Value-Based Modifier Is Coming: What You Need to Know

Lea Chatham April 30th, 2014

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By Lisa A. Eramo

CollectionsThese days, no practice can afford to take a financial hit. That’s why it’s important to understand the importance of the Value-Based Payment Modifier, a CMS-imposed qualifier that provides a differential payment to a physician or group of physicians under the Medicare Fee Schedule based on the quality of care provided compared to cost during a performance period.

 

Medicare will begin to apply this modifier in calendar year 2015 to payments for physicians in groups of 100 or more eligible professionals (EP) who submit claims under a single tax identification number. But this doesn’t mean smaller practice providers shouldn’t stay up on what is going on. Eventually, it will apply to them too.

In its attempt to promote value rather than volume, CMS will essentially use the modifier to either penalize physicians for low quality of care or reward them for providing high quality care, Glade B. Curtis, MD, MPH, FACOG, CPC, CPPM, CPC-I, COBGC, said during the AAPC 22nd annual HEALTHCON conference in Nashville, TN earlier this month.

“Many or most physicians are probably not aware of the Value-Based Modifier at this point in time,” Curtis said. “However, it’s likely that this modifier will impact all physicians by the year 2017 even if they don’t know about it now.”Tweet this Kareo story

What exactly must physicians know about this modifier?

First and foremost, know that the modifier is not optional. Everyone must get on board, Curtis urged attendees. Physicians cannot avoid the Value-Based Modifier by simply electing not to participate in the Physician Quality Reporting System (PQRS).

“If you don’t report [PQRS measures], then you will be assigned a negative value modifier,” he said.

The best way to prepare for the Value-Based Modifier is to get involved in the PQRS as soon as possible, Curtis told attendees. This is particularly true for solo practitioners and smaller groups. Tweet this Kareo story

Why? CMS used 2013 PQRS data when determining 2015 payment impact for groups of 100 or more EPs, and there’s no doubt that they will do the same for all other EPs eventually, Curtis said. If EPs in groups of 100 or more did not participate in PQRS in 2013, these providers will receive a 1% decrease in Medicare in 2015. If these groups don’t report in 2014, their Medicare payment rate will decrease by 2% in 2016. These percentages will likely increase over time, he added.

Curtis noted that PQRS measures change annually and generally vary by specialty. Although PQRS and the Value-Based Modifier attempt to qualify and quantify quality of care, doing so often only raises more questions than answers, Curtis said.

“One of the criticisms is that primary care physicians manage a lot of different conditions—up to 400 or more different conditions in a given year,” he said. “These doctors may report to PQRS about only a couple of things, but still they are required to treat many, many different conditions. Many of the PQRS measures, especially for specialists, have little relevance to the competence of the individual doctors.”

There are other concerns, too. Physicians who are labeled as ‘low performers’ may have legal risk during a deposition, for example. “Attorneys and insurers already use reports of federal reimbursement to make decisions in medical malpractice cases to support claims of negligence, so I think it’s a real concern,” he said.

The Value-Based Modifier may also affect patient care—and not in a positive way, Curtis said. Physicians may only respond to incentives and not necessarily make decisions based on the patient’s best interests.

Rather than strive for quality, some professional organizations are instead focusing on how to avoid services that have no value or low value. Curtis cited the Choosing Wisely Campaign, sponsored by the American Board of Internal Medicine Foundation, which encourages physicians, patients, and other healthcare stakeholders to talk about medical tests and procedures that may be unnecessary or even cause harm.

Rather than penalize physicians for low quality care, Curtis said physicians may respond more effectively to value-based relative value units (RVU) that promote quality. These RVUs would reimburse physicians more for cognitive level work rather than procedures.

“I think this is already happening to some degree,” he said. “As we see the reimbursement for procedures go down, we see the reimbursement for office-based activities go up.”

