An acronym for “Accountable Care Organization”, an ACO is a model of healthcare delivery in which a group of healthcare providers agree to accept payment for their services based on the aggregated health outcomes of the patients they see, as opposed to the total number of services performed. ACOs reward providers in a “fee for health” model, as opposed to a traditional “fee for service” model. Although the term ACO can apply to a variety of types of organizations, regulations for establishing ACOs to participate in the Medicare Shared Savings Program specifically were included in the Patient Protection and Affordable Care Act of 2010.
Three technology trends are creating big opportunities for healthcare providers and managers to improve their bottom line, drive savings, and empower a mobile workforce with “The Cloud”:
Improved cellular and network access to the Internet at all times, from all devices.
More powerful, less expensive smartphones and mobile devices to harness this improved access.
The move to deliver computing services to these mobile devices, as well as traditional personal computers through these ubiquitous, powerful Internet connections, so that most of the work is actually done “In the Cloud”- saving a lot of resources.
The Cloud is more than just a fashionable concept – this is a real change in the way people work– and leading organizations are looking past the buzz into the substantive improvements that technology can offer in work flow and cash flow.
I’ve had a lot of questions since last week when I offered to help readers “get on the cloud.” Most people want to know – what exactly does getting on the cloud mean?
The term cloud comes from both the look of technical drawings which depict the relationship between cloud services and consumers, and is also a metaphor for the fact that cloud service providers exist out of sight in some distant location. My favorite definition of the cloud is “Using the Internet to store, manipulate and deliver data.” Here are 76 ways to do just that!
SECURITY & RISK MANAGEMENT
Decide user by user which files and folders each employee or stakeholder may have access to. Decide if the user may view information, upload information, download information, invite other collaborators or edit documents. Change the user’s permission instantly, or eliminate their access to everything on the spot.
Store critical documents: letter of incorporation, Tax ID assignment, Medicare letters, shareholder agreements, by-laws, etc.
Scan in any and all documentation of lawsuits and or legal correspondence about patients.
Collate logon information for important sites: CAQH, NPPES, PECOS, state board, specialty board, etc.
Collect all information needed for credentialing and privileges for all providers in one easy place: CV, photo, license, board credentials, DEA, state registration, malpractice, references, etc. Keep copies of all credentialing applications in the same file.
Keep a licensing and privileges spreadsheet for all professionals so deadlines don’t take you by surprise. Include CPR, ALSC, DEA, state licenses, and board certification and recertification.
Never worry if you’ve locked your office, your file cabinet or your desk again. Your information is safe in the cloud.
Store important logons and passwords on the cloud along with instructions and know that if something happens to you, the business will recover quickly.
Have employees watch for health fairs and special events that your practice can participate in. Develop a calendar for community events that you can prepare for annually.
Share files up to 2GB (images, video, audio, text)
Turn a folder into a public web page.
Start a secure referrers’ area and give access to those practices that refer to you. Stock it with FAQs, referral forms, maps and directions to your practice, and phone numbers and emails for communication. Keep a referrer satisfaction survey on their pod at all times.
Push the patient schedule into the cloud so any provider can check their schedule at any time from anywhere.
Store building or suite blueprints.
Develop a practice glossary to document all abbreviations and specialty-specific terminology – very helpful for new employees and transcriptionists.
Make a secure education area for your patients which they can access from your website or in your waiting area on iPads. Include websites, blogs, patient satisfaction and other surveys, health tracking programs, etc.
For those providers on productivity bonuses, push a productivity report to the cloud for them to review privately.
Put staff education programs on the cloud for new employee orientation and annual training on compliance, OSHA, HIPAA, fire safety and disaster communication plans.
Post photos of the office picnic or Christmas party, or the new baby, or the bride and groom.
Use the cloud as a digital scrapbook of events, new employees, new services, accolades, advertising or publicity.
Pass around a digital birthday greeting card to all staff except the one having the birthday!
Post a job on craigslist. Once you have a group of candidates you want to consider, give them a link to a folder with the position job description, benefits schedule and in-depth information about the hiring time line.
Post lunch menus for restaurants and take-outs within several miles of the practice so employees can get lunch efficiently and quickly.
