Posted by SATISH MALNAIK on Tue, Oct 11, 2011 @ 04:19 PM
On one hand, physicians across the board are under financial distress - particularly, primary care physicians. On the other hand, the government mandates the use of electronic medical records (EMR) system over the coming years.
The 2009 HITECH Act provides fiscal stimulus to encourage practices to adopt EMRs. Medicare will provide a total of $44,000 over five years starting in 2011. Furthermore, Washington is evolving "meaningful use" guidelines that must be met for an EMR user to qualify for the stimulus. So what must a practice do?
In the heightened and confused state of EHR adoption, there have been many articles written about what to take into consideration when picking your preferred EHR and EMR. We have been painted with a pretty picture of the future world but not a clear path to get there. The list for evaluation can be quite exhaustive but I thought a cheat sheet that takes care of what I view as critical elements would come very handy.
Here's a small checklist of questions to ask yourself while reviewing an EHR system:
- Other than complying with a government mandate and earning $44,000 over five years, what is my motivation to use an EHR?
- Is the system flexible? Will it disturb my workflow?
- In a world where my bank and brokerage are web-based, is the system web-native?
- Does it understand my medical specialty and not simply provide me a template?
- How long does it take to document a patient chart when I'm with a patient? How long does it take to retrieve intelligent information?
- How much do I have to invest in training myself and other clinical users?
- Is it secure? If things don't work out, will I have access to my patient data?
- Does it integrate with my procedure room?
- Is billing intelligence integrated at the point of care? (not simply upcoding E&M codes)
- Does the vendor integrate business services with the product that would allow for complete automation at the practice?
Posted by SATISH MALNAIK on Wed, Sep 21, 2011 @ 04:16 PM
In the recent decades, caring for our health has become almost entirely reactionary. Other than the health conscious minority, you really don't think about it much unless something goes wrong. This is surprising behavior because on average, we are quite good at getting the oil change in our cars done a lot more efficiently. So what drives one to be so attentive to the car versus one's own body and health? The obvious answer that comes to mind is that you don't want your car dying on you, or to incur significant repair costs or not having a car for a few days. But the same would be true for your health, yet it's treated differently. Perhaps it may be because it's more work one has to put into it or maybe it is easier to not worry about it the other way around. If one doesn't make the effort to take care of their physical health akin to oil changes or maintenance for our cars, damage is likely, especially long term and detrimental.
Both the automotive and the healthcare industry are trying to move into a new era of what they deliver to us, the consumers. The auto industry has a renewed focus on smaller cars, fuel efficiency, and most notably, battery powered green technology. Whether their intentions were driven by market demand or a true motivation to drive change in our daily lives is still debated. Favorably enough, federal and state financial incentives helped boost some of that innovation and made it a worthwhile direction to pursue.
A similar change is happening in the healthcare landscape. I am sure many of you are aware that perhaps one of the most spoken about agendas of the current administration is improving healthcare delivery and contain the ballooning cost of care. As someone knee-deep in the era of healthcare delivery changes permeating through to our lives, I frequently get asked about what I think this new world brings, and looks like in the end. Will it truly transform the healthcare system? What does the healthcare system really do for your health beyond all the hype? What will all the investment in technology and electronic medical records translate to for the common man or woman? There might be a connection after all, if I had to put it in simple language.
One of the more noticeable changes expected as an outcome (or maybe just wishful thinking) is that the digital tools will become a catalyst for preventive care in addition to looking at the complete picture of one's health. Many of you may have noticed changes when you visit your primary care physician or a specialist doctor. Perhaps not as much in the way they practice medicine, but in terms of your experience as a patient in a practice or facility. One sees physicians and nurses walking around with less paper and tablet computers being used. The documentation of care is going digital (mobile) and so is the ability of such systems to capture data and ensure that care can eventually move away from being reactionary to preventive. It's too early to say if consumers (patients like us), providers (physicians), facilities (hospitals, labs) and insurers will all play nice towards that single goal – providing coordinated care for your continuous well being.
