ICD-10 | EMR and EHR

Must-See Sessions, Exhibitors at HFMA #ANI2013

It’s that time of year again. The Healthcare Finance Management Association’s annual ANI conference is just days away. I’ve come to associate the month of June with all things revenue cycle and the anticipation of learning more than I ever wanted to know about financial risk, reimbursement strategies, RACs, coding … the list could go on and on. I do enjoy the show, almost more than HIMSS, because it is smaller, shorter and so much more manageable from a logistics standpoint. HFMA puts out a great mobile app each year, and this year marks the first time I’ll be able to take advantage of it thanks to a (finally) upgraded phone.

Last year in Las Vegas, the show floor and educational sessions were largely focused on ICD-10 and ACOs. Flipping through this year’s brochure, I see that health insurance exchanges, Stage 2 of Meaningful Use and payer relationship strategies will also see a bit of the limelight. Personally, I’m looking forward to learning what healthcare finance folks think of this surge in healthcare consumer cries for price transparency. Are they paying attention? Will charge masters ever change (for the better)?

I thought I’d share some of the sessions I’m most looking forward to attending. I admit that I’m a big fan of panel discussions. Solo presenters can turn into sleep-inducing monologues far too quickly.

To Merge or Not to Merge: Hospital Executive Panel Discussion (Monday, 6/17)
What are the advantages and challenges of maintaining stand-alone status? What factors could influence a decision to see affiliation partners? What various affiliation strategies have worked for others?

Living in Atlanta, which has seen its fair share of hospital mergers and partnerships, I’ve often wondered why some facilities choose to go it alone and some choose to affiliate. I’m looking forward to hearing some inside scoop from the four scheduled hospital executives.

Transitioning to Value: Barriers, Solutions and Opportunities (Tuesday, 6/18)
Former CMS administrator Don Berwick will give this keynote address, which promises to “identify the barriers that must be overcome to reform the delivery system, the outcomes of successful delivery models, and the signals of progress within provider organizations.”

I can’t help but wonder how his stage presence will compare to Farzad Mostashari’s, and what sort of neck attire he’ll don.

Physician/Hospital Revenue Cycle Integration: a Panel Discussion (Tuesday, 6/18)
This session will cover the “opportunities and challenges of unifying the revenue cycle to reduce overall costs while increasing collections and patient satisfaction.”

I think it will be interesting to hear from providers just how important patient satisfaction (and presumably referrals) are to a provider’s bottom line. I expect at least one of the panelists will bring up Stage 2, as I’m learning that patient engagement and satisfaction are closely intertwined.

Women as Leaders: Charting the Course (Tuesday, 6/18)
As I mentioned in a recent post, I’m looking forward to learning how the HFMA board members (dare I call them #RevCycleChicks?) on this panel manage careers, families and communities.

Quiet: Harnessing the Strengths of Introverts to Change How We Work, Lead and Innovate (Wednesday, 6/19)
This keynote from author Susan Cain seems tailor-made just for me. Until social media came into my life, I’d always considered myself an introvert. But social networks have turned that idea on its head in unexpected ways, and so I wonder if Cain will touch on digital media in her presentation.

Best Practices for Managing Consumer Payments in the Current Environment (Wednesday, 6/19)
This “late-breaking session” promises to share best practices on improving collections and patient satisfaction.

I hope they’ll touch on the “future” environment, as it seems reasonable to assume that 2014 will likely make a number of current best practices out of date.

Then, of course, there is the exhibit hall, which I always enjoy roaming around without plan or purpose. A few recent postcards have piqued my interest in several companies:

I’m not even sure what the name of this company is, but the idea of a singing sock intrigues me.

I fared poorly at Emdeon’s Cash Stacker games last year, and am determined to do better this time around. Plus, the company always seems to be doing interesting things in the revenue cycle space, so I look forward to catching up with several of their team members to get the inside scoop.

