EHR

Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

April 13, 2012 in Blog by support Team  |  Comments Off on Continuity of Care in Pediatric Practices & the Link to Cloud-Based E.H.R. Systems

While at the pharmacy waiting for prescription Medication, I experienced the gap in knowledge by the average patient. One patient requested a medication to treat his wife’s pink eye from the pharmacist. When she explained that his wife will need an antibiotic he asked if he could use the antibiotic he was using to treat his ears. She explained to him that his wife needed a health care provider to exam her then based on the diagnosis, prescribe the appropriate medication for her red eyes. The husband was not coordinating care with his wife’s primary care physician.

Many in the health care system are missing the big picture when they do not call their primary care physician. In pediatrics, the outcome of the patient can be improved via strong continuity of care. If a patient is atopic and calls the office about a reaction to a medication, the pediatrician can use this information to appropriately manage the patient as well as record the incidence in the patient’s history. From the patient’s point of view, strong coordination with their pediatric office could reduce their burden and costs associated with using the Emergency Room. The pediatrician receives calls after office hours. The information available to the pediatrician should be able to be accessed easily at any time. Cloud-based Pediatric E.H.R. systems provide the best option for easy access to patient information on multiple devices in multiple locations…smart phones, IPads, lap tops, home computers. Who wants the burden of ‘dial in’ to the office server as well as maintaining constant security of the server?

As coordination of care continues to evolve as well as the option in wireless devices, Pediatricians can continue to reduce admin burden, costs and improve continuity of care with cloud-based E.H.R. Systems.

Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

March 30, 2012 in Blog by support Team  |  Comments Off on Minimizing Technology Burden in a Pediatric Practice Using the new IPAD

Most Pediatricians want to focus on treating their patients and not all the technology burden associated with Electronic Health Records. A Pediatric Health Record system should align with the technology in today’s market. The ‘old’ days of Television sets were large furniture or appliance size devices with low quality screens. Today every person seems to own multiple flat screen TVs in the House. The computer field evolved from a difficult to use device that had a mono chrome (usually green) screen to a wireless tablet that you can check your e-mail and banking while sitting on the couch. Less weight, less technology burden for the owner, less space with more features. The new IPAD (“IPAD 3”) has some features that a small Pediatric Practice could use to reduce their technology burden.

If you purchase the 4G model of the IPAD (about $640 with a $15-$30 4G cost), you can use the IPAD as a 4G Hot Spot. This means that the IPAD appears like a “WIFI” to the other lap tops/tablets in the practice. A small Pediatric practice could have a Desktop, the IPAD with 4G and a previous IPAD or another tablet computer to see patients all day (assuming all your systems are on the cloud). The practice could either use the existing internet connection or the 4G connection provided by the IPAD. Additionally, the physician on call can review charts on the IPAD (vs. using a smart phone) no matter where they are located. What would be the cost of this set-up? Two new IPADs, Desk Top computer and wireless router….less than $1500 brand new. Let’s say you also purchase a ‘good’ copier/scanner/fax machine…another $500. What is the maintenance? No back-ups, no IT people needed, no hassles…..this technology is now here today so that you can reduce the cost and hassle to your practice using the latest technology. Think of the freedom that you will achieve by moving to this model as well as improved operation by using a Pediatric Specific Cloud E.H.R. system.

There is plenty of supply of IPADs available at stores like Best Buy. Speaking of Best Buy, their leaders understand the importance of reducing overhead and space. They understand that due to the changes in technology, cloud systems and the high utilization of smart phones that there is not a need for a large store (the management of Best Buy announced recently that they will reduce the number of large stores and lay off 400+ individuals). Using the ‘right’ technology should lead many Pediatric Offices to evaluate the appropriate space for their practice. No need for the practice to have a file room, a server room (think of a server similar to that old box TV), extra break rooms, large storage. With the right system and devices, Pediatric Practices can be optimized to eliminate the burden of these extra spaces. Additionally, the practice can improve the scheduling so that the focus of the practice is the Exam rooms, Front Desk and small lab/nurse prep area. I recommend you consider leveraging the IPAD in your Pediatric Practice to see if you can remove the administrative and IT burden.

