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Daniel: Hello everybody, and welcome to the Tuesday webinar series, Chiropractic Economics Webinar for Doctors of Chiropractic. I’m Daniel Sosnoski, Editor-in-Chief of Chiropractic Economics. Today’s webinar, “Eight Crucial Insights that DCs Ignored in 2016,” sponsored by Infinedi. And as always, our program is being recorded and will be archived at Chiropractic Economics website, chiroeco.com/webinar for one year. Our expert is on here, is on board here today to expect with you and when his presentation is complete will follow with the question and answer period. You can submit questions throughout the presentation by clicking on the appropriate icon on the right side of your screen. We’ll do our very best to get to all of your questions, but if we run out of time, we’ll forward the remaining questions to our expert and notify you via email and the answers are posted on our website chiroeco.com/webinar. Our presenter today is Brad Cost, the President and CEO of Infinedi, who is here to help you learn how to make the most out of the data you’re already collecting and use new tools that are now available to you. Brad, thank you for taking the time to participate in our webinar and for sharing your expertise of data analytics in helping our audience understand how they can best operate in this new information-driven environment. Before we get started, Brad, please give us a brief background on yourself and your work with data analytics.
Brad: Thank you, Daniel, and thank you to the audience for tuning in today to listen to it. I am Brad Cost, I’m the CEO of Infinedi, claims clearinghouse and an analytical company that has been making its place in the industry of trying to help providers understand the revenue cycle generation analytics and how the future is going to involve data in analytics in your practice. So, today in today’s topic I thought it might be interesting if we, we actually look at some of the crucial insights, some of the things that we’ve learned about data, about computer systems from 2016. Sort of ending the year looking back at what’s going on.
By far, the most important topic that we’ll find is that we’re going to transform health care through big data. Big data, that’s a term that we throw around a lot, it’s a buzz word, but what does it actually mean? Big data refers to the ability to sort of collect and analyze complex data sets that will help uncover new insights about the world around us. In our industry, we find that big data sets are talking about how we see patients, how we look to prevent disease, how we can look at the over prescription prescribing of medications. So that you as a provider can use this information to better understand what’s going on.
We’re also gonna look at the analytics and consumerization of that data, trying to look at how do we get that information to the consumers, the patients would you say, of the industry as far as chiropractic. But in that process, we have to take some positions, we have to accept and understand and invest more in technology. And that’s technology in several different areas not just claims processing but all the areas that data is being collected as crucial points in the industry. We’ve got to focus on the consumer, that’s one thing that we’ve learned in the process. We’ve gotta help the consumers understand.
Today, it’s very common when you go to see your general practitioner that you end up with a patient portal for you to go to. That’s moving more strongly into the chiropractic industry, but just one step of looking at the data and trying to consumerize the information of the data that’s being collected.
And then we’ve got to form strategic partners, not only with vendors throughout the industry, not only with other practitioners throughout the industry, but we’ve got to bring those patients into this picture also, and form a strong strategic partner with them.
How’s data collected? That’s one of the things that I find really fascinating, in every time I update and look at that information, I’m always surprised at the kind of numbers that I see. In here, I simply try to choreograph of what the flood of big data. What kind of data is coming to us as individuals not only as practitioners? I apologize for the resolution of this graphic. When I went to save this art piece, it down [inaudible 00:05:13] and it’s a little bit fuzzy, but let me read the numbers of to you. Typically on a daily basis, there are two 2.1 billion dollars spent on mobile apps in the year of 2011 looking back at the data. There were 83.2 billion dollars estimated spent online in itself, in 2012.
Now, if you talk about storage and the collection of information, lots of us relay to a gigabyte or a few gigabytes for our hard drive. Well, if you look at Facebook and we’re all very familiar with Facebook, if you’ll look at Facebook we look at they’re being a hundred terabytes of data that is uploaded to Facebook alone on a daily basis. And the terabyte is basically a thousand times of that gigabyte, so it’s a tremendous amount of data that we’re uploading online in a day-to-day basis. We look at emails, 249 billion emails sent on a day-to-day basis, 230 million tweets a day. That’s very interesting that Twitter is really just a social network, can connect people together, but it is becoming a very, very powerful portal for us to use not only us practitioners but to understand what people and individuals are talking about, thinking about from a social networking perspective. And a very important part of this whole scene, maybe a little bit of out of control but a very important part of the scene that we need to utilize and pay attention to.
