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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 Implementation Vital for Value-based Care Payments

ICD-10 Implementation Vital for Value-based Care Payments | EHR and Health IT Consulting | Scoop.it

When the SGR bill was passed by the Senate without any ICD-10 implementation delays, the proponents of the new coding set rejoiced. Not only did passage of this bill bring about a stronger formula for Medicare reimbursements but it also meant that the ICD-10 implementation would most likely take place by the scheduled deadline of October 1, 2015.


When President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on April 16, the legislation moved American physicians away from fee-for-service payments toward value-based care and accountable care delivery, according to the Healthcare Information and Management Systems Society (HIMSS).

Additionally, the new SGR bill includes innovative objectives for establishing the meaningful use of certified EHR technology. These payment models will be key for improving population health outcomes throughout the country. The volume-based payment reductions under the prior sustainable growth rate formula will now be altered with a new annual payment update of 0.5 percent through 2019.


By 2019, doctors will be able to choose their reimbursement method among two options: the Merit-Based Incentive Payment System or the Alternative Payment Model. While the Merit-Based Incentive Payment System will depend upon the performance of physicians, doctors who choose the Alternative Payment Model must utilize certified EHR technology standards and authorized quality measures as well as assume financial risk.


The overall push toward value-based care among the federal government, patient advocacy groups, and healthcare providers will require the medical industry to quickly and efficiently transition to the ICD-10 coding set. Documenting patients’ medical histories as well as accurately reporting and coding diagnoses and treatments is vital in the quest to pay for value and enhance population health outcomes across the sector.


The Coalition for ICD-10 also reports on the importance of the ICD-10 implementation in the move toward value-based care, as ICD-9 codes do not have the same capabilities as the newer coding set. While the healthcare community supports the SGR reform bill, many physician groups are still against the ICD-10 implementation and are hoping for additional delays.


However, a move toward measuring and paying for value-based care is not possible without transitioning to a modernized form of diagnostic and procedure coding. In order to accurately measure the value of a healthcare service, it is vital to have the detail available in the ICD-10 coding set, the coalition explains.


One example of the subpar quality of ICD-9 codes involves putting two patients with similar conditions but differing symptoms under the same code while ICD-10 accounts for a variety of divergence among patients. Essentially, ICD-10 codes will include key information about patients and record their medical history more accurately with additional detail.


“Despite opposition to ICD-10 by some physician groups and a few isolated state medical societies, there is general recognition in the medical community that a modern and precise coding system like ICD-10 is essential for measuring and paying for value,” the Coalition for ICD-10 stated. “ICD-9 represents medicine of a bygone era. It cannot support a move to measuring and paying for value. To meet the demands of SGR there can be no further delays in the ICD-10 implementation date.”


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How Patient Access to Doctor Notes Affects Physicians

How Patient Access to Doctor Notes Affects Physicians | EHR and Health IT Consulting | Scoop.it

Releasing physician notes to patients is scary for many doctors. Common concerns include patient misunderstandings regarding the health information included in the note, damaged physician-patient relationships due to the content included, and a flood of questions from patients who are confused about clinical terminology.

But presenters at the Healthcare Information and Management Systems Society (HIMSS) conference in Chicago said it's time to put those concerns to rest.


The presenters, Jan Walker, assistant professor at Beth Israel Deaconess Medical Center and codirector of the OpenNotes initiative; Amy Gleason, chief operating officer at CareSync; and internist Susan Woods, director of patient experience and connected health at the Veterans Health Administration, agreed that providing patients secure online access to physician notes is a win-win for all parties.

Here are three key findings they shared during their presentation:


1. More patients want — and expect — access to physician notes.
During the presentation, Walker shared results from a one-year Open Notes demonstration project funded by the Robert Wood Johnson Foundation. About 100 physicians from Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center participated in the project, affecting more than 13,000 patients in multiple locations.


Jan Walker In the demonstration project, patients received an alert that their note was ready to view as soon as the physician signed the note (and they received another alert prior to patient visits).

Walker acknowledged that one big question prior to starting the project was whether patients would be interested. Ultimately, over the course of the 12-months, 82 percent of patients at Geisinger who had a visit to their provider opened at least one note.


