growth. ACOs do require significant provider involvement, but multiple groups can provide the direction or leadership in the creation of the ACO. Specific entities that sponsor the ACO come in many types, but four general categories have emerged: hospital systems, physician groups, insurers and community-based organizations. (See exhibit 3 below, click to enlarge.) Community-based organizations are non-profit, non-medical entities that bring together the payers and providers that will contract to form the actual ACO.
A year after the passage of the Affordable Care Act (first quarter 2011), hospital system-led ACOs outnumbered all other types at a rate of two to one, but there were still relatively few (71) ACOs. By the end of 2011, ACOs had doubled in number; hospitals still accounted for a majority of all ACOs, but physician groups and insurers saw faster relative growth.
In 2012 and the beginning of 2013 ACOs have nearly tripled in number again, with growth coming among all types of sponsoring entities. Of the 282 new ACOs in this period, 158 (56 percent) are sponsored by physician groups, 103 (36.5 percent) by hospital systems, 17 by insurers (6 percent) and 4 by community-based organizations (1.5 percent). The initial movement of ACOs was led by hospital systems, but physician groups have now surpassed them as the most common sponsoring entity among all ACOs. Health insurers, though they may not appear as the sponsoring entity, continue to play a strong role in ACO formation with financial backing and a willingness to explore novel payment models.
While physician group-led ACOs are most numerous, they are generally smaller than those run by hospitals. CMS reports that approximately half of all Medicare ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries, meaning hospital-led ACOs in the MSSP must have, on average, at least twice as many patients as those led by physician groups to cover the estimated 4 million Medicare beneficiaries. Our research has found similar results among private sector ACOs, with hospital-led ACOs having, on average, considerably larger ACO populations than those led by physician groups. While physician groups now sponsor the majority of ACOs, hospital systems still oversee the larger volume of total ACO patients.
The Next Step For ACOs
Based on reviews of these ACOs and interviews with ACO leadership, there are some significant differences across ACO models in how they try to achieve savings and manage their patient population, particularly between those sponsored by hospital systems and physician groups. Physician groups have the general approach that ACOs save money by keeping a patient out of the hospital and seek to accomplish this by managing patient care in outpatient settings, such as by using patient-centered medical homes to coordinate care among specialists. Hospital system-led ACOs, meanwhile, focus on better managing patients once they have been admitted to a hospital by trying to coordinate care among departments and providers. Both types of entities are trying to break down artificial silos so that the appropriate providers will work together to treat the patient at the proper time, as well as follow best practices and more effectively monitor their patient population.
Each of these approaches has merit. An ideal ACO will focus on keeping patients from entering a hospital and cost-effectively treating those that are admitted. A major challenge to achieving this lies in sharing governance for the ACO and responsibility for a patient population between organizations that are capable of efficiently managing patient care across the whole continuum of health care services.
Within a level of care providers, are making great strides to improve care coordination, but between care levels (such as between inpatient and outpatient), there is less progress being made. If a large physician group or a hospital system can achieve savings by working alone, they have little incentive to partner with another provider group as equals to further improve patient care. The next step in the accountable care movement will require a recognition that levels and locations of care are artificial constructs and that patient care should instead be focused on treating the patient appropriately; whether the care is being reimbursed by Medicare Part A, B, D or a private payer should matter much less than focusing on connecting patients with the right provider in the right location for their illness acuity. This, though, will require large physician groups and hospital systems (and eventually post-acute and long term care providers) to work together and align their goals around patient care. This does not require wholesale integration of providers, but that may be the result in some markets.
The Future Of The Accountable Care Movement
The accountable care movement is progressing rapidly, as many provider groups throughout the nation are officially adopting the title of ACO and are adopting some form of contract that encourages population management and cost minimization. While ACO growth will undoubtedly continue for at least the immediate future, it still represents a small minority of care delivered in the United States. Whether the numerous organizations that are cautiously observing ACOs from the side will ever take the plunge and adopt accountable care models will largely depend on the success of these early adopters. It’s much easier to adopt a new payment model when your peer institutions achieve success rather than end up millions in the red.
