Monday, July 16, 2018

Small Practice

Small Practice

Zen and the Quest For Quality

21

Screen Shot 2014-08-21 at 11.45.17 AMCelebrating its 40 anniversary this year, Robert M. Pirsig’s Zen and the Art of Motorcycle Maintenance bears several distinctions.  It is listed in the Guinness Book of World Records as the eventual bestseller that was rejected by more publishers than any other, 121.  It went on to sell more than 5 million copies, making it the most popular philosophy book of the past 50 years.  And it focuses on a truly extraordinary topic, which its narrator refers to as a “metaphysics of quality.”

Quality is a hot topic in healthcare today.  Hospitals and healthcare systems are abuzz with the rhetoric of QA and QI (quality assessment and quality improvement), and healthcare payers including the federal government are boldly touting new initiatives intended to replace quantity with quality as the basis for rewarding providers.  Yet as Pirsig’s narrator, Phaedrus (see Plato’s dialogue of the same name), comes to realize, quality is very difficult to define.

In fact, giving an account of quality is so difficult that it drove Zen’s author mad.  And this is a man whose IQ, 170, would make him one of the most intelligent people in any health system.  The problem, of course, is that there is a big difference between intelligence and wisdom, and in the quest for wisdom, mere intelligence often leads us dangerously astray.  Something similar is happening in healthcare today, where schemes to improve quality often precede sufficient efforts to understand it.

For example, we seek to gain greater control over healthcare outcomes through measurement, only to discover, to our chagrin, that people are massaging the data to meet their numbers.  We create new programs intended to increase patient throughput, only to discover unintended perverse effects on the quality of relationships between patients and physicians.  Initiatives intended to reduce error rates turn out again and again to stifle innovation.

Death By Documentation

2

In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress.

In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.

1. EMR – especially if you use multiple EMR software programs that don’t talk to each other

2. Dealing with lab reports and refill requests

3. Returning patient and consultant calls and documenting them adequately and all the other places information streams have to be forced together by the sweat of your brow.

The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.

How much more time will ICD-10 take?

A Radical Policy Proposal: Go Easy On Older Docs

5

flying cadeuciiThrough Dec. 15, federal regulators will accept public comments on the next set of rules that will shape the future of medicine in the transition to a super information highway for
Electronic Health Records (EHRs).  For health providers, this is a time to speak out.

One idea:  Why not suggest options to give leniency to older doctors struggling with the shift to technology late in their careers?

By the government’s own estimate,in a report on A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure, a fully functioning EHR system, for the cross-sharing of health records among providers, will take until 2024 to materialize.The technology is simply a long way off.

Meanwhile, doctors are reporting data while the infrastructure for sharing it doesn’t exist.  Now, for the first time, physicians will be reporting to the federal government on progress toward uniform objectives for the meaningful use of electronic health records.  Those who meet requirements will be eligible for incentive payments from Medicare and Medicaid, while those who don’t may face penalties. In addition, audits are expected to begin in 2016.

A Powerful Tool For ICD9-ICD10 Conversion

0

Screen Shot 2015-06-19 at 6.19.20 PM

Prior to attending medical school, Parth Desai took a gap year to help his mom manage his dad’s small internal medicine practice.  She was worried about how she was going to handle the looming transition from ICD-9 to ICD-10.  Parth said he would help her out.

He looked at different consultants and programs, but they were all too complicated, too expensive, or both.  He also looked at a number of different ICD-10 training programs, but didn’t really find anything that he thought was that good.  He wanted help with code conversions, but everything he saw was slow, or required additional personnel, or was too costly.

So, he did what lots of entrepreneurs do, he decided to build what he needed himself.  He enlisted his former college roommate, Will Pattiz, a “tech whiz, outdoor enthusiast, and filmmaker” to help him and together they developed software that automates the conversion of ICD-9 to ICD-10 codes. 

How I Use P4 Medicine to Maximize Patient Engagement

0

Molly MaloofThe healthcare industry is changing as new models of care and reimbursement emerge. One of these approaches is P4 Medicine. P4 Medicine stands for predictive, preventive, personalized, and participatory. This approach deeply resonates with me because the philosophy is aligned with how I have been developing my medical practice, which is focused on optimizing health and avoiding disease. In my opinion, P4 Medicine is one of the best models for maximizing patient engagement.

The earliest manifestation of P4 Medicine began eight years ago at the Institute of Systems Biology when Dr. Lee Hood, MD, PhD, a physician scientist and creator of the automated gene sequencer, recognized that the application of systems biology to medicine would fundamentally alter our understanding of health and disease. This model has merged three powerful aspects of science and technology:

My Doctor Just Gave Me His Cell Phone Number …

15

flying cadeuciiThat’s right…it really happened.