The real benefit lies in what you and I do with access to such information, and also access when it is perhaps most important. I believe that the simple ability to monitor one's own health in shorter periods of time and to have it be a reminder to us will inculcate good habits geared towards better health. One would become more proactive, if for example, one were informed that their blood pressure is creeping up beyond that acceptable edge. Or for example, your BMI (body mass index) is moving away from what would be considered healthy. All kinds of gadgets and apps are being developed to both check vitals at home and also to provide you access to information from doctors, labs and hospitals. You can more or less get anything on your PDAs these days. Despite the fear of such information being transported on the internet, embracing such tools will make you aware of changes to your body sooner, not when it is too late.
Enabling better patient care with information outside the bounds of doctors' offices or the insurer will make a difference where it matters the most – your health. The next time your car is due for an oil change, schedule time for a quick self-check too.
Posted by SATISH MALNAIK on Tue, Aug 09, 2011 @ 08:23 AM
As I walk down the isles of the grocery store, I am constantly amazed at the variety of even the most basic commodities. How much more value and taste can one can of beans provide compared to another? But some cans proclaim boldly they are much better. There's always the colorful bold "NEW" label if nothing else sounds convincing. So which can of beans would you buy? What is right for you? Is price the deciding factor? Or is it the taste? Or perhaps the source or the company that produces them? Organic, low sodium, no preservatives, etc, etc. The list can go on...just for a 99c can of beans.
Like most typical commodities or gadgets sold to consumers, EMR vendors are just as determined on selling or advertising their way through to acceptance. Comparisons are flying off the shelf these days as physicians, nurses, medical assistants, medical practices, hospitals and surgical facilities become more aware and expect more of their EMR purchases. There is always meaningful use certification as new elimination criteria, but that is hardly a real differentiator. If one were to take a survey on how much time was spent in making an EMR decision, and the thought process that went into it, you will come across some very startling responses.
Perhaps the most critical element being underestimated is whether the EMR was designed for the healthcare provider's best needs. The truth is, every physician or group functions within their medical practice in a certain style. The patient management style changes between specialties and even within specialties. Other factors such as practice workflow, geographic and demographic factors, population density, etc all contribute to how a practice functions on a day-to-day basis. Though the primary goal of an EHR is to document patient/ encounter data and facilitate the flow of that data seamlessly, the usability of the EMR is more about how well it fits into the practice and the provider's style. And that is where the design of an EMR plays in significantly. It is easy to accumulate hundreds of required data points and put them into software without too much thought given to whether it improves practice efficiency or helps provider's do a better job with managing patient care.
The right EMR product not only appeals to you when used in practice but it also follows your flow within the practice just as well and stays flexible and fluid. The best test for an EMR being considered for purchase it to put it through the grinder with a variety of patient scenarios and cases in a live patient care environment. Making a large decision on a expensive software that will impact every single day based on demos and sales brochures is as good as rolling the dice at Roulette. Buying into a solution that is cloud based makes it easier to play with the product before betting on one. Cloud based choices also offer a better alternative than expensive client server systems where the jury is out till after months of time and money invested see it work in a live environment.
The simplest and most effective way out of this is to spend time understanding the EMR product being marketed to you. Having time to go through those motions is always a constraint, but this is perhaps one of the most critical decisions impacting the next three to five years that one is typically locked into, in order to realize their return on investment.
A few days spent on good due diligence will pay off handsomely for years.
Posted by SATISH MALNAIK on Thu, Jul 21, 2011 @ 09:28 AM
EHR or EMR - It is in every physician's vocabulary these days and perhaps the most talked about topic. And like most things new, or most things forced, there is a mad dash to get to the finish line - unlike anything even the Kentucky Derby has ever seen.
