Practice Wise 9/30/12

Stuck in the Mud!

There is a great nationally coordinated race that raises funds for St. Jude’s called the Warrior Dash. It’s a combo 5K fun run and obstacle course that literally ends in a mud pit.

My husband and his coworkers signed up to do the race last month. Not wanting to be left out, I joined their team. I heard from friends and one of my consultants that it was more “fun” than “run.” Lots of teams wear really fun costumes that I was sure meant they weren’t really running, but loping along a nice wooded trail.

I’m in reasonable shape, power walk three miles, and do yoga, so of course I thought I’d be fine. However, I didn’t actually look at the event website to see what this activity entailed. I didn’t train for it properly. Boy, did I pay for it! The first half mile of the run was up a very steep incline, the first of many steep inclines. Then there was the rope wall to climb, the swimming obstacles, and so on. I shouldn’t have been surprised that it was much harder than I anticipated.

I see this happen all the time with our clients when they take on an EHR implementation. Doctors in particular have a tendency to short shift their training. I wish I had a dollar for every time I’ve heard, “I’m not changing how I practice or chart. I will make it work.” I always have to bite my tongue (and if you know me, that’s a tall order) because I want to ask these physicians if they figured out medical school and made it work as they went along instead of studying!

There is good reason for a project schedule with an implementation plan and required training. The people who do this work for a living know what a tremendous task it is to learn a new EHR. Learning anything new and committing it to habit takes time.

I get it. Doctors spend their lives in the top 10%, applying for medical school, residency match, and fellowships and jobs. They train, study, and work really hard to make these goals. So I marvel at those who spend tens of thousands of dollars on new software and think they can just figure it out with little or no training.

You’re busy trying to practice, and patient care is the goal. However, if you have this new tool to chart your patient encounters, you owe it to your patients, your staff, and yourself to invest your time in training.

Take the plunge and maintain your sanity:

• Do sign up for all training offered by your vendor, show up and participate.
• Don’t blow off the trainer and tell them that you don’t need to know what they are trying to teach you. True, you know how to practice medicine. However, you don’t know how to use your software. Accept it, learn it, and become proficient. You won’t regret it.
• Do invest in the most training offered. Your vendor should know how much you’ll need to be successful (that’s the goal!) based on your specialty, the complexity of the software, staffing demographics, etc.
• Don’t skimp on training and implementation support. If the vendor offers onsite training and go-live support, take it. The money you save in not having the vendor come on site will be lost in productivity.
• Do pay attention to timelines. They are set for a reason. Get your training done or postpone your go-live if you can’t get it done. This is not just about how proficient you are — your inefficiencies negatively affect your staff and patients.
• Don’t set unrealistic expectations for yourself. It’s not unusual for providers to do fine ‘not knowing’ during go-live week and then get very frustrated in the following weeks because they have not mastered the software yet. It takes time.
• Do plan on taking the better part of a year to master the software, for your staff to master the software, for all your customizations and workflows to become fluid, all your interfaces etc. to be setup and adopted by all.
• Don’t blame the software and everyone around you when you fail to master the software if you don’t do the necessary training. Nobody can learn this for you.

I plan on tackling the mud run again next year. This time, I know what I’m getting into. I plan to train appropriately for it (e.g., running hills and getting over my fear of the big, scary rope climbing things).

Do yourself a favor. Train hard for your EHR implementation. And if you’re already on an EHR and struggling, there’s no shame in going back for training. Just do it.

Final push to the end, last obstacle before the mud pit, not that you can tell by my clothes!

Julie McGovern is CEO of Practice Wise, LLC.

News 9/27/12

Parents are 50 percent more likely to fill their children’s medication prescriptions when doctors send the orders electronically to pharmacies.

Physicians are working six percent fewer hours than they did in 2008 and seeing almost 17 percent fewer patients. More than half the physicians participating in a Physicians Foundation survey plan to take additional steps to reduce patient access to their services over the next one to three years. Doctors also report spending 22 percent of their time on non-clinical paperwork.

4medica releases OfficeSuite, a cloud-based EHR with integrated practice management.

Amae Plastic Surgery Center (MI) implements eClinicalWorks EMR.

I’ll be heading to San Antonio in less than a month for the MGMA 2012 Annual Conference. I’ve already penciled in a half dozen sessions I’d like to hit and considering what product demonstrations to squeeze in. If you have any session and exhibitor suggestions, send me your picks.  Attendees will also want to look for our annual Must See Vendor List that we’ll publish the week of October 14. Meanwhile, MGMA is already accepting speaker applications for its 2013 event in San Diego.

MedCity News warns physicians to read end user license agreements before signing up for a “free” EMR. Providers should understand specifics on implementation, training, upgrades, support, and PHI security protocols, as well as any disclaimers related to liabilities and warranties.

Some common EMR implementation pitfalls that can alienate patients, courtesy of AMA News:

• Lack of infrastructure, especially inadequate hardware and network speed
• Lack of workflow assessment to ensure a good match between work flow and the selected EMR
• Inadequate training
• Failure to get employee buy-in
• Failure to communicate with patients about the transition
• Failure to figure out the role of the computer during the patient encounter.

E-mail Inga.

News 9/25/12

Wednesday Oct 3 is the last day for EPs to begin their 90-day reporting period for the 2012 MU EHR incentive program.

Park Avenue Associates in Radiology (NY) selects McKesson to provide revenue management services for its 15-physician group.

MedAptus makes available its Mobile Schedule application for the Apple iOS platform, giving physicians access to their schedules and patient information.

