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Join ReportingMD and our guest client, Nick Orlowski from Ankhos and Carolina Oncology Specialists to learn how to seamlessly integrate quality into your process.


Molly Minehan: “I’m excited for this webinar. I’m excited about our guest speaker today. So gaps in care in quality care or Care Management can be discrepancies between the care provided to patients and the recommended best practices in health care, meeting those that quality challenge can be difficult as we all know so this webinar will dive into some ways that we can seamlessly integrate quality into your process so before we dig into how to meet the quality challenge you’ll hear that term that phrase a lot we first need to get a grip on exactly what the quality challenge is: so is quality a challenge with

Technology, is it a challenge with data, is it a challenge with interoperability,

between systems or one with data delivery, is it a provider challenge or a challenge with measures, is it a benchmark challenge, is it a regulatory program challenge or a staffing challenge, is it a business challenge or a funding challenge maybe a process challenge. We all know that quality touch is basically all facets of our systems. Quality saves lives it prevents trauma and now with value tied to payments, quality gets our providers and our practices paid the quality challenges and everything we do and every practice is challenged by it in one way or another so when we talk about the potential fallout um you know, what is the fallout from not meeting that quality challenge head on and it really is it’s about you know difficulty meeting the value-based care and risk-based contract targets, lost revenue potential for practices negative patient outcomes

um social and or economic disparities patience dissatisfaction departmental performance variation higher Hospital readmission rates those are costly Health Care compliance issues or audits um you know increased total cost for providers and patients provider dissatisfaction on Staffing shortages and maybe the all-encompassing and probably the reason that we’re all here on this call at least and still invested in qualities the patient’s Quality Care suffers so there are also some advantages to meeting the quality challenge uh whether under the direction of CMS or commercial payers the triple or quadruple aim of better care for individuals and

populations along with reduced per capita costs and newly added fourth order of improving the health care teams the the team’s well-being is realized through these value-based care models and programs that are implemented today or starting in 2023 the charge for health care providers and institutions is to refine perfect workflows processes and utilization through proper preventive and high quality care but also improve the wellness of individual patients and populations and Studies have shown that by improving the quality of care for individuals we’ve also seen relative cost of care

reduces well so better management of chronic disease better preventive care

management have been proven to reduce Ed utilization as well as costly and traumatic hospital stays so to express the impact of quality has on today’s value-based Health Care System I’m going to go through a couple of different programs but we’ll start with the Medicare shared savings program today through 2025 and Beyond um we know quality is a major contributor to acos maximizing on the shared savings that they create through the management of costs and utilization quality can also help to limit the losses full risk-based ACO contracts can face when those entities fail to create sufficient savings above their benchmarks for 2021 and 2022 CMS replaced the

previous sliding scale with an All or Nothing approach to determining shared savings based on quality performance the quality performance standard uh is the minimum or sometimes I refer to that as the the QPS that’s the minimum performance level that acos have to meet in order to share in any savings earned um and and also to avoid maximum share losses if they have a risk-based contract and as well as avoid um Quality related compliance actions acos that meet the QPS in 2022 and had sufficient savings created will share in those savings um at the maximum rate if the pandemic’s extreme and uncontrollable circumstance uh flexibilities weren’t in place losses owed would also be reduced when the QPS is met um when you when you have quality that’s that’s high enough where the quality performance standard is going to add noting um again noting that it’s a pandemic’s extreme and uncontrollable circumstances flexibilities were not in place ACO entities that failed to reach the QPS threshold would not share in any savings that they created or would owe the maximum losses back to CMS for acos in 2023 the same quality challenges exist but CM CMS in the fun

in the proposed rule has proposed to bring back the sliding scale approach

um and that would allow acos that come close to the QPS to still enjoy more of

the savings that they created it’s not an All or Nothing concept anymore it also allows for those that don’t create sufficient savings that are risk-based to reduce the losses that they might owe back to CMS if their quality scores are high so failure to reach the if you didn’t reach the QPS at all um and you still owe and you had a risk-based contract and you still owed losses you would actually and you did not meet the full uh the threshold for the QPS you would actually owe Max losses um in 2023 in 2024 the quality performance and this is just an extra note the quality performance standard will change from being required to me to get to the 30th percentile across all um reporters for Quality uh and that will change from the 30th percentile up to the 40th percentile making quality basically an even harder challenge to meet and then in 2025 Medicare shares Savings Program ACLS have a very significant new challenge coming ACO entities are well aware of the retirement of the CMS web interface quality measure reporting method which will end after um 2024 in 2025 those ACO entities especially

