EHR and Health IT Consulting
33.7K views | +12 today
Follow
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
Your new post is loading...
Your new post is loading...
Scoop.it!

EHR System Satisfaction Declines to 34% Among Physicians

EHR System Satisfaction Declines to 34% Among Physicians | EHR and Health IT Consulting | Scoop.it

Multiple motivations are driving EHR adoption in the healthcare industry from the EHR Incentive Programs to the promise of increased healthcare efficiency. Yet in a recent survey by AmericanEHR Partners and the American Medical Association (AMA), researchers found that physician satisfaction is on the decline.


The report finds that in 2010 a total of 61 percent of respondents were satisfied or very satisfied with their EHR systems. In 2014, after the total number of EHR users has increased, a mere 34 percent of respondents are satisfied.


Additionally, nearly half of respondents reported that EHRs actually decreased efficiency, with 42 percent saying EHR technology made it difficult to improve efficiency, 72 percent stating it was difficult for EHRs to decrease physician workloads, 54 percent saying EHRs increased total operating costs, and 43 percent saying their practices have not yet overcome these challenges.


The report notes that other findings in the survey heavily depended upon whether respondents were satisfied or dissatisfied with their EHR system. This means that there was polarized variation in responses depending upon how respondents felt about their EHR systems. Naturally, respondents who were satisfied responded positively to the survey questions, while those who were dissatisfied did not.


For example, when responding to questions regarding staff time spent processing and refilling prescriptions, 42 percent of all respondents said they were satisfied with their EHR. However, of those who were dissatisfied with their overall EHR use, only 25 percent were satisfied in the processing and refilling prescriptions category. Of those who were satisfied with their overall EHR use, nearly 69 percent were satisfied with the process and refilling prescriptions category.


However, there were some questions all respondents were generally able to agree upon. Merely nine percent of respondents — or 19 percent of those who were satisfied with their EHR — reported that adopting an EHR system decreased their practices’ overall costs. Likewise, only 13 percent of respondents — or 21 percent of those pleased with their EHRs — reported that their EHR technology made a positive impact on a number of their employees.


The report also indicates that primary care physicians tend to be more satisfied with EHR systems than specialists. This is because primary care physicians on average have worked with EHR systems for longer than specialists have, and therefore have figured out the best and most efficient ways to use them. The report also indicated that it took an average of three years for physicians to get used to working with an EHR and to resolve the initial challenges the systems presented.


Shari Erickson, MPH, Vice President of the American College of Physicians Division of Governmental Affairs and Medical Practice, contends that as EHRs continue to be integrated into physician practice, satisfaction ratings will increase.


“Perhaps we are getting over the curve in EHR adoption,” she said. “It may be that as we see more practices that have been using these systems longer we will see satisfaction begin to rise.”

more...
No comment yet.
Scoop.it!

Three Risk Management Strategies for Physicians

Three Risk Management Strategies for Physicians | EHR and Health IT Consulting | Scoop.it

Healthcare costs. Every time I turn around, doctors are being lectured on another aspect of the elusive goal of taming this beast.

In fact, a recent study published in the March issue of Academic Emergency Medicine caught my eye, indicating nearly all of 435 emergency department physicians surveyed admitted to ordering too many diagnostic tests out of fear of error, uncertainty, and fear of being sued if they don't cover all their bases.


This isn't breaking news. The reasons are pretty obvious. If you miss a diagnosis or detail, you increase your risk of being sued. The real question is: What to do about it? It's a lot more complicated than, "Stop practicing defensively and ordering so many tests."


At the most basic level, ordering additional diagnostic tests is a doctor's way of saying: "The risks aren't well understood in this particular situation, so I'm going to order additional testing just to make sure."

Specialized Risk Management


One medical specialty with a heightened level of risk is making strides in understanding and containing those risks and associated costs: bariatric surgery. Currently one of the fastest growing areas of medicine, bariatric procedures offer surgical alternatives for obese patients who have exhausted other weight-loss avenues.


Currently, the probability of a bariatric surgeon being sued during their career is 50 percent. However, groups of risk management specialists have put together training, procedures, protocols, and practices specifically for bariatric surgeons and their practices that significantly reduce the risks associated with this specialty. Bariatric surgeons who employ these solutions can see a significant reduction in risk associated with a medical malpractice lawsuit.


What Can We Do?


Looking at the problem from the malpractice insurance side, the vast majority of carriers offer risk management services and training as part of their insurance coverage. Many of the courses provide CME credits and/or premium rate incentives for completion.


However, a frequent complaint I hear from my medical malpractice insurance colleagues is there is all this great content and training available, and yet few doctors take advantage.


Maybe the content isn't as great as we think it is, and we need to offer more targeted, applicable information — like our bariatric risk management friends. Maybe we need to listen more closely to physicians who are in the cost containment crosshairs and provide more actionable information that can help reduce risk and the associated defensive over-testing.


What Can You Do?


While we're working on the insurance end to improve our content and quality, here are a few suggestions for physicians:


1. Check with your specialty association for additional materials, training or certifications that can improve quality decisions and reduce risk. Many specialty colleges and societies are active in this area and can provide valuable resources for providers and practices.


2. Check your medical malpractice carrier's risk management resources. Many carriers offer meaningful risk management training and resources that too often go unused by physician clients. Many offer free CME credits as well.


3. Ask for specific training topics. If your carrier doesn't offer what you need, ask them specifically to provide it. Many insurance companies are eager to hear from their customers and respond to requests for improved risk management — it's good for the physician and it's good for the company. If they are unresponsive, have your broker look at other carriers' programs to find something that is a better fit for your needs.


Risk, like anything else, changes with time. It's clear that taking advantage of education, tools, and programs offered to better understand risk for you and your individual practice can pay off big in the end.


more...
No comment yet.
Scoop.it!

Fixing What's Wrong with EHRs is Easier Done than Said

Fixing What's Wrong with EHRs is Easier Done than Said | EHR and Health IT Consulting | Scoop.it

Immigration, drought, and EHR are all of great concern. We know people are concerned about immigration because of the daily news. The message is basically, "Solve the immigration crisis." In California, farmers are concerned about the drought as the "Solve the water crisis" billboards in the central valley attest.

