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Pediatrics in the Facebook generation, is your practice ready?

November 8, 2011 in Blog by support Team  |  Comments Off on Pediatrics in the Facebook generation, is your practice ready?

One of the benefits of Pediatrics is being surrounded by youths that adopt the latest technologies. Many of
Pediatric patients are very familiar with technology. Almost all teenagers cannot image not being connected to the Internet. They see the web as operating all the time to check Facebook, watch movies, play games, and interact with their school, teachers and friends.

Are their parents able to connect with your pediatric practice via web? The patient portal via the
physicianXpress system allows a practice to customize how a practice establishes and manages their web
interface. A practice can implement one, some or all of the options of the patient portal. These options
include:
-area to request for office to update demographics and insurance information
-request an appointment
-pay a patient statement
-provide patient education materials based on their conditions
-provide lab results
-select medical information such as vaccination list
Cloud based applications reduce costs and burden for Pediatric offices since the office does not need to
employ or contract an IT specialist to maintain appropriate security, back-up of data, system
performance. Does a pediatric practice care if the issue is the software or hardware? The old model of
the 1990s was client server. Over the last five years, inexpensive high speed Internet access as well as
wide spread use of smart phones (iPhone, android phones) provide multiple Internet sources for users.
Physicians can be free to complete their charts anywhere while being removed of the burden of managing
an IT infrastructure in the office.

Pediatricians can feel free today inline with their ‘Facebook’ generation patients by using a cloud-based Pediatric
specific EHR and practice management system.

Is “ObamaCare” good or bad for children and Pediatrics?

October 24, 2011 in Blog by support Team  |  1 Comments

There is much discussion related to “ObamaCare” especially with the debates heating up. Was this change in our healthcare system good or bad for your Pediatric practice? Like all changes, there are positive and negative aspects of the change.

Let’s take a look at some of the positive aspects:
*Reduce co pay cost for well checks. No co-pay provides an incentive for parents to seek the recommended Preventive appointments by a Pediatrician. Invest in the prevention of diseases or catching diseases early is great for the children of our country. Overall, Pediatricians are very focused and dedicated to preventative healthcare.
*Potential higher reimbursements for Medicaid. There is a significant gap in payments between Medicaid vs.
Medicare. The government pays for both of these programs- pediatricians need to make a living so many cap the number of Medicaid patients or do not accept Medicaid payments. With potential increase in Reimbursements in a few years, I would anticipate more Pediatricians accepting Medicaid. This could lead to less use of the ER and/or hospital by Medicaid patients. Theoretically, the healthcare system would save money since paying for outpatient visits is on average, much less cost burden than the hospital. This should also increase the revenue for Pediatric practices – alignment of incentives for patients to use the most cost effective treatment.
*Requirement for insurances to cover vaccines and preventative services. The lower the cost of
service to patients the more they will seek out preventative medicine. Preventing a condition is much
more cost effective than treating, in general.

Some of the negative aspects of the changes:
*More patients moving into some of the Health Insurance plans that do not raise their reimbursements to practices each year but increase the profitability of the insurance company significantly. The busy Pediatrician is trying to pay their bills, their staff, and make a reasonable income, are they able to monitor and appropriately manage the insurance carriers? Are the partners watching the reimbursement by carrier and identifying carriers that a contract negotiation or termination is needed? Some of the carriers are reasonable each year which others are unreasonable.
*The increase costs on businesses due to ‘children’ now being covered until they are 26 years old (many 18 year olds are working full time – should their parent’s employer receive the cost burden of their adult children?). This
increase cost to businesses may trigger lay offs to reduce cost or an employer to remove coverage. We
are considered adults at 18 years old….this means an 18 year old should be on their own plan, an employer’s plan or a plan purchased by a student at a college vs. a higher burden on an already fragile economy and over burden businesses.

As the debate heats up over the next year related to the healthcare system changes make sure to evaluate
the proposals from the perspective of what is the best approach to optimize pediatric patient management. Neither the emergency room nor a pharmacy is the right place to manage the optimal grow and maturity of the
children of our great nation. Primary care pediatrics is both cost effective and clinically effective.

