Lead Blogger: Seth Flam, DO
Dr. Flam is one of the founders of HealthFusion® and serves as the company’s CEO and President. He is board certified in Family Practice and is one of the creative forces behind MediTouch EHR®.
I recently did an informal survey of a few of my physician friends. I asked them to tell me about some of their recent patients, or some of their interesting medical cases. Without failure my friends could tell me about their patients in great detail. A cardiologist could explicitly explain to me about a specific patient’s lesions of the left main artery and what that patient’s left ventricular ejection fraction is. The family doctor I was speaking to could recall the trend of one of her patient’s HbA1c over the past few months. The level of detail that these physicians could recall was mind boggling, but then again we all know that doctors are selected by medical schools because they in part have an outstanding ability to process and recall information, especially data that is presented “scientifically”. Next I asked them about the financial metrics of their practice:
What were your Days in AR last month and how is it trending?
What percent of your AR is greater than 120 days outstanding?
How does your Work RVUs compare with your practice partners?
Do you know the general trend of No Show Appointments in your practice?
The answer to these questions and to similar questions regarding the financial health of their practices was always the same; I don’t know or I’m not sure. I was not surprised because as physicians we are trained to focus on our patients’ health, we trust others or perhaps no one to focus on the details of the financial health of our practice while we focus on the details of our patients’ health.
Physicians always have medical data available to them to make the correct diagnosis, and they use that data to carefully navigate the road to optimum health for their patients. I began to ask myself, why physicians don’t have the financial benchmarking data that assists in the diagnosis and management of the health of their practice at their fingertips? The answer is simple. Most doctors don’t have the systems in place to easily access, review and compare key medical practice financial benchmarking data. They are using software that doesn’t supply a graphical interface that provides a deep understanding of the financial health of their practice.
Think of benchmarking as health maintenance for the financial aspect of your medical practice. Like preventive care management of patient populations it is the continuous process of measuring and comparing performance data internally over time and when appropriate externally against the “best in class”. Benchmarking for physicians must be simple; most doctors don’t have the time to pour through pages of Excel schedules to deduce metrics that help diagnose their practice’s financial health. MediTouch Dashboard Charts provide the graphical interface that makes benchmarking simple.
Below is a sample of a simple dashboard chart of Evaluation and Management (E/M) coding for established patients.
The five common established office visit E/M codes are compared with a bell curve published by Medicare. In this case the provider may be too conservative – billing less 99213 and 99214 codes than the average (of course the key is in the medical documentation). This provider may have a revenue opportunity.
The same report is displayed below for another provider; in this case there is a skew toward 99214 visits. The percent of 99214 visits is above the bell curve. This provider should understand that this could be a red flag for payers. The provider may decide to reduce the number of 99214 visits billed. Alternatively if the provider does not want to change their E/M coding practice they should be documenting with great precision should a payer make a request for a chart audit.
MediTouch provides scores of dashboard charts that take just minutes to review. Each dashboard report has an explanation of how the data impacts their practice’s financial health. Each month providers can review their dashboard data and use that data to make meaningful changes in their office processes.
Billing companies that use the MediTouch system are in complete control of the dashboard reporting process. With MediTouch software the billing company is the resource that physicians use to access the data and exchange ideas with regard to increasing revenues and streamlining workflows that impact the bottom line. If you own a medical billing company and you are not supplying your physician clients with benchmarking data in dashboard format your competition will. Providing dashboard reports that reflect the outstanding work your team is performing on behalf of your clients is a great way to grow your billing practice.
Providing medical services has become a complex business. Doctors should not be ashamed to spend some of their time understanding the financial health of their practice and with MediTouch Dashboard Reporting they don’t need to make a great time commitment. The charts work on the Apple iPad so just a few minutes per month on your home sofa is sufficient. Remember, ultimately you are the manager of your own financial health. If you don’t measure it you can’t manage it and if you don’t value it you won’t change it. Who doesn’t want a better sense of financial security?