Many physician owners, especially those in specialty practices and facilities such as surgery centers have either made, or are in the middle of making their EHR decisions. One that is meaningful use certified, of course. Got a new EHR? Shouldn't those incentive checks should be rolling right in? Pause. Think again. Well, you got the prize horse (and perhaps overpriced) but the jockey is nowhere to be seen!
Too much attention is being paid to groom that prize Thouroughbred EHR (pick any big name brand here) and not enough to the fact that without the skills to train and lead that horse, winning the race is not realistic.
Surely, Medicare wasn't going to write those checks out that easily. Meaningful use incentives, the catalyst behind the EHR commotion, was not designed for just buying and setting up a certified EHR. A lot of attention these days are going to towards selecting and buying an EHR, thanks to incentive deadlines, aggressive sales (and scare) tactics by select EHR vendors but not as much attention is being paid to qualifying for those very EHR incentives which launched the great EHR Derby of today. To be eligible, physicians are required to meet specific use requirements over and above just claiming the use of a certified EHR system. 15 of those to be fulfilled by all physicians and another 5 that can be cherry picked from a list of other options. (Read: http://www.ama-assn.org/ama1/pub/upload/mm/399/ehr-meaningful-use-criteria.pdf). In addition, certain quality measures have to be reported as well, 3 of them forming the core and 3 additional ones to be picked from a list. I won't go into an elaborate discussion on the qualification criteria, since all of it is already laid out there.
Let's think back to the Jockey for a bit. It is just as important to ensure that careful thought has gone into evaluating the qualification needs and selecting a partner or EHR vendor. One that is truly vested into and interested in helping you and your practice/ surgery center meet those criteria. Well integrated solutions that apply good practice management and revenue cycle management principles to the use of an EHR system are the winners. Don't forget that the EHR was not meant to be just a means to an end.
With so many horses and jockeys to choose from, who would you rather bet your money on?
Posted by SATISH MALNAIK on Tue, Jul 12, 2011 @ 09:04 AM
Why do EHRs have to be implemented and not video games?
Have you ever played Halo? Or at least watched someone play it? It's a game about interstellar wars between humans and aliens. You, the Master Chief, fight the Covenant (not the hospital - sorry) to well, save humanity. Halo is often regarded as the Xbox killer app and has sold 40million copies worldwide.
Technically speaking, the game is far more complex in design than the average EHR (we can easily go to specifics but it would be beyond the scope of this ramble). And what's more, it doesn't ask you to have a Halo Implementation Plan. You don't have to hire an IT guy (whom you can never understand anyways) to help with buying more hardware. You don't have to have a plan to integrate with other pieces of software just to make it work. You don't have to pay thousands of dollars to undergo several hundreds of hours of training. You don't have to generate streams of data that no one will ever use. You don't have create templates for your play-type. You don't have to pay for upgrades to continue playing. You don't have to pay maintenance fees. And best of all, you don't have to pay upwards of $100,000 to get you and your team to just start playing the game!
Ever wonder about all this? I do. All the time. I can't also help but think that I didn't have to go through training to use Facebook or Gmail or Yahoo! or Wikipedia or ebay or Amazon. Did you? If you skim all the fat out, the EHR is basically a good record keeping system. You store data, you retrieve data and that's that. Why does it cost a $100K again?
The answers are actually very simple. There was the old way of designing software and now, there's the new way. Yes, there was the Microsoft suite of products that cost thousands of dollars and then came along goodies from the cloud (I'm referring to cloud computing of course). Cloud based products offered only what you wanted - without the need for hardware, the IT guy, software updates, training and of course, the annual maintenance fees. With the cloud, there's really nothing to implement (think how absurd this sounds - "I implemented a book on my Kindle today"). And with the old way? Oh yes, there is a lot to be "implemented". Somewhere along the way, the healthcare industry tagged itself to the old way of doing things. The big guys in the industry made more money by selling the $100K products (but of course!) - why would they ever want to sell things the new way? The incentive program encourages doctors to do something - anything - as long as it is MU-certified and they get on some of form of a digital record. So what do vendors do? They think that now's their time to sell, sell, sell (what they already have) because someone else (government/ tax payers) is paying for it. Doesn't everyone know that doctors don't have the time?
