Sunday, October 30, 2011

Meaningful use - a CMIO perspective

The following is an excerpt from a panel discussion organized by HIMSS-Minnesota in May 2011. Four CMIOs from the major health systems in Minnesota participated.
As the Chair for the panel discussion, I asked six questions to the group. The panel’s responses are given below. I have bulleted the responses for an easy read.

1) How have the Meaningful Use rules impacted your organization?

• Effort intensive/energy intensive
• Need work flow changes/strong change management focus
• Ongoing education at provider and support staff
• Can leverage the foundation for newer initiatives

2) What is your organization's strategy to meet Meaningful Use requirements?

• Governance Structure with Executive involvement and oversight
• Committees to divide and conquer
• Intense Provider engagement
• Buy in required at various/ levels groups
– Physicians
– Nurses
– Support staff
• Strong Program Management
• Use of various tracking tools

3) What are the challenges you faced /are facing in adoption on Meaningful use requirements?

• Subjectivity in interpretation of MU requirements
• For organizations with large enterprise wide EMRs, the flexibility to redesign work flows is limited as a standard workflow is prescribed by the EMR vendor
• technology challenges/vendor readiness
• Workflow redesign challenges
• Quality reporting requirements vs providers perceived best practices in quality reporting
• Productivity challenges for providers

4) Have the Meaningful Use requirements impacted other strategic initiatives such as ACO and ICD-10 conversion plans? If so how?

• Can leverage some of the learning and investments in technology and process improvements being made
• Juggling of priorities
• Demand on organization’s human and financial resources

5) What tips can you give other organizations to meet Meaningful Use requirements?

• Needs to be seen as an end-user driven project and not as an IT driven initiative
• Process improvement is critical
• Early engagement of Operational leadership, physician leadership crucial
• Training/training/Training
• Remove jargon in communication and use plain English
• Need to ensure that physician productivity is not impacted adversely

6) Thoughts/comments if any on Stage 2 requirements?

• Aggressive schedule is a challenge
• Start Planning now !!!
• Quality measures could be an area to think about ahead of time
• Manage schedules around Medicaid an Medicare deadlines

Monday, June 28, 2010

McKinsey's $ 2 BILLION medical tourism revenue projections for India by 2012 - time to rethink?

When I heard that a friend of mine is quitting her full time job to join the medical tourism bandwagon, I thought it is about time to clear the air on some of the rosy projections out there. Here is a recent report that projects 30% growth in medical tourism revenue for Fortis (I do not have data to question this..)

However the devil is in the details. Though the 30% number looks good in percentage terms, the absolute number of patients in 2009(4000 patients), is what one may need to look at more closely.. The revenue figures for Fortis Hospitals (formerly Wockhardt Hospitals ) for 2009 was Rs 93 crores ( about $ 25 million) making the revenue from medical tourism segment for Fortis Hospitals to 9 crores (about $ 2.5 million).

If we are seeing $ 2.5 million for Fortis Hospitals, the total including other major hospital groups could add up to a reasonable of $ 15 million for 2009. A 30% growth would put the 2010 revenue at about $ 20 million.

So I was wondering if it is high time we revised Mc Kinsey’s medical tourism revenue estimates for India downward from $ 2 BILLION in 2012. Would $ 20 -30 million million be more realistic?

For those who are chasing the hype cycle it makes sense to take a realistic look at the numbers based on the facts available. Medical tourism in India will continue to grow, however the pace of growth is debatable.

Saturday, May 22, 2010

Why are international hospitals not setting up shop in India?

I would think there are a lot of hospitals in India that provide better outcomes than what is provided in developed countries. But in general there is a lot that can be done to improve management practices in Indian healthcare sector.

There are a few projects underway,where healthcare groups from US and Europe are esatblishing presence in India. However in general international providers are reluctant to set shop in India due to various reasons

US providers:
1. Many have a local and regional focus, not even expanding within US
2. Profit in dollar terms would be miniscule, unless they build scale
3. Healtchare projects have long gestation periods; medium term geopolitical risks could upset plans
4. Availability of staff in the paramedical area
5. Business models and marketing in India are vastly different from US
6. Hyper competitive due to the presence of a lot of quality providers in India
7. Many hospitals in US are barely getting by, profit margins are razor thin
8. Potenatial for PE investments other co investment models leveraging existing infrastructure/business models.

1. Since Europe in general has a public health system, the number of expert players in private sector is lesser compared to the US.
Many of the India centric issues listed above apply.
We may still see a couple make inroads in India, but would face intense competition from established Indian players.

If the financial system in Europe worsens, and senior patients struggle to find affordable public health care, we may see investments in medical tourism projects in India coming from Europe. However the first choice for such investments would be in Eastern Europe.

