From the Consultant’s Corner 7/6/12

Centralizing Patient Access and Revenue Cycle Holds Great Promise

For healthcare execs, it’s like the search for the Holy Grail: finding a system that seamlessly supports patient access and revenue cycle management for both inpatient and ambulatory operations. The concept of a single consolidated patient statement covering both hospital and professional services not only reduces cost of collections, it is a major driver of improved patient satisfaction.

That prize is now within reach, as more application vendors have focused significant development resources to more closely integrate patient scheduling, registration, and billing functionality. But major obstacles still remain — often as much on the human side as with the technology.

Many CFOs call this kind of centralized approach the “single business office,” and there’s no argument about the major benefits it delivers. We have worked with several clients to implement a “one call does it all” model for patient access. In this model, a patient can schedule coordinated appointments across a variety of specialties and service locations.

As physicians and hospitals continue to work more closely together, several of our clients who have implemented centralized patient access units are now continuing their push towards centralization by developing a single business office capable of supporting professional and hospital services. These organizations will be well positioned to support the changes facing our industry. A common example is the ability to support bundled payment programs for organizations creating an Accountable Care Organization.

The common benefits an organization can expect from centralizing functions such as patient access or billing operations include:

• Improved patient satisfaction and care quality. Patients enjoy the benefit of making one call rather than multiple calls in which they repeat the same registration and demographic details over and over again. What patient wouldn’t love the convenience of one-call scheduling compared to spending hours on “hold”? Additionally, a single consolidated patient statement covering inpatient and professional services is easy to understand and more efficient for patients to respond to.
• Reduction in call volume. Patients aren’t the only ones who benefit from making fewer scheduling calls. Healthcare organizations need fewer staff to take those calls as well.
• Cleaner claims. Consolidating registration operations enables greater control over the quality and consistency of data capture, which reduces registration related denials.
• Accelerated self-pay payments. Patients who receive only one consolidated bill are more likely to pay it faster because it’s easier to understand. They don’t have to puzzle over separate bills from the hospital and specialists. In addition, by centralizing patient access and billing, a healthcare system can cut costs and reduce staff and the data captured is more consistent and of higher quality, resulting in fewer denials down the road.

Competing governance structures are perhaps the biggest obstacle to achieving the benefits of centralization. Most hospitals and their allied medical groups are governed separately. In many organizations, doctors don’t want the hospital to see sensitive financial data, and vice versa.

Secondly, implementing a seamless system uniting patient access and billing is a big job. The codes and fee schedules in ambulatory care differ greatly from those used for inpatient procedures. Plus there’s the expense and disruption of doing the system overhaul. It takes courage and leadership to oversee such a project. Fortunately, though, courageous leaders are rising to the occasion more and more often because the long-term benefits of centralization far outweigh the challenges.

Brad Boyd is vice president of sales and marketing for Culbert Healthcare Solutions, a professional services firm serving healthcare organizations in the areas of operations management, revenue cycle, clinical transformation, and information technology.

Readers Write 7/4/12

Dear Doctor, From Your Lawyer – Four Questions Doctors Should Ask Themselves
By Jessica Shenfeld, Esq.

I have worked with doctors throughout my entire career and have noticed a few areas that are commonly overlooked by many private physicians. As such, I believe every physician with a private practice should ask themselves the following four questions.

Have you established electronic health records (EHR)?

• Common answer: I don’t want to change the way I have practiced for years. The EHR systems will slow me down. The government will be more likely to audit me if I have EHR. The Meaningful Use regulations are too complicated.
• Best practice: act quickly. The sooner you adopt EHR, the sooner you can take advantage of the incentives. Plus, it will streamline your practice. As if you needed more incentives, there are already reductions in reimbursement for those that don’t comply with e-prescribing. For those physicians accepting Medicare, October 1, 2012 is the last date that a physician can adopt a new EHR system while still being eligible for the full $44,000 incentive. After October 1, the maximum incentive available drops to $39,000. For those physicians accepting Medicaid it is even simpler – all you need to do to be eligible for the first incentive payment of over $18,000 to each physician is install a certified EHR system.

