One of the biggest pain points for CIOs—at large health systems, community hospitals, and everywhere in between—has been positioning themselves as Accountable Care Organizations. The ultimate goal of aligning the patient, provider, and insurance carrier to provide quality care at a low cost is not an easy one, especially when factoring in Meaningful Use, ICD-10, and other top priorities. To help provide some guidance, a number of leaders—including Steven Riney, CIO of Methodist Medical Center of Illinois—collaborated with Premier to develop a multi-phased ACO roadmap. In this interview, Riney talks about what it takes to make the ACO transformation, how Meaningful Use has challenged vendors as well as healthcare organizations, and how Methodist worked with their vendor to tailor a system that accommodates the needs of different specialties.
- Thoughts on Meaningful Use
- MU crowds out innovation — “Might be better called Minimal Use”
- ICD-10 preparation
- Riney’s career — the second time around at Methodist
- The HealthLink experience — “It was a phenomenal company”
- Remembering the consultant’s life
Meaningful Use has not changed our direction as much as given us an additional ability to recoup some of our investment over a period of time. It has not changed our direction at all. It’s actually helped us pull together some internal focus.
I applaud Meaningful Use, because we all have to be sort of equal, and we have to be able to do these things. But in some ways Meaningful Use could more effectively be called minimal use, because so many of our vendors have gone back the mindset of, ‘I’ve got to be able to do this to get the checkmark.
I think it’s going to be tremendous for us as an organization to be able to capture as much as we can, know what we need to capture for ICD-10 well before the deadline, and then be able to use decision support to make sure that we’re doing the right thing in terms of documentation.
HealthLink was a great organization, and IBM is a great organization. It’s just sometimes when you put two great organizations together, it doesn’t work as well as you think it might.
There’s something to be said for sleeping in your bed an average of six to seven nights a week. On the other hand, the ability to see and understand and work in such diverse, phenomenal organizations—you can only get that in consulting. So there are extreme positives on both sides.
Guerra: I’d like to get your thoughts on Meaningful Use; specifically, how the government has done with the program. They’re currently talking about some options to delay Stage 2 or do something to mitigate what is a little bit of a crunch in terms of the timing. What are your thoughts on the program overall and how your organization is lining up to meet it?
Steven: We’re in great shape. With CPOE, we could trip over the finish line on so many of these things, because we’ve been doing this for years. It’s been our vision for years. So Meaningful Use has not changed our direction as much as given us an additional ability to recoup some of our investment over a period of time. It has not changed our direction at all. It’s actually helped us pull together some internal focus, but really, that focus has been there for us. We’ve been wanting to get this stuff done. The fact is, closed loop meds, CPOE, clinical—all of this stuff has been here since before Meaningful Use was even considered. It speaks well to this organization.
The one thing that I will tell you—and I’m going to step back and look at it from an industry prospective—is that the vendors have been challenged in delivering Meaningful Use and they will continue to be. If you look at Stage 2, the way it works is, the government releases the specs, your vendor makes sure they’ve got them, they implement them, and then there is a possibility that you have four to six months to get the entire customer base that went with Stage 1 to Stage 2. That’s an issue, and it’s a challenge.
One of the things that I have said in various open environments—and I’ve had some fairly good response to it—is that I applaud Meaningful Use, because we all have to be sort of equal, and we have to be able to do these things. But in some ways Meaningful Use could more effectively be called minimal use. Because so many of our vendors have gone back the mindset of, ‘I’ve got to be able to do this to get the checkmark. Here’s another checkmark I’ve got to take care. Oops, there’s another checkmark.’ And then all of a sudden their development bandwidth is fully utilized just filling out checkmarks that will allow us to prove that we’re Meaningful users. But we’ve been Meaningful users for six years at this point in time. So I think that’s the unintended consequence, and there is always an unintended consequence with this kind of thing. But the bottom line is it has hurt overall creativity in my estimation, and that’s why I refer to it in some sort of a humorous, sort of a tongue-in-cheek way, as minimal use. Still very positive, but minimal use.
Guerra: They’re still focused on the vendors because they have to do it, right?
Steven: They have to do it, and if they don’t do it, everyone is going to look for another vendor that will do it. And the strange twist to that is there won’t be anybody out there who can respond to them, because they’re all focused on minimal use—I mean, excuse me, Meaningful Use.
Guerra: Right. What about ICD-10, how are you positioned for that?
Steven: We have really started cracking that nut. One of the things that we’ve looked at is getting a CDI implementation. We’ve done CDI with our clinical resources on the floor to work with the doctors to improve clinical documentation. We’ve done that for years. We had a group come in and they said, ‘You know, you’re missing some money. You’re leaving some significant money on the table. If you would just document correctly, we believe that you would be able to be paid accurately.’
