What Is the State of EHR Satisfaction?

Lea Chatham June 26th, 2013

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On Tuesday, June 25, Kareo hosted a live, interactive Tweet Chat about EHR satisfaction. Kareo staff, industry experts, and medical practice staff joined the conversation. A few key points came up that generated great feedback.

  1. The numbers vary but the message is the same: many medical providers are dissatisfied with their current EHR and are looking to make a change:
    1. @PhysiciansPract: According to our 2013 Tech Survey, 14 percent of EHR users are dissatisfied w/theirs: http://bit.ly/17A05ku
    2. @RobPickell: According to @barrms “Dissatisfaction is increasing regardless of practice type or #EHR system.” http://goo.gl/Hk9C4
  2. This trend of dissatisfaction and transition to new EHR solutions is the result of many factors:
    1. @Brad_Justus: Amazing how the buy-in or lack thereof from front desk staff member can impact experience.
    2. @PhysiciansPract: Lack of training is sometimes cited as a big barrier to #EHR satisfaction.
  3. How do we deal with this and improve satisfaction?
    1. ‏@Brad_Justus: Engagement Starts With Culture, Culture Starts With Leadership
    2. @PhysiciansPract: When deciding whether to ditch an old EHR, here’s what experts told @PhysiciansPract: http://bit.ly/scrap_EHR
    3. @Brad_Justus Implement/use it right and staff will become champions! Mine did, with no computer literacy at start.

This is just the tip of the iceberg! The conversation provided many great ideas on how to improve provider satisfaction. Find out more by checking out the chat.

Stay in the know on more events (or share ideas for topics) by becoming a fan on Facebook or Twitter.

Kareo tweet chat on EHR Satisfaction

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With HIPAA Omnibus, Take a Second Look at Your Business Associates

Lea Chatham June 25th, 2013

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By Ron Sterling

Ron Sterling explains key aspects of HIPAA Omnibus for Kareo

The HIPAA Omnibus rules significantly affect Business Associate (BA) relationships and will require an adjustment to your Business Associates Agreement (BAA). Indeed, you may need to take another look at your BAAs, contractual relationships, and even your vendor strategy.

Under the original HIPAA Security and Privacy Rules, non-employee entities or persons who worked with your Protected Health Information (PHI) were required to abide by the applicable HIPAA Security and Privacy standards through the BAA.  However, the Business Associate was not subject to penalties and your organization was pretty much limited to the power to fire the BA, if you could.

Under the “new and improved” HITECH Rules and made better by the HIPAA Omnibus rules, BAs and even their subcontractors that use your PHI to do their job are now responsible for penalties for breaches. However, these changes require some additional considerations in managing your Business Associates and your contractual relationship.  The key issues to consider are:

  1. Do BAs sign your BAA or will you sign the BA’s BAA? Many vendors that have significant business with Covered Entities have their own BAA that they want their customers to sign. These vendor BAAs will address compliance with HIPAA Security and Privacy, but may also include some additional terms at the discretion of the Business Associate. For example, BAAs may include limits on costs to notify patients of a breach, use of deidentified patient information, decisions on response to a breach, and even termination triggers that could compromise your clinical operation. If you have your own BAA that includes favorable terms that you prefer, then you will want to negotiate whose BAA will be used as part of your contract discussions. However, if you do not have a BAA, carefully review the vendor BAA before signing to get rid of surprises in their BAA and even how the BAA works with the contract.
  2. How do you insure that your Notice of Privacy Practices prevails? Your organization cannot provide authority to handle or use PHI that is beyond your published Notice of Privacy Practices. Organizations with obsolete NPPs need to update the documents and need to take a look at the NPP on a periodic basis, but the NPP is basically a part of the BAA. For example, your NPP may state that you would not use patient information (in PHI or any other form) for any purpose but clinical care. Some vendors reserve the right to use deidentified information for other purposes. Regardless of how the BAA may deidentify your PHI, you cannot authorize the BAA to use deidentified information if your NPP represents that you will not use patient information for any purpose but clinical care. Indeed, you may consider deidentified PHI as confidential practice information.
  3. How do you monitor vendor protection of PHI? Under HIPAA Omnibus, BAs and subcontractor Business Associates (SBAs) have to maintain a mechanism to evaluate impermissible disclosures and uses of PHI to determine if there is a breach and act accordingly. However, the BA and SBA only have to report breaches to your organization. In other words, your BAs and their SBAs could have a variety of impermissible disclosures and uses of PHI, but the events never exceeded the low probability of compromise barrier. Indeed, a BA vendor could have serious and frequent events involving impermissible disclosure and use of PHI that didn’t qualify as a breach or whose analysis may be more generous that you may want. Such a situation is certainly an indicator of problems to come or perhaps a liberal interpretation of the probability of compromise. In order to monitor what is happening with impermissible uses and disclosures, add the right to periodically review the BA’s and their SBA’s log of impermissible disclosures and uses as well as their probability of compromised PHI analysis.
As part of you compliance with HIPAA Omnibus, you need to reevaluate your Business Associates Agreements to add appropriate terms to meet the Omnibus Rules. However, you need to think beyond the HIPAA Omnibus rules to insure that you do not end up with a contract or Business Associate relationship that does not protect your interests or business objectives.
About Ron Sterling

