Anesthesia practices, obviously, need different data points to be able to successfully report compliance, safety, productivity, and all kinds of other meaningful measures. But do they need to enter all of that data by hand?
A good portion of that data already exists in the hospital's EMR, and the value of sharing the data is immense. Not only can an anesthesia group objectively evaluate and improve their performance, but individual providers can spend less time entering duplicate values on multiple sheets of paper.
BUT: The data would need to be shared.
This can get political and roadblocks can appear, seemingly, out of nowhere if the hospital or its IT team don't share a cooperative spirit.
In this episode, Dr. Z shares some familiar questions that come up along these lines and how to navigate them successfully.
Our team frequently encounters hospitals that claim ownership of the patient data, and it makes sense from a security standpoint and even from a compliance standpoint. I get it. I understand it.
However, when you're talking about sharing data with third parties, and you frame that conversation in terms of data ownership, it can create some unintended political obstacles. So, I wanted to spend some time going into, what might sound like a bit of an abstract question: “Who owns the data?”
How that conversation unfolds directly impacts the patient experience, and it ultimately increases the cost of delivering anesthesia services when you encounter a hospital that doesn't understand the value of sharing the data with the anesthesia group.
Why talk about data ownership in the first place? Because that's exactly where the rubber meets the road in getting the anesthesia group the information they need to run their business. Getting the data is often not a technical problem, but rather it's a political problem. Take, for example, setting up an ADT feed where you get demographic information from the hospital to the anesthesia billing group. It’s not technically challenging, but too often, it still takes weeks or months and costs thousands of dollars to get in place.What’s you have is actually a people problem, revealing that there is a direct correlation between your group's ability to get information from the hospital and your group's ability to deliver quality care at a reduced cost.
If you don't have access to the data, you're lost. Your billing workflows are more expensive, you're less likely to be MACRA compliant, you're at more risk for financial penalties, you have a much greater problem managing your human resources, and ultimately it exposes you and makes you more vulnerable to competition in the marketplace. Other companies who can get access to that data have an enormous advantage over someone who doesn't.
A ton of reasons point to the importance of access to the data. Let’s go down some rabbit holes and better understand how this conversation evolves or how it can even take some turns.
There's this balance between data sharing and data ownership, and, thankfully, there are hospitals that recognize that the more information they share with their anesthesia group, the more likely it is for that anesthesia group to deliver quality care to their surgical patients.
Unfortunately, there are also lot of hospitals who don't understand that, and we're going to explain how that conversation unfolds. But before that, it's important to understand a nuance that occurs when you talk about sharing data. Typically, in the physical world when you talk about sharing, there's only one object to share. For example, if I share my pen with you, there are times where you have possession of that pen, and there are times that I have possession. There's just one thing, one object which we share. In the world of data, that's really not how it works. Rather than sharing data, really what we're saying is, “I want a copy of data set X from you, and once you give me that data set, then I am under the same HIPAA laws and regulations of how I manage that data set.” But it's really not sharing. What you're really asking is: “Will you give me a copy of the data from your system. You’ll have yours, I’ll have mine, and then I can do what I need to achieve my goals for the anesthesia group.”
It's an important difference, and naturally, the hospital has questions.
And those kinds of questions make sense. You can't just give data to anyone who knocks on the front door and asks for it.
We typically answer with how we're helping the anesthesia group manage its business. That, in a sense, should be the end of the discussion. After all, we're not random people just asking for hospital data, rather we represent your anesthesia groups. We have Business Associate Agreements (BAAs) in place and are contractually obligated to be the IT team for this Anesthesia Group, and we're asking for access to the EMR data.
But the hospital may then begin saying, “What data do you need?” We need patient demographic data, all the billing information, we need case data, times, places, procedures, any codes that might be available; we need quality data for MACRA compliance; we need OR scheduling data. All of that may seem like a lot of data. So then they say, “Well, why do you need that data?” And you start to see this mindset of ownership over the data, which makes them feel entitled to know how exactly you are helping the anesthesia group manage their business. This can really cause the wheels of progress to grind to a halt.
