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What Healthcare Must Plan for in Q4

Posted on September 19, 2014 I Written By

The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
In some ways, 2014 turned out to be not quite as cataclysmic. The early announcement of delaying the adoption of ICD-10 and the more recent announcement to allow hospitals/CAHs and Eligible Professionals participating in CMS’ Meaningful Use programs to attest using their existing Certified Electronic Health Record Technology (CEHRT) took the pressure off healthcare providers scrambling to upgrade their CEHRT to a version that was both ICD-10 and MU-compliant. However, this is only a temporary reprieve through the end of 2014 and there are other priorities that must be addressed before the year ends.

Navigating the ever-evolving healthcare environment will seem much less daunting if you focus on these four areas:

  • Meaningful Use
  • Value-Based Payment Modifiers
  • Transparency
  • Open Enrollment for ACA

Meaningful Use (MU)

If you were not able to upgrade to the 2014 Edition EHR, you will still be able to attest for MU using 2013 criteria. This provides reprieve from the 2014 criteria that requires the implementation of and patient enrollment in a patient portal.

In order to be MU-ready, your organization must proactively:

  • Determine your strategy based on the final rule. Gather data and be prepared to attest for MU by the deadline for the MU program you participate in..
  • Create an audit binder which should include screenshots of required EHR configuration during the reporting period. Should you get an audit 2 years from now, you can refer to this binder for accurate information.
  • Prepare a statement citing why you should be allowed to opt out of those MU measures that you think do not pertain to your practice. Auditors will ask for this on any audit preformed.

All organizations should be prepared to start collecting data for MU 2 by January 1, 2015. This includes having a strategy around the implementation of a patient portal and patient enrollment, sharing data amongst community and other healthcare providers, and radiology interfaces.

Value-Based Payment Modifier

The current Value Based Payment Modifier for providers who serve Medicare beneficiaries is a descendent of the Physician Quality Reporting System (PQRS). It is a way to keep the ACA cost-neutral, but there are some important things you need to know about this newer system. Value-Based Payment Modifier takes claims, Meaningful Use, and physician quality data and rates the quality of care you provide against your peers. Consequently,

  • When you report your Clinical Quality Measures or any clinical data to CMS, make sure your thresholds demonstrate that your practice is providing high quality care.
  • If your practice suffered from vendor problems with data accuracy in the past, this should be fixed.

Transparency

Transparency is something all providers should be aware of. Although available only in a few markets right now, all patients will soon be able to look up information about physicians before deciding where they would like to have their medical procedures done. For instance, if a patient decides to have an ACL repair, s/he can go online to compare exact costs and quality measures (based on the Patient Quality Reporting System) for ACL repair. Practices need to be aware that their prices and quality are being reported publicly. The implications go beyond losing reimbursement. You can actually be delisted from an insurance network. To ensure that your practice remains a viable option for patients:

  • Market your own practice and post your own prices.
  • Make sure you are reporting good quality data.
  • Use sources such as MGMA or OPTUM to see what providers in your area are charging and how you compare.
  • Determine how your reimbursement ranks vs. your competitors on the Medicare website and ensure data accuracy.

Open Enrollment for the ACA

November 15 marks the beginning of the second Open Enrollment period for the Affordable Care Act and there is no indication that this time around will be any easier than the first. Patients will be choosing plans, dealing with things very unfamiliar, and perhaps unaffordable, to them, like deductibles. This directly impacts clinics and the bottom line, especially with those patients who cannot pay their share of the costs. Last year, patients became the number one payor for many practices, even more than insurance companies, because so much revenue came from deductibles. That all resets January 1, but there are things you can do to avoid a possibly painful Q1 of 2015:

  • Check and confirm all patients’ eligibility, what plan they are on, and what their deductible is prior to their scheduled appointment, preferably through an automatic batch eligibility service. Keep this information in the practice management system.
  • Notify patients about their deductibles before they come into the clinic, and make sure to collect payments upfront, or keep a card on file.

The healthcare industry as we knew it for the past many years has ceased to exist. As we move into a new era of integrated delivery systems and a greater emphasis on value-based rather than volume-based reimbursements, the industry is going to remain in a state of flux before it stabilizes once again. The only way organizations are going to survive in this shifting landscape is by anticipating and planning for the next change so that they can stay ahead of the curve. The more an organization knows, the better it can be prepared to confront any potentially negative impact of the ever-evolving nature of the industry.

