September 2016

Thoughts From Our President

Telemedicine, along with walk-in clinics, are two emerging trends that are disrupting the current delivery of healthcare and we expect their impact will increase significantly over the next few years. While providing more convenience at a lower cost in many cases, they serve many patients quite well. However, these trends hold some risks as these services are often independent of electronic medical records and their clinicians may not have access to critical medication or patient history data.
 
In this month’s newsletter we have included a case study on the success Avera Health has realized with their telehealth program.
 
A recent article suggests that employer health plans may be 100% telemedicine enabled by 2020, and if growth continues at its current pace, this will become a major factor in your EHR planning.
 
Finally, we have two important Quality and Compliance updates in this month’s newsletter. Hope you find this information helpful. 

John Haffty, President

Things We Learned This Summer

As the only consulting company dedicated exclusively to supporting the MEDITECH community, we are often asked by our clients (past and present) to answer questions or clarify information. We consider it a privilege to provide this benefit for our clients as these research activities keep us on top of all things MEDITECH. Also, as the leading 6.1 READY consulting company, we have been involved with almost every new product and feature, providing us with more experience and knowledge than all other certified consulting partners combined. 
 
Over the past two months, we covered a variety of topics and thought some of you might find this of interest:

• MEDITECH has delivered into test the 6.1.6 WebAcute software for the first early adopter. NHA is working with this hospital and has already shared lessons learned from this experience.
   
• NHA is working with one of the first 6.1 implementations where the hospital is converting from another Home Healthcare system to the MEDITECH product. MEDITECH’s Home Healthcare product is written in MAT (the 6.x technology) but resides in a separate universe. There are many integration points and advantages of using MEDITECH’s Home Healthcare product over any third party because of these integration points; however, residing in a separate universe created some misunderstandings. Working closely with the client and MEDITECH, we were able to clarify and ensure the level of integration the client expected. There is extensive documentation on the integration benefits for those interested.
   
• CMS is piloting an initiative for bundled payments for joint replacement. We have worked with MEDITECH to increase our understanding of what it takes to analyze this for one of our clients and MEDITECH has recognized the need to improve its tools for these new requirements. Expect to hear more from MEDITECH on this topic in the near future.
   
• One of our clients was interested in MEDITECH’s Business and Clinical Analytics (BCA) product but has multiple facilities and had information suggesting that there were limitations. We received the following clarification:

The financial and operational standard content dashboards contain facility or corporation “view bys” that display a comparison of facilities or corporations for a set of metrics. Additionally, we are creating a series of Enterprise Executive dashboards that are intended, for a high-level audience, to do facility comparisons and aggregations (total revenues, total admissions, etc. for selected facilities or corporations). The Enterprise Executive dashboards will be available at the end of Q3 this year.

• There has been some interest expressed in analysis of claims data. NHA has conducted research on this topic and we are finding that very few organizations are actually doing much with this. The two areas of focus have been trying to understand total cost of care for patients and referral patterns for physicians that are in their network. However, to date only a few of the largest healthcare organizations are doing this at any scale.

We welcome the chance to share what we have learned.  If you have any questions on these or other topics, please contact us at info@navinhaffty.com.

Avera’s Telehealth Program

Telehealth has become a hot topic in the news lately, and as more of our clients adopt telehealth it is helpful to hear from health systems successfully implementing telehealth. We recently came across a great case study and webinar that highlights a successful telehealth deployment at Avera Health, an integrated delivery network that includes the Avera Health Plan and Avera Medical Group. Here’s an overview on Avera’s direct-to-consumer telehealth initiative, as well as its nationally recognized business-to-business telemedicine network:
   

• Avera introduced a direct-to-consumer telehealth offering called AveraNow in the summer of 2015, with goals to attract new patients, create strong primary care affiliations and reduce costs. AveraNow saw 372 of its 2,500 enrollees complete a telehealth visit in the first twelve weeks of the program. Twelve percent of AveraNow patients were completely new to the Avera system. Avera saw an estimated net savings of $48 per visit. Patients that completed a visit on AveraNow were extremely pleased with the service, giving it an average overall satisfaction rating of 4.71 based on a five-point scale. To learn more about AveraNow, check out American Well’s case study or hear about the marketing and consumer engagement strategy from Jennifer Schultz, Vice President of Marketing at Avera, in this recent webinar.
   
