Off The Record


Doctor, Heal Thy ICD-10 Worries – The game’s not just for Coders Anymore

965897_data_01Is your practice counting down to October 1, 2014 with fear, or anticipation?

The transition to the ICD-10’s keeping just about everyone up at night – and not just coders either.  Everyone in the health care revenue cycle – physicians, payers and vendors – has got a stake in the game.  One company even coined an affliction for HIMs, coders and physicians alike – “ICD-10 Stress Syndrome. “ (Is there a code for that??)

Like it or not; there are just 200 some days until the deadline.  (Cue the creepy organ music…)   And while HIMs everywhere are scrambling to prepare, doctors are most at risk for lack of readiness.  “If claims are not submitted accurately, physicians simply won’t be paid.  According to Beth Hertz’ piece in Medical Economics, “With less than a year until the one-day ICD-10 conversion … a physician’s ultimate life preserver is going to be planning and training,” says Shari Erickson, MPH, vice president of government and regulatory affairs for the American College of Physicians.

The piece goes on to argue the leap from the ICD-9 to the ICD-10 is historically ambitious, requiring a much more precise detailing in reporting diagnosis.  Outpatient diagnostic codes will increase from about 13,000 to 68,000.  Go time to learn all those?  (How about time to just get to the bathroom between patient intakes?)

The system requires training for everyone on the team – including coders, billers and providers. This is a ONE-DAY transition, so readiness has to happen immediately with plenty of preparation ahead of time.  Distress call!

5 Tips for Moving From Panicked to Prepared

Keep calm and prepare on for a smooth transition on October 1st

  1. Small practices may want to secure a line of credit to mitigate cash flow issues temporarily if payers aren’t ready.  “It would be prudent to take out a credit line equal to about 5% of the total reimbursement for the year for the practice. “  -Michael F. Arigo, CPHIT, CPEMR managing partner of No World Borders
  2. Identify a Project Coordinator or Point Person.  Identify someone on staff who can assume responsibility for training, implementation, communication and accountability to keep the process on track for the big date.  Ideally this person is familiar with coding but if not, choose someone who will embrace the challenge and find the help they need.
  3. Fight the urge to get overwhelmed.  Keep it in perspective; learning every single new code isn’t necessary.  Become familiar with the ones used most often in your practice – identify the top 20 codes for medical and diagnoses procedures and start there.
  4. Connect with your EMR vendor.   If your practice uses an EMR, your vendor should be a great resource.  Be certain to connect with them to ensure delivery of software upgrades and ask if they offer training. 
  5.  CALL iDATA!  While clinical documentation has long been regarded by doctors as a necessary evil, physicians must become more involved in the process of ensuring documentation meets the high standards of the ICD-10 compliance.  Partnering with an expert company (like iData!) aligns physicians with expertise to ensure documentation – for which the ICD-10 environment requires considerably more detail – is captured accurately and efficiently.

 So don’t panic.  Just get prepared.  We can help!

 

Chime in here or on our Facebook page – or connect with me personally at ktant@idata-llc.com.

Warmly, Kendall Tant, CEO, iData 

 

 

 

 

 

 

 

 

 

 

 

9-1-1 for the ICD-10: One of the many Challenges facing HIM Departments

It’s always a relief when a deadline is extended, and the new ICD-10 implementation is no exception.

According to HealthCare IT, in August, HHS announced a one-year delay as the launch date for compliance of the ICD-10 codes.  Beginning October 1, 2014, the ICD-10, or International Classification of Diseases, 10th Edition, will include some 155,000 codes for new procedures and diagnoses.  (Someone call a doctor for help!)

Compare that number to the 13,000 found across the ICD-9, plus, an inclusion of twice as many categories and an introduction to alphanumeric categories.  It’s obvious the transition is going to be ripe with challenges.  HIMs are scrambling for readiness, and the Medical Group Management Association (MGMA) is after CMS to offer help and support to expedite critical coordination between practices, software vendors and health plan partners.

