Vertical Market Information Center Healthcare Market 2005 Toshiba America Business Solutions, Inc. Training and Dealer Development Group
Physician s Office / Clinic Market Overview General The U.S. continues to spend more on healthcare than any other developed nation, whether measured as total spending, spending per capita or spending as a percentage of GDP. Per capita expenses were $6,167 in 2004. National Health Care Expenditures 2004 - $1,794 billion. Expected for 2010 - $2,751 billion (Copyright Plunkett Research, Ltd) Healthcare Market Final 11-28-05 1
(Copyright Plunkett Research, Ltd) (Copyright Plunkett Research, Ltd) National Health Care Expenditures for Physician and Clinical Services in 2004 - $386.8 billion Number of physicians in the U.S. in 2003 871,535 (Copyright Plunkett Research, Ltd) 2 Final 11-28-05 Healthcare Market
In 2002, approximately 583,000 physicians and surgeons practiced medicine; approximately 1 out of 6 was self-employed. About half of salaried physicians and surgeons were in office-based practices, and almost a quarter were employed by hospitals. Others practiced in federal, state, and local government; educational services; and outpatient care centers. A growing number of physicians are partners or salaried employees of group practices. Organized as clinics or as associations of physicians, medical groups can afford expensive medical equipment and realize other business advantages. New England and the Middle Atlantic states have the highest ratio of physicians to population; the South Central States have the lowest. Employment of physicians and surgeons will increase about as fast as the average for all occupations through the year 2012 (10 to 20 percent) due to continued expansion of the health services industries. The aging of the U.S. population will drive overall growth in the demand for physician services, as consumers continue to demand high levels of care using the latest technologies, diagnostic tests, and therapies. (U.S. Department of Labor, Bureau of Labor Statistics) Healthcare Market Final 11-28-05 3
Physician s Office / Clinic Market Trends (IDC) Aging Population The U.S. population is aging rapidly as baby boomers move into their senior years. At the same time, the life expectancy of seniors is increasing. The larger senior population will place a significant strain on the healthcare system in coming years. 4 Final 11-28-05 Healthcare Market
Healthcare Costs Rising Healthcare costs have risen rapidly for years and are expected to continue to increase. Total U.S. healthcare expenditures are projected to increase from $1.8 trillion in 2004 to $2.6 trillion in 2010. Health spending in the U.S., at over 16 percent of Gross Domestic Product (GDP), accounts for a larger share of GDP than in any other major industrialized country. Biotech Era We are entering the Biotech Era. Breakthroughs in diagnostics and drug therapies are occurring at a rapid pace, creating financial and ethical challenges along with opportunities. Attempts to regulate controversial procedures are resulting in new state and federal laws that increase reporting and compliance requirements. Healthcare Market Final 11-28-05 5
Medical Savings Accounts President Bush is expected to continue pushing the use of Medical Savings Accounts, which are used by only a small number of Americans at present. Two types of accounts are the Health Savings Account (HSA), which combines a tax-free savings and investment account, somewhat similar to a 401(k), with a high-deductible health coverage plan, and a Health Reimbursement Account (HRA), which is a form of health care coverage provided to employees by their employers. These new methods of paying medical expenses greatly increase the tracking and reporting required to implement the new payment plans. (Plunkett Research, Ltd) Limited IT Technology Adoption of clinical information technology (IT) in physicians practices has the potential to improve quality and reduce the cost of care for people with complex health problems, including many Medicare patients. A majority of Medicare fee-for-service outpatient visits in 2001 was to physicians without significant IT support for patient care, according to a new baseline analysis of Medicare claims data linked to the Community Tracking Study (CTS) Physician Survey. More than half of Medicare outpatient visits (57 percent) were to physicians in practices that used IT for no more than one of the following five clinical functions: Obtaining treatment guidelines Exchanging clinical data with other physicians Accessing patient notes Generating preventive treatment reminders for the physician s use Writing prescriptions. Monitoring adoption trends and assessing gaps in Medicare patients access to physicians with clinical IT are important as policy makers try to speed IT adoption. (Center for Studying Health System Change) Physician Services Spending Spending on physician services per privately insured person held steady in early 2004. During the first six months of the year, spending on physician services grew by 5.7 percent only slightly higher than the 5.4 percent increase in the second half of 2003 and identical to the increase in the first half of 2003. In the recent past, physician services has been the slowest growing category of healthcare spending. (Center for Studying Health System Change) 6 Final 11-28-05 Healthcare Market
Hospitalists Mounting financial pressures, increasing problems with patient flow in hospitals, a growing focus on patient safety, and rising malpractice costs have spurred the use of a new breed of physicians who specialize in caring for hospitalized patients. Known as hospitalists, the number of physicians specializing in hospital medicine has increased from a few hundred in the mid- 1990s to more than 8,000 in 2003, according to information in the HSC study provided by the Society for Hospital Medicine, the professional society of hospitalists. (Center for Studying Health System Change) Physician Shortage In June 2005 the American Medical Association (AMA) recognized that there is a shortage of physicians, at least in some regions and specialties, and that evidence exists for additional shortages in the future. To address shortages, the AMA will work to develop mechanisms, including identification of funding sources, to create medical school and residency positions in or adjacent to physician shortage/underserved areas and in undersupplied specialties. (AMA news release) Specialty Hospitals Physician groups are investing in new specialty hospitals in an effort to provide their patients with better, more efficient care. June 2005 marked the end of an 18-month moratorium on new specialty hospitals, which was originally imposed by the Medicare Modernization Act of 2003. The AMA has repeatedly called for an end to the moratorium on specialty hospitals, and has testified before Congress on the importance of these care centers, often opposed by general hospitals. (AMA news release) Healthcare Market Final 11-28-05 7
