As I work closely with many healthcare professionals, I am hearing all the latest and greatest (and usually false) rumors about Covid-19.
The latest one is of special importance to independent healthcare providers, many of whom are turning to telehealth sessions during shutdowns to help enforce social distancing. There is a rumor going around, especially on social media, that the government has essentially suspended all HIPAA privacy rules and is allowing all forms of communication for telehealth sessions. This is simply untrue. To read the full, official statement, please click here (link to HHS.gov article).
In a nutshell, it says this: yes, as of this past week, the government will be temporarily suspending enforcement and fines for some non-compliant platforms, but not all of them, including FB Live, Twitch, and other public platforms.
However, we are advising clients, prospects, and all providers we know to be careful about employing non-compliant platforms, even in light of the new, temporary waivers. We have four main reasons for issuing this advice:
1) Privacy rules are in place to protect patients, and our ethical duty to do that does not end just because we (temporarily) cannot be fined for failing to do so. Applications like FB Messenger, consumer Skype, and FaceTime are not subject to BAAs and you (and by extension your patients) are therefore not protected in case of breach.
2) From an operational point of view, consumer applications like FaceTime are not optimal, since they are not integrated into a practice's workflows. A good telehealth platform should simply be another feature in an overall patient portal that allows you and your patients to manage the entire interaction, from setting the appointment to holding the secure, HIPAA-compliant telehealth session, to having the patients pay their co-pay/fees, to following up with messaging/labs retrievals/notes/prescribing (as applicable). Burnout among healthcare professionals was already high before this crisis; let's not make it even worse by forcing staff to jump through extra hoops.
However, if you do choose to go with a standalone telehealth offering, it should at least be true telemedicine, not simply a video chat tool. Our platform- and vendor-agnostic Blum Telehealth, for example, is a true telehealth app: it is the first Bluetooth-enabled telemedicine app, allowing physicians to monitor vital signs such as temperature and blood pressure, and even to look into patients' eyes and ears.
3) From a best-practice point of view, we do not recommend that practices get in the habit of using non-compliant platforms. Sooner or later (and quite likely sooner), HHS will rescind the enforcement waiver. So we recommend asking yourself this: were you aware of the article linked above? Possibly. Also quite likely you were not, given how chaotic everything has been. So will you be equally unaware when the rescission of the waivers is published? HIPAA fines range anywhere from $100 to $50,000 per violation. That's a lot of long-term downside risk to save very little money in the short term.
4) We all need to start thinking about the "New Normal." Practices of almost every kind are under tremendous financial strain thanks to this crisis. And let's face it, with all the rules, regulations, bureaucracy, paperwork, bad technology, and the constant insurance company push-back on claims, it was already a challenge to be an independent provider to begin with. For example, on average, the insurance companies make a practice resubmit one out of every three claims at least once, with an average re-work/re-submission cost of $25 a claim. We are projecting those rejection rates to climb in the months to come as insurance companies scramble to cut their losses from Covid-19 coverage. (That's a polite way of saying they are going to try and claw back as much as possible from you, the healthcare providers.) I bring this up in the context of these waivers because we are concerned that this is just another opportunity for many independent practices to delay making the changes they already needed to make to stay financially viable in the long term. Practices that fail to adapt to the New Normal, practices that were already under pressure to begin with, are going to struggle to stay afloat if they do not act now.
In summary, please be careful about the decisions you make regarding telehealth, and be sure to consider those decisions in the larger context of your practice's long-term health. Reach out to us today and we can get you up and running on a safe, fully compliant teleheatlh platform at a reasonable cost and in a very short time frame.
In closing, a heartfelt thank-you to everyone in the medical and mental health community. Your dedication during this dark time for our country is an inspiration and gives us all hope. Please stay safe!
Covid19, the deadly and highly contagious disease caused by the novel coronavirus that was first reported late last year, has already tested our country’s healthcare delivery system, and it is almost certainly not even close to peaking yet. Here at Fast Layne Solutions, we are, as always, focused on how to help small- to medium-sized independent medical practices, so today’s blog post is about how technology can assist these vital players (and the patients who rely on them) in this crisis in their tireless efforts to serve patients, while also helping them keep their offices operationally and financially viable. We will conclude with some specific additional measures that Fast Layne Solutions will be taking to help out.