The next topic that I wanna turn to is, is more of the security. We talk about big data and how it is affecting, how this affecting what’s going on, but there are some, there are some challenges of protecting than the security. If you’ve attended any of my CE classes, you’ll find that one of the topics I talk about is security. It’s not just security but it’s also the privacy issue. Protecting the privacy of data information of patients and information that you have about your patients within your practice management system, within your EHR system, or your paper charts.
Let’s look at it as a growing threat. When I did the research from it, I looked from the years 2010 to the year 2015. It looks like there were a 143 billion paycheck records that were had known compromised efforts. In other words, they had been hacked into the… that’s estimated to be six trillion dollars a year that are lost each year to some type of cyber hacking. So, in this survey, when you drill down to it, we found that 99% of all individuals who are impacted by data breaches in 2015 were victims basically from hacking, that the data breach was a breach resulting from some type of a hacking result that leading to this six billion dollars of year of lost revenue. That’s an amazing number in my eyes that I look at how quickly security of this information is becoming. So strong security is the answer that we have to go to when we’re looking at it. We have to be ready, we have to understand what is going on. The things that are important in providing the good security with our systems.
Healthcare data security is much more than security ingestion in EHR system. You have to be proactive and thoughtful about the information and how it will help you identify these problems. Hacking into your security system, any system that is linked to the outside world through the internet, whether it be your practice management software, your EHR system, your billing system, your claims processing, other vendors that you might be using, your claims clearinghouses. Any company that is used to storage and process the information is really the companies that you need to look at and understand.
Under the HIPAA privacy law, that puts that responsibility into your hand. You are the responsible entity. As the patient signs off and passes that chain of trust to you, it is important that you do everything…the Health and Human Secretary demands that under HIPAA that you take every necessary precautions that are at your tools of disposal to secure that information. So it’s very important that you do everything that you possibly can. If you’re using the EHR or billing system that’s cloud-based, it’s very important that you understand where that information is stored. If there is a disclosure of that information via a hacking or some kind of breach, and you’re investigated, I think one of the first questions they’re gonna ask is, where is that information stored if it’s not stored here. If you say, “I don’t know,” that may not be a very satisfying answer to the department, to the auditor that is doing the audit. So some of those kinds of information is where is that information stored whatever job in the cloud, I’d wanna know the exact location where your information is stored and are they a HIPAA compliant data storage facility. So being prepared, being open to cyber attacks is a very, very important thing for us as health care practitioners as we do more and more online information, we need to understand.
One of the other things that I found very interesting is Wearable Tech. It’s becoming a more and more popular thing, and I thought, well, how is this gonna really affect the chiropractic industry? But as I attend chiropractic shows across the United States, I do about 30 of them a year. I find that technological changes are occurring. More and more wearable tech is occurring. How many of you today do something simple as the FitBit? That is a form of wearable tech. Very quickly we’re gonna have health care providers that can tap into that. We’re gonna be able to find out and monitor patients in a continuous mode to look at their sleep cycles, their blood pressure, their physical activity, whether they’re an implantable wearable device. They’re gonna become more and more popular of a way to become aware of the kind of things that are going on. Even things today that we wouldn’t think about blood sugar levels or something that is becoming more and more of a common device that patients are wearing or that they are implantable.
And what does this mean for health care providers? It means that you’re gonna have more and more information accessible to you. You’re gonna have to become more tech savvy, more data savvy so that you can understand it, that you can explain the technology, that you can take in the vast amount of information that this technology in itself might be sending to your practice. Patients, of course, are gonna be interested in this technology. They’re gonna want to be involved in it. They’re gonna want to wear devices that track caloric burn, their exercising. Helping them understand how to obtain goals that they’ve set for them, and ultimately you as a provider, how you can become part of that experience in helping bring a value based to these, a value proposition to these patients. It only is natural that you as a healthcare provider be involved in that scene. You know, as we get into more complicated devices that are doing self-diagnosis, for sure, you use a provider will need to be the one that gets involved in that.
