News 8/25/11

Children’s Clinics for Rehabilitative Services (AZ) deploys DigitalPersona Pro and U.are.U Fingerprint Readers for fingerprint biometrics and secure access to the practice’s NextGen EHR.

Millennium Healthcare Inc. signs a letter of intent to acquire billing and consulting firm Premier Technology Resources.

e-MDs launches e-MDs Rounds for the iPhone, giving doctors access to their EHR data via their mobile device.

Speaking of e-MDs, Acacia Research Corporation announces that e-MDs has signed a license agreement with Acacia subsidiary Document Generation Corporation and thus resolved pending litigation. Specific terms were not disclosed, though the litigation involved certain e-MD products and patents for Document Generation software.  Mr. H once called Acacia a “patent troll,” so I have to wonder if this lawsuit was really much ado about nothing.

Office Ally will integrate with Ideal Life’s monitoring systems.

Delaware Health Hub, a subsidiary of the Medical Society of Delaware, adds Aprima Medical Software as an approved vendor.

Almost half of all physicians worked with nurse practitioners, physician assistants, or certified nurse midwives in 2009, most commonly in practices that are larger, younger, and Medicaid-accepting.

The AMA issues a favorable response to CMS’s introduction of the Bundled Payments for Care Improvement initiative. AMA applauds the proposed flexibility and urges CMS to be prepared to provide technical assistance to interested physicians who do not have experience with bundled payment models.

Healthcare Blue Book introduces a free iPhone app that gives consumers the ability to check the price of common healthcare services. An enhanced app for employers allows employees to search for in-network providers offering the best value.

Jason Colquitt, Greenway Medical’s director of research services, is elected to a two-year term on the HIMSS EHR Association’s executive committee.

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News 8/23/11

Providers with Seton Healthcare Family (TX) receive $18K each from CMS for their Meaningful Use of eClinicalWorks EHR.

Urology EHR vendor meridianEMR files a lawsuit against competitor Intuitive Medical Software (UroChart), claiming UroChart cloned one of its servers and thereby gained illegal access to meridianEMR’s product and the protected health information stored by its clients. A federal judge denied meridianEMR’s request for a restraining order against UroChart, saying that it was not needed because a third party has control of the test server involved.  Update: meridianEMR sent us an e-mail saying that its request for a restraining order was not denied, but rather that the judge lifted the part of it involving the server that meridianEMR claims was used to copy its software. The court order requires IMS to turn the server over to a neutral third party.

While looking for more information on meridianEMR, I noticed the above chart on the company’s website. I must admit that if I were investing in an EMR, I’d be asking the vendor to provide this type information.  I like the transparency, even though 36 attestations (less than 4% of the company’s 1,000+ physician users)isn’t a terribly impressive figure.

Midwest Physicians Services (MN) selects Zotec Partners to provide billing services for its radiology clients.

About three-quarters of all US doctors will be sued for malpractice at some point in their career, though only about 22% of claims lead to payment. Surgeons, particularly neurosurgeons and obstetricians, have the highest risk of being sued. The average claim payment was about $275,000 in the 15-year, 41,000-physician study.

RCM provider PracticeMax acquires American Billing Services, which offers billing and PM services to physicians and hospitals.

Joint Commission designates AltaMed Health Services (CA) as the first organization to earn Primary Care Medical Home (PCMH) designation under its Ambulatory Care Accreditation Program.

GE Healthcare names Clerity Healthcare its exclusive systems integration solutions provider for GE Centricity Practice Solution and EMR.

Electronic Health Records of Rhode Island (EHRRI), a provider-led implementation services organization, donates its activities and operations to the Massachusetts eHealth Collaborative (MAeHC). Members of the former EHRRI team will provide a Rhode Island presence, provide EHR implementation and support, advisory services, and quality data warehousing and analysis via MAeHC’s proprietary Quality Data Center.

Hospitals are employing more physicians to grow market share and revenue, but the trend may lead to higher healthcare costs and does not guarantee clinical integration. That’s the conclusion of the Center for Studying Health System Change, which found that employed physicians face pressure from hospitals to order more expensive test alternatives  and that hospitals usually negotiate health plan contracts for their physicians at higher rates than physicians could negotiate independently.

E-mail Inga.

