Performance based reimbursement – coming soon to a place near you


telehealth

Healthcare services delivery in the USA is out of control.

Costs have skyrocketed, facilities are overloaded, doctors are suffering burnout and government intervention has, under the guise of improving patient safety and outcomes, yielded only modest improvements.

MU (Meaningful Use) is largely responsible for the current alarming state of affairs.

It takes longer to process patients than before MU and it seems the focus has shifted away from treatment of individual patients to long-term outcomes data collection.

The remedy, after billions of dollars spent, is to rewind and set the focus on quality, efficiency and effectiveness of healthcare services delivery. Something that should have been the focus of MU from the start. Better late than never.

The problem is going to be with implementation.

Current EHRs were not designed to generate performance data. Replacing what is currently in use will be expensive and we can expect several rounds of false starts as vendors shift into a feeding frenzy to crank out “new” and “improved” EHRs using, the same old, in many cases, database architectures invented in the 1960s. Customers will be buying pigs with lipstick.

Strangely, the methodologies to do things the right way are readily available. We need four methodologies (BPM, R.A.L.B., ACM and FOMM) to make performance-based reimbursement a success.

And, there are two hurdles that need to be sorted.

One is “not invented here” and the other is “resistance to change”. Both of these are cultural hurdles.

NIH is particularly well entrenched in healthcare so it will be difficult to port BPM / R.A.L.B./ ACM / FOMM. The easy solution for NIH is to get over it.

As for Resistance to Change, there is an easy fix that  does not require making changes in  the way we manage work.

If you think about it, all of us, each day, come into our places of work and immediately take note of our fixed time appointments. No one has a problem with a calendar. No change, no resistance.

Following calendar inspection, we look at our to-do list and we micro-schedule to-do tasks to fit between fixed time commitments.

If you have a half hour appointment at 0900 hours and another at 1100 hours, you may reasonably pick a couple of small tasks to clear off your desk between 0930 and 1045. Or, you may prefer to make progress on one large to-do task. Up to you, and no obligation to stick with one approach or the other from one day to the next.

Resistance to change in healthcare can be minimized so long as the pitch is right.

The thing is case management has been at the core of medicine since the 1600s. Accordingly, healthcare workers have no problem going to a patient chart prior to meeting with a patient so transitioning to an e-chart that looks the same as the old manila folder is not a problem.

The other thing is the concept in healthcare of “best practices” is understood.

BPM excels at enabling building and enhancing best practices, but it has a reputation of imposing rigid protocols. BPM and ACM together replace the rigidity of structured protocols where these make sense and accommodate unstructured or ad hoc interventions where appropriate. No rigidity, no resistance.

The other positive attribute of BPM is that lets agency functional unit staff document their workflows featuring existing agency forms, so healthcare professionals see their workflows posting their forms. No change, no resistance.

All of these scheduling maneuvers are eminently handled by R.A.L.B.(i.e. 3-tier scheduling or Resource Allocation, Leveling and Balancing).

FOMM (Figure of Merit Matrices) is also not new, and easy to implement. Basically, it’s all about non-subjective assessment of progress toward meeting Case objectives. You could do it on the back of an envelope, but it’s a lot faster/easier if you append a spreadsheet template to each Case Record and follow the methodology.

None of these tried and true healthcare services delivery methods will work if the software User Interface is not right.

Here again, no change will result in no resistance.

So, let’s go forward with a UI  consisting of a split screen featuring two constructs everyone is familiar with (a calendar and a to-do list) and let’s make things such that using the UI requires less effort than not using it. No resistance here.

OK, how does this get us to performance-based?

This is where IT comes in – with end-users in the drivers’ seat, building and enhancing their own workflows, IT will have time to focus on predictive analytics. As users perform interventions, record data, the data will flow to the EHR (as it does now) but with a parallel feed to a data warehouse where all manner of analytics can take place.

The final piece of the puzzle is not to simply crank out after-the-fact statistical and tabular reports but to analyze data in real-time and improve decision-making in respect of healthcare services delivery to individual patients.

Reporting on measures is the easy part.

=======================================================================

BPM: Business Process Management

ACM: Adaptive Case Management

R.A.L.B.: Resource Allocation, Leveling and Balancing

FOMM: Figure Of Merit Matrices

 

About kwkeirstead@civerex.com

Management consultant and process control engineer (MSc EE) with a focus on bridging the gap between operations and strategy in the areas of critical infrastructure protection, healthcare, connect-the-dots law enforcement investigations, job shop manufacturing and b2b transactions. (C) 2010-2017 Karl Walter Keirstead, P. Eng. All rights reserved. The opinions expressed here are those of the author, and are not connected with Jay-Kell Technologies Inc, Civerex Systems Inc. (Canada), Civerex Systems Inc. (USA) or CvX Productions.
This entry was posted in Adaptive Case Management, Business Process Management, Case Management, FOMM, Meaningful Use, Performance Based Reimbursement, R.A.L.B. and tagged , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s