Physician Office / Clinic Market Regulatory Issues The Health Information Portability and Accountability Act The Health Information Portability and Accountability Act (HIPAA) was enacted in 1996 to provide standards for protecting the privacy of personal health information. It also provides standards for electronic transactions and protects the health insurance coverage of workers when they change or lose jobs. Deadlines for compliance with various aspects of these laws stretches from its inception to April 2006, and understanding the requirements and complying with them is a concern for every healthcare organization. (Centers for Medicare and Medicaid Services) The following terms are often used in HIPAA-related discussions: Patient Health Information (PHI): Any information gathered during the registration, diagnosis, or treatment of a medical condition. Covered Entity (CE): Any entity that handles patient health information, including providers, health plans, employers, public health authorities, life insurers, clearinghouses, billing agencies, information systems vendors, service organizations, and universities. HIPAA Rules Privacy Rule: This HIPAA rule requires CEs to take all reasonable measures to ensure the confidentiality, integrity, and availability of individually identifiable patient health information. It applies to paper and oral information as well as to electronic information. The Privacy Rule was finalized in August 2002 and became effective for all health plans and healthcare providers as of April 2004. Security Rule: This rule sets standards to provide a uniform level of protection for all health information that is stored or transmitted electronically. It also includes proposals for the use of electronic signatures. This rule was finalized in February.2003. Most health plans and healthcare providers had to comply with the new requirements by April 2005. Transaction and Code Set Rule: This rule standardizes the formats and protocols used for electronic data interchange (EDI). EDI allows medical, billing, and other information to be exchanged and processed quickly and cost effectively. This rule became effective October 2000. 8 Final 11-28-05 Healthcare Market
Identifier Rule: This rule proposes standards for National Standard Health Care Providers, National Standard Employers, and National Health Plan identifiers. This rule became effective July 2002. (ecopy white paper ecopy and the Health Insurance Portability and Accountability Act ) Joint Commission on Accreditation of Healthcare Organizations The Joint Commission on Accreditation of Healthcare Organizations (JACHO) evaluates and accredits more than 15,000 health care organizations and programs in the United States. This accreditation is necessary for reimbursement of Medicare and Medicaid expenses. An independent, not-for-profit organization, the Joint Commission is the nation s predominant standards-setting and accrediting body in health care. Since 1951, the Joint Commission has maintained state-of-the-art standards that focus on improving the quality and safety of care provided by health care organizations. The Joint Commission s comprehensive accreditation process evaluates an organization s compliance with these standards and other accreditation requirements. The Joint Commission s evaluation and accreditation services are provided for the following types of organizations: General, psychiatric, children s, and rehabilitation hospitals Critical access hospitals Medical equipment services, hospice services, and other home care organizations Nursing homes and other long term care facilities Behavioral health care organizations, addiction services Rehabilitation centers, group practices, office-based surgeries, and other ambulatory care providers Independent or freestanding laboratories (JACHO web site) Healthcare Market Final 11-28-05 9
Physician Office / Clinic MarketResources American Medical Association http://www.ama-assn.org/ American Hospital Association http://www.aha.org/aha/index.jsp List of the 100 Most Wired Hospitals http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=hhnmag/pubsnewsarticle/d ata/0507hhn_coverstory_winnerslist&domain=hhnmag List of state hospital associations http://www.americanhospitals.com/resources/hospassns.htmhttp:/www.pohly.com/assoc.html Society of Hospital Medicine http://www.hospitalmedicine.org//am/template.cfm?section=home Independent Physicians Organization http://www.phdelivery.com/ipa.asp Association of Medical Professionals with Hearing Losses http://www.amphl.org/ Chinese American Medical Society http://www.camsociety.org/ National Hispanic Medical Association http://www.nhmamd.org/ American Association of Medical Society Executives http://www.aamse.org/ Comprehensive list of organizations by medical specialty http://www.practicesight.com/directories/organizations/physician%20organizations.htm#interna l%20medicine 10 Final 11-28-05 Healthcare Market
Success Story Medical Information Management Company Business Problem: A medical information management company processes medical claims for various medical services providers. These forms are filled out by hand and sent by courier or fax to the centralized processing service. Implementing a faster and more efficient way of processing these documents could lead to quicker payments for the firm s clients, improving customer service and providing a competitive advantage. The Toshiba Solution: ecopy provides the connecting link between the digital copier and the company s e-mail system, enabling employees to move these scanned forms between offices. The staff can now send and receive paper documents quickly, easily, and inexpensively. They are also able to fill out paper forms directly on their PCs, avoid long waits at busy fax machines, and effectively archive all of their paper-based communications. (ecopy) Healthcare Market Final 11-28-05 11