It's obvious that physicians are concerned about EHRs. The concern is so great that the AMA convened an advisory committee and has spoken out. In September, they recommended overhauling (their word) the design of EHRs to improve usability and called on EHR vendors and the government, "To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs..." The AMA framework outlines a list of "usability priorities" — things they cannot specify precisely but are easily identified when you haven't got enough. The tip-off that these are "non-functional" requirements lie in the words of the AMA statement: enhance, support, promote, offer, reduce, promote, facilitate, and expedite. The first item on their list is, for example, "Enhance physicians' ability to provide high-quality patient care."

According to the AMA, "these priorities were developed with the support of an external advisory committee comprised of practicing physicians, as well as noted experts, researchers, and executives in the field of health information technology."

To me, their announcement essentially says no more than, "Somebody, please solve the EHR crisis." If this reformulation sounds critical, it is, and I'll explain why.

"Solve the ... crisis" statements do little to advance a solution; they merely express concern, dismay, and helplessness. They lack actionable suggestions for how to solve the crisis. They merely express the hope that someone who is smarter or more knowledgeable will be able to do what they cannot.

This is where the EHR crisis diverges. Immigration and drought are the result of forces beyond the control of policymakers, legislators, vendors, or individual organizations. They are truly complex problems. Immigration and drought cannot be solved, only mitigated or accommodated.

Turning to EHR, let's consider the AMA's priorities. What does it mean, for example, to "Enhance physicians' ability to provide high-quality patient care?" Is there a single enhancement that would work in every EHR? How do you enhance a computer system in a way that will result in predictably higher-quality care? The vendors already claim (or perhaps believe) that their systems are optimal, or at least adequate. Will they have any idea how to make their "practically perfect products" better? Similar questions can, and should, be asked about each of the AMA's eight challenges.

Taking a step back, several points are inescapable:

• The problems with EHR were smoldering for years, but only became a crisis when the federal mandate was imposed.

• The mandate effectively put a stop to the development of new EHRs since, in addition to implementing their new concept, they must replicate everything that is old to get certified or no one would buy them.

• Few comprehend the root causes of the EHR problems about which they complain. The few have an idea, either don't disseminate their knowledge, can't get it published because editors assume that ordinary physicians don't need to know that stuff, or the publications appear in obscure journals that no physician will ever discover. Thus, most physicians, probably including the committee members, have only vague notions of what it might mean for an EHR to be better. They can't have had much experience with one that is significantly better because if there were such a beast, people would be using it instead of complaining. Most notions of what would be better are based on daydreams, not evidence.

• The AMA's contention that EHR just needs a minor overhaul implies that they believe that today's EHRs are basically sound and well-designed. This assumption has no basis in fact. Just because EHRs are bought and used is not evidence that they are well designed, easy to use, or that they do what people expect.

Unlike drought and immigration, there is a solution to the EHR crisis.

It is to abandon mandates, abandon certification, and abandon penalties and incentives. Instead, efforts should be directed toward educating physicians about the information science behind medical records, be they paper or electronic.

The money that is currently being wasted on incentives and bureaucracy should be redirected to fund:

• Research that concentrates on basic science and is not tied to, or conducted using, an existing EHR; and
• Development of completely new EHRs that start with a blank slate and embrace design concepts that put the medical record, not data, at their core.


more...
No comment yet.
Scoop.it!

Physician Job Satisfaction on the Decline

Physician Job Satisfaction on the Decline | EHR and Health IT Consulting | Scoop.it

Healthcare bureaucracy and greater focus on data entry may be negatively influencing the physician profession including physician job satisfaction, according to a recent survey from the healthcare solutions group Geneia. The company polled 416 doctors in January 2015 and found that 84 percent claim the amount of quality time with patients has decreased over the last ten years.

Physician burnout is also on the rise, as 67 percent of respondents said they know a doctor who will likely stop practicing medicine within five years. Most respondents were unhappy with the work-life balance aspects of their profession. Only 25 percent surveyed stated they were “very satisfied with the work itself.”

Even though the Department of Health & Human Services (HHS) focused on improving patient engagement through Stage 2 Meaningful Use requirements, it seems that the patient-doctor relationship is actually floundering. A total of 78 percent of respondents said they feel rushed when speaking with patients.

Additionally, many physicians are feeling overwhelmed by the large amount of paperwork and regulations of the healthcare market. The majority of survey takers – 87 percent – felt that the federal regulations in the medical field are impacting “the practice of medicine for the worse.”

In order to counter the negative effects of the business side of medicine on physicians’ career outlooks, Geneia has implemented the Geneia Joy of Medicine Challenge. This will be a web-based event in which the organization will seek ideas from doctors about the best ways to restore the meaning of practicing medicine.

In an interview with EHRIntelligence.com, Heather Lavoie, Chief Operating Officer of Geneia, has said that an excess of information has come from the business and technology side on ways to improve the patient-doctor relationship and that it is time for physicians themselves to come forward with creative solutions. This is why Geneia is holding the Joy of Medicine Challenge.

“They’re [physicians] are in a much better position now to design what will work for them,” Lavoie said in the interview. “Some of what you hear from physicians about what they really need is less data entry and less time in the office clicking away.”

Geneia has already seen some doctors submit ideas for improving the practice of medicine. Some suggestions include hanging EHRs on the wall and limiting the direct interaction necessary with the systems while enabling the tools to capture more data automatically. Additionally, one idea on improving population health management includes leveraging the broader care team, and not just physicians, to categorize patients who are at highest risk, who have missed important preventive services,  as well as those with less serious conditions.

While the survey did not directly ask about how meaningful use stages are affecting the practice of medicine, the takeaway shows doctors are unhappy with the bureaucracy and high amount of data entry required through recent regulations.

Despite the dissatisfaction with data entry, EHR systems are here to stay, Lavoie mentioned. Physicians are not asking to go back to paper-based charting and in general going backwards would not work for the medical industry. For example, there are many medical school graduates getting into the field today who have never used paper charts.

However, Lavoie does say that EHR systems may need better design and improved implementation in order to give physicians more time for direct patient care. Both meaningful use and the Affordable Care Act were “a good shot in the arm” in the move from paper-based to electronic systems, “but with any shot in the arm, there may be side effects,” Lavoie infers.