those with multiple different uh systems those that have disparate systems will face interoperability data and new process challenges that many of them are simply just they’re not ready for today for some SEO entities with multiple disparate systems the quality challenge will increase considerably so putting the right people processes and systems in place now is critical for Success under the Medicare shared Savings Program um and and for years to come and I will say that and and nakos just recently came out with an update pushing on CMS to basically um have a pilot version of Quality

Reporting on the all-payer patients for mips cqms and ecqms which is what will

be required when this this shift is is made um so we’ll see what happens in the final rule making but uh Nikos has had an impact on CMS in the past so we’ll we’ll find out in a couple of weeks when the final rule comes out on the other side of the quality payment program is the mips track those that are mips eligible know the significance and the growing importance uh that quality plays in that program somost of us are also aware that the CMS estimates for for the incentives have been lower than expected to say the

least uh that being said if no pandemic exception is allowed for 2023 and if the

proposed physician fee schedule rule is finalized as proposed practices could

see incentives reach almost 7 percent with a mips perfect mips score no matter

what it is going to take 75 points to avoid penalty in both 2022 and 2023

which is uh certainly No Easy Task without the bonus points that CMS retired after 2021. so the reality is the mips is a budget neutral program 2023 may be the first year where it becomes obvious who has really invested in their quality infrastructure and who hasn’t um for now we reporting MD continue to consult our practices so they understand their potential payment adjustment how it’s changing throughout the year how they’re improving quality and other factors to to change that score throughout the year and uh you know sometimes we just find that just knowing the potential mips Roi or return on investment can convince their organizations their providers to further invest in quality um so as an example of that let’s take a quick look at how mips looks for a five million dollar practice in 2023 so here you can see the incentive payment adjustment potential for a five million dollar multi-specialty practice in 2023 based on the CMS scale um scaling from the proposed rule so the the for five million dollar

practice the penalty could be as much as 450 000 so that’s the full negative nine percent but the incentive could be could also go as high as 345 000. um and one thing to note here is just by going up one point from an 89 to a 90 it brings this practice an additional fourteen thousand dollars and this is why our dedicated advisors the

people that consult practices and providers on quality under these programs that’s why we we work so hard to get every last mips point for our practices um and you’ll see some some methods of how we do that later on in the presentation government payers and programs are not the only institutions making quality a focal point commercial payers consider various measures including hedis measures in their payment rates so managing your practice and provider performance on these measures across the

various commercial pairs is also crucial so those are some of the potential ways

that quality has an impact on some of um you know and create some advantage in

terms of on payment rates so now that we understand the quality challenge the potential fallouts from not meeting it and some examples of ways that quality can play a role in you know creating value under some of the value-based Care programs out there today let’s go through a couple of suggest suggestions to help improve quality and meet that challenge head on so starting with patient care coordination

let’s get everyone talking care coordinators help communicate among caregivers

um open and up-to-date information and that includes verbal written digital forms of communication so the caregivers are up to speed and in agreement on patient care next get everyone sharing ensure that patient referrals are shared amongst care providers ensuring that follow-up requirements are clear and shared amongst care providers we’ll talk a little bit you’ll hear a little bit more about that later and that could include forming agreements with other care providers in your area um or organizations to share patient information get everyone meaningfully using certified EHR technology cert offers

electronic referral capabilities make sure your team and other caregiver partners are taking advantage of these capabilities we’ll also come back to this this one a little bit or a lot and the impact it has on clinician burnout later in the presentation annual Wellness visits I talk about these a lot they play a significant role in advancing quality care it’s well documented that preventive care saves lives and reduces costs in the long run so create a plan utilize your EHR to

ensure each eligible patient returns annually for their exams and or Wellness checks it helps identify potential

costly and traumatic care gaps and they also create more trickle-down Revenue

opportunities for preventive measures like immunizations mammograms colonoscopies Etc