Post the office schedule for the year showing which dates the office will be closed for holidays.
Post the call schedule and let your answering service and the hospitals view it.
Publish your weekly practice newsletter on the cloud – it becomes an instant record of when and how things were communicated.
Scan invoices to the cloud for storage once you’ve paid them.
Scan invoices to the cloud for an external bookkeeper to access and pay them.
Scan invoices to the cloud for a physician to approve them for payment.
Scan the daily accounts receivable work (EOBs, checks, deposit slips, denials, reconciliations) to the cloud and shred the originals at the interval of your choice.
Scan documents to the cloud when you are notified that employees are having monies withheld from their paychecks for child support or garnishment, or when they change their deposit information or retirement plan contribution.
Track the history of files and folders – when did we change this policy? When did we go to this compensation system? What was the original wording of this contract?
Generate reports on employee productivity, looking for patterns of collaboration and innovation.
Scan RAC, CERT, ZPIC and other audit letters when they come and keep a spreadsheet of dates records and appeals are due.
Have online meetings centered around documents in the cloud.
Post job protocols and empower employees to change protocols regularly as information and routines change.
Start a CME log for each provider that the providers can easily add to.
Have your employees collect stories, links and other items in the cloud to push to your Facebook page or website blog.
Keep minutes from physician meetings and request all physicians review, ask for changes and sign off.
Keep attendance and minutes from staff meetings and ask all staff to electronically sign the minutes.
Have each employee keep a continuing education log for face-to-face and online education.
Assign tasks. Place something on the cloud and assign staff to respond to it, change it, develop it or implement it.
Develop a “How Do I?” document for quick information new employees need to know and established employees may not remember. Some examples: How do I reach the inclement weather information line? What do I do if there is a blood spill in the practice?
For the manager – develop a staff roster with dates of hire, dates of birth, social security numbers, phone numbers, hourly wage and termination dates. One document will answer 25% of questions you have or others ask you every day.
Standardize protocols and information when you have multiple sites or divisions.
Show each employee how to keep their most-used files on their digital desktop to access without a logon and password.
Sync desktop folders to cloud folders automatically – documents are updated to the latest version without thinking about it.
Restructure your files and folders as many times as you want or need to. Rename files, move and copy files, and delete files if they are not serving the purpose you thought they would.
Expand the number of users instantly for special projects.
Put every form on the cloud, have employees complete them on the cloud, sign them electronically, then share them with you for your electronic signature.
Put new templates or forms on the cloud for everyone to draw from – eliminate old letterheads, logos, addresses, etc. instantly.
Fax documents from the cloud to a fax machine.
Email files from anywhere.
Search for anything in your cloud by words or phrases. Never lose anything again!
Access the cloud from anywhere and from any device – smartphone, PC, iPad…
Put the patient schedule information into the cloud so if inclement weather hits, staff can access the schedule at home and contact patients about their appointments.
Access your business 24/7/365.
Assign a folder for your CPA to be notified when financials are available for download, or for you and the physicians to be notified when s/he finishes the financials or taxes.
Assign a folder for your benefits broker to be notified when new employee applications for medical and dental benefits are available for download.
Assign a folder for your banker to be notified when quarterly financials are available for download.
Assign a folder for your physicians/owners to be notified when monthly or quarterly financials are available for their review.
Post practice calendars for paid time off requested and approved.
Develop a physician referral resource tool if your PMS does not organize that information well. Create your own spreadsheet with all the fields of information that are important to your practice and have all employees add to it and correct it routinely. Have someone in the practice or a temp or prn person call every practice/group on the list twice a year and confirm all the pertinent information.
Post a “Who Covers Whom” list that spells out who covers primary responsibilities in the practice when someone is out of the office. Building your team 3 deep (for every primary task, there are at least 3 people that can perform that task) is crucial for reducing vulnerability.
Video new employees answering a few questions about themselves and post it on the cloud for all staff to view.
Put video of all staff introducing themselves and telling what they do on the cloud for new employees to view.
Video benefit providers discussing benefits so employees can watch at any time – medical insurance, dental insurance, vision insurance, short and long-term disability, life insurance and retirement benefits. Employees will get more out of and become more aware of what their benefits are.
