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Medical Groups Struggling To Collect Payments Promptly

Posted on August 18, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Particularly as patients assume responsibility for more of the costs of care, it’s getting harder for providers to collect on outstanding bills.

My recent look at a dashboard created by the Medical Group Management Association certainly underscores the point. The story it tells is a grim one. Despite their best efforts, few practices are succeeding at meeting RCM challenges.

The MGMA intends the dashboard, which focuses on the number of days bills spend in Accounts Receivable, to give medical groups some benchmark RCM data. It relies on data from the group’s 2016 DataDive Cost and Revenue study, and allows users to view (at no cost):

  • Mean percentages of accounts receivable aged 0-30 days, 31-60 days, 61-90 days, 91-120 days and over 120 days
  • Mean days gross fee-for-service charges in A/R
  • Meeting days adjusted fee-for-service charges in A/R

It also allows users to select a specialty group type, including primary care, nonsurgical, surgical and multispecialty practices and look at their specific profile.

For example, the dashboard reveals that roughly 50% of accounts held by primary care practices spent a mean of 0-30 days in A/R, 11.2% of accounts were aged 31-60 days, 6.9% were at 61-90 days, 6.2% stayed in A/R for 91-120 days and 25.4% for 120+ days in A/R.

The MGMA page also stated that primary-care groups had an overall average of 61.86 adjusted days in A/R and 35.60 gross days in A/R.

Does that sound depressing? Well, it should. What’s more, other specialties’ performance was nearly as bad in some categories and even worse in others.

Look at the performance of nonsurgical groups. Only 44.7% of nonsurgical groups’ revenue came in within 30 days in A/R or less, almost 13% of accounts averaged 31-60 days before being paid, and almost 15% of accounts spent between 61 and 120 days in A/R. Twenty-eight percent of accounts had a mean 120+ days in A/R before being satisfied.

The other stats were even worse. For example, nonsurgical groups’ accounts spent a mean of 88 days in A/R and 46.2 gross days in A/R. Not very encouraging.

Even well-paid surgeons weren’t exempt from this problem. Most of the account aging stats were distributed similarly to the other specialty areas, and only 28.2% of accounts in this area spent more than 120 days in A/R. However, adjusted days in A/R came in at 136.7 and gross days in A/R at 54.

Meanwhile, the tally for multispecialty groups was a bit better, but not much. Account aging benchmarks were very similar to primary care practices, and adjusted days in A/R came in at 69.4.

Most of you probably had an idea that medical groups were facing these kind of collection problems, even if you didn’t have these benchmark numbers in hand. The thing is, they were even worse than I feared. (An acquaintance working in medical billing called the results “comical.”)

I don’t know what percentage of the accounts in question were self-pay, but given that self-pay is becoming a steadily higher proportion of medical practice revenue, these stats are pretty bad news. Something’s gotta give eventually. Plus, we’ll have to keep tracking how this data trends over time.

Few Practices Rely Solely On EMR Analytics Tools To Wrangle Data

Posted on May 23, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new survey done by a trade group representing medical practices has concluded that only a minority of practices are getting full use of their EMR’s analytics tools.

The survey, which was reported on by Becker’s Hospital Review, was conducted by the Medical Group Management Association.  The MGMA’s survey called on about 900 of its members to ask how their practices used EMRs for analytics.

First, and most unexpectedly in today’s data-driven world, 11 percent of respondents said that they don’t analyze their EMR data at all.

Thirty-one percent of respondents told MGMA that they use all of their EMR’s analytical capabilities, and 22 percent of respondents said they used some of their EMR’s analytics capabilities.

Another 31 percent reported that they were using both their EMR’s analytics tools and tools from an external vendor. Meanwhile, 5 percent said they used only an external vendor for data analytics.

According to Derek Kosiorek, CPEHR, CPHIT, principal consultant with MGMA’s Health Care Consulting Group, the survey results aren’t as surprising as they may seem. In fact, few groups are likely to get  everything they need from EMR data, he notes.

“Many practices do not have the resources to mine the data and organize it in ways to create new insights from the clinical, administrative and financial information being captured daily,” said Kosiorek in a related blog post. “Even if your practice has the staff with the knowledge and time to create reports, the system often requires an add-on product sold by the vendor or an outside product or service to analyze the data.”

However, he predicts that this will change in the near future. Not only will EMR analytics help groups to tame their internal data, it will also aggregate data from varied community settings such as the emergency department, outpatient care and nursing homes, he suggests. He also expects to see analytics tools offer a perspective on care issues brought by regional data for similar patients.

At this point I’m going to jump in and pick up the mic. While I haven’t seen anyone from MGMA comment on this, I think this data – and Kosiorek’s comments in particular – underscore the tension between population health models and day-to-day medical practice. Specifically, they remind us that doctors and regional health systems naturally have different perspectives on why and how they use data.

On the one hand there’s medical practices which, from what I’ve seen, are of necessity practical. These providers want first and foremost to make individual patients feel good and if sick get better. If that can be done safely and effectively I doubt most care about how they do it. Sure, doctors are aware of pop health issues, but those aren’t and can’t be their priority in most cases.

Then, you have hospitals, health systems and ACOs, which are already at the forefront of population health management. For them, having a consistent and comprehensive set of tools for analyzing clinical data across their network is becoming job one. That’s far removed from focusing on day-to-day patient care.

