From the Consultant’s Corner 5/1/14

ICD-10: Now Get it Done Correctly

Since the delay of ICD-10 until October 1, 2015, at the earliest, many healthcare organizations have questioned what the delay means to their existing ICD-10 implementation programs. At the time the delay was announced, most organizations fell into one of three categories in terms of ICD-10 readiness:

• The Prepared
• Those Getting Prepared
• Those Who Remain Out to Lunch

Organizations residing in the first two categories expressed frustration at the delay. They had appropriately taken control of their own fate, identified and managed risk, and prepared or were preparing their organization for this change. The third group, however, either held false hope their EHR/PM vendor would take care of everything, or banked on a delay.

Regardless of which category best describes your organization, the plan forward is simple: Take the newly allotted timeline to get it right.

Many organizations have delayed other important  transformative or IT efforts until after ICD-10, given their limited resources and the work necessary just to achieve ICD-10 compliance. Some organizations took a much broader strategy for their conversion, leveraging this challenge as an opportunity to better enable their physicians and clinical staff to optimize clinical documentation workflows; thus, improving quality reporting and patient outcomes.

With the delay now in place, organizations should absolutely continue implementing their ICD-10 program. They should also use this time to prepare to more effectively compete in the era of expanding, value-based reimbursement models. In addition, organizations should take advantage of this opportunity by re-evaluating project scope.

Identify opportunities to include other initiatives into the ICD-10 conversion program in order to more fully streamline your clinical documentation workflows. Ensure your training program is inclusive of new workflows and EHR functionality, not just coding principles and requirements. Engage payers and intermediaries to ensure your testing program is robust. Expand your use of dual coding and evaluate reimbursement variance to prepare your organization for the downstream financial impacts. Optimize the use of informative, specifically predictive analytics and clinical decision support within the EHR.

ICD-10 poses several risks to a physician practice. Take advantage of the delay to not only ensure compliance, but also to improve your ability to manage your patients’ health.

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

News 5/1/14

CMS publishes a final rule that will increase Medicare payments to FQHCs by as much as $1.3 billion over the next five years in compliance with the Affordable Care Act. Beginning October 1, FQHCs will transition from the current fee-for-service model to a daily single rate of about $155 per Medicare beneficiary, which may increase a clinic’s payments from Medicare by a third.

Athenahealth will offer its customers PatientPoint’s patient engagement and care coordination services through its More Disruption Please program.

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Ingenious Med will integrate Entrada’s digital voice capture technology into its mobile application to support the mobile charge capture process.

DrFirst will add electronic prior authorization functionality from CoverMyMeds into its Rcopia e-prescribing, RcopiaMU for Meaningful Use, and Patient Advisor medication adherence platforms.

E-MDs recognizes its customer Jennifer Brull, MD for being named a 2013 Million Hearts Hypertension Control Champion. Brull says that the documentation and reporting capabilities in e-MDs EHR and PM “played an important role” in her practice’s success at achieving blood pressure control rates greater than 70 percent.

Medication adherence could be improved if physicians gave more consideration to medication costs and increased follow-up care for their patients with chronic conditions. That’s the conclusion from Canadian researchers who found that almost one-third of patients fail to fill first-time prescriptions. Medication adherence was found to be more likely if the prescription was for an antibiotic, if the patient was older, and if a greater proportion of all physician visits were with the prescribing physician.

Three boxes of medical billing records from the former Western Berks Internal Medicine (PA) practice are returned two years after they were mistakenly left in a former office and then stored at the home of a maintenance service vendor. Particularly troubling is that during that time no one at the practice ever noticed the records were missing. The 1,800 patient records included clinical information, social security numbers, and other demographic details.

Kaiser Health News highlights the rise of more aggressive billing strategies among practices that are struggling to improve collections. Practices that might have once waited 180 days to refer a patient to collections are now taking action sooner, while more practices are requesting patients pay for any out-of-pocket costs in advance of procedures.

While many physicians may be breathing a sigh of relief over the ICD-10 delay, not all providers are happy about the pushback. Physicians such as New York’s David Weiner, MD, have already invested time and money for several ICD-10 training sessions. Likewise Christine Doucet, MD notes that the delay will force her to eventually participate in a refresher course.