ACOs are still a work in process and their eventual success or failure is still to be determined, but the accountable care movement’s influence on the American health care system is already being felt. In 2013, many ACOs will complete their first year under a risk-based ACO contract, and their early results will influence how payers, providers and policymakers experiment with future iterations of accountable care. If the results are good, then the ACO model may become the dominant form of health care in the United States over the next decade. If the results are negative, accountable care may never gain a permanent foothold in our delivery system. The health care system will be watching to see how the accountable care movement plays out.
How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings.
Dr. Young is Ankota's Chief Medical Officer, and serves jointly as Assistant Professor of Medicine at the Welch Center for Prevention, Epidemiology, and Clinical Research, and Core Faculty of Johns Hopkins Bloomberg School of Public Health. In these roles, Dr. Young is involved in population health programs and community based initiatives that are aimed at decreasing readmissions and lowering the overall cost of care. Managing Care Transitions has emerged as a critical element in reducing avoidable readmissions and lowering overall costs, and health care providers are looking for information to guide them in the creation of these programs.
Last week, we reviewed the lessons learned from Medicare’s Coordinated Care Demonstration Programs. Those programs that were most effective in controlling costs emphasized face-to-face interactions between the patient and care coordinator and between the care coordinator and the physician, focused on medication management, included behavior change interventions, and facilitated communication among all the providers.
This week, we will focus on one of the 15 programs, Washington University’s pilot care management program, as reviewed by Peikes and colleagues in a Health Affairs article published in 2012. The importance of effective program design could not be any more clear in this example. The opportunity for post acute providers like home health, therapy, and DME companies is tremendous in these rapidly emerging models.
Key lessons from the Washington University program include
The health care expenditures in the Washington University program actually increased by 12% during the program’s first 4 years.1 This result is not unlike those experienced by many care management programs underlying the point that it’s hard to save money by spending money. it requires efficient program design to accomplish the desired savings.
Fortunately for Washington University, and for us, the story did not end at 4 years. When Washington University’s program was extended in 2006, their telephonic care management vendor stopped participating to focus on other programs. In response, Washington University expanded and modified the component of their program employing local case managers. In addition, they added ancillary staff including a licensed clinical social worker and care manager assistants. The care coordinators focused on the sickest patients, strengthened their transitional care and medication reconciliation processes, and supplemented frequent phone contacts with occasional in-person visits. They also redesigned their care plans to more closely focus on key conditions and to more clearly guide clinical interventions. Finally, they standardized the assessment process to eliminate assessment gaps and increased supervision to ensure periodic patient contact per established protocols.
The results were remarkable given the program’s previous increase in costs. The redesign resulted in a 12% reduction in hospitalizations and a decrease in monthly Medicare expenditures of $217 per member. This success emphasizes the importance of several characteristics to effective care management programs. First, all health care is local and depends on building trusting relationships with patients. Second, care transitions and a focus on sick patients provide the opportunity to lower costs. Third, standardization, clearly defined goals, and close operational supervision are essential for an effective and efficient care management process. Finally, medication reconciliation is an essential element of effective care management programs.
The program's abstract provides a good summary, "The results underscore findings from the overall Medicare Coordinated Care Demonstration that suggest that programs with more in-person contacts were more likely than others to build trusting relationships with patients and providers, improve patient adherence to care plans, and address additional needs and barriers that entirely telephonic contacts had been unable to identify. The results also indicate that programs can be more effective by focusing on the highest-risk patients, for whom the largest savings resulted."
This presents numerous opportunities for post acute providers, which are playing increasing roles in such programs. Hospitals and ACOs do not have sufficient staff or expertise to manage these outbound and highly mobile care delivery models, nor do they have the systems to manage them. Many are already expanding case management functions to lead care for patients following discharge, but will increasingly need to leverage existing channels such as home health, physical therapy and DME providers to be effective. New software systems are required to coordinate roles and dependencies, manage complex schedules and track services while assuring that protocols are followed consistently. Ankota's Healthcare Delivery Management platform manages these models effectively today and assures that programs deliver on the promise of better care at lower overal costs, and can scale approppriately. Contact Ankota using any of the blue buttons to learn more.