I’m very intrigued by the idea of provider benchmarking at the moment, so I’m planning to learn more about what RelayHealth is doing in this area.

While this postcard doesn’t allude to athenahealth’s recent claims of guaranteed ICD-10 compliance, it will definitely be my main talking point when I stop by their booth.

Good works are always a good idea, and several companies are making charitable contributions in lieu of giveaways:

What sessions and exhibitors are you looking forward to? Let me know what I shouldn’t miss via the comments below.

Post a Comment(0)

June 13, 2013 I Written By Jennifer Dennard

As Social Marketing Director at Billian, Jennifer Dennard is responsible for the continuing development and implementation of the company’s social media strategies for its three key properties – Billian’s HealthDATA, Porter Research and HITR.com. She is a regular contributor to a number of healthcare blogs, and currently manages the Technology Association of Georgia Health Society’s social media channels. You can find her on Twitter @SmyrnaGirl.

Tags:ACO ANI ANI 2013 HFMA HIMSS Hospital CFO ICD-10 LinkedIn Meaningful Use RACs RCM Revenue Cycle Management

Great & Powerful Oz Grants Kansas PHR Access

It is unlikely that author Frank L. Baum imagined citizens of the Emerald City would ask the Great & Powerful Oz for better healthcare. In reality, that is just what the state of Kansas – home to Dorothy, Toto, Auntie Em and fantasy-inspiring twisters – is offering its citizens in the form of a free personal health record.

The news is timely, only because I just saw the movie Oz the Great & Powerful, which portrays Oz as a con man who stumbles into greatness, and saves the people of Oz along the way. (Anyone know the ICD-10 code for injury due to hot air balloon crash? Leave it in the comments section below and I’ll have my daughter Dorothy sing Somewhere Over the Rainbow to you.)

While Kansas isn’t suffering from attacks of the Wicked Witch variety, it seems to be facing healthcare challenges similar to the rest of the country – a need to improve communication and quality, and a desire to increase patient engagement as part of Meaningful Use requirements.

According to a recent write up in The Wichita Eagle, the Kansas Health Information Network (KHIN) may be “the first statewide exchange in the country to provide a personal health record portal for patients.” It plans to provide portal access this summer to patients at no charge, with full operation anticipated by next year. Provider access will be included in KHIN membership. KHIN selected PHR vendor NoMoreClipboard to supply the technology.

Details around set up and access have yet to be determined, according to the story. The bigger question, I think, is how are providers going to get their patients to fill in information on their own time, and on their own dime, so to speak. I’ve attempted to be proactive and fill out one for my daughter, and, I’m ashamed to admit, it was just too time consuming to keep up with. Perhaps making the PHR portal available to patients on mobile devices would up the data input rate. The NoMoreClipboard website does mention its PHR is available for mobile phones.

I’m thinking that patients would need some serious incentive to go to the trouble of all that data entry, which is perhaps where payers come in. I might be persuaded to keep up with my PHR is I received some sort of discount on healthcare services.

Perhaps the Great & Powerful Oz could grant the good patients of Kansas the ability to enter their own healthcare data in the blink of an eye, or, as they say in the Emerald City, at least no longer than it takes to follow the yellow brick road.

Call to Halt ICD-10 Puts New Angle on Demand for Physicians

The American Medical Association’s most recent call to halt implementation of ICD-10 codes brings to light an interesting angle to the coding story – one that I hadn’t recognized until I read up on just why the AMA has consistently made it known that the switch is a bad idea.

The association believes transitioning to the new, 68,000 codes will place too much of a financial and administrative burden on physicians (especially small practices), and will ultimately force many of them to shut their doors.

Attending education sessions at AHIMA last fall left me with the impression that though learning the new codes and suffering through dual coding wouldn’t be fun, they would ultimately help physicians and hospitals receive proper reimbursement for their services. Yes, there were vendor cheerleaders on many panels, but the logic made sense even to a novice like me.

