By Matthew Oldham, vice president of engineering, Graphium Health.
Matthew Oldham
Over the course of my career, working in a variety of industries, I have developed certain design patterns when modeling data that guide my approach to tackling a new data domain. One simple example is how I choose the right data type for a given value an application will capture.
While it may sound straightforward, interesting nuances can quickly surface during the data modeling step that necessitate a shared language and vocabulary between the functional experts and the software engineers. In other words, we need to figure out how to work together and speak the same language in order to solve the problem well.
The importance of nuanced semantics may be illustrated with the example of how an anesthesiologist documents the administration of an antibiotic. . The type and timing of antibiotic administration is a key metric that anesthesia providers have historically had to report to Centers for Medicaid and Medicare Services (CMS) since it correlates with both patient outcomes and healthcare costs.
As I analyzed the paper anesthesia record used, I noticed an “antibiotics” checkbox, accompanied by an antibiotic name, an amount, a unit of measure, and the route of administration. These all made sense to me, and I proceeded to incorporate these concepts into my data model. For the antibiotics checkbox, I naively interpreted it as a simple boolean value, and I named it Antibiotics Administered Indicator. In my mind, that simply indicated that the antibiotic denoted on the form was either administered (true), or not administered (false).
During a review of the model, I learned that a clinician interprets this checkbox to mean an “indication for antibiotics”; in other words, antibiotics were or were not determined as a necessary course of action given other clinical conditions. A true value didn’t mean that antibiotics were administered, only that they were indicated, and thus needed to be given. That is obviously a completely different understanding than the one at which I had arrived. Needless to say, this was eye opening for me, even having been down the road of developing a functional understanding of data domains many times before.
The illustration highlights the importance of having both functional (i.e., the doctors) perspectives and technical perspectives present and engaged during software design. A purely technical survey of a subject area will certainly be valuable, and in some cases may provide decent coverage in terms of establishing a foundational understanding of that domain. In most cases, however, a functional perspective will also be required to complete the picture and add the necessary insight required to create an accurate and intuitive user experience.
In fact, healthcare may serve as the poster child for just how challenging, complex, and unforgiving software design can be. Clinician dissatisfaction and fatigue with existing electronic health report software is well documented, and the explanations are plentiful: failed interoperability, difficult user experience, inefficiency with simple tasks, onerous data capture burden, etc. Perhaps the common denominator is a failed understanding of complex and poorly defined clinical workflows being interpreted and standardized in software by technical experts working in isolation. The real issue here is that foundational errors propagate as the software evolves, and there is no easy way to reverse course once construction begins.
Anesthesia billing can be tremendously complicated. Small errors can result in delays and a failure to collect. To improve revenue cycles, we’ve compiled some key ideas that will make an impact on your billing and collections.
#1: How is the charge established?
There are a number of factors that can affect anesthesia billings, but the process can be broken down to a relatively simple formula. Charges are established by adding base units, time units, and modifiers, and then multiplying by your fee per unit. In other words:
(Base Unit + Time Units + Modifiers) x Fee Per Unit = Charge Amount
#2: Accurate Start and Stop Times
The industry follows Medicare’s definition for anesthesia billing start and stop times. Anesthesia billing start and stop times are based on the continual presence of an anesthesia provider. It is critically important to record accurate start and stop times. Do not round your time, and never guess when the start or stop time was.
#3: Understanding Billing Modifiers
Billing modifiers can have a big impact on your charge amounts. There are a number of modifiers that come into play including physical status, medical direction, anesthetic type, and add-on codes. These modifiers can affect your charge amounts in a variety of ways so it’s important to understand each modifier and the role they play in billing.
#4: Documentation is critical
Accurate documentation is the difference between success and failure in generating cashflow. You can have the best systems available, but if the information that you feed into the system is inaccurate or incomplete, your billings and collections will suffer. Pay close attention to your start and stop times and record them accurately. Keep up with the billing modifiers that we discussed in #3. If you log these accurately, your revenue cycle management is set up for success.
In response to the rapid rise of community-based healthcare programs around the country, Graphium Health is leveraging its history in developing intelligent software for healthcare professionals to launch FieldMed, a dedicated community health software platform. The new software is the first of its kind to offer paramedics readily accessible, accurate and HIPAA-compliant data capture capabilities to better serve patients in community health programs.
Community health paramedicine is community-based healthcare that utilizes certified paramedics to facilitate non-emergent response resources and treatments in the home of patients. Created in an effort to close the gap between 911 emergency response and home healthcare, community health programs provide efficient and effective patient care, while reducing emergency calls, hospital readmissions, and overall costs to cities, fire departments, hospitals and patients. Programs are currently active in over 500 cities nationwide.
Through FieldMed’s intelligent software, community health programs are empowered with in-depth patient data and trends, such as vitals and labs, food and shelter needs, and environmental risks, allowing paramedics to know and understand their patients better than ever before and deliver focused care for the patient’s unique needs. With FieldMed’s reporting capabilities, community health programs can provide enhanced patient care, while reducing lost hours and resources for paramedics, city fire/EMS departments and hospitals.
“Having served as a community health paramedic, I’ve seen the need for this software first-hand, as it allows paramedics to track data points that previously didn’t exist in other EMR systems,” said Daniel Frey, co-founder and vice president of business development at FieldMed. “FieldMed is delivering a groundbreaking advancement for community health programs, now empowering paramedics to access and track patient data to provide the best possible care. Instead of an automatic trip to the hospital, paramedics can now better track the root of 911 calls, particularly for non-emergent needs, such as food, shelter, environmental risks, and more.”
FieldMed was created by a team of experienced paramedics alongside the founders of the healthcare software provider Graphium Health, who developed intelligent anesthesia technology that advances how practices operate by providing automated data capture, MACRA-compliant reporting, and billing integrations.
Daniel Dura
Daniel Dura, co-founder and CEO of FieldMed and Graphium Health, added: “Through our work with Graphium, we saw an immediate need in the healthcare industry for a software platform to streamline community health patient care. FieldMed is transforming community healthcare by creating technology that allows providers to capture rich data which, in turn, helps them to prioritize patient care. This leads to better patient outcomes, better use of city and hospital resources and overall creates better communities.”
Randy Barker, co-founder of FieldMed and Graphium Health, continued “In our work, we want to create real solutions that make a lasting difference for not only the healthcare providers, but ultimately for the patients. Community health programs are revolutionizing emergency responses for both paramedics and patients, and coupled with FieldMed’s innovative software, the opportunities to enhance patient care and reporting capabilities are endless.”
FieldMed is now available nationwide and offers a variety of pricing structures based on specific program needs. To learn more about FieldMed and the software’s capabilities, visit www.fieldmed.com.