Currently, there are too many “business burdens” for clinicians. The implementation of EHRs may have occurred too rapidly, which puts the systems at a disadvantage for being instrumental or meaningful in the healthcare system. Many medical facilities have felt rushed when implementing health IT tools, which often translates to less training for staff members. The deadlines of federal regulations have also put a time constraint on the design of EHRs, which may benefit from better construct.

“We jumped into implementation very rapidly in some cases and when you do that, you might shortcut design and you might not efficiently implement them… or adequately train the staff,” Lavoie explained.

The talent and the skill of physicians are not being used effectively if they spend more time with data entry than direct patient care. Freeing up physicians from the administrative tasks of their job may improve their career satisfaction.

One solution that Lavoie proposed involves greater data capture and automating data entry. For instance, when a patient’s blood pressure is measured, it would be useful to have a system that incorporates automatic uploading instead of manual recording.

Some supplementary solutions to these issues could come from dictated notes and natural language processing tools. Bringing physicians back to connecting with patients is important for both the satisfaction of practicing medicine and patient participation. Additionally, patient portals that are designed well and have greater usability do improve the patient experience, according to Lavoie.

“Access to information about an individual’s health status… [and] their full medical history has the potential … to improve the physician-patient relationship ultimately and improve satisfaction. That said, we can implement things well or we can implement them poorly.  It isn’t necessarily a limitation of the system itself, rather, so much of it is in how we implement it, how we communicate about it, and how we use it as a tool,” Lavoie spoke on the benefits of patient portals.

Even though two-thirds of doctors know someone who is considering leaving the occupation, Lavoie says most doctors are problem-solvers and optimists who would rather heal the profession rather than leave it. By incorporating the suggestions from the Joy in Medicine Challenge, job satisfaction among those practicing medicine may be restored.


more...
Kush Pathak's curator insight, March 11, 2015 6:00 PM

The bureaucracy that is being discussed in this article is the Department of Health and Human services. I did not realize that they spend so much of their time and resources on petty data entry and statistics. These things may be important, but what is more important is to ensure that those in the healthcare field and satisfies, and are protected under the law. I do not agree with what this bureaucracy is doing because it just goes to show that these governmental and restrictive bodies are not always here to show protect us, sometimes they are more focused on their their own public image and less on the well being of their actual members and the people that rely on them. 

Scoop.it!

CMS Extends Physician Quality Reporting System Deadline

CMS Extends Physician Quality Reporting System Deadline | EHR and Health IT Consulting | Scoop.it

Recently, the Centers for Medicare & Medicaid Services (CMS) extended the meaningful use attestation deadline for the Medicare EHR Incentive Program for the 2014 reporting year to March 20, 2015. This was implemented in order to give providers more time to submit meaningful use data. In addition to this extension, CMS also prolonged the deadline for Physician Quality Reporting System (PQRS) participation.

The new date for submitting PQRS reporting processes has also been moved to Friday, March 20, 2015 at 8:00 PM. The Healthcare Information and Management Systems Society (HIMSS) explains that the deadline is set specifically for the submission methods certified EHR direct or data submission vendor and the qualified clinical data registries (QCDRs).

The clinical data registries are needed for reporting the clinical quality measurement element of meaningful use as part of the Medicare EHR Incentive Program. Eligible professionals and physician practices receive an incentive payment from CMS if they sufficiently participate and report quality measures information. This is conducted under Medicare Physician Fee Schedule (PFS) services.

PQRS is essentially a program that promotes the reporting of quality data by eligible physicians through incentive payments and payment adjustments. Providers who are looking to begin participating in the PQRS reporting program should first determine whether they are eligible to take part, CMS explains.

The next step to take is to define which reporting method is best for your physician practice. The options available for submitting data to CMS include qualified EHR, claims-based, registry-based, Group Practice Reporting Option (GPRO), and Qualified Clinical Data Registry (QCDR). Additionally, providers should consider each method’s reporting criteria and ensure that they are capable of meeting the requirements.

If a provider chooses qualified registry-based reporting, he or she will need to determine among the reporting options of either individual measures or measures group. Eligible professionals that are using 2014 PQRS individual measures will need to submit nine or more clinically appropriate measures among three National Quality Strategy (NQS) domains. This will allow the participants to qualify for PQRS incentive payments.

Additionally, providers should be aware of the timeframe or reporting frequency requirements for each measure among every eligible patient. The instructions section of each measure specification will include an explanation of the reporting frequency. Staff members will need some training to ensure that they are properly able to capture the data needed for PQRS participation.

Also, it is useful to review information related to the PQRS payment adjustment. It is important to note that eligible physicians who do not meet 2014 PQRS reporting provisions will be subject to a payment adjustment on Medicare Part B PFS services completed in 2016. Those looking to avoid the PQRS payment adjustment should be sure to meet the requirements for satisfactory reporting in the 2014 PQRS or report at least one individual measure through one National Quality Strategy (NQS) domain for a minimum of 50 percent of eligible Medicare Part B FFS patients.

Additionally, providers should be aware that all other PQRS reporting deadlines have not changed and will stay the same.


more...
No comment yet.
Scoop.it!

ICD-10 Implementation Costs Hinge on Physician Practice Size

ICD-10 Implementation Costs Hinge on Physician Practice Size | EHR and Health IT Consulting | Scoop.it

A new survey of ICD-10 implementation costs in small physician practices in the Journal of AHIMA again raises doubts about the accuracy of previous reports estimating the financial costs of transitioning to the new code set.

These new data come by way of the Professional Association of Health Care Office Management (PAHCOM), which specializes in working with physician practice managers.

As Blanchette et al. indicate, respondents to the PAHCOM survey first provided specifics about the number of providers in the practice, practice average expenditures, and per provider average expenditures.

“Generally, as expected, the expenditures associated with ICD-10 increase as the size of the practice increases, but the per provider expenditures decrease as the size of the practice increases,” the authors write. “The per provider ICD-10 average expenditures ranged from $4,372 for a practice with a single provider to $1,838 for a practice with six providers.”

Here’s a complete breakdown of the 276 responses:


Lastly, respondents were asked to calculate the amount of time expended by all physician practice staff on ICD-10 preparation. “On average, the combined amount of ICD-10-related hours expended across all personnel types in practices with six or fewer providers was 45.5 hours per provider in the practice,” Blanchette et al. report.

