News 7/4/13

ONC releases its patient safety and surveillance plan which provides guidance on the reporting and tracking of patient safety issues. Issues addressed include a requirement for certification bodies to confirm functionality of certain capabilities in the field and for MU and certification standards to include more patient-related objectives.

Through the end of May CMS had paid $15.1 billion in EHR incentives since the program’s January 2011 inception. That includes almost $6.2 billion paid to EPs.

Piedmont Orthopaedic Associates (SC) selects SRS EHR.

Nine medical clinics affiliated with San Francisco General Hospital reduced average wait times for an initial consultative visit from an average of 112 days to 49 days after implementing an electronic referral system. In a New England Journal of Medicine commentary piece, the physician-authors contend that referral and consultation systems that link PCPs and specialists, such as their homegrown eReferral program, have the potential to improve the care of individuals and populations and lower costs.

EHR, PM, and RCM provider MTBC acquires Metro Medical Management Services, a New York City-based RCM company.

Happy Independence Day!

E-mail Inga.

News 7/2/13

As rumored on HIStalk this weekend, Intuit announces plans to divest its health group, including the patient portal business it acquired from Medfusion in 2010 for $91 million. I wouldn’t be surprised if Intuit tried to find a buyer among its pool of resellers, which includes Allscripts, GE, and Greenway. I realize Allscripts recently purchased Jardogs’ patient portal technology, but Allscripts could still be a potential suitor given its large number of customers using the Intuit product.

Allscripts, eClinicalWorks, and Epic lead all vendors in ambulatory EMR adoption, with just over 10 percent of the market each. Almost three-quarters of all practices using EMRs are supported by the top 20 vendors; over half of practices with more than 41 physicians use Epic.

CareCloud hires Paul Henry (ADP/AdvancedMD) as VP of small group sales.

Women’s Healthcare Associates (LA) selects the Vitera PM/EHR platform.

The ONC Beacon-EHR Vendor Affinity Group names Adele Allison, national director of government affairs for SuccessEHR, as co-chair, along with Chuck Tryon of MyHealth Access Network.

ZirMed announces that its first claims acceptance rate is averaging 98 percent or higher.

A Nebraska practice warns patients of the possibility of identity theft after a physician loses a thumb drive containing 2,125 patient records. The office says the lost records included patient demographic information but no social security numbers.

Thanks to SRSsoft CEO Evan Steele who did some number crunching and found that 17 percent of EPs earning an $18,000 EHR incentive in 2011 did not earn the $12,000 incentive in 2012. To earn the incentive in 2011, EPs had to demonstrate MU for 90 days. A full year’s demonstration was required for the follow-up year. As Evan states, “a 17 percent loss rate in any business is wholly unacceptable, and this failure does not portend well for the future of the EHR Incentive Program.”

Porter Research looks at ICD-10 readiness among physician practices and finds that most are concerned with disruptions in cash flows when the new code set goes into effect. Of practices that have not yet started preparing for the transition, more than a third believe they have adequate time to prepare. The rest either don’t know where to begin or lack time, staff, or training resources.

Administrators at two Phoenix children’s clinics claim the use of scribes for EMR documentation has improved physician workflow, eliminated transcription costs, and improved revenue cycle. One orthopedic surgeons says the scribes “may have very well saved the clinic by helping with the implementation of the new EMR.”

E-mail Inga. 

From the Consultant’s Corner 6/27/13

Covering Your Bases: Preparing for ICD-10 Cash Flow Impacts
By Brad Boyd

You know those routine chart audits you regularly complete as part of your billing compliance program to make sure patient encounters are coded and documented correctly? That audit process can be invaluable when it comes to your ICD-10 conversion.

Imagine for a moment your organization’s conversion to ICD-10. You’ve trained your coders and physicians on the new code set and even done some test runs. Despite this, 30-60 days after October 2014—right around the holidays—your organization experiences a dramatic drop in cash flow. After looking into the issue, you realize that you’re not getting paid as much as you once were. Gaps between current documentation and coding processes and ICD-10 requirements will impact reimbursement.

To avoid this situation, I suggest to medical group clients that they leverage their current claim auditing and coding education program to look for gaps between ICD-9 and ICD-10 coding and documentation requirements, as well as reimbursement impacts. Here’s how the process works. After you audit your current charts for ICD-9 compliance, you determine what the reimbursement would be for those charts. You then figure out what needs to be documented to achieve the same level of reimbursement if the charts were coded in ICD-10, revealing potential gaps that need addressing.

One way to close gaps is through physician and coder education. I also suggest you go a step further and share information about gaps with your vendors who are currently in the process of designing upgrades to ICD-10 coding and documentation tools. By providing feedback about gaps to vendors right now, you give them the opportunity to address those disparities, further ensuring tools and solutions that adequately meet your organization’s needs.