DOCtalk by Dr. Gregg 8/19/11

Academies, Vendors, and Medical Wagon Wheels

In this month’s AAP News, the American Academy of Pediatrics’ Department of Practice announced the results of the very successful (and first) HIT vendor consortium held by the AAP’s Child Health Informatics Center (CHIC) in June. The meet was designed to explore ways to partner with electronic health record vendors to disseminate the AAP’s extensive pediatric knowledge base and expertise. As far as I am aware, this is a first for the AAP, and is not terribly common amongst medical academies in general.

Maybe it’s a bit different for pediatrics, as we do have lots of rather unique needs: multiple family members with multiple surnames and multiple caregivers all with blended or unblended family, social, and health histories; immunizations and tracking thereof; patient consent and privacy issues that are extra complex with child versus parental rights with which to contend; and more.

But I would wager that most areas of healthcare provision have some unique needs, too. Plus I know for certain that they all have volume upon volume of unique expertise that could benefit all if only it could be easily accessed.

It makes great sense –  to me, anyway – that medical academies of all sorts should reach out to vendors to help share their wealth of specialty-specific health expertise and work with the vendors to guide their contingent’s special EHR needs. We certainly don’t need hundreds of EHR vendors trying to recreate every healthcare “wheel” if there are best practice ways to do so.

Defining those best practices may be challenging, and converting reams of medical reference materials to a distributable digital format will be a lengthy and costly process, but doing so together will likely get us to the most functional wheels for our joint healthcare “wagon” faster and more economically.

A longstanding roadblock to this collaboration is the resistance of medical academies to show any sort of preference or participation with capitalistically-driven vendors. I’ve seen this firsthand as the director for the AAP’s “Pediatric Office of the Future” (POF) exhibit for their annual National Conference & Exhibition. The AAP has some pretty strict rules and regs for associating the AAP name with outside sources such as technology vendors. Understandably, they don’t want to appear to endorse any particular corporate brand name tool/service or seem to have any untoward influences from same.

This can be tricky when engaging sponsors for the POF, which is strictly an educational exhibit and not a sales booth. We want and need their support, but we cannot appear to be showing any endorsement. But by watching where we step, we have followed all the rules and still grown some 500% in five years. The learning opportunities for our attendees – both via hands-on demonstrations and our nearly 30 short topic talks in our new “Education Theater” – are almost exponentially larger.

I have become convinced that working with technology vendors to advance technological literacy among healthcare professionals can be done without conflicts of interest or implied endorsements.

And now, the AAP via CHIC has successfully reached out to the first round of 11 EHR vendors to start the conversation around ways that pediatric-specific knowledge and standards of care might be digitally distributed to promote child health. From the Bright Futures child health guidelines to the patient-centered medical home (a concept originated by the AAP in 1967) to forms standardization to the unique needs of pediatric EHRs, CHIC and the vendors in attendance all agreed that “the Academy’s first step in working to develop partnerships with the EHR vendor community to advance child health informatics” was both welcomed and useful.

I was particularly impressed by the enthusiasm the vendors expressed when we first broached them with the idea. They loved the thought of receiving this type of expertise and knowledge sharing. And, this was just a first step. CHIC plans on a much broader reach out to EHR vendors.

I can’t really speak for other Academies, though from personal experience I know that the American Osteopathic Association and the American Academy of Family Physicians do have some history of working with EHR vendors or associated entities to further their unique needs. I believe there have been some other vendor/academy collaborations, but generally limited. Maybe some of you out there can offer some other examples where such academic orgs have found successful corporate cooperation without integrity compromise…?

I’m very happy to see this sort of progress, and hopefully we’ll see lots more of it. I look forward to the bigger, better digital medical expertise “wheel” which could roll us all into a joint electronic future more effectively.

From the trenches…

“Coming together is a beginning. Keeping together is progress. Working together is success.” – Henry Ford

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, directs the Pediatric Office of the Future exhibit for the American Academy of Pediatrics, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

News 8/18/11

The Big Lake Clinic (MN) will go live on Epic EMR September 1. The four-provider clinic is part of New River Medical Center and CentraCare Health System, both of which also run Epic.

Anesthesia Healthcare Partners, a provider of anesthesia practice management, hires RCM service provider MediRevv to provide A/R management services.

