The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) has been in effect for nearly three months, but many physicians are just now beginning to understand the implications of the final rule and how to successfully comply with its requirements. Put simply, MACRA ended the much-maligned sustainable growth rate formula and introduced a new system for paying physicians and other eligible clinicians based on their performance.
Pamela Ballou-Nelson, Senior Consultant, MGMA Health Care Consulting Group
To find out more about MACRA and how providers should think about it, we spoke with Pamela Ballou-Nelson, RN, MSPH, PhD, a senior consultant with the MGMA Health Care Consulting Group. Ballou-Nelson, who has more than 30 years of experience in healthcare leadership and consulting, shared her top five takeaways from the law.
It’s not new
It’s a common misconception that MACRA began in 2015, Ballou-Nelson says. Although that’s the year the act was signed into law, she argues that it is actually the next logical step in a long continuum that began nearly two decades ago when the Institute of Medicine released To Err is Human, followed by Crossing the Quality Chasm. The two landmark reports are widely viewed as the launching points of the healthcare quality improvement movement.
Judy Capko, healthcare management consultant and founder of Capko & Morgan
Providing a high-quality patient experience isn’t just the right thing to do. According to Judy Capko, a healthcare consultant and founder of Capko & Morgan, making the patient experience a practice management objective is also a good business decision. Phreesia Content Director Maureen McKinney spoke with Capko about some of the financial benefits of improving the patient experience, including improved retention and better performance in incentive-based payment programs.
We’ve all heard stories about how a satisfied customer might tell five people about their pleasant experience with a business or brand. By contrast, an unhappy customer might share their bad experience with as many as 100 people.
The same principle applies to patients and their experiences with your healthcare organization—positive or negative, there’s no doubt word of mouth is a powerful marketing tool.
Word-of-mouth referrals are powerful marketing tools
Word-of-mouth Marketing Makes an Impact
“Word-of-mouth marketing has always been one of the most effective pillars to building a strong medical practice and remains so today,” says Andrea Eliscu, president of Medical Marketing Inc. and author of It’s Personal: The Art of Building Your Practice.
When choosing a physician, word-of-mouth recommendations and referrals from other physicians carry a lot of weight, according to a research letter published in the February 19, 2014 issue of the Journal of the American Medical Association (JAMA).
Consistent with JAMA’s findings, nearly 35 percent of the patients in Phreesia’s database reported hearing about their physician through word of mouth from family and friends.
Practice operations and RCM expert Elizabeth Woodcock
The coming year promises to be another period of immense transformation in healthcare, with looming MACRA requirements, a new incoming Administration, ever-increasing patient financial responsibility and a slew of other big changes. Phreesia Content Director Maureen McKinney spoke with Elizabeth Woodcock, a practice operations and revenue cycle management expert, about what healthcare organizations should expect and prepare for in 2017.
Laurie Morgan is senior consultant and partner at Capko & Morgan. Her practice management consulting work focuses on operational excellence, revenue capture and the effective use of technology. Her recent title, “The People-Profit Connection: Smarter Staffing for Practice Profitability,” focuses on how the right staff using the right technology can elevate practice productivity, profitability and patient service.
“Employee engagement” is one of those squishy-sounding management concepts that sounds like it’s probably a good idea, but maybe not a top management priority. It sounds a bit like a fancy term for morale—but if that’s all it is, why all the hype about it?
Laurie Morgan, senior consultant and partner at Capko & Morgan
Engagement actually goes much deeper than happiness or job satisfaction, according to experts. After all, employees can be quite happy without working hard or productively on behalf of the organization, explains Kevin Kruse, author of Employee Engagement 2.0, in Forbes. Engagement goes beyond job satisfaction. Engaged employees aren’t just contented with their jobs; rather, they’re committed to their organizations in an emotional way. That commitment translates to what Kruse calls “discretionary effort” – i.e., taking the initiative to go above and beyond the requirements of the job description. That sense of connection and responsibility for the success of their employers makes engaged employees much more valuable.
Healthcare organizations are complex and introducing new technology into the mix is challenging, especially amid other competing initiatives.
Phreesia Content Director Maureen McKinney recently spoke with Don Hamden, clinical IT coordinator at Summit Healthcare, in Show Low, Ariz.; Kathy Curran, manager of front-office operations at Summit Healthcare; and Sharon Gardner, front-desk staff manager at Urology of Virginia, in Virginia Beach, about their past experiences implementing new technology and their recommended strategies for boosting staff engagement, reaching timelines and managing unexpected curve balls.
Happy patients not only keep coming back, they also recommend your medical practice to their friends and family members.
It’s no surprise, then, that most medical practices are looking for more effective ways to measure, understand and improve the patient experience. Many healthcare organizations are taking a lesson from other industries that rely on the Net Promoter Score, a simple tool that gauges how loyal customers (or patients) are to a service or product.