I realize that physician practices are quite a different kind of beast when it comes to handling administrative tasks, and I can certainly understand how a small practice would feel completely overwhelmed when, as the AMA stated in a letter to CMS, overlapping federal regulations combined with predicted Medicare pay cuts will make switching to ICD-10 a huge difficulty for them.

But I feel as if there’s a catch 22 here. If physicians don’t make the switch, they won’t see the potential financial benefits of more accurate coding. If they do make the switch, they’ll likely face such huge financial strains that they’ll opt to go out of business. Are there any physician readers out there who are cheerleading the ICD-10 switch?

It occurred to me, reading recently about the predicted banner year for physicians seeking hospital employment, that physicians that do decide to close their doors as a result of ICD-10 may contribute to this glut of MDs looking for work.

Perhaps there’s a domino effect waiting to happen – CMS stands firm on the ICD-10 deadline / Physicians work incredibly hard to try and make it happen. / Physicians fail and go out of business, or decide early on that it’s just not worth the trouble and close up shop. / Said physicians seek hospital employment. / There aren’t enough hospital jobs to go around and many MDs are left in the unemployment line.

That’s just one scenario I’ve been mulling over, and of course doesn’t take into consideration the large amount of other challenges facing physicians right now. What’s your take on the ICD-10 and physician staffing situation?

ICD-10 Implementations and EHR Workflow Optimization

These two topics don’t necessarily go together, but they were both short and sweet thoughts I’d written down at one of the many healthcare IT events that I’ve attended this Fall (Thankfully I don’t have any travel on my schedule until HIMSS).

Here’s the first one that was said by an EHR vendor:
“Not All ICD-10 Are Created Equal”

Obviously the idea here is that this EHR vendor believes that his EHR has produced a higher quality ICD-10 engine than many of the others he’s seen on the market. It’s interesting that an ICD-10 engine could be so different when the output is exactly the same (a number). Although, when you get into the complexities of how a doctor may go about finding the right ICD-10 code, it makes more sense. Maybe we need to have an ICD-10 lookup challenge with each EHR vendor at HIMSS 2013. Would be interesting to see the results.

This next one was an interesting insight info one of the side effects of meaningful use on EHR adoption. This came from a former hospital CIO and current hospital EHR consultant who said, “There’s no time to optimize as you go anymore, because you have to get to meaningful use to get the EHR incentive money.”

I wonder how many others have seen this change as well. I’ve no doubt seen the rush to implement EHR in order to show meaningful use and get access to the government money for EHR. It’s just unfortunate to think that the process is rushed by the dangling carrot. Rushing an EHR implementation can lead to very bad results in the long term. Many EHR users will be dissatisfied. EHR does not solve bad workflows. In fact, it often accentuates whatever bad workflows may exist.

Post a Comment(0)

December 11, 2012 I Written By John Lynn

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 15 blogs containing almost 5000 articles with John having written over 2000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 9.3 million times. John also recently launched two new companies: InfluentialNetworks.com and Physia.com, and is an advisor to docBeat. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and Google Plus.

Filed Under: ARRA EHR Electronic Health Record Electronic Medical Record EMR Healthcare IT Meaningful Use

Tags:EHR Adoption EHR Consultant HIMSS HIMSS 2013 Hospital CIO ICD-10 ICD-10 Lookup Meaningful Use Side Effects

ICD-10 Benefits for Population Health

I’ve asked many people why we haven’t had more stories on the benefits of ICD-10 since so many other countries have been using ICD-10 for many years.

In the following video I asked Doris Gemmell, BSc, MBA, CHIM, Director of Coding Services at Accentus Inc. about the benefits of ICD-10 to population health and she provided an answer from her ICD-10 experience in Canada.

You should also check out this video where Doris Gemmell talks about the patient benefits of ICD-10. Plus, Doris also has a blog.

