I want to welcome you to the relaunch of my blog ChasinChat. I originally launched this blog in the summer of 2014 after requests from some employees and social network colleagues. While I started out strong writing about weekly that quickly became much more work than I thought. I honestly didn’t realize how difficult it was going to be to think up engaging content on a weekly basis but I still had this desire to write about my experiences and engaging content I could share that would spark interest and hopefully discussion. So, as you can see I am back at it. My goal for this blog is multifactorial. I want to provide an avenue for any SLHS employee to read, digest the content and engage in discussion with me or their colleagues. I want to share the fantastic work SLHS IHT is embarking on. Additionally I would like to use this forum to discuss area that I feel are interesting. As you know HIT is an evolving field and many health systems have become very dependent on our services. This causes tension and unrealized expectations. Through sharing my experiences I hope you will learn from my mistakes, learn what I am passionate about and hopefully some leadership lessons along the way. For those of you that aren’t aware we have recently started our Flourishing Workforce Program (FWP) and my next couple of posts will be about employee and patient engagement and we will transition to some broader topics from there. So I welcome you to exchange some ideas and contribute to the ongoing dialogue and content.
Beginning this past January there were 4 new CPT codes introduced for the billing of telephone/internet consultations.
- If the consultation lasts longer than five minutes, and if the primary purpose of the consultation is more than simply arranging a transfer, one of these 4 codes can now be used for billing.
If prior history is any indication, just because a CPT code now exists, this doesn’t necessarily mean that payors will actually pay for the service.
The question I pose is.
- As we move toward our new world of value and reducing the per member per month (PMPM) cost of care just because you can bill, should you bill? Will the cost/hassle of collecting demographic and insurance information outweigh the financial benefit?
- If you don’t bill in this situation, does it constitute some form of kickback?
- If you do happen to drop a bill, are you disadvantaging your outreach relationship? This would certainly be the case if the industry norm is “not to bill” and if your system we the only one billing for tele-consults.
- I wonder if there is any formal legal interpretations on the above that has or will necessarily impact how systems in the United States conduct and bill for telephone and internet consults?
I was reading this fascinating article written by Robert Pearl, MD the CEO of The Permanente Medical Group on the 5 Megatrends that could Transform U.S Health Care. I completely agree with the major trends Cisco chairman and CEO John Chamber sees:
- The Formation of Accountable Care Organizations (ACO)
- Moving away from Fee-For-Service Payment Models
- Rewarding Better Health Outcomes and Quality
- Health Information technology (HealthIT) Incentives
- A New Generation Of Physicians
I agree that we are at the cusp of a tipping point. I was rather intrigued regarding the fourth megatrend, Health Information Technology Incentives. While I agree with the premise there is some inconsistencies within the details. It is truly unfortunate that healthcare is behind the technology wave that other sectors have adopted decades ago. I feel that there is good reason for that which goes back to the reason physicians choose to dedicate their lives to treating people. While that is easily another blog topic the fact is that we need to change and start to change quickly. Not because of the meaningful use incentives but because it is the right thing to do for our patients. Our patients are more mobile than before and want to access the healthcare system on their own time. We are living is a physician centric system evolving to a patient centered system. That change is going to take a lot of time when the current system has been in existence for almost 50 years. As Mr. Chambers articulates lack of connectivity is the issue. This is where the topic goes awry. There is assumption that every hospital and physician office is on the same system. That is far from the case. Even if they happen to be on the same system that still doesn’t mean that the two systems will connect. They could be on 2 different versions of the same system. Perhaps these two organizations don’t equally value the exchange of clinical information, or are fierce competitors. Please don’t assume I am a proponent of this as an excuse but just current reality. And those scenarios are for organizations that have the same system. The issue compounds when the systems are from different vendors and you may need a HISP for connectivity not to mention developing Query and Trust Frameworks. As you can quickly see that the technology is the minor component and the People and Process areas are what make this successful. While I agree that Meaningful Use Stage 2 will provide the incentives for interoperability I feel that this is just the beginning. I honestly don’t think that the federal incentives will even cover a fraction of the cost required to connect these systems as we need to develop the appropriate trust framework necessary for complete interoperability. What I truly feel is that it is in the best interest of the patient and the communities we serve. A patient should feel safe and well taken care of within the healthcare system whether seeking care in California or New York. As stated before, this is going to transform the health system and we need to understand that meaningful change takes time.
Hello and thank you for taking the time to visit my new site where I would like to start sharing my experiences and journey through the transformation of healthcare from the clinician and Health IT perspective. I have been contemplating this blog for well over 2 years now and felt it needed to be perfect before I start to write. Well as you can see by the layout it isn’t anywhere near complete. I will be learning how to develop a more aesthetically pleasing site while improving my content along the way. For those of you who don’t know me I am originally trained as a family physician and learned early in my career that my passion lies at the intersection of clinical practice and health IT. I will tell you at the onset that I am far from a technician and rely on my stellar IT team to take me through the technicalities of solutions. I plan on posting issues I am facing as CIO of a large Integrated Delivery Network, new trends in Health IT, how consumer IT will change the way we engage with our patients well as my perspective on Health IT policy and trends in our environment. I look forward to engaging conversation.