The National Association of Community Health Centers Financial, Operations Management and Information Technology (FOM-IT) Conference took place on November 12-14, 2012 in Las Vegas, NV.As a technologist, this conference is always interesting for me, as it allows me to see what topics are of interest and significance to the health center community. It also allows me to speak with health center colleagues about the topics I think are most interesting and relevant. This year I was pleasantly surprised at the balance in the presentations and workshops at the conference. They were a mixture of topics I thought were dated, topics that were relevant right now and some topics about the future state of finance, operations and IT for health centers. What follows are my general impressions, ideas and reflections from my three days as a conference attendee.
First, I had expected to find general excitement following the re-election of President Obama, and was surprised to find instead a muted enthusiasm, damped by ongoing concerns about the continuing opposition to healthcare reform. Even with the Supreme Court’s decision on the Affordable Care Act, the States have a considerable responsibility for implementing healthcare reform and especially for Medicaid financing and administration. At least nine states have said that they will not participate in Medicaid Expansion (under the ACA) with two others opting to run their own exchanges. There is a lot of work to do, and along with worries about the “fiscal cliff” and general economic uncertainty that could affect CHC budgets and operations, this seems to be weighing heavily on health centers nationally.
Still, the conference provided a good introduction to some current and timely topics such as mHealth applications, data mining and portals along with continued discussions of older issues – optimizing EMR use, reporting, privacy and health information exchange.
The program included several specialty multi-hour learning lab sessions related to conference themes. The feasibility studies and business cases “lab” focused on doing feasibility studies for new lines of CHC business and revenue enhancement opportunities. This is, I believe, a very import topic and area of focus for Health Centers as their continued viability may rely on new lines of business. There was also a lab on Medicare cost reporting, a topic and effort that often is confusing and difficult for CHCs. The last lab focused on optimizing EMR and specifically, on using the alignment between PCMH and MU to qualify for both and also including UDS, P4P and other practice priorities in this effort. The lab format provides a concentrated and interesting opportunity for more in-depth discussion of issues, challenges and approaches; it can really be used as a great introduction or tutorial, especially to broaden the knowledge base on new issues.
As always, the best part of the conference was the chance to meet and talk with my colleagues in the field, at health centers large and small, urban and rural, free-standing and networked. A lot of our hallway learning related to social media and telehealth so much so that I took notes. Telemedicine and remote consulting appear to offer substantial benefits for all CHCs, not just rural centers. About half of the people from the 18 health centers I spoke to about telehealth were in urban statistical areas and so could not bill for these services. Despite this, three of the nine were actually offering remote consultation of various types, mainly in retinopathy for diabetes care and in dermatology. Of the nine CHCs in rural areas, five of them either were or had tried to offer telehealth services in behavioral health and specialty consulting such as retinopathy. Several worked with the VA on PTSD and suicide prevention programs. Three of these five rural clinics had stopped offering teleheath services for a variety of reasons that included: 1) Loss of consulting partners, often academic medical centers; 2) the complicated logistics of remote consultation; 3) lack of reimbursement or inadequate reimbursement; 4) trouble deploying the technology.
Several of the issues cited by centers for their difficulties in starting and/or maintaining telemedicine services are systemic – reimbursement issues, both which centers are eligible, and whether and how claims are reimbursed – fall into this category. Issues with consulting partners have at least two causes: 1) does the provision of these services align with the business model and other business relationships that the partner has? and 2) even if it does, is the reimbursement enough to keep the partner available to the health center? The issues around eligibility for billing, reimbursement and business models, for both health centers and their business partners, will require real focus and commitment to solve. They also highlight the importance of working with payers, potential consulting partners and our elected officials to align reimbursement and business models, because telemedicine could be an effective and efficient way to expand access to essential services.
Telemedicine seems straightforwardly an advantage for health centers, while the set of issues related to social media makes its use by health centers a more difficult call. I won’t write in depth about these issues here, but you can read about them on the RCHN Community Health Foundation’s website.
I spoke to about 15 people from different health centers about their use of social media for clinical, administrative, marketing, community development or, in fact, any purpose. Of the fifteen, only three said they were trying to use social media in any way. All three of them were using Facebook for marketing – that is, using a Facebook page to give people information about their health center and linking to their home page on the web. One of the centers had a Twitter account and used it to post more timely information about operations and services. They also used it to informally survey their followers (many of whom were not patients at the center) about things such as what hours were best to be open, how available providers should be electronically, etc. This same center had several providers and CEO blogs that readers could (and did) respond to. Still, the majority of health centers that I spoke with have made no attempt (other than very informal ones) to integrate social media into their clinical or operational practices. We know from several large-scale surveys (such as the PwC one done late last year) that people are already sharing substantial amounts of personal health information on public social media such as Facebook and Twitter. Health centers need to figure out how to make use of this and to integrate it both into an operational social media strategy they may be developing and into their clinical practice.
All told, lots to think about and work on with our colleagues in the year ahead. I’ll be at FOM-IT next year, as it always provides a window into health center issues and an opportunity to meet and talk with health center staff. I look forward to new topics – perhaps a lab on alignment with HIEs and ACOs, and a session on the use of new technologies such as the place and use of social media or telehealth mechanisms. I hope to see you in Las Vegas in 2013.
David Hartzband, D.Sc. is the Director for Technology Research at the RCHN Community Health Foundation.