Post a Comment(0)

November 13, 2012 I Written By John Lynn

Filed Under: Healthcare Healthcare IT ICD-10 Population Health

Tags:Accentus AHIMA AHIMA 2012 Doris Gemmell ICD-10 ICD-10 Benefits Population Health

And the #AHIMACon12 Winner Is …

… ICD-10 by a landslide. For those of you wondering whether “upcoding” might just steal 10′s thunder, it wasn’t meant to be. Providers and vendors alike brushed aside the phrase – some with a shrug of the shoulders, others with a roll of the eyes, and some with a “What did you expect?” The general consensus I gathered on the show floor was that technology such as electronic medical records enables doctors to code more accurately – not fraudulently. Everyone agreed that paper-based processes have for years resulted in doctors under-coding, and now that technology and workplace culture have caught up, those same doctors are finding it more efficient to code accurately, thus leading to more accurate, i.e. higher, reimbursement.

Speaking of reimbursement, John mentioned in a recent blog that ICD-10 is on the list when it comes to Top 5 Revenue Cycle Management Issues, and I couldn’t agree more. Talking with vendors and their physician customers at the show brought home to me just how fine a line providers walk when it comes to coding and revenue. As we move closer to Oct. 1, 2014, and the final push towards ICD-10, I am eager to see how these more granular, accurate codes play out in the revenue space. If a doctor codes more accurately in 10 (and hopefully provides quality care at the same time), and as a result sees higher reimbursements, will this somehow turn into a price increase that will trickle down to patients through payers? Where will the touted cost-effectiveness really come in? At any rate, I am definitely seeing the cause and effect relationship between coding and revenue more clearly as the ICD-10 deadline draws near.

ICD-10 was the focus of the only educational session I was able to attend, and it was well worth the time. “The Good, the Bad and the Reality: Lessons from the Frontlines of ICD-10 Implementation” featured the stories of Sutter Health, Vanderbilt University Medical Center and Deloitte Consulting. Both Danielle Reno from Sutter Health and Gary Perrizo from VUMC stressed strategy, education and testing in the run up to 2014. I got the impression from them and the physicians in the audience with me that though everyone is grateful for the extra time to make the switch, no one should be taking the time for granted. “Lollygagging” as I tell my children, is not advisable.

As you probably know by now, I’m a big fan of social media in the healthcare space, and I was very impressed with the efforts the AHIMA team took to incorporate social networking into just about everything – especially compared to last year. The attendees at AHIMA seem more like a Facebook crowd, and that was indeed the sentiment I heard from several vendors. That being said, I do think the tweet stream was more active than last year, probably due in large part to the @AHIMAResources team taking a proactive approach to socially marketing the event. I hear that next year (the event will be in my hometown of Atlanta) we’ll see the hashtag on all the slide presentations, which may encourage attendees to get in on the tweeting action.

Overall it was a fun, educational first trip to Chicago and second trip to AHIMA. (You can check out some of the more memorable images from the show below.) Seeing the sun rise and set over Lake Michigan in early Fall was a real treat. I hope that Atlanta will have equally spectacular vistas to offer next year.

AHIMA 2013 will take place in Atlanta Oct. 26-30.

This book caught my eye on the show floor. Anyone read it yet?

This picture does no justice to the spectacular views I had from the 95th floor of Chicago’s John Hancock building, thanks to the fun folks at Healthport.

The Precyse team flew a special member in just for the show.

The Friedman Marketing group was nice enough to hold another tweetup after show hours.

My coworkers presented me with a lovely birthday balloon bouquet from one of the two balloon artists on the show floor.

Post a Comment(0)

October 3, 2012 I Written By Jennifer Dennard

Filed Under: Electronic Medical Record EMR Healthcare

Tags:AHIMA AHIMA 2012 Danielle Reno Deloitte Consulting Electronic Medical Record EMR Gary Perrizo ICD-10 LinkedIn Sutter Health Upcoding Vanderbilt University Medical Center VUMC

Top 5 Revenue Cycle Management Issues

Like Jennifer, I’m going to be heading to AHIMA 2012 as well. She correctly identifies that ICD-10 is a major AHIMA topic and Upcoding is the topic de jour, but another topic which I think continues to sit under the radar at AHIMA is revenue cycle management.