The Impact of Proper Coding to a Pediatric Practice

March 9, 2012 in Billing and Collections by support Team  |  Comments Off on The Impact of Proper Coding to a Pediatric Practice

The revenue cycle depends on teamwork between the front desk, providers, Medical Assistants, Nurses as well as the back-end billing team. Coding of the visit is dependent on the reason for the visit, complexity and time. Each provider should invest at least 2-3 minutes per visit to insure they are capturing the proper codes. A well-designed Pediatric Electronic Health Record and Practice Management system should help link the front end to the providers to the back-end office team. The providers are busy managing patients each day and usually do not have much free time and in many cases do not choose to invest in taking quarterly courses related to the Pediatric Revenue Cycle.

The practice could consider hiring a Practice Manager that completes at least quarterly training on the revenue cycle and have this person educate the providers and office as needed. The challenge with this is that the providers/partners need to achieve a certain level of understanding of the revenue cycle to insure they have an “A” rated Office Manager. An average office manager on the revenue cycle cost the practice twice – once in their salary/benefits while a second time with inappropriate/under coding. I call this the “hidden” lost revenue – a physician partner does not know what is missing until they work with a high caliber team that corrects their issue. Leveraging a company that spends all day only on Medical Billing for Pediatrics can increase the overall profitability of the practice while reducing the workload. Additionally, the office manager can focus efforts on the front end of the revenue cycle as well as Marketing to optimize the growth of the practice.
We have some clients that were missing up to 18% of revenue prior to us optimizing their revenue cycle – imagine an 18% change in your income with less administrative work. Usually, from the perspective of a Pediatrician, managing the revenue cycle for a Pediatric Practice does not excite them. There are a few Pediatricians that are on top of every claim and patient statement. This level of detail is usually redundant work and not needed (why spend all your free time looking at every claim if the audit report as well as your own audit functions shows above a 99.5% collection rate?).

We have competitions each month to see which biller can achieve the highest collection rate, who can improve patient collections the most as well as achieve the best AR days. What concerns me is that the Medical Group association benchmark data shows that the average office collects 95% of their contract amount and 70% of offices have theft at the front desk. This is easy found money with the right systems and billing team that know how to optimize the Pediatric Revenue Cycle.

Importance of Appropriate Documentation of Different Sick and Well Visits in a Pediatric Office

February 10, 2012 in EHR Selection by support Team  |  Comments Off on Importance of Appropriate Documentation of Different Sick and Well Visits in a Pediatric Office

Remember during Pediatric Residency when you had more time to document Visits in the clinic? As a Pediatrician in training, you were probably not seeing 25+ patients per day. This slower pace and multiple residents in the clinic allowed time to write and write and write (usually there were paper charts in previous residency programs). Once in clinical practice, many Pediatricians were only able to document a sentence or some key words for the visit due to the time pressures of Practicing Primary care Pediatrics. Although, in most cases, the Pediatrician had a total well visit, the clinical paper chart did not completely reflect what was done during the visit. This level of charting is not optimal for continuity of care as well as documentation related to coding and billing.

A visit at a Pediatric office has a much different look and feel than the visit at a plastic surgeons’ office. When an Electronic Health Record system is designed for all specialties, the system usually misses many of the day-to-day details of a particular specialty (if you are in a Multi-specialty group, you might not have a choice). Even if a general E.H.R. system maintains all the content of a One Physician Specialty, the E.H.R. system has many extra windows/screens/options due to being designed for every specialty. A ‘universal’ design usually causes hours of extra charting time and in many cases misses pertinent information found in a single specialty Electronic Health Record system.

Clinical Templates provide a list of options for a visit (e.g. Asthma Template) that can also serve as reminders of options for treatment. Template design is also important for ease of documentation. A template that looks like MS Excel with boxes and many pop-ups is generally much more different to see, use and document than a template with appropriate ‘white space’ that looks more like paper. Differences in design also might provide an indicator of how up-to-date the vendor is on their User Interface.

Here are some areas that all Pediatric-Specific E.H.R. systems should contain:
• Layout and design of system based on today’s Pediatric office. This means easy to use and see screens, different views of the system depending on role of individual in the practice (Front Desk, Medical Assistant, Nurse, Practice Administration, Billing, Physician, other Providers).
• Templates based on content similar to either bright futures or Denver development.
• Growth charts based on today’s recommended standard per the AAP/CDC.
• Listing by family, linking siblings, ability to copy medical and social history from siblings
• Communication tools such as e-mail reminders, voice message reminders and announcements.
• Patient Portal.
• Link of Back-end Medical Billing to Front Desk team to communicate/flag charts that have a balance to be collected on next visit.
• Ability to link to Vaccine Exchanges, Quest, Lab Corp and Health Exchanges.
Some other questions to consider: Was and does the system continue to be developed via a Pediatric Office? Is this office similar to your office in operations (for instance, do they accept Medical Assistance and have integration with Vaccine for Children)?