Let’s start with social distancing. It is absolutely vital that we minimize human-to-human contact to stem the spread of the virus. For any medical procedure that does not require in-person consultation, we strongly recommend e-visits, aka telehealth. If your office is not already equipped to do telehealth visits, please contact us. For the duration of the Covid19 pandemic, we are waiving much of the implementation cost for our clients and, for qualifying practices, will amortize the rest over one year. We will work to get you set up on telehealth extremely quickly, as it is embedded into the patient portal that we provide with our EMRx and Revenue Cycle Management offering (see iClaim below). With just a few clicks, you can be seeing a patient anywhere in the world in a secure, HIPAA-compliant environment. (Because Apple will not sign a BAA, FaceTime, for example, is not compliant. Do not make that risky and potentially expensive mistake.) In the same portal, your patients can make appointments and even pay for their visits, as well as message your office, review their records, and check lab results.
Another way your office can facilitate social distancing is to get rid of the old practice of having patients arrive early to fill out paperwork. Using our portal, patients fill in their paperwork online in advance, and your office staff see it as highlighted entries ready for them to check and confirm before making them permanent entries into the patients’ records. As noted above, that same portal can also minimize face-to-face interactions by facilitating online payments, scheduling, records and results retrievals, and messaging.
Now we need to discuss an unpleasant topic, doctors and practice administrators. The insurance companies have waived certain co-pays related directly to testing, but this will not impact any other costs to patients, including actual treatment. Independent doctors already struggle with denials, claim rejections, and outstanding patient debt even at the best of times. During this crisis, those problems will only grow. So let’s look at how we can use technology to help minimize the impact on your practice so that you can continue serving your patients:
By ensuring that every single one of your patients who is covered by insurance has their claims properly submitted and paid by the insurance companies, you can not only survive but thrive in this challenging time.
Technology has an important role to play in this crisis, and we are ready to help you implement it quickly and efficiently to minimize negative outcomes for both you and your patients.
To further assist doctors and their patients at this difficult time, Fast Layne Solutions is also offering a monthly 5% rebate to any of our clients who are in a position to offer medical care to uninsured patients, in order to help them defer those costs. This offer remains in effect until the pandemic is declared over by the WHO.
For the duration of the crisis, we will also be donating 5% of our clients’ monthly invoices to the Center for Disaster Philanthropy’s Covid19 Response Fund.
We want to close by thanking our tireless and brave healthcare workers who will be on the front line in the battle against Covid19. You are our heroes and America’s best hope.
Last week, we talked about the challenges facing a fictional doctor, Dr. Janelle Smith, a young endocrinologist trying to serve the South Side of Chicago as an independent practitioner. When we left off, she was facing an impossible choice: stay in her private practice but barely scrape by, or join a large hospital and let go of her dream to serve her community. But it's a false choice, because all those problems we described actually have solutions.
Let’s take her EHR. Her total annual costs, including maintenance, updates, and training, for her current system exceed $25,000 for the practice. And that’s just what she pays to her provider. What she’s not capturing in that figure is the value of the time wasted by her and her PA due to how complicated and user-unfriendly her system is. So she sits down and runs the numbers: she and her PA are averaging 10 minutes per patient encounter and they see 40 patients a day. To her horror, she realizes that almost an entire headcount is dedicated just to charting. But a tablet-optimized, Cloud-based EHR like NextGen’s EMRx costs a fraction of that, and because it was designed by doctors, it’s intended to get doctors through the charting process as quickly as possible, in an average of just two minutes per encounter. Her first year savings alone are going to be almost $10,000 just for the software, and it leads to productivity gains equating to getting ⅔ of a new headcount for free. She almost has enough to add a second PA and expand her practice. And she’s just getting started.