Regardless of how the healthcare industry moves forward with pay-for-performance, Curtis said a comprehensive approach to defining quality is necessary. He urged attendees to consider these questions:

  • How do patients perceive quality of care, and how might this affect patient satisfaction scores?
  • Will practices cherry pick certain patients who are likely to have better outcomes? For example, might they avoid patients who don’t fill prescriptions or attend follow-up appointments? “Are physicians going to be likely to take on these patients if it’s going to affect their quality evaluation and the money you’re receiving from Medicare?” he said. How will physicians perceive patients insured through Medicaid or health exchange products? If they perceive these patients as more likely to have poorer outcomes, might they avoid treating them?
  • Will physicians only respond to quality of care incentives and not make decisions based on the best interests of the patient?
  • How can practices ensure quality of care on an ongoing basis even despite CMS measures for reporting?

For more information about the Value-Based Modifier, view presentation slides from a CMS National Provider Call held on August 2, 2012.

About the Author

Lisa A. EramoLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

 

 

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Mobile Access Tops List of EHR Trends in 2014

Lea Chatham April 29th, 2014

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By Tom Giannulli, MD

Kareo EHR

 

Recently, Software Advice, a free resource that reviews EHR systems, released its 2014 EHR BuyerView report. To compile the report, Software Advice analyzed 385 interactions with EHR buyers to reveal their primary reasons for evaluating new software, and their most desired features and applications.

 

 

The key findings support my past assertions that healthcare IT is moving towards cloud-based solutions and mobile access. According to the study:

  • Mobile access tops the list of desired features with 40% of buyers requesting it, followed by e-prescribing (24%) and lab integration (20%)
  • 85% of buyers overwhelmingly prefer a web-based over a server-based system
  • The majority of buyers (89%) are seeking an integrated system, that includes applications such as billing or scheduling

This is not surprising as more and more data shows the benefits of cloud-based solutions, especially for smaller practices. Cloud-based software is less expensive, more easily accessed anywhere at any time, and automatic updates keep you as up to date as possible.

“A good many buyers are still undecided about what type of deployment model they want, either because they truly have no preference or, in some cases, because they simply don’t understand the benefits of one deployment model versus another,” according to Melissa McCormack, the medical researcher at Software Advice. “But we’re seeing a clear trend toward buyers preferring cloud-based solutions. Among buyers who had a deployment request, the overwhelming majority (85%) wanted SaaS systems.”

For many reasons, nearly half of the practices that have an EHR are looking to replace this year. That is in addition to the 40% of practices that still don’t have an EHR, many of whom have to make a decision this year about Meaningful Use. Cost remains a top concern for many and cloud-based software helps mitigate that.

In addition to cost, I find that physicians also continue to be concerned about ease of use, efficiency, and accessibility. A good mobile solution helps to address these concerns and awareness of this is also pretty clear in the study. But even more important is the awareness providers now have that EHR, billing, and practice management integration is the wave of the future.

“Nearly 90 percent of EHR buyers were looking for EHR software that could also provide some sort of integration with a billing and/or scheduling application,” said McCormack. “This would include EHR systems who partner with practice management products to offer their customers integration. Among buyers replacing an existing EHR, nearly one quarter cited the inability of an EHR system to help facilitate billing or scheduling as the reason for their current dissatisfaction.”

The combination of integrated cloud-based technology with mobile connectivity is now an affordable, easy-to-deploy reality for medical practices. And in addition to the low cost, it can result in significant benefits to your bottom line and patient outcomes.

If you’re interested in learning more about these trends and the benefits, join me at Practice Rx on May 2 and 3. Register here.

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3 Ways to Get Elderly Patients to Use a Patient Portal

Lea Chatham April 28th, 2014

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View Patient Portal WebinarAt the recent webinar, The Patient Portal: Meaningful Use, Engaged Patients, and More, Laurie Morgan discussed her thoughts on why and how to implement a patient portal. There were many questions from attendees specifically about getting their elderly population to engage online. This is not the first time this has come up. It is a concern that comes up anytime there is talk about Meaningful Use Stage 2, patient engagement, and the use of patient portals. In her response to attendee questions, Laurie provided three great suggestions to get your elderly patients engaged with your portal.