10 Ways to Improve the Bottom Line of Your Pediatric Practice

January 3, 2012 in Blog by support Team  |  Comments Off on 10 Ways to Improve the Bottom Line of Your Pediatric Practice

Managing a Pediatric Medical Practice is full of opportunities and challenges today. In the ‘old’ days managed care plans had minimal influence on the bottom line of your practice, Malpractice rates we’re relatively inexpensive and patients were flexible to meet 9-5 office hours. Today, much has changed in society as well as in managing a Pediatric Medical Practice. Other ‘conservative’ services such as banking have changed drastically in the last 15 years. Look how easy it is to gain access to your bank/bank account today versus 15 years ago. You can be successful in Pediatric Medicine today by understanding how to meet the needs of Patients and Managed Care Plans. Patients want good access to a good Pediatrician while Managed Care Plans know that seeing a Pediatrician is more economical then using the ER or Urgent Care Centers. Also, many Pediatricians act like a Medical Home that provides continuity of Care. Managing a pediatric practice needs to be done in an objective manner by providing goals while measuring and monitoring success toward these goals. Here are 10 suggestions to improve the bottom line of a Pediatric Practice:

1. Optimize New Patient Additions: how many patients are in your Pediatric Practice? What are the ages of these patients? What is the average # of New Patients joining your practice per month? How do your hours, location(s), facilities, and staff compared to other choices for Parents? The more practices in the same location, the stronger the value proposition needed for your practice to be successful. Patients choose a Pediatrician to obtain good advice and treatment. They need to feel heard, have their questions managed and feel that your practice provides the best options. If a provider is not meeting these needs, the practice manager/physician Partner needs to discuss the importance of service. Suggested reading, although in the Hospital Segment, includes “If Disney Ran You Hospital, 9 ½ things you would do differently”. http://www.amazon.com/Disney-Ran-Your-Hospital-Differently/dp/0974386014

2. Provide and Measure Quality Care/Patient Satisfaction: Quality Care is important in any Pediatric Practice. How do you measure “Quality” in your practice? You should be able to set up reports in your E.H.R. system to measure HEDIS measures such as the % of patients that were vaccinated per a pre-determined vaccine schedule. The patient and parent have an opinion of the care in your Pediatric Practice. If you provide them an option on each visit to provide feedback either via a ‘Feedback Box’ or an online link, you have a great opportunity to see trends in the perception of the care provided by your practice. If the patient survey is created and implemented correctly, you will also be able to use the tool to view feedback per provider. This can be used as a tool to constantly improve care and/or the perception of care. To receive continuous improvement in your practice, you need the feedback and the providers need to choose to change based on the feedback.

3. Leverage the “Right” Technology: Patients and parents are use to convenience via their smart phones and home computers (look at the dramatic increase in on-line sales in 2011 versus 2010 as an indicator). Does your Electronic Health Record System have the ability for parents to schedule appointments, view select information through a patient portal (determined by the Pediatrician), and pay bills on-line? If you are not sure, ask your E.H.R. vendor what options they have the cost for the options. Also inquire if you and the providers on call can view all your patient records via a smart phone. The system used on a smart phone should be configured for a smart phone.

4. Managed the Fee Schedule: I am surprised at the number of practices that have established their fee schedule significantly below appropriate levels established by consultants in the field of Medical Practice Management as well as recommended levels provided in practice management courses through the Medical Group Management Association (MGMA). Generally, the billed rate per CPT code should be 2-3x the Medicare reimbursed amount for that code. The practice needs a consistent and well thought out fee schedule that is reviewed at least 1x per year. If you are unsure how to establish appropriate fees, contract with an organization that manages Pediatric Offices or does consulting for Pediatric Offices. This is not a task for companies that primarily sell software and have services as an afterthought. If you want to learn on your own, recommend attend courses provided by MGMA.