1. Peikes D, Peterson G, Brown RS, Graff S, Lynch JP. How changes in Washington University's Medicare coordinated care demonstration pilot ultimately achieved savings. Health Aff (Millwood). Jun 2012;31(6):1216-1226.
"...new patient-centered population health models will cause more than $1 trillion of value to rotate from the old models to the new and create more than a dozen new $10 billion high-growth markets."
It's already happening: why should you, as a provider, care?
Why should Hospitals, Accountable Care Organizations and post acute providers care about this dramatic shift? After all, you're still going to get paid for delivering services, right? THINK AGAIN! This shift will have a PROFOUND impact on every provider. You will either benefit from participating in new models of care, or you will suffer a painful death by being disintermediated.
Disintermediated? Cut out. Left behind. Irrelevant. Out of business.
As reported in FORBES last month, and detailed in the Oliver Wyman paper you can download here, "Healthcare innovators are already redefining healthcare value, putting patients first and inventing with little regard for current constraints. They have ignited a powerful, self-funding upward spiral by focusing first on healthcare’s big opportunities, transforming the value equation, generating large savings, and fueling smart reinvestment in the next wave of innovation."
Ask yourself this: Am I among the trillion dollars worth of healthcare business that goes away?
Read the FORBES article in its entirety here and link to the Oliver Wyman white paper.
Learn how Ankota is helping Hospitals, ACOs and post acute provders to operate efficiently and be a valued partner in the new healthcare Ecosystem - click the blue button below.
We see it all the time, and perhaps you even catch yourself doing it in your practice. As the president of one of our new physical therapy customers said to me,
"Sometimes we get so focused on the clinical side
of providing care that we forget we're
running a business, too."
"I think I know why," I replied, "that's easier to do and it's more interesting." His smile said it all, and he agreed, "It's what we already know and what our people are trained to do."
Indeed, providers tend to focus on what they know: providing care. Therapists focus on therapies and rehabilitating patients, infusion nurses focus on administering antibiotics and chemotherapy drugs, and HME businesses focus on the delivery and set up of home medical equipment (while losing sleep over how to navigate the competitive bidding nightmare!).
The business stuff should take care of itself, or "we're not a business," says conventional health care wisdom. Not so. That's just an excuse to justify focusing on the most comfortable and certainly more interesting things like taking care of patients. People get into the "business" of healthcare because they care about taking care of patients. They're forced into marketing the business and developing referral sources to stay alive, yet the business operations are often assumed or even neglected. It's the way they've always done things, but the inefficiency becomes especially obvious when compared to other industries. This neglect is fundamentally an issue of attitude. If you choose to focus on what you know best, you won't improve on the things where you are weakest. It's a mindset. Choose to focus where your business needs it and where you can improve, where you are least comfortable, in addition to the areas where you are more comfortable.
Am I saying that business owners have a bad atttude? Not at all! I'm saying that it's easy to focus and what you already know, where you're already good. Likewise, it's easy NOT to focus where you're uncomfortable.
Agencies of all types simply must decide to tackle the issues they may not know much about. Set aside discomfort, and simply decide to act. Focus. Redirect. Change your attitude. And enlist the help of others. Leverage technology as much as possible to improve both and challenge technology providers to show you how you can run your business more productively. We see literally hundreds of operations every year, and have tremendous expertise in business performance management and optimization of people and resources. The vendors you talk to can be a tremendous asset if you take advantage of them.
Even if it means you may not be good at what you're now focusing on, just change your attitude. Study after study shows that attitude triumphs and is a larger contributor to success than anything else. Take a look at this piece by Dan Waldschmidt
in the Business Insider, which discusses attitude as the primary factor of success. "Your Attitude Determines Whether Or Not You'll Succeed"
Think this is a problem only for smaller home health and therapy agencies? think you're too big to suffer some of the operational problems that many providers experience? Think you're too small for change to matter or for technology to help?