Selling Tips for the Physician s Office / Clinic Market All healthcare organizations deal with massive amounts of paper-based documentation. Patient medical histories, enrollment forms, and claim forms are constantly being sent, received, archived, and retrieved. At the same time, the Health Information Portability and Accountability Act requires healthcare organizations to implement appropriate administrative, technical, and physical safeguards to protect the privacy of patient health information, whether in electronic form or hardcopy. Your questions should help discover solutions that can accomplish the following: Maintain the privacy of patient records Provide for convenient transmittal of data to appropriate offices Allow for additional information to be added to documents and additional documents to be added to patient records Ensure the staff s ability to maintain accuracy in patient records Provide for quick access to medical records. 12 Final 11-28-05 Healthcare Market
Key Questions for the Physician s Office / Clinic Market Document Management 1. Are you looking for a solution that will meet the requirements of the Health Information Portability and Accountability Act? 2. Do you use fax to communicate with outside concerns (labs, doctors, patients, etc.)? > What is the average daily number of outbound fax transmissions? > Do you often need to retransmit faxes due to busy signals or complaints about image quality? > Does the staff often wait for access to the fax machines? 3. Do you have a plan for security and confidentiality of electronic health information? > Are your paper documents secured from unauthorized access? 4. How are you communicating patient records: > Between healthcare institutions/providers? > Between your facility and insurance companies? 5. What is the average daily volume of documents sent via UPS/FedEx/Airborne, U.S. Postal Service, or other courier service? > What is the average monthly expense for courier and carrier services? > Do courier/carrier pickup schedules create challenges in providing timely communication with your patients or healthcare partners? (ecopy) Healthcare Market Final 11-28-05 13
Toshiba Solutions for Physician s Office / Clinic HIPAA Compliance Business Need When the transfer of patient health information is involved, organizations must ensure that they comply with HIPAA s privacy and security regulations. This concern is the biggest driving factor in the need for a comprehensive and secure document scanning and distribution solution within the healthcare market. Toshiba Solution Toshiba e-studio MFP with Questys software connected to the client s network. For large scanning requirements, a dedicated scanner should also be added. <graphic note text will pop up as cursor moves over boxes in the flowchart> Benefits Electronic storage and backup of documents with protected access Keycode access to multifunction devices Tracking and reporting MFP usage by user or department Private Print feature Fax-to-email feature 14 Final 11-28-05 Healthcare Market
The security benefits meet all privacy protection requirements of HIPAA by restricting access to personnel with keycodes, faxing secure documents directly by email to users, and by tracking copier usage by department. ecopy integrates real-time with Outlook and Notes, and uses LDAP. Sent emails show up in the users' email sent folders. And emails that get bounced back show up in users' email inbox. These two functions provide a valuable audit trail for sensitive medical documents, thus allowing medical concerns to comply with HIPAA regulations. Healthcare Market Final 11-28-05 15
Toshiba Solutions for Physician s Office / Clinic Managing Medical Records Business Need Thousands of files can jam up a small medical practice. Often, the staff must pull a patient file, copy and forward it to an affiliated office across town and ask the patient to wait days, if not weeks, for the process to be completed. Toshiba Solution With an e-studio MFP and Questys and DocForm software, all records can be managed electronically; medical staff can type in a simple query (the patient's name and social security number, for example) into the powerful search engine, and pull up all of the records instantly. They can then simply send retrieved files directly by fax or email to the appropriate medical office. Additional documents can be added to a patient s file at any time, and existing documents edited and updated as needed. 16 Final 11-28-05 Healthcare Market
Benefits Increased speed and savings in the distribution of critical patient documents Cost reduction through more efficient use of medical records storage space Higher productivity from staff based on faster processing of patients due to immediate document availability Healthcare Market Final 11-28-05 17
Toshiba Solutions for Physician s Office / Clinic JACHO Accreditation Business Need The Joint Commission on Accreditation of Healthcare Organizations evaluates and accredits more than 15,000 health care organizations and programs in the United States. This accreditation is necessary for reimbursement of Medicare and Medicaid expenses. The Joint Commission s comprehensive accreditation process evaluates an organization s compliance with these standards and other accreditation requirements. Management of information is included in onsite surveys necessary for accreditation. All records must be maintained in a manner that ensures accuracy and security for patient records. Toshiba Solution An e-studio MFP with Questys and Re-Rite software can maintain patient records and billing information safely and efficiently. 18 Final 11-28-05 Healthcare Market
Benefits ecopy enables index values to be sent directly into doc management systems, such as Questys, at the time of the scan. This reduces labor and errors. Confidentiality of records is maintained through access codes. Efficient, electronic storage of documents reduces costs and improves productivity. Availability of documents for editing or transmission increases productivity. Accurate OCR translation of documents reduces errors and labor. Healthcare Market Final 11-28-05 19