News 7/11/13

CMS proposes changes to payment policies, including a provision to begin paying providers in 2015 for non-face-to-face care of Medicare patients with multiple chronic conditions. To be eligible, providers will be required to use a certified EHR. Other proposed changes include the addition of new quality reporting measures for 2014; an expansion of telehealth services to include sites designated as health professional shortage areas in rural or urban areas; and, the addition of transitional care management services as an eligible Medicare telehealth service.

The percentage of physicians using at least a basic EHR system increased from 25 percent in 2010 to 38 percent in 2012, according to a Robert Wood Johnson Foundation study, while the percentage of practices participating in an HIE has jumped from three to 10 percent. Other notable findings:

• The highest relative increases in adoption were among physicians with historically low adoption levels, including older physicians and those working in solo practices or community health centers.
• As of 2012, physicians in rural areas had higher rates of adoption than those in large urban areas, and physicians in counties with high rates of poverty had rates of adoption comparable to those in areas with less poverty.
• Small practices continued to lag behind larger practices.

ONC National Coordinator Farzad Mostashari, MD discussed the findings at a press conference and predicted that full EHR adoption will be slow until 2014 – just before penalties for not hitting MU standards start in 2015.

The success of e-prescribing initiatives can be tied to federal programs offering financial incentives for e-prescribing providers, according to a report authored by representatives from the ONC and Surecripts, Federal incentives resulted in the addition of 94,000 new e-prescribers between July 2008 and December 2010, leading the authors to make the less than profound conclusion that “financial incentives can drive providers’ adoption.”

Greenway Medical will add PatientPay’s online patient payment solution to its PrimeSUITE EHR/PM platform. Greenway also announces that providers are successfully exchanging CCDs between the Greenway platform at Doctors May-Grant Associates (PA) and the Epic system installed at Lancaster General Health’s Women’s & Baby Hospital (PA).

The 340-provider UT Medical Group (TN) signs a three-year contract with MediRevv for its Day One Self Pay A/R Management services.

E-mail Inga.

News 7/9/13

From Gloria: “Re: EMR features. Can you please help me understand if there is any major difference in EMR features for practices depending on the number of providers? For example, how would an EMR used by a solo physician differ from an EMR used by a large practice of 41+ physicians? Do both of them not do the same thing..namely treat the patient for conditions?” I am sure many readers can answer this better than me, but here are a few thoughts. While most EMRs include the same basics, such as the ability to track patient history and capture clinical notes, EMRs used by larger groups tend to include more features and functionality. For example, many EMRs catering to small primary care practices have less developed templates and rely more on free-text data entry. Larger groups have a greater need for care coordination, especially if patients are seen by multiple providers within the same practice, and will likely seek a variety of bi-directional interfaces to automate high volumes of orders and results. The architecture behind an EMR is also important since a program designed for small offices may not scale beyond a handful of users. Beyond features and functions, many EMR vendors don’t have adequate training and support resources to satisfy the demands of large groups. Readers, please offer additional insights.

The medical director for 70-provider South Texas Medical Clinics says its recent implementation of EMR has allowed the practice to “substantially” reduce its percentage of medical errors below the national average. I assume that STMC uses eClinicalWorks since it is part of Memorial Hermann Medical Group, a large eCW client.

The American Academy of Ophthalmology plans to implement an eye disease patient database that will enable ophthalmologists to statistically review and analyze their own care and compare it to benchmarks and peer physician performance. The Intelligent Research In Sight Registry (IRIS) will be populated with de-identified data collected from practices’ EHRs and serve as a PQRS EHR submission vendor.

HIMSS Analytics recognizes 31 Bon Secours Health Systems (VA) ambulatory clinics with the HIMSS Stage 7 EMR Ambulatory award for its implementation of Epic.

Almost one-third of physician executives participating in an ACPE survey believe that healthcare costs go up when hospitals buy physician practices.

The doctor shortage and an improved economy has led to an increase in physician recruitment activities. A quarter of practicing physicians report receiving 24 to 40 job solicitations a month.

E-mail Inga.

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.