EHR and Health IT Consulting
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EHR and Health IT Consulting
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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CMS Chief to Address ICD-10 Implementation in National Call

CMS Chief to Address ICD-10 Implementation in National Call | EHR and Health IT Consulting |

The Centers for Medicare & Medicaid Services (CMS) continues gearing up for the October 1 ICD-10 compliance deadline with Acting Administrator Andy Slavitt scheduled to address the ICD-10 transition during a national provider call later this month.

On August 27, Slavitt will provide a national implementation update as the nation reaches the five-week countdown to October 1. Also scheduled to speak are American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman and American Hospital Association (AHA) Director of Coding and Classification Nelly Leon-Chisen.

Two recent surveys show industry-wide progress toward a successful ICD-10 transition in October. In July, the 2015 ICD-10 Readiness reportpublished by AHIMA and the eHealth Initiative stated that half of respondents had completed test transactions with payers or claims clearinghouses.

Despite these positive findings, the report also revealed that ICD-10 preparation gaps still remain for many providers in the area of testing and revenue impact assessments. Only 17 percent indicated that they had completed all external testing. Similarly, only a minority of respondents (23%) have contingency plans related to ICD-10 go-live.

More recently, latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI) showed physician practices to be lagging behind their counterparts.

As compared to seven-eighths of hospitals and health systems ready for October 1, less than a half of physician practices indicated they would be ready. This disparity was also evident in the area of provider impact assessments. Only one-sixth of physician practices had undertaken the assessment versus three-fifths of hospitals and health systems. "This lack of progress is cause for concern as it will leave little time for remediation and testing," WEDI reported.

In a letter to Department of Health & Human Services Secretary Sylvia Mathews Burwell, WEDI cautioned that without a concerted effort the ICD-10 transition could lead to negative consequences for the healthcare industry.

"We assert that if the industry, and in particular physician practices, do not make a dedicated and aggressive effort to complete their implementation activities in the time remaining, there is likely to be disruption to industry claims processing on Oct 1, 2015," the organization stated.

Around the same time, CMS provided clarification about ICD-10 flexibilities it make available to providers following a joint statement with the American Medical Association (AMA) in June. The major ICD-10 flexibility is the federal agency's decision not to reject claims coded incorrectly in ICD-10.

"Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code," the federal agency stated. "The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service. Submitters should follow existing procedures for correcting and resubmitting rejected claims."

Here's a quick look at the agenda for the MLN Connects Call:

  • National implementation update, CMS Acting Administrator Andy Slavitt
  • Coding guidance, AHA and AHIMA
  • How to get answers to coding questions
  • Claims that span the implementation date
  • Results from acknowledgement and end-to-end testing weeks
  • Provider resources

As the entire healthcare industry counts down to October 1, CMS appears ready to ramp up its activities.

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Dress Codes: Yea or Nay in Medical Practices?

Dress Codes: Yea or Nay in Medical Practices? | EHR and Health IT Consulting |

A recent article in Harper's Bazaar featured a woman that wears exactly the same thing to work every day: black pants and white blouse. That started me thinking about my practice's "uniform" and also about what I tend to wear at the office.

At my dentist's office, everyone from front desk to dental assistants dress in the same color palette. I usually go on Wednesdays and the colors are aqua and brown. When I asked about it, they told me that they have different colors for each day of the week. It is a really professional appearance.

In my pediatric office, a daily color code probably wouldn't work. But we do have our own dress code and it is in writing. All staff members are expected to dress professionally. Scrubs are an acceptable alternative for both front and nursing staff. On Fridays, we do allow blue jeans but encourage everyone to wear the shirts with our logo. And we specify that the jeans should not have holes or a ragged appearance. Obviously, low-cut blouses or miniskirts are not acceptable.

The doctors and nurse practitioners have never been a problem with the clothes they pick. I think that we intuitively know that we must look professional. This is especially important for new patients or patients that haven't met us yet.

That doesn't mean we don't have fun. We can wear Disney or Sesame Street shirts and the kids are delighted. I personally love wearing crazy socks and shoes. The little girls especially love my hot pink cowgirl boots.

And in pediatrics, we can have dress-up days. We will have a theme such as sports jerseys, hat day, or my favorite: pajama day. Recently a young child that was in for a sick visit asked the doctor wearing pajamas and a robe: "Oh, are you sick too?"

Halloween is especially great in our office. We ALWAYS wear costumes on Halloween. Attached is one of my favorites from last year. This is one of our nurse practitioners, Lauren (right).

Now, about that white lab coat: pediatricians almost never wear them. Young children quickly develop a "white-coat syndrome" and start crying as soon as they see one. In residency, one of my attending physicians only wore pale blue coats just so that children were not so afraid.

Male physicians can have fun with the ties they wear. Sometimes I wish that it were more acceptable for females to wear neckties. However, one of my male physicians has stopped wearing ties after a child blew her nose on it when the doctor leaned in close.

Do you have a dress code policy? Does your office ever have dress-up days? Let me know how you handle dress code infractions or generational differences for acceptable business attire.