“Very simply, the ICD-10 is behind schedule.  MGMA continues to advocate on behalf of members and provide tools and resources to help practice executives make the transitions to ICD-10 cost effective and less disruptive to their organizations,” said MGMA President and CEO Susan L. Turney, MD, according to the piece. 

Increased demand for HIM staff meets Less Revenue:  Outsourcing fills the gap

The switch is proving a daunting one for providers as they re-assess HIM strategies.  In his piece, “’Storm’s brewing for HIM,” HealthCare IT managing editor, Mike Milliard, cites findings from the KLAS (a company that measures healthcare vendor performance) study, HIM Services 2012: Helping to Weather the Storm, that claims the changes ushered in by the ICD-10 bring plenty of cost and disruptions all around.

The burgeoning Boomer population – along with the boom of new patients – in the system and increased regulatory requirements means a spike in productivity demands across technology staffing.  Problem is, healthcare reform will decrease revenue streams from government payers, affecting HIM departments’ abilities to adequately provide staffing.

The KLAS report discovered that providers are looking to outsourcing to fill the gap, particularly with regard to medical transcription, and specifically to clinical documentation providers to help with the transition to ICD-10 coding.  Hey – that’s us.

According to the KLAS report, providers identify consistent differences in performance across transcription vendors in turn-around-time (what we affectionately call TAT), quality and satisfaction.  No surprise there.

This is where a company such as iData – forgive us for saying so – shines.  Our expertly skilled documentation specialists thrive on challenges presented by the ICD-10 transition, because we can be a part of the solution.  Our robust, integrated, secure systems and services save our customers time and money, and boost physician productivity.  Our partnership can fill in the gap in staffing, and reduce the massive costs of implementing the ICD-10 into an EMR system, leaving your IT staff to focus on core business.

So don’t be afraid of the big, bad ICD-10.  With us in your corner, we’ll take 155,000 worries off the plate.

 

Habits: Breaking the Cycle, One Cookie at a Time

cccookiesWhat is it that you do over and again, without thinking?  Brushing your teeth is one.  It’s ingrained, automatic, a good habit.  Driving is another – it’s become routine, something you can do singing to your favorite tunes or chatting with your teenager. Consistent exercise is a positive habit, as is expressing love to our family or going to worship each week. Some habits are affirming, even powerful.

Then there are those habits that aren’t so great for us, like smoking, or in business, staying with the same vendor because it’s just, well, habit.  Why can’t we just nix those habits, already?

Because it turns out, habits are really tough to break without intentional effort.  What is a habit, exactly?   Oxford explains it this way:  “a settled or regular tendency or practice, especially one that is hard to give up.”  What’s the one thing you do you do over and again you wish you could just stop doing, never to look back?

Charles Duhigg, New York Times reporter and author, asked himself the same question.  His answer?  Cookies.  Each day around 3:30, he’d head to the cafeteria for a chocolate chip cookie. He thought it was because he liked cookies, and his waistline revealed the story he worked on faithfully each day.  It was a habit he just couldn’t seem to kick.  Inspired by a revelation about the prevalence of habits in the military, he did a little investigative journalism himself, which he shared in his book, The Power of Habit:  Why we do what we do in Life and Business.   (Turns out he made his former habit work for him!) 

During his self-study, Duhigg discovered that what he was after wasn’t really the cookie. By shaking up his routine, he discovered it was social connection he was really after.  The cookie led to a reward – in his case, time to chat with colleagues during a break.  It’s never about the cookie!

Habits form, he argues, via a 3-part process.  First, there’s  a cue, or trigger, that tells your brain to go into automatic mode.  A cue could be a person, a place, a time of day, an image, an emotional state, and others.   The cue signals the launching of a behavior, then engaging in a routine, or the behavior itself, such as eating the cookie.  Finally, the reward reinforces the brain to remember the process going forward.  Are we really all the different from mice in this regard?

Duhigg replaced his cookie habit with a new behavior attached to the reward of social interaction, tossed the cookies aside, and lost 12 pounds in the process.  Getting inspired?