So here's how life seems (at least to me) as it stands today for a lot of physicians implementing EMRs/EHRs. The doctor uses really expensive software in the office to do something (e.g. storing data in a record) as technically complex as shooting an alien on the Xbox at home. Just that he paid a few tens of thousands more to do that. Ahem.
Posted by SATISH MALNAIK on Wed, Jul 06, 2011 @ 02:35 PM
Compiled below is a list of some of the most common reasons we see physicians either losing money or simply leaving it on the table. If you're a physician, I have a feeling you might find at least one area listed here that could use some more attention.
When money
is lost
|
The reason why
|
What to do about it
|
| Before Service |
1. Patient’s insurance and demographic information is not correctly captured.
2. Patient’s insurance is not verified prior to service for expiration, plan coverage and in-network coverage.
3. Patient’s responsibility is not correctly determined. Previous balance is “billed later.”
|
- Scan insurance cards and driver’s license into software system.
- Online and phone eligibility verification.
- Collect payments at the door, offer ALL payment options.
|
| After Service |
4. Using invalid diagnoses codes, incorrect modifiers.
5. Under-coding or over coding because of insufficient medical record documentation.
6. Claims are not submitted in-time.
|
- Keep up-to-date on changing CMS guidelines for top 20 codes. Use LCD/LMRP guidelines.
- Conduct regular coding reviews.
- Submit claims, post payments within 24 hours.
|
| All the time |
7. Using old software.
8. Not keeping up with the credentialing.
9. Not doing same-day denial management.
10. Limit or no analysis on the revenue cycle
|
- Invest in good software-it will pay for itself.
- Set reminder tasks.
- Age denials correctly, engage insurances every day.
- Conduct periodic analysis on various trends.
|
Remember the Income Equation
Income = insurance reimbursements + patient payments - (all of the above)
Find out more scenarios where physicians lose money and answers to keep you from losing money. For ways NextServices helps clients solve these problems and address them before hard earned money is lost,
Posted by SATISH MALNAIK on Thu, Jun 30, 2011 @ 03:04 PM
As wildfires in New Mexico burn through 70,000 acres and continue to force the evacuation of Los Alamos, our client faced some tough decisions. Like all residents and businesses in Los Alamos, the medical practice was required to shut down and vacate its office indefinitely as the wildfires loomed closer. The practice served patients spread throughout the region given the sparse population density.
As they continue to cross their fingers and we all hope that the wildfires are contained and damage is prevented, their decision to switch to an outsourced cloud based medical billing and revenue cycle solution that managed all their patient data and medical claims data has been a boon. Since the entire practice management system is now web based, there was no claims data on site that would have been lost permanently had any fire damage occured. Patients could still call in to the 800-number service and access their information as the office remains closed going into the long weekend. Both from a practice and patient perspective, cloud based computing and services win, hands down. The schedules were accessible from a remote location via web and patients could be alerted with appointments moved around, even with the facility and office being inaccessible. And this was all part of how the system and workflow process was designed to function. And whenever they are able to be back in the offices again, they can start right back where they left. They will definitely face some challenges on lost time, lost revenues, scheduling headaches, etc but they won't have to worry about servers and backups in case any damage occured.
One doesn't need a wildfire to make a business case for cloud computing but in the harsh reality of life and the world around us, sometimes we get these not so pleasant reminders that things can change very dramatically and quickly. And it always helps to have a few less things to worry about.