  1. The first and most important thing is not to assume that elderly patients aren’t online. Many people think this is the problem, but in fact, while older Americans were slow to adopt the Internet early on, they’ve been making up for lost time. Recent Pew Research data shows that more than half (57%) of Americans over 65 years old are online, and nearly 90% of those 50-64. This and other studies also show that older people are the fastest growing demographic adopting social media and other new Internet technologies. Unless you are in a very remote area with limited connectivity, odds are that about half of your older patients will have access. (Even in remote areas, Pew finds that 83% of citizens are now connected!) So, ask your elderly patients if they are online. If they are then you are half way there. If they aren’t, it may not be as hard to get them online as you think. Also, keep in mind that their family caregiver may be online and can use the portal on their behalf. If you want to help the patient get online, there are a couple options. Make sure they know where they can access a public computer: the library, Internet cafes, and even a secure computer or kiosk in your office. If you have adult education programs in your community that teach classes on using the Internet, keep that information handy to share. Give them opportunities to try it out and see what they think.
  2. Then, you face the bigger obstacle, which is convincing seniors that using the portal will be better for them. One reason older people took longer to embrace the Internet was because they felt they didn’t need it; once they understood how it could benefit them, they came online in big numbers. The same process will likely hold true for portals.
    When introducing the portal to older patients, emphasize the features that are likely to help them most: Tweet this Kareo story
    - the ability to set appointments without waiting on hold,
    - more convenient access to prescription refills
    - the option to provide access to a family member caregiver
  3. The third thing to keep in mind is who should talk to your elderly patients about the portal. When launching a portal, you should have a comprehensive marketing program. That plan must include a wide range of ongoing communication through several tools and vehicles to make patients aware of the portal. For your senior population, communication from their physician during a visit may be the most impactful. Doctors can play a critical role with older patients, who may be more likely to follow physicians’ instructions to the letter. Make sure your providers are on board and informing patients that the portal is something that can help them better manage their health, and that using it is an important part of their care plan. You might even want to try the idea of ‘prescriptions’ for portal access. Tweet this Kareo story

Share your suggestions for engaging seniors in the comments below.

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Your Top 5 Patient Portal Questions Answered

Lea Chatham April 24th, 2014

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View Patient Portal Webinar Now

 

As a follow up to our recent webinar, The Patient Portal: Meaningful Use, Engaged Patients and More, speaker Laurie Morgan and Kareo have answered the many questions posed by participants. Here are the five top questions posed by attendees:

 

Q: Are there any tips for implementing a portal in a place where patients don’t always have access to the Internet readily available?
A:  Even when patients don’t have computers, many will have smartphones—so check with your EHR/portal vendor to learn what kind of support for mobile devices is (or will be) available for your portal.

Setting up one or more computers in your reception area that patients can use to access the portal may be another solution. It will be important, though, to be sure the computers are a bit segregated to allow for privacy. The system should automatically log patients off after a brief period of inactivity, and other available measures should be implemented to protect personal information. (Check with your vendor(s) before setting up a public computer.)

Q. How do you identify the uninformed patients and reach them?
A: Providers and nursing staff are often in the best position to identify patients who are timid, discouraged, or overwhelmed.

It may be useful to designate a staff person to provide a bit of extra support and coaching to patients who are intimidated by the patient portal. Tweet This

Many practices are designating a clinical staff member—often an RN—as a care coordinator or case manager as part of the medical home (PCMH) certification effort. This person will also be in a perfect position to identify uninformed, unengaged patients and help get them on board—since coordinating care across multiple providers and engaging patients with chronic conditions more directly is a key focus of the medical home.

Q. Do text or email reminders meet the MU2 requirement for secure communication with patients?
A:  Text and email don’t typically meet HIPAA standards on their own (although some email providers do state that they offer HIPAA compliant encryption). For this reason, it’s usually not advised to use text or email as two-way communication with patients. Instead, secure communications should take place via your portal, and use the secure messaging functionality built into the portal and your EHR. This way, patients can respond securely—which is the key to meeting the 5% threshold requirement. Email can be used to remind people and direct them to your portal to receive their secure messages and respond.

Q. We have many patients who have a family caregiver. Can caregivers access the patient portal for their family member? Are there any privacy issues we need to consider?
A:  HIPAA allows for sharing of information with family members and other authorized caregivers. Be sure to get authorization from the patient to share the information via your portal.