According to an NPR interview with Duhigg, “neuroscientists have traced our habit-making behaviors to a part of the brain called the basal ganglia, which also plays a key role in the development of emotions, memories and pattern recognition. Decisions, meanwhile, are made in a different part of the brain called the prefrontal cortex. But as soon as a behavior becomes automatic, the decision-making part of your brain goes into a sleep mode of sorts.”    

So, like driving that becomes automatic – pun intended – breaking your own habits at home or work requires awareness, time and effort.  But habits can be transformed into adopting something powerful and positive.  Like golf.

What about you?  Is a lingering habit holding you back from experiencing excellence?  Such as, for example, exploring other clinical documentation companies?

At iData, we’d like to become your next hard habit to break.

Read an excerpt from Charles Duhigg’s book here.  Then, chime in.  Share your experiences with us across social media, or make a comment on our blog post.

 

The Hazards of Copy and Paste: EHR Fraud on Trial

The EHR gives, and it takes away.

As if there weren’t enough issues surrounding healthcare reform, EHR usage is experiencing an unintended consequence – fraud.

Recently, HealthCare IT News reported that while electronic health records can make important contributions to patient care, the spotlight’s shining on an a function that sounds so, well, benign – copy and paste.

It’s an essential function thing we all learn in keyboarding – copy and paste to shave time and save keystrokes.  Now, it’s costing some $11 billion in fraud, intentional or not. The potential to “do harm” occurs when clinicians copy and paste text into a patient’s record multiple times, often failing first to update the data or ensure accuracy. Or, the data is copied into the wrong templates, creating “upcoding,” or making duplicates that result in inflated billing.

CMS (Centers for Medicaid & Medicare Services) itself has landed squarely on the hot seat for issues such as this one, since meaningful use falls under its jurisdiction.  Seems the OIG – the Office of the inspector General, tasked with safeguarding the integrity of Department of Health & Human Services (HHS), issued a report showcasing the shortcomings of the Centers of Medicare and Medicaid Services in properly identifying and investigating EHR fraud.  (A September AIHMA report concluded such errors endanger patient safety or impact the quality of care, and that 74 to 90 percent of physicians use the copy/paste function in their EHRs.)

And wasn’t the EHR touted as safeguarding patient information, and delivering savings of both time and costs to doctors?  Seems that savings is, well, costing.

According to Erin McCann’s piece in Healthcare IT News, “It’s become such a compliance and payment problem that the U.S. Department of Health and Human Services Secretary Kathleen Sebelius together with Attorney General Eric Holder wrote a letter last year to industry medical groups underscoring the seriousness of doctors’ gaming the system, possibly to obtain payments to which they are not entitled.”  Again, ouch.

It’s likely, though, doctors are simply trying to take shortcuts in order to record patient data under the pressure of time.  It’s another reason for us to underscore the continued need for the human touch when it comes to the health record’s integrity.  A doctor’s time is stretched to the max, and partnering with a company suited to deliver flexible solutions to ensure patient data is accurate, secure, and shareable is worth the investment.

That AIHMA study found that policies, usability principles, and best practices for proper EHR system still have a long way to go before widespread, consistent adoption. There is still no sense of shared accountability between system developers and users for product functioning. Adverse outcomes associated with EHRs are not being systematically and consistently tracked.   Therefore, while the EHR is often touted as a cost-saver, the losses in productivity that pressure busy practitioners to take shortcuts actually trump up costs, in the end.  Until those issues are streamlined and adopted broadly, many hospitals will continue to partner with clinical documentation companies to share the burden of data input, freeing doctors to do what they do best – take care of patients.

Want to add your 2-cents?  Chime in – or make a comment on our Facebook page!

 

 

 

 

The Annual Report: Alive, Kicking and Grateful

KT HSYou may have heard the doom and gloom.  But Don’t buy into it.