• Avera eCARE, Avera’s robust business-to-business telemedicine network, has been in place since 1993 and connects rural hospitals across eight states and 80 counties with specialists headquartered in Sioux Falls, South Dakota. To date, Avera eCARE has saved over $17 million in healthcare costs and touched over 790,000 patients. There are currently six subdivisions within this business-to-business program, including eICU CARE, ePharmacy and eConsult.
   
• Through its eICU CARE program, which was established in 2004, Avera provides 24/7/365 virtual access to intensivists and continuous monitoring of ICU patients. Avera eICU covers 91 ICU beds at 28 facilities within its network. To date, the program has covered 61,000 patients and saved 1,400 lives and $78 million in healthcare costs.
   
• A recent survey revealed that 43% of health systems implementing telehealth utilize it for provider-to-provider visits. Provider-to-provider consultations are especially relevant for health systems with a footprint spanning thousands of miles, often encompassing rural and sparsely populated areas. Avera’s eConsult program connects physicians with approximately 35 medical specialists, including infectious disease, pulmonology, cardiology and nephrology. Avera eConsult completes more than 900 video visits each month with patients in over 100 clinics and hospitals. In the past 12 months alone, eConsult has saved patients over 39,000 hours, 2.5 million miles and an estimated $1 million in costs.
   
• Hospital regulations recognize the need for 24-hour pharmacist review of medications, yet there is a major shortage of pharmacists within the United States. Through Avera’s ePharmacy program, Avera is able to provide remote, 24/7 pharmacy coverage to over 744,000 patients across 70 sites. In the past year alone, Avera’s ePharmacy helped avoid 5,000 adverse drug events and saved an estimated $13 million in costs from adverse events.
   

Health systems that are considering implementing telehealth can learn a lot from Avera Health’s success and best practices in both business-to-business and direct-to-consumer telehealth. If you are interested in learning more, please reach out to Avera eCARE for additional information on their services.

MEDITECH’s 6.1 Surveillance Identifies, Prevents Infections at Valley

We are very proud to have partnered with The Valley Hospital, Ridgewood, New Jersey on their implementation of MEDITECH’s 6.1 EHR. MEDITECH recently posted an article describing one of the many collaborations with this hospital and the following is from the MEDITECH website:

When The Valley Hospital moved forward with MEDITECH’s 6.1 EHR, hospital leaders recognized the potential in its new electronic surveillance tool and agreed to be an early adopter. Less than a year after going LIVE, MEDITECH’s Surveillance solution has earned their confidence for its power and versatility.

With 23 boards in use, Valley counts on Surveillance for everything from identifying and preventing sepsis and other infections, to complying with core measures and improving patient throughput. For example, in March 2016, 100% of HIM-coded septic patients at Valley were found by electronic surveillance.

“Why wouldn’t you want to free staff from performing repetitive tasks or surveilling patient information, when the EHR can accomplish those same functions faster and more easily?” asks Chris Neumann, project specialist at Valley.

Read more about Valley’s journey from early adopter to success story in MEDITECH’s new case study, Detecting the Undetected: MEDITECH’s Surveillance Identifies and Prevents Infections at Valley.

Quality and Compliance Update: eReporting Clinical Quality Measures for 2016

Over the past several years CMS has aligned Meaningful Use (MU), Inpatient Quality Reporting (IQR) and Physician Quality Reporting (PQRS) to share common quality measures and reporting requirements. It has been a slow process and is far from complete, but, for this year and 2017, some major steps have been taken.
 
For MU in 2016, hospitals are allowed to either manually attest to 16 of the 29 possible Clinical Quality Measures (CQMs), or they may electronically submit results on 4 of 28 possible CQMs. The 28 electronic CQMs is not a typo; the ED-3 measure in MU’s 29 is not an inpatient measure, so it would not qualify for IQR. 
 
The carrot for hospitals is that eReporting requires fewer measures, and a single electronic submission will count toward MU as well as IQR. Independent of MU, for 2016, IQR requires electronic submission of four CQMs, or the hospital will be assessed a penalty in 2018. So if you have to perform an electronic submission anyway, why not become familiar with the process and make it count for two programs? 
 
