Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

When the ABIM Foundation launched its Choosing Wisely initiative, news outlets, including Inside Healthcare, picked up the story in droves, focusing on how much money excessive and unnecessary tests are costing the healthcare industry. The campaign, and more broadly the overall concept, still causes debate. But to come to any real solution to over-testing, the medical community and regulators have to address the root causes, one of those causes being the fear of malpractice lawsuits.

According to survey results from The Future of Healthcare compiled by The Doctors Company, the nation’s largest insurer of physician and surgeon medical liability, in the era of healthcare reform, doctors’ fear of malpractice suits hasn’t lessened. That fear often results in defensive medicine, which can then lead to over-testing – the very thing that Choosing Wisely campaigns against. According to the survey, 65 percent of respondents do not think that healthcare reform will reduce defensive medicine. One New Mexico surgeon stated that “We all practice very expensive defensive medicine. I realize I order between five to 15 unnecessary MRIs, maybe two to three specialist consults, maybe some unnecessary lab test weekly to prevent lawsuits.” Another respondent from Oregon stated “Until you can control medical malpractice, you will have defensive medicine.”

I don’t know how those two states are doing with tort reform, but the American Medical Association just commended Georgia for being the first state to enact legal protections for physicians engaged in quality and delivery improvement initiatives included in the federal health care reform law.

“The new State Physician Shield Act is based on model legislation developed by the AMA Advocacy Resource Center to make it clear that federal standards or guidelines designed to enhance access to high-quality health care cannot be used to invent new legal actions against physicians,” AMA states. “The decisive action of Georgia lawmakers holds the line against medical liability abuse and helps avert more civil actions against physicians, which increase medical liability insurance premiums and reduce access to health care for Georgia’s patients.”

Healthcare reform today preaches innovation – innovation to increase the quality of care and innovation to reduce its costs. But if physicians are afraid to pioneer new methods, than the reform healthcare seeks won’t come as soon as some would like. On the other hand, according to the National Practitioner Data Bank, 28.6 percent of malpractice payments are for diagnostic mistakes, and without proper diagnoses, treatment is pretty much useless. A healthy dose of caution might be expensive, but it doesn’t necessarily hurt, either.

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Josh Cook

Security is always on my mind as an IT director, and as a healthcare business, protecting patient health information is the top priority at The Cardiac & Vascular Institute (TCAVI). When I read this year’s ISTR (Internet Security Report from Symantec), the findings meshed with a lot of the current concerns in our industry, specifically around keeping sensitive information safe in an increasingly hostile world. With 35 percent of all data breaches now occurring in healthcare – more than in any other industry – it shows that we still have a lot of progress to make when it comes to effective security.

We’ve also been more concerned about mobile security lately, from several different standpoints. Not only are the bad guys likely to pay more attention to mobile devices as more employees use them, but BYOD introduces a whole new set of challenges, with employees managing their own devices. The ISTR shows that our concerns are grounded in reality. About one-third of mobile threats are stealing information, and mobile threat families have gone up 58 percent. It was especially interesting to see that mobile vulnerabilities in 2012 increased to 416, almost tripled from just two years ago.

A lot of small and medium businesses tend to think we’re not really on the radar of hackers and other cybercriminals, at least not as much as bigger companies. But the ISTR showed that we have to be more careful than ever because 31 percent of attacks are targeted at companies with fewer than 250 employees. It’s a dramatic wake-up call, because they’re not only after us for our information, but we could possibly be used as a stepping stone to attack others. It was startling to see web-based attacks used to initiate situations like watering hole attacks, using an infected website of one organization to attack another organization. This and other web-based threats are especially important for our organization to pay attention to because a lot of our users are not especially technical savvy. Because they are more likely than others to click on links that look interesting, even though they might lead to infecting their computers, the ISTR helps us understand the need for robust protection for our endpoints.

For months at TCAVI we’ve been working on shoring up our defenses, especially anticipating user behavior. We’re educating our employees about the risks of social engineering and also establishing policies and procedures. We also understand that antivirus alone is not enough to protect against today’s threats, and we use a defense in-depth strategy that uses additional layers of protection.

Josh Cook is IT Director at The Cardiac & Vascular Institute

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Laura Speek

Around the globe, hospitals, clinics and medical practices are scrambling to adopt increasingly complex health information technology (HIT) systems. While medical CIOs evaluate a lush offering of sophisticated technological advances, they still face the challenge of dealing with old-fashioned human resistance to change.