You know, on the screen you’ll see some of the common devices that are being used, such as smart wrist-worn devices that’s measuring the number of steps you take, how many miles that you’re doing, what your heart rate is, much like the current FitBit that we’re going through today. But what about some of the unusual ones, such as, new technology that may seem strange to you, but really and truly, it’s part of today’s scene that is being prototyped, such as 3D plastic printing technology where you’re doing the replacement of bone structures with 3D printing technologies.
Pave Technology which is embedding sensing devices into plastic that are used and worn by patients or replaced on the patients. Bio-skin technology such as the one that you’re seeing in the lower left corner here are becoming actually wearable devices today and more sophisticated self-diagnosis technology. And one that I’ve been particularly interested in is the glucose monitoring. One of my other companies actually started working on glucose and A1C monitoring and cardiac enzyme monitoring. But Google has come out with a technology that you, by simply wearing a contact lens with your prescription and for patients that need the monitoring of glucose. They have found a way to test the glucose within the teardrops. So whatever we’ll be able to think of in technology, whatever as the brain will lead us to, it’s going to develop health care technology. Wearable technology for the future, and as providers, we’re gonna have to get involved in understanding that technology, being part of that technology, and helping our patients be a part of it.
One of the other things that I thought was important is just the financial viability for providers. That’s gonna lead into my next topic about, value-based health care but, [inaudible 00:16:01] and involved in that is a Merit-Based Incentive Payment System, MIPS. You probably have all have heard about MIPS now. And that really is looking at value-based payment methodology. It was started under the Affordable Care Act, even though that may be repealed with the upcoming presidency, it is also important for understanding how do we as health care providers, how are health care providers going to find financial viability for ourselves in 2017, 2018. Even though it is CMS and we know that there are limited chiropractors that participate in Medicare Medicaid programs, these models, as we know, get adopted by the commercial payers across the United States. So it’s very important to stay and pay attention to what is happening for financial viability.
Most likely, private insurers will remain a significant source of health care funding for 2017, 2018 through fee for services which is how we’re paid today in capitation. But you’re going to see them, and we see them actually already in 2016, testing the water for value-based proposition and how that health care providers can look at the patient and what is best valued for the patient, what is the most cost effective methodology. Commercial payers looking at third based [SP] and bundled payment kind of methodologies, pay for performance as we’ve been talking about, retainer kind of payment, concierge kind of service, and then shared savings which is part of the ACO methodology, accountable care organizations which we’ve seen formed over the last couple of years across the United States, both in successful and unsuccessful ways as the first models have been put out there. ACOs are a little bit different in the fact, not only to the idea of the fee for service kind of mentality, but they also are being involved in earned shared saving. Earned shared savings occur whenever the providers in this group can show that they save the payer, CMS, or a commercial payer, that they save dollars for the patients by providing lower-cost services. They then get to share in those earnings one time a year. And in some cases, the ACOs are reporting very, very million dollars kind of earned shared savings for providers to take a portion of.
So on the horizon in 2017, 2018 these new models are gonna be talked about more and more. Most providers will have to focus their attention on talking and looking at it, understanding it, and all the different models that are being made available for them to remain financially viable for the upcoming years.
One of the things that I want to focus in on that financial viability is a value-based healthcare and what it actually means. Value-based healthcare is initially meant for it to be some form of an alternative payment model known as APMs or Merit-Based Incentive Payment Programs, the MIPS. And it’s really taking, letting providers take a stake in what is happening in health care, trying to find ways for the health care systems to save money and be more cost effective in the MIPS. And that’s what’s going to be talked about as we move into 2017. Where you’ve done the initial PQRS meaningful years, that’s what with the beginning phases that are now morphing into penalty kind of programs as opposed to bonus programs. So the new value-based programs will take those place and ultimately become the model that, I believe, driven by data that will be important.
One of the things that the value-based health care is gonna bring about in that change is how that we create partnerships and collaborations. It’s gonna be a bigger picture than what chiropractors are used to today. Those partnerships are gonna involve hospitals, uninsured social programs, insurance, in some cases prescription drugs relating to medical research, and ultimately coming down to what is the cost of health care. But it’s gonna take these relationships. That’s why the first models of the ACOs, accountable care organizations, have been the first attempt to trying to bring these groups of providers to, under the same table to care for where the patients in a collaborative way.