Seems plenty have eagerly authored eulogies for the field of medical transcription.  The emergence of the EHR (Electronic Health Record) with its promise to deliver reduced costs, interoperability and shared patient data across platforms can’t be labeled, “Mission Complete” just yet.   It sounds like Utopia, but both the technology, and its usage is still maturing.

In the years since the passage of 2009’s HITECH Act, while much has been achieved in the name of Meaningful Use, we’re still very much navigating a time of transition.  And clinical documentation is front and center.  Can you remember any other time in history during which the patient record garnered so much press?

The EHR still has some work to do in making doctors happy.  Over and again, word is doctors are frustrated with entering patient data while trying to focus on patients.  The clinician’s narrative doesn’t always fit neatly into drop-down templates embedded into EHR systems, and voice recognition software still requires editors to proof and affirm the integrity and accuracy of the data.

In other words, the medical knowledge and human touch skilled transcriptionists bring to the table is still very much necessary, often even preferred.

While some say the future for medical transcription is bleak, we’re here to tell you that at iData, we’re thriving, and even growing as we head into 2014.   (We’ve noticed plenty of our competitors are still in business, too.)  As Mark Twain quipped, “The reports of my death have been greatly exaggerated.”  Our roles are changing, but they’re hardly extinct.   We’re grateful for our loyal customers – hospitals, doctors and group practices – who are finding innovative ways to integrate our expertise into emerging technologies.  At the end of the day, we are the “faces” behind the integrity and safety of the patient record.

One of our largest customers, in fact, renewed a multiyear contract.  During negotiations no one issued even one complaint.  This is a facility to which we return hundreds of reports a week – in fewer than 90 minutes each!  So during this season of gratitude, we’re thankful for our talented staff of MT’s, editors and operations group who work tirelessly each day for our customers, and ultimately, for patients.

It’s true – our industry is adapting, and even facilitating the healthcare marketplace’s assimilation to the digital age.  Our work hasn’t been replaced, but instead complements the mandate for seamless EHR interfaces.  Our ability to capture discreet (or selected) data from dictated reports empower doctors toward efficiency, and our highly trained and skilled MT’s use templates to make report completion more efficient.  Further, when the clinician prefers, we use speech recognition. Agility, flexibility and diverse, robust solutions that address varied needs enable us to create customized solutions.  Oh yeah – and on time. Or it’s free.  Where else can you get that kind of guarantee?

So for us, the future’s a bright one.  Our plan is to stay ahead of trends, embrace change and innovate new solutions – just like our customers.

Wishing you a Merry Christmas and Joyful Holiday Season!  For the record, you’re the reason we exist!

Planning for the Hospital of the Future

Red cross 1During the season of gratitude, we’re thankful for hospitals – and not just because they heal the sick.  They’re customers – and our interoperable clinical documentation services empower their mission.  Never before in history has the patient record received so much attention.  And our own industry is adapting to change along with the rest of the healthcare marketplace.  So we have a vested interest in learning what they’re innovating under pressure, and expanding patient base.

We wonder, wouldn’t they like to just close the doors for a day and think, plan and strategize?

Well, a few of them left their hospitals long enough to brainstorm with others in the name of progress.  In November 2013, U.S. News and World Report gathered hospital executives and experts to the first annual “Hospital of Tomorrow” forum.  One thing’s for certain – the times, they are a-changing.  The strongest will thrive, and they inspire us to do the same.

The Inaugural Launch

Cleveland Clinic CEO Toby Cosgrove launched the inaugural forum coordinated by US News & World Report with a keynote speech, discussing the issues with which hospitals are coping right now.   (Watch it here.)

A panel discussion about the changing face of hospitals and health care ensued, as did break out sessions that included topics such as staffing solutions, designing hospitals for the 21st century care,  absorbing the newly insured, and new strategies for preventing re-admissions. Big stuff.

As you can imagine, the Twitterverse lit up with discussion, collaboration and debate under @USNHOT13.  Round up the industry’s best and the brightest, and you’re bound to conjure varied opinions and passions!  Check out the tweets, pictures, quotes and musings posted during the conference.