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Challenges of EHR Cloud-Based Solutions for Rural Providers

Challenges of EHR Cloud-Based Solutions for Rural Providers | EHR and Health IT Consulting |

Urgent care provider ClearChoiceMD (CCMD) spans northern New England, operating clinics in rural areas whose EHR technology and other systems rely on multiple forms of connectivity to access clinical data centrally housed in New Hampshire.

By leveraging an array of connectivity options, CCMD has begun aggressively expanding its operations throughout Vermont, New Hampshire, and Maine and along the way come face to face with the challenge of keeping vital health information accessible and available at the point of care for its urgent care providers.

Using an EHR cloud-based technology and a mixture of connection options, the growing healthcare organization is able to provide care in hard-to-reach areas outside larger cities in Northern New England. As CCMD IT Director Alex Fuchs reveals in an one-on-one interview, keeping EHR cloud-based solutions operational in a rural environment with limited connectivity requires maintaining multiple arrangements with internet service providers, both grounded and over-the-air, and exploring new opportunities for connectivity. What makes CCMD unique and what are its top challenges in terms of health IT?

Alex Fuchs: We're a relatively small organization compared to some of the large hospital groups that are out there. We have some pretty aggressive growth targeted. We tend to predominantly open in areas that are very rural, underserved communities outside of major cities that don't have easy access to healthcare. Those are our target markets for the most part. In opening in locations like that, it tends to present challenges at least on the IT end of things because we do have a centralized infrastructure but everything is so distributed and being so rural things like bandwidth and connectivity are hand to come by. What kinds of connectivity does the organization employ?

AF: Being so distributed, we don't have a ton of options and the options we do have are generally pretty limited. As an example, we have a location up in Scarborough, ME, and the extent of connectivity there were bonded T1s, bonded DSL lines, and business cable lines. We hedge our bets and for every facility that we open, we make sure we run at least three different ISPs with three different paths. The third ISP is always an over-the-air 4G backup in case someone takes out a pole or kind of infrastructure. We’re trying to be as redundant as possible because our EHR or billing system is cloud-based or based out of our centralized infrastructure here at the corporate office in New London, New Hampshire, where all of infrastructure is located. We have a data center consisting of multiple virtual server hosts, a couple of SANs and NASs that we use for data backup. Everything is out of that corporate office. From there all the other sites either use an MPLS or site-to-site VPN link to phone home. Loss of connectivity is pretty devastating to business. You recently contracted with Evolve IP, but how have you managed EHR downtime and disruptions to other systems beforehand?

AF: As a new company, we didn't have established policies and procedures to deal with something like that. It was very much a situation of making it up as we went along. We have since developed very comprehensive outage procedures. We train on them every so often, so the staff is well aware of what to do when there is an outage. I guess you could say luckily we got to practice not that long ago when we experienced a power outage at one of our busier locations. We now have a mechanism to go to paper if need be, but we really haven't had to do that very much because we have a number of tablets in the environment and can actually run right off those battery-powered tablets to continue operations for about two and a half hours. It's only if it carries on longer than that that we need to make a change.


Before we made this partnership with Evolve IP, one of our biggest issues was that we were consolidating bandwidth using our SonicWALL appliances that we have deployed at all of our individual clinical locations, and that wasn't a very smooth way to consolidate the different ISPs that we had to those locations. We had issues with the fail-over process when an ISP did experience an outage. Those types of lines are not nearly 100 percent. Unfortunately, in many locations we find ourselves relying on that as a form of connectivity. The 10 to 15 millisecond interruptions that we had in service that caused that fail-over process to take place were actually causing a larger disruption to the business than if we had just waited out the interruptions. How does the organization go about exploring new connectivity options?

AF: That is definitely something we're looking at at some of our more rural locations. The problem is New England in general doesn't have a great fiber network unless you're in a major metropolitan area like Boston. We starting to see companies like Comcast, Sovernet Communications, and FastRoads building out their fiber networks and reaching more and more of our locations. And as they have done those build-outs, we started installing dedicated fiber circuits — at least 30 Mbps to 40 Mbps fiber circuits at all of our locations — where that is available. Thus far, we're up to five out of ten that are serviceable by fiber. We're hoping that continues to increase. We have another pending installation in another location that will make us six out of ten. It is something we continue to keep an eye on. Would this kind of business model be possible without today's connectivity options?

AF: I don't really think it would. Part of our efficiency, and part of our ability to compete with some of the larger hospital groups, is the fact that we use an EHR vendor that is specifically geared at the urgent card setting. That is a cloud-hosted system. We don't host that on premise. It is delivered via a Citrix app. That is one of our magic bullets, as it were, of our formula and business strategy that allows us to compete because it does cut down significantly on the amount of time it takes us to see patients.

Last time I visited the emergency room, I sat in the waiting room about three hours and the whole process maybe was six to ten hours overall. Our target and we meet it about 95 percent of the time is from the time a patient walks in our front door to the time he leaves should be an hour or less across the board. That is the game changer for us. We wouldn't be able to do that without the various technologies we employ.

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