Monthly Archives: December 2011

2012 Pediatric Practice “To-Do List” or Establishing Goals

December 22, 2011 in Billing and Collections by support Team  |  2 Comments

As we head to the end of 2011, it is a good time for administrators of Pediatric Practices to establish goals for the practice. To establish appropriate goals, the practice needs to take some inventory on how they are doing in different areas of Pediatric Practice Management. Some of these areas include:

• Practice Growth: What is the average growth rate in new patients to the practice per month in 2011 vs. 2012? How can the practice increase the growth rate? Does the practice have appropriate staffing to manage the growth rate of the practice? What are the total patient visits in 2011 vs. 2010 and % change? Was there a change in average revenue per patient visit? What marketing channels should the practice invest that provide the best return on investment? Which marketing channels in the past has yielded the best return?

• Patient Satisfaction: Does the practice have a formal or informal feedback system related to patient satisfaction? If the system is informal, it is important to establish a formal patient feedback system that can help the practice identify areas to improve. If the system is already formal, in what areas has the practice increased their patient satisfaction versus last year? What areas has the practice decreased patient satisfaction? Some areas to consider are front desk interaction, Medical Assistant/Nurse Interaction, Physician/Provider interaction, website, tools and treatments. Evaluate the patient satisfaction scores by provider. There can be good feedback to provide a specific provider on how to improve their impact with patients.

• Provider Satisfaction: Which providers are most satisfied with treating patients? What are their drivers to obtain optimal performance? Which providers are least satisfied with treating patients? What are the reasons for their level of satisfaction (e.g. patient interaction, challenging patients, call schedule, disconnect between their expectations of position and actual position)?

• Billing & Revenue Cycle Management Operations: What is the collection rate for the practice? Is this above or below the Medical Group Management Association (MGMA) benchmarks? What systems can the practice implement to further improve the collection rate in 2012? What is the cost of paying the Billing Company or Billing Staff (remember with own staff to include cost of facility space, postage, taxes, management time for billers)? Is this cost above or below the MGMA Benchmarks?

• Update Practice Charges: This is a good time to review all the CPT codes on the super bill and make updates in the billed rate as well as cash rate. Also, include a plan that requires a review of the insurance contracts and reimbursement rates for the top 4-6 carriers. The insurance company, in general, will pay a reimbursement rate that is the lowest of the Billed amount or the contract amount with the insurance company. There are practices that have not updated their billed rate whom send bills to the insurance company that is below their contract rate. A strong billing team will be able to manage this appropriately and proactively. Physician partners should verify this each year by obtaining a list of the CPT codes, the current billed rate for the practice.

• Cost Structure: Review the primary cost items to the practice. How can the practice appropriate reduce overhead expenses while still providing high-quality care? Some areas to review include: leases for facilities, general and Malpractice insurance, telephone charges, supplies, vaccines, general office equipment. Health plans are just beginning to understand that higher overhead does not mean higher quality care. In fact, there is an acticle in the Boston Globe on December 20,2011 titled “Insurer to Reward Patients for Finding Cheaper Care” – Harvard Pilgrim plan seeks to reduce costs.
http://bostonglobe.com/business/2011/12/20/insurer-reward-patients-for-finding-cheaper-care/a6ajBBBu2hpHZ1IyiRPmLP/story.html
The article provides some background on what is occurring in the state of Mass: “Two reports from Attorney General Martha Coakley over the past two years have documented disparities in what hospitals and doctors are paid by insurers for the same services.” If this is just the ‘start’ then there could be a major change in payments which would benefit high quality Pediatric Groups with lower overhead (regardless of size).

Being proactive on the 2012 goals for the Pediatric Practice early in January of 2012 should help the practice optimize the benefits of these results.

Reliability and Redundancy of Electronic Health Record (EHR, EMR) IT Systems

December 16, 2011 in EHR Selection by support Team  |  Comments Off on Reliability and Redundancy of Electronic Health Record (EHR, EMR) IT Systems

I am sure that most practices do not spend time thinking about redundant systems to manage and maintain their EMR, EHR, and Practice Management System. We had a major slow down earlier this week when we needed to move all practices to the back-up systems. This made me think of what does a physician office do if their server is down? Do they lose production for a ½ day, a day, two days, or a week? Does an office have a back-up plan if the systems are down? What is the disaster recovery plan? Good cloud-based companies have thought through these issues to maintain your data. When there is a system outage, how a team reacts, learns and improves their systems is important for minimizing the down time for practices.