For HIM’s and IT and records managers who didn’t get to go, check out a recap of two technology related issues discussed at the forum:

Uncovering the Power of Big Data

While navigating massive amounts of information is nothing new to hospitals, “Big Data” is the latest buzzword that’s got everyone talking.  In the context of medicine, innovative thinkers will figure out how to sift and utilize key data to predict and solve clinical issues, and also, to facilitate better hospital management.

According to the US News & World Report, Brad Ryan, a general manager at IMS Health stated, “Effective interpretation of Big Data can help identify which new technologies are working and which aren’t.” (Shameless plug:  iData’s customers enjoy the delivery of critical data that can be parsed, extracted and exploited for purposes other than the EMR.  In the future, what if treatment could begin before the patient experienced real symptoms, just indicators, for example?)

Is your hospital harnessing the value of the enormous amounts of data to collect genetic information, spot business trends and more?  It’s an enormous task and we’re curious how others are mining through to find the “diamonds” contained within.

Applying Technology to Hospital Business Needs

We often think of technology related to medicine in terms of patient care, such as robotic, or computer assisted surgery.  But one breakout session during the forum apparently discussed the need for technology to empower the business side of healthcare.

Troy Kirchenbauer, general manager of Aptitude LLC, an online direct contract market for healthcare, talked about the critical need for effective supply chain management.   Their platform serves as a transparent and open space in which hospitals negotiate and manage contracts.  Their service builds thriving partnerships between hospitals and suppliers, driving down costs, promoting compliance and improving efficiency in supply chain management. (Visit aptitude.com for more.)

We applaud the great work done by US News & World Report to knit together invested providers, legislators and vendors to sharpen the sword together for the good of everyone’s ultimate customer – the patient.  We look forward to hearing about the next forum.

For a full recap of the topics discussed at the forum, click here.  Want more tips, information and news related to healthcare documentation, IT and administration?  Sign up for our newsletter in the upper right hand corner!

 

Image courtesy of Dreamstine.

For Forward Thinking Hospitals, the Future is NOW

hospitalWe spend a lot of time serving hospitals, and the times are changing.  Hospitals today are doing critical work in the most real-time setting there is – the doors never close; patients never stop arriving.  Many of them are embracing ground breaking, forward thinking work under tremendous pressure to adapt to a rapidly changing landscape.  No rest for the weary!

The clarion call to deliver a more personalized, flexible and empowered health care experience to a highly invested customer base (remember, patients are customers after all) is one heard across the country.  While the topic of health care is landing square in the eye of the storm these days, we thought it would be interesting to showcase a few herculean efforts hospitals are making to forge the new frontier.

In a two-part post, we’ll introduce a few heroic hospitals doing some heavy lifting, breaking ground from which other hospitals can draw inspiration:

Personalized Medicine

The Mayo Clinic’s Center for Individualized Medicine is working toward leveraging the power of gene sequencing, which looks to patients’ genomic blueprints to determine aspects of their health.   In a piece for US News and World Report, the center’s director, Gianrico Farrugia, said the primary value should be the needs of the patients, and, “We can’t live up to it unless we turn to genomics.” Perhaps in the not too distant future, patients will be able to tote their genome mapping on their iPads.

Telemedicine

This sizzling hot new delivery mode enables clinicians to interface with patients via video conferencing to assess, diagnose and monitor health issues remotely.  Telemedicine most often benefits patients and families in rural communities by broadening access to distant specialists; plus, hospitals can  bring in readily accessible staff to meet unexpected demands, such as in the ER.   Mercy Health was an early pioneer in telehealth, beginning in 2006, equipping its ICU with telemedicine capabilities.   Since then, Mercy has reduced mortality rates to 20 percent below the expected level, and reduced hospitals stays’ durations by 30 percent, according to the US News & World Report.