An additional carrot had been that an electronic submission would only require one quarter’s data, whereas manual MU attestation would require a full year’s data. With the current proposed revisions to MU for 2016, all attestations and reporting would be for a calendar quarter, so this benefit would be removed if the proposed changes are approved. Please note that the eReporting data must come from either CY2016 Q3 or Q4 and be submitted by February 28, 2017.  
 
Although some hospitals will choose to use a third party to submit their results, electronic submissions can be performed by the hospital and would be made through the QualityNet system. CMS requires that data be submitted in a QRDA-1 format, which produces single-patient reports. MEDITECH CQM reports produce their results in that format, so no additional intervention of the results should be required prior to submission. 
 
Preparation for submissions should begin now in order to meet the deadline. The most obvious need would be to assemble your site’s MEDITECH analysts/informaticists, and quality department staff, to begin gathering data and testing reports. Additionally, there are requirements on the QualityNet end, which include: 

• Registering with QualityNet to obtain a QualityNet portal account
• Downloading their User Guide and Pre-Submission Validation Application (PSVA) tool
• Submitting test files using the PSVA tool to verify file structure
• Submitting PSVA-verified files to the CMS test directory on the QualityNet site

To beat the end of February rush, plan on submission of Q3 or Q4 data before mid-February 2017.

Quality and Compliance Update: CMS Finalizes 2017 Rules for eReporting Clinical Quality Measures for Meaningful Use and Inpatient Quality Reporting

In the final rule published on August 22, 2016, CMS made several major changes that affect hospitals’ reporting of CQMs for CY2017. 
 
CMS is requiring hospitals to select and submit eight of the available electronic Clinical Quality Measures (eCQMs) that are included in the Inpatient Quality Reporting (IQR) program. They are requiring four quarters of data, submitted as an annual aggregate, for the CY2017 and CY2018 reporting periods. 
 
CMS is removing 15 measures for the CY2017/FY2019 payment determination year. This removal will remain for subsequent years. The rationale behind their removal is that they are topped-out, and further tracking and analysis will not provide additional improvement in patient outcomes. Of these 15 measures, delineated below, 13 are eCQMs, two of which CMS is also removing from their chart-abstracted form.    

1.     AMI–2 Aspirin Prescribed at Discharge for AMI

2.     AMI–7a Fibrinolytic Therapy Received Within 30 Minutes of Hospital Arrival

3.     AMI–10 Statin Prescribed at Discharge

4.     HTN Healthy Term Newborn

5.     PN–6 Antibiotic Selection for Community-Acquired Pneumonia in Immunocompetent Patients

6.     SCIP–Inf–1a Prophylactic Antibiotic Received Within One Hour Prior to Surgical Incision 

7.     SCIP–Inf–2a Prophylactic Antibiotic Selection for Surgical Patients 

8.     SCIP–Inf–9 Urinary Catheter Removed on Postoperative Day 1 (POD1) or Postoperative Day 2 (POD2) 

9.     STK–4 Thrombolytic Therapy; in chart abstracted form

10.   VTE–3 Venous Thromboembolism Patients with Anticoagulation Overlap Therapy

11.   VTE–4 Venous Thromboembolism Patients Receiving Unfractionated Heparin (UFH) 

12.   VTE–5 Venous Thromboembolism Discharge Instructions; in chart abstracted form

13.   VTE–6 Incidence of Potentially Preventable Venous Thromboembolism

14.   Participation in a Systematic Clinical Database Registry for Nursing Sensitive Care 

15.   Participation in a Systematic Clinical Database Registry for General Surgery

This leaves 15 measures available for eReporting in CY2017, which include: 

1.     AMI-8a Patients receiving primary PCI within 90 minutes of arrival

2.     CAC-3 Care plan provided to pediatric asthma patients

3.     ED-1 Median time from ED arrival to ED departure for patients admitted to Inpatient

4.     ED-2 Median time from admit decision time to ED departure for admitted patients

5.     Exclusive Breast Feeding

6.     Newborn Hearing Screening

7.     PC01 Elective Delivery

8.     STK-2 Patients Prescribed Antithrombotic Therapy at Discharge

9.     STK-3 Patients Prescribed Anticoagulation Therapy at Discharge

10.   STK 5 Patients Administered Antithrombotic Therapy by End of Hospital Day Two

11.   STK-6 Patients Prescribed Statin at Discharge

12.   STK-8 Stroke Education Provided During Inpatient

13.   STK-10 Patients Assessed for Rehab Services

14.   VTE-1 VTE Prophylaxis Received

15.   VTE-2 VTE Prophylaxis Received in ICU

Additional clarifications in the final rule include: 

