pediatrics

Meaningful Use Requirements for Your Pediatric Practice

February 24, 2012 in EHR Selection by support Team  |  Comments Off on Meaningful Use Requirements for Your Pediatric Practice

The last few weeks there has been much discussion about the stage 2 meaningful use due to a recent press release from CMS: “The Proposed Rule for Stage 2 Meaningful Use has been Posted to the Federal Register; CMS Fact Sheet Provides Overview.” A Pediatric practice that is eligible for the incentive payments first needs to adopt a certified E.H.R. system (ONC-ATCB Certification). Then the practice starts with stage 1 meaningful use parameters. How difficult will stage 1 Meaningful Use be for your Pediatric Practice?

The answer to this question depends on how close the E.H.R. vendor was able to align the Meaningful Use requirements to the design of their system. If the system is multi-specialty or a ‘dated’ E.H.R. system or just a poor design, the disruption to meet meaningful use might be so great that the practice should either not pursue the additional incentive money or switch to an E.H.R. System that is less disruptive. Let’s look at the parameters for Stage 1 Meaningful Use. The parameters for meaningful use stage 1 include:
• Problem List
• Active Medications
• Active Medication Allergies
• Demographics
• Patient-specific Resources
• Information Updates
• Medication CPOE
• Permissible Prescriptions
• Vital Signs
• Smoking Status
• Labs
• Electronic Copy
• Clinical Summaries
• Appointment Reminders
• Transfer Medications
• Referral/Transfer Records

How does a practice meet or exceed the benchmarks? Some suggestions include leveraging the dashboard to monitor where the practice is exceeding the benchmarks and where there are gaps. During a demo of a Pediatric E.H.R. system, request the vendor to review the meaningful use dashboard/report. This should be a simple to use tool that color codes the results (green, yellow, red) so a reviewer can quickly see the strengths and areas to correct. The report should be able to be used by Identifying where in your workflow there are gaps. For example, maybe the practice is not capturing some of the key demographics such as race, ethnic group, smoking status while the patient checks in to the office. This is very easy to correct. Many of the benchmarks are fairly easy to meet as long as the system is connected and the providers are using the connections such as sending electronic prescriptions, sending/receiving laboratory orders/results to Lab Corp or Quest, sending data to the state immunization registry. Your Pediatric E.H.R. vendor should be able to provide some quick tips to your practice that will make it relatively simple to meet the meaningful use goals.

Simplification of Pediatric Medical Office Operations

February 17, 2012 in Billing and Collections, EHR Selection by support Team  |  Comments Off on Simplification of Pediatric Medical Office Operations

There are many vendors and sales people that want to sell you extra ‘stuff’ for your Pediatric office. Does the product you are being sold simplify your operations, management time and increase revenue or increase your overall burden and cost? This is a basic question that every decision maker of a Pediatric Practice needs to make. The goal should be able to see 30-40 patients per day without hours of work on charts, processes, computer systems, servers, and people. Keeping this simple approach can be done with a few basic questions: what is the time I spend on charting? What is the collection rate of my practice? Does my billing team obtain continuous training on Pediatric Medical Billing? What is my audit system? Is my electronic Health Record system only designed for Pediatrics? Are we collecting above the Medical Group Management Association(MGMA) Benchmarks? Does my system require me to be the manager of Servers, IT Protocols, data back-ups as well as management of vendors whom manage these items?

Your Pediatric Billing Vendor (or internal team) should be able to provide a simple monthly report that answers the billing and claim follow-up. This report should also provide trends of billing and collections by provider in the group as well as a list of summary of claims by Insurance Company.
A practice management and E.H.R. system should be designed to first optimize your Pediatric Office as well as for the clinical workflow of Pediatrics. Our clinical system is designed and developed by Pediatricians only for Pediatrics by first optimizing the payment systems so that the offices we manage achieve >99% collection rate (significantly above the MGMA benchmarks). Not all vendors are meeting these standards. Many products are very difficult to use that requires so much training and change in workflow design. The system should not ‘feel like working in Microsoft Excel’. If so, maybe the vendor is out of date.

Some vendors hold their clients ‘hostage ‘ to their own data. All vendors should provide the practice data in a usable format if they decide to switch. There are many vendors, both large and small, that make it very difficult for practices to pull their data out of the system (this includes Client-Server software vendors that lock the data into their application….all because the server is in your office does not mean that you are protected for a hostile tactic of a vendor). If a system is simple, increases revenue, decreases hassle then a vendor does not need to move to these tactics.

Continuous improvement should be the norm in the industry. Pediatricians work very hard. If the existing system in your office is complicated and/or date, look at other options. If your collection rate is below 99%, look for a vendor whom specializes in Pediatric Medical Billing.

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)?

The importance of appropriately managing expenses in a Pediatric Medical Practice

February 3, 2012 in Blog by support Team  |  1 Comments

A simple evaluation of a practice is Profit = Revenue – Expenses. The ‘old’ days of practicing Medicine there was more forgiveness in managing expenses. This was due to higher margins in the business. Also, with well-designed practice processes, procedures and computer systems, there is a need for less space today than yesterday. If your Pediatric Practice allows patients/parents for walk ins, then you will need to establish your space differently than if all appointments are scheduled via phone and/or the web. Let’s take a look at some considerations on appropriate space planning:

1) If your practice schedules all appointments, evaluate the rate per hour. For example, if you see 4 per hour (25-35 per day), many offices can manage well with 2 exam rooms per provider.