About Ben Quirk
Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

Eyes Wide Shut – Patient Engagement Pitfalls Prior to Meaningful Use Reporting Period

Posted on June 30, 2014 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

July 1, 2015 – the start of the Meaningful Use Stage 1 Year 2 reporting period for the hospital facilities within this provider integrated delivery network (IDN). The day the 50% online access measure gets real. The day the inpatient summary CCDA MUST be made available online within 36 hours of discharge. The day we must overcome a steady 65% patient portal decline rate.

A quick recap for those who haven’t followed this series (and refresher for those who have): this IDN has multiple hospital facilities, primary care, and specialty practices, on disparate EMRs, all connecting to an HIE and one enterprise patient portal. There are 8 primary EMRs and more than 20 distinct patient identification (MRN) pools. And many entities within this IDN are attempting to attest to Meaningful Use Stage 2 this year.

For the purposes of this post, I’m ignoring CMS and the ONC’s new proposed rule that would, if adopted, allow entities to attest to Meaningful Use Stage 1 OR 2 measures, using 2011 OR 2014 CEHRT (or some combination thereof). Even if the proposed rule were sensible, it came too late for the hospitals which must start their reporting period in the third calendar quarter of 2014 in order to complete before the start of the fiscal year on October 1. For this IDN, the proposed rule isn’t changing anything.

Believe me, I would have welcomed change.

The purpose of the so-called “patient engagement” core measures is just that: engage patients in their healthcare, and liberate the data so that patients are empowered to have meaningful conversations with their providers, and to make informed health decisions. The intent is a good one. The result of releasing the EMR’s compilation of chart data to recently-discharged patients may not be.

I answered the phone on a Saturday, while standing in the middle of a shopping mall with my 12 year-old daughter, to discover a distraught man and one of my help desk representatives on the line. The man’s wife had been recently released from the hospital; they had been provided patient portal access to receive and review her records, and they were bewildered by the information given. The medications listed on the document were not the same as those his wife regularly takes, the lab section did not have any context provided for why the tests were ordered or what the results mean, there were a number of lab results missing that he knew had been performed, and the problems list did not seem to have any correlation to the diagnoses provided for the encounter.

Just the kind of call an IT geek wants to receive.

How do you explain to an 84 year-old man that his wife’s inpatient summary record contains only a snapshot of the information that was captured during that specific hospital encounter, by resources at each point in the patient experience, with widely-varied roles and educational backgrounds, with varied attention to detail, and only a vague awareness of how that information would then be pulled together and presented by technology that was built to meet the bare minimum standards for perfect-world test scenarios required by government mandates?

How do you tell him that the lab results are only what was available at time of discharge, not the pathology reports that had to be sent out for analysis and would not come back in time to meet the 36-hour deadline?

How do you tell him that the reasons there are so many discrepancies between what he sees on the document and what is available on the full chart are data entry errors, new workflow processes that have not yet been widely adopted by each member of the care team, and technical differences between EMRs in the interpretation of the IHE’s XML standards for how these CCDA documents were to be created?

EMR vendors have responded to that last question with, “If you use our tethered portal, you won’t have that problem. Our portal can present the data from our CCDA just fine.” But this doesn’t take into account the patient experience. As a consumer, I ask you: would you use online banking if you had to sign on to a different website, with a different username and password, for each account within the same bank? Why should it be acceptable for managing health information online to be less convenient than managing financial information?

How do hospital clinical and IT staff navigate this increasingly-frequent scenario that is occurring: explaining the data that patients now see?

I’m working hard to establish a clear delineation between answering technical and clinical questions, because I am not – by any stretch of the imagination – a clinician. I can explain deviations in the records presentation, I can explain the data that is and is not available – and why (which is NOT generally well-received), and I can explain the logical processes for patients to get their clinical questions answered.

Solving the other half of this equation – clinicians who understand the technical nuances which have become patient-facing, and who incorporate that knowledge into regular patient engagement to insure patients understand the limitations of their newly-liberated data – proves more challenging. In order to engage patients in the way the CMS Meaningful Use program mandates, have we effectively created a new hybrid role requirement for our healthcare providers?