Unquestionably, a driving force behind resistance to change is fear. This includes fear of the unknown, fear of wasting money, fear of losing productivity – and in the case of healthcare providers – fear of making a life-threatening mistake. Given the stakes, caregiver resistance to HIT adoption is both understandable and natural.

In a clinical setting, fear-based resistance can manifest itself in creating “work-arounds” to avoid using technology or creating a string of excuses to delay the inevitable. As a learning and development specialist with The Breakaway Group, I have the opportunity to help healthcare organizations neutralize fear-based resistance to technological change through simulation-based HIT adoption training. Here are a few key points that underlie our unique approach:

Identify the Depth and Breadth of the Resistance
In many medical organizations, certain providers appear to lead resistance campaigns. Smart CIOs realize that as a group, doctors have loud voices and command large audiences. But providers may only be a visible (and audible) tip of a fear-frozen iceberg that is much larger and deeper than originally thought.

It is a good idea to survey all employees to identify the scope and shape of HIT resistance in your organization. This is the foundation for developing a systemic training plan to overcome silent but deep opposition.

Capitalize on Learner Characteristics
Although every medical group has multiple job descriptions and responsibilities, adult learners are the primary target audience. Adults share some learning characteristics that can be leveraged to launch a strategic anti-resistance training program.

• Adult learners are motivated by practicality. They eagerly engage in learning opportunities that directly relate to their particular challenges and responsibilities. Training that is based on real-life, role-based scenarios immediately captures their attention and interest.

• Adult learners have limited time. They respond well to training that can be accessed 24/7, and is presented in small, manageable chunks. They also prefer the convenience of individual, self-paced learning.

• Adult learners are naturally skeptical regarding change, particularly technological change. If the goal is to reduce fear and resistance, training should be non-threatening and repeatable. Ideally, it should gently guide users through workflows and procedures to systematically develop proficiency and confidence. While learners may need to pass exams to prove they have mastered the material, making the exams logical and repeatable reduces test anxiety. This encourages learners to focus on absorbing the material as opposed to fixating on potential test questions.

• Adult learners can be overwhelmed with information overload. While it is tempting show off every technological bell and whistle in a new HIT system, we urge clients to initially focus only on tasks required to develop proficiency (not mastery) for regular job performance. It takes discipline (and sometimes surgical skill) to limit training in this way, but we find it has the benefit of getting people up to speed quickly while building confidence, and most importantly, developing a desire to learn more.

Get Creative with Metrics
Adult learners can be highly competitive. A smart training program uses metrics in a way that encourages healthy competition, gives participants a sense of accomplishment, and provides feedback to make continual improvements.

Short, interactive simulation courses tick all the boxes discussed here. They are relevant, manageable, convenient, repeatable, and non-threatening. They take advantage of adult learner characteristics in a way that naturally reduces fear and resistance, builds knowledge required for HIT proficiency, and even puts a little fun into the equation. One physician described his simulator experience as “addicting.”

Organizations using simulation-based training report smoother, less stressful go-live events – and over time – deeper, more permanent integration of new technology into workflows. In the long run, smart training programs that truly address the needs, concerns and learning styles within an organization can result in a lot more bang for the HIT investment buck.

Laura Speek, MBA, is a Learning and Development Specialist at The Breakaway Group, A Xerox Company.

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Zachary Jones

Where will your nursing career take you in the next five to 20 years? Nursing is a great career because it allows you to help the sick and injured. However, you may want to take your nursing career beyond just caring for patients and making doctors look like the experts nurses are. Here are some tips to consider when advancing your nursing career.

Advance Your Education
Advancing your nursing career starts by investing in your nursing education. Some nurses stop pursuing their education when they complete an LPN or BSN. However, to gain more nursing career opportunities you must have the education and skills needed beyond caring for patients. Thus, it’s important to continue taking post secondary classes. For instance, some nurses return to school to become nurse practitioners. Other nurses want to add to their skill set by pursing a MSN Executive Leadership degree. Even if you love the type of nursing you’re doing now, pursuing an advanced degree is important to advancing your career .

Maintain Professionalism
You know the importance of nursing professionalism of maintaining patient confidentially, being honest and respecting co-workers. After all, you know that ethics and professional demeanor is vital to earn and keep patients’ trust. It’s also important for future employers too. Yes, professionalism is important on and off the job. For example, after a nurse has earned an MSN degree he or she applies for jobs. It’s common practice for employers – not just nursing employers – to look at a candidate’s social media and/or personal websites. So, maintain professionalism at all times – even on social media sites.

