I was on the phone with one of our valued customers this morning discussing Phase I Meaningful Use and the details on the “how” related to Meaningful Use. The overall goal of Health and Human Services is that providers utilize a certified E.H.R. in a meaningful way. A group of individuals invested months of discussions and feedback to obtain a list of parameters. One challenge for the group is to provide a universal list that applies across all fields of medicine. Some of the parameters in Pediatrics only apply to a certain segment of the population. For example, smoking status is for patients greater than 13 years of age. There are core measures that each provider needs to meet the benchmark for all these measures during the 90 day period being measured as well as selecting a list of 5 of the 10 menu measures.
A good E.H.R. system should provide a simple manner for a physician and/or Practice Administrator to evaluate performance of each of these benchmarks as well as very easily ‘drill down’ to identify how to correct/update patient data associated with the measure. How to use a meaningful use dashboard should take minimal training and review. The E.H.R. vendor should be able to guide an individual in the practice on the process via a web meeting or teleconference. So if you selected the ‘right’ E.H.R. system for Pediatrics, using the software and monitoring meaningful use should be straight forward.
The ‘tough’ part of Meaningful use: Changes to how the practice operates. For example, most practices did not record language, race and ethnicity as part of their intake/demographics. This needs to be captured for over 50% of patients seen during the 90 day measurement period for Phase I. If your E.H.R. system is well design, the practice should be able to click on a link and show the patients that do not have this information during the 90 day period. The most efficient way to enter this information is to capture the data when the patient visits the office. The “ah-ha” moment for many individuals is when they first run a meaningful use report, then they make the changes to their office flow and intake forms as needed.
Some questions to ask related to Meaningful use and your Pediatric Practice: Are we entering all medications in the system and sending medications via electronic prescriptions? Do we list the problems for each visit and maintain the patient problem list? Are we maintaining our Medication list and Allergy List? Does our standard protocol for demographics include recording smoking status of patients >13 years of age? Do we record vitals on each visit? Can we connect to the immunization registry? Are we connected to the lab companies that we send the majority of our labs?
This is not meant to be an a complete list of questions but a list to stimulate thinking around meaningful use. There are many resources, websites and references to obtain detailed information. Good luck on meeting Phase I Meaningful Use!
1. Determine if the company is structured Primarily for Pediatric practice billing. There are a number of
EHR companies that are in Pediatrics that started as software for electronic health records and then
developed a practice management system then offered billing. The order of development of systems and
processes is important for developing holistic systems and processes. Optimizing collection rates to above
99% consistency is important. Unfortunately there are many consultants whom have good knowledge of
meaningful use with absolutely no knowledge of Pediatric practice management. Solid practice
management and financial management are critical to each pediatric practice.
2. Evaluate if Their ENTIRE business is based on optimizing Pediatric offices in both medical billing and
Electronic Health Records. There are a number of companies that market themselves as a specialty
medical billing company in pediatrics while they are really a general medical billing company with a
marketing campaign focused in pediatrics. Their software processes and usually medical billets have
general medical billing training. This lack of ‘organizational focus’ can mean thousands of dollars in missed
revenue per month for your pediatric practice.
3. Does the pediatric medical billing company reduce burden on the providers and the practice? System
design can decrease burden and increase accessibility. A good pediatric decal billing service will provide a
monthly report that monitors the top benchmarks needed to manage a Pediatric practice. Some of these
benchmarks include collection rate account Receivable days versus national standards such as benchmarks
provided by the Medical Group Management Association. Just as today’s technology allows you to access a
book you purchased on Amazon or a song on iTunes in multiple locations and multiple devices, so should
the software provided by your Pediatric Medical billing service. The is NO NEED for the practice to have to
purchase, maintain, back-up, maintain server firewalls, stay on top of the latest firewall and virus
technology, and update servers. This is an old dated model that provides an extra burden on the Pediatric
4. Ask about training of their billing staff. Does the billing company train in Pediatrics? The billing and
coding rules in pediatrics change each year. It is difficult for a biller whom is provided general billing
training stay up to date in pediatrics. This lack of pediatric billing training can cost your practice thousands
5. Do they have Standard Operating Procedures (SOPs) designed and developed solely for Pediatric
practice billing? The revenue cycle contains the co-pay, the insurance responsibility as well as the patient
liability. Although the revenue cycle is similar in medical practice management, there is great variation on
how to optimize the revenue cycle by specialty. For instance, understanding all the rules in vaccine
administration codes is not a benefit to billers for surgeons but is critical in Pediatrics.
Choosing the ‘right’ Pediatric medical company should Increase revenue, decrease administration burden
and reduce stress to the practice.
March 30, 2012 in Blog by Ken | No Comments
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 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.
February 10, 2012 in EHR Selection by Ken | No Comments
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)?