It’s all well and good to measure whether physicians use EMR analytics tools or not. The real issue is whether large health organizations and practices can develop compatible analytics goals.

MGMA Raises Meaningful Use Stage 2 Concerns

Posted on August 26, 2013 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Becoming another of several groups asking for Meaningful Use changes, the head of the Medical Group Management Association has written a letter to HHS outlining several concerns the group has with Meaningful Use Stage 2.

In the letter, which was addressed to HHS Secretary Kathleen Sebelius, MGMA President and CEO Susan Turney raised several issues regarding the ability of her members to step up to Stage 2. She argued that physicians have a “diminished opportunity” to achieve Stage 2 compliance, and that as a result it would be unfair to impose Medicare reimbursement sanctions on her members. Turney argues that HHS should institute an “indefinite moratorium” on practices that have successfully nailed Stage 1 Meaningful Use requirements.

Why should HHS give practices a break?  The reason, she says, is that vendors are proving slow to produce Stage 2-certified products, leaving medical practices in the lurch. At the time of writing, Turney said, there were only 75 products and 21 complete EMRs certified for Stage 2 criteria, a small fraction of the more than 2,200 products and nearly 1,400 complete EMRs certified under 2011 criteria for ambulatory eligible professionals.

With vendors largely not ready yet to help practices through Stage 2, practices are likely to have little time to work on software upgrades or expect timely vendor support, she notes. And worse, EPs who invested big in Stage 1-certified EMRs might need to “rip and replace” them for a new one certified to meet Stage 2 if they want to avoid Medicare reimbursement cutback deadline.

On top of all of this, she notes, many practices are having to wait in line for Stage 2 upgrades of their EMR product behind practices adopting  an EMR for the first time. The wait is lengthened, meanwhile, by vendors’ attempts to cope with ICD-10 support, whose Oct. 1, 2014 deadline falls right in the middle of preparations for Meaningful Use Stage 2.

Turney makes a lot of sense in her comments. The vendor market clearly isn’t going to be able to keep up with ICD-10, MU upgrades and new installation within the same time period. I don’t know if an indefinite moratorium on Medicare penalties is the right policy response, but it should certainly be given some thought.

After all, punishing doctors who drop out of Meaningful Use due to factors beyond their control isn’t going to help anyone, either.

EHR Experiences – One Clinic’s Road to Meaningful Use

Posted on July 14, 2011 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.

Our next edition of EMR and EHR interviews covers the experience of Jan Patterson and the West Broadway Clinic’s path to meaningful use. The full EMR interview with Jan Patterson can be found on the new EHR and EMR interviews website. The following is a summary of that interview written by Kathy Bongiovi.

If you’re a doctor, nurse, practice manager, EHR consultant, CEO or executive of an EHR vendor, etc with EMR experience that’s interested in being interviewed, let us know on our Contact Us page.

West Broadway Clinic is one of the first clinics to show Meaningful Use. Jan Patterson, the office manager of West Broadway Clinic explained it was the clinic’s desire, from day one, to start using an EHR. The EHR certification is a vital piece for meeting the CME incentive requirements. Additionally the providers felt by using an EHR on day one they could ensure a continuity of care, regardless of which provider a patient might see in the clinic.

The clinic had heard about Cerner Corporation through one of the local hospitals. After interviewing several other vendors it felt that the integration of Cerner’s Practice Management System and Ambulatory EHR would suit its needs best.

West Broadway began using its EHR in May of 2008 and Patterson stated it was able to meet at least 9 of the meaning use requirements because of its EHR. Patterson felt two of the major factors contributing to meeting those requirements so easily were the elements already built into the EHR and the use of the Cerner EHR. As the clinic encountered issues it was able to contact Cerner’s Meaning Use team to assist in the process of attestation.

Additionally, attending Webinars set up by Cerner Corporation, examining materials provided by Medical Group Management Association (MGMA), and attending an MU Summit set up by Cerner Corporation to highlight some of the more important segments of MU, all played an integral role in ensuring West Broadway Clinic would meet Meaningful Use requirements.

The most challenging Meaningful Use requirement was encouraging all of the providers to use the electronic prescriptions function. After reaching MU in just over three months, just two days after attestation opened, Jan Patterson states the clinic continues to maintain its high level of entering the patients’ correct and necessary data and the numbers of electronic prescriptions being sent to pharmacies are increasing.

The benefits to patient care are immediate access to the most current visit information and patient history at its finger tips. Patients receive more continuity of care due to the fact that regardless of what provider they are seeing within their office , the provider can quickly and easily track what services and/or medications a different provider has provided the patient. Components such as eprescribe, medicine/drug interactions, allergy checks, complete documentation, immunization schedules and growth charts etc., have made the clinic more efficient throughout the office.

Patterson’s advice to anyone starting the MU process is to make sure you have gathered all the information and facts first and ensure all physicians/staff are not only fully advised of what is required to meet MU but are also committed to following the process through to its completion. It is important they understand the benefits and necessity of Meaningful Use. After three years of being on an EHR, Patterson cannot imagine functioning as efficiently on a paper system. Although Patterson acknowledges the money as an incentive, the real benefit in successfully attesting is the benefit to their patients. As Patterson suggests, “The increased benefits of safety cannot be undersold. With the assistance of the EHR, we are practicing better, safer medicine than we could on paper records.”

Read the full transcript of Jan Patterson’s interview.