foreign contributor to the what we’ll call the

depersonalization of medicine ehrs really do remain a vital part of

managing and improving quality make sure your EHR is best suited for your specialty and purpose

you have to know that discrete data fields are the target having discrete data will make quality work for you in

the long run creating discrete data should be seamless if you set your EHR up for

easily accessible and readily available drop down menus or selection picks it’ll

pay off with faster documentation and as well as higher Staff compliance

tailor your EHR to your practice’s abilities such as having reminders in place that indicate a patient is due for

a screening if your EHR can’t keep your providers and teams up to date on these

Critical Care delivery needs you know find a third party intermediary that can help

consider the who when tailoring the individuals that need to be alerted to Patient Care needs and follow-ups

um so on a recent Mayo Clinic podcast called incidental findings developing processes

to ensure follow-up this this is a great podcast by the way I highly recommend it

um Dr Timothy morgenthaler describes an extreme car accident involving an intoxicated woman

she had several tests and surgeries and on the full body CT scan in addition to

the accident related injuries and incidental lung nodule was found and documented in the chart

um after her recovery and Rehab including treatment for the various for

various other Primary Care Services like blood pressure the woman returned to her normal life she was instructed to follow

up with her PCP for additional preventive care which she did not do unfortunately three years later she

presented at the Ed with right side chest pain and the CT scan showed a mass

where that lung nodule was seen after her accident the woman now has advanced

stage lung cancer that spread and the woman dies shortly thereafter nobody followed up with a woman

specifically on the nodule and the patient was never informed of it because she was just she was in recovery

um the Mayo Clinic put together they’ve seen this before they put together a special projects team to

specifically Target situations like this one they started at the most critical question who needs to be made aware and

I think that really applies across the board on a lot of these things who needed to be in this case alerted to the

incidental lung nodule so it could have been managed once the patient was rehabilitated they determine the patient the ordering

provider and the DCP for the follow-up were the three individuals that needed to know

the Mayo Clinic created a large in their technology system for scenarios like this one so the critical parties were

informed of need to know information at the right time to be informed

there’s really there’s no way that we’re ever going to know every possible quality challenge but the intent of

value-based care is that we keep striving to find meet and answer these challenges setting up our Solutions

our processes so the right people know what to do and when to do it takes the

burden out of quality and it turns it into a havoc which brings me to

Aristotle who may have really said it best when he said quality is not an act it is a habit it is not a one-person job

organizations should consider what works best for each member of The Care team what tools or Technology Solutions are

needed to support the team and finally what processes should be implemented to make that technology work

for you and and obviously to benefit the patients

um on a different podcast the healthcare quality cast the guest was the director of quality metrics for the for

um a larger Primary Care Organization who described her first presentation of quality analytics to a large group of

providers to convince them that they needed to change and improve their performance

she knew her data was right she knew it was accurate but when she stood up and presented it the providers all basically

bore holes through her and never asked a single question she realized that telling a group of

providers what they were doing wrong with charts and graphs was not the right medicine for her organization

specifically instead she began meeting with each individual provider independently she listened to their

input and feedback and she used it to implement change moving forward implementing change is hard it’s

necessary though to improve bringing individuals impacted the most into the conversation is critical sharing ideas

and solutions getting provider buy-in this is huge will help move any quality

improvement project forward just remember what works for one organization may not work for all the

goal is really let’s align the right collage of teams Technologies and

processes that make quality habit that works and really one that sticks

so the next few slides will cover insights actionable insights and technologies

that can help turn quality into your best habit

the top chart you see here is our provider performance comparison chart this not only shows provider performance

which is the green line or the light green lime green line um as it compares to the Benchmark which

is the straight orange line but it also shows the count of events for each provider the visual can help

quality directors and teams to quickly determine who to focus on who is bringing the practice up who’s

weighing it down it can also help to determine who might have lower

performance because their patient load you know far exceeds their peers once you’ve identified the buoys and the

anchors in the organization you can meet individually to show the data and discuss what they’re doing differently

you know for those that are that are bringing the practice up share those ideas

um getting their buy-in on new processes to improve outcomes and ultimately Quality Care is critical

information is a source of learning but unless it’s organized processed and available to the right people in a