Ron Sterling discusses strategies for EHR success for Kareo

Ronald Sterling, President of Sterling Solutions, Ltd., is a nationally recognized thought leader on the selection and implementation of electronic health records (EHR). He authored the HIMSS Book of the Year, Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, and publishes the popular EHR issues blog: Avoid-EHR-Disasters.com. He has worked with a wide array of practices on EHR decisions and issues and has reviewed electronic medical record and practice management systems from over 150 vendors.

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Join the EHR Satisfaction Tweet Chat!

Lea Chatham June 24th, 2013

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Do you sometimes feel like you don’t get a chance to give your two cents on the big issues in healthcare? Well, never fear, the tweet chat is here!

On Tuesday, June 25 at 10:00 AM Pacific/1:00 PM Eastern, Kareo is hosting a live, interactive tweet chat on EHR satisfaction. Join us and get in on the conversation. We’ll be talking about some of the recent research on physician satisfaction and how we can improve satisfaction and the EHR experience. Experts from the healthcare industry will be sharing their thoughts and responding to your questions.

We’ll be using the hashtag #Kareochat. If you aren’t already on Twitter, it’s easy to set up an account. Once you are set up, follow Kareo and use these tips participate in the Tweet Chat:

  • Click on #Kareochat to open a column that only searches for the #KareoChat hashtag, that way you will be able to see every post (You can also do this with a tool like Tweetdeck).
  • Because of the 140 character limit, it’s always great to use sites that shorten any links you might want to include (Bit.ly or http://goo.gl/ work really well).
  • When posting a question or responding to a question end every tweet with #Kareochat.

We look forward to your participation!

Join Kareo for live twitter chat on EHR satisfaction

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3 Can’t Miss Things Said in Healthcare This Week

Lea Chatham June 21st, 2013

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As a manager, staff, or physician at a small medical practice, you know there is so much going on in healthcare, but its hard to keep up. At Kareo, we want to help. So, here are some interesting things said on today’s hot topics.

Recent Changes to HIPAA that go into effect in a few months have us all thinking about security! Of course medical practices should be thinking about data security all the time, but with so many things to do, you might find that you set something up and then move on to the next thing. Let’s remember that no matter what your technology can do, in the end it is all about people. You should always to be thinking about security and privacy and continually train your team members to think about it too. Lee Kim, an attorney with Tucker Arensburg in Pittsburgh, said it well at the Government Health IT Conference & Exhibition in Washington, D.C. this week, “Secure the human. Breaches are often the result of things that we as humans do. Guard your information systems as if you were going home and locking your door.”

Have you been hearing about ICD-10 a lot? Of course you have. With just over a year to go, it’s the Y2K of 2013/14! In an interview with Healthcare IT News, Fareed Mostashri, National Coordinator for Health IT, discussed the relationship between SNOMED and ICD-10 and how vendors can help providers make the leap without feeling totally disrupted. “Frankly, I don’t see ICD-10 as disrupting progress toward meaningful use. If anything, I’m seeing that if we can get the synergy going that I talked about—people seeing if I have a meaningful use certified EHR, if I have clinical documentation, then it’s easier for me to get to ICD-10, then that’s another reason for me to move forward on the clinical side.” This one is worth reading all the way through!