Scenarios we’ve actually run in to begin with the hospital’s question: “How exactly are you using this data?”
You may answer, “We're providing it to our coders who are adding ASA CPT codes so that we can then file claims for the services rendered. Perfect, right? “No problem there,” the hospital says. “We’ll give you data set ‘X.’”
But let’s say that you answer in a bit of a different way. Maybe you provide more clarity on everything that you're doing with that data. You might say, “We're running it through our proprietary QCDR coding engine and reporting quality to CMS, via QCDR reporting.”
That's when suddenly people will stop and say, “Wait, wait, wait. Quality? Who are you reporting to? Who are these people? We already record quality! What is a QCDR and who are they?” You run into this hornet's nest of questions. Now you have to provide more answers, like, “Well, it's a qualified clinical data repository, and this is what they do, and, by the way, it's the anesthesia group's decision on which QCDR they want to report to, and it changes potentially every 12 months…”
And just like that, we're already outside the purview of the hospital's IT team's interest. Well beyond the initial question: “What are you doing with that data?”
Often, we find this chasm between the hospital IT and us where we're trying to explain that the hospital’s capturing of quality does not equal MACRA compliance. The reality is the market-leading EMRs are not recording enough discrete information to appropriately code for all QCDR measures across all medical specialties. That's an unrealistic expectation. And even if it was attempted, the measures change every 12 months, and so as soon as we tell you what quality measures that we report for MACRA, it continues to open up more questions. Next they'll ask, “Which MACRA questions do you support?” And we'll say, “Well, these are the 13 that we recommend for 2021, but they're gonna soon change.” Then they say, “Well then what quality codes are you actually producing and we want those codes back in our system because it's our data.”
As the questions then dive deeper, an expectation evolves out of it: that it's our responsibility to educate the hospital IT on what MACRA compliance for anesthesia means, the measures, the specific discrete fields that help you code each one of those measures, the codes that are generated from all of that discrete information, etc. And at some point, we have to draw a line and say, “Hang on, that's our expertise, and we're happy to share it with you, but we need to enter into a consulting arrangement, because right now my client is the anesthesia group, not the hospital, IT's team who is working on enhancing their EMR.”
If the conversation prevents the sharing of data, anesthesia is going to continue to be doing their documentation, their billing and their quality capture on paper. They're going to continue to have couriers send it. They're going to continue to experience burnout from duplicated data entry into multiple systems. That is the reality, regardless of the interface. The anesthesia group is still collecting that data and reporting it to CMS. It's not like something new is happening here, in the sense that new data is being sent to CMS. It's the same data. We're trying to bring the work flows up to the 21st century, make them electronic and streamlined to help reduce the data entry burden, to help improve efficiency with the anesthesia group, to help them improve their oversight.
And this isn't just about quality. That's the example we've used here-- and hopefully you can understand the complexities a little bit better-- but when the hospital originally asks, “What are you doing with the data,” we could have answered in other ways that are just as problematic as quality. For example, we could have said, “We want to use the data to administer anesthesia patient satisfaction surveys to all of our surgical patients,” or “We want to use the data to send off anesthesia pre-payment alerts so that the anesthesia group can collect payment prior to the anesthesia services being rendered,” or we could say, “We use that data to provide analytic reports to the anesthesia group on productivity and efficiencies and throughputs.” For any one of those lines of questioning, the hospital can end up back in the same place of saying, “No. We do that.”
So that brings me back to the original question: when the hospital says, “Who are you and what are you doing?” We tell them, “We're Graphium Health, and we are helping the anesthesia group manage their business, and to do that, we need data set ‘X.’”
Ultimately, we can't provide better care for the patients unless we have a cooperative spirit from the hospital IT teams. It's really important to manage that relationship and to have a positive constructive relationship with that hospital IT team, because it's critical to your survival and to your success.