2) If the practice allows walk-ins, evaluate the number of patients seen during the walk-in time during both the busy and slow days to evaluate the range of walk-ins. Determine the number of exam rooms for walk-in over flow based on these extra patients and apply a factor (since the exam room can be shared other times). This might move the number of exam rooms by provider to 3 or a different number.

3) If there are multiple providers in the practice, evaluate the number of providers during any four hour period and evaluate the load (# patients an hour or day) during this period. Although the practice might be open from 8 am – 8 pm with five full time Pediatricians, there might only be 3 providers working at any one time. Using the 2 exam rooms per provider example, the practice would need 6 exam rooms plus waiting room, front desk area, lab area, bathroom(s) and shared offices.

Interesting that walk-in “Minute Clinics” and similar type areas manage their clinics with one room per provider. Interesting that many Pediatric practices built on the ‘old’ model are grossly oversized. This leads to extra cost for Rent, Common Area Maintenance, utilities as well as extra management time. Other areas of business evaluate their sales and expenses on a square foot basis (e.g. Retail segment), I believe the Medical professional should embrace this factor as well. More efficient practices provide a means to drive down health care costs while providing the Pediatricians a good income to support their family. The evaluation of square footage needed for the practice requires a different mind-set and a willingness to change by all involved in the practice. The leadership for the change needs to come from the Physician Partners. The physician partners should consider leveraging Pediatric practice consultants to help them with this evaluation.

Why Payers should update their reimbursement model for Pediatricians

January 27, 2012 in Blog by support Team  |  Comments Off on Why Payers should update their reimbursement model for Pediatricians

For the last 20 years, Healthcare costs increase at a rate higher than inflation. Why? I would argue that the alignment of incentives in the current Healthcare system rewards use of the high cost treatments. If we look at the 2010 Medicare Spending (provided by Avalere Health and the centers for Medicare and Medicaid Services), 59% is spent on Hospitals and Long Term Care, 20% on specialists and other clinical services, 12% on prescription drugs and only 2.8% on Primary Care Doctors. This information was published the Wall Street Journal today in an article titled “An Rx? Pay more to Family Doctors”. After reading this article, I began thinking about how patients use our healthcare system as well as the non-alignment of incentives in the system.

Let’s look at some of the current incentives:

• Incentive to add more specialists: Many specialists make 2x per year than a Primary care Physician. It is interesting how the US has twice as many Medical Specialists per population as other developed countries (Seems that when specialists are paid so much more, so many more individuals practice as a specialist).

• Incentive to treat Symptoms & not Align Care: Pharmacies that add treatment clinics with NP and PA which ‘patch up’ a patient by prescribing an antibiotic when it is not needed. Although a Rx at the Pharmacy as well as a patient purchasing OTC drugs and other products at the chain pharmacy brings additional revenue to the pharmacy, this type of treatment can cost the system more overall. This pharmacy care is ‘non coordinated patient care’ in the system that benefits pharmacies. This lack of coordination causes some patients to over use the ER as well as specialists that drive more procedures because an issue was not identified appropriately by a Pediatrician.

• Incentive to Pay for Size vs. Quality: Payer incentives that allow health systems with larger power and size to be paid more for the same procedure without any proof in decrease in cost or improvement in quality to the healthcare system. The large systems add layers of management, personnel, expensive buildings and pay for these upgrades by increasing their size so they can negotiate a higher rate from the payers.

• Incentive to Payers for making reimbursement ‘Difficult’: Complicated payer systems and processes for which the ‘average’ provider is only being collecting 95% of the contract amount (managed care keeps 5% of the missed opportunities – this leads to an incentive system for Managed Care to make more $ by denying payment).

Hospitals have been on a buying spree to own large physician networks that increase their revenue in two ways: referrals to the hospital and organization size to force managed care to pay higher reimbursements. What has been happening is that many of the payers are paying for more and more services in specialists and the hospital. It is difficult for the independent Pediatric Office (non-owned by a hospital or multi-specialty large integrated health system) to stay independent. Many payers have been short sighted and provide minimal rate for services for Primary Care providers as well as minimal increases to these rates (unless the Pediatrician is in a large health system). One representative from a health plan explained a year ago to me that their standard increase was 0% due to increase cost in the system. During the discussion, I pointed out to this representative that their rates were in the lower 25% of all payers, their company increased their profits by over 25% and their CEO made approximately $20M in the previous year. The payers seem to be able to benefit from the current model

Many payers have been under paying the total costs of vaccines to the independent practices while paying larger systems more money. The payment difference is not due to better quality outcomes but due to many of the smaller offices not being able to identify the issue with their ‘dated’ systems, people, processes as well as the payers taking advantage of the Pediatric practice that is 1-5 physicians.

What can Pediatricians do in this environment?

1. Utilize up to date systems that update coding and payment rules continuously versus just one update a year – this points to why using cloud computing is an advantage.

2. Identify all the costs in your practice and establish a minimum rate of reimbursement that will be rejected from payers.

3. Analyze the payers in your practice at least 2x per year.

4. Evaluate if there is a payer that is below the minimum and speak with this payer. If they do not meet the minimal payer mix, discharge the insurance from the practice. The patients can either see your providers as out of network or cash.

5. Evaluate the total compensation for well and sick visits in your practice. Identify the payers that reject paying for nights and weekends. Call the representative and explain the extra costs for after hours and that the insurance company has established 9-5 as routine hours (the hours that they are available).

These are just a few recommendations on how to operate in today’s healthcare system.