Are you collecting on accounts receivable from patients?

• Common answer: it’s the cost of doing business. My billing department is taking care of it. My collections company is taking care of it, slowly but surely. I don’t want to sue my patients.
• Best practice: hire a collections attorney or a very good collections agency, especially if you are an out-of-network provider and insurance companies send reimbursement to the patients directly. Although your billing department and office manager can try to collect from patients and appeal denials, if you farm out this work to professionals, you will likely see a greater return. Additionally, a third party is doing the collecting, which will allow you to maintain your relationship with patients.

When is the last time you looked at your office lease?

• Common answer: when I signed it.
• Best practice: have an attorney that specializes in health law review your lease, particularly if you sublease any space to another provider. Leases for medical offices are much more complex than standard commercial leases. Health law attorneys are familiar with the Stark Law and Anti-Kickback Statute, as well as requirements for fair market value in all sublease transactions. Their review will ensure that physicians are fully protected while complying with the requirements of the law.

Have you negotiated employee contracts? Do you have a written office policy?

• Common answer: a handshake is enough — I don’t need more paperwork.
• Best practice: have your employees sign a contract laying out the terms of their employment. Employee contracts are a useful tool when running a medical practice because they define the scope of the employee’s job and your expectations upfront. More importantly, physicians must protect themselves from possible lawsuits in the future. Negotiating solid contracts now will protect doctors’ interests down the line.

This list is certainly not exhaustive, but it highlights some of the areas where physicians can enhance the administration of their practice. As business management becomes more complicated (as if it wasn’t already) addressing the above four items will help protect a physician’s interests now and in the future.

Jessica Shenfeld, Esq. is the founding partner at The Law Office of Jessica Shenfeld, a boutique law firm that caters to physicians’ legal needs. She is also CEO of EHR Incentive Help, Inc., which helps physicians satisfy the Meaningful Use criteria and apply for the Medicare/Medicaid EHR Incentive benefits.

News 7/3/12

House lawmakers introduce legislation allowing behavioral health providers, including clinical psychologists and licensed social workers, to qualify for MU incentive payments. The Senate introduced a similar bill last year.

The Pennsylvania eHealth Collaborative announces a grant program that gives providers a free year of DIRECT messaging services for secure health information exchange.

New York eHealth Collaborative says it’s the first REC to hit 1,000 providers qualifying for Meaningful Use money.

Waiting Room Solutions announces several new EMR clients, including Connecticut Behavioral Health, ENT and Facial Plastic Surgery (VA), and Okeechobee Family Practice (FL).

Kareo releases a free iPhone app for accessing physician schedules online.

Are you a physician office considering between multiple HIE options? Here is some advice from the AMA’s American Medical News:

• Physicians should determine who they need to share information with and find an HIE that provides those connections. Possible connections include hospitals, labs, and public health agencies.
• Identify the geographic region that the practice needs to be connected with and make sure the chosen HIE covers the required geographic footprint.
• Understand the business model of potential HIEs and assess their long term sustainability.

Mr. H and I are expecting a slow news week, so I’ll likely be celebrating Independence Day eating watermelon and grilling ribs and corn rather than gathering news for HIStalk Practice. I mention for all the die-hard HIT fans who were considering staying home from fireworks festivities in order to wait for a HIStalk Practice e-mail to hit their inbox. Happy 4th of July to all!

E-mail Inga.

Bowtie Confidential: The Internal Security Threat 6/30/12

Despite the potential impact of negative publicity, penalties, fines, and lawsuits, healthcare organizations continue to breach patient information. The threat to privacy and security is not only external; it is also internal, including employees, temporary staff, and third parties.

