From the Consultant’s Corner 2/6/13

There’s No Time Like the Present: Shifting to a Core Vendor Before ICD-10 Implementation
By Brad Boyd

Is your organization thinking about transitioning your patient access, EHR and/or revenue applications to a single core vendor? If you are, you are not alone. This has been a strong industry trend over the past three years, and many IT vendors have made this a development priority.

With healthcare reform ushering in initiatives like Meaningful Use, accountable care organizations, and value-based reimbursement models, technology systems that smoothly integrate clinical and business data are essential. In most cases, a core vendor that provides tight integration across these applications is better positioned to meet a healthcare organization’s business intelligence requirements.

I recommend that organizations evaluate the benefits of a core vendor from feature, functionality, total cost of ownership, and reporting perspectives. Truly integrated systems provide a variety of benefits which often include decreased operating expenses, reduced lost charges, improved reporting, and a rich functionality which can enhance the overall patient experience. However, with the benefits of a core vendor often come trade-offs from a best-of-breed perspective, particularly gaps in workflow capabilities.

Given the delay in ICD-10 implementation, now is an opportune time to engage in a focused assessment on long-term vendor strategy. While a system conversion is not an insignificant undertaking, there are efficiencies and cost advantages to make this switch in tandem with other changes required by ICD-10.

While switching to one core vendor may not be appropriate for your organization — or resource availability may not permit tackling both ICD-10 and a system conversion concurrently — examining the benefits, cost impact, and operational readiness is a valuable exercise. The delay in ICD-10 provides you with an opportunity for this analysis.

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

News 2/5/13

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Cerner will integrate Gateway EDI’s claims and remit systems within Cerner PM solutions.

Medicare administrative contractor Palmetto GBA posts the results of a prepayment review for CPT code 99214 (established office visit), which included denial rates between 44 and 65 percent. Documentation inadequacy and coding too high an intensity were the most frequent reasons for denials.

More than half of cardiology practices have sold or leased their practices to hospitals compared to 32 percent in 2011. The primary driver was business expenses.

Five practices within Stellaris Health Network deploy PatientKeeper Charge Capture to send charge information from Meditech to their NextGen billing system.

Mississippi House members approve legislation that would allow insurance companies to pay physicians who consult with rural doctors via telemedicine.

SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.

A study finds that HIT adoption by FQHCs is associated with significant improvements in care quality. FQHCs with higher HIT capacity were found to be more likely to use discharge summaries, notify patients for preventive services and follow-up, and create timely appointments for specialty care.

Greenway Medical announces that is compliant with 37 ONC 2014 Edition criteria and is certified as an EHR Module by CCHIT.

eClinicalWorks announces the availability of billing services charged as 2.9 percent of monthly collected revenue.

E-mail Inga.

DOCtalk by Dr. Gregg 2/3/13

Is Meaningful Use Becoming “Lost In Translation”?

From dear Dr. Jayne in her “Curbside Consult” on HIStalk to enigmatic SRSsoft CEO Evan Steele on EMR Straight Talk and more, the phrase “runaway train” keeps popping up in descriptors of the current state of Meaningful Use. I’m on record as a fan of Meaningful Use, but I’ve been seeing some signs, both external and internal, that have me concerned.

First, the external.

As mentioned above, the increasing clamor in the HIT blogosphere seems to be congealing around a core concept that MU has gone (or is going) off track. Not only are smart folks like Jayne and Evan questioning MU’s current trajectory, we’ve even got some of the original stalwarts for HIT who helped craft our technological rail lines making increasing queries about our train’s timetable and rail network design.

The New York Times article, “In Second Look, Few Savings From Digital Health Records” from January 11, 2013, states , “While there is strong evidence that electronic records can contribute to better care and more efficiency, Dr. [David] Blumenthal said, the systems in place do not always work in ways that help achieve those benefits.”

Later in that same piece, David J. Brailer, MD, PhD is on record as saying, “The vast sum of stimulus money flowing into health information technology created a ‘race to adopt’ mentality — buy the systems today to get government handouts, but figure out how to make them work tomorrow."

How many vendors are spending all of their developmental resources solely addressing MU? I know that every vendor with whom I’ve spoken this past year or two is spending the majority of their dev teams’ time on this. Some are spending all of their dev time on it. If everyone’s development is focused upon MU, that sure doesn’t leave much room for creativity and new “meaningfulness” that may not yet have been considered.

Now, the internal.

More by happenstance than plan, I was the first provider in the State of Ohio to receive payment for Stage 1 Meaningful Use via Medicaid. (I was ready for it, for sure, but I just happened to be looking at e-mail when the sign up announcement came through.) I was grateful to receive it, believe me, because margins in small town pediatrics are about as skinny as a heroin-addicted runway model, i.e., deathly thin.