Despite thorough planning, your organization’s cash flow may still take a hit for a period of time after ICD-10 goes into effect. As a further “insurance plan” against money loss, I recommend communicating with your biggest payers and trying to negotiate a worst-case scenario cash flow plan. You must be careful when broaching this topic. I suggest being fully transparent about your approach to ICD-10 implementation, showing the payer that you’ve done your due diligence. This could involve sharing your risk assessment, project plan for mitigating any anticipated risks, training programs for clinicians and coders and governance structure for the implementation.

Once payers understand that you’ve done everything you can to prepare, they may be open to discussing a short-term, emergency payment arrangement based on historical information about service volumes. I firmly believe that setting up this type of back-up plan can help your organization ensure adequate cash flow for a period of time as you work through unexpected issues with the new code set.

Although October 2014 may seem like a long way off, it will be here before we know it. Most of the organizations I work with are making steady progress toward implementing the new code set, having completed an impact assessment and project plan. However, I have noticed that organizations often underestimate the need to consider the potential cash flow impacts of the switch. Taking the time to understand and prepare for changes in cash flow can help your organization put mitigation strategies in place to support a smoother transition with limited disruptions.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions.

News 6/27/13

Humana earns the top spot in athenahealth’s 2013 PayerView Report, which ranks health insurers based on claims-payment data. Other highlights from the report:

• Medicaid continues to underperform on key metrics, such as days in A/R
• Many payers performed worse than the 95 percent benefit accuracy, including six payers that returned correct co-pay information less than 50 percent of the time
• Payers still require enrollment by fax or mail for 65 percent of transactions.

The seven-provider Athens Bone and Joint Orthopedic Clinic (GA) selects simplifyMD’s EHR.

Financial management issues are the most challenging difficulties facing group practice executives, according to an MGMA member survey. Specific concerns include managing rising operating costs, preparing for potential cuts in reimbursement rates, and navigating transformative federal policies. Implementing an EHR is considered less of a challenge than a year ago, but optimizing an existing EHR has become a more pressing concern.

Orion Healthcorp., a provider of medical billing and coding for physician offices, names Dale Brinkman (Western Skies Billing Service) CEO and promotes Joseph Seale from COO to president.

UCSF Dermatopathology and Oral Pathology Service selects McKesson to provide revenue management services for its eight-physician group.

Kareo reports that one-third of the 4,000 providers signed up for its EHR have moved from another EHR system.

Consumer Reports publishes an excellent overview of the PCMH model that should be a must-read for anyone wanting to understand the why and how of this emerging care model. The article outlines what a PCMH is, how it is run, how it can reduce costs, and how it benefits patients. The use of “smart medical records” is recommended to facilitate preventative care,  improve provider-patient and provider-provider communications, and manage the coordinated care process. If you work for a vendor serving the ambulatory physician market, it’s worth the read. If nothing else, you will seem really smart at your next company cocktail party.

A Maine newspaper profiles Michael Clark, MD, owner of Lifespan Family Healthcare Center, which is part of the PCMH Pilot Program. Clark believes the success of the PCMH is dependent on modern technology, including EMRs that are available to both providers and patients:

Electronic medical records allow for easier tracking of complex medical problems, help to prevent medication prescription errors, provide automatic reminders for overdue care, flag critical lab values and improve coordination among different specialists and healthcare facilities. Equally important, patients have the same access to all of their records as providers.

E-mail Inga.

News 6/25/13

From Sleepless: “Re: Priorities. The customer should be the priority, but you know how people are programmed to cater to doctors’ schedules and timelines. It is as though we are living in the 1950’s. I also find it offensive when I call the doc office or pharmacy and get the recording that says doctors press 1 and the rest of you press 2.” Apparently I am not the only one who is annoyed by office staff that seem to believe their doctor’s time is more valuable than mine. As another reader pointed out, the staff’s priority should be to assist, “the one with cash in their hand.”

eClinicalWorks has signed up 1,000 providers to its RCM during the first six months of 2013 and is projected to reach $100 million in revenues by 2015. eCW offers the service for 2.9 percent of monthly collected revenues and includes EHR.

Georgia Governor Nathan Deal announces that athenahealth will expand into Atlanta, bring 500 new jobs, and make an $10.8 million investment in the Ponce City Market area.

An American Medical News article discusses ways that practices can use patient data from EHRs to  impact the way care is delivered and identify improvements on the business side. For example, EHRs help practices identify patients in need of preventative care, facilitate the management of chronic care cases, and monitor outcomes. To improve population health, experts recommend using Meaningful Use measurements as a guide and selecting target measures from the 64 included in Stage 2.

The AMA votes to lobby CMS for a two-year grace period to avoid complying with the ICD-10 transition, despite the announcement last week by ONC head Farzad Mostashari, MD that there will be no additional ICD-10 delays.

A CMS study concludes that adoption of EHRs in community practices doesn’t necessarily decrease costs, but can facilitate either increases or decreases in costs depending on how the EHR is used and the context in which it is used.

E-mail Inga.