We’ve said before and we’ll say it again… big data is coming and it matters for small practices. Payers are using it to identify patterns that may lead to fraud. The government is using it to show consumers hospital cost and quality information. And, your patients want more. So the AMA is responding by asking payers to use data to provide better cost estimation. In a statement, AMA Board Member Barbara L. McAneny, M.D., said, “Physicians want to provide patients with their individual out-of-pocket costs, but must work through a maze of complex insurer rules to find useful information. The AMA is calling on insurers to provide physicians with better tools that can automatically determine a patient’s payment responsibility prior to treatment.”

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Is Anyone Ready for ICD-10?

Lea Chatham June 20th, 2013

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Practices need to start thinking about how they’ll revamp their superbill in preparation for ICD-10

You probably won’t be surprised to hear that a new study by the Medical Group Management Association (MGMA) on ICD-10 readiness indicates that you aren’t ready. In fact, less than 5% of the practices surveyed said they had made “significant progress” in their ICD-10 preparedness.

MGMA surveyed 1,200 practices representing 55,000 providers, the majority of whom said that they are “very concerned” about the cost of ICD-10, loss of productivity, and managing changes to clinical documentation. While the American Medical Association (AMA) and other groups are supporting legislation to stop ICD-10, Marilyn Tavenner, Acting Administrator of the Centers for Medicare & Medicaid Services says they have no plans to delay the October, 2014 start date. According to a recent article in Forbes, ICD-10 doesn’t just impact providers, it creates challenges for payers and vendors as well, and physicians are concerned about the readiness of those partners.

Providers do seem to have more confidence in their practice management vendors to meet the challenge according to another article in Modern Healthcare. “We asked them what is their confidence that they and their trading partners would be ready, the confidence level is lowest with their health plans and highest with their practice-management systems vendors, so I’d say they’re cautiously optimistic their software will be upgraded and less confident of their payers being upgraded,” said Robert Tennant, the MGMA’s senior policy adviser.

If you’re ready to start your ICD-10 planning (and even if you aren’t), a good place to start is the CMS ICD-10 website. This site provides a fact sheet and overview of ICD-10 along with an option to sign up for ICD-10 updates from CMS. There are also tools and resources from CMS and Medscape that are designed to help walk you through the transition.

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Do Your Patients Want a Patient Portal?

Lea Chatham June 19th, 2013

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At a recent event on Meaningful Use Stage 2, Barbara Drury provided a great overview of what you need to know to start preparing for attestation. We received many great questions, but several people were particularly concerned about the requirements to communicate electronically with patients and provide access to medical records information electronically through a tool like a patient portal. We responded to these questions at the time, but we also wondered how much patients cared about these issues. So we did an informal three-question survey using the online tool instant.ly.

Here is what we found out:

  1. 72% of respondents said they would choose a physician who uses computerized patient records over one who doesn’t.
  2. 70% of respondents said they would be very likely to access their medical record online if that feature was offered by their doctor, and 23% said they were somewhat likely to access their medical record online.
  3. 63% of people said they would prefer to receive communications from their doctor via email.

We aren’t the only ones asking these types of questions. In fact, this is an issue that has been looked at widely. Over the last ten years or so, many organizations have looked at how many people are accessing health information online, how many people want electronic access to medical records, and other related issues. The Pew Internet and American Life Project estimated that 59% of people have looked online for health information in the past year. According to research from the American Medical Association, the number of people who want to correspond with their doctor online is even higher than our estimate at closer to 90%, but that same study shows that only about 5-10% of providers use email for patient care. Research has also suggested about 20% of people already have some form of a personal health record online through a physician, insurer, or independent service.

These are just some of the pieces of data we have seen and the results vary somewhat depending on the exact question, but one this is clear—people’s lives are more electronic and mobile then they once were. And this is regardless of age, gender, or where you live. You may be surprised to find out that your patients are more interested in using the Internet, email, and text to get and manage health information than you thought.

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Work Smarter, Not Harder (Part 3)

Lea Chatham June 17th, 2013

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My previous posts, Part 1 and Part 2, described how one particular practice addressed its cash flow, or lack thereof, by optimizing its claims and collections instead of adding another provider, service line, or additional payers.

I also introduced some additional areas the practice focused on to further boost its bottom line, which I describe in more detail below. By employing similar medical billing tactics, I’m confident that any practice can increase its cash flow and overall financial performance.