And what fresh new hell have we created for some patients who seek wisdom from all this information they’ve been given?

Caveat – if you’re reading this, it’s likely you’re not the kind of patient who needs much explaining. You’re likely to do your own research on the data that’s presented on your CCDA outputs, and you have the context of the entire Meaningful Use initiative to understand why information is presented the way it is. But think – can your grandma read it and understand it on HER own?

Three Things About Meaningful Use That Will Affect Your Practice

Posted on May 28, 2014 I Written By

The following is a guest blog post by Steve Baker, President of Eyefinity®
Steve Baker headshot
As a practice owner, new regulatory requirements are not always perceived positively as a benefit to the business or to the patient. However, if approached with a different mindset, they are an opportunity to reflect on your business – for example, where you are today and where you want to be in the future. Today, you have the pressure of electronic health records (EHR), attesting for meaningful use (MU) and the explosion of digital communication in the office and with your patients. The list seemingly goes on forever and at times may appear to be at odds with primary goals of patient care.

I have spoken with eye care providers all around the U.S., and patient care consistently rises to the top as their highest priority. One interesting question that I receive frequently is, “What is the anticipated benefit of MU in my personal practice, and what will it look like in the future?” From my perspective, EHR and MU should be viewed as the underlying platform for healthcare moving forward.

The pace of technology creation and adoption and the medical industry’s constant move toward interoperability are things that should be viewed as positive benefits for your patients, as well as for your business. This connectivity will enable healthcare to progress to the next level. Here are three circumstances that will have an impact on how MU will ultimately benefit your patients and your practice:

  1. Consumer demand: Consumers are mobile and technology-enabled and expect endless choices. According to Google/Ipsos, 96 percent of smartphone owners have researched for a product or service on their phone. They are using technology to connect and interact with everything that is important in their lives. Healthcare will inevitably become a part of this.
  1. Changing demographics: The 65+ age group, which represents approximately 13 percent of the population today, is projected to be 20 percent of the population by 2050, according to the U.S. Census Bureau. The late teens to early 30s age group (Gen Y, or Millennials), makes up perhaps the largest segment of the workforce at approximately 80 million people.
  2. Telemedicine:BenefitsPro.com, citing an IHS Technology report, shares that there will be a 20-fold growth in patients who are using telemedicine in the coming decade. What’s more is that 72 percent of consumers are willing to see their health provider via video conference.

MU objectives are propelling the industry to collectively meet the needs of the consumer, and if you don’t have the right systems in place, then you won’t be relevant to your patients in the future. For example, how would you answer the following questions?

  • How do you connect securely with your patients outside of the exam room to discuss treatment and follow-up care?
  • Can your patient securely access his/her medical information, and does the patient have a positive experience when trying to schedule an appointment?
  • Can you access your records from any location, at any time and from any device?

The answers to these questions need to align with the views of your patients as their expectations continue to evolve. Understand that regulatory requirements are opportunities to reassess your business and determine how you can be relevant to your patients, now and over the coming years. Connect with your peers to see what is working for them. Make sure that you are using a certified EHR and have the right business partner in place to help you get the most out of your systems and business.

The MU discussion should focus on how the medical industry can increase value to the patient – the same patient who is your customer and who is becoming a self-directed, technology-connected individual who is reluctant to accept in his or her healthcare less than what is experienced in other aspects of life. Effectively taking care of the patient can lead to enhanced business results, and MU is one path to the future.

Steve Baker, President, oversees the day-to-day operations of Eyefinity®, the eye care industry’s leading provider of practice management and EHR solutions and one of five innovative companies comprising VSP Global®. Steve is focused on business growth, strategic planning and product development. Steve holds a Bachelor of Science degree in computer science from California State University, Northridge, with a concentration in systems design and mathematics. Steve enjoys most anything outdoors and is an avid cycling fan. He can be reached by e-mail at Steve.Baker@eyefinity.com.

Meaningful Use As a Requirement for Medical Licensure

Posted on May 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

About a year ago, you might remember the article I wrote about the Massachusetts law that would require doctors to be meaningful EHR users to have a medical license. The law was shocking then and the idea is shocking to consider even now.