Technology can be a culprit (it is easier to access and transfer data online), but it can also be part of a solution. Although it is impossible to prevent all insider attacks, you can leverage technology to minimize the risk.

Culture is also a culprit. Look at Facebook – people are becoming comfortable putting personal information online. There is a cultural “loosening” of privacy boundaries, which can affect an organization’s culture and therefore its security.

The following action steps should be part of your plan for reducing internal security threats:

• Cultivate a leadership culture of respect for individual privacy regarding access to information
• Include the “insider threat” plan in the organizational strategic plan
• Create and assign the role of a chief information security / privacy officer
• Develop enhanced human resource screening processes and interview techniques to seek out potential insider threats
• Develop ongoing and consistent HIPAA (security and privacy) training and awareness programs that extend beyond orientation
• Implement appropriate data and application access monitoring software
• Establish clear policies and procedures to address identity, access management and overall data protection
• Develop and implement a system and data access monitoring process that includes summary dashboard reports to leadership
• Implement and schedule risk assessment audits

Internal threats are just as dangerous as external threats – or more. By creating and implementing a specific strategy to reduce and address insider threats, healthcare organizations can better manage their risk. Everyone is accountable for privacy and security. However, the message has to come from the top with policies, procedures, and monitoring to reinforce it.

Rob Drewniak is vice president, strategic and advisory services, for Hayes Management Consulting.

News 6/28/12

From MGMA: the biggest challenges of running a group practice include managing finances with the uncertainty of Medicare reimbursement rates, preparation for reimbursement models that place greater financial risk on the practice, the ICD-10 transition, rising operating costs, and participation in the EHR MU program.

The 38-provider Mowery Clinic (KS) selects NextGen Ambulatory EHR/PM and Patient Portal.

Mitochon, a provider of free EHR, launches a free, integrated e-prescribing solution.

Atlanta Women’s Health Group (GA) contracts with VeriStor Systems to provide cloud services, data protection, and disaster recovery for its 30 locations.

Physicians have until July 6 to comment on NCQA standards for specialty practices wanting to become part of a PCMH “neighborhood.” NCQA’s specialty practice recognition program will be designed to recognize specialty practices that work with PCMHs to coordinate care, provide timely access, use IT to reduce test duplication, and work toward quality improvement.

The president of CVS Caremark’s MinuteClinics says the company plans to expand from today’s 565 retail walk-in clinics to 1,000 by 2016. He adds that the clinics support continuity of care by providing each patient a copy of their medical records at the end of each visit and by sending patients’ physicians a copy of the records either electronically or via fax.

Wal-Mart, by the way, has closed 33 of its retail walk-in clinics this year and currently has only 149, which far less than the 2,000 the company had projected in 2007.

Medical billing and collections company Alleviant announces plans to open a facility in Vermillion, SD and hire 120 people by the end of 2013. Alleviant already employs about 240 workers in South Dakota.

In case you missed it, we had our first HIStalk Practice Advisory Panel post yesterday. We asked the provider participants to share impressions of their EMR and other office technologies. Participants offered feedback on eClinicalWorks, GE Centricity, Pulse, Cerner, and a few others and most responses were quite enlightening. Some highlights:

As we apply to be certified as a Patient Centered Medical Home, the EHR’s registry function is critical to our ability to manage registrations of patients with various demographic, clinical, or therapeutic criteria. Identifying all asthmatic patients, for example, who do not have a current Asthma Action Plan by a search of our registry allows proactive patient scheduling and improved care.

Our EHR has easily customizable templates to fit my workflow.

Our vendor’s technical support has historically and notoriously been abysmal. That could very well hold true for other EHR vendors.

Secure messaging has gotten pretty hot recently. I’d love to it see fully implemented at my facility.

We do use a nifty system for security which involves initial authentication with a card swipe, but then system security via a sensor on the door.

The vendor needs to stop making claims that are not true.

If you’d like to share your impressions of the Panel post or if you are a provider interested in participating, let me know.

E-mail Inga.