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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Survey: Texas Docs not Ready for ICD-10

Survey: Texas Docs not Ready for ICD-10 | EHR and Health IT Consulting |

Just 10 percent of Texas physicians are confident that their practice is prepared to transition to ICD-10 on Oct. 1, according to a new survey from the Texas Medical Association (TMA).

In July of 2015, Texas physicians were surveyed regarding their practice’s readiness to transition to ICD-10. Approximately 37,000 Texas Medical Association members and non-members with email addresses in the TMA database were emailed a link to the survey. The results are based on 936 responses. According to TMA, 97 percent of respondents currently treat patients in active medical practice. Among physicians who quit treating patients in active medical practice, 48 percent quit due to regulatory and/or administrative burdens and 22 percent quit due to ICD-10.

Nearly two-thirds (65 percent) of all physicians responding have little or no confidence that their practice is prepared to transition to ICD-10 by the deadline, even though the new coding system is supposed to enable doctors’ offices to collect and report more detailed patient data. “It’s horrible,” TMA President Tom Garcia, M.D., said in a statement. “The United States is the only country that couples the ICD coding with payment. The implications are that the doctor/patient relationship is going to be stressed.”

The survey found that few physicians have begun transitioning to ICD-10 extensively (7 percent). Physicians employed in hospitals are least likely to feel their practice has begun to transition to ICD- 10 extensively (3 percent). Even among physicians who feel very confident their practice is prepared to transition to ICD-10, only 42 percent report their practice has begun transitioning extensively.

Regarding training, 53 percent of physicians report the staff, and 46 percent report the physicians in their practice have taken ICD-10 preparation courses or training. Physicians in partnerships (34 percent) and the staff of solo practices (39 percent) are least likely to have taken preparation courses or training in ICD-10.

What’s more, older physicians are more likely to close or sell a practice and/or retire early in response to delayed or denied claims payments as a result of ICD-10. Physicians in the youngest age group (40 years and younger) are more likely to terminate or renegotiate plan contracts (34 percent).

Regarding electronic health record (EHR) status, 74 percent of physician respondents said that their practice currently uses an EHR. Among EHR users: 65 percent report their EHR is currently capable of handling ICD-10 codes; 29 percent of physicians whose EHR is not currently capable of handling ICD-10 codes are expecting an update; 15 percent of physicians report their will be a median cost of $10,000 associated with this update; and 1 percent of physicians report their software will need to be replaced.

The survey found that physicians fear the massive switch to the new coding system will disrupt patient care, and delay payment. In fact 83 percent of the doctors anticipate delayed or denied claims because of the transition, regardless of specialty. More than one-third of the physicians expect disruption so bad they will have to draw from personal funds to keep their practice open (36 percent) and almost one-third (30 percent) might retire early over anticipated cash-flow problems. (Almost half of the doctors age 61 or older might retire early.) Nearly a third (32 percent) might cut employees or reduce employee work hours or benefits.

Responding to the industry’s pleading, Medicare has said it will not deny doctors’ claims for one year whose ICD-10 codes are not specific enough, as long as the doctor submits an ICD-10 code from the correct family of codes. And if the doctor submits claims in the correct code family but are not specific enough, Medicare also will not audit those. Dr. Garcia said, “I asked for two years’ grace period but they only gave us a one year grace. I think it is going to take at least three years before this thing is finally settled down.” 

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Three Financial Products Every Young Physician Needs

Three Financial Products Every Young Physician Needs | EHR and Health IT Consulting |

There are three aspects of financial planning that are important for every young adult beginning their career: having the protection of disability and umbrella liability insurance along with appropriate estate planning.

Having a serious accident or illness that results in disability is a catastrophic occurrence that can happen to anyone.  Not having sufficient disability insurance ensures a potential life of poverty. If you have dependents, it is so much worse. Disability insurance should be in place in an amount to replace at least 60 percent of income. It is best (if possible) to pay the premiums with after-tax funds so that any benefits paid will be untaxed. There are many riders and options that can literally double the cost of this insurance, so having a trusted agent or other advisor to guide you is important.