And so we looked into that solution, but when I looked at it as a CIO, I said, you know, that seems a whole lot like a small stand-alone siloed system. And so I asked the organization, do we really want to do that, or do we really want to take a look at this whole process within the coding scheme? And do we want to take what we do from the CDI prospective, leverage that, and then get that automatically into a position that we’re going to—at the time of coding when the patient is gone—be able to ask all the right documentation questions, making sure the documentation is right, being able to leverage everything we have to get the right DRG as often as we can. But then have the professional coders be able to look at that data, analyze it, and really add more value to it as opposed to just trying to get another record out the door.
So what we’ve done is we’re looking at a couple of organizations right now that will take the coding system and so computerized coding around that coding system so that the documents that we have on our EMR will be able to come down, be looked at on the coding side, and we’ll be able to highlight those things and say here’s a CHF, here’s the description, here’s the diagnosis, and here’s the procedure, and to do that automatically.
We’re challenging our vendors and saying that’s a great idea, but we want to be able to take that CAC, put it over the top of the CDI for the clinical documentation piece, and have that computer-assisted coding upfront while the patient is on the floor, so we can make sure that the documentation is appropriate for that patient.
And here’s where ICD-10 comes in. So when we get to ICD-10, we’ll have that one smooth process and actually we can start looking at that today from an educational prospective, which I think is going to be tremendous for us as an organization to be able to capture as much as we can, know what we need to capture for ICD-10 well before the deadline, and then be able to use decision support for the CDI staff to make sure that we’re doing the right thing in terms of documentation. And we think that whole process will help us transition smoothly into ICD-10.
The other thing that I would say is that McKesson has been very smart about this. They’re doing an ICD09 and an ICD-10 and they’re going to be able to go concurrently. So we’ll be able to do either coding scheme the entire time—even past the deadline, because we’re assuming that some folks won’t make the deadline on the payer side.
Steven: Does that help?
Guerra: Yeah, sure. I’d like to talk a little bit about your career. I was looking at your LinkedIn profile, and it looks like you’ve had a very long and interesting career. As you mentioned before, you spent 15 years in Methodist before doing a bunch of others things and then winding up back there. Take me through your career a little bit.
Steven: I grew up here. And I’ll make this as short as I can, but the bottom line is that when I was in sixth grade I toured Methodist, and I fainted three times. So it’s not likely, from my prospective as a seventh grader, that I would consider a career in health care. I went to Illinois State University, and after three and a half years, three hours short of a degree, Methodist sent me a letter and said, ‘We have two jobs that we’d like you to come in and interview for.’ And I said, ‘I think I can do that.’ So I went over and I talked to those folks and they said, ‘Well, which job do you want?’ And I said that I wanted the warehouse supervisor job. And the vice president of HR at that point in time, Jim Farrell, great guy, looked at me and said, ‘We want you to take the data processing supervisor job. Because we believe that position will be a vice president of this organization. He said that in 1979.
Guerra: Wow, that’s amazing.
Steven: Who else was thinking about that in 1979? And that goes back to our original HBO days when we were the third hospital and the first hospital of McDonnell Douglas. So I was in an environment where I could learn, I could be nurtured, I could make some mistakes, I could have some success, etc. It was just as phenomenal organization for me to start my career. At one point in my career I thought that the vice president thing wasn’t going to happen here. So I was going to go see how that works, and I went from here to St. Joseph Regional Health System, where I had eight hospitals in that area. We joined Catholic Healthcare West and went from eight to 48 hospitals. I was there for an extended period of time, and then I travelled to WakeMed in Cary, N.C. I love the area out there and I love the organization—it’s a phenomenal, quality organization.
And then I went into consulting with HealthLink. I’ve been at Partners, UCLA, Sutter, Sharp, Cedars Sinai, Exempla, LSU—I’ve been at some of the best organizations in the country. I was able to really go in and do some IT strategy with those folks, and it was just phenomenal. I have to tell you, I’ve thoroughly enjoyed my entire career, and so the thought of fainting in a hospital in sixth grade—that’s a distant memory. There is a real need for automation in health care and process improvement, and I’ve been able to do that and been able to help with that, and it’s just been a joy to be in that position.
I came back to Illinois because I knew the position was open at Methodist. I wanted to learn about it, so I made a contact with the search firm. And that previous night, they had sent out a blind announcement about a job that said, ‘Here’s a high quality organization—low-cost, bond-rated,’ etc. I read that and say, ‘Hey, I want to know about Methodist, but I really want to know about this other company or hospital.’ And she laughed and said it was Methodist. So it was like I really wasn’t coming home because the organization had actually changed significantly, and it was very aggressive on so much of the automation. And it’s been a joy to be here.