Now let’s look at her overhead. She has a staff of five, including herself. Of those, three produce no revenue whatsoever and are not involved in providing care to her patients. They spend their days in purely administrative tasks, as noted above. But how much of that work is even necessary? Very little of it. With a full-feature practice and revenue cycle management suite, claims are generated automatically based on the integrated EHR, and reviewed by experts who handle claims for many offices, getting her practice out of the billing and claims business. (Any self-pay bills can be printed with a push of a button.) And because those claims are scrubbed by the advanced iClaim claims management system, the rejection rate is under 2%, and the payments hit Dr. Smith’s account within just a few days, thanks to the separate clearinghouse the system uses.
Patients can now fill out their paperwork in advance through the patient portal. They can also submit their medical records requests there, make appointments, and even pay their bills. And all benefits verifications are now automated and executed with the push of a single button when the patient checks in. And denials? A thing of the past thanks to a rigorous and automated verification system.
So the work of three staff who had been working 45-50 hours a week can now be done by two staff members working 40 hours a week. Now Dr. Smith has a receptionist/admin working no overtime and a far less stressed-out office manager working a normal schedule. Including overhead, salaries, and overtime, she is saving over $50,000 a year. That’s the rest of the money she needs to add that second PA or a nurse practitioner!
She also implements ChoicePay, cutting her credit card transaction fees to 1.79%, saving her money, allowing her to take payments online, and giving her a fully HIPAA-compliant merchant services solution that is seamlessly integrated with her billing system.
Her overall financial situation starts to improve dramatically as her AR days fall and she all but eliminates write-offs and bad patient debt caused by denials. Cash flow is excellent, with payments coming in within days of service provision. She’s no longer worried about making payroll. Her staff of five is now three healthcare providers, all of whom are caring for patients and generating revenue. She’s thriving. She’s able to dedicate more hours to her free clinic. She’s no longer living month to month; on the contrary, she’s making bold plans to expand to a second location.
As you look back through this scenario and consider the impact on the South Side, you can see the obvious benefits in terms of keeping quality care in the area and helping a local practice thrive. But you might have one concern. What about that biller? Yes, the practice still employs five people, but that biller is out of a job, and that isn’t good for the community. That’s why Fast Layne Solutions is proud to announce an initiative to create jobs in the communities we serve by training and equipping claims handlers in those neighborhoods. For example, we are committed to adding one new job for every five providers we serve on the South Side of Chicago. Note we’re saying providers, not clients, here. So a single office with, say, three doctors, one physician’s assistant, and one nurse practitioner would lead to a new job on the South Side. We will provide the training and the equipment, and the claims handlers can not only work from home, but also set their own hours, since we require only that a certain number of claims be processed within a given week. Think about what that means for, say, a single mother. Single mothers in economically vulnerable neighborhoods often struggle to find sustainable employment because working outside the home simply doesn’t pay once you account for childcare. But if you have a job that can be done from anywhere and at any time of day, you have the flexibility to earn a good living while still caring for your children.
The term “win/win” is thrown around a lot, but that’s truly what this is. We are giving practices the tools they need not just to survive but thrive in a challenging environment, while also creating new jobs in the community, jobs that involve highly valued, transferable skills.
Want to learn more? Email us today and let’s set up a free, no-obligation practice analysis. If we can’t prove that we’ll save you more than we will charge you, we just won’t ask for your business. It really is that simple.
In December, Fast Layne Solutions CEO Christopher Hughey sat down for an interview with Business Innovation Factory founder and author Saul Kaplan to discuss the state of healthcare delivery in the United States and how innovation must play a role in fixing the complex issues facing it.
According to Kaplan, the current American healthcare delivery system is a product of the industrial revolution and, in its current state, leaves too many people behind. It is a hard-working system with a lot of well-intended actors trying their best to help people. The question is how do we open it up to change, given that it is a self-fulfilling system, a system set up to protect itself and the status quo?
What people fail to understand is that the drive to provide universal healthcare is not a fix, but rather a precursor to the actual fix itself. Getting everyone covered is important, but will do absolutely nothing to address issues like trying to change incentives, innovate, disseminate information to stakeholders more efficiently, educate patients, and motivate people to take responsibility for their health.
