Tag Archives: #storytelling

Healthcare’s Alternative Universe — The APM

APM’s are better known in healthcare as Alternative Payment Models.

Simply stated, an alternative payment model is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

Advanced APMs are a subset, and let practices earn more for taking on some risk related to their patients’ outcomes. You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

The APM’s are enabled through the Quality Payment Program via the Department of Health and Human Services.

Now that you know what APMs are, I want to dispel a myth I often hear:

APMs are difficult, risky, and really hard to develop let alone implement and be successful.

The reality is that if you understand your market, listen to your stakeholders, and have a strategy for data collection, then it is not any more complex than any other reimbursement you get today.

As a matter of fact, in 2008 it was even more difficult to design and create an alternative payment model since there was no programs or support from the Department of HHS.

Yet, that is exactly what I did.

I designed a model of care to screen for cancer and caring for oncology patients.

Our focus was to go from “Do I have cancer to here are my treatment options in 72 hours or less.”

The key to all of this was radiology and pathology. (as well as support from surgeons and oncologists)

In order to allow the radiologists and pathologists to practice in this model, we had to change their compensation models.

We deliberately threw out the RVU models and generated a new physician payment model based on their ability to generate a definitive diagnosis by cancer type. A model that rewarded communication to all stakeholders.

We mapped all of the downstream work that was ordered by surgeons, medical and radiation oncologists, primary care, and other physicians after a diagnosis was made.

We also mapped out the additional lab and imaging work that historically was ordered by these physicians.

We ran our operations for 6 months.

During that time we collected data on the downstream orders, coding and billing, and appointments.

We were then able to show that we saved time and dollars.

We saved time in missed appointments, repeat imaging exams, duplicate exams, and unnecessary orders.

We saved time for patients, physicians, and technical staff.

We also demonstrated that we made better use of surgeons, medical oncologists, and radiation oncologists time.

At the end of 6 months, we were able to prove that we saved over $4.5M.

We also proved that our outcomes and overall “patient experience” were better than anyone else in our market.

I leveraged the data, the proof, and the revenue with our payers to develop a risk share model. We split the savings 70–30, in which we kept 70% and the insurance kept 30%.

We used that money to continue to improve our physician compensation model for radiology and pathology. This allowed our physicians to focus on ensuring they had all of the information needed to generate a definitive diagnosis. It also allowed them time to educate referring and ordering physicians, spend time with patients, and to communicate with surgeons, medical and radiation oncologists to help them in their treatment decision making process.

It allowed us to earn a preferred status within our market and with our insurance groups.

In a time when advance payment models weren’t invented or widely being used, we took destiny into our own hands.

Everyone else waited.

We acted.

We created an alternate universe.

A universe that allowed us to get back to “why” we do the work we do.

A universe that allowed us to deliver care at the N of 1.

As always you can feel free to email me at cancergeek@gmail.com or follow me on Twitter @cancergeek


Healthcare’s Digital Natives

Whether you read a medical journal, a magazine, or get news delivered to your email or Twitter feeds you will notice that there is a lot of talk about the use of technology in healthcare.

On a daily basis, I get pulled or tagged in multiple conversations online about the use of electronic medical records, digital health, mHealth and the lack of interoperability.

I get to have conversations with physicians and administrators from both academic medical centers, integrated delivery networks, and community hospitals.

I get to hear the good, the bad, and the stories on the struggle of implementation, culture change, and other issues surrounding the transition into the electronic world.

My hypothesis is that most physicians and administrators struggle because they are not the “digital native” within healthcare.

The term digital native was coined by Marc Prensky in his 2001 article entitled: “Digital Natives, Digital Immigrants.” His observation was simple:

“…children raised in a digital, media-saturated world, require a media-rich learning environment to hold their attention, and Prensky dubbed these children “digital natives”.

When I apply this concept to healthcare, the most natural “digital natives” would be those physicians and administrators that reside in radiology and radiation oncology.

While x-rays have been around since 1895, the invention of computed tomography is a more recent development. One that is about 45 years old. Same holds true for MRI. Other imaging technologies such as hybrid imaging like PET-CT are less than 30 years old.

The world of radiology has adopted new technologies quickly.

Radiologists have taken the time to understand the clinical applications, the impact to diagnostic medicine, and the benefit(s) to the care of patients.

In fact, radiologists were the first within the healthcare system to drive mass adoption and successful implementation of electronic medical records with HIS/RIS and Picture Archived Computer Systems, or PACS.

Yet in the world of healthcare, radiologists are the last physicians that an EMR/EHR implementation team considers to partner with for success.

Instead, healthcare IT teams recruit the “digital immigrants” to be the champions to drive adoption of new technology in healthcare.

The “digital immigrants” of healthcare refer to the other “ologists”.

Think of the neurologist, nephrologist, cardiologist, oncologist, surgeons, or primary care physicians.

While all of these physicians are extremely smart and knowledgeable, the majority of their daily work doesn’t occur in the digital world.

Healthcare is a business that thrives on sharing best practices.

The best practice for mapping out a new digital world, creating the roadmap, and generating directions to arrive at the right destination in healthcare has been done multiple times by radiologists.

As healthcare continues to change, evolve, and explore uncharted roads into the digital ecosystem we need to consider creating a treaty and allowing the digital natives in radiology to help guide us to the new world.

A world where care is delivered at the N of 1.

As always you can feel free to email me at cancergeek@gmail.com or follow me on Twitter @cancergeek