However, since my lovely EHR was sunsetted, I’ve declined to pay for server software upgrades needed to upgrade to the last version my EHR will ever have. That version would allow for Stage 2 achievement. But this expense just doesn’t make sense to me at this point. That money would basically turn the Stage 2 incentive monies into a pass-through, more for a software vendor’s benefit than my practice’s. (And, it makes even less sense if my next EHR is cloud-based!)

I’d prefer to just find my next system upon which to grow, so that any the Stage 2 incentive dollars that pass through to someone else are at least supporting a system with which I’ll be moving forward. (Finding that next system, the one that’s right for me and mine, is a whole other story!)

But, since being on hold, I’ve also noticed that the lower dollars incentivizing Stage 2 seem less motivating. As I spend more time looking at systems, I spend more time thinking about MU hoops. The more I think about Stage 2, then Stage 3 (and Farzad’s talking Stage 4 stuff), the less incentivized I feel.

Don’t get me wrong. I love the potentials and all of the truly meaningful stuff that connected EHRs will allow, once we’re all connected. The problem is, I’m starting to doubt that a federally-legislated definition of “meaningful” will actually play out as was once hoped by all the brains that crafted MU and all of us who have supported it or who even just went along.

I still support the overall idea of Meaningful Use. I’m just wondering if the meaningfulness part has started to get lost in translation.

There’s a part of me that envisions Bill Murray and Scarlett Johansson, standing somewhere off in the wings of an imagined HIT train station, snickering.

From the trenches…

“But the good news is, the whiskey works.” – Bill Murray as “Bob” in Lost in Translation

Dr. Gregg Alexander, a grunt in the trenches pediatrician at Madison Pediatrics, is Chief Medical Officer for Health Nuts Media, an HIT and marketing consultant, and sits on the board of directors of the Ohio Health Information Partnership (OHIP).

HIStalk Practice Interviews Jim Riley, President and CEO, Capario

Jim Riley is president and CEO of Capario of Santa Ana, CA.

Tell me about yourself and the company.

Capario is a physician office revenue cycle management company. Our mission is to simplify the healthcare reimbursement process, making it easier for providers to get paid faster and more accurately.

A lot has changed in the past three years. We have emerged from a corporate reorganization with a healthier sense of purpose and increased focus on the provider side of our business. As a result, we’re seeing double-digit year over year growth in that segment, and have just completed our strongest year ever as a company both financially and operationally.

Our focus is on the physician office market, which includes practices of all sizes. Our business is divided between direct sales into physician offices and partnering with PMS/EMR systems to offer wrap-around services to their customer base.

For me personally, I’ve been around the healthcare space for over 15 years. I love the vibe within Capario right now. We’re really finding our momentum. Even with over 20 years in this business, our growth is better than ever, client satisfaction scores are high and climbing, and we just have that startup feel. It’s a fun time for me.

There’s been a lot of activity in the revenue cycle market, including product changes, regulatory requirements, and changes in service-based companies. How would you characterize the major differences in RCM today vs. a couple of years ago?

Even as recently as a few years ago, I think most players in the revenue cycle space were still focused on rounding out traditional offerings – a proper tool to do the basics like claims management and tracking. For the most part, everyone has those tools now.

Looking ahead, most of us are focused on providing solutions to help providers get paid, whether it’s tools to bill patients or collect payments or enhanced suites of services to help providers identify and combat denials. With cost pressures in the physician office space, it all comes down to helping providers understand the financial health of their practice and to collect the most possible from every dollar they bill.

The other big difference is the volume of changes that are coming at this industry. We see change as the only constant within the next 3-5 years. There are more and more regulations and standards coming down the pike that could really revolutionize this space, including ERA, EFT, HPID, attachments and more. 

These are just the start. Provisions put in place with the Affordable Care Act call for new standards to be proposed no less than every two years. Providers will need to continually stay on top of these changes in order to grow and adapt with the market.

Small practices are often too busy taking care of patients to network with other practices and stay on top of vendor and regulatory news. How does your marketing plan address getting your message in front of people in those practices?

This is a great question. We’ve really been shifting our focus over the last couple years to offer more educational services. You’re exactly right — practices are often too busy to hear a hard sales pitch. They need to know what changes and trends are affecting them and what they need to do about it.

To that end, we strive to be a good partner and raise these issues to practices through webinars, video on demand learning, etc. This year, we’re also beginning to offer courses that carry CEUs as well. We’re confident that even with this less direct marketing approach, our customers will still hear our message and will know that Capario is a solid choice for them when they are in the market for a solution.