The good news is that it looks like the law is going to be modified so that physicians don’t have to demonstrated EHR proficiency as part of their medical license. As you can imagine the Massachusetts Medical Society has been working hard to advocate for this change. They say that the modification was “designed to prevent disenfranchising more than 10,000 physicians who, by law or other circumstance, cannot achieve meaningful use certification.” Probably took a rocket scientist to figure that one out.

I think it’s more than heavy handed to tie EHR proficiency to a medical license. The reality is that EHR’s will become mandated thanks to things like reimbursement and medical malpractice insurance. There’s not going to need to be a law that says you have to be proficient in an EHR to hold a license.

Is it any wonder why many doctors are revolting against EHR?

One of the worst thing you can do to get someone to do something is to force them to do it. Instead of these heavy handed approaches, there should be a focus on the value an EHR provides. I don’t know any provider that doesn’t want to do something that provides value to their clinic and their patients. Forcing someone to do something is the lazy approach.

Surviving 2014: The Toughest Year in Healthcare

Posted on March 26, 2014 I Written By

The following is a guest blog post by Ben Quirk, CEO of Quirk Healthcare Solutions.
Ben Quirk
How bad is 2014 for the healthcare industry? We’ve all read about ICD-10, EHR incentives, Medicare cuts, and the Affordable Care Act. But the most telling moment for me occurred during this year’s HIMSS conference in Orlando. There was quite a bit of B2B enthusiasm, but among the civilians it was mostly a lot of stunned looks and talk about how to get through the year. Here are some of my observations:

ICD-10. CMS has made it abundantly clear there will be no further delays to the October 1 deadline for ICD-10 implementation. This is possibly the most significant change to the healthcare industry in 35 years, affecting claims payment/billing systems, clearinghouses, and private and public software applications. Anyone who provides or receives healthcare in the US will be touched by this in some way.

In a recent poll of healthcare providers conducted by KPMG, less than half of the respondents said they had performed basic testing on ICD-10, and only a third had completed comprehensive tests. Moreover, about 3 out of 4 said they did not plan to conduct tests of any kind with entities outside their organizations.

Incorrect claims denial will be the most likely result. CMS will not process ICD-9 Medicare/Medicaid claims after October 1, and there is a high potential for faulty ICD-10 coding or bad mapping to ICD-9 codes. Error rates of 6 to 10 percent are anticipated, compared to an average of 3 percent under ICD-9. ICD-10 will result in a 100 to 200 percent increase in denial rates, with a related increase in receivable days of 20 to 40 percent. Cash flow problems could extend up to two years following implementation. This will be a costly issue for providers, and a very visible issue for patients.

We advise our clients to be proactive in their financial planning. This should include preparation for delayed claims adjudication and payments, adjustments to cash reserves, or even arranging for a new/increased line of credit. Having sufficient cash on hand to cover overhead during the final quarter of 2014 could be very important, as could future reserves to cover up to six months of payment delays. Companies not in a position to set aside reserves should consider working with lenders now before any issues arise.

Meaningful Use. As with ICD-10, CMS has stated there will be no delays to MU deadlines in 2014. That means providers who have never attested must do so by September 30, or else be subject to penalties in the form of Medicare payment adjustments starting in 2015. Providers who have attested in the past will have a bit longer (until December 31), but the penalties are the same.

There is much dissatisfaction with the government’s “all or nothing” approach to MU, where even the slightest misstep can invalidate an otherwise accurate attestation. While the ONC has proposed a more lenient model for EHR certification in coming years, everything will be measured against a hard deadline in 2014.  CMS is offering some mitigation through hardship exemptions, based on rules that are somewhat broad at this point. Providers should consider applying for an exemption if no other options are available.

We advise against taking shortcuts or rushing to beat the clock on MU. Up to ten percent of eligible professionals and hospitals will be subject to audit, and large hospitals may have millions of dollars at stake. Being prepared for an audit means more than just making sure an attestation is iron-clad; internal workflow and communication are also important. A mishandled audit notification can result in a late response and automatic failure.  Data security should also not be overlooked. Medical groups have failed audits due to lapsed security risk assessments as required under HIPAA.