At the conclusion of a recent doctor visit, he gave me his cell phone number saying, “Call me anytime if you need anything or have questions.”

In disbelief, I wondered if this was a generational thing – and whether physicians in their late thirties had now ‘gone digital’.

My only other data point was our family pediatrician, who is also in her late thirties. Our experience with her dates back nearly seven years when my wife and I were expecting twins.  A few pediatricians we met with mentioned their willingness to correspond with patients’ families via email as a convenience to parents.  The pediatrician we ultimately selected wasn’t connected with patients outside of the office at that time, but now will exchange emails.

Surviving the Affordable Care Act Grace Period

0

Screen Shot 2015-04-16 at 10.39.10 AMSince the first open enrollment in 2014 more than 11 million people have gotten coverage through the insurance exchanges established through the Affordable Care Act (ACA). While the plans offered through the exchanges are provided by the same insurers you deal with every day, there are some differences.

The biggest one is the 90-day grace period. As we near the end of the grace period for 2015, many practices are still struggling to manage the ins and outs to ensure they get paid. Here’s why.

When a person goes into the exchange to select a policy, they get a 90-day grace period to pay premiums. This grace period is between the insurance company and the policy holder. As with other coverage, when the patient makes an appointment and/or goes to the doctor, he or she shows the insurance card. When the practice verifies eligibility, it shows that the patient is covered. If the patient comes into the office during the grace period, the claim will go out as usual and get paid. However, if the patient did not pay their premium during this grace period, the insurance company will come back to the practice and ask for the money back. Then, the practice has to bill the patient directly. This is difficult for providers for many reasons, not the least of which is that the longer it takes to bill a patient, the lower the chances of getting paid.

As a provider you may feel a strong reaction to this 90-day grace period and want to wait to see patients until the grace period is past. This is probably not realistic. Patients need care, and you need to have a positive relationship with your patients. So, here are a few steps to help manage the grace period and ensure you get paid:

  1. If the patient is in this grace period, ask them to bring proof of payment of their premium (cancelled check or receipt of some kind).

  2. If the patient cannot provide this, have them pay at least 50% of the billed charges at the time of service.

  3. Have patients sign a contract that states that they will pay the charges if the payer denies them or asks for the payment back after services are rendered.

  4. Implement a credit card on file option. Patients provide a credit or debit card and sign a contract that it can be charged up to a specified amount (i.e., $150). If the payer denies the claim or asks for the payment back, the practice can charge the card and send a receipt to the patient.

Over 30% of physicians believe that the largest barrier to good healthcare is inadequate insurance coverage. So it is no wonder that over 40% of physicians also believe that the Affordable Care Act is mostly good and a similar number are accepting exchange plans. However, this doesn’t change the fact that the new plans come with challenges.

As a small business you can’t really afford to wait too long to get paid, or worse, have to return payments and then wait again. By implementing some simple steps now you can help reduce the headaches of exchanges plans in the years to come.

Kathleen Young is the CEO and co-founder of Resolutions Billing & Consulting, Inc., which was founded in 2003. Kathleen is also the owner of Healthcare Chart Audits, which offers auditing to physicians and attorneys. Kathleen has been in healthcare since 1989 and has worked for physicians, large corporations and three billing companies. Kathleen is a CPC and a CPMA with the American Academy of Professional Coders and speaks to many groups on coding, billing, and auditing.

 

Being Graded

7

Munia Mitra MD“Lawyers aren’t graded.”

“CEOs aren’t graded”

“How would you feel if I tracked every e-mail you sent and tracked how many people responded to them? You wouldn’t like that very much would you?”   

“The people who make EMRs. Why aren’t they graded?”

If there’s one negative I hear time and time again from doctors when the subject of quality measurement comes up, it’s this one near-universal complaint. The world is unfair, the cards are stacked against us.

As a specialist at a busy urban medical center I hear the complaints almost every day from colleagues and peers at other hospitals. We’re being singled out for unfair treatment:  They’re out to get us. It’s the world against the doctors.

Many of the so-called experts I’ve talked to at meetings around the country express disdain when the topic of physician resistance to quality improvement programs comes up.

But it shouldn’t be terribly surprising that the idea that one’s performance is being tracked can be seen as intrusive and threatening. The reaction is in many ways completely predictable.

When it Comes to Healthcare IT Success Stories, Don’t Count out the Little Guy

0

Tom GuillaniToday’s healthcare information technology headlines are littered with how large delivery networks are scaling up and successfully building and using IT infrastructure. But the real success story is hiding in the shadows of these large enterprise deployments, in the small and independent practices across the US. The recent ICD-10 transition, that had been foretold to drive small enterprise into financial despair due to their lack of IT savvy and infrastructure, has shown just the opposite. A report from a leading provider of billing software that was based on government and private payer claims analysis for the past 30 days shows a different story.