format for decision making it is a burden not a benefit so can the way that

information is delivered affect quality

developing a system to deliver and address open care gaps is Paramount to Long-Term Care Management success

in our system the reporting MD’s outcome manager system part of the application is we refer to as our day sheets they

deliver open care gaps to Providers and Care teams at the point of care based

and it’s really it’s they they start based on the appointment time so day sheets what they they offer a list of

the open care gaps for every patient coming into the office for that day um if certain pay uh care gaps cannot be

closed at the time of the visit they also offer the opportunity for scheduling to plan for any incomplete or

future screenings that are needed before the patient leaves day sheets can be used in the

application or they can be delivered to any user or caregiver in the form of lists they can be delivered via email

mobile phone or even printed they can be configured or set to get

sent to Providers care teams schedulers billers or whoever should be aware or

alerted of the action that needs needs to happen even if that’s setting up

annual Wellness visits and getting those scheduled making sure

Quality Care gaps are delivered in a way that meets the needs of your practice should never be a burden it should only

serve as a benefit to both you and your patients if your systems limit your care

teams by not sharing care gaps in a readily accessible way you should explore solutions that meet that need

again value-based care is here to stay if your organization doesn’t have the tools and the processes in place you

will be penalized in one way or another and in addition to financial and compliance penalties or audits you’ll no

doubt face constant turnover challenges

so sometimes strapping an Roi return on investment to the Quality indicators you’re monitoring can help to engage

Physicians boards executive leaders to support your care team and get you that

buy at that buy-in um additionally just understanding the count of gaps that move your

organization or your practice or clinicians to the next Benchmark threshold can help Drive quality

improvement so no matter if it’s an Roi or just breaking the work out into manageable

Parts whatever works to motivate your quality teams uh and caregivers to close

those gaps everybody wins the quality needle better patient care it’s all

still moving forward regardless of of the reason so two ways that our customers have had

success in closing care gaps and improving performance has been through patient chasing and chart chasing as

well as day sheets but I’ve already I’ve already discussed those so patient chasing is about following up

with patients on their next visit within the calendar year to make sure that any open care gaps are addressed at that

time or even potentially schedule them for a follow-up if an urgent Gap exists

not only does identifying the potential care Gap help to manage outcomes help to increase regulatory program Revenue but

it also brings additional Revenue in for the mammogram or the colonoscopy or whatever procedures are being done

chart casing requires the patient um chart and or EHR

uh search for any missing data points so I often you probably all heard if you if

you’ve talked with me I often use the example of a relatively small Medical Center in Maine they had a single open care gap on

measure on a measure that was for preventive um prevention of central venous catheter related blood

bloodstream infections that single care Gap was worth 44 000 the measures

looking to have all elements of maximal sterile barrier technique used so the act the quality action has to be done at

the time of the procedure we recommended that the practice review the chart again to see if by chance a non-discreet text

field or note was used to indicate the correct technique was used the practice did so and discovered there

was a note in the text field that documented the right technique was used for the procedure they closed the open

care Gap credit for the work that was done which they should and increase their MIP score

and revenue by forty four thousand dollars we often see this when ehrs go

down or there’s some other factor that prevents the use of discrete data fields or drop down selections to Mark these

events as met or closed data and Technology should not get in the way of delivering quality care or

get in the way of giving credit to the caregivers that are doing the right quality work when these systems do fail

us it’s important to know where to focus efforts and your attention so that the critical

care Gap can still get closed and your caregivers can get credit for it

so here’s an example of three different quality mips measures and the potential Roi for various size

practices to close out patient care gaps on pneumococcal oncology care and

dementia assessments the revenue is the value add but the clinical care being

done to close those gaps is what improves quality patient care and this is what CMS had in mind when they they

started this program and they attached Roi uh to it and and getting a higher mid


so when talking about ways to seamlessly integrate quality into your process it’s clear that it takes people process and