Declining reimbursements, competition for specialists, and the cost of technology contributed to the significant operating losses many provider organizations experienced last year. Physician compensation was relatively flat, with 70% of specialties seeing small increases in pay;  overall compensation growth was about 2.4%.

Nuance Communications unveils Dragon Medical Practice Edition, which targets the needs of physicians in practices smaller than 25 providers.  Nuance reports that the new edition yields a 15% improvement in accuracy over previous Dragon Medical releases and supports dictation directly into ambulatory EHRs.

Medications for blood pressure, cholesterol, infection, and depression are the most commonly prescribed drugs by Practice Fusion users, according to the company’s Prescription Index report.

The above charts show the breakdowns for Meaningful Use payments to eligible providers, though the end of July.  The Medicare figures (for a total of 1,078 total providers) break down the number of providers by specialty; Medicaid numbers (3,334 total providers) show recipients by provider type.  More nifty facts can be found on the CMS website under “Provider Registration and Payments.”

In communities across the country, increasing numbers of physicians are moving from independent private practices to become employees of hospital systems. An Idaho paper reports on the trend in Boise, where  Saint  Alphonsus Health System added 19 doctors between September 2010 and June 2011. At St. Luke’s Health System, staff physicians were increased  50% after the hiring of about 100 doctors from June 2010 to June 2011. Physicians are making the move for a variety of reasons, including concerns about ongoing technology costs, fear of pending changes in reimbursement, and the desire to reduce the administrative tasks associated with running a private practice.

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E-mail Inga.

From the Consultant’s Corner 8/17/11

Beyond A/R Days: An Integrated Approach To Revenue Cycle Performance Management

Many physician practices make the mistake of measuring revenue cycle performance with a single number: accounts receivable (A/R) days. While no one will argue that this is an important metric, it doesn’t tell the whole story.

For a realistic, meaningful understanding of financial performance, providers must examine multiple key performance indicators and appreciate the relationships among them. In fact, an isolated number can be worse than meaningless — it can be deceptive.

For example, A/R numbers on their own may look perfectly respectable, but if it takes three weeks to fix coding or charge entry errors so the A/R “clock” can start, your revenue cycle is really 21 days longer than your measurement shows. Similarly, a 10-day lag for a charge to make it into the system or a backlog of charges awaiting missing data also affect your overall revenue picture.

It takes an integrated approach to effectively manage and improve financial performance. Your billing report card should include a broad range of metrics and indicators, such as:

• the number of days it takes to get charges into the system;
• how long it takes to produce the claim form;
• how thorough you are at capturing charges for all services rendered.

Monitor charges on a monthly, year-to-date and annual basis and then make sure to compare them to previous years to track practice productivity. But don’t forget to consider whether charges have increased. For example, if payment is up 10% over the previous year but charges are up 50%, the picture isn’t so rosy.

Other significant numbers to track include:

• A/R days over 90 (at risk for denial based on timely filing limits).
• the number of days between the date of service and the date the charge is entered in the system (sometimes called a charge log).
• the dollar amount of charges sitting in claim edits because they’re missing data, the procedure code doesn’t match the diagnosis code, or other errors.
• claim rejection percentages.

Billing and revenue cycle directors and managers should follow these numbers daily, present them to C-level executives once a month, and be willing to educate the executive audience about their relevance and relationships.

It’s also a good idea to measure your benchmarks against those of your peers at least once or twice a year, or ideally, each quarter. Comparing your numbers relative to those of top performers will identify areas for improvement as well as deficits that warrant deeper review.

Effectiveness and efficiency both count

These measurements and analyses obviously take time, and in a busy practice it’s easy to postpone them. But just because you’re satisfied with your A/R days doesn’t mean your organization’s financial performance can’t improve.

Keep in mind that there are two distinct factors driving revenue cycle management: effectiveness and efficiency. Effectiveness is the amount of money a practice collects. Efficiency represents the cost of collecting it.

Even if you can’t move A/R days from 36 to 35, for instance, you may be able to make your revenue cycle more robust by shrinking the time to get a charge into the system, reducing claim rejections, or other cost-cutting measures.

Especially with recent government initiatives and incentives for electronic health record (EHR) adoption, regular monitoring of the revenue cycle is becoming easier and more imperative. More than ever, tracking and monitoring a robust suite of key metrics is essential to developing a realistic picture of financial performance.

Rob Culbert is founder and president of Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation and information technology.