Medicare Payment Cuts. Medicare Sustainable Growth Rate (SGR) cuts continue to hover over Medicare providers. Enacted by Congress in 1997, the SGR was intended to control costs by cutting reimbursements to providers based on prior year expenditures. But every year costs continue to rise, as do ever-worse SGR cuts (almost 24% in 2015). And every year Congress prevents the cuts via so-called “doc fix” legislation.

In early 2014 there was surprising bi-partisan agreement on a permanent doc fix, whereby Medicare reimbursements would be based on quality measures rather than overall expenditures. However, the legislation was derailed by linking it to a delay of the ACA’s individual mandate. As of mid-March there is still no permanent or temporary solution. Congress will almost certainly intervene to prevent SGR cuts, but by how much is uncertain.

The ACA. As the cost of insurance has increased over the past decade, high-deductible plans have become more and more common. Due to the Affordable Care Act, this trend has become the norm. Media outlets focus on the impact to consumers, and argue about whether more “skin in the game” leads to better choices or less care. What we’re hearing from the front lines is much more concrete: high deductibles are having a negative impact on revenues.

Very few people understand their liabilities under a typical health insurance plan. Last year George Loewenstein, a health-care economist with Carnegie Mellon University, published a survey showing that only 14 percent of respondents understood the basics of traditional insurance policies. At the same time, hospitals report that about 25 percent of bad debt originates from patients who are currently insured. With millions of new enrollees in high-deductible plans and an ongoing economic slump, the situation can only get worse.

The ACA had a further impact by reducing the amount of Disproportionate Share Hospital (DSH) charity funds available, based on a projected increase in insurance coverage.  But with some states not participating in Medicaid expansion, combined with an increase in patients lacking the knowledge or resources to manage large medical expenditures, the reduction in funds comes at exactly the wrong time.

Providers can cope by adjusting revenue cycle processes. For example, new programs should focus on estimating patient liabilities pre-arrival, educating the patient at check-in, and instituting proactive billing/collection at the point of service. In general, providers must pay more attention to the self-pay process, focusing on patient education and offering transparent, easy-to-use billing and payment methods.

Value Modifier. This program has not been a worry for most providers thus far. Not because it won’t have an impact on revenue, but because they don’t know about it. A little-known provision of the ACA, the Value-Based Payment Modifier mandates adjustments to Medicare reimbursement based on quality and cost measures. The program is being phased in, and so far has applied only to group practices of 100 or more Eligible Professionals (EPs). In 2014, smaller groups of 10 or more EPs will be subject to the legislation. These groups must apply and report to the program by October 1. Otherwise, they will be subject to a 2 percent cut in Medicare reimbursements starting in 2016.

One of the most important aspects of the program is its definition of “eligible professional” when defining the size of a group practice. For the purposes of Value Modifier, eligible professionals include not only physicians but also practitioners and therapists. That means that a practice with 8 physicians, a nurse practitioner, and a physical therapist would qualify as a practice with 10 EPs.

Value Modifier is part of the growing trend toward quality-based reimbursement. Even commercial payers are considering some version of the program. The scoring calculations are complex and poorly understood, so we advise clients to get up-to-speed as soon as possible. Groups with high quality and low cost will receive incentives rather than cuts, with additional upward adjustment for services to high-risk beneficiaries. Groups that are not paying attention may be surprised by an additional hit to revenue in 2016. In addition, quality scores will eventually be published to the general public on the Medicare.gov Physician Compare website.  Sub-par or missing scores could have a negative financial impact on a practice.

Conclusion

These are only the most high-profile impacts to the healthcare industry during the current year. Much else flows from them: changes to workflow, to computer systems, to financial expectations. Tremendous pressures are coming to bear within a limited timeframe.  We’re seeing an industry in the midst of tectonic change, with 2014 as the fault line. It’s unclear whether these disruptions will be for better or worse. But there certainly will be winners and losers, and those who plan ahead are most likely to survive.

______________________

Ben Quirk is CEO of Quirk Healthcare Solutions, a consulting firm specializing in EHR strategic management, workflow optimization, systems development, and training. The company’s clients have enjoyed remarkable success, including award of the Medicare Advantage 5-star rating. Quirk Healthcare presents a weekly webinar series, Insights, to inform clients and the general public about government programs and industry trends. Mr. Quirk is also Executive Director of the Quirk Healthcare Foundation, a learning institution which fosters innovation in the healthcare industry.