Think again. Many of the very largest, publicly traded home health agencies still run on paper at the point of care. Existing scheduling tools are basic and don't optimize for concerns such as time, travel, skills, or availability. That's ridiculous and providers know it. Reporting takes forever. Billing takes days or even weeks in some instances. They waste millions of dollars each year processing time sheets when technology at the point of care would automate such things and render time & attendance reporting obsolete. One large home care agency we studied spends more than $3 million annually processing time sheets alone. Technology from Ankota can eliminate this expense entirely.
Why do they do it this way? Because that's how they've always done it. That's the attitude that costs them $3M each and every year. It seems to be changing, but it first requires a change in attitude to acknowledge that there may be better ways and seek them out.
Think your agency is too small for automation to make a biug difference? Consider this: A typical home health agency may support roughly 20-25 care givers with a single scheduler using existing technology. Using more powerful (and often less expensive) technology from Ankota, the same scheduler may support 2-3 times as many caregivers. When you're a smaller agency, the cost of hiring new bodies to scale operations is tremendously expensive. Rather than assuming that the only option is to hire more, turn to your software vendors and demand that they show you how to accomplish more with the resources you already have. Expect your partners to act as your advocates to help make you better at what you do, no matter how small your business is.
We're seeing numerous programs emerging among hospitals and Accountable Care Organizations (ACOs) that are intended to improve the cost and quality of care for populations, but are repeating old mistakes. They're taking a "safe" route and building new programs on old technologies and sometimes even using paper documentation. The attitude shift that is needed here is to assume that existing ways are not safe, not productive, and not in compliance. Assume that there are better ways to design and manage community based and population health programs and find tecchnologies to make them better. Change your attitude.
That's why Ankota built software solutions that scale for organizations of all sizes, small to very large. To solve some of these problems of managing care delivery, to make it easy to Plan, Coordinate and Deliver care and to do it efficiently across virtually any healthcare setting.
You've probably heard a thousand "-isms" about attitude driving success, about perspiration, inspiration, and more. All you need to do is make a choice to change your attitude, change your focus, and make it so.
"If you don't run the business like a business,
you'll be out of business."
"If you continue to do what you've always done, you always get what you've always gotten."
Change your organization's attitude by leading with your own. And ask Ankota to help!
Some of the best articles I come across are published on LinkedIn by members of groups that I belong to. LinkedIn bills itself as "the World's Largest Professional Network," but does a great job of allowing you to direct your time and efforts by connecting with others where you have commonality. I find that most people are aware of LinkedIn but many therapy agencies are not on it and are confused about whether it's worth their while.
You can find a group for just about anything on LinkedIn. This article below was posted on the Physical Therapist (PT) Network, which, at about 4500 members, is the largest physical therapy group on LinkedIn. Ankota's success with physical therapy agencies is due, at least in part, to the fact that we listen to therapists about what they need from technology to help them run their businesses better. LinkedIn is one of many ways that Ankota seeks to stay connected with therapy agencies.
On LinkedIn: How to Hire the Right Staff for Your Physical Therapy Practice
This was posted on PTPN Insights, but shared on LinkedIn by a member of the Physical Therpist Network. Get it?
I tend to pay a more attention to articles that I see on LinkedIn because they are already vetted by members of a group that I know shares some of my professional interests. When I see a blog or an article posted on the Physical Therapist (PT) Network on LinkedIn, I know that other physical therapists have already read it and thought it was worth sharing with the rest of the group. So I pay more attention than to those things that simply make their way to my email inbox.
So should you!
Virtually every executive running a Physical Therapy business today knows that therapies will play a significant role in Accountable Care. The clinical value is indisputable, yet most therapy execs are confused about how to engage and position themselves to be a strategic partner in Accountable Care. One way to engage is to join ACO groups on LinkedIn. Look for groups with the words "accountable care" and "care transitions" in their titles, for starters. You will quickly see what the groups are talking about and the events and conferences they attend. This can be an easy way to sit in on the conversations that matter to the partners you want.
A few things that LinkedIn is especially good for, in addition to PT related articles:
- See what Accountable Care Organizations (ACO) are talking about
- Explore the role of Phyiscal Therapy in managing Care Transitions
- Job Postings, hiring practices, and other employment related articles
- Connect with other physical therapy businesses, share best practices
And if your Therapy agency is in need of technology to help simplify complex scheduling needs, move to electronic documentation at the point of care, bill instantly, cooperate with referral sources and connect with ACOs, then contact Ankota to take a look at our software.