1.     Hospitals can report using an EHR certified to either the 2014 or 2015 edition for the CY2016 reporting period 

2.     Hospitals must submit eCQM data in a QRDA-I format 

3.     Hospitals may use third parties to submit QRDA-I files on their behalf 

4.     Hospitals can use abstraction or they may derive the data from non-certified sources in order to then input the data into their certified EHRs for capture and eReporting

There have been some questions regarding validation by CMS of eCQM results being submitted for 2016 and 2017. It was noted in the Final Rule that CMS is considering review and validation of 200 hospitals, starting in CY2018, but no validations of submitted results would occur for CY2016 or CY2017.
 
Finally, while it is quite a bit down the road, CMS is considering adding three new quality measures for the IQR program, in addition to considering stratification of IQR data by race, ethnicity, sex and disability. These might take effect in CY2020, would be directed to measuring patient outcomes, including: 

1.     A version of the NIH Stroke Scale

2.     A measure of Antimicrobial Use

3.   Inpatient behavioral health measures 

KLAS Rankings

Each month we share our KLAS rankings and some comments from clients. We believe KLAS provides the best representation on how vendors are performing in the eyes of their clients in our industry. We hope this serves as a reminder to check KLAS rankings and commentary when considering a consulting company.
 
In every category we score above the industry average. As of September 12, here are our rankings:  

3^rd – HIT Enterprise Implementation Leadership – We were awarded “Best in KLAS” for this category for 2015/2016. Please note that only one other MEDITECH READY certified company is even ranked in this category, and our score is equal to our score when we were selected for the Best in KLAS award.

2^nd – Technical Services – Our score has improved since year-end as well. This category covers report writing, data repository and proration rules services.

10^th – IT Advisory Services – Previously known as Planning & Assessment, where we were “Best in KLAS” for 2014.

15^th – HIT Implementation Support and Staffing – for small READY implementations and backfill resources. Note that our score is higher than every other MEDITECH consulting company.

Selected comments from August 2016:
 
“One thing that went well was that our consultant from Navin, Haffty & Associates left us with a wealth of knowledge and a very detailed list of things that we needed to do in order for us to accomplish our objectives after she left. This list was a step-by-step process list that really helped us after she left. This helped us feel empowered that we could do it on our own.” Director/Physician       
 
“When Navin, Haffty & Associates came in and helped us implement our cost-accounting system, I can’t really think of anything they could have done better. I look at how my staff members are functioning now and how well they understand it, and I understand that is the result of Navin Haffty’s efforts. We have a part-time staff member doing our cost-accounting systems now, whereas before we had a full-timer doing it. They really helped us become efficient at this.”   Director/Physician

  “One thing I thought Navin, Haffty & Associates did a very nice job at was integrating the educational process with our staff. As they went through and worked on things, they didn’t just fix the problems and hope that we would watch and learn from what they did. They actually would draw us in and show us step by step how to fix certain things. They even would have our staff members fix issues, giving us a hands-on approach. This helped make our staff well prepared for when Navin Haffty was no longer working with us.” Director/Physician
 
“One thing I really liked about Navin, Haffty & Associates is that the person they brought in was very conscious of the time he spent helping us. He made sure he stayed within the time constraints of what we could afford. They only charged us for the time they were here; they did not nickel-and-dime us. In fact, they even did some work without charging us for it.” Director/Physician
 
Please note selected commentaries may not represent the whole of provider sentiment related to this product or service. For a complete view, visit KLASresearch.com

Quick Notes

• Congrats to our friends at Colquitt Regional Medical Center, Moultrie, Georgia on their successful migration from MAGIC to 6.1. NHA is proud to have been their consulting partner for this project. To read more about Colquitt’s success, click here. 
    
• As part of its sepsis prevention program, Avera implemented a standardized sepsis toolkit directly into clinicians’ workflows with the MEDITECH EHR. This initiative has led to significant rate reductions in sepsis mortality and readmissions, as well as dramatic cost savings. Learn how MEDITECH helped Avera reduce sepsis mortality by 45% and save $10 million in MEDITECH’s new case study, “Every Patient, Every Time: Sepsis Screening Leads to 45% Mortality Rate Reduction.”
   