Technology uh and and it’s all of them to truly meet the quality challenge but

what’s the cost so what we previously referred to as the triple aim of better care for individuals better care for

populations and reduced uh per capita health care costs more recently there’s

it’s taken on a fourth aim for improving the health care team’s well-being we know medicine and how it’s practiced

today is not what many clinicians imagined when they decided to pursue a medical career the concept of

documenting everything in a computer while in the room with the patient has been a major challenge to say the least

even here some of our most of our suggestions relate to more and better discrete data points to improve quality

which suggests more and better use of the EHR in everyday workflow

with this transition in practice mode in combination with the trend of more clinicians in employed practice models

it seems reasonable that some of the value being created in value-based care should be shared with the clinicians

charged with improving it it’s surprising to me that only a handful of organizations have discussed creating or

improving physician compensation models to reward their clinicians as it relates to meeting the quality challenge head on

if more providers are employed then increased revenue is not the same driver as it was before but physician

compensation can turn that dial back by tying quality or Roi

bring back the pot that could pay out for physician compensation ehrs have fundamentally changed the way

medicine is practiced with a degree of depersonalization and administrative burden that has contributed to clinician

burnout and dissatisfaction with work life integration another there’s an article from NATO

clinic in 2019 um they described how clinician burnout rates changed between 2011 2014 and

  1. they noted that 2014 may have been specifically bad due in part to increase

EHR penetration and increase administrative burden the article continued to suggest that

2019 may have shown that the situation was improving as Physicians and organizations adapt to the new practice

environment as clinicians grow accustomed to a new normal when it comes to practicing

medicine there are other factors that are proven to help track Improvement in clinician well-being implementing more team-based

care documentation assistance streamlined work workflows and also

position compensation these have all helped to improve the efficiency of the practice environment

which ultimately helps to meet the challenges of the quadruple aim for patients as well as providers

so to wrap up the themes covered in the presentation of understanding the quality challenge Potential fallouts

from not meeting it how it plays a role in the movement from volume to value-based care and suggestions as well

as some solutions to help improve quality we thought it would be helpful to get the perspective of one of our

client champions uh so before I do hand it back to Jess

um I want to emphasize the degree of client Champion as this practice has achieved a perfect 100 mips score for

four of the five final score performance years and an average of 99.13 across all

five performance years and maybe closest to my heart it’s also important to

mention the practice achieved the maximum possible quality category points on all five years so they serve really

as a great example and resource to learn more about how they seamlessly integrate

quality into their process and succeed as a result of it so Jess I’m going to

hand this back to you um for a little for a bit of q a with our our guest speaker


Jess: all right well thank you Molly

um again we are pleased to have our guest Nick Orlowski again EMR vendor from um Carolina oncology Specialists as

well as being the onco software founder and as Molly said um we do we have some questions that we constructed prior to

the webinar that we’ll have Nick answer for us today so again Nick thank you very much for joining us

these questions you’ve managed to achieve multiple perfect scores with cos and Reporting MD

sure achieving a perfect score may seem daunting for practices new to the mips process how are you able to accomplish



Nick: uh it certainly was daunting for us uh in the very beginning

um ultimately it was about culture we had a great CEO Carol Kammer who I guess

was 2017 um decided she looked at the benefits and the risks of the whole mips program

and said I want to make this I want to deal with this 100 I want to get a perfect score that was our goal

um and so she assembled a team of EHR vendor provider you know had a provider manager

as a representative medical records billing so she had a whole team together who knew all of the facets of very in

and out of the office foreign and so then we kind of looked and said what’s going to be the highest risk

highest effort part of this mips thing and it was going to be we realized it was going to be quality because there

are so many things that touch the patient you know that we’re going to have to work through it’s not just a

process that we can write down or um you know eat prescribe or something so we really had to dig into that quality and

develop processes um and we kind of took it from there

um it was daunting but uh you know if we get everyone pushing in the same

direction you’ll eventually get there and it was her great leadership that made it happen and uh furthermore like

you know the processes she put in place have remained and that’s how we’ve kind of just kept us going over the years


Jess: wonderful can you share specific questions fields and workflows

that you’ve added into your process


Nick: yeah so the the best example of this is

the advanced care plan measure um it has a number of very key features

that the team identified as being very valuable to the whole practice so um

number one it’s something in oncology we want to do all the time anyway we want to make sure every patient has some sort

of living will Advanced care plan so we knew the providers would be on board with it

number two it was a discrete measure it was they do they don’t or they’ve declined

um so we knew that whatever we develop in the EMR we can design it to be a fast

data entry mechanism by the provider and then we know that that discrete data Falls all the way through to reporting