Become a Leader
Becoming a leader involves developing skills that have a positive impact on your career such as conflict management, problem solving and active listening skills. You can start in your current nursing job, but pursue a MSN Executive Leadership degree too. The degree teaches you those critical skills to help manage a nursing unit or department. In addition, this degree prepares you for a nursing career that doesn’t involve taking care of patients. Nurses who graduate with this degree advance into administrative leadership positions because they know project management, budgeting and assessing policies.

Keep Abreast of Nursing Positions
Even if you’re satisfied with your current nursing position now, keep looking at the different available nursing positions – especially the jobs that don’t include duties you’re doing now. This opens up your thinking about where you want your nursing career to take you in five or 10 years. Whether you decide to get a MSN Executive Leadership degree or not, invest in your education. Looking at current career opening helps you take control of your nursing career.

Becoming a nurse is a great accomplishment. Working in the medical field is very rewarding. If you love healthcare but would like a change from your current career, than furthering your education is a terrific option that will enhance your skills and advance your career.

Zachary Jones can be reached at ztjones@yahoo.com

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Zachary Jones

Today’s healthcare environment is rapidly changing. The advent of value-based Medicare physician payment is supposed to motivate healthcare professionals to change their behavior and services for the better, especially when commercial players are following suit. This transition period is unique and critical. It gives an opportunity to reorder medical practices to be more effective, resourceful and ingenious to gain better outcomes in patients. One of the methods to achieve this is clinical integration, which means, physicians are entailed to work systematically together, with or without other professionals and organizations to come up with improved high-quality delivery, valued care and safety to their patients as well as to the communities.

Preparing for the Challenges
To respond to the sophisticated healthcare management in both clinical and organizational settings, healthcare professionals feel the need to hone their acumen in personnel management, negotiation and organizational theory. To become more effective, they strive for additional education. Schools and training centers cooperate by having their doors open to those who seek improvement in the healthcare services field by facilitating a connection between a huge organization and frontline providers of patient care.

Advancing a Career through a Master of Science in Nursing
Nursing program or course graduates typically want to continue their work in a medical setting, but they may soon go further in the organization. Thus, they pursue studies such as Master of Science in Nursing (MSN) While currently working in the healthcare field, nurses can conveniently pursue career advancement through eLearning.

Online MSN Features
• Gives hands-on experience in working with great healthcare executives, top administrators and nursing leaders.
• Students can learn to evaluate various healthcare delivery systems, acquire expertise in allocating resources by analyzing the needs of a facility.
• Provides a program that is flexible, fast and focused and doesn’t require a long list of pre-requisites.
• Have the learners gain clinical leadership and confidence to aid in re-shaping patient care that can be taken in nursing homes, hospitals and healthcare companies as well as possess a global mindset to solve issues in a broader way to impact the country and the world.

Advanced Nursing Career – Caring for the Care Providers
The need for well-trained administrators in nursing is increasing. The U.S. Bureau of Labor Statistics said that there is a high demand for managers in the health and medical service areas and that it is expected to grow by 16 percent by 2018. Online MSN is a master’s program that prepares nurses to manage care services in specialty areas and face the challenges of the ever-dynamic healthcare environment.

Zachary Jones can be reached at ztjones@yahoo.com

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Russell Benaroya

Health plans around the country are struggling to find the right tone and message during these rocky times of change. Appeals to the consumer to stand together against rising health costs and in support of healthy lifestyles may contrast with the reality of plans increasing individual rates because costs are still soaring.

This is a time for a smart strategic communications plan. Health plans will be sending out renewal notifications to many of their members in 2013, passing along rising rates. Here is the gist of the messages that get sent out:

“We are all in this together. Rising healthcare costs are out of control. We don’t like it either, but we need to work together to fix this. In the meantime, we are going to be raising your rates (I know, we don’t want to have to do this) but feel comforted that we are empathetic and stand by you.”

Consumers may perceive this message as disingenuous because of some fundamentally wrong assumptions such as:

1. I actually have an affinity toward my health plan and am empathetic to their plight.
2. We are all just victims of an out of control system.
3. We can be conversational with each other because we’re on the same side of the table.
4. I actually accept that this is supposed to be personally impacting me.