Renewing the debate

Continuing in the vein of previous Journal of AHIMA research, Blanchette et al. compare the findings from the PAHCOM study with previous reports estimating the cost of ICD-10 implement for physician practices.

The authors note that a study conducted by the American Academy of Professional Coders (AAPC) has likely reported lower-than-average ICD-10 implementation costs “due to limitations on the types of implementation costs included in the AAPC data and/or the additional costs that have been incurred as a result of the delay in implementation of ICD-10.”

That being said, Blanchette et al. still emphasize the high costs of a report commissioned by the American Medical Association and conducted by Nachimson Advisors which ranged from $22,560 to $105,506:

The lower costs reported in this survey may be in part due to vendor response to the implementation of ICD-10. ICD-10 educational materials are now readily available for a nominal cost. Practice specialty-specific superbills can be downloaded at no cost from the internet. Many software system vendors are providing ICD-10 system updates at no additional cost. The adoption of electronic health records by physician practices has further facilitated the transition to ICD-10.

Last November, Nachimson Advisors issued a strong response to a report by Kravis et al. in the Journal of AHIMA that questioned its findings.

“The AHIMA article omits any mention of planning and assessment, as well as internal testing,” the organization told EHRIntelligence.com. “These are critical steps that practices must take to ensure that their ICD-10 implementation is done correctly and that there will be little or no revenue impact post October 1, 2015, the compliance date.”

At the time of publishing, the AMA has yet to furnish a response to the latest survey’s findings.


more...
No comment yet.
Scoop.it!

Seven Ways PAs Strengthen the Team, Deepen the Bench | Physicians Practice

Seven Ways PAs Strengthen the Team, Deepen the Bench | Physicians Practice | EHR and Health IT Consulting | Scoop.it

Physicians often ask me whether they should consider hiring a PA and how to integrate one into their practice.

Much like a sports team’s game plan, every practice functions differently. But if you need to draft a new player, consider what areas of your practice could use some relief and what skills that player needs to complement your practice. A PA can be the leadoff batter, collaborating partner, supporting player, or the rebounder.

At the core of PA training is team-based care through the medical model. We practice with our physician partners and enjoy being the all-around players that execute the fundamentals of medicine in a way that expands the team’s capabilities, resources and positive outcomes.

Here are seven ways PAs may benefit your practice:

1. Make room for more patients. If you are already working overtime, another provider may be the only way you can grow your practice. For services that are incident-to a physician’s services, the reimbursement rate is at 100 percent. For other services, reimbursement is 85 percent of physicians' fees. Our ability to see our own panel of patients, or share yours, will generate revenue and more than cover the cost of our salary and benefits.

2. Free you up to handle the most-complex medical cases or those that will generate more revenue. For example, surgeons want to operate and can turn over some of the pre-op and post-op care to PAs.

3. Improve your work-life balance. Having a PA manage patients with chronic conditions, help manage phone calls, and share other responsibilities can give you back hours in your day.

4. Give patients what they want. Patients want to spend time with their provider, and you want to extend this coverage so patients feel good about their care. When you and a PA work as a coordinated team, patients will not feel slighted if you do not see them on each visit.

5. Assume administrative roles. PAs can create wellness programs, initiate and lead group appointments, and perform as lead PA or the clinical interface to the business office.

6. Improve care coordination. PAs can help you coordinate care between your office and other providers or locations, for example specialists, physical therapists, or hospitals/outpatient surgery centers.

7. Focus on CMS requirements. There are many new requirements for quality outcomes, EHR use, and patient engagement. A PA can give the team the additional knowledge, skills, and time that it needs to hit these goals.

Currently there are approximately 100,000 certified PAs in the United States. According to the National Commission on Certification of Physician Assistants (NCCPA), every week certified PAs work 3.8 million hours enabling them to increase healthcare access by treating 7 million patients in every clinical setting across the U.S.

PAs can increase team wins:
Ultimately, patients seek healthcare from providers with whom they are most comfortable and get the best service. PAs can help meet the needs of your most demanding patients, deliver on quality and satisfaction targets, and increase revenue.

So if you are considering adding a player to your team, now is the time to make your move. Assess current strengths, determine skills needed, and draft a PA to be the utility player, who can help bring your team to the next level.



more...
No comment yet.
Scoop.it!

New Medical Practice Staff Performance Reviews: 5 Tips | Physicians Practice

New Medical Practice Staff Performance Reviews: 5 Tips | Physicians Practice | EHR and Health IT Consulting | Scoop.it

Many practices hold a 90-day review with new staff members to discuss performance, areas that need improvement, and provide kudos for a job well done. Here are a few tips to help ensure you are making the most of these important evaluations:

1. Gather perspectives. Speak to physicians and staff members with whom the employee works closely. While you can (and should) observe the employee in action, it's impossible for you to understand exactly how that new staff member works with and interacts with his colleagues and supervisors in various situations. "I try to get their perspective on things they're seeing on the floor that maybe I don't see," said Cynthia Blain, director at healthcare consulting firm SS&G Healthcare.

2. Criticize right. The 90-day review presents a great opportunity to identify how the employee can improve and what she needs to work on. But remember: Motivation and correction is much more about giving people something to work toward, than it is telling them to stop doing something, said Carol Stryker, founder of practice management consulting company Symbiotic Solutions. For instance, rather than telling a staff member she needs to stop looking down when she speaks to patients, ask why she is having trouble making eye contact. Then say, "What can we do to help you make eye contact, because that's a real important part of making patients feel welcome."

3. Be detail oriented. Frame the review (and your conversation with the staff member) around their job description. Be on the lookout, however, for smaller details when it comes to professionalism and patient relations. For instance, consider whether the staff member is willing to ask questions (a good thing), and if he is always asking the same questions (a bad thing). Similarly, don't focus on how often he makes mistakes, but on how often he learns from those mistakes, said Stryker. "If you make the same mistake repeatedly then we've got a problem — you have to learn from that."

4. Gauge engagement. You want your staff members to be engaged and committed to helping improve your practice. Consider how many suggestions the staff member has made that were helpful and whether the staff member is willing to share her input and ideas, said Stryker.