MD um and then you know it was just high quality we

knew that was going to benefit the whole community so you know there’s this kind of extra cherry on top

um so it needs to be really sellable to the provider and and a lot of this comes down to choosing the right

um measures so you have to choose them for your practice for your providers um and then you kind of get in the

process and which Fields you put in the EMR


Jess: one comment we often hear from providers is measure fatigue how do you manage or overcome

talk to Providers


Nick: there’s no substitute for actually going in talking to Providers understanding

what they need and understanding you know because they’re thinking in their minds I’ve got all these clicks to do so

you need to think both from like a CEO process point of view and an EMR point of view how can we get the discrete data

we need and display the value to you you know in the case of advanced care plan

that is valuable to you to you and your patient but we’re also getting the data

and then the ROI when it gets to reporting MD and ultimately CMS so it’s

really trying to find that wholesome

Pinnacle of what a feature should be and it always starts with the provider because we are asking them to do more

data entry that is a fact and we need to show them a positive return for that


Jess: does your current workflow enable you to capture this measure without interaction from providers or staff


Nick: yeah so so like I just said we you are asking providers to do more work and so you know it’s it’s only going to work

better if you provide value positively for them and so the best way

to do that is to not make anyone like make them do more work so we want to make it so that the EMR captures that

value and transmits it all the way to reporting MD without other interactions because what happens is other

interactions um then it goes back to the provider for double checking or you know back and

forth so we want to get it right the first time and for instance um Advanced care plan we only need that

measure once per reporting period so why do we even show it to the fighter the second time and so that’s the kind of

thing you you should ask your EMR to do is really listen to your providers listen to which measures make sense for

your practice and Implement them in a way that’s the

providers are going to get on board with okay with so many potential measures to

monitor how do you determine which ones to track uh reporting MD helps a lot uh because

they um you know they’re always on top of CMS regulations um you know we have a monthly call and

they always say like this is coming down the path or this Benchmark is going to change and so then I take it back to the

CEO or the office manager and say you know this is kind of where our levels are it could go this way or this way you

know what do you want to plan for next year um and so really kind of Under reporting

MD’s guidance we we kind of continue the process internally


Molly: I mean Nick you really are just take that information that quality is so important that you

have to integrate it and so you’re planning for how you’re going to integrate it in future years as well and I think that’s and that’s the way you

said it it says a lot the way you said it it is an investment it’s it’s

these requirements and these even if it wasn’t a requirement the expectation from greater society that we have higher

quality is coming because people are good it’s going to be in the news Etc and so it is an investment in your

business to integrate some sort of process where you have a rolling quality

initiative um the other the other important part when you’re talking to your EMR vendor

or uh planning your process meetings is you should also be planning for things

to change so um today’s quality measure may not because of benchmarks changes it may not be the

same as one from five years from now and if you kind of try to think about how

you’re going to have that change in five years maybe not change the whole system but at least know that something could

change you might save yourself some work in the future so flexibility setting up your system so

that there’s options to move options to be mobile app options to mold

um to maybe like different things different surprises yeah and like you said it is an investment it’s a little

bit more work but it will pay off in saved work down the line you’ll be ahead

of other competitors in your field um you know you’ll be able to put advertising out saying you know we’ve

got this high quality um for instance one of the one of the additional things with Carolina oncology

is they uh we were able to take the mips quality and uh the CEO found a Humana

um kind of screening they wanted to do as an as a beta test and so oh we can just take one of our mips things we’ll

turn that into this Humana um basically a Humana quality measure and

they started paying extra money because it was this beta program so if you have a quality process implemented you could

even start going to your payers and saying what do you have for us what you know we’ve got this process how can you

you know how can everybody benefit here well said


Jess: I think just the last question that we have here um have there been particularly challenging measures to

track if so why did you stick with them yeah so uh the most challenging measure

we’ve had so far is the pain measure um this is one the team shows it it has

the aspect where you have to do this at the time of visit just like Molly was saying you know if you missed in that

vascular example if you miss it at the time of visit you don’t have documentation so you