I would argue that health plans should not play the role of victim, as public perception would generally not agree. Instead, plans could frame the problem in this way:

“Our healthcare system is going through enormous changes and we are all going to be impacted. As your health plan we care not only about your wellbeing, but also about managing down your costs. In 2013, you will see a new [health plan], one that works in partnership with our members to increase healthy lifestyle choices and share the burden of rising health care costs. We will incur some of that burden and we will ask you to pay an increased share as well. We want to work together with consumers and health care providers to turn the tide of skyrocketing health care costs. What we do together will determine the future of healthcare and its costs for all of us. We are looking forward to earning your trust through this time of transition.”

Health plans must drive a culture that can translate these words into actions. Part of this will include inspiring consumers to take charge of their health. Our company estimates that $56 billion per year is paid for medical claims that are the result of poor lifestyle decisions. Members can become more empowered through a strong communication campaign followed by action.

How would you like to get this message from your health plan?

“We are so excited to share that your premium this year went down $200 because of your healthy lifestyle. Based on others like you, your premium is 15% lower than average. We are thrilled that together we are sending a message that as partners we are going to win the fight. We will be with you during your good times and be by your side when the unexpected occurs. Together, we win. Keep it up!”

Russell Benaroya is the co-founder and CEO of EveryMove, a consumer-driven healthcare technology company. Benaroya can be reached at 206.779.1359 or russell@everymove.org. Follow on Twitter @EveryMove or visit www.everymove.org to learn more.

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

My Marathon Challenge
Chicago Marathon registration opened this week. I made a commitment a month ago to a friend and to my brother that I’m going to do this; I’m going to run 26.2 miles. I’ve registered for two other marathons in my life and both times I’ve gotten injured during training, though I was able to come back in good enough shape to do a half.

This time around I’m trepidatious, nervous and overwhelmed. Given all of the stressful emotions, do I really need to do this? No, but I look at the benefits I expect to reap: strength, stick-to-it-iveness, adventure, admission to an elite club (though as a slow member of the pack) and it is one more item to cross off my bucket list.

The Hospital and Clinic Adoption Marathon
I venture that hospital leadership teams experience similar feelings of anxiety when deciding to move from paper charts to electronic medical records. Then rather than settling for implementation, they don’t stop until the EMR has been fully adopted by the organization. They may have tried system-wide change before and come up short of the original goal. And though any accomplishment was better than no accomplishment, perhaps the results weren’t what they expected or wanted. Today, healthcare leadership contemplates EMR adoption because of its strengths and benefits; and because successfully navigating the process guarantees admission to an elite club that is current within the healthcare industry and focused on providing quality, state-of-the-art care to patients.

However, like training for a marathon, adopting an EMR is not a jog-around-the-block-and-you’re-done proposition. True adoption takes endurance, intense focus on the long-term goal, expectation of frustration, but also an overwhelming expectation of success. Just as it may rain on a long-run training day, so may there be a stormy reception and push back by hospital staff as the EMR is introduced. Success in both arenas requires a willingness to endure harsh weather and train anyway, with the optimum results in mind.

Commitment Contract is Signed
So I’m registered! My contract between the Chicago Marathon sponsors and myself is that I’ll be there on Oct. 13 to run through the streets of that beautiful city on Lake Michigan! I’ve started training – slowly and optimistically. I’m excited, though still trepidatious, but I’m going to move ahead with a strong preparation plan, put one foot in front of the other and become a marathoner.

Once a hospital or clinic signs the contract to implement a new EMR, it begins marathon training by putting in place the right leadership team. Engaged leadership doesn’t mean the CIO or IT but rather clinicians. Clinicians are busy people and are in the business of improving lives – but the fact is they are the ones on the ground using the new EMR systems, and must be trained on the tasks relevant to their roles. Simulation training, for example, gives caregivers an opportunity to practice tasks like entering orders and writing prescriptions without real-life risks and consequences. By training caregivers on the tasks that are applicable to their role, it reduces go-live stress and chaos; optimizes proper, lifetime use of the EMR; maximizes return on EMR investment; and makes leaders and advocates out of the clinician staff.

As I begin my marathon journey, so will hospitals and clinics all over the world. We’re strapping on new shoes, warming up, and looking ahead to a rewarding finish.

Jennifer Bergeron is a learning and development consultant at The Breakaway Group, a Xerox Company.

Inside Healthcare magazine is pleased to present the points of view of many different industry stakeholders. If you would like to contribute your own guest blog to our site, please contact the editor at jamie.morgan@phoenixmediacorp.com

By Hal Stern

Many people have been talking lately about the importance of patient engagement in healthcare. But this conversation is taking place wholly around the actual delivery of care which, while incredibly important, does not include the entire picture, namely the billing process.