5. Ask for input. The 90-day review isn't just for you to share your thoughts, it's also the new hire's opportunity to share his thoughts, experiences, needs, and questions. Ask the staff member how he feels about working in the practice, how the orientation process could be improved, and so on, said Troy Jaklich, president of Legacy Human Resources, which specializes in medical offices.



more...
No comment yet.
Scoop.it!

Lessons All Practices Can Learn from the Concierge Model

Lessons All Practices Can Learn from the Concierge Model | EHR and Health IT Consulting | Scoop.it

Starting a private practice requires a heavy dose of entrepreneurial spirit. Keeping one afloat requires a keen mind for business operations.

Rather than shrugging his shoulders at an overly complex healthcare system, internal medicine physician Tom Lee founded a practice that focused on fixing some of the glaring flaws in healthcare delivery at the practice level.


One Medical, a large concierge practice, epitomizes what’s required to succeed in private practice: ambition, innovation, and efficiency. Even if you’re not pursuing a concierge model for your practice, this practice's success still has several lessons to offer healthcare providers looking to maintain some autonomy through a private practice. It may also offer a window into the future of the physician-patient relationship.

Here are three things private practice providers can take from Lee’s success.


 Build Your Foundation on Technology


Despite seeing an average of 35 percent fewer patients per day than the average practice, One Medical already boasts patient numbers in the thousands as well as a reported growth rate of 50 percent.

Can seeing fewer patients while growing at a meteoric rate be anything other than a paradox?


The answer seems to be yes. This coupling of rapid growth without tortuous physician hours and work flows is best explained by the practice’s effective use of technology to increase the operational efficiency.


It’s no secret that One Medical receives significant backing from venture capital firms — much of which is likely due to Lee’s success with Epocrates, which he cofounded. But instead of exclusively spending those assets on new office buildings and advertising, Lee invested heavily in technology, specifically iOS and Android apps.

As part of the annual $199 membership fee, One Medical patients receive access to the practice’s app from which they can book online appointments, renew prescriptions, and even get a review of their medical information and have subscriptions sent to a pharmacy or tests scheduled.


This same functionality can be found in many patient portals, though these features are less common on mobile devices at the moment.

Instead of worrying about how the patient portal-esque app would fulfill meaningful use requirements, Lee seized the opportunity to automate all the clerical processes he could. As a result, One Medical employs half as many office staffers per provider as the normal practice.


Center the Experience Around the Patient


One Medical’s emphasis on technology streamlines the way the practice functions, and improves the patient experience. Creating a useful mobile application wasn’t done for reimbursement purposes, but rather to create a more intuitive experience for patients.

Many practices lack this focus on the patient experience. Instead of taking the time to make sure the patient is comfortable with a diagnosis, providers must rush the examination in order to move on to the next patient.


This directly contradicts the mindset of the modern consumer, and it only feeds healthcare’s reputation for anachronistic operating models. Consumers now use their experience with a service provider as validation for continuing to choose that provider. Failing to focus on experience is a surefire way to lose patients — perhaps driving them to competitors who do seem to have the time to talk longer in the exam room.


Remember that One Medical physicians see less patients? That’s so they can dedicate more time with each individual.


To be sure, technology powers the customer experience by making the healthcare provider more efficient and enabling him to prioritize the patient. But using the lack of technology as an excuse for the poor engagement is self-defeating.


Patients now expect a holistic experience from providers, beginning with digital access to health information and ending with follow-up after the appointment.


Look Past the Status Quo


Physicians have a reputation for being resistant to change. However, the current reimbursement system mire and the myriad of new regulations aren’t asking physicians to change; these forces are demanding it.


Doing things the same old way simply won’t suffice. A concierge model may not be the answer for every practice, but it does serve as an example of what’s possible with technology and the right priorities. Luckily for independent practices, there’s an expansive market of medical software that supplies the raw materials for building a more effective, patient-centered practice.


more...
No comment yet.
Scoop.it!

Strategies for Dealing with Value-Based Modifiers

Strategies for Dealing with Value-Based Modifiers | EHR and Health IT Consulting | Scoop.it

As we know many payers are implementing various approaches to pay-for-performance reimbursement or value-based reimbursement programs. Medicare has announced significant goals in modifying payment models; rolling out value-based payment modifiers (VBPM) this year. Patient care activity in 2015 will impact every Medicare payment in 2017. Physician groups of 100 or more will have payments affected this year, groups of 10 or more in 2016, and all groups in 2017. Medicare will determine the amount of payment incentive or adjustment based on the information noted below. The range is from - 4 percent to + 4 percent of Medicare payments.

Below are some thoughts on how you can respond to VBPMs and optimize the care provided patients and maintain or gain financial viability.


1. Continue to participate in PQRS which is the basis for the Medicare Value-Based Payment Modifier program. Understand how your profile fits within the six domains (check meaningful use): clinical process/effectiveness; patient and family engagement; population/public health; patient safety; care coordination; and efficient use of healthcare resources.


2. Access your practice Quality and Resource Use Report, QRUR, by obtaining an IACS number from CMS. This report was published by CMS last fall and compares your practice to peers on both quality and cost measures. This can be downloaded in both PDF and excel formats. It's complex but worth spending time on to both understand and identify your practice profile.


3. Monitor your entire provider panel in key measures:

Quality:

a. Preventable hospital admissions:

• Patients with acute episodes of dehydration, UTI, and bacterial pneumonia

• Chronic patients with heart failure, COPD, and diabetes

b. All cause hospital readmissions

Cost — your practice status:

a. All Part A and Part B payments (Part D excluded)

b. For disease categories: COPD, heart failure, coronary artery disease, and diabetes

c. Medicare Spend Per Beneficiary, MSPB, for three days prior to and 30 days post discharge

d. Total Medicare Allowable per applicable CPT code

4. Report monthly on what is occurring.

a. Your practice will not know the Medicare ranking until the end of period.

b. Rankings are determined by the eligible provider (EP) who has a "plurality" of primary-care codes assigned and the Medicare allowable charge amount assigned. Primary-care providers will be considered first, but any specialist may qualify.

c. A minimum of 20 episodes per measure (see quality above) hence the need to monitor your practice. If insufficient numbers are there, you may not see either the incentive or adjustment.