It’s gonna look a lot at outcome management, trying to prevent hospital care and hospital admissions. We know that hospital admission is one of the largest driving cost factors in the healthcare scene today. So trying to find low-cost, high-effective outcomes which for chiropractics great description of chiropractors is looking at those kinds of things. They’ve got to be a piece of this model.
We’re going to start looking at community education access. Taking and driving our patients to community-based education programs such as alcoholism, diabetic, any kind of community-based resources that are available in your local area and regional areas and we can draw our patients to help be part of that re-training of the patients and part of that program in which performance is measured. It’s gonna be working with primary care physicians, specialists, looking at hospital care and when it is appropriate and when it is not appropriate and how we can collaborate. So all of this will be driven by data, about communicating, looking at communication systems where you’re part of that group, you’re communicating, you’re looking at collaboratively at x-rays, labs, exams, and those kinds of systems to measure engage the patient’s outcome.
I’d be amiss if I didn’t slightly cover single payer systems. Single payer systems have been talked about, although with the outcomes of the elections we’re probably further away from single payer systems than what we used to be. Single payer systems basically were identified as looking at Medicare for everybody. Where we simply created a national program that everybody went on through to, essentially doing away with commercial health insurances we know today. There are pros and cons to that, probably is a program that is more partisan today and has been politicized, but single pay systems probably will be on the decline, unless something drastically happens in the Affordable Care Act or drastically happens with the new administration that is coming in into the White House. But it is important that I thought that I at least mention what single payer systems were and how and what they’ve been talked about in our health care picture today.
One of the other big topics of 2016 that really affected chiropractors was an OIG audit that came out that basically off of a report on the audit, they said that the CMS estimated that 358 million dollars are approximately 82% of the 438 million paid out to chiropractic service was really unallowable. These overpayments occurred because CMS’s controls requiring chiropractors to include the AT modifier and the initial treatment type on the claims were not effective in preventing these kinds of payments for medically unnecessary chiropractic services. That may be true and may not be true. The piece that I would like for chiropractors to take away from this is that, A, the audit that was done was done in a flawed way, in my opinion. This study was done based on 105 services, so if you’re familiar with a claim, a typical claim will have two and a half services on it, statistically nationwide. So we’re really talking about this was on 40 to 50 claims is what they looked at across the United States to make this determination that chiros were overpaid 358 million dollars.
Number one, I believe that’s a flawed study. In doing the math for that, the standard form methodology for determining the sample size is this formula that you see in front of us where we’re looking for a 95% confidence level. In this case using the mathematics in a standard study, statistically, they should have looked at 5,000, a minimum of 5,670 services. A little over a hundred services in every state or to be a nationally based state. So, A, we know that the study was flawed, but the thing to walk away from this with is a few chiropractors we looked at. A few of them I’m sure, were because of poor documentation that occurred, that they didn’t code claims correctly. And it was that very few doctors that didn’t do these things correctly that caused the entire nationwide chiropractic stats to have this kind of strike against them. So it is very important that we look at how we document across the United States. We look at that we’re doing things on a medical necessity kind of way, that we are coding correctly and using AT modifiers when they are necessary, that we play by the rules.
My friend Baron Hogg mentioned that if we just play by the rules, if we do everything that we’re supposed to do as chiropractors, we have nothing to fear. And that is true, it’s only whenever we try to go out to the edge, when we don’t do good jobs of documenting, when we run that risk of fraud and abuse creeping into the system that we get looked at and in an incorrect lens across the United States. And in this case, almost 400 million dollars being, that even though it was done incorrectly, the damage has already been done. This was on the front page of the Wall Street Journal.
How big of a problem is fraud and abuse? You know we look at fraud and abuse in many different cases, but fraud and abuse is at large and actually is in single digits and actually what occurs across, but again, it is the very few doing the fraud and abuse that causes all the pain for those of us that are doing it correctly. In this case, when we look at fraud and abuse is when we’re looking at charges and services per provider. We see that each one of these dots representing a provider, by the way, you see that most of them are all in two standard deviations among the statistical means that are occurring. It is only these few that pop up in these upper two deviants that we find in a fraud and abuse way. It’s very, very easy today using data, and all payers use data today, to make that determination of whether doctors are doing fraud and abuse. So if you think that you can get away with it, you’re just wrong in that process. They are looking at it more and more, and it’s very, very easy to detect.
