News 7/5/11

The top struggle for medical practice managers: preparing for reimbursement models that place a greater share of financial risk on practices. Other pressing concerns, according to the results of MGMA’s annual member survey, include participation in the Meaningful Use incentive program, dealing with rising operating costs, selecting and implementing an EHR, and implementing or optimizing an ACO.

A report in JAMIA concludes that the error rate with e-prescribing is similar to that of handwritten scripts. Mr. H weighs in on the study on HIStalk, pointing out that the data came is a bit dated (from 2008); researchers could not make any conclusions on particular e-prescribing or pharmacy systems; and,  the study did not assess how practices implemented the technology or how physicians were trained to use them. I haven’t seen the full study so I will defer to Mr. H and his lukewarm assessment, though I wouldn’t mind seeing a similar study based on today’s  ever-growing use of e-prescribing (68 million e-rxs in 2008 versus 326 million in 2010.)

Wisconsin Health Information Technology Center identifies six Value Vendors for its REC program, including athenahealth, Cerner, eClinicalWorks, e-MDs, Greenway Medical, and McKesson.

Please join me in welcoming and thanking Bulletin Healthcare as HIStalk Practice’s newest Platinum Sponsor. Bulletin is all about providing medically relevant news to healthcare professionals, including 400,000 physicians a day. The company sends eNewsbriefings on behalf of two dozen medical associations, as well as to the President, the majority of US cabinet members, and a whole lot of Fortune 500 execs. If you are a vendor interested in connecting with Bullentin’s large healthcare audience, check out the company’s advertising opportunities. We appreciate their support of both HIStalk Practice and HIStalk.

gloStream adds Health Network Solutions as a certified partner to sell and support gloStream’s EMR and PM software.

NextGen parent company Quality Systems wins three Stevie awards in the following categories: Investor Relations Campaign/Program of the Year; support staffer of the Year; and, Live Event: Best Internal Recognition/Motivational Event for the NextGen Users Group Meeting. CEO Steven T. Plochocki (left) looks pleased.

Happy Independence Day, if you are still celebrating.  It’s obviously a slow news day, as evidenced by the fact that the only HIStalk-related e-mail I received today came from one of our Canadian sponsors. I found this photo I took a few years back when I celebrated the holiday in DC. Definitely the best fireworks display I’ve ever witnessed and the best city to be in if you prefer to reflect more on Independence than on hot dogs – and don’t mind sticky, hot, humid weather. Wherever you are and whatever you are choosing to celebrate, have fun and be safe.

E-mail Inga.

From the Consultant’s Corner 7/2/11

Workflow Diagrams Improve Customer Satisfaction and Cash Flow

In the business of healthcare, missteps and wrong turns can be disastrous. Workflow diagrams are a proven way to help make sure your organizational strategies are headed in the right direction.

Many organizations don’t see the need for documenting business and clinical workflows, but failure to do so can hurt both the facility’s bottom line and patient retention rates. When a facility takes the time to create workflow diagrams and supporting documentation, there’s nothing left to chance.

By diagramming workflow, healthcare organizations can improve customer satisfaction scores and boost financial performance. Sometimes it’s the most obvious things that can get overlooked, such as having a solid check-in process to collect co-payments and outstanding self-pay balances.

One of our clients, for example, was getting complaints from patients about the fact that they were left standing in the hallway after appointments, trying to figure out for themselves what to do next. The problem: there wasn’t an operational workflow for check-out. Once we documented and evaluated the operational flow, we quickly made the necessary adjustments. Patient satisfaction has greatly improved.

Workflow diagrams can also remedy many puzzling financial problems. For example, it’s not uncommon for a healthcare organization to get discrepancies between actual deposits and amounts posted to the system. When you create a workflow diagram, it’s easy to spot the missing step: posting the co-pay, for instance. By documenting workflow, a facility can improve cash flow and accurately reconcile system information to deposits.

A couple of tips for diagramming workflows successfully:

Keep your eye on two workflows

I recommend creating two separate workflow diagrams, operational and functional. The operational workflow identifies all the steps needed to successfully complete a process from start to finish. A functional workflow shows your employees exactly what to do to accomplish the operation in the most timely, efficient manner.

Let’s use patient check-out as an example. An operational workflow might conclude with a step like, “Nurse escorts patient all the way to check-out.” The functional workflow might include a step that says, “Nurse tells patient, ‘Follow me, and I’ll escort you to our check-out area.’” By documenting this step, the nurse doesn’t have the option to say, “Go down this hall and make a left to get to check-out.”

Document everything!

It’s usually not enough to document one or two problematic operations. Your facility can see major improvements by documenting a wide range of operations, including:

• Registration
• Appointment scheduling
• Co-pay collection and posting
• Eligibility requests and results
• Encounter form documentation and charge posting
• Coding and collection
• Denial management
• Credit card processing and posting
• Return appointment scheduling
• Collecting insurance data
• Third-party payment posting
• Collection agency processes

There’s an old saying in science: “Anything you document will improve.” Once your operational and functional workflows are documented, you can use them as blueprints for even greater improvements down the road. Organizations that implement workflow diagrams have a better chance of consistently outperforming those that don’t in terms of quality, compliance, cost containment, and patient satisfaction.

Rob Culbert is president of Culbert Healthcare Solutions of Woburn, MA.