If you are an EHR user – ePrescribing on your Smartphone is a convenience that you really shouldn’t live without. Medical Professionals need to view themselves as mobile providers with the newfound ability to respond to patient requests “everywhere and anywhere”. Meeting the needs of patients when you are away from the office and on-the-go will improve patient satisfaction. Since the release of the iPad the world has shifted to essentially 3 form factors for computing.
- The traditional desktop or laptop computer (not very mobile but very versatile)
- The mobile tablet (iPad) for work away from the desktop – like in the exam room
- The Smartphone – limited in its utility compared to a desktop, but highly mobile
Providers need an EHR that gives them the flexibility to use the appropriate hardware form factor for a specific time and place of use. Medical charting full-time on a Smartphone is not practical – possible yes – but just not enough landscape for fast-charting a full encounter note. Reviewing your schedule and mobile prescribing on a Smartphone make a lot of sense. These are 2 activities that are built into the MediTouch EHR Smartphone Web App.
Smartphone electronic prescribing should not be viewed as an additional burden for the provider; in fact it is a new time management tool like the “Blackberry Effect”. When the Blackberry first became popular it was the de facto mobile email system. Its users loved it because it replaced “downtime” like waiting in a line at the airport. Returning emails in the airport saved the busy traveler the time it would have taken to perform the same task when they returned home to their clunky desktop PC. The same holds true for mobile prescribing. Let’s say you are attending a baseball game and you are notified that one of your patients requires a prescription, you probably don’t have your iPad and you definitely don’t have your desktop. It is in between innings and you have 2-3 minutes of downtime till the next pitch – well that’s all the time it takes to fulfill your patients’ prescription request with the MediTouch Mobile ePrescribing Web App. When you return home or back to the office – just one less thing to do.
The MediTouch Mobile ePrescribing Web Application is really our same award winning EHR prescribing interface – just reformatted for the Smartphone. It includes the same powerful drug-to-allergy and drug-to-drug interaction warnings and it also displays the patient’s Allergy and Problem list.
Remember there is always the “right tool for every job” and the MediTouch Mobile Web App for ePrescribing is the best tool for physicians to respond to patient medication requests on-the-go! Best of all it is provided for FREE in every implementation of MediTouch EHR.
On September 27, 2011, I wrote a blog entitled “Free EHR Software — Be Careful, a Real Catch- 22”. In that blog I discussed that the Internet advertising model had migrated to the EHR space and that there are several companies that will provide EHR services “for free”, in return for being allowed to advertise to you — the physician. I discussed the moral dilemma related to using an advertising based model. What we didn’t know at that time was that Congress could be legislating new laws that will make it very hard for a physician to choose those free EHRs without breaking the HIPAA law.
Earlier this month the U.S. Department of Health & Human services released the new HIPAA megarule that imposes new limitations on marketing. The new rule requires providers to obtain patient authorizations “for all treatment and healthcare operations communications where the covered entity receives financial remuneration for making the communications for a third party whose product or service is being marketed.” According to Fierce EHR “the authorization can’t be buried in the provider’s notice of privacy practices, and it must inform the patient that the physician is receiving a financial benefit for sharing the third party’s information with the patient.”
The goal of banner or pop-up ads is to promote the advertiser’s products to physicians with the expectation that they will prescribe, endorse or sell those products to patients. This is important because the targeted buyer is not the doctor; instead it is the patient. We believe this type of marketing is what the new HIPAA rule is addressing. If the physician sees the ad and then promotes the drug, product or service in the ad without patient authorization then there is a violation of HIPAA. Per the rule, the financial benefit can be direct or indirect. Since the ads are assisting in the sponsorship of the free EHR then the physician incurs a financial benefit.
In our last blog on this topic we explained the Catch-22 of free EHRs and this new law just reinforces the no-win dilemma, “heads I win, tails you lose”. If you recommend the product or service you may be breaking the HIPAA law, if you don’t then the advertisers won’t continue sponsorship and your EHR vendor will no longer be able to offer the software for free. The funny thing is that viewing advertising is like the old trick your friends used to play; they would say, “Don’t think of Pink Elephants” and of course that’s all you could think of once the impression was verbalized. Those ads are like Pink Elephants – subliminally impacting physician decisions, it will be hard for doctors to deny they were influenced.