Other linked groups to explore on LinkedIn:
American Physical Therapy Association
Accountable Care Organization Networking Group
Home Care Sales and Marketing
National Transitions of Care Coalition (NTOCC)
Whether you are a hospital or ACO planning for care that is ultimately delivered outside of the hospital, or you are a post acute provider providing therapy or home care, this applies to you.
I visited a new customer recently that we're very excited to work with. I was there as they "went live" with our software immediately following their training. With many businesses being so remote and virtual--including ours--we don't always get to see this in person so I make it a point to visit customers and talk with the people that use our technology. This customer is a therapy staffing business in the midwest, with a top notch staff who are professional and committed to providing fantastic therapy services for their clients. Like a lot of our therapy customers, this business provides physical therapy, occupational therapy, and speech therapy in the home and other residences like Assisted Living Facilities (ALF). That may sound a lot like your business, or perhaps you provide other services we work with like infusion nursing, HME delivery, or Private Duty Home Care.
As a developer of technology, it feels really great to make a big impact on a customer's business. Knowing that we've developed technology that improves business operations, makes you more profitable and helps your staff do their jobs better, while not at all glamorous, is incredibly fulfilling. Your patients may never know Ankota's name, but you and the team you rely on to run your business will love us. Your therapists will be happier and more productive, and will no longer spend evenings completing paperwork. Same goes for nurses, home care aids or technicians, if that is your business. They'll be fully electronic, completing and synchronizing care forms in real time so that the business can be paid faster and grow.
But that's not why customers choose us. Health care providers choose us because we help them transition their businesses into highly coordinated care delivery models and take a leadership position. If you're not thinking this way, then you're preparing to fail. If your software vendor isn't helping you do this already, it's time to look elsewhere.
Therapy is one of our most successful markets, and it's a customer we really like to work with. It seems that all of our customers value technology as a way to better manage business processes, and they value their staff and are considerate of their time. Most providers realize that their therapists often spend hours completing paperwork in the evenings and they'd rather provide them with the tools to help them be more productive during the day...and happier in their jobs! They have specific goals for the business that they expect us to help with and when we make that commitment, that is our oath.
Frankly, we believe that the physical therapy market, like several post acute providers, has been grossly underserved by technology. The fact that most providers still use paper forms at the point of care is ridiculous. For this, I fault the software companies. Most software products are difficult to learn and use and are way too expensive for most agencies. The typical software product for a therapy business is pretty limited, costs too much, and runs on old code. Incumbant technologies do not address healthcare as a process that can be Planned, Coordinated, and Delivered efficiently. That is why most care plans are still on paper, scheduling is simplistic, work is not reported and tracked electronically, and caregivers are still using timesheets. If your vendor hasn't solved these problems, what are the chances that they will be able to help you tackle more difficult problems like managing Care Transitions? To address the future of healthcare delivery which is already upon us, providers must modernize.
The thought for today is this: Is your technology helping you strategically?
Or, are you like most therapy agencies and other healthcare providers whose software simply automates things you used to do? The vendor you chose 3 to 5 years ago may not be the vendor to carry you forward. You can and must do better.
Does your vendor have a clear vision for their role in helping you to participate in accountable care? Can they connect you to collaborative models that have already emerged and on which your business will increasingly depend? Maybe they're even paying this some lip service...promises promises. If they aren't showing you the way there is a reason for it.
Ankota customers already do this. They collaborate electronically with partners, share care plans and schedules, track work in real time and share analysis and reports with their partners. Their process is entirely electronic and saves substantial time and money almost imediately. That's why Ankota therapy agencies typically grow very fast, their therapists are happier, and they are connected with ecosystems of other providers. They operate efficiently and are desireable to do business with: they rapidly become the provider of choice.
The agency I visited chose Ankota for these reasons, and every one of their staff understand this. We genuinely appreciate the trust that all of our customers place in us when they choose to do business with us. We take the commitments we make to you seriously and enjoy contributing to your success.