5. Review Contract Rates with Plans: The fee schedule is one component, what the actual contract rate with each insurance company is an important component to improve the bottom line of your pediatric practice. The fee schedule should be re-visited each year. Look at the difference between your fee schedule and the contract rate for each of the top 8-10 plans. There will be a few plans that will try to not give an increase in their rates. There were two plans I worked with for a Pediatric Practice that try to sell in ‘no increase’ from the previous year while the plans increased their profitability by 15-20% year versus year and the CEO’s of the plans made millions in salary and bonus. Remember, that Pediatricians are usually the lowest paid specialty in Primary Care and Pediatricians help the managed care plans reduce ER visits, Urgent Care centers as well as inappropriate use of the health care system. No increase in a fee schedule is a decrease in your salary since the costs associated with Rent, Employees, taxes, insurances, supplies and vaccines increase each year. You might need to cap or discharge a particular ‘poor’ performing insurance from the practice. Many of the patients from a particular plan will stay with your practice. Obtain good advice and use appropriate consultants that understand contracting.

6. Evaluate Payer Mix: What is the payer mix of your practice? Some practices have minimal patients that utilize Medicaid and/or Managed Medicaid Insurance while other Pediatric Practices are >75% Medicaid. Understanding the geography and plan mix will help you make informed decisions. You should become with some of the reimbursement and desires of the plans that comprise greater than 80% of the revenue for your practice. Analyze the capitation rate per patient per month for each of the insurance companies as well as the facility usage rate for the average capitated patient. Does your practice management system track the monthly capitation payments? What % of your monthly revenue is from the capitation checks? If you added a new provider or have a new practice, you should be more flexible on the insurances that you accept as well as the ‘cut off’ for contract rate. If you are unsure how to evaluate the payer mix, seek advice from your billing team (if you use a vendor that specializes in Pediatric Billing) or a Pediatric Practice Consultant. Recommend evaluating the payer mix at least 1x per year to determine what changes are needed.

7. Monitor Collection Rate: Net collection rate is the % collected versus the contract amount. For example, if your fee schedule for 99214 is $145 and the contract amount for the fee schedule is $100, a 99% Net collection rate means that $99 was collected of the $100 contract amount. The contract amount could be broken into three areas: co-pay collected at front desk, amount paid by insurance and amount due by patient. Let’s do an example with the $100 for a 99214 (assuming this was the only code for the visit). Let’s say the patient had a $20 co-pay and $50 paid by the Insurance per the Explanation of Benefits and another $30 due by the patient. The back-end billing team needs to bill the patient for the remaining $30. MGMA benchmarks show that the average collection rate for charges >120 days aged is approximately 95%. MGMA establishes a goal of 97% of Net collections. What is the Net Collection rate for your practice? Do you monitor this monthly? Do not settle until the collection rate is above 99%….when contracting a vendor; ask for their range in collection rates for the Pediatric Practices that they manage. When you use your own internal billing team, make sure and monitor multiple patients per week to insure that billing and write offs are appropriate per the protocols of the practice. Any person can upload charges to a clearing house, but not all practices have systems that manage the entire Pediatric Revenue cycle. An average collection rate can cost a practice thousands of dollars in lost revenue.

8. Monitor AR Days: Accounts Receivable days or AR days is a simple formula of taking the total $ in Accounts Receivable and dividing this by the averaged $ generated per day. Again, benchmarks are important to monitor on a monthly basis. The MGMA averages are between 42 and 50 with

9. Evaluate Front Desk & Providers: Both the Front Desk team as well as the providers in a Pediatric Office have a significant impact on the Revenue Cycle. The front desk team needs to verify the insurance, scan the insurance card, and collect the co-pay as well as any outstanding balance on a patient account. The Pediatric E.H.R./Practice Management system should have a system for the Practice Administrators/Physician Partners to monitor/audit the collection of co-pays. Note that some resources report that approximately 70% of practices have theft at the front desk. If you have a strong audit system that verifies the amount each day (like a bank teller) you can avoid revenue being taken from your practice. The providers have a responsibility in the revenue cycle to make sure they capture the work/advice they provided to the practice. Strong Pediatric Practice management systems should be able to simplify the choices so the providers just select from one of the most common Diagnosis codes and CPT codes.

10. Review E&M Coding: The “bell” shaped curve is the ‘ideal’ for Pediatric Practices. Some high quality based might have a curve that has slightly to the right. Some practices either under or over code. This either reduces the appropriate level of revenue for the practice or places the practice at an audit risk for which they could owe revenue back to the insurance company. The E&M coding should be reviewed by provider and practice at least 1x/quarter. If there is a provider that is ‘under’ or ‘over’ coding, consider enrolling in an on-line course provided by either MGMA or the American Academy of Pediatrics.By implementing these 10 suggestions early in 2012, your Pediatric Practice can benefit from appropriate changes for the entire year. A well-managed Pediatric practice leads to happy providers, staff members, and patients.