Usable EMR, Post EMR World, and Impact of Meaningful Use

Posted on February 23, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.


This is an important nuance. Although, I’d argue that the biggest challenge to EMR usability is onerous billing requirements and prescriptive meaningful use requirements.


I’m really interested in the description of a post EMR world. It makes me ask myself the question, “What can we do with 100% EMR implementation?”


MU has spurred EHR adoption. No arguments there. Hard to argue against MU killing much of the EHR innovation and usability. We’ll see which exceptions emerge from the dust.

Eyes Wide Shut – Teaching to the Meaningful Use Stage 2 Test

Posted on September 30, 2013 I Written By

Mandi Bishop is a healthcare IT consultant and a hardcore data geek with a Master's in English and a passion for big data analytics, who fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.

According to Twitter analytics, one of my more engaging tweets recently stated that Meaningful Use is stifling innovation by requiring that health IT vendors and healthcare providers employ very specific tactics to capture and report on clinical data capture and interoperability standards compliance – ostensibly to engage and empower the patient, and improve coordination of care between providers. Of course, I said it much more succinctly than that. In effect, conforming to the Meaningful Use Stage 2 attestation measures is akin to “teaching to the test”:

Here’s a real-world example of what it means to “teach to the test” of Meaningful Use. In order to qualify for CMS incentive dollars, Meaningful Use Stage 2 Year 1 patient engagement measures must be met, with auditable data captured, in a 90-day contiguous period in 2014. An eligible provider (EP) must demonstrate that 50% of all patients with encounters during that time period have online access to their clinical summary within 4 days of the data becoming available to the provider. 5% of those patients must access the clinical information within the 90 days, and 5% of those patients must leverage secure messaging to communicate relevant health information with the provider. Finally, the MU-certified EMR must proffer patient-specific education materials for 10% of the patients seen during that time.

What I believe the ONC had in mind when they crafted these measures: engaged patients who will log in to their portal after each encounter, review the findings and lab results to assess their own progress and outcomes, read or listen to the condition-specific educational materials provided that resonate with them, and ask more meaningful questions of their providers as a result of this new-found, data-enabled empowerment. That is why they categorize these measures as “patient engagement”, right?

Wrong. This is what “patient engagement” looks like, from the EMR implementation, Meaningful Use-consultant, EP business process standpoint.

First, establish the bare minimum thresholds for meeting the measures. If the EP saw 1000 patients during the same 3-month period the previous year, your denominator is 1000; calculate the numerator for each measure based on that. So, we need 500 patients to have access to their clinical data online; 50 patients must access their information; 50 patients must communicate with their provider via secure messaging; 100 patient encounters must prompt specific educational opportunities.

To meet the 500 patients with online access to their clinical data, patient portal software is preloaded with patient demographic accounts, based on the registration data already available in the EMR. An enrollment request is emailed to the patient or authorized representative (assuming an email address is available in their demographic information). The EMR captures the event of sending this email, which contains the information about how to enroll and access the patient’s medical records via the portal. This measure is met, without the patient acknowledging the portal’s existing, and without any direct communication between provider and patient.

The medical records view and secure messaging measures can be met simultaneously, in a matter of days, by planning to add a few extra minutes to each encounter for 50 patients’ worth of appointments. The EMR has already triggered an email with portal enrollment information to each of the patients in the waiting room on a given day. As the medical assistant (MA) is taking vital stats, she asks whether the patient has enrolled in the portal. It’s likely the patient has not; the MA hands the patient a tablet and has him log in to his email, and walks him through the portal enrollment and initial login process. Once logged in, the MA directs the patient to click the link to view his medical record. That click is recorded, and the “view” measure is met; whether a CCD or C-CCD is actually displayed is irrelevant to the attestation data capture.

Having demonstrated how a patient can view his record, the MA then asks the patient to go into the portal’s message center, to send a test communication to the provider. The patient completes the required fields, and the MA prompts him with a generic health-related question to type into the body of the message. Once the patient hits “Send”, the event is recorded, and the “secure messaging” measure is met.