Technology is an important component, but it is a double-edged sword: it can help innovate, but it is often used to simply reinforce the weaknesses of the current model. Kaplan cites the example of artificial intelligence (AI): look how many healthcare and pharmaceutical companies are using it not to improve patient outcomes, but simply to make themselves more efficient and profitable.
At the core of the challenge is the very nature of the system itself. We built an Industrial Revolution-based system to help people who are sick, and America is excellent at providing that expertise. But what we are failing to do in the post-Industrial modern age is proactively help people stay well in the first place. It is therefore an antiquated, reactive sick-care system, not a proactive wellbeing system. Ideally, we want both: help people stay well and address their issues once/if they get sick.
A big challenge to changing the system is that so many people start with the financial considerations and work backwards from there. At the Business Innovation Factory, Kaplan’s team starts at the front end: what is the problem we are trying to solve and how can we solve it in a way that delivers value in an economically viable model? That idea is at the heart of Kaplan’s new initiative “Luna You,” a woman-centered maternal wellbeing program that is focused on helping minority women improve pregnancy outcomes by educating and empowering them through outreach, personal coaching, and connecting to the needed medical and social service care. It is centered on the idea that health outcomes are better when patients have increased agency and can take ownership of their health once you give them the tools they need. It kicked off on 1 January of this year in Providence, RI, and will hopefully expand nationally once established.
Why start with one of the toughest problems in the American healthcare system? After all, many articles have cited minority maternal health and pregnancy outcomes as one of the greatest failures of our delivery system and it is a problem fraught with big social issues as well, not least of all the racial component. According to Kaplan, it’s part of his counterintuitive approach to innovation: “Never mind the low-hanging fruit. Give me the absolute hardest problems first. If I can solve those, the rest is easy.”
Does Kaplan expect resistance from the medical community in his attempts to intervene in these challenges? That is actually the beauty of such empowering programs: instead of asking permission of the Powers That Be, the large institutions, they are going straight to women, empowering them, and then going to the providers with them, hand-in-hand in partnership. The goal is to get outcomes on par with the those of the general population, and Kaplan’s team will be measuring their success accordingly.
To close out our interview, I asked Saul what he would change about how healthcare in America innovates if he could wave a magic wand and get those changes done immediately. He focused on three things: 1) Changing mindsets. Too many are at one extreme or the other: they either want to tweak timidly and incrementally or blow up the whole system and start over. So first and foremost we need to define what we mean by innovation and get everyone on the same page. 2) We must get far better about focusing on human-centered design and “shifting our lens” to move away from views that see the world in terms of what’s in the best interests of the existing institutions and towards what is in the best interests of the people those institutions are supposed to be serving (i.e. patients and those seeking to avoid becoming patients by improving their overall wellbeing). 3) We have to get more comfortable with exploration. Our current mindset is that we can analyze our way to solutions, that if we just capture enough data we can predict the future and increase profits. But that is antithetical to exploration and innovation because it leads to safe, risk-averse, incremental improvements at best. We have to be more comfortable with failure, with risk, with true exploration, because otherwise we will stay mired in the status quo.
We’d like to thank Saul for sitting down with us and sharing his unique vision. For more information on how the Business Innovation Factory is helping bring innovation to the healthcare system, please visit the BIF website.
Corporate Social Responsibility
CSR, or Corporate Social Responsibility, is undeniably important, and is also largely industry-agnostic. What we mean by that is this: doing good is good for business, any business. We believe this deeply, and as a company that combines a subscription-giving platform, volunteer concierge, and personalized impact reports to serve as a "CSR-in-a-Box" for 50-500 person companies, we are incentivized to believe it. Additionally, though, we have identified that some companies can move beyond the baseline notion above that doing good is simply good for business. What we mean by that is this: Some companies are set up to be better at the "doing good" part, as well as receive higher returns from the "good for business" part. HealthTech companies are one such example.