Social media shows tremendous potential to help better manage Care Transitions and chronic disease, while improving patients lives and reducing hospitalizations. The opportunity here for creativity and innovation that helps patients is unlimited.
With the rise of Accountable Care and focus on managing Care Transitions to reduce hospitalizations, more care will be planned and coordinated in settings outside of hospitals. That is no secret. Settings will include homes, assisted living facilities (ALFs), skilled nursing, offices of primary care physicians, and more. As the challenges of geography of patients and care givers are met with increasing volume and complexity of services provided, technology that reduces physical barriers and speeds "time to information" will be incredibly valuable. Social media has already proven to knock down these barriers in other industries, and health care is well on its way to similar dramatic change.
In a related paper titled "The Evolving Business Case for Social Media in Healthcare," Chris Hoffman of Triple-Tree writes, "Social media is radically changing the nature of business relationships in every economy and industry - and healthcare is no exception. 'Like' it or not, social media is forcing health plans and healthcare providers to adapt and evolve, changing how they communicate with and engage consumers."
Triple Tree has detailed an assessment of how this unique communication platform is helping healthcare consumers, care providers and other stakeholders support decision making and simplify complex online interactions. Click on the image above to download the report directly from Triple-Tree, or contact Chris Hoffman directly.
To learn how Ankota is helping to integrate social media into care coordination models, click on the cool blue banner below and ask us about it.
CMS has made it very clear that reducing needless hospital readmissions is a priority, with or without healthcare reform. The long anticipated financial penalties took effect in September 2012 and will become increasingly severe for those hospitals that do not improve and meet published benchmarks. Thes first round of penalties is scheduled to double next October and then reach 3% of the hospital's total medicare reimbursements by October 2015.
The problem is significant: 1 in 5 Medicare patients are readmitted within 30 days of discharge, and 30% are readmitted within 60 days -- for conditions that are widely considered avoidable. This translates to a burden on the Medicare system that exceeds $25 BILLION per year.
Every hospital in the nation faces these new performance & quality requirements, which are measured by readmission rates for the most prevalent and costly of chronic conditions. Without exception, it is the number one issue facing hospitals today. Further, it is not enough to satisfy CMS's requirements today to avoid penalties because the both the requirements and the penalties continue to escalate. The entire system is being forced to continuously improve and reduce costs, which is a well-developed cornerstone of performance management models long used in other industries. Stiff penalties assure that hospitals take them seriously by taking responsibility for coordinating follow up care that helps patients recover and thrive outside of the hospitals. These settings include the patients' homes, assisted living facilities, and skilled nursing facilities. Clearly, more care will be delivered in homes and other residences and the complexity of that care will continue to increase. This presents a tremendous growth opportunity for the ecosystem of post acute care providers.
From the November 26, 2012 New York Times article "Hospitals Face Pressure to Avert Readmissions," In a common example, Barnes-Jewish Hospital in St. Louis, will lose $2 million this year. Dr. John Lynch, the chief medical officer, said Barnes-Jewish could absorb that loss this year, but “over time, if the penalties accumulate, it will probably take resources away from other key patient programs.”
"The readmission penalties will recoup about $300 million this year. But the goal is to pressure hospitals to pay attention to what happens to their patients after they leave. The penalties have captured the attention of hospitals, and many are trying to improve their supervision of discharged patients’ recoveries." This will require new technologies and processes to coordinate care from hospital to home, an area where Ankota is squarely focused.
A few doctors have long advocated such a model, including Dr. Eric Coleman, a professor at the University of Colorado Anschutz Medical Campus who has devised proven approaches to reduce hospitalizations. These methods focus on helping elderly patients by caring for them more proactively and encouraging cooperation among primary care physicians, home care, physical therapy providers and those delivering equipment and supplies, for example. This is also the right model to help patients recover at home when events do force a hospitalization.
Even with the development of protocols to better manage care, like those of Dr. Eric Coleman, these protocols generally exist only on paper. There is a fundamental lack of technology in place to connect providers to support these programs of care. Ankota's Healthcare Delivery Management (HDM) platform provides web based, secure technology through which providers are able to manage Care Transitions as well as models like Dr. Coleman's and others.