One of our practices placed the outage disaster recover into perspective for me. Prior to switching to PhysicianXpress, this large practice had a server in their office for the practice management system. A practice in the same building complex moved to a server-based EMR System a few years ago. This year, there was a major lightning storm that ‘fried’ the router of the practice we served and ‘fried’ the server of the practice that was on a server-based practice. Our client needed to install a new router and they were back up and running with no loss of data. The other practice was not so lucky. A server in the office can deliver faster speeds; the down side is that the practice needs a qualified team of IT personnel either on staff or on call to insure back-ups are occurring multiple times per day. Even in this case, not many practices have redundant systems (2+ servers hosted in different locations to minimize chance of loss in a disaster like a building fire).
No system is available 100% of the time. An up time average of 99.95% means that there are >4 hours a year that the system is down. We evaluate system components and design to identify areas to increase system up time as well as verification of data back-up systems. We are in the pursuit of the perfect system design and operation – this requires continuous improvement reviews and changes. When evaluating a system, there are some good questions to ask including: how many locations and how often is the data backed up for my practice? Who is responsible for the back-up? What has your company done in the last 12-24 months to improve the back-up and recovery? If using a cloud based system, can I maintain a daily copy of our records and schedule on a local computer for read-only access?

There are a number of reports related to the reliability of the data in Electronic Health Record Systems. In fact, there are even international publications looking at the actual reliability of the data in the system (see http://www.scielo.cl/pdf/jtaer/v4n2/art06.pdf
By Alhaqbani, Josang, and Fidge). This component shows that there are data errors by other systems or users of the system. In the United States, some insurance companies calculate the HEDIS scores of practices (e.g. evaluating the vaccines given to a select number of patients versus an established recommended vaccine schedule). Their systems miss data routinely (e.g. they capture the vaccines given in the office but not the vaccines given in the Hospital or other locations). This is another area of Medical Reliability compared to the reliability of the hardware or software.

Why Pediatric Patients should not obtain Routine Medical Care at Pharmacy Clinics like The Minute Clinic (CVS), Take Care Health (Walgreens), and other walk-in clinics.

December 9, 2011 in Blog by support Team  |  Comments Off on Why Pediatric Patients should not obtain Routine Medical Care at Pharmacy Clinics like The Minute Clinic (CVS), Take Care Health (Walgreens), and other walk-in clinics.

There has been an evolution of the services provided in Pharmacies over the past few decades. Pharmacies started as a local pharmacist that spent time teaching their clients, families and providing extra counseling care. Pharmacies also had some over the counter (OTC) medications available for patients. The pharmacy evolved into a “mini-grocery store” driven by high volumes of Prescriptions. Counseling at the Pharmacy changed today to providing more patient handouts to a point that most patients pick up their medications without speaking to a pharmacist. No physician would ever sell or consider selling tobacco products at or close to a Medical Facility. Pharmacies sell tobacco products including cigarettes. How can a pharmacy try to be a medical facility and/or treat patients? Here are some conflicts that Walk-in clinics found in Pharmacies have with good Pediatric Care:
1. Obtaining care at a walk-in clinic disrupts the continuity of care provided in the Pediatric Medical Home. Solid Pediatric Management principles minimize the chance that Patients over use Emergency Rooms, Medications (such as anti-biotics) as well received duplicate care.
2. The Pediatrician insures that the patient is up to date on their vaccines and does not receive duplicate vaccinations. Some continuity of care issues can occur with walk-in clinics including: the clinic providing an additional vaccine that the patient received on their last visit to the Pediatrician, disruptions in flow of information – the walk in clinic forgets to identify the primary care practice or the patient does not provide this information so the information is not in the medical record.
3. The Nurse Practitioner (NP) usually has a broad knowledge but limited knowledge in Pediatrics. The NP might not have the skill to identify a significant health issue that appears during an encounter in the pharmacy. She/he does have training and oversight by a Pediatrician in a Pediatric office. They might be performing this work as weekend work.
4. The walk in clinic does not know the history of the patient to provide optimal treatments. For instance, the NP at the clinic would not be aware of the number of visits to an Allergist for a patient’s asthma and if a patient has the tendency to move from mild coughing to severe asthma. The NP might in this case only provide a beta agonist and cough syrup vs. an anti-inflammatory Medication.
5. The Walk-in clinic might over prescribe certain Medications (like antibiotics) which are not necessarily in the best interest of the patient (good for a pharmacy though).
When a patient is on vacation outside of their home town is probably an appropriate example of when a patient might need to leverage a walk-in clinic. If a walk-in clinic is a health care facility, then they should accept all insurances including Medical Assistance as well as not be located in a pharmacy that sells tobacco products. As large institutions test and try to make money with walk in clinics, it is unclear on the future these pharmacy clinics have in the health care system.