Guest post by Tom Giannulli, MD, MS, chief medical information officer, Kareo
Quality assurance (QA) in healthcare is exactly what the name implies — the process of implementing programs to improve and assure quality care for patients. In a hospital, these programs are often quite robust and monitored closely, but in a small practice, the picture can be quite different.
Smaller practices have limited resources and staff. There is already a huge burden to stay compliant in so many areas while keeping up changes to reimbursement and other programs like meaningful use. Often, there isn’t much time left over for QA.
Unfortunately, measuring and monitoring patient satisfaction and outcomes is becoming more important as reimbursement shifts to a more value-based model and patient expectations change. Whereas patients once stayed with the same doctor forever, now the majority would change providers for a wide range of reasons. While 80 percent of healthcare providers think that patients depart because of relocation or change in insurance, the reality is far different. Nearly 60 percent of patients switch physicians because of better service or treatment from a new provider.
For practices that are stretched for time, dollars and staff, technology can play a valuable role in improving the patient experience, compliance, and outcomes. Ultimately as the industry shifts to value-based reimbursement it can also help the practice improve revenue. Here’s how:
Let’s face it, return on investment (ROI) for an electronic health record (EHR) has been has been a rainbow unicorn kitty for practices over the years. Some studies have indicated that many practices don’t see positive returns for years if ever while others show very positive results of increased revenue per full time provider and ROI in as short as two and half years.
Why the big variation? It’s hard to say for sure but some of the factors may be practice size, type of EHR, and looking for the ROI in the right places. According to the Physicians Practice 2014 Technology Survey, sponsored by Kareo, over 40 percent of practices have seen a return on their investment from their EHR.
Some of the places they are seeing financial rewards may be old news but others could be a surprise.
CMS Incentives
It will come as no great shock that practices that got on board with PQRS and meaningful use at the beginning have reaped some financial benefits. The full incentives for MU early adopters was $44,000, and they avoid any penalties. For the past several years one of the top three reasons physicians cited for changing or adopting and EHR was qualifying for incentives.
The incentives are gone but the penalties are still in play. If you haven’t started yet, you will have reductions in your Medicare payments starting this year, but that doesn’t mean you shouldn’t get on board. If you serve a large portion of Medicare patients it may make sense to attest for MU to avoid further penalties.
Reducing Expenses
The ability to cut costs has always been a bugle call for EHR, and nothing has changed. You can cut costs and streamline with an EHR. The key is to ensure it is implemented correctly with the right workflow, that everyone is onboard and using it the way they are supposed to, and you let go of paper as much as you can.
When you do that, you can save anywhere from $5 to $8 per new paper chart along with ongoing savings on paper, toner, and printer and fax equipment. They are seeing so many benefits from the EHR, they’d never go back now. Eric Pokky, practice manager at Total Healthcare for Women, says about 20 percent of their patients are new and those charts run $5 at their practice. With 15 new patients a week, that is a savings of around $300 a month.
When physicians maximize the EHRs documentation tools, you can also cut transcription significantly or all together. Transcription has been estimated at as much as 11 percent of total collections so that is a substantial savings. For a primary care provider who brings in $300,000 a year, that is a savings of more than $30,000 alone.
I remember when the Health Insurance Portability and Accountability Act (HIPAA) passed. I was working for a leading practice management software vendor. Everyone was overwhelmed by what was involved. We developed a huge amount of education and information for our customers. Some people wondered if the healthcare industry could make such a major change.
Today, HIPAA is ubiquitous. Many practices take it for granted. They are not concerned about a breach because they believe they have done everything they need to do. In a recent study by MedData Group of physicians top practice management priorities for 2015, HIPAA didn’t even make the list.
“We instigated HIPPA when it came out, and it is in place and second nature to us,” said Joann Lister, a provider at a family medicine practice in Texas. “We have all worked at the hospital so we had plenty of training on the rules. Our physical space and computers are confidential. Our practice management and EHR software, Kareo, always goes back to login when we are done in a room so the next patient does not see anything. We have limited personnel so it is easier to know that everyone honors the HIPAA rules.”