Through March 31, CMS has paid $22.9 billion in MU incentive payments, including $8.6 billion to EPs. For the 2014 program year only 32 EPs had received MU payments, which could suggest a slow-down in participation.

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News 4/29/14

Medfusion announces that its relationship with Allscripts has ended “due to unresolved payment disputes.” The termination is hardly a surprise given Allscripts acquisition of the competing JarDogs patient engagement platform last year. Medfusion says it will continue to provide uninterrupted services to the 30,000 Allscripts providers using its products through May 31, 2014; after that time customers wishing to remain on the Medfusion platform must contract directly with Medfusion.

Practice Fusion launches a population health management offering in collaboration with Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with other Practice Fusion providers.

The HIMSS Electronic Health Record Association (EHRA) tells the ONC it opposes the proposed 2015 voluntary certification EHR criteria, saying that by the time the final rules are published there won’t be enough time for vendors to properly code and test enhancements. EHRA also argues that “more frequent certification is not desirable and would be costly.”

AAFP board member Daniel Spogen, MD rants about the administrative hassles of EMR in an AAFP blog post. Among his complaints: EMRs lack interoperability, are not user-friendly, take time away from patient encounters, result in mixed patient outcomes, increase overall costs, and complicate office workflow. I guess his only goal was to fire up his peers since he fails to suggest any solutions and notes that EHR vendors have little incentive to change things.

The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to be licensed where the patient is located; for providers to establish a credible patient-physician relationship; and for an adherence to safety and privacy principles.

Meanwhile, an Idaho medical licensing board has fined a physician $10,000 for prescribing a patient an antibiotic while working for Consult-a-Doctor, a telehealth provider that has since been purchased by Teladoc. The Idaho Board of Medicine sanctioned the physician, who was licensed in the state, for prescribing medicine without an in-person examination of the patient.  A group of  telehealth-friendly legislators are now pushing stakeholders to establish standards for the practice of telemedicine.

Pay-for-performance programs unfairly penalize providers treating large numbers of poor people, according to a panel commissioned by the Obama administration. The panel notes that it is often harder to achieve successful outcomes when treating people who don’t have much income or education because low-income people may be unable to afford medications or transportation to doctors’ offices and the less educated may struggle to understand written instructions for home care and medication use. As a result, the existing payment policies unintentionally worsen disparities between rich and poor by shifting money away from doctors and hospitals that care for disadvantaged patients.

Forty percent of physician practices are looking to replace their existing EHR, according to a Software Advice report. Among buyers replacing their EHR product, the most common replacement reasons: the current solution is too cumbersome and/or integration is needed between applications. Mobile support for tablets and smartphones, e-prescribing, and lab integration were the most desired features among potential buyers. Based on the above time frames, it looks like a pretty good time to be selling EHR if you’ve got a good product.

MGMA Health Care Consulting Group’s Rosemarie Nelson offers insights into the use of kiosks in practices to improve RCM and patient satisfaction and cites several examples of practices that have reduced their claim denial rates and A/R days while also streamlining the patient check-in and registration process.

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News 4/24/14

Greenway Health President Matt Hawkins is leaving the company to pursue “an exciting new leadership position outside of the company,” according to an email sent to Greenway customers Tuesday. The departure of Hawkins, who was CEO of Vitera Healthcare prior to the Greenway/Vitera merger, could be unsettling for any Intergy customers already concerned about Greenway’s long term product strategy. I emailed the company for a comment but have not yet received a response.

Athenahealth resigns from the HIMSS Electronic Health Records Association (EHRA) trade association saying it “never really belonged” since it is neither an EHR company nor a software vendor. In a company blog post, Dan Haley, athena’s VP of government affairs, says that because many EHRA members are unable to meet MU timelines and standards, the organization “consistently urges slower timelines, delayed deadlines, and lower bars” than athena. Given the collaborative ideals of EHRA, I think athenahealth might have been better served to simply say, “we aren’t a good fit” rather than throwing in the disparaging comments.

American Health Network goes live on eClinicalWorks Care Coordination Medical Record for population health management to manage its three ACOs in Ohio and Indiana.

First Med Urgent Care (OK) will implement DocuTAP’s PM and EMR software.

The 37-provider Integrated Medical Alliance (NJ) selects Emmi Solutions to provide multimedia programs for patient engagement.