can’t you can’t report it to Medicare because you don’t have that documentation so we had to build in kind

of daily chart chasing features into the HR to make sure that um not one pain was missed the important

part there is when you’re talking to Providers and designing the process you should think does this particular action

need to be performed by provider in some cases making a diagnosis does but just

obtaining a pain value does not need to be performed by a provider so then you can talk to your UMR vendor and say

where else in the office can we have this happen and so one of the things we

did was open this up to the phlebotomist to say let’s make sure everyone has a chance to ask for pain and then before

checkout there’s an indicator right there that says they have had their pain level today if there’s a doctor visit you know

because that that’s that’s the full length of the um mits reporting so

um that was the most challenging but they wanted it to be it was important enough

for the whole team that they wanted to make it happen and so we made it happen

Molly: hi I think Jess you’re getting some questions for for Nick from our audience

as well sorry Nick we’re going to put you on the spot a little bit yeah that’s fine so uh yeah go ahead and read it just


Jess: yeah I can read out for you so this yeah this question specifically for relief how important is it to your

individual providers to know their own performance on a monthly basis or are

they satisfied with quarterly or less frequent updates



Nick: so we we don’t have any enormous

customers um what I have found is that

I’m going to speak colloquially here uh providers don’t really like being told

how to practice and I probably everyone in this call knows that um and so

it’s letting them know I I haven’t found for

them to care that much but when you do show them they’re like oh okay you know if if you

bring it up in the right conversational track um you can say you know you had like maybe

compare them to themselves a month ago um more than comparing you know Dr John

to Dr Sally um because then it comes adversarial um I I’m not a manager but I’ve like

kind of seen the CEO kind of work the relationships um and you I think it just depends on

each uh providers personality um you know I I personally know a doctor

who would who doesn’t really care you know because he’s close to retirement

um and then another doctor where you bring it up and he’s speaking conferences and he really would like to know did he improve from last month

um so it really I think it really the best answer is it it depends on the provider and you just have to know the

provider going off of that

do they care about their performance as compared to their colleagues in the same practice

I have not experienced a provider who cares but that’s that’s my limited experience

um that’s funny because I’ve heard from other practices and this is about what works for one may not work for another

uh where it definitely does matter yeah like I said we you know our clients are

kind of closer knit and the way our software works is we help

the Physicians like practice at the top of their licenses so some of them are team oriented and they have a lot of Pas

and MPS so it’s a little bit of a different culture from like a multi-specialty where you’ve got Orthopedics and

vascular so that’s you know we’re we’re a specialty oncology EMR so that’s kind of

our wheelhouse um my experience may not transfer everywhere

I saw a question earlier um said Molly how important is integration and the openness of the EHR

for successful successful quality program it is critical um

everyone in this call should be expecting more of their ehdr vendor in my opinion

um so many of the customers we’ve gone to and in fact Carolina oncology we

initially replaced their EHR because they were so unsatisfied with it their EHR made no modifications

um had no plans to cost a lot and especially if you’ve got a web-based

EMR you know ours is web-based there’s no excuse for large companies to be able to

just kind of ignore you and you know especially in this age of quality if we can do it certainly the larger groups

can do it and I think everyone in this call should step up and feel better about asking

their EMR to do more yeah you have to be able to adapt adapt

to the things that that change and get better and improve and do this

that and the other thing the EHR has to be willing to do that and has to be flexible to do it too I agree yeah

that’s a great point because you know management has to get better at communicating providers have to get

better at data entry and then the EHR has to get better at providing those services and

connecting everything so yes

okay okay well I guess we can move on to

the rest of our q a session um again if there’s any other questions at the moment um I did see Molly would

you mind confirming what that podcast was just to make sure we have the correct one the one you mentioned earlier I hit a couple um the the best

one that I’ve listened to is actually both fantastic but um I think one has

stopped for a time and I think it’s going to restart later but the Mayo

Clinic um podcast and it’s it’s LED and hosted by Dr Timothy morgenthaler

um it is it’s you know it’s funny I I run and listen to it and it’s it’s actually started to replace music for me

but um it’s fantastic they go through different things they talk about different studies it’s all about

improving quality uh it’s fantastic I think it’s weekly