What we said in our last blog still holds true.
In the exam room the doctor’s attention should be focused exclusively on the patient. Frankly, I don’t want to seek medical advice from a physician that is distracted from my care by anything or anyone, especially when I am one-on-one with my doctor in the exam room.
The big question: How do I move advertisements that are blocking the screen? Well…
There is no free lunch. “Free” EHRs are not free; in fact, they are expensive. They require a costly ethical and now a legal compromise, is that risk really worth a couple of hundred bucks a month?
On November 1st the Centers for Medicare and Medicaid Services (CMS) made an adjustment to the 2013 Electronic Prescribing (eRx) Program’s payment exemptions. CMS’ adjustment finalized two new e-Prescribing hardship exemption categories pertaining to the EHR Medicare and Medicaid Incentive Program in the 2013 Medicare Physician Fee Schedule Rule. The new eRx hardship exemptions from CMS are as follows:
- Eligible professionals who achieve meaningful use during certain eRx timeframes. For the 2013 eRx payment adjustment, this will include any eligible professional who achieved meaningful use during January 1, 2011 through June 30, 2012 and has attested to this by January 31, 2013.
- Eligible professionals who demonstrate intent to participate in the EHR Incentive Program and adoption of Certified EHR Technology by registering for the EHR Incentive Program by January 31, 2013. Please note: EHR Incentive Program participants must provide their entire EHR Certification Number in the CMS EHR Certification ID field during registration to receive this hardship.
Prior to the adjustments made on November 1st to the eRx incentive program, CMS was acting unfairly toward many eligible professionals who were trying diligently to implement the e-Prescribing program. CMS required the use of G codes in healthcare claims to prove that providers were compliant with e-Prescribing, and then also made those very same providers attest to the utilization of eRx as part of Meaningful Use. In one of our previous blog posts titled, “Hundreds of Thousands of Dollars Lost in Penalties — Is that motivation enough?”, we stated that the “incentive” programs are, “really penalty programs with just a taste of incentive in the early years.” Healthcare stakeholders obviously felt the same as we did, and with this adjustment CMS is attempting to rectify the unfairness. Eligible professionals now only need to register or attest for the EHR Incentive Program by January 31, 2013 to avoid penalty, even if they did not use the G code method of attesting to eRx use. However, if an eligible professional previously registered for the EHR Incentive Program but did not supply the EHR Certification Number for their EHR product at that time, and has not since achieved meaningful use, they need to go back and add that piece of information to their registration before January 31, 2013.
CMS is listening to feedback from vendors and providers alike, this adjustment is evidence of that. Be sure to double check if you qualify for the new eRx exemptions, and join HealthFusion in the evolving conversation with CMS. You can always stay current on industry news and happenings with HealthFusion’s EHR Blog.
The iPad® has not only been a consumer technology phenomenon, it is the best form factor for documenting a patient encounter with an EHR/EMR. Apple® has sold 100 million iPads in the past 2+ years, and the iPad is responsible for most of the Internet traffic spawned from mobile tablets. The MediTouch EHR® Web application was designed from the “ground up” for the iPad and every day we experience thousands of logins from iPad devices. Even though Apple’s last iOS release (iOS6) was flawed, prompting an apology from the CEO, it is still the best tablet for Web applications on the market today. Steve Jobs once commented that a smaller form factor than the original 11.9 inch screen in the “large” iPad would not be appealing to consumers. Well the rumor is that before his untimely death he changed his mind. Either way, his successors have come to the realization that a smaller form factor that fits between the iPhone and the traditional iPad is required to compete with hardware manufactured by Apple’s arch rivals: Google®, Samsung®, and Amazon®. Hence, today, we have been “blessed” with a new kind of iPad — the iPad Mini. Continue reading…