The question is: Have practices gotten too complacent with HIPAA? With the latest changes to HIPAA in 2014, have they followed through on making changes and updates? The data and experience of industry experts and consultants suggests that there may be a problem with HIPAA compliance.
“The last analysis we did for a practice had 41 pages of regulations that required implementation,” recalled practice management consultant Rochelle Glassman, CEO of United Physician Services. “Most practices do not know what the complete requirements are. They believe that if they have the patients sign the privacy form that is all they need to do. This year there were updates that included the new HITECH Act and the HIPAA Omnibus rule. I can guarantee that many practices have not updated their HIPAA program to include the changes because they do not even know they exist.”
Guest post by Tom Giannulli, MS, MD, chief medical information officer, Kareo.
It seems like everywhere you look there is a new piece of wearable technology to help people monitor their health and lifestyle. The latest and greatest, of course, is the Apple Watch, which hit the newswire with a bang last month.
There is no doubt that mobile health apps and wearable technology and devices are big business. Both patients and clinicians are using mHealth apps on their smartphones and other devices. There are tens of thousands of these apps, and the Robert Wood Johnson Foundation says this number will grow by 25 percent a year. Their research also shows that by 2018 1.7 billion people worldwide will download a health app.
Despite what the media may say, the fact is most people aren’t using these apps and devices yet according to a new study from Technology Advice. Their research found that nearly 75 percent of adults do not track their weight, diet, or exercise using a fitness tracking device or app and most cited reason was general lack of interest.
However, one interesting thing to note is that more than half said they would be more likely to use a health tracking app or device if there was a possibility of lowering their insurance premiums. Just over 40 percent said better advice from their healthcare provider would be a possible incentive to use a fitness tracker.
Guest post by Lea Chatham, content marketing manager, Kareo.
In the recent Physicians Practice Technology Survey, sponsored by Kareo, there are two trends that bode well. First, the majority of practices surveyed were independent, and second, there were more positives about EHRs than negatives. It looks like things are finally heading in the right direction.
Ongoing EHR Concerns Linger
That isn’t to say that practices don’t continue to have concerns, however. Nearly 20 percent of those surveyed still don’t have an EHR. The barriers? Implementation, interoperability and cost. And implementation of EHRs is cited as the top technology challenge for practices.
“The transition to an EHR can be hard, especially when practices choose the wrong system the first time and have to go through the process twice,” explains Laurie Morgan, senior partner at Capko and Morgan, a practice management consulting firm. “So it is really important to make the right choice. What we have seen is that the practices that have been on a good system for while do see the value and the workflow benefits. It just takes some time.”
On the flip side though, 57 percent are happy with their choice of vendor, which may mean that we will start to see a slowdown in EHR switching, giving providers a chance to focus on patient care and building their practices. In addition, more than 40 percent say they have seen a return on investment, and even more cite an improvement in efficiency.
For those who are unhappy with their EHR, this is a clear sign that better technology is out there. It is a matter of making sure to choose the right one and implement it correctly. “There are several steps practices can take to make sure they get the right EHR at the right price,” says Tom Giannulli, MD, MS, chief medical information officer at Kareo. “These days most of the affordable cloud-based EHRs will have the basic features so it often comes down to a few special needs and the implementation and training. To help improve satisfaction with the EHR it is really important to take advantage of all training and support and invest the time to get familiar with the system.”
ICD-10 has been delayed. Change has been left unchanged. The can has been kicked down the road by politicians in Washington, despite a great deal of opposition from those in healthcare. Of course, opposition to the delay seemed to matter little as it was voted upon, and passed, as part of the broader SGR patch.
Athenahealth, one of the better known vendor names in the health IT landscape issued the following statement in reaction to the news of the delay of ICD-10 for another year to October 2015. Ed Park, executive vice president and chief operating officer, athenahealth, said: “It is unfortunate that the government has once again chosen to delay ICD-10. athenahealth and its clients are/were prepared for the ICD-10 transition, and in fact we have national payer data showing that 78 percent of payers are currently proving readiness in line with the 2014 deadline. The moving goal line is a significant distraction to providers and inappropriately invokes massive additional investments of time and money for all. The issue is even more serious when considered in association with another short-term SGR fix and 2013’s meaningful use Stage 2 delay. It is alarmingly clear that healthcare is operating in an environment where there is no penalty for not being able to keep pace with necessary steps and deadlines to move health care forward. Our system is already woefully behind in embracing technology to drive information quality, data exchange, and efficiency, and delays like this only hinder us further.”