This is one of those topics no one really wants to talk about. Many people see the relationship between the patient and the healthcare provider as only taking place in the exam room and not outside of it. Money is generally something healthcare providers don’t want to talk about with the patient. And it is true that there are appropriate times and places to bring up the topic. But, with healthcare reform on the mind of every hospital in America, billing issues and revenue are becoming impossible to ignore. And just like the policies are changing, the ways hospitals approach this issue are going to have to change.

With the implementation of patient satisfaction scores impacting Medicare reimbursements, hospital executives must begin to recognize that a lousy billing experience could ruin whatever pleasant experience is provided to the patient at the front door. Spending millions of dollars on a lobby and having a concierge are all well and good. But how much of all that money and effort spent delivering a positive experience is wasted by putting the patient through a bad billing experience?

The truth is that most hospitals do not have sufficient internal systems in place to provide the best customer service to their patients once they leave the hospital. Patient telephone calls that aren’t returned or not returned for days leads to patient dissatisfaction and resistance to voluntary, timely payment. And having a cumbersome payment process only leads to greater resistance to payment. How many hospitals provide patients with payment options other than writing a check, getting a stamp and an envelope, and mailing it in? How many hospital executives pay their bills this way anymore?

What this all really comes down to is the necessity to engage with the patient during the billing process just like you engage them when providing healthcare. Many items go into make this process better and more effective. Better registration and better cost estimation are among them. But here are the three biggest issues:

The Bill
This is where it all starts – the bill. It’s fives pages long and incredibly complicated. Half the time, a patient doesn’t understand it or even look at it twice because it’s along with a blizzard of other paper bills. Some hospitals are trying to make them more manageable by breaking it up into categories like pharmacy, medical, and equipment. But is the patient actually being better served by this? The fact is that the average patient doesn’t understand everything that went into their healthcare and isn’t going to take the time to sit down and try to understand it themselves. This situation has only been made worse as the result of the highly publicized recently published Time magazine article on hospital bills.

The nature of a hospital bill is complicated. Simply cutting it from five pages to one isn’t going to make a difference in helping the patient. What will make a difference is someone from the hospital explaining the details of that bill to the patient. Most patients are more than happy to pay a bill if they understand what is on it. This requires engaging with the patient on this issue and working closely with them to help them understand what went into the healthcare they received.

Education
There is no way around the fact that this is a very confusing business and hospitals have to work closely with patients to help them understand the process. Hospitals have just as much of a duty to the patient to educate them on what they are experiencing as providing them with quality healthcare.
Patients will tend to think, “I thought my insurance pays 100 percent.” Of course, few, if any insurance policies pay 100 percent so every patient is going to get an EOB and then a bill. Hospital executives must face the simple reality that most consumers do not know what is covered under their plan and what isn’t until they get the hospital bill. Most consumers also don’t know where to go to find the answers, either. Hospitals need to accept the fact that they must provide this information to their patients. It is no longer acceptable to simply send out statements, answer some of the patient calls and send unpaid accounts to collections. This traditional work plan is obsolete in the 21st century and is a major patient satisfaction killer. So hospitals need to effectively educate patients on their payment options and their insurance benefits and coverage. This situation is even more critical starting in 2014 with the expansion of Medicaid and mandated health insurance coverage.

Financial Counseling
You provided healthcare and it cost money. But your obligation doesn’t end there. Now help your patients find options on how to pay their bills. Someone has to do it and the more hospitals can provide that type of financial counseling and advice to a patient, and the closer it is to the time care is provided, the more satisfied your patients will be.
Hospitals need to see themselves in a collaborative relationship with their patients. Engage patients in conversations about payment at the appropriate times during the healthcare delivery process. If patients are admitted in the middle of the night and a financial counselor isn’t there, follow up with a phone call. Assist patients with enrollment, and whatever needs to be done to aid the patient in settling the debt quickly.

As with any human relationship, thoughtful communication is the key to success. Engaging patients in this conversation, talking respectfully with them about their bills, third party coverage and payment options will make a significant difference in helping patients settle their debts as well as increasing their satisfaction with their overall hospital experience.

Hal Stern is the founder and CEO of Financial Health, a hospital billing and Medicaid enrollment company, with more than 30 years of experience in the healthcare finance industry. He is also a member of the District of Columbia and Maryland Bars.