5. Regular review and reporting will help lead the practice toward a more "quality" impact and focus. When all staff, not just providers, work together, the cumbersome nature of reporting will become easier and part of everyday practice life — since in many cases the impact is not significant this year. It will however become more impactful in the years to come, as not only VBPM programs come into play, but overall payment model reforms are implemented. There will be an eventual culture change!


Long term outcomes for practices should be improved patient care, compliance with the new paradigm, and an improved financial picture. How you approach it now may determine the long-term success and viability of your practice in the future.


more...
No comment yet.
Scoop.it!

RNs want investigation into EMR failure

RNs want investigation into EMR failure | EHR and Health IT Consulting | Scoop.it

Nurses at a California hospital are asking state officials to investigate the failure of the hospital's electronic medical recordsystem, an incident they said led to the closure of its emergency room and compromised patient safety.

 
The EMR system at the 420-bed Antelope Valley Hospital in Lancaster, California, reportedly failed last weekend, resulting in clinicians unable to review patient labs, verify physician orders and access patient records, according to the California Nurses Association and the National Nurses United union. 
 
"Our entire electronic and data system failed," Feb. 27 wrote Antelope Valley's Maria Altamirano, RN, on behalf of California Nurses Association, in a letter to the Los Angeles County Department of Public Health. Due to the failure, the hospital, Altamirano explained, had to close its emergency department because it failed to have adequate backup plans in place. 

"How many hospitals are compromising the lives of their patients by not having a back up or plan of action in place for a catastrophic event as this?" she asked.
 
The hospital's pharmacy system and its backup also crashed, according to an emailed statement from a CNA spokesperson.  
 
However, according to hospital officials, downtime procedures were indeed in place and utilized, said Dennis Knox, chief executive officer at Antelope Valley Hospital, in an emailed statement. When the EMR outage occurred Friday, Feb. 27, hospital officials took immediate steps to bring the system back online. The system was fully working again on March 1. 
 
Clinicians were able to resort to hand-written medical record keeping, and despite the EMR being down, the hospital was still able to process medication orders and lab results, Knox explained. What's more, although medication requests were processed via hand-written paper orders, the prescription management system was on a server unaffected by the outage, and thus the pharmacy could continue filling those orders. 
 
Knox acknowledged that there were times during the outage when they had to send certain patients to nearby facilities for treatment, but its emergency department did continue to treat patients. 
 
"Our team of professionals worked tirelessly throughout the weekend to process lab orders and results, review radiology exams, carry out treatment plans and deliver overall patient care as promptly as possible," added Knox. 
 
National Nurses United, the largest registered nurses union in the U.S. with some 185,000 members, in the last few years has criticized specific hospitals' use of EMR systems, platforms that have significant downtime, fail or are not designed well for clinician users. 
 
As NNU Spokesperson Liz Jacobs told Healthcare IT News back in 2013: "We're not anti-technology." Rather, "we want smart technology that embraces and includes the clinicalexpertise of a registered nurse who really knows how best to put together a system that will work for them."
 
The union also spoke up in a similar EMR outage back in August 2013when Sutter Health's $1 billion EMR system went dark for a day, preventing clinicians from accessing patient medical records and seeing medication orders. 
 
"This caused intermittent access challenges in some locations," said Sutter Health Spokesperson Bill Gleeson in an emailed statement to Healthcare IT News of the incident. 


more...
AmandaTotten's curator insight, March 19, 2015 6:35 PM

What if EMRs fail and are able to be accessed by everyone? 

Scoop.it!

UCLA Health to integrate genomic data into EHR in pilot

UCLA Health to integrate genomic data into EHR in pilot | EHR and Health IT Consulting | Scoop.it

UCLA Health will soon begin a pilot project with Seattle-based startup ActX that will integrate genomic patient data into its Epic EHR system, with the eventual intent of applying precision medicineto a large-scale patient base.

ActX, founded in 2012 and just out of stealth mode six months ago, collects a patient’s genetic information by way of a saliva sample, and then analyzes the information in real time. The data is integrated into an EHR – already, ActX is working with Allscripts and Greenway Health – and physicians will receive an alert about a medication and possible side effects, or warn of potentially serious risks for cancer.

Think of it as a 23andMe that is integrated into an EHR and available to the patient.

Molly Coye, chief innovation officer at UCLA Health, which operates four hospitals, said that’s precisely what intrigued the academic health system.

“Our goal is to try to bring precision medicine to a much larger proportion of patients,” she told MedCity News. “Right now it tends to be focused particularly on people with cancer, and even then on a low number of patients.”

She added that genomic data combined with an EHR could have “real clinical meaning for a larger number of patients than we could have known about five or 10 years ago.”

The pilot will begin in the coming weeks on 50 patients that the health system thinks will be a good fit, Coye said. Depending on initial success, it will be expanded to a greater number.

“If successful, and our physicians are enthusiastic about it, we’ll rapidly make it available more widely,” she said, adding that most UCLA Health pilots range from three-to-six months.

ActX co-founder and CEO Andrew Ury, a physician who has worked extensively in the EHR space, said up until now, few if any genomic data collectors have been integrated into an EHR. Dr. Ury previously worked for Practice Partner, which was acquired by McKesson in 2007.

As he sees it, EHR integration is the only way to harness genomic data on a large scale while at the same time providing the results for patient.

“We believe the way to do that is to build it into the everyday tool, the EHR,” he said. “The consumer factor is because we have to get the patient’s genomic data in order to make it work, so we offer access to affordable DNA sequencing. In order to that, we involve the patient.”

Given that UCLA Health uses an Epic system, which dominates the hospital market, Coye said the potential to reach a mass of patients is significant, and that such an EHR add-on could someday be a standard feature if it proves successful.

“They’re actually working with Epic, so decision support means a lot more if it pops up in the EHR,” Coye said. “This is going to be a game changer, I think. That’s the real promise that everyone recognizes about genetic testing,  that this will become a standard. It’s just a question of how you do it early on.”

Importantly, Coye cited the autonomous nature of ActX in how it’s available to both patient and physician.

Dr. Ury elaborated on the potential of precision medicine and EHR integration from a clinical standpoint.

“What this means is that if a patient’s genetic data is on file, because we’ve analyzed it, each time the physician writes a prescription in the EHR, it’s going to see if a drug is going to work, or if there’s an adverse reaction,” he said. “If there is an issue, the physician will get an alert.”