Posted by SATISH MALNAIK on Thu, Jun 23, 2011 @ 03:49 PM
In our offices, we have a single critical number displayed and dynamically updated on LCD screens at all times. I picked up this idea after attending one of Verne Harnish’s sessions. Our critical number is the total cumulative collections across all clients. It’s important because our business is dependent on it. Every organization has a critical number whether it knows it or not or whether it monitors it or not. And yes, medical practices do too.
But the point isn’t about just one number. There are a set of numbers that need to be on your practice dashboard – that’ll tell you the whole story. Not only that, there need to be productivity numbers that visually indicate what’s happening at any given point of time. If you have special projects going on, there needs to visual demonstration of the progress of these projects.
I can’t stress enough the importance of visual indicators. It serves the following purposes:
- helps you monitor what’s going on at a quick glance
- helps you take corrective action as close to the time of occurrence of the problem as possible
- helps everyone on the team get on the same page without room for ambiguity
What might be those indicators that are relevant to the health of your practice? A thermometer would tell you in a minute if your patient has fever – it tells it visually and numerically and that helps. If your practice has the flu, how would you know?
Posted by SATISH MALNAIK on Wed, Jun 22, 2011 @ 01:25 PM
Run the practice one patient at a time, focusing the entire practice and process on one John Smith at a time.
Take a handful of post-it notes and write a step of how the practice manages patients daily and maximizes reimbursment on each of the encounters. Stick these post-its in order of steps at different points on a string. Tie one end of the string somewhere. Now, pull the other end. What happens? Nothing dramatic, but each of the post-its jiggle up and down. More slowly now…a small tug at the end of the string triggers all the post-its (processes) one after the other. That small tug is the patient call – that’s when John Smith calls your practice to schedule an appointment.
The post-its are essentially several steps linked to each other in the process – from checking John’s insurance eligibility, procuring prior authorization for services, confirming copay and pending balance amounts, medical assistants pulling up clinical reminders, checking on drug interactions, physicians preparing for his visit based on medical chart histories, medical billers marking the precise day to bill the claim and follow-up with John’s insurance company (because they know the average payment cycle from the date of service), documenting all the details in an EMR, and so on. Every step of that process should be ready to focus on one John Smith at a time.
If it’s sounding overwhelming, it’s because we are seeing all the steps in action at once. Focus and fix one step at a time. For example, start with verifying eligibility for all patients 3 days prior to the date of service. Once that is working perfectly, fix the next one and then the next. Your patients will notice the difference when they visit your practice and how they feel after their visit.
Posted by SATISH MALNAIK on Wed, Jun 15, 2011 @ 04:26 PM
Let’s go to your practice and do some cleanup. All you have to do is answer the following questions:
- What information is collected from our sample patient John Smith at the front desk that is not required or has been provided before or could’ve been provided before?
- What information does staff look for? Where is this information located? (psst careful readers, I’m not hinting an EMR here. I’ve seen practices manage information beautifully even without an EMR).
- How far are the fax machine, scanner, photocopier from where they are needed? Why are they printing so much? (Have you ever wondered why a front desk scans the patient’s insurance card, then photocopies it twice, attaching one to the medical chart and saving one for some other reason?)
- Is the inside wall of the front desk looking like a post-it notes hall of fame? (how do they ever find the info they need quickly?)
- Is any staff member doing two patient activities at the same time? (e.g. puts the patient on phone on hold, talks to the patient at the window, asks her to wait and reverts back to the one on phone)
Read your answers above (have you written them?) and finally list 5 things that you can unclutter immediately with no negative impact to your workflow. C’mon, you know these. Here’s one idea (“Folders”) to help you get started:
- Make two columns: clinical and practice management (PM).
- Under each column list down all the types of information that people seek from time to time. For e.g. under the PM column you might list Patient Eligibility, Insurances, Denials, Accounts Receivables.
Using the information above, create a common folder on your computer network (anyone with basic IT skills should be able to help). A sample folder is provided below. There’s no one right way – do what’s right for your practice situation with the objective of finding any information that’s needed within 5 minutes or less.