For all patients, whether portal-users or not, a new process begins when the MA finishes, the provider enters the room and begins her evaluation of each of the 100 patients required to meet the education measure. As the patient talks, the provider is clicking through EMR workflow screens, recording the encounter data. The EMR occasionally prompts with a dialogue box indicating educational materials are available for patients with this diagnosis code, or this lab result. Each dialogue box prompt is recorded by the EMR; the “patient-specific education” measure is met, whether the provider acts on the prompt and discusses or distributes the educational information or not.

To put it simply: the patient never has to log in to a portal to meet the 50% online availability requirement, they don’t have to actually view their records to meet the 5% view requirement, they don’t have to have an actual message exchange with their provider to meet the 5% communication requirement, and they don’t have to receive any tailored materials to meet the 10% education requirement. Once those clicks have been recorded, the actions never have to be repeated; meaningful and ongoing patient engagement is not needed to meet the attestation requirements and receive the incentive dollars.

In a previous post, I introduced my interpretation of the difference between the spirit and letter of the Meaningful Use “law”. By teaching to the test, we’re addressing the letter of the law, only, in its narrowest interpretation. When will we incent vendors and providers to go above and beyond and find ways to truly engage patients in meaningful ways, empowering them with accurate, timely data access and tools to analyze it?

A Patient’s View of Meaningful Use Questions

Posted on July 22, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The creativity of humans will never cease to amaze me. If you’re someone who works in the EMR world, you’ll love this video. I honestly don’t know whether to cry or cry laughing. I’m sure many doctors and nurses reading this will have had some first hand experiences like this. Enjoy a nice patient view of meaningful use thanks to Ashley Fuller.

Patient Education, Cloudalization of Healthcare, and EHR Vendors – #HITsm Chat Highlights

Posted on March 23, 2013 I Written By

Katie Clark is originally from Colorado and currently lives in Utah with her husband and son. She writes primarily for Smart Phone Health Care, but contributes to several Health Care Scene blogs, including EMR Thoughts, EMR and EHR, and EMR and HIPAA. She enjoys learning about Health IT and mHealth, and finding ways to improve her own health along the way.

Topic One: How valuable do you see the use of gaming as a vehicle for patient education and engagement? #mHealth

Topic Three: Is healthcare departing from the client/server architecture toward the cloud? AKA, “The cloudalization of healthcare.”

Topic Three: Is HITECH to blame for introducing false demand for #EHRs? What will happen after all the money is flushed out of the system?

Topic Four: If an #EHR vendor fails, how will their customers migrate to another product if their data is locked in a proprietary system?

 

An Interview with Mitochon About Their Recently Launched EMO (Electronic Medical Office)

Posted on February 27, 2013 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is an interview with Mitochon about their newly launched EMO (Electronic medical Office) and a discussion of some of the various trends happening in healthcare IT like: ACOs, Meaningful Use, and HIEs.

Q: Tell us about your recently launched EMO (Electronic Medical Office) product.

A: Our Electronic Medical Office product is a complete end-to-end solution for the modern day medical practice. Allowing the practice to accomplish all their daily task in one solution. One application, one vendor, one solution….. EMO.

Q: When did you start thinking about a suite of applications beyond just EHR?

A: We have seen for years the issues the practice has had to endure when dealing with multiple vendors, products and interfaces. The finger pointing and passing the buck when many different vendors are involved. Its the old right hand left hand issue. Just over two years ago as a team we knew we had to step forward and develop an end-to-end solution and give the practice the continuity and consistency of dealing with one vendor and one solution to take care of all the practice needs from the Patient accessing their medical records and financial data from their own PC to the tracking of insurance claims and collections.

Q: Will EMO (Electronic Medical Office) be free like your past Free EHR offering?

A: Yes EMO will be a FREE offering. In addition to our FREE EMO we are offering a plus package, with EMO+ you get all the features of EMO and back office Revenue Cycle Management. With EMO plus the practice pays only 2.85% of their monthly collections and we handle all the billing and collections from a back office perspective.

Q: In this world of EHR consolidation, EHR’s closing down, etc, why should a doctor feel comfortable choosing Mitochon?