  • Collecting co-payments at time of service. Billing patients for their co-payments can delay revenue 30-60 days, or longer. By collecting co-payments at the time of visit, the practice immediately increased daily revenues by 15%. Furthermore, this activity reduced the number of patient statements sent out after the visit, significantly saving costs on postage, paper, envelopes, and staff time. It also resulted in less accounts receivable (A/R) while decreasing bad debt and write-offs. What’s more, the practice soon found out, is that patients did not mind making their co-payment at time of service, which has since become the practice’s standard. While it required a change in procedure and associated staff training, collecting co-payments at time of service has increased the billing staff’s efficiency and enabled them to spend more time working higher-amount A/R—versus collecting co-payments.
  • Collecting past due balances at time of service. Similar to co-payments, the practice took advantage of the opportunity to collect past-due balances in person (at initial or follow-up visits), versus billing patients later. This required communication between the scheduler, receptionist, and billing staff, as well as a new procedure whereby patients were notified of their outstanding balances ahead of time and asked to pay at their next visit. While not all balances were collected, this did result in a 10% increase in collections on past-due amounts and helped avoid outstanding balances from growing further.(Note: Both of the above activities required full staff participation, management setting new expectations and holding staff accountable, and establishing new policies for the patients. The result? A 15% increase in collection of co-payments per day, a 10% increase in collecting old balances, a 5% reduction in A/R , and a 2% reduction in direct costs. These savings will fluctuate for various practices, but clearly the straight-forward change in activity and procedures demonstrates working smarter, not harder.)
  • Reviewing and adjusting its fee schedule. At a minimum, practices should assess their fee schedules annually to ensure they are capturing the revenue they’re entitled to. Like our example practice did, review the fee schedule against all insurance contracts and make sure you’re charging the maximum allowable amounts. Don’t leave money you’ve earned—and are legally owed—in the payers’ hands.
  • Transferring balances and sending statements. Yes, as fundamental as it sounds, some practices delay or overlook transferring balances to patients. Simply transferring balances and sending out statements can generate faster payment and, more revenue.
  • Checking eligibility. Checking patient eligibility (or change of insurance) in advance of service significantly cuts down on claim denials and subsequent follow-up work.

Happy collecting!

About the Author

Thom Schildmeyer shares tips to solve real world medical billing problems

Thom Schildmeyer is President of Aesyntix Health, Inc, a leading provider of billing and purchasing solutions for dermatologists and cosmetic surgeons. He has more than 20 years experience consulting with practices in the areas of financial analysis, practice valuation, human resources, training and development, sales management, marketing, and patient relations.

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Complimentary Webinar: Key Strategies for EHR Success

Lea Chatham June 13th, 2013

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Wednesday, June 19, 2013 1:00 PM EDT/10:00 AM PDT
Speaker: Ron Sterling

Dissatisfaction with electronic health record (EHR) performance is a continuing problem for practices trying to take advantage of EHRs and/or qualify for Meaningful Use. In many cases, problems are the result of a lack of design, analysis, and planning in the practice to drive the adoption and use of EHR.

This webinar focuses on the key management approaches you should use to guide and document your due diligence in the use and adoption of an EHR. In this discussion, led by Ron Sterling, you’ll discover how to:

  • Make the transition from paper to electronic charts
  • Manage clinical decisions to support adoption and use
  • Maintain the efficacy and accuracy of your EHR-based records
  • Prevent your EHR from dominating your practice and patient interactions
  • And much more

Register today!  You don’t want to miss this.

Who Should Attend Private practice owners, physicians, practice managers, office managers and others concerned about selecting, purchasing, and implementing an EHR.

Ron Sterling discuss strategies for EHR success for Kareo

About Your Speaker:

Ron Sterling discusses strategies for EHR success for Kareo

Ronald Sterling, President of Sterling Solutions, Ltd., is a nationally recognized thought leader on the selection and implementation of electronic health records (EHR). He authored the HIMSS Book of the Year, Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, and publishes the popular EHR issues blog: Avoid-EHR-Disasters.com. He has worked with a wide array of practices on EHR decisions and issues and has reviewed electronic medical record and practice management systems from over 150 vendors.