In many ways this makes sense when you consider that the ICD-10 has such an influence on revenue. Upcoding is all about revenue. Even healthcare documentation is dominated by a discussion of its impact on revenue (Yes, we could discuss why this should be about patient care in a future post). While many don’t want to admit it, humans need to get paid to survive and they want to get paid as much as they can get. Last that I checked doctors were human.

What then are the challenges that doctors face with revenue cycle management (or revenue integrity which many like to call it)? Here’s a great list of RCM challenges as listed by Ruth Zwieg on LinkedIn:

1. Managing the revenue cycle of a practice starts with good Practice Management (PM) software; one that has an easy to use scheduling tool for the front desk and that can determine insurance eligibility before the patient arrives so that the practice can collect the correct co-pay and/or out-of-pocket expenses up front before seen by the physician. This increases A/R and saves time instead of spending resources collecting after the fact which is time consuming and expensive.

2. The PM software must be easy to integrate with their existing or new EMR so that the physician group can show meaningful use and get that incentive money. Many practices still think they have to get new Practice Management software when they start looking at EMRs and many EMR companies try to sway them this way so they can get the sale for their PM software and their EMR.

3. ICD-10 – Need I say more – you have written about this in detail. Some Practice Management systems have a coding assistant built in but most do not. Coding correctly determines payment.

4. Staff training is very important from the beginning of the revenue cycle (scheduling, verifying insurance) to managing the patient once he/she checks in to when the physician sees them to check out and billing/collecting. Just like every other business, time has to be managed and time is money, especially a physician’s time. The more efficient the staff and their use and understanding of the software, the more patients the physician can see.

5. Many hospitals have and still are purchasing physician practices because the physician either does not know the business side of running a practice or just wants to be on salary and get rid of the headaches. Billing for physician practices is different than hospital billing. Hospitals are realizing that their hospital staff may not be doing the best job of that. In addition, the hospitals are realizing that their hospital system’s EHR does not have the desired functionality that a physician group needs or worse, they have multiple physician practices all using different EMRs that the hospital now has to manage or integrate into one.

I find this list really interesting and does speak to many of the revenue challenges healthcare faces. If we could solve these five challenges we’d have done a lot of good for doctors.

Things EMR Doctors Never Say

Here’s a quick look at Things EMR Doctors Never say (maybe I’ve been watching too many late night shows):

“I’m so glad to be doing meaningful use!”

“I can’t wait until ICD-10 makes my life easier.”

“I wonder when that ACO model is finally going to kick in. I can’t wait.”

“I miss trying to read Dr. Smith’s handwriting.”

“I wish I could go and ask HIM for a chart pull.”

“I miss hiding behind the pile of paper charts on my desk.”

“I love this fax machine.”

“I miss the coffee stains on the paper charts.”

“I love the mix of EHR, EMR, HIE, ACO, ONC-ATCB, ICD-10, 5010, BI, with the RCM cherry on top.”

I’m sure I missed some. Please add more in the comments and I’ll add them to the list.

Study: ICD-10 Could Slam Operations

We all know physicians are dreading the ICD-10 deadline. Who wouldn’t be a bit blue around the gills if they had to switch from a system with 17,000 codes to one with about 141,000 codes? Now, a study by practice management vendor Nuesoft has given us some specifics as to just what worries them.

Nuesoft surveyed 480 physicians, administrators, office managers and billers in their survey, “Attitudes Toward the Transition to ICD-10 and ANSI-5010.” All told, they found that 96 percent of respondents were concerned about the transition, with 60 percent reporting that they were “highly” or “significantly” concerned.