Guerra: Let’s talk a little bit more about HealthLink. That was a pretty interesting organization. It had a lot of very well known people who have moved on—Ivo Nelson, now at Encore Health Resources with Dana Sellers, and Lynn Vogel at MD Anderson Cancer Center in Texas.
Steven: Yes, I know Lynn well.
Guerra: It must have been an interesting place because so many people have gone on from there to do great things, and a lot of people left there because of the acquisition by IBM. Give us your thoughts on HealthLink.
Steven: HealthLink was a phenomenal company, and I was able to go into some of these top places and do IT strategy, and I had that opportunity because of HealthLink, Ivo, Dana, Ed Kopetsky, Lynn—these are quality individuals. The thing I liked most about HealthLink is that every client they ever had was referenceable, and I think that in itself is such a strong statement. It was easy to work there because you knew you were going to be able to do the right work and be backed up to make sure it was right for the customer.
Guerra: You joined in August 2006 and the acquisition was in April 2005. Is that correct? You came in after the acquisition?
Steven: Yes, I had the opportunity to live through the IBM acquisition. And IBM is a great organization, but there was a great opportunity for them to leverage HealthLink and I don’t think they made the most of that opportunity. That’s probably the best way to say it.
Guerra: Was there a culture there that they didn’t understand? Was there a way that people enjoyed working that made them successful that IBM did not understand?
Steven: I don’t think it was the way that the people enjoyed working, but I think there’s definitely a culture element to it. I think the challenge with IBM is that they’re a great, large, phenomenal, widely functional organization that does tremendous work on so many fronts. And that’s where I think the challenge is—the ‘so many fronts.’
Had they taken Ivo and continued to let him run in organization and pull the IBM resources around him, I think they would have been very, very successful.
Steven: They decided not to do that for their purposes and for their reasons, and that’s their decision. But I think that limited the transition. And again, HealthLink was a great organization, and IBM is a great organization. It’s just sometimes when you put two great organizations together, it doesn’t work as well as you think it might.
Guerra: What were your thoughts on the consultant life, since you’ve done both? Did you enjoy consulting? Did the travel get to be a bit much? A lot of CIOs today want to try it out, and a lot of consultants maybe want to try to be CIOs. So I ask people who’ve done both to give advice to either side.
Steven: There’s something to be said for sleeping in your bed an average of six to seven nights a week. On the other hand, the ability to see and understand and work in such diverse, phenomenal organizations—you can only get that in consulting. So there are extreme positives on both sides. We had a person that had left Methodist and they went to do a little consulting and I said, what you’re going to find is that you’re going to like it, and it’s going to be exciting, but the travel will get old. You’ll get tired of schlepping the suitcase through airport after airport. But there’s so much opportunity to learn, and so many opportunities to make great contacts.
Guerra: It sounds like it could be extremely valuable and important for someone’s career path to do consulting for a few years, but you have to do it at a right time in your life and being on the road so much. But it gives you experience you would never get any other way.
Steven: Absolutely, and for me it was right after the kids graduated high school and the last one was going into college. So the timing was perfect for me. Had I had that opportunity when I was 30, it wouldn’t have been good at all. I’d have been away from the kids for so long.
Guerra: Right, and then you kind of want to wind it down when you get into your later years. The travel may become less interesting because it’s exhausting.
Steven: I don’t think the travel would become less interesting in later years as opposed to earlier years. I think it’s exhausting no matter what. So would take a little issue with that, and maybe it is for some people, but the travel is a challenge. That’s the challenging piece, but there are many benefits of doing the consulting.
Guerra: We hear about people who are consultants having more health issues—they don’t eat as well, they don’t get as much exercise, they’re in airplanes where you get a lot of germs flying around. Is that the case?
Steven: I’ll tell you, I lost a lot of weight when I started consulting.
Steven: You either gain weight or lose weight, from what I understand, because I was able to eat better on the road. I was able to find salmon every night; I was able to find fish or very lean steak, that kind of thing. The road helped me, but clearly it does not help everyone.
Guerra: Because a lot of people just hit the fast food.
Steven: Yes, exactly.
Guerra: Alright, well I think that is all I had for you today. Is that there anything else you wanted to touch on?
Steven: There’s one more piece, going back to the ACO. I think the challenging piece for the ACO is that data is the key driver to success, to the extent you can’t get to that data accurately and timely—it’s buried within a payer system that you don’t have access to. I believe that to be a real threat to the success of an ACO from a provider prospective. And I think that’s the challenging piece, especially as we have the potential to have multiple ACOs with differences between them. I think those are a couple of pretty good-sized challenges.
Guerra: All right, well thanks so much for your time, Steven. I hope we get to talk again soon.
Steven: Very good. I look forward to it, take care.