• NHA consultant Candy Edie will present Your Revenue Cycle: It’s Not Just Billing Anymore at the American Association of Healthcare Administrative Management (AAHAM) Pine Tree Chapter’s revenue cycle meeting on September 23 in Spurwink, Maine. This presentation will detail what one needs to consider, evaluate and measure when assessing revenue cycle effectiveness. For more on AAHAM and the upcoming revenue cycle meeting, please click here.
   
• Congratulations to our friends at Tanner Health System, Carrollton, Georgia, for being selected for the NOVA Award for improving community health. Tanner was honored due to its Get Healthy, Live Well patient program which focuses on improving community health outcomes through programs to prevent obesity, diabetes and other chronic conditions. The NOVA Award is given annually by the American Hospital Association to those organizations they consider “stars” of the healthcare field for their achievements in quality, community health and palliative care.

MEDITECH’s Physician and CIO Forum – October 20-21

Last year MEDITECH combined its Physician and CIO Forums into one session, which was a huge success, providing significant education and helping bridge the understanding of the needs of physicians with the challenges of CIOs. They are repeating this format this year on October 20 and 21 at their new conference center in Foxborough, Massachusetts. Registration is open, and MEDITECH has announced the keynote speakers for this event. Further, MEDITECH has published the agenda and there are four breakout sessions to allow maximum participation. There are 25 separate topics covered in these sessions, including:

• Integrating Mental Health Best Practices
• 6.1 Lessons Learned
• Physician Governance Panel
• Care Management Tools and Approaches to Support Population Health
• New Ambulatory and Acute Problem List Governance: Identifying Stakeholders and Workflow Best Practices
• Business and Clinical Analytics: Actionable Insights
• Doctors’ Lounge: Anesthesia
• Interoperability: Solutions to Connect Your Community
• Technical Town Hall: Q&A with Our Executives
• Leveraging MEDITECH Physician Documentation to Improve CDI Processes

CloudWave, Forward Advantage, and NHA will again co-sponsor a welcome reception for attendees the evening before the forum gets underway. The reception will be held October 19 at Bar Louie in Foxborough from 6 to 9 p.m. To request your invitation for the event, please contact Susan LaVita.

NHA is Hiring

To keep up with the demand from our clients, NHA continues to need excellent MEDITECH specialists. We have been named to the Top 100 “Best Places to Work” for the third consecutive year.
 
We believe there are significant advantages to being part of NHA. As part of the largest consulting company focused exclusively on serving the MEDITECH community, we enjoy an exceptional working relationship with MEDITECH, offer a collaborative work environment and treat each of our staff with respect. Our competitive compensation package includes exceptional medical insurance coverage as part of our extensive benefits as well as on-going education to maintain and develop skills and talent. Our employment approach and focus on long-term business relationships has led to an unparalleled record for consultant and client retention.
 
If you have interest in consulting and have solid MEDITECH experience with implementing one of their applications, please contact us. We have an outstanding mentoring program for new consultants and the best reputation in the MEDITECH community for training and development of our staff. We are the first company certified in the new MEDITECH READY implementation methodology.
 
We are also interested in experienced consultants from other companies. As the largest company that works exclusively with MEDITECH, you would be supported as you continue to build your skills. In addition, our management approach has demonstrated a respect for our consultants and created a collegial atmosphere that encourages information sharing and support.
 
While we have a number of openings, at this time, we are particularly interested in candidates with strong project management experience (6.x preferred), Revenue Cycle and Ambulatory.
 
If you are interested please contact us at recruiting@navinhaffty.com or call us at 855-309-9334. See what positions are currently available by visiting the NHA Current Openings page.
 
Please note that at this time, we are only able to consider those able to travel up to 80% of the time. (Current employees of MEDITECH or of our clients cannot be considered.)

Client Job Board

If you are interested in exploring new positions at other organizations visit the client job board section of our website. This is a free service of NHA to the MEDITECH community. Currently, there are many postings from MEDITECH organizations. If you or a colleague are interested, check out what’s open.

If you would like to include your organization’s listing on the NHA website, please email Katie Kelly at kkelly@navinhaffty.com. (Please note that as this is a courtesy to the MEDITECH community, we will not accept postings from recruiting companies.)