You know, we look at the Pareto Principles where there is 20% of the investment is responsible for 80% of the outcome. So why do we need to reduce fraud and abuse? Because it’s costing all of the people that are not being involved in fraud and abuse. Payers pullback on reimbursements because to compensate for the fraud and abuse that’s going on. So if there were fewer fraud and abuse, there’d be a much bigger piece of the pie for everyone else to get. There are some great organizations around the United States today, especially even in Chiropractic SecureCare of Nebraska maybe one that you’ve heard of, where they’re actually looking in a proactive way for docs to help them… I’m sorry, not proactive, pro advocacy way to help doctors understand where they’re at in utilization, find their ways to bring that utilization, and have been very, very successful in finding higher reimbursement for chiropractors across the United States. But you have to understand that all of these has been driven by data. It is important that you get involved in that data as we move into 2000 and 2018, 2017.
One of the simple ways to do that, one of the most effective ways, is a clearinghouse. Clearinghouse has your back. It looks at patient demographics, it looks at insurance eligibility, it looks at claim entry. One important piece that almost all clearinghouse does is claim validation and scrubbing. They are scrubbing out at all of the mistakes, they’re looking for custom kind of edits that payers would ask of them to do. They’re cleaning your claims up in the best way possible prior to the submission of the payer. They’re making sure that your claims are submitted in the HIPAA compliant methodology that’s required by the federal government. And they also are looking at payment posting to make sure that your postings are correct, both in an automated way and in an integrated way. Integrated payment processing is becoming a very popular thing with practice management software, so you’re never leaving the software system. Simply by clicking a couple of buttons, it’s going behind the scenes, doing a lot of these valuable services, and then in the end reposting and resubmitting the A35s when they come back from the payer showing your payments.
Clearinghouses are still one of the most cost-effective ways to look at lots and lots, hundreds of millions of claims across the United States. It’s also a great way that we at Infenidi found that we grab that information for analytical purposes, to help you as a provider look at your data in an analytical way. And so, if you look at basically, if you sum up five ways a clearinghouse has your back, it has your back in compliance. It’s gonna help make sure that you’re doing things in a compliant, nonviolent, non-violation way. It’s looking for accuracy, it’s scrubbing those clients, it’s correcting your errors or allowing you to correct the errors before they go on to the payer. It’s trying to help you audit-proof by looking at your information, looking at your rights, and looking at the responsibilities and trying to alert you when those occur. Practice management software integration as we mentioned earlier, integrating billing and scheduling in the EHR, the patient portal, are all within the clearinghouse services.
And one of the final, the fifth way is looking at business analytics, trying to give you those tools that you as a doctor that are busy every day. We don’t think that you have but just a few minutes a day to focus on your business, trying to give you tools such as we do at Infenidi. To give you a simple phone app that lets you look at what are the business analytics that are going on within your practice? Give me 30 seconds one time a week, look at your business analytics and let you know. We’re gonna be building on this principle in 2017 to help you know when you’re using codes, what percentage to help alert you when you are overusing those codes. To let you know when you have mistakes within your practice, how often are your claims rejecting out, how many times are your claims being denied? What kind of money do you have out still in the payers that are not being reimbursed back into you? We’re gonna watch out for your back the best that we can as a claim’s clearinghouse, by simply looking at that data for you and giving you simple ways to look at it so that you can build those into your busy days.
This is one of the phone apps that Infenidi analytics has pushed out and is available for our clients across the United States. And with that, I’ll bring it to an end, and I’m gonna turn it back over to Daniel for questions. Again, I thank you for your time today. I hope that you’ve learned some things. And now, Daniel, I’m gonna turn it back to you for questions.
Daniel: All right. Well thank you so much, Brad, this has been extremely informative. Before I get to questions from the audience, I wanted to comment on your observations on the OIG report. Chiropractic economics did special coverage on that, and our analysis was exactly the same as yours. The sample size was too small, and the conclusions drawn by the auditors were excessively broad. And I think that DCs generally have their heart in the right the place, and it’s just gonna be important for data providers such as yourself to help close some of the open loops that are out there as we strive towards increased compliance.
