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.

News 8/16/11

Maine Medical Center PHO signs an agreement with athenahealth to offer athenaCollector and athenaClinicals to the PHO’s 1,000 member physicians.

Annual healthcare spending for patients served by community health centers is about 62% less than for patients served in traditional primary care settings. Some of the reason: more physicians are salaried in CHCs; federal price discounts are available to CHC patients; more comprehensive services are provided by the CHCs than by other types of care venues; and, the majority of CHC board members are health center users and thus have more accountability.

Maui Medical Center (HI) renews and extends its relationship with GroupOne Health Source to provide RCM services and eClinicalWorks EHR to its affiliated physicians.

Physician EHR adoption rates are creeping up, according to the organization hired by the ONC to measure EHR adoption and usage in medical offices. Overall adoption is up 2% since October to 40%. Practices that are owned by hospitals and health systems have the highest adoption levels (60%), which is a 6% increase since October.

Emdeon announces its support for the DEA’s quicker-to-market option for the e-prescribing of controlled substances. This option, which has been referred to in the industry as “Option 2,”  requires the transmission of a flag from the prescriber to the pharmacy indicating that a controlled substance prescription has ben sent using a two-factor authentication method.  “Option 1” requires more complex technology, would require more standards to be developed, and ultimately would take longer for pharmacies and providers to adopt.

Kyle Swarts joins Culbert Healthcare Solutions as a regional sales executive,  responsible for the business development of Culbert’s strategic planning, revenue cycle, and IT services. 

The GAO advises CMS to improve its physician quality reporting and to survey physicians on how to make its reports more  meaningful, actionable, and reliable. Among  the GAO’s recommendations: CMS should evaluate why so few physicians access their electronic feedback reports and should develop better methodology for distributing its reports.

Telehealth is gaining in popularity and acceptance, at least in Minnesota. A local paper reports that the number of practices statewide offering electronic visits has grown from 13% at the end of 2010 to about 25% today. Health insurers like UnitedHealth Group and Blue Cross, along with health systems, are driving the trend.

E-mail Inga.

Practice Wise 8/13/11

What’s In an Upgrade?

There is much excitement in the community. EHR software vendors are rolling out their long awaited Meaningful Use product upgrades. There has been so much anticipation for the new features and functionality, as well as standardization across platforms. 

It’s hard to imagine that this process could be painful. In your excitement, are you considering the scope of the upgrade and impact it will have on your practice?

In the ambulatory practice setting, these upgrades should be treated with the same respect and degree of planning as a new software implementation. The phenomenon I am seeing in the community we serve is that many practices are assuming that since they are already users of the software, they can get by the upgrade process with little extra effort.

A few recommendations from the trenches:

1. Recognize the scope of the upgrade and share this with everyone in the practice, providers and staff alike.
2. Set appropriate expectations for everyone.
3. Take full advantage of any and all upgrade training provided by your vendor. Reading a release notes document will not suffice.
4. Plan as if you were getting new software.  Assign an internal project manager or point person to coordinate upgrade expectations with your vendor’s project manager. Document your contingency plan, so when things don’t go according to plan, you are still able to see patients. Print schedules and progress notes for the day of and day after upgrade. Reduce your schedules for the day of/after upgrade. Plan to have vendor support on site for day of/after upgrade if possible, even if it costs you money. It’s more costly to try and figure it out on your own or on the phone with 1-800helpme support when things are going wrong.
5. Coordinate the upgrade with your IT team. If that is an external party who will not be performing the upgrade itself, they still need to be part of the process to ensure that your hardware and network are up to spec and be on hand or on call for any IT issues that arise out of the upgrade or that could prevent the upgrade from completing successfully.
6. Communicate with your patients. If they know that you are in the process of upgrading prior to or on arrival for their visit, they will be less intolerant when there are delays. Let them know that you have taken all the steps possible to anticipate their needs and make their visit as smooth as possible.
7. Breathe! Try to keep your sanity as you move through the changes of your software and adapt your processes. Just like with a new software implementation, it can be difficult to master the new functionality at first, but in time, you will gain proficiency and a sense of normalcy.

If you are fortunate enough to have purchased software from a vendor that continually develops their product, then upgrade planning and implementation will be an ongoing part of your business processes. Work with your vendor to develop an estimated frequency for upgrades and plan and budget for these events so that they are not dreaded disruptions, but rather the valued improvements they are intended to be.

Julie McGovern is CEO of Practice Wise, LLC.