As the Nuesoft chart below details, physicians are a bit freaked out over impact of ICD-10. As the chart below indicates, roughly one-third of the physicians questioned were “highly concerned” about the impact of the ICD-10 transition, and another 20-odd percent were “significantly concerned.”

Thirty percent of physicians expect that the ICD-10 transition will affect their operations very negatively, and 45 percent “somewhat negatively.” The results were more or less the same for the other categories, which included finances, staff state of mind and personal state of mind (physician).

Thanks to Nuesoft for delving further into the headache that will dominate medical practice for years to come. Now, though, Nuesoft, how about a follow up? What I’d love to know, personally, is what differentiates those doctors who weren’t worried from those that are. That could prove to be an eye-opener. Maybe we have something to learn from them?

P.S. Now, as a treat for those who made it to the bottom of this piece, here’s Nuesoft’s hip hop video on the subject:

Photo IDs as Part of the Patient Record – Flashy Trend or Future of Medicine?

Some time ago I read about the sad case of a toddler who underwent surgery for lazy eye correction, only the ophthalmologist “corrected” the good eye instead of the lazy one. Apparently she realized her error mid way and fixed the lazy eye as well. The child’s mother learned of this later.

I find many categories of lawsuits to be frivolous (that infamous hot, scalding coffee case anyone?) but if the parents ever had a strong case against a doctor, Jesse Matlock’s parents certainly did. But reactionary impulses aside, I’ve been thinking about how such errors can be prevented.

ICD-10 coding for example offers laterality info, but its implementation is still a-ways from becoming reality. Also ICD codes simply help you or your organization bill appropriately. If you need laterality information in any stage prior, you’re probably dependent on your trusty clinical notes.

Today Reuters had an article about patient photos as part of hospital records. Apparently it’s being tried at Children’s Hospital in Colorado. When a child is brought in for treatment, his or her digital image is added as part of the medical record.

Reuter reports that compared to 12 occurrences of mistaken orders in 2010 (in which treatment intended for one patient was performed on another) the number had fallen to 3 in 2011. All three of the cases involved children whose photos were not added to their medical records on arrival. There are similar feel-good statistics on near miss cases in which another worker caught a medical error put in place by a colleague (33 near misses in 2010, 10 in 2011).

The Reuters article notes CH, Colorado sees something like 13500 patients a year. The improvement in numbers after photo ids might not seem like much but each error prevented helps us gainthat much more confidence in our care providers. The article states that some parents refuse photo ids for kids out of privacy concerns. Let’s face it, this is for a loftier purpose than a child modeling. One workaround could be to discard the patient’s ID soon after the encounter is complete.

While the article doesn’t explicitly discuss laterality, that too could be a possible use for photo ids, if maybe the photo can be marked to point out surgery sites for example.

In terms of cost, digital photography has never been more affordable than now. For a couple of hundred dollars you can buy a good quality digital camera and its needed accessories. Basic photo editing software can assist with keeping image sizes manageable. The big downside I see is that it increases the workload somewhere along the encounter – someone needs to take these pictures and upload them, and knowing how things roll downhill, it might well be the already harried nurses and aides.

But the payoffs to quality healthcare could be enormous. So what do you think – has the time come for this idea?

Must-See Sessions, Exhibitors at HFMA #ANI2013

Great & Powerful Oz Grants Kansas PHR Access

Call to Halt ICD-10 Puts New Angle on Demand for Physicians

ICD-10 Implementations and EHR Workflow Optimization

ICD-10 Benefits for Population Health

And the #AHIMACon12 Winner Is …

Top 5 Revenue Cycle Management Issues

Things EMR Doctors Never Say

Photo IDs as Part of the Patient Record – Flashy Trend or Future of Medicine?

Top EMR & EHR Posts

Calendar

Recent Posts

EMR and EHR Resources

Recent Comments

Categories

June 2013
M	T	W	T	F	S	S
« May
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30