Sharp words, but appropriate. It’s nice to see a vendor come out and speak some truth, at least as they see it. Despite the somewhat shocking and seemingly inappropriate delay of ICD-10, it’s clear the waiting will continue for the new deadline.
Athenahealth is not alone. Others feel similarly about the delay. The following are responses from several healthcare practitioners and their partners about the ICD-10 delay. They provide some interesting insight about the move from October 1, 2014, to 2015 and express disappointment and, in some cases, anger about the postponement.
Michele Hibbert-Iacobacci
Michele Hibbert-Iaccobacci, vice president of information management and support, Mitchell International
ICD-8 was not an industry standard, so when ICD-9 was introduced, it was a huge undertaking to try and get people trained. For the ICD-10 transition, we have a current standard to work with. The real roadblock for many are the intricacies of ICD-10 because despite all the preparation training you go through, if you don’t have an anatomy and physiology background, it’s going to be a lot harder. I can understand why then, the compliance date would be pushed back but with all the time the industry has spent talking about ICD-10, there are so many resources and educational materials by now that are readily available to healthcare entities. The 2014 ICD-10 compliance date was actually very realistic and attainable with the proper resources.
What’s more confusing in this scenario, is the fact that non-covered entities including property and casualty insurance health plans and worker’s compensation programs, along with others, have started to switch to ICD-10 codes in effort to seamlessly align with the rest of the industry. It’d be a mess if the vendor or partner you were using wasn’t prepared. So now there’s a disconnect. Half of the industry is prepared, half isn’t. There will always be bumps in the road when you’re talking about an entire industry switching to a new language, but a bit of tough love would have done the industry good here. Now we’ll see more time, more energy and more resources go to waste.
One of the greatest sources of information that depicts the changes in health IT trends across the industry landscape is from Michael Lake, healthcare technology strategist. Through his monthly reports on the state of health technology, published by his company Circle Square, he provides succinct highlights from throughout the last month. Possibly, what’s best about these reports is that they cover such a diverse segment of the ecosphere.
For example, in one of his most recent reports, the focus was the EHR vendor sphere, cloud EHRs and their importance to independent practices, the use of faxes in hospitals, vendor news and transactions and practice portal insight, among other news.
According to his most recent report, cloud-based EHRs with integrated billing are quickly becoming a key to a practice’s future success as an independent practice. In his report, he cites Black Book as ranking solutions that seamlessly integrate electronic health records (EHR), revenue cycle management (RCM) and practice management (PM). Kareo tops on the list, per KLAS.
However, most practices feel that billing and collections systems and processes need upgrading (87%) and more than 40 percent (42%) are considering an upgrade to RCM software in in the next year . Most practices (71%) are considering a combo of new software and outsourcing services for improvement.
Kareo, a company I have come to quietly respect (the company does not sponsor this site in any way) issued the following graphic (something else I have come to really like). I’m a visual person and there’s often no better way to convey complicated information like that found in health IT and I find the following graphic filled with much telling information, and seems to beg whether small practices are served well by EHRs.
This graphic seems to speak to a bigger picture of what’s going on currently in the space. This information tells the story of how it is becoming more difficult to maintain autonomy in private practice, but not impossible. With technology, small practices can thrive. But, is there enough focus on the small practices for technology to make the difference Kareo says it can?
Kareo has skin in this game, after all, and makes its position clear: “The solution is technology, and not just one piece of software but a fully-integrated seamless package of solutions from a single vendor … most physician practices know that to remain independent they will have to make changes.
“The willingness to change is important because success may rely on seeing your practice as a business and carefully considering and evaluating your bottom line. While many physicians in practices with five providers or fewer are still hesitant to adopt an EHR, the potential benefits are indisputable.”
Guest post by Tom Giannulli, MS, MD, chief medical information officer, 
Kareo, a company I have come to quietly respect (the company does not sponsor this site in any way) issued the following