Most patients would like access to their health data online and are interested in emailing their physicians, however most providers don’t offer the capability. An Optum Institute survey also finds that 70% of physicians have at least basic EHR capabilities, though only 40 percent have EMRs that support e-mail communications or patient access to health records.

Wood River Health Services (RI) goes live on NextGen’s EHR; the practice also uses NextGen for its billing and dental applications.

Rosemarie Nelson of MGMA Health Care Consulting Group argues that cost is not the only reason for low EHR adoption rates among small practices. Key issues include a shortage of personnel to oversee the EHR project, staff’s limited knowledge of technology, and insufficient time to stay current with changes:

Implementing an EHR is a full-time position for at least three to six months even in a small practice. And, after that, the ongoing support (optimizing, implementing new releases and features, managing incentive program participation, etc.) will require about .20 or .25 FTE for the system guru in the practice. Given the challenges facing medical practices of all sizes, is it any wonder that it’s a daunting task to select and implement a PM/EHR system in a small practice?

Data conversion failure is the most common issue reported by practices that have replaced their practice management system. Other problems noted include reduced cash flow, increased days in A/R, and increased number of claims denials.

The local paper highlights Duke Primary Care Hillsborough (NC), one of Duke Medicine’s first clinics to go live on Epic’s EHR.

Marketing and communications consultant Cindy Thomas Wright offers several tips for using EHRs as a practice marketing tool and to increase patient satisfaction. Suggestions include using automated test reminders; analyzing practice demographics to develop a targeted media plan; and, analyzing patients’ geographic locations to assess expansion possibilities and identify and foster relationships with referral sources.

E-mail Inga.

News 9/20/12

Sen. John Kerry (D-MA) introduces a bill to expand the MU program to include safety net clinics that don’t necessarily qualify under the Medicaid incentive program. Kerry’s legislation would allow providers to qualify for incentives if at least 30 percent of their patient volume comes from lower-income patients. The current MU program requires providers to have at least 30 percent of their patient volume from Medicaid beneficiaries.

EDI provider MD-Online acquires Intivia, Inc., developer of the InSync EHR/PM system and a provider of RCM and medical transcription services.

EHR vendor Data Strategies will integrate Alpha II’s ClaimStaker scrubbing solution into its MDsuite EHR/PM product.

The Texas-based FQHC CommUnityCare selects NextGen-RCM Services to incorporate with its existing NextGen-Ambulatory EHR and NextGen-Practice Management.

Michigan Health Connect HIE and Greenway Medical will provide data exchange between Greenway’s PrimeSUITE customers and hospitals on the Michigan Health Connect platform.

White physicians are more likely than black, Hispanic, and Asian physicians to use HIT to communicate electronically with patients and to exchange clinical data with other providers, but minority physicians are more likely than white physicians to use HIT to generate service reminders and find information about drug formularies. Researchers were unable to establish a cause for disparities in IT acceptance but speculate that white doctors are less concerned about using electronic drug formularies to help patients reduce drug costs. The study, which was published in Perspectives in Health Information Management, includes all sorts of limitations and is based on data collected in 2004-2005. While I suppose it may help policy makers to be aware of potential variations in HIT acceptance, I wonder if eight-year-old data is relevant to the current HIT environment.

RAC auditors from CMS will begin auditing physicians in 15 “Region C” states, focusing on claims containing Level 4 (99214) and Level 5 (99215) CPT codes.

AMA releases the 2013 CPT code set, which goes into effect for claims filed as of January 1, 2013.

The state of Colorado says that early results of its Medicaid medical home initiative show a 14 percent drop in inpatient hospital stays among children and a five percent drop in adult ER visits.

E-mail Inga.

News 9/18/12

EHR adoption at community health clinics has jumped from 8% in 2006 to 74%, thanks to HITECH funding.

The 200-provider Integrated Physician Network joins the Colorado RHIO.

eClinicalWorks launches Join The Network to give providers an open means for accessing peer-to-peer communication, regardless of the EHR system or even if no EHR is in place. eClinicalWorks is investing $10 million over the next year to expand the network, which for now is free to any provider.

Speaking of eClinicalWorks, the privately held company forecasts revenues of $250 million this year, up from $204 million last year and $38 million five years ago. CEO Girish Kumar Navani notes the company added 500 new employees last year, spurring the company to purchase an additional $7.7 million, 61,000-square-foot building for its headquarters. The new site, across the street from its current 100,000-square-foot headquarters in Westborough, MA, will open in about a year after eClinicalWorks completes $3 million in renovations.

Massachusetts Eye and Ear Infirmary and its physician group Massachusetts Eye and Ear Associates agree to pay HHS $1.5 million to settle potential HIPAA violations following the theft of an unencrypted laptop containing electronic PHI of patients and research subjects.

Wider use of EHRs over the last decade may be contributing to a growing up-coding trend that has added $11 billion to healthcare costs. Medical groups argue the fee hikes are justified because treating seniors has become more complex and time consuming and the higher codes reflect more accurate billing. Furthermore, EMRs and automated billing systems have enabled doctors to document and treat the level of treatment provided more easily, which results in higher level codes.

SuccessEHS promotes Lori Hines Junkins to VP of physician services, Elizabeth Featheringill Phara to VP of client services, and Elizabeth Pitman to general counsel.

An American Medical News article looks at patient portals and whether Stage 2 MU requirements will spur adoption. Stage 2 requires that at least 5% of an EP’s patients access their records online. The biggest adoption barriers today: the cost of implementing portal technology and convincing patients to access their records online.

Coming soon: SchedFull, an online waiting list that allows practices to email or SMS waitlisted patients when there is a cancellation and the available appointment matches specific patient preferences. The software works independently of a practice’s scheduling system.

E-mail Inga.