Make an easy-reference spreadsheet with the payer contracts listed and images of the plan cards for staff to be able to identify the contracts and plans in force at any given time.
Keep personnel files on the cloud. You may choose to have a file of documents the employee may see and get a copy of, and a file of documents they may not see or get copies of. Both can be a part of the same folder.
Store scripts for your messages on hold, your after-hours message and your scripting for employees.
Increase storage space without buying any hardware or software.
Scan charts into the cloud as a preliminary repository before implementing EMR, or scan charts of inactive patients in so you don’t have to pay to store them offsite.
Never back-up your documents on your computer again.
Put your triage algorithm or flow sheet on the cloud. Hire nurses to triage from home.
If a manual doesn’t come electronically, scan it onto your cloud. Check the manual before you call the repairman.
Preserve your valuable employee knowledge – have each department develop a folder with the important resources for their staff. The billing department may have websites they refer to for coding questions, a primer on evaluation and management coding, a cheat sheet on standard practice fees, and a calendar for the times of the year that different updates and revisions to CPTs, ICDs and NCCI edits.
Patients want to know why they can’t get a return call from their doctor’s office – here are six reasons why the calls have increased and physician offices are having trouble meeting the needs of their patients.
Medication questions and requests for a prescriptions change. The average number of retail prescriptions per capita increased from 10.1 in 1999 to 12.6 in 2009. (Kaiser Family Foundation calculations using data from IMS Health, http://www.imshealth.com.) Because it is not easy to access prescription cost by payer in the exam room, medical practices get lots of callbacks from patients asking to change their prescriptions once they arrive at the pharmacy and find out how much the prescription costs. Related issue: Many national-chain pharmacies have electronic systems that automatically request a new prescription when the patient is out of refills. Also related: Patients calling to ask for additional medication samples.
Patients are delaying coming to the physician’s office by calling the practice with questions. Patients want to forestall paying their co-pay or their high-deductible by getting their care questions answered without coming to the doctor’s office.
Patients call back with questions about what they heard or didn’t hear in the exam room. They may not remember what the physician told them, they may not have understood the medical jargon, or they may have a hearing problem and were not comfortable asking the physician to repeat something.
Impatience: we live in an instant gratification world and patient expectations are not aligned with what physician offices can realistically provide.
Some patients will not leave voice mail messages and will call back multiple times until they get a live human being or will punch in options until they find someone to answer the phone.
Physician offices are often understaffed. Physicians find it untenable to add more staff to do more tasks for less money or no money at all.
And here are some possible solutions:
Have formularies for all major health plans on hand in the exam room. These could be paper lists, or electronic lists for the tablet or smartphone. (Note: Epocrates currently has a deal with Walgreen’s to support their discount program on the smartphone.) Don’t underestimate the patient satisfaction and reduction in callbacks for sending the patient out of the exam room with the right prescription. Automatic refills are not an appropriate function of pharmacies. Physicians should provide samples (check the formulary!) and a prescription to get filled if the samples do the job. If a patient can’t afford the brand name prescription, a prescription assistance program is the next step.
Patients need to be advised appropriately when they need to see the physician and when they don’t. Good triage nurses can be worth their weight in gold, but you can hold the costs down by hiring a triage nurse or several to work from their homes taking calls from your patients. The nurse will need to have access to your practice management system to schedule appointments and to document the conversation if the patient is given advice.
Provide patients with different modes of assimilating health information. Some patients are recording office visits via voice or video and one of the goals of meaningful use is providing patients with an office visit summary when they exit the practice. Websites should be loaded with educational information that physicians can “prescribe” to their patients. Some physicians help to cut down on return calls and improve understanding by asking the patient how they’ll describe the visit to a family member.
Give patients (on the web, in the practice, on your on-hold messages) realistic timelines for callbacks and make it so.
Yes, some patients will game the system to get their needs met ahead of others. Ask them to adhere to the practice guidelines. There will always be some cheaters, but most patients will respect you if you respond to them when you said you would.
The only answer to understaffing is technology. Use a patient portal to allow patients to request refills, schedule appointments and chat with billing staff or nurses. Replace paper charts with EMR. Use efaxing to eliminate paper faxes. Use the cloud to store information and collaborate.