Forbes profiles Surescripts and its evolution from an “alliance of foes” to its current status as the dominant e-prescribing network. I vaguely knew that the company had been involved in a few mergers over the years but hadn’t realized the extent to which its success is based on the alignment of adversaries. Forbes notes that EHR vendors, who have traditionally been reluctant to facilitate the exchange of patient information, could possibly learn a lesson or two from Surescripts and its creators.

The AMA reminds providers to pre-order the 2015 edition of the ICD-9 codebooks, leading me to contemplate the wide-sweeping impact of the ICD-10 delay. Both providers and vendors are having to reassess everything from training and staffing to marketing and product development. I’m thinking if I were an ICD-10 coding expert I wouldn’t mind having another skill in my back pocket, at least for the short term.

McKesson Business Performance Services adds outpatient and inpatient facility coding services to its coding and compliance portfolio of services.

Navicure adds 300 new clients representing 1,225 providers in the first quarter and posts a 19 percent increase in revenues versus a year ago. Recently added customers include Nemours Children’s Health System (NJ), Western Psychological and Counseling Services (WA), and Arizona Digestive Health (AZ).

Athenahealth reports that 95.4 percent of its participating providers successfully attested for MU Stage 1 in 2013. CMS will release overall industry attestation rates in the next month.

ZirMed introduces Clinical Link, a HIPAA-compliant secure messaging tool that enables ZirMed users to exchange messages and clinical documents with other provider organizations, regardless of their EHR or PM system.

CVS MinuteClinic says it has surpassed 20 million patient visits since opening its first store-based clinic in 2000 and expects to add 150 new clinic locations in 2014.

HHS says two entities have collectively paid almost $2 million to resolve potential HIPAA violations following the theft of unencrypted laptop computers.

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News 4/22/14

The USA Today highlights the dilemma of rushed physician exams, which creates frustration and tension for both doctors and patients. As long as the pay for performance model dominates the market,  primary care physicians will continue to feel pressured to squeeze in as many patients as possible into their schedule. The implied “fix” is to change the reimbursement model, which will no doubt take time. No mention is made of the how EMRs, patient portals, and other technologies impact the situation, but obviously HIT alone isn’t the cure.

Orthopedists were the most highly compensated physicians last year, earning an average of $413,000. Cardiologists, urologists, and gastroenterologists took the next highest spots while family physicians were near the bottom at $176,000. The same Medscape survey found that 35 percent of employed physicians spend at least 10 hours a week on paperwork; only 26 percent of self-employed physicians spend more than 10 hours a week on admin tasks.

Maine’s HealthInfoNet HIE offers providers access to the state’s Prescription Monitoring Program through the HIE’s portal, giving clinicians a single sign-on to both systems.

Steward Health Care System (MA) selects athenaCoordinator Enterprise to enable care coordination for its employed providers and their patients.

Wikipedia tracks flu outbreaks up to two weeks faster than the CDC, according to Boston Children’s Hospital researchers. Using an algorithm that collected data on how many of 35 flu-related Wikipedia pages were viewed, researchers were also able to identify flu-related activity with 17 percent more accuracy than with Google Flu Trends, which was recently criticized for overestimating the incident of flu.

GetWellNetwork announces details of its GetConnected 2014 conference in Chicago June 3-5.

The CEO of scribe staffing company PhyAssist reports his business has grown from 45 scribes in 2008 to 1,400 today and expects demand to increase as more providers adopt EHRs.

Surescripts awards DrFirst and 31 of its EMR partners that have integrated Rcopia e-prescribing software within their EMR with its White Coat of Quality Award.

An AHRQ report on health information interoperability finds that MU criteria falls short of achieving MU in any practical sense and recommends that Stage 3 be used to advance interoperable health data infrastructure. The JASON report also recommends that Stage 3 require vendors to develop, publish, and verify APIs that allow third parties to build on them with new applications and that EHRs should have enhanced encryption and fraud detection capabilities.

The Society for Adolescent Health and Medicine recommends that EHR developers consider the special needs of adolescents when designing and implementing systems to ensure patients’ access and confidentiality requirements are met. In order for adolescents to realize the benefits of EHRs, providers should also advocate for adolescents’ specific privacy needs.

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