We initially identified this super-CSR mutation from a few of our early, successful clients in Visibly & Candid Co. We then looked across the HealthTech industry to confirm if it was widespread, and confirm we did. Here's why all companies prioritize CSR, and why HealthTech companies carry super-CSR mutations:
Why all companies prioritize CSR programs:
Why HealthTech companies carry super-CSR mutations:
So, to the thousands (ok, hundreds) of HealthTech companies who've read this far, how are you going to do better by doing good?
In an average day in clinic, I might see 15 patients, get 75 emails, 10 secure messages, 3 pages and 5 EMR messages in my inbox. Not too long ago, some emails were from frustrated colleagues, asking me to do something for a second or third time. Sadly, some were from parents of my patients, kindly reminding me that they were sitting in the lab waiting for the orders I forgot to place or trying to book their colonoscopy, for which I had forgotten to submit the form.
I pride myself on making sure my patients and their families feel cared for and supported, yet here I was dropping balls, overwhelmed by emails, camp forms, 504 plans, orders to place and callbacks. I needed help and jotting chicken scratch on the back of clinic notes, Post-Its and even a little black book wasn’t enough.
I had an incredible team of nurses and administrative assistants, yet there was no effective way to collaborate; the time, effort and inability to close loops made it almost easier to do things myself. I was burning out, increasingly frustrated and weighed down by the “toil” of practicing medicine. The dozens of clinicians and healthcare teams we later interviewed were feeling it too.
Healthcare, Meet Design
Last year, I received an email out of the blue. Keather Roemhildt, a veteran user experience designer from the Silicon Valley, was interested in applying her talents to problems in healthcare. Well, I though, we certainly have plenty of those.
Just a few weeks later she spent an “afternoon in the life” of our busy gastroenterology inpatient team and was captivated by the potential. After just a few hours together she saw the awesome re-design challenge that is healthcare and was willing to work together to build something that could bring the joy back to healthcare for providers and improve the quality of care for patients.
Boiling the Ocean
We spent several days in clinic together and countless late nights on Zoom from Boston to San Francisco designing solutions for how we could make things better. We thought we’d start off small and redesign the electronic medical record (EMR) [sarcasm]. Over our first several months, we built a beautiful user interface, a visual story chock full of icons, graphs and all the things that us clinicians find frustratingly inadequate about existing options. We explored navigating this EMR by voice, freeing up the hands of clinicians and getting their eyes back where they belonged, on the patient. Our explorations led to three things that have been part of the software revolution in every other industry — except healthcare: communication, collaboration and task management.
The Digital Divide
I began reflecting on my life outside of medicine, my Apple fanaticism, my dependency on elegantly designed productivity tools like Evernote and Dropbox. The ease of asking my wife to pick something up at the supermarket by simply adding it to our shared to-do list on Wünderlist. How platforms like Slack, Asana, Trello and many others have become engines for collaboration and communication, eliminating hundreds of dead-end emails.
Yet, in healthcare, we’re forced to use antiquated software and click our way through poorly designed interfaces, because HIPAA and the nuances of healthcare have scared off the disruptors. Increasingly, the lack of HIPAA-compliant corollaries to the apps that have changed our lives outside of medicine is helping lead to insecure and risky use of many consumer apps.
Keather and I started to realize that beyond the crappy design of the EMR, there was no system to collaboratively manage the workload. Despite the fact that healthcare is a team sport, we all are forced to do it alone.
Not surprisingly, when we asked 14 colleagues about stress resulting from fear of forgetting to do something for their patients, the stress level averaged a 3.9 out of 5. This is despite having dozens of communication platforms: email, EMR message centers, secure and insecure text messaging. Sadly, most of these platforms end up creating more work as a byproduct. Unread and flagged emails quickly get buried, paper notes get thrown out or lost, tasks continue to pile up. Unfortunately, loops are rarely closed as the cognitive load is simply too much and the inertia to generate a formal email or place a message in the EMR is too cumbersome. In the end, we work in our silos, slowly chipping away at the tasks that adds up over the course of the day and week. We spend nights and weekends catching up on notes, billing and the seemingly mundane to-dos that we’re able to remember. And we’re all stressed about dropping balls, forgetting to do something for our patients who we took an oath to care for and protect.