The data, and its use within an EHR, can also help physicians better determine if a patient is at higher risk of a genetic disease or a certain type of cancer. With that knowledge, more effective medications and treatments can be determined far earlier than before.

Coye said UCLA Health hopes the pilot can bring precision medicine to primary care and a further breadth of specialists “across a wide variety of clinical conditions.”

ActX is so far privately funded and has about 25 employees and independent contractors, including scientists, pharmacists, genetic counselors, physicians and software developers, according to Dr. Ury.

Dr. Ury noted that it’s “the dawn of precision medicine,” referring to the $235 million initiative championed by President Obama and overseen largely by the NIH.

“While genetics can’t predict everything, genetics can predict more and more and whether a patient has a side effect,” he said. “We think this is the future.”


more...
No comment yet.
Scoop.it!

Five Keys to Help Physicians Connect via Social Media

Five Keys to Help Physicians Connect via Social Media | EHR and Health IT Consulting | Scoop.it
So physicians, you've finally come to the realization that you need to be present in the digital world in order to be found. According to Pew Research, 80 percent of us go online first to answer our questions about health — before we call our family or friends or doctor. And you have updated your ancient website with a fancy new format that can be viewed in a browser, but also on mobile devices … right?

But you still don't have visitors to your website. And those people who do visit don't make appointments to see you at your practice. What are you doing wrong?

Too many of us use our websites as if they are traditional marketing materials: brochures, direct mail, etc. We place flashy descriptions on our home page about our services; we include our impressive credentials; maybe we even post on Facebook or send out Tweets about how great our practice is. And if we're really ambitious, we license some articles from Mayo or other sources, include some stock photos to make it pretty, and add those to our "blog" or digital newsletter.

But that's all about you.

In the digital world, it's not about you, it's about them. It's about your patients and your prospective patients. Frankly, they don't much care about where you received your degrees, or about your website's flashy features. They're looking for help answering their health questions. They're looking for evidence of expertise and authority in their area of need. They're looking for evidence of a caring physician who will listen to them. They are looking for human connection.

So how, exactly, do you achieve these goals? May I humbly suggest five keys to online content that connects with patients?

1. Understand your patients. You can't deliver if you don't know what they want. How to know? Easy: Listen. Keep a small notebook in your pocket during clinic. Record frequently asked questions (FAQs). Keep a similar record of patient FAQs at the receptionist's desk. Have these patient FAQs collated weekly to determine important themes. Then you can create content that people are looking for.

2. Serve them. A great content brand passionately serves its community's needs. Your content must be interesting and informative, but most of all, helpful. Above all else, great content helps solve your community's health problems.

3. Be consistent. Provide online content with a consistent tone, and consistent delivery. All of your marketing materials should deliver the same vision, image, look, and feel — the same message — to your community. Keep to a schedule: If you produce a quarterly newsletter, don't produce it weekly for a while, then every six months for a while. Be consistent.

4. Demonstrate expertise. By delivering helpful and accurate content, your practice becomes an authority. Your community will see you as their go-to source for any information related to your specialty. They will return. And when they need to make an appointment, they will call your practice.

5. Provide unique, quality content. Maintain a high standard, and don't stoop to licensed articles from other sources. Those will appear on many websites and dilute your authority. Your site may even be penalized for "duplicate content" by search engines. Better to produce less quantity and greater quality.
more...
No comment yet.
Scoop.it!

4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch

4 Ways Your Practice Can Benefit from a Mix of Technology and Human Touch | EHR and Health IT Consulting | Scoop.it

One of the biggest misnomers about an EHR implementation is that it will replace many of the human elements of your practice. While the EHR can replace some of the tasks and processes that were done by humans, the reality is that EHR software is most powerful when paired with human touch. This concept is infused into our Ideal Medical Practice Workflowwhitepaper and should be infused into every clinical practice.

As we enter 2015, here’s a look at 4 more ways your practice can benefit from a mix of technology and human touch:

1. Rescheduling Patients
One of the biggest forms of lost revenue for a practice comes in not rescheduling patients who missed their appointment. While some of these missed appointments represent low quality patients, many missed appointments happen for a good reason and are an opportunity for more revenue for your practice. Unfortunately, most practices don’t consistently reach out to patients and reschedule their appointment. Along with providing additional revenue for your practice, this extra patient outreach is a great form of customer service that will be appreciated by many of your patients and shared with their friends. While some of the rescheduling can be done using technology like emails and text messages, nothing shows a patient you care about them more than a telephone call about a missed appointment.

2. Complete Eligibility Verification
I’ve written previously about the importance of complete eligibility verification and a quality eligibility verification team. While having the correct eligibility information is always important, I can’t stress how much more important eligibility verification is at the start of a new year. At the start of a new year, patients once again are working to meet their deductible and therefore have a higher patient pay amount. Plus, the new ACA insurance plans means many patients will start the new year off with a new insurance plan. If you don’t have a 100% consistent process for verifying a patient’s eligibility, then you’re office is likely working off of old information which will hamper your ability to collect the correct payment from the patient.

3. Referral Tracking
Not appropriately tracking referrals is a big issue in many practices that can easily be handled with a mix of technology and human follow up. Not tracking these referrals is a big clinical compliance issue for your practice that has the potential to lead to a lawsuit. Along with the potential legal liability, I believe having a dedicated team following up on these orders will become extremely important in the new world of value based reimbursement and ACOs. In this next generation of reimbursement, your payment will depend on your ability to ensure patient compliance with outside referrals.

4. Annual Well Visit Reminders
Annual Well visit reminders are another great way to increase high quality visits to your practice. Many practices convert a regular visit into an Annual Well visit. While this may seem convenient for the patient, it usually means you’re cutting the patient short in the care you could provide them. You just don’t have the time in a sick visit to do a thorough well visit exam as well. Even more important is reaching out to those patients you haven’t seen for a while. It’s incredibly valuable to have a dedicated person or team who identifies all of these patients and sends them a reminder or calls them about their annual well visit. Plus, these annual well visits are a great way to add to your bottom line.