Physicians in Executive Leadership

The entrenched hierarchies that divided a hospital’s clinical and administrative staff are dissipating.  After all, who has a deeper understanding the real needs of patients than doctors on the front lines?  Today an increase in physician hospital executives who work in tandem with hospital administration to develop policy and make critical decisions regarding patient care is a model garnering more interest.   According to Becker’s Hospital Review, now there are more than 60 joint MD-MBA degree programs, compared to only a smattering in the 1990s, for example.

Becker’s cited San Diego-based Scripps Health as one example of a system that broadened physicians’ role in decision-making.  When the Physician Leadership Cabinet was created, the group included chiefs of staff and CEOs from each hospital campus, along with the VP of nursing. The cabinet strengthens collaboration between Scripps administrators and physicians as they develop strategies to improve quality and efficiency while reducing costs and clinical variation.  Win win!

We applaud the continuous efforts of progressive minded hospitals to innovate toward improved patient care, reduced waste and costs, and a more flexible,  empowered patient experience.  As always, we stand ready to empower physicians with an integrated approach to capturing the physician’s narrative with accuracy and speed.  After all, it all begins with a patient’s story. More on that in part 2!

Want to connect with Kendall Tant?  Find him on Linkedin.

 

Tech Wreck: Will the new “Surge” Dig healthcare.gov out of the Hole?

hcPerhaps an SNL “news” anchor ‘s joke was best:  “For the Obama administration to claim they weren’t prepared for the demand for health care is like saying a florist wasn’t ready for Valentine’s Day.”   

Since the highly publicized launch at the top of October, the newly minted Healthcare.gov’s website – the aggregate for people to compare and purchase health care coverage from the exchanges – failed to deliver, no doubt.  Folks eager  (or grudgingly resigned) to explore their options reported endless wait times, difficulties just logging on and/or hassles creating a new account.   The buck stops at his desk, and at a press conference this week the president admitted as much. “There’s no sugarcoating it: The website has been too slow and people have had trouble navigating it,” he said.   Yes; that about sums it up!

If the president was looking to sell the benefits of the Affordable Care Act, the initial roll-out didn’t help his cause.  The topic is already radioactive, and it’s going to take time and a continued communications effort to explain the advantages for 85% of Americans who do have coverage, and to showcase those it is intended to help.  Still, regardless of where you stand on the contentious legislation process and subsequent efforts for repeal, beginning March 31st, 2014, the mandate for healthcare insurance takes effect.

Now, the Obama administration’s technical team sits squarely on the hot seat as they try to rescue the beleaguered site and calm the storm of public dissent.  Talk about an unintended consequence – there’s something for everyone to agree on here.  Those who support, and reject the ACA can each lay claim to frustration – the website’s crashing debut was something to which everyone’s pointing a finger.   So what went wrong, and how is it going to get fixed?

Most reporting seems to focus on three key areas:  1. Lack of appropriate or timely key testing before the launch, 2.  A rush to roll-out on October 1st, and 3.  Changes in key decisions just weeks prior to launch.  The finger pointing is certain to continue – with HHS Secretary Sebelius scheduled to testify before Congress to offer a collective mea culpa – while a newly ordained team of IT experts joins forces with the current team and toils away, no doubt, to clean up the mess.

Yes – the White House has called in the big guns.  A renewed effort is underway – a “tech surge,” to help rescue the glitches in the code and repair the public’s confidence.  NPR’s Elisa Hu wrote, “The Obama administration says this surge is made up of engineers from inside and outside government, but beyond saying Presidential Innovations Fellows are involved, officials haven’t specified who’s making up those teams and what exactly they’re doing to fix the systemic issues with the site.”   (Come to think of it, I’m not sure I’d want to be identified as a member of the S.O.S. team – they’re going to get little sleep over the next few months as it is.)

As the drama unfolds, the president was quick to reinforce that, “This law is more than a website.  The policy is already helping people with a pre-existing condition – its helping students stay on their parents policies longer.  The law isn’t broken, just the website.”  

You know, you just never appreciate coders under something goes wrong.  We’re hoping the new A-Team delivers – until then, we’re watching!

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