Capario also tends to do a lot of proactive messaging. We allow customers to sign up for customer notifications via our website. These are targeted messages around activities happening in the industry as well as real-time messages around the status of certain payers and transactions being available. We’re often complimented on providing this service to our customers. To us, it just makes good business sense. The more we all know, the better we can all make decisions.

EMRs get all the attention, but for practices and physicians themselves, is it financial and administrative applications that can make or break their opportunity to keep serving patients?

Truthfully, they are both important. As a physician, you have to take advantage of EMRs and all of the power they possess to revolutionize healthcare in this country. While it’s a big adjustment for many practices, there’s no question that the benefits are ultimately there.

What’s ironic is the number of practices embracing EMRs that still have very little technology around the business side of their practice. I’m constantly amazed when we talk to physician practices and find out how few of them really know how they’re performing as it relates to their revenue cycle, especially in the small to mid-sized markets.

Due to the cost pressures we’ve previously discussed, it’s imperative that every practice has a set of tools that can put key performance indicators at their fingertips. EMRs are needed to help improve the health of patients, but good RCM tools are needed to manage the financial health of the practice.

What are the trends of practices demanding and using “Pay Now” services?

I would say that for most practices, the ability to easily bill and collect payments from patients is at the top of their priority lists for 2013. The facts are just too great to ignore. Nearly 25 percent of payments are coming directly from patients. That number is going to continue to grow.

More and more employers are also advocating high-deductible healthcare plans, HDHP, as a way to control costs, and they’re really starting to gain widespread adoption in the last few years. HDHPs are not just plans for the young, single, and healthy employee any more. I even switched my family over to one this year. It just made financial sense.

However, these moves mean more and more of the first dollars reimbursed in healthcare are coming from the patient. This is a radical shift in just the last few years. Physicians on the whole aren’t ready for it. It brings in an element of consumerism that they haven’t had to think of before. For example, many of us pay our bills online now, but most practices do not have a way to collect payments online. Practices need flexible solutions that will help them answer this critical need.

What regulatory and payment trends do you think will most affect your company and customers over the next 2-5 years?

ICD-10 will be huge for the industry, no question. While 5010 was a change to the technical formats, ICD-10 will be a change in the way physicians and payers conduct business with one another. That said, I have confidence now that the industry is behind the new compliance date next year. I don’t think anyone is under the impression it will be delayed again, and most are taking the courses they need and making adjustments to their billing and coding processes to be ready.

Also, the continued shift of payments moving from insurance companies to the patient is going to continue to trend in upcoming years. This is a reality that the physician office space will need to have solutions to address.

Beyond that, there isn’t any one single regulatory trend – it’s more just the volume and pace of changes coming. As I look out over the next few years, there seems to be something coming at least every 12 months. These changes can and will make a huge difference to the healthcare space

News 1/31/13

From LightsOut: “iPractice Group. The company posted a notice on its Website that it has ceased operations as a result of ‘depressed sales in the late 4th quarter leading to insufficient funding to continue operations.’” Between market saturation, practice consolidations, and MU requirements, I am certain that iPractice will not be the only EHR vendor to close up shop this year.

Huron Valley Physicians Association (MI) chooses eClinicalWorks EHR for its 600 providers. eClinicalWorks also announces that Holyoke Medical Center (MA) is adding eCW Care Coordination Medical Record for advancing ACO and PCMH objectives.

The website Software Advice scrubs CMS data on MU attestations through October 2012 to identify the top ambulatory EHR vendors. Epic, Allscripts, and eClinicalWorks had the most complete EHR MU attestations and accounted for 42 percent of all attestations. A total of 355 vendors had at least one attestation, though two-thirds of all attestations came from the top 10.

MacPractice and RT-MediBus integrate their MacPractice PMS and RT-MediBus EHR programs.

Cara Buckhaulter, a medical billing and coding consultant with Nuesoft, offers some tips for boosting practice revenues, decreasing rejected and underpaid claims, and reducing claims A/R days. Recommended steps include verifying insurance, submitting claims daily, following up promptly on rejected or unpaid claims, reviewing codes semiannually, and monitoring financial reports monthly.

Medical Office Today profiles NextGen customer Associates in Women’s Health (KS) and its use of NextGen’s NextPen digital pen technology.

SOAPware will implement the ELLKAY connectivity bridge for its EHR clients to provide integration with third-party PM systems.

CPA B.J. Hoffman suggests some internal control procedures to prevent fraud, waste, and abuse in medical practices. The bottom line: physicians should regularly review key financial documents and staff should segregate financial tasks to ensure proper checks and balances.

E-mail Inga.