Some links related to ObamaCare:
http://www.whitehouse.gov/healthreform

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Analysis of the EHR Complete ONC-ATCB Certified Health IT Product List

January 5, 2011 in Blog by support Team  |  Comments Off on Analysis of the EHR Complete ONC-ATCB Certified Health IT Product List

As of today there are >110 certified ONC-ATCB complete EHRs listed on the ONC Certified health it product list (http://onc-chpl.force.com/ehrcert). As a continuous student of Health IT (I have been in healthcare for over 20 years) I invested a few hours to briefly review every EHR system listed on the 2011\2012 ONC-ATCB complete certification list (as of 1/5/11). During this review I identified the website, phone number, city/state of each ONC-ATCB certified EHR as well as provided a few notes (e.g. EHR for a particular specialty of medicine). I applaud ONC for clarifying the standards for certification and providing one certified product list. About 20% of the certified products state on their product website claim that they are specialized to a particular specialty of medicine vs. a system for all specialties of medicine. Medicine is such a complicated field with wide variations on the function of each specialty. Currently, specialty EHR systems that achieved ONC-ATCB certification include:

  • Pediatrics (1 system – physicianXpress)
  • Ophthalmology/optometry (7 systems)
  • Urgent care (1 system)
  • Mental health (1 system),
  • Orthopedics (1 system)
  • Urology (2 systems)
  • Oncology (2 systems)
  • Podiatry (1 system)
  • OBGYN (1 system),
  • Radiology (1 system)
  • Emergency medicine (1 system)
  • Cardiology (2 systems)
  • College health (1 system)
  • Plastic surgery (1 system).

If you have an internal medicine or multiple-specialty group, there are over 80 systems that are generalist for all areas of Medicine.

Where does a provider start? If you practice in one particular field of medicine (e.g. Pediatrics), recommend first evaluating the ONC-ATCB certified EHR systems in that specialty. These vendors spend 100% of their time optimizing the system for your specialty as well as staying up to date on the changes in that specialty. If there are multiple vendors with E.H.R. products in that specialty, look at each system.

Some vendors have not stayed up to date on the new technology and are trying to update ‘dated’ technology to meet the functional requirements. Unlike consumer electronics where it is usually easy to evaluate if a vendor has been investing significant money and years of time on Research in new technology, it is more difficult in the field of Health IT. Some vendors spend the majority of their time, money and focus on optimizing the revenue stream from their legacy systems. Their sales team promotes how many systems they have installed (usually include all the ‘dated’ systems). If we compare this to the consumer electronic world, it would be like a company that sells the old picture tube television stating that there are more picture tube televisions installed in the market than flat screens (plasma, LCD) – although this sales tactic usually does not work in consumer electronics, Health IT vendors have had good success quoting the number of installs (no matter how dated the technology).

The business and medical rules in medicine change continuously. For this reason, a system used for revenue cycle management and EHR should be ‘fluid’ and update continuously. Systems built on ‘old’ client server technology are not ‘fluid’ due to the system design (updates need to be scheduled and can be disruptive). This is why each industry (including Healthcare) is heavily focused in cloud computing. Look at all the major software companies to see that cloud computing is their focus. If you are interested to receive a copy of the excel file that lists the certified products as well as the contact information and focus of EHR, feel free to e-mail me at Ken@physicianxpress.com.

Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

December 23, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Follow-up to December 2, 2010 Experience with Five Managed Care Organizations (Aetna, IBC, Highmark, Cigna, United Healthcare)

It has been about three weeks since I contacted the top five managed care organizations for a customer of ours. The purpose of my initial call was to obtain their current agreement and fee schedule for their top five payers. I started as if I had no experience or contacts in the field to see how long it would take to obtain the proper information. Here is the update by managed care plan:

  1. Aetna: The Physician Network Account Manager on 12/2/10 stated that I would receive the information via e-mail within 3 business days. I called at the end of the third business day to check on the status. She did not call me back until I called again and sent and an e-mail to her as a follow-up (10 business days after our original call). After some further back and forth via e-mail (few hours), I was able to obtain a copy of the agreement as well as fee schedule.
  2. IBC: Independent Blue Cross (IBC) – the office had to request the information, sign a document, follow-up with the representative. IBC provided the agreement and fee schedule by 12/17/10.
  3. Highmark: The most disappointing of the five carriers. After a few phone calls and e-mails the network representative provided a general mailbox (estprovcred@highmark.com) for contract and fee schedule requests. She stated would only take 1-2 business days. I followed up after 10 business days and still have no response or information. The Network Representative is out of the office from 12/23/10 until 1/3/11 due to the holidays. I left a message and will need to follow-up again in a few weeks.
  4. Cigna: The representatives (888-992-4462) stated there is no provider representative and could only provide a fax for this information. Cigna would not expect a Pediatric Office to not provide the name of their doctors or not to provide the location of their doctors when they need help, why do they avoid their providers when requesting simple information related to contracting? The woman on the phone stated that we need to send an urgent fax (866-463-6175) and that there might be a provider representative that would call us back. We sent the fax, as instructed, 10 business days ago, no one called as of yet. Today, at the main number, they instructed me to send another fax to the same number.
  5. United Healthcare: The Network Manager (obtained proper information by calling 877-842-3210) was good at providing the fee schedule and initial follow-up. He was available we I called or followed-up within a few days. There were a few additional codes missing from the fee schedule for which I requested the information and he was able to obtain after a telephone call.

The commitment to follow-up on contractual items is very inconsistent with the Health Plans (even if the representative states they will follow-up). Due to this, the burden of follow-up is on the provider’s office or the company that works for the provider’s office.

Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

December 10, 2010 in Blog, Uncategorized by support Team  |  Comments Off on Electronic Health Record (E.H.R.) Incentive Programs for Pediatricians

The HITECH Act has an Electronic Health Record (EHR) incentive program paid via either Medicare or Medicaid. Since Pediatricians do not have Medicare Patients, their opportunity to participate is via the EHR incentive program provided by the Medicaid program. The Medicaid program starts as early as 2011 and eligible providers in a Pediatric Group (MD, DO, NP) can each receive up to $63,750 over a six year period. Unlike Medicare, eligible professionals have until 2016 to implement a certified E.H.R. system and still qualify for the maximum incentive. The HITECH act has recommendations to the state of the threshold for this incentive money. A provider must have at least 20% of their total patient volume be via Medicaid/Managed Medicaid/Children Health Insurance Program (CHIP) Patients during a 90-day measurement period. If a provider has 20% Medicaid volume during a 90-day period, they are eligible for up to $42,500 over a six-year period. If a provider has over 30% volume during a 90-day measurement period, they are eligible for up to $63,750 over a six-year period. Note that the “up to” is dependent on maintaining these thresholds each year as well as implementing a certified EHR system to show meaningful use. The table below provides a summary by year.

Medicaid Eligible Professional (20% – 30% Medicaid/Managed Medicaid/CHIP vol.)

Medicaid Volume

Year

20%-30%

>30%

1

$14,165

$21,250

2

$ 5,667

$ 8,500

3

$ 5,667

$ 8,500

4

$ 5,667

$ 8,500

5

$ 5,667

$ 8,500

6

$ 5,667

$ 8,500

Total

$42,500

$63,750

Medicaid, different than Medicare, is administered by the state. The state Medicaid programs are required to verify the eligibility of the provider as well as disperse the payments. Per the CMS.gov website: “The Medicaid EHR Incentive Program is voluntarily offered by individual states and territories and may begin as early as 2011, depending on the state.”

The question and answer section on the CMS website related to the Medicaid EHR program I found to be a useful resource (22 pages). One of the questions is if the State Medicaid program needs to verify the “installation” or “signed contract” of a certified EHR . The answer on the CMS website concludes that: “Thus, a signed contract indicating that the provider has adopted or upgraded would be sufficient.”

There are details to verify and implement to insure eligibility and then receive disperse these funds. I recommend that each office invest some time learning about the HITECH act. Also, having a knowledgeable EHR vendor and/or consultant should greatly reduce the detail knowledge needed within each office.

http://www.cms.gov/EHRIncentivePrograms/

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