After the third email from my admin reminding me to do something, I realized I needed a system and a process. As the great Atul Gawande suggested in the all-too-relevant The Checklist Manifesto, checklists provide a “cognitive net…that catch the mental flaws in all of us.” I was using Wünderlist, a beautifully designed checklist so effectively in my home life, why not try it at work I thought?
I was easily able to convince my core team, my administrative assistant, and nurse to try out a shared to-do list; they probably thought getting in touch with me couldn’t get worse. Since Wünderlist isn’t HIPAA compliant, we decided to only use patient’s first names and not put any PHI on the app.
So I invited my team to our “GI clinic” list on Wünderlist and within minutes, we were assigning tasks to each other. We sifted through our unread emails for all the outstanding stuff that was pending and suddenly had clarity on what the tasks were and who was assigned to them. Perhaps more impressive was how fast things came off the list. We all felt motivated to clear the list as quickly as we could, since nobody wanted a task assigned to them languishing for the group to see. Checking that box announcing that you completed your assignment was deeply satisfying.
Wünderlist for Healthcare
Suddenly we had a minimum viable product. Without a dollar spent or an engineer writing a single line of code, Wünderlist had provided us with a proving ground. Over the next several months, my colleagues and I completed nearly 1,000 tasks and learned invaluable lessons about what was needed to make something like this truly impactful in healthcare.
My team had never been more efficient. We were collaborating on tasks that might have never risen to the level of an email or EMR message. The truth was, few of these items were even EMR-worthy, mostly administrative chores. Suddenly we had clarity, we had accountability and we were all on the same page.
Using a shared task list brought a life-changing reduction in my stress level. I had a place where I could easily deposit all the inbound requests, reminders and minutiae that had previously weighed me down. Tasks were declared and assigned by design, so an email or EMR message was no longer necessary. The barrier to entry was incredibly low, and the ability to work together, collaborate and communicate was transformative.
We learned from pioneers like our friends at TigerText: create an indispensable tool for healthcare, fundamentally built on a technology that is ubiquitous in the consumer world. Our solution couldn’t be just HIPAA compliant, it had to integrate into the workflow of providers. Fortunately, for us there is no incumbent system or workflow, our largest competitor is the Post-It note. The scary truth is that most providers don’t have a process for remembering their to-dos, let alone a shared one.
Getting Accelerated @Boston Children’s Hospital
So we had a good idea, a great MVP and a bunch of market research validating the pain point and our proposed solution. Thanks to Keather, we even had killer designs for our mobile app. You know where that gets you as a healthcare startup? Nowhere, fast. We still had to develop the technology, figure out the sales and marketing, and prove our value proposition, for starters.
Fortunately, we had the opportunity to apply to the Innovation & Digital Health Accelerator at Boston Children’s Hospital where their impressive advisory board selected our idea (then called HeyDoc) to be accelerated in 2016. This enabled us to work with talented software engineers, startup analysts, marketing experts and graphic designers who helped to create the working app we now call Dock Health. In collaboration with HT Developers, we began a closed beta program in early September, using our native iOS app and responsive web platform at Boston Children’s Hospital. We’ve already learned a ton from our users and continue to improve upon it daily. We’re excited about the future, with our public launch at Health2.0 and our first external pilot at UC-Irvine School of Medicine to kick off in the next few weeks.
Into The Wild
Nothing has been more exciting than to see the impact of our product in the hands of real clinical teams. We have a long journey ahead of us, but we know that we are going after something of critical importance.
Clinician burnout is an emerging epidemic, in large part due to the administrative burden of patient care. The triple aim — improving patient experience and patient care, and lowering costs — can only be accomplished if the providers are able and willing to work towards that important goal. We believe in the quadruple aim, and that easing the administrative burden will make for happier, more productive providers. While something as simple as a to-do list for healthcare might seem trivial on its face, we believe that a secure hub to store, prioritize and collaboratively delegate a mounting number of tasks may very well change the game of healthcare. And that’s just the beginning.
To learn more about Dock Health and sign up for secure team collaboration and better patient care, click here. We’ve got a better way to-do healthcare.