Fred Reichheld, a fellow at Bain & Company, first introduced the Net Promoter Score* in a 2003 article in the Harvard Business Review. By analyzing customer feedback and purchasing data, Reichheld demonstrated a correlation between the Net Promoter Score and growth. Across numerous industries, those companies with strong customer relationships grew faster than competitors with weak customer relationships.
The Net Promoter Score revolves around this basic question: On a 0-10 scale, “How likely is it that you would recommend (a given company or medical practice) to a friend or colleague?” Based on those ratings, customers (or patients) are divided into three categories: “Promoters,” or most loyal customers with ratings of 9-10; “passives” with ratings of 7-8; and “detractors” with ratings of 0-6.
Net Promoter Score is calculated by subtracting the percentage of detractors from the percentage of promoters, leading to a highest score of +100 (all promoters) and lowest score of -100 (all detractors).
According to Jason Barro, a partner at Bain, the Net Promoter Score is useful for medical practices because it helps them understand “whether their patients are happy and loyal and it why they are getting or losing business.”
In fact, Barro and other experts cite numerous reasons why practices should not only pay attention to their Net Promoter Score but should also incorporate it into a systematic effort to improve patient loyalty and the patient experience.
More than one in two Americans cope with a chronic disease, such as diabetes, hypertension, asthma and heart disease. And 75 million Americans have two or more of these ongoing and often incurable conditions. The costs of treating chronic diseases are enormous—more than $2 trillion annually—and chronically ill patients often struggle with fragmented care.
Beyond the countless initiatives aimed at containing costs and improving health outcomes for those with chronic diseases, what simple steps can medical practices take to improve the care experience for their complex, high-needs patients?
Laurie Morgan, senior consultant and partner at Capko & Morgan
To find out, I talked to Laurie Morgan, a senior consultant and partner at Capko & Morgan who advises medical practices on operational excellence, revenue capture and the effective use of technology.
Maureen: When it comes to improving the patient experience for those with chronic diseases, where should practices begin?
Laurie: My first recommendation would be to focus more on the human touch. These patients are often scared and overwhelmed, they’re in pain and they have to make frequent trips to the doctor.
Prioritizing a more personal touch isn’t easy, especially in practices that treat a large number of chronically ill patients. Such practices are typically very busy and their staff often doesn’t have the bandwidth to pay close attention and answer patients’ questions. Luckily, there are technology solutions now that can remove some administrative burdens and give staff more time to make patients feel welcome and address their concerns.
But even simple things, such as greeting a patient who comes in frequently by name or listening intently to a patient’s questions, go a long way.
It’s no secret that people are spending more and more of their time on social media sites, sharing everything from vacation selfies to political opinions to photos of last night’s lasagna. But what about social media rules at your own practice? Do your employees understand the consequences of inadvertently or intentionally sharing sensitive patient information? Are they familiar with patient privacy rules? Do they know whether they’re allowed to be on social media while on the clock, or which sites are off-limits at work?
Ericka Adler, Partner, Roetzel &Andress. Photo by Andrew Collings.
If your practice doesn’t have a clear and defined social media policy in place, the answer to those questions is probably a resounding no, says Ericka Adler, a healthcare attorney and partner at Chicago firm Roetzel & Andress.
According to Adler, having a social media policy that educates employees, sets expectations and outlines consequences is important for practices of all sizes.
“Every group should have a policy, or at the very least a detailed discussion,” she said. “Exposing patient information is a huge liability concern, and you can’t just assume employees understand that. “Staff operate better with rules, and a good social media policy gives them those rules.”
So what should your practice’s social media policy look like?
Americans with private health insurance have seen their total out-of-pocket healthcare costs rise steadily during recent years, according to a study published Monday in JAMA Internal Medicine.
The study, conducted by researchers at the University of Michigan, found that the nation’s overall heath spending increased 2.9% per year between 2009 and 2013. Patients’ out-of-pocket costs for hospitalizations, on the other hand, jumped 6.5% each year, totaling a 37% increase in out-of pocket hospital costs during the five-year study period.
“I think the increases are very significant given this is a period of low health-care inflation and stagnant wages,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the Washington Post. “It’s really about finding the right balance between out-of-pocket costs that don’t discourage people from getting care they need, but also don’t encourage people to use care that is maybe wasteful. I think we are — as a society, we’re struggling to find the right balance.”
Deductibles rose 86% and coinsurance costs increased 33% from 2009 to 2013, according to the study.
The research comes as the number of Americans enrolled in high-deductible health plans continues to grow. Nearly 50% of workers are covered by a plan with a deductible of at least $1,000 for individual coverage, according to survey data from the Kaiser Family Foundation. Almost 90% of the plans offered in the Marketplace are considered high-deductible plans.
Read the JAMA Internal Medicine study (subscription required)
Read the Washington Post story
Read the Bloomberg story
Read a Health Affairs policy brief about high-deductible health plans