Ron Sterling discuss strategies for EHR success for Kareo

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Check Out Great EHR and Billing Tips in June Newsletter

Lea Chatham June 12th, 2013

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The June edition of the Getting Paid Newsletter is packed with information about EHR implementation, HIPAA compliance, and improving your medical billing. Check out advice from Ron Sterling, an EHR expert, on how to improve use of EHR in your small practice along with guidance on HIPAA Omnibus and improving the collection of co-pays. Ron Sterling is also our monthly webinar speaker in June. He’ll dig deeper into how to to prepare for and maximize use of your EHR. And, find out how you can become a fan on Facebook and win $150 or refer a friend to Kareo and you might win an iPad. Read all this and more now!

EHR and medical billing tips from Kareo

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Own Your EHR Efforts

Lea Chatham June 10th, 2013

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Ron Sterling discusses EHR success for Kareo

In the final analysis, your doctors and practice are responsible for the integrity and efficacy of patient records. There is nothing that you can do to delegate accuracy of your clinical records, or patient service processes, to any electronic health record (EHR) vendor or systems integrator.

In too many cases, smaller practices look to the technogeeks to make decisions that are operationally, and legally, the responsibility of the practice. Seeking another party to “channel” your EHR efforts is holding back many practices from achieving EHR success. Taking ownership of your EHR is not an easy task, but neither is managing the avalanche of messages, documents, and clinical notes that we encounter in the paper chart.

The key challenge is engaging the doctors and staff in planning, analyzing, and designing EHR use as well as managing the ongoing decisions needed to maintain and manage the relevancy of the EHR to your practice. Take responsibility for these key areas and you’ll not only feel more in control but have more success with your EHR.

  • Adoption of Clinical Content: Clinical content consists of the checklists, forms and documents that support your specialty. As a practical matter, the smaller practice should try to buy an EHR that addresses your area of medicine or provides easy to use customizable templates. Few small practices have the physician or staff time to create and program the clinical content into their chosen EHR. However, the doctors and staff still need to have a good understanding of where clinical information is stored and how to document patient care. In the event that there is a clinically significant problem with the EHR or the clinical content, you have to work with the vendor to get the problem fixed. Don’t get derailed by a lack of comparable wording or findings in a different order from your previous paper forms. These are not good reasons for changing the system or not using the clinical content to document patient care. Work with your vendor to find solutions and stay at it until you figure it out.
  • Workflow That Supports Patient Service: EHRs can be very effective tools to manage patient care and service if used properly. Working around the EHR features or using miscellaneous text notes instead of the designed feature may prevent you from dealing with patient service and evolving standards of care under Meaningful Use and Patient Centered Medical Home initiatives. Workflow responsibilities include designing how your staff and doctors use the EHR to track patients in the office and issues for patients outside of the office. Such an effort includes designing (and documenting) the handling of messages, referrals, and treatment orders as well as making sure that the documentation and work is completed on a daily basis.
  • Managing Change: Whether the EHR vendor releases a new version of their software, or your practice changes, you need to monitor and manage the evolving use of the EHR. Even small practices need to make sure that EHR tactics evolve to meet practice dynamics as well as taking advantage of new features. For example, a patient portal requires a support workflow process that involves staff and doctors. As important, you need to look at how the EHR is operating on a periodic basis to make sure that the way you use the EHR continues to be effective and practical.

Using these strategies will help you own your EHR and maintain the records you need to promote patient service and wellness. Otherwise, your doctors and staff will be trying to cope with a product that they do not understand in an office that is not designed to work with this important clinical tool.

This is just one of the many topics I will be covering in my upcoming webinar, Key Strategies for EHR Success on Wednesday, June 19. Register Now and discover more ways to prepare for and successfully implement your EHR.

About the Author

Ron Sterling discusses EHR success for Kareo

Ronald Sterling, President of Sterling Solutions, Ltd., is a nationally recognized thought leader on the selection and implementation of electronic health records (EHR). He authored the HIMSS Book of the Year, Keys to EMR/EHR Success: Selecting and Implementing an Electronic Medical Record, and publishes the popular EHR issues blog: Avoid-EHR-Disasters.com. He has worked with a wide array of practices on EHR decisions and issues and has reviewed electronic medical record and practice management systems from over 150 vendors.

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Welcome to Getting Paid, a weblog by Kareo offering ideas, news and opinions about medical billing and practice management with the goal of making medical billing easier and yes, getting you paid. Visit the Product Blog for more information on our products.

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