Dr. David K. Butler came to healthcare as a digital native, unwilling to accept the paper-based status quo. In about a decade he went from using Microsoft Word to make medical notes legible to being named Epic Systems Physician of the Year for his contributions to the field of EMR implementation and optimization.
Butler is VP of EHR Optimization and Transformation at Sutter Health. In this podcast interview, I asked him to share his opinions and expertise. You’ll hear interesting perspectives on workflow, video games, and more.
(0:13) You went into medicine to be a practicing physician. How did you get interested in EMRs?
(2:58) EMR implementation has supporters but also detractors. What do you say to people who complain that EMRs have ruined the practice of medicine?
(6:36) In a decade you went from your first insight on electronic record keeping to being name Epic Physician of the year. How did it happen? What does it mean?
(9:32) How do video games fit into your view of how an EMR should operate?
(12:50) You work near Silicon Valley. What are you seeing from startup companies there? How do you advise them?
(16:18) What changes do providers need to make in EMR utilization as they shift from fee-for-service to value based payments?
Neil Smiley is CEO and Founder of Loopback Analytics, which supplies tools to providers to manage bundled payments. I asked him to comment on the growth of bundled payments and the role of analytics.
Why are hospitals hesitant to adopt bundled payment options? What strategies can long-term care providers take to encourage bundled payment adoption on a large scale?
In most cases, a hospital’s financial responsibility ends upon patient discharge. Bundled payments significantly lengthen the care episode, making hospitals responsible for the costs of downstream care partners. The shift to value-based reimbursement from our current environment of fee-for-service represents a sea-change for the industry. Decades of business practices, clinical relationships, payment structures and core competencies are being reevaluated in light of this new payment model. Such evaluation and reflection takes time, and we are starting to see leading organizations embrace this challenge as an opportunity to develop differentiating capabilities.
Long-term care providers can help accelerate this process through proactive engagement with their hospital colleagues. Hospitals will need better data from their post-acute care partners to have confidence that they can consistently deliver efficient care and strong clinical outcomes. The long-term care providers that can demonstrate these capabilities pave the way for hospitals to better understand, trust and rely on the broader care delivery pathway they must manage with bundled payments.
What are the main benefits patients will reap from bundled payments?
Bundled payments have the potential to significantly improve patient outcomes through better care coordination across providers and care settings.
Under a fee-for-service payment model, there is little financial incentive to help ensure a patient makes a successful transition to skilled nursing after an acute care stay, or ensuring that patient successfully transitions home after leaving a skilled nursing facility.
Under bundled payments, there is now an aligned incentive with providers across care settings to ensure transitions are clinically successful and financially efficient. Patients are likely to get more help in navigating multiple silos of care, when participating providers are financially responsible for the cost of poor outcomes.
What factors are holding back scalability of bundled payments options?
Broader scalability of bundled payment options will be paced by the availability of accurate and timely data from network participants and workable frameworks for sharing risks and rewards among bundled payment partners.
At the national level, CMS has relayed its intention to aggressively advance pay-for-value reimbursement models, with bundles being a prominent example. Ready or not, the expectation is that bundles will quickly expand to include additional conditions and broader mandated participation.
At a health system level, first movers that have invested in the tools, competencies and partnerships needed to succeed in bundle configurations will be courting more bundle opportunities to take advantage of their lead in the market.
What is the role of analytics in bundled payment? Can you provide an example?
Advanced analytics are absolutely essential to success in bundled payments.
Bundled payments require that different providers across the care continuum come together to consistently deliver a clinically successful and financially efficient episode of care. Without deep knowledge of potential partners’ strengths and weaknesses, a bundled payment manager stands a poor chance in creating a winning network.
CMS provides data to healthcare systems, ranging from high-level quality ratings to detailed, individual claims records. With effective application of data analytics, these sources of information, combined with data from network partners can be used to create the most effective care delivery network possible.
How will analytics advance over the next 5 years? 10 years? How do you measure progress?
Looking towards the future, we expect a pronounced shift from retrospective, historical analytics to prospective, predictive analytics. The former allows healthcare systems to accurately assess their current and historical states, and is an essential component for improving operations. The latter allows healthcare systems to avoid costs and adverse clinical events before they even occur. The availability of real-time health data will continue to grow with the proliferation of digital monitoring devices. Machine learning and predictive algorithms are already establishing themselves in matching patients with appropriate resources based on a diverse set of data markers. We foresee significant expansion on this front in the coming years.
With so many analytics solutions vendors out there how do you distinguish yourself?
Loopback Analytics puts analytics into action. Loopback has an integrated technology platform that allows our clients to move from investigatory analytics to data-driven interventions, through a platform that provides a closed loop feedback system to ensure executed actions achieve the expected impact.
It is only through such an integrated solution that healthcare organizations can be assured that the problem is understood, the appropriate actions executed and impact quantified.