Q: We have a lot of elderly patients who do not have computers or Internet access. How can we meet the requirements for MU?
A: One important thing to do is not assume that elderly patients aren’t online. In the early years of the Internet, older people were slower to adopt, but they’ve been making up for lost time in recent
years. Recent Pew Research data shows that more than half (57%) of Americans over 65 years old are online, and nearly 90% of those 50-64. Also, many caregivers are online (see answer above). A bigger obstacle for older people may be convincing them that using the portal will be better for them.

When introducing the portal to older patients, emphasize the features that are likely to help them most: the ability to set appointments without waiting on hold, more convenient access to prescription refills, and the option to provide access to a family member caregiver are examples of portal features that might be more compelling to an older patient. Additionally, doctors can play a critical role with older patients, who may be more likely to follow physicians’ instructions to the letter.

If you missed this informative event, you can view the recording or download the slides. And consider joining us for the next free webinar from Kareo, Your Medical Office Software: Coding Pitfalls & Promises.

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ICD-10 Delay Just One of the Topics Discussed at AAPC

Lea Chatham April 22nd, 2014

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By Lisa Eramo

Kareo ICD-10 ResourcesNearly 1,900 physician practice coders and other healthcare and compliance professionals gathered in Nashville, TN earlier this month for the 22nd annual AAPC conference. Hot topics included how to make the most of the ICD-10 delay, coding for various specialties, mitigating compliance and legal risks, preparing for ACOs, and understanding Value-Based Payment.

The conference was held just days after the U.S. Senate passed legislation that delayed ICD-10 until at least October 1, 2015. Many coders voiced frustration about the delay, stating they were more than ready for the transition.

Bill Gracey, CEO of BlueCross BlueShield of Tennessee, said that payers are also frustrated by this surprising change in the timeline that seemed to have been ‘snuck in’ at the last minute. Gracey delivered the conference’s opening keynote, touching on not only the ICD-10 delay but also topics such as the shortage of primary care physicians nationwide, the role of big data and informatics in population health, and healthcare pricing.

“The game keeps changing. For the last six months, it has been a real challenge,” said Gracey.

To date, there have been more than 40 changes and delays in the specifics of healthcare reform.Tweet this Kareo story

BCBS of TN has spent $13 million to prepare for ICD-10 with no clear implementation date on the horizon, Gracey said with frustration.

AAPC CEO Jason VandenAkker said coders must continue to move forward despite the delay. “Be part of the solution—not part of the problem,” he urged attendees.

Healthcare reform offers coders opportunities to advance their careers, said VandenAkker. “More covered lives means more patients walking through the doors, which means more services rendered, which means more coding. That’s guaranteed … Revenue cycle management will remain at the heart of every discussion, and [coders] are at the heart of revenue cycle management.”

VandenAkker urged coders to embrace these opportunities and ensure that physicians are fully prepared for the transition. “If there is a greater focus on coding, that means there is going to be greater visibility for coders in their organizations. People are going to be looking at you for answers. There is a greater need for trained certified professionals.”

During a panel discussion about ICD-10, Rhonda Buckholtz CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, vice president, business and member development at the AAPC, said:

Coders need to keep the ICD-10 momentum going in their practices. Tweet this Kareo story

“If our coders aren’t ready, they’re going to be putting their practices at risk,” said Buckholtz. She urged coders to use this extra time to prepare physicians using simple documentation tips and strategies, she added.

“You have either another year to prepare or you have another year to procrastinate,” said Michael D. Miscoe, founding partner of Miscoe Health Law, LLC. He said coders should ask these questions:

Physicians need to be aware of how unspecified codes may impact their revenue, said Angela Boynton, director of provider regulatory compliance, communication, adoption, and training at UnitedHealth Group. “No two payers are going to have the same policy around unspecified codes,” she said. “I’ve heard some payers will issue flat-out denials and not accept a single unspecified code in ICD-10. I’ve also heard some payers say, ‘Yes send us the unspecified code. We’re immediately going to flag you for education.’ This is another way of saying audit. I’ve also heard payers say, ‘Send us the unspecified code. We’re going to send you a payment, but we’re going to reduce it by 50%.”