As you look at each of these 4 ways to improve your practice, they all require the right mix of technology and human touch to be done properly. In a busy practice, that can often mean hiring more staff or outsourcing some of these processes to an outside company. Either way, the value created for your practice by implementing these small but important changes will easily offset any additional costs. Plus, you’ll have happier and healthier patients in the process.


more...
No comment yet.
Scoop.it!

Physicians Must Lead the Charge to Improve Patient Care | Physicians Practice

Physicians Must Lead the Charge to Improve Patient Care | Physicians Practice | EHR and Health IT Consulting | Scoop.it
Communication, coordination, and follow-up are highly prized entities in patient care. Indeed, without these entities, little can be accomplished, and the more complex the issues are, the more important these entities become.

Sadly, great communication, coordination, and follow up become less and less evident in patient care the more complicated the patient's care becomes. This is especially true when the case entails a high degree of social issues as well as health issues. It is clear to any experienced physician and case worker that the more complex the patient's condition is, the stronger the need becomes for optimal communication, coordination, and follow-up.

I maintain that ensuring optimal communication, coordination, and follow-up requires a system that motivates physicians and healthcare systems with positive incitements. There is an urgent need for clear and obvious mechanisms that create negative feedback loops every time communication, coordination, and follow-up care are inadequate, and that strongly encourage the opposite.

Until now, no practical guidelines have existed that define how to establish and maintain such motivation at the system level. Good practice guidelines exist for specific diagnosis groups, but even here, the motivations are most often less than clear.

This is by no means to belittle many good practices that see traction in specific communities, such as Patient-Centered Medical Home recognition criteria, but these are predicated rather by top down mandates from entities such as the National Committee for Quality Assurance and enthusiastic practitioners than by concerted and positive financial and motivational structures.

For these reasons, it falls on physicians to lead the charge to improved communication, care coordination, and follow-up care in their own practices. Here are a few small changes that I recommend that all physicians begin making:

1. Ensure that all nurses active in your practice and visiting nurses have cell phones. Having these numbers for ready access 24/7 can mean the difference between coordinated care and catastrophe for the patient.

2. Gather your ranks, and get a town hall meeting going where physicians proclaim their willingness and energy to make things improve for those in most need of optimal communication, coordination, and follow-up.

3. Bring in experts who can help define what is doable within the given financial framework to make primary prevention and health promotion front seat drivers instead of passengers on an evidence-based express train that no one knows where it is going.
more...
No comment yet.
Scoop.it!

Fixing What's Wrong with EHRs is Easier Done than Said | Physicians Practice

Fixing What's Wrong with EHRs is Easier Done than Said | Physicians Practice | EHR and Health IT Consulting | Scoop.it

The crises of immigration and drought cannot be solved, only mitigated or accommodated. The EHR crisis, on the other hand, has a solution.

Source: 
Physicians Practice

Immigration, drought, and EHR are all of great concern. We know people are concerned about immigration because of the daily news. The message is basically, "Solve the immigration crisis." In California, farmers are concerned about the drought as the "Solve the water crisis" billboards in the central valley attest.

It's obvious that physicians are concerned about EHRs. The concern is so great that the AMA convened an advisory committee and has spoken out. In September, they recommended overhauling (their word) the design of EHRs to improve usability and called on EHR vendors and the government, "To leverage the power of EHRs for enhancing patient care, improving productivity, and reducing administrative costs..." The AMA framework outlines a list of "usability priorities" — things they cannot specify precisely but are easily identified when you haven't got enough. The tip-off that these are "non-functional" requirements lie in the words of the AMA statement: enhance, support, promote, offer, reduce, promote, facilitate, and expedite. The first item on their list is, for example, "Enhance physicians' ability to provide high-quality patient care."

According to the AMA, "these priorities were developed with the support of an external advisory committee comprised of practicing physicians, as well as noted experts, researchers, and executives in the field of health information technology."

To me, their announcement essentially says no more than, "Somebody, please solve the EHR crisis." If this reformulation sounds critical, it is, and I'll explain why.

"Solve the ... crisis" statements do little to advance a solution; they merely express concern, dismay, and helplessness. They lack actionable suggestions for how to solve the crisis. They merely express the hope that someone who is smarter or more knowledgeable will be able to do what they cannot.

This is where the EHR crisis diverges. Immigration and drought are the result of forces beyond the control of policymakers, legislators, vendors, or individual organizations. They are truly complex problems. Immigration and drought cannot be solved, only mitigated or accommodated.

Turning to EHR, let's consider the AMA's priorities. What does it mean, for example, to "Enhance physicians' ability to provide high-quality patient care?" Is there a single enhancement that would work in every EHR? How do you enhance a computer system in a way that will result in predictably higher-quality care? The vendors already claim (or perhaps believe) that their systems are optimal, or at least adequate. Will they have any idea how to make their "practically perfect products" better? Similar questions can, and should, be asked about each of the AMA's eight challenges.

Taking a step back, several points are inescapable:

• The problems with EHR were smoldering for years, but only became a crisis when the federal mandate was imposed.

• The mandate effectively put a stop to the development of new EHRs since, in addition to implementing their new concept, they must replicate everything that is old to get certified or no one would buy them.

• Few comprehend the root causes of the EHR problems about which they complain. The few have an idea, either don't disseminate their knowledge, can't get it published because editors assume that ordinary physicians don't need to know that stuff, or the publications appear in obscure journals that no physician will ever discover. Thus, most physicians, probably including the committee members, have only vague notions of what it might mean for an EHR to be better. They can't have had much experience with one that is significantly better because if there were such a beast, people would be using it instead of complaining. Most notions of what would be better are based on daydreams, not evidence.

• The AMA's contention that EHR just needs a minor overhaul implies that they believe that today's EHRs are basically sound and well-designed. This assumption has no basis in fact. Just because EHRs are bought and used is not evidence that they are well designed, easy to use, or that they do what people expect.

Unlike drought and immigration, there is a solution to the EHR crisis.

It is to abandon mandates, abandon certification, and abandon penalties and incentives. Instead, efforts should be directed toward educating physicians about the information science behind medical records, be they paper or electronic.

The money that is currently being wasted on incentives and bureaucracy should be redirected to fund:

• Research that concentrates on basic science and is not tied to, or conducted using, an existing EHR; and
• Development of completely new EHRs that start with a blank slate and embrace design concepts that put the medical record, not data, at their core.



more...
No comment yet.