The parent company of Tufts Medical Center plans to expand its hospital network with the addition of Hallmark Health System, a merger that will help both sides compete in a market dominated by bigger institutions…
“Both of these systems were undersized to be able to compete effectively, so it’s a good matchup from that standpoint,” said David E. Williams, president of the Boston-based consultancy Health Business Group. “It’s unlikely that there will be any serious regulatory opposition to this. If anything, I think the regulators will look favorably on this. I think it will help create more competition with Partners than if these companies just stayed on their own.”
This seems like a pretty good outcome for the institutions involved and for the healthcare market in Eastern Massachusetts.
I’m just back from vacation and look forwarding to jumping back into the blog!
I bought an Amazon Echo this week and have been enjoying using it in the kitchen. I can ask, “Alexa, what time is it in Germany?” and it will tell me. Or I can say, “Alexa, play music by the Beatles,” or ask, “Alexa, how many ounces in a cup?” and it will let me know. It’s remarkably easy –and not at all frustrating– to use. The whole family is enjoying it.
Naturally I started almost immediately to think of healthcare uses, so I wasn’t at all surprised to pick up the Boston Globe yesterday and see that my friends from Boston Children’s Hospital are a step or two ahead. Chief Innovation Officer John Brownstein, PhD and clinical innovation director Michael Docktor, MD have launched a KidsMD app for the platform and are testing out uses for Echo in the OR, ICU and bedroom.
Although the article lays out some of the potential for Echo, overall I find it too dismissive, highlighting a software glitch, voice recognition problem, and asserting that “another layer of technology might frustrate staff.” The article ends with a quote from a Children’s engineer whose own kids aren’t interested in speaking with Alexa. None of this reflects my family’s experience.
What the article misses is that Echo represents the latest example of physicians bringing cutting edge consumer technology into the hospital and running circles around the standard tools offered by the IT department. In the real world, physicians are early and enthusiastic adopters of tools like the iPad and iPhone, and through the bring your own device (BYOD) movement they have upended the traditional, clunky hospital IT environment.
Here are some thoughts about what could make Echo so useful for healthcare:
It’s the rare tool that can be used equally well by doctors and patients
It’s a handsfree device, which makes it easy to use when one’s hands are occupied, dirty, or injured
The voice recognition is really good, and works just fine in a noisy environment
It enables continuity of care because a patient could use the same device at home that was used at the hospital
It gets smarter all the time as new intelligence and apps are added to the cloud
It can entertain as well as inform
I can foresee apps that help patients remember their customized care instructions, “Alexa, how often am I supposed to change my dressing?” or “Alexa, am I supposed to take my medication with food?”
I also think it will be useful for hospitalized patients who are trying to remember questions they want answered the next time their doctor or nurse comes around. There is a built in ability to say, “Alexa, add butter to my shopping list.” So there’s no reason it couldn’t compile a list of doctor questions as well.
These are the veritable tip of the iceberg, and I look forward to seeing a thousand (or more) flowers bloom as the healthcare field embraces Echo. “Alexa, I love you.”
My wife was sick a few weekends ago so I took her to the Beth Israel urgent care clinic in Chestnut Hill where they diagnosed her with the flu. Nice modern facility. In network. Convenient parking. You get the idea. Care was good, but slow.
Then a few days ago, I received an Explanation of Benefits (EoB) from my health plan.
One reason to go to urgent care is that it’s more cost effective than the emergency room. In this case BI sent Blue Cross a bill for $1328. Blue Cross marked it down to $365.81, subtracted our co-pay ($35) and deductible ($231.68) and sent BI payment for a whopping $99.13.
In looking at the bill I was most struck by a couple line items. Microbiology/lab was billed at $202.00 and reimbursed at $26.48, or 13%. And Technical Component (maybe for an ultrasound?) was billed at $427.00 and paid at $22.33, or 5%.
Although medical charges (i.e., what’s billed) are known to be detached from reality, I found this EoB particularly galling. How can I explain my visceral reaction, especially to the $427 charge being reimbursed at $22.33?
If something is billed for $427 but reimbursed at just $22, it seems that BI is overcharging or Blue Cross is underpaying. Or is it both?
What happens to the poor schlub who’s out of network, or worse, lacks insurance? Is the $427 from rare patients like that –who pay 20x what Blue Cross pays– accounting for more than 100% of the center’s profits?
Is what I see on the EoB actually the economic reality behind the transaction? Or is BI or my wife’s BI practice being paid a capitated amount for her care and is this bill only meaningful for calculating our cost?
What is a patient who’s interested in “transparency” and “cost effectiveness” supposed to think? Did we do the right thing by going to urgent care or not? I think it would have been a lot more useful to see a comparison between the actual urgent care visit cost and a hypothetical visit to the ER or physician office