Umbrella liability (UL) insurance picks up and covers you for accidents and other general risks (not business- or practice-related) after your current homeowners and auto policies hit their maximum payouts. This insurance is sold in million-dollar increments and is inexpensive (usually around $300 per million per year). The underlying liability coverage on your auto and home policies needs to be coordinated with the UL policy, and sometimes you can actually save money with lower underlying limits than you already have. This insurance is usually available from the same companies that sell your current homeowners and/or auto insurance coverage.

Having some estate planning documents is usually important. If you have any dependents, it becomes very important to decide on the future of your family. Who will take care of your children? Who takes care of the money you have left for your children? Do you want a judge to decide?  All you may need is a simple will, but consider having backup trusts in place if you have minor children. The only person who really does not need estate planning is a young, single individual without any substantial assets or dependents.

Note that I did not suggest that you need life insurance. Indeed, if you are single and/or have no one financially dependent on you, life insurance may not be a priority at all.

The need for disability insurance, umbrella liability insurance, and estate planning documents are the bedrock of a financial plan. Many of the other things to consider can be worked on after your "big three" are in place.

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Failing EHR Systems May Harm Triple Aim of Healthcare

Failing EHR Systems May Harm Triple Aim of Healthcare | EHR and Health IT Consulting |

The medical industry has been determined to achieve the “Triple Aim of Healthcare” over the last several years, which is essentially dedicated to improving the quality of care, reducing healthcare costs, and strengthening patient health outcomes. The American Hospital Association (AHA) reported that AHA chairman, Jonathan Perlin, M.D., has committed to focusing on the Triple Aim of Healthcare, which he announced in front of attendees at the AHA Annual Membership Meeting in Washington, D.C.

“We can’t have a sustainable health system without constantly improving healthcare and health,” Perlin said at the meeting. “And we can’t let our momentum in increasing access through the health insurance marketplace and Medicaid expansion dissipate.”EHR Incentive Programs

The adoption and implementation of EHR technology across the healthcare continuum was expected to improve the Triple Aim of Healthcare, but the lack of effective data exchange among multiple systems and across medical facilities has led to significant barriers for quality care improvements.

U.S. Senator Lamar Alexander (R-Tenn.) has been one of the most vocal lawmakers about the failings of the Medicare and Medicaid EHR Incentive Programs. The $28 billion invested in implementing health IT systems has not brought about significant advantages with regard to the Triple Aim of Healthcare, as there are still many systems that are unable to exchange data, according to a release from Senator Alexander.

“We’ve got to get these records to a place where the systems can talk to one another – that’s called interoperability – and also where more doctors, particularly the smaller physicians’ offices, want to adopt these systems, can afford the cost, and can be confident that their investment will be of value,” Alexander explained at a committee hearing. “Dr. Francis Collins, director of the National Institutes of Health, has told us that a properly functioning records system is essential both to help assemble the genomes of one million individuals and for doctors to be able to use a patient’s genetic information when they write a prescription for individual patients.”

This specific hearing was based on discussing precision medicine and developing ways to more quickly and affordably move medical devices, drugs, and treatments from discovery and the regulatory process to doctors’ offices. Precision medicine refers to more innovative processes for tailoring treatments such as gene sequencing of tumors.

Alexander also mentioned the importance of defining how EHR systems can benefit healthcare innovations. For example, one proposal from the White House is to map the genome of 1 million people across the United States and make this data available to scientific researchers throughout the country. The issues that need to be addressed to make this a reality, however, is how EHR systems will hold the data and how to develop a simple way to access this information across multiple platforms and facilities.

Greater focus on precision medicine is expected to reduce healthcare costs, Senator Alexander explained. If this decline in spending occurs, it would lead to a gain for the Triple Aim of Healthcare.

Additionally, Lamar feels that EHR technology has caused more harm than good, as it has disrupted workflow and negatively affected the patient-physician relationship. Currently, Senator Patty Murray (D-Wash.) and Senator Alexander are collaborating on finding five or six items they can take to improve the EHR Incentive Programs and EHR technology as a whole.

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