A: We started Mitochon with the belief that Health IT services are too expensive and too complex! We wanted to take away the cost barrier that many independent physicians couldn’t previously overcome, enabling them to provide better patient care while qualifying for Meaningful Use incentives. Our advertising business model is proven, sustainable and successful and is a similar model that works for TV, radio, newspaper and the web. We’re here to stay!

The Mitochon application is used in other markets on a paid basis. We are saddened by the fact that companies still pay to use systems that were closed down such as Kareo and Epocrates recent announcement, they are late and trying to resurrect a system that was closed down. We understand other free vendors have over spent on promotion and the day of reckoning is coming closer, we gain 30% of our new users from other free systems that offer poor support, when the investors get sick of running a business with scant regard to profits they will go the way of MySpace, remember them?

Q: Do you think that most of the doctors using your EHR will becoming “meaningful users”?

A: The question should really be if the physicians believe the meaningful useage criteria, as defined, really add to their patient care or do they see it more of a hassle or prying eyes of payers. The vast majority of our users have achieved Meaningful Use. We are a conservative company owned by physicians, we build a real base of users, no hype. We believe we likely have the highest percentage of users achieve MU versus any other EHR.

Q: The claims clearinghouse is a new Mitochon feature. Tell us more about that part of the product.

A: EMO would not be an end-to-end solution if we did not include medical claims clearing. There are no gimmicks or gotchya’s with our clearinghouse. The sending of medical claims as well as status updates of those claims is FREE as well! We are redefining the end the end solution

Q: What other applications aren’t part of EMO (Electronic Medical Office) that you’ll look at incorporating in the future?

A: We have appointment reminders, Statement printing, fully integrated credit card processing that is linked to a users account. We have the in built HIE that allows Physician to Physician referral as well as the soon to be launched Patient Health Record. As the market demands we will continue to add features and functionality. In office dispensing solutions can bring Physicians significant revenue, up to $7,000 per month profit depending on sub-speciality. We are also working to bring an integrated sample closet so physicians can add further value to their patient interaction. Also remember we also have free mobile access to our EHR.

Q: How do you think what you’re doing fits in with other trends like ACOs (Accountable Care Organizations)?

A: In an ACO the goal is population management, better outcomes with lower cost. As such you have to manage the 30% of chronically ill patients who are utilizing 60-70% of the health care dollars. To do so, every provider needs to be engaged, integrated and connected. So our free solution has a role to complement the other solutions so that an ACO can gather information from all their providers. The risk is very high for an ACO that has a leaky infrastructure because the management of risk will be exposed and the cost curve will not be bending, hence no savings will be generated. Our EMO solution is created for instant collaboration and coordination because of the built in HIE function. In our network physicians who care for the same patients instantly are connected and can share medication list, problem list, labs, radiology and progress notes without the additional cost of integrating. We have contracts with 3 ACO’s.

Q: What’s your take on mobile adoption by doctors, particularly when it comes to products like EHR?

A: Mobile phones are ubiquitous in the medical community. We see Physicians and Nurse Practitioners adopting our mobile solution. It is unlikely they will undertake a full clinical interaction on an iPhone but they do use our native iPad App. The key here is it is a tool for the Doc on the run. The office based PC will always be the tool of choice in the foreseeable future, many have just purchased them recently!

Q: What’s something that doctors aren’t paying enough attention to right now?

A: Connectivity. They have just paid for a stand alone EHR, now they need to coordinate care with other providers/hospitals/labs etc. These other entities are cherry picking and paying certain providers who have enough volume or contribution to the hospital or system. It is a cost that may be just as expensive as the EHR in the long term for the physician. This is a crucial part of the solution and why we have an inbuilt HIE functionality allowing physicians to immediately refer patients across our system. This is particularly attractive to the ACO market.

Also, the meaningful use subsidy will end in a few years, if a provider is using an expensive system, how will that affect the ability for the provider to sell their practice to a new physician who is already in debt from med school. We have many fat cat EHR vendors just milking the Physician who they see as an equal opportunity victim. How many EHR’s are showing 60% revenue growth since 2009? This will come to a end soon and the physician will be leveraged again unless they are using a system with an alternate revenue model. Thats where our Mitochon Patent comes in, introducing contextual clinical content into the workflow and subsidize the Physician’s cost.

Full Disclosure: Mitochon is an advertiser on EMR and HIPAA.