Middle East: Not many established healthcare brands in the Middle East.
However, we may see lot more co-investment in healthcare sector in India coming from the Middle East.

Tuesday, March 23, 2010

US healthcare reforms- impact on offshore vendors

My take:

Though some of the technology work from the top three outsourcing vendors would go to India, Indian based IT outsourcers may not stand to benefit much. However India based BPO firms could see an increase in business.

Friday, December 18, 2009

Was your mother under the influence of alcohol?

About eight years ago when I wrote in Express Healthcare Management about the need for electronic claims processing standards for India, ( little did I know that questions like these could mean endless struggles for patients grappling with the beauty of insurance claims processing in India.

In my article in 2002, I made the case for a standards based claims processing system modeled on HIPAA standards, than trying to re-invent the wheel. Not sure how many healthcare managers paid attention that story in 2002. Health Insurance was in its infancy. Today claims processing worries have come to the fore front of the healthcare executives' agenda.Not sure if the patients concerns are being heard…

Today I am writing, not as a healthcare management consultant, but as an ordinary citizen, handling his mother’s hospital admission in a reputed hospital in India, frustrated working with the health insurance unit in the hospital, faxing and re-faxing documents coupled with several calls to the TPA across various cities, listening to a wide variety of “the put on hold” music etc.

I tried my best to go through the painful experience and not pull strings/use short cuts, because I wanted to endure the whole process as a lesson learnt in a patient’s experience with claims processing.

Now going back to whether my 65 year old mom involved in an accident was under the influence of alchohol …. This was a question on one of the forms provided by the TPA and had to be completed by the doctor. The doctor had omitted this question, because she did not think this was a relevant question. Unfortunately the hospital’s insurance cell which has been working for several years with TPAs did not cross check the form prior to faxing it to the TPA. A few days hence, the TPA rejected the claim that came in an incomplete form. From then on it was a back and forth of discussion with doctor who did not want to fill the form again, to more detailed documentation requirements from the TPA. This was just the beginning; wrong address on the hospital admission form, wrong age on the record; we had a cocktail of issues to sort out leading to endless calls and faxes… I was even thinking this could be the plot for a Hindi movie.

My intent is not to blame the TPA or the sympathetic but untrained insurance clerks at the hospital. The entire system around health insurance in India needs a revamp; claims processing challenges are only a symptom of a health insurance system that is ill. However issues with claims processing have major implications that can cripple the progress of insurance adoption in the country.

Even with my back ground,if I found navigating claims processing a nightmare, one can imagine what an ordinary patient, often illiterate has to endure to make cashless insurance processing a reality.

It was also a lesson that could be useful in our start up organization, health FIRST Hospital Network. For me it was a grim reminder that transferring best practices to the Indian healthcare sector is not as easy as it seems on slicks presentations and that India shining is a long way off atleast in healthcare sector.

Shall be writing about some of the issues with claims processing and TPAs in my next blog.

Thursday, July 30, 2009

MassGen Hospital to enter India?

This recent story carried by Economic Times caught my attention.

To me this is a sign of the times ahead. As the purchasing power of the Indian middle class improves and insurance penetration increases, we will see more US based healthcare players look at India as a destination for expansion.

For these players the revenues from operations in India may not a huge impact on the top line in dollar terms. However this could be seen as a medical tourism play and/or a pilot project to test out the Indian market. Though several US based payers have started to push medical tourism packages in India, the perception of quality has been an obstacle to adoption of India as a healthcare destination by employee unions,thus slowing the momentum. Mass Gen may be able to break those perception barriers and channel patients to its Indian venture. The other possibility is for MassGen to recruit high value patients for its centers in the US.

For the Indian healthcare industry, this could be turn to be an inflection point. Indian healthcare providers deliver some of the best quality care in the region. However there is potential to adopt better management practices and technology in the hospitals.

The arrival of competition would definitely change the healthcare delivery model in India.

Monday, June 29, 2009

Healthcare sector in India to grow from $75 billion in 2012 to $150 bllion by 2017

Please refer to excerpts from recent study by Technopak advisors.

Healthcare, which is a US$ 35 billion industry in India, is expected to reach over US$ 75 billion by 2012 and US$ 150 billion by 2017, according to Technopak Advisors in their report – ‘India Healthcare Trends 2008’.

The sector offers immense potential to healthcare players as the country witnesses a rise in the incidence of lifestyle-related and other diseases. A growing elderly population and rise in income levels are also pushing for better facilities in the country.

To meet this growing demand, the country needs US$ 50 billion annually for the next 20 years, says a Confederation of Indian Industry (CII) study. India needs to add 3.1 million beds by 2018 to the existing 1.1 million, and requires immediate investments of US$ 82 billion, as per the Technopak Advisors report.