Speakers participating in the ICD-10 panel each reiterated the importance of end-to-end testing. “Make [vendors and payers] test with you,” said Buckholtz. “If they say they don’t have to test with you, make them prove why they don’t have to test specifically with you. One size really doesn’t fit all. Just because it works for another practice that has your systems or programs doesn’t mean it’s going to work inside of your practice.”

Ask your payers to prove whether they’ve tested with another practice similar to yours, said Boynton. Ask your vendor or payer to publish testing results based on geographic location (e.g., urban vs. rural) and number of physicians in the practice.

Aside from the tangible buzz about ICD-10, other sessions at the conference focused on specialty-specific coding dilemmas, compliance questions, hiring and retaining coders, and more. During a legal trends panel, many coders asked questions about concierge services—specifically whether practices must legally bill for covered services. Other questions pertained to cloned medical records, write-off policies, and non-compliant patients.

Health attorneys participating in the panel identified these top compliance challenges in today’s practices:

  • Modifier -25
  • EHR cutting and pasting
  • Modifier -59
  • Incident-to billing

Although coders generally lamented the ICD-10 delay, speakers encouraged a ‘forge ahead’ attitude, encouraging coders to continue to improve documentation and address ongoing compliance challenges.

For more on the ICD-10 delay, visit the Kareo ICD-10 Resource Center. And watch for more updates from AAPC from Lisa Eramo in April.

About the Author

Lisa A. EramoLisa A. Eramo is a freelance writer/editor specializing in health information management, medical coding, and healthcare regulatory topics. She began her healthcare career as a referral specialist for a well-known cancer center. Lisa went on to work for several years at a healthcare publishing company. She regularly contributes to healthcare publications, websites, and blogs, including the AHIMA Journal and AHIMA Advantage. Her focus areas are medical coding, and ICD-10 in particular, clinical documentation improvement, and healthcare quality/efficiency.

 

 

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6 Experts Offer Advice for Reducing Medical Practice Wait Times

Lea Chatham April 21st, 2014

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1653094172_e370ec42f0_zWait times can be the bane of a medical practice. Physicians get called away for an emergency or run over with a particularly needy patient. Suddenly you are 10 minutes behind. Within a couple of hours, you’re 30 minutes behind. And it doesn’t just happen in the waiting room. It happens on the phone and in the exam room. On top of that, sometimes patients have to wait to get an appointment in the first place. All that waiting can have a negative impact on your practice.

 

The problem is that patients are less patient these days. They see your medical practice more like a retail or other service industry business, and they want to get in quickly and get their needs met.

To help you reduce wait times and improve your customer service, six medical practice consultants and experts offer their top suggestions.Tweet this Kareo story

  1. Laurie Morgan of Capko & Morgan suggests measuring your wait times. “Too many practices rely on gut or (often incorrect) assumptions,” she says. “You need to track and analyze where your bottlenecks are to know for sure.”
  2. Judy Capko, also of Capko & Morgan, says eliminating waste and inefficiency throughout your practice can help. She suggests, “Ask every employee to examine their entire day and document all of their tasks then look for duplication and waste across the whole practice. Then, be very critical in your review of those processes.”
  3. Audrey Christie McLaughlin, RN believes that reducing wait times is a team effort. “Make sure all staff are trained to hear the phone ringing and the hold alert buzzing back,” she says. “The receptionist may be busy checking in patients, in the clinic, or stuck on the line with a chatty patient. Anyone in the clinic can pick up and assist the next person calling. In addition, it takes an aware team to move patients through efficiently. If the doctor is waiting on a nurse to get a suture removal kit for instance, this is time wasted. It is up to the nurse to know what the patient is there for and set it up in advance so that everything runs smoothly.”Tweet this Kareo story
  4. Kathy Young of Resolutions Billing & Consulting advocates for checking eligibility for every patient before they arrive. “Checking eligibility before the patient arrives can save time for the practice and avoid delays for the patient,” she explains. “When the scheduler speaks to the patient on the phone to make that initial appointment, taking the full insurance information is very important. It is even better if patients complete information online or through the main and then send it back ahead of time. Then, the process of checking in and paying the co-pay is much faster.”
  5. Deborah Walker Keegan is a fan of same day appointments, but she recommends creating a very streamlined process for them. “Patients will place telephone calls to the practice early in the morning to seek a same-day appointment,” says Walker