Okay. Moving on, we do have some questions from the audience. One doctor would like to know, looking back at 2015, what has been the most crucial item for chiropractors in your estimation?
Brad: Well, Daniel, I think the OIG had the most damaging thing that went on. Just because I think that it caught chiropractors off-guard, those that were staying alert, because it made them look like they were really over-utilizing the system. I think CMS in themselves and their comments after that report did show that there had been substantial work done by some of the state and national organizations to help doctors understand what was going on, especially with the AT modifier. And there had been classes now being taught. So I think CMS recognized that these organizations are trying to change the culture out there. But as hard as we do, that as hard as we get out, those of us that are out there teaching classes, teaching for pro advocacy kind of ways, it is still up to the provider to be involved in making those changes in their office. I hear doctors come up to me after my classes all the time and say, “You know what? Man, I am one of those offenders in documentation. I document [inaudible 00:37:04].” It is those doctors that we’ve got to affect. We’ve got to bring about those so the few cannot harm the large. We want everybody to be involved. Go to a class, get education on these things. They are available in many, many different states across the United States.
Daniel: Okay. Another question, I think it’s related to the statistic that you brought up regarding patient data records being compromised. You noted that in the previous year, 143 million records had been compromised in some way. So a doctor would like to know, how do I know if my computers have been hacked?
Brad: Well, you know, Daniel, that’s one of the big questions. It’s a very hard to do, matter of fact, hackers won’t tell you they’re successful when you don’t even know that they’ve been in your system. Here at Infinedi, we watch for threats on a second by second basis, because we run some of the latest technology and upfront routers and switches. We’re able to actually even see when there are attacks going on. We had that case the other day when we had an IP web bot they’re called trying to break through our switch. We traced that IP portal down to China.
And so, I believe that there are constant attacks. I believe many more doctors offices and systems have been invaded than they realize. And the best defense is malware software, anti-virus software, and physical hardware devices upfront that serve firewalls. Those are your best frontline. And just showing an auditor that you tried to do the best that you could is your greatest line of defense if are audited by the HSS.
Daniel: Yeah. That sounds like a good advice. I’ve certainly heard a lot of expert’s advice in the same thing. We do have time for one more question, and it’s a subtle one, but I think you might be able to address it. A doctor asks, we keep talking about data, but I don’t a direct effect on my office. Will that change?
Brad: Yeah, absolutely. Just from the things that I pointed out, one in particular, value-based metrics. I believe many, many payers, not just the government, are gonna go to a more value-based methodology. All the principles around CMS that they’ve done, most commercial payers take their lead, eventually. And it only make sense, if we’re really gonna transform healthcare costs across the United States, we have to look at value-based proposition in earned shared savings. The great thing for chiropractic in this, Daniel, and the doctor that posed this question. The great thing is chiropractors are posed to take the lead in that because they are a very cost-effective methodology for patients and treatments for patients, and that’s what everybody is looking for. The problem that concerns me is we’ve got to get these providers out of the dark ages. We’ve got to get them used to using data. We’ve got to get them used to the world of technology, all the things that I mentioned. We’ve got to pull them into today’s modern world in their health care practices. And when we can do that, they’ll be at the table and the industry will be successful.
Daniel: Yeah. I certainly agree with you there. And there’s no question that we’re in the age of big data and rather than resisting it, I certainly hope that DCs across the country will see the opportunities that lie there. Well, thank you very much, Brad.
And at this time, we would like to thank our sponsor, Infinedi, and Brad Cost, for today’s webinar. And thank you, everyone, for attending. Remember, this webinar including our speaker’s PowerPoint presentation has been recorded. If we did not get to your question during the webinar, the questions will be posed to our expert and the answers posted shortly at chiroeco.com/webinar. We will alert you when the webinar is available. Thank you again, everybody, for attending, and we look forward to seeing you next time. Have a great day, everyone. Bye.
About the speaker
Brad Cost became the chief executive officer, president and owner of Infinedi, LLC in 1999. He is a highly knowledgeable and credible source within the healthcare and data analytics industry. Cost has an impressive work history proving his success and owns various companies including: an electronic data interchange consultant firm, an interactive software development firm, an innovative software system and many more. His primary focus is in the development of cutting edge electronic data technology as it relates to the big data analysis of medical and health data.