Notably, that included older patients, sicker patients, and less educated patients. In fact, patients with no more than a high school education looked at notes at same rate as everyone else, said Walker.

Ninety nine percent of patients said they wanted to continue having access to physician notes, and 85 percent said availability of physician notes would influence their future choice of providers.


2. Patients report positive results when they can view physician notes.
So what effect did that increased access to physician notes have on patients? The study suggests a positive one. About three-quarters of the survey respondents said they take better care of themselves, understand their health better, feel more in control, take their meds as prescribed at greater rates, and feel better prepared for patient visits, said Walker.


Other positive results Walker said patients reported included:

• Improved recall of the patient visit and improved ability to adhere to follow-up recommendations, because looking at the note helped patients refresh their memory.


• Improved trust between patients and their physicians because it removed the "mystery" of what the physician was writing in the record.

 
• Improved ability of patients to be prepared for their next visit and to engage in shared decision making.


3. Physicians report positive results when patients can view their notes.
While many of the physicians reported concerns regarding how patient access to notes would affect their work flow, very few actually saw these concerns come to fruition, according to Walker.


Only 2 percent reported longer visits, 3 percent reported spending more time on patient questions, and 11 percent reported spending more time on documentation. In fact, Walker commented that a common question received from physicians who were participating in the demonstration was whether the access to physician notes feature was on, because they weren't getting questions from patients about the notes. 


And, contrary to the fear that patients might be confused, unnecessarily worried, or offended by the notes, only one percent to eight percent of physicians reported these problems, said Walker.

Perhaps most telling is that, at the end of the 12-month demonstration, none of the participating primary-care physicians stopped participation, even though that was an option. "We really believe this is the right thing to do," said Walker.


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Work-Life Integration for Physicians

Work-Life Integration for Physicians | EHR and Health IT Consulting | Scoop.it

While I was preparing a talk on work-life balance, I stumbled across a 2014 article in Harvard Business Review by Stewart Friedman. It is worth reading for all those in search of work-life balance, although he argues that the whole idea of balance is the wrong way to approach the issue. Mr. Friedman articulates the concept of work-life integration: instead of viewing yourself being pulled in different directions (work, family, self), you consider how the various parts of your life overlap and integrate.

In the article, he describes several different exercises that can help you consider your own ability to integrate the personal and professional arenas, as well as identifying the skills you will need to achieve improved integration. What I like about his method is that there is not a "one size fits all" approach in which it is verboten to check e-mail at the dinner table or zone out on your morning commute. Instead, he challenges his readers to experiment, test, and explore what works best for each individual.

So, over the past week, I've been considering my own work-life integration. Truthfully, it still feels like a balancing act rather than a friendly merger. However, by using some of his exercises, I can report a recent success. In January, I changed from a primarily clinical to a primarily administrative/leadership role in my organization. One thing I failed to consider as carefully as I should have was the time demands for "after-hours" meetings and events. With young children at home, I am fiercely protective of the dinner time to bed time window. As a physician, I am used to being at work late or being called back to the hospital, but these demands somehow feel better than skipping dinner just to attend a meeting. Patient care can occur at all hours, meetings shouldn't.

My promise to my family and myself was to limit my late evenings to once a week. However, I started the month of April with seven or eight requests already and became concerned about my ability to be professionally and personally successful. I started with a heart-to-heart with myself. Truthfully, my amazing stay-at-home husband could handle it if I was away from home more often than just once per week. While I was concerned about childcare/homework/bedtime items, I knew that it was more than that. The fact is, I love my family and enjoy spending time with them. Even if it is just being silly around the dinner table or watching DVDs of old 80s sitcoms that my kids love now as much as I did then, that time can be the best part of my day. I am not willing to give it up, even for career advancement.

I concluded that my first resolution was the right approach — a maximum of four evenings per month. Next, I reviewed the invitations and requests on my time and determined that I needed to both prioritize and strategize, first on my own, and then with my boss. I am happy to say I was successful on both fronts, and now feel that I am achieving a balance between professional and family demands.

Desire to succeed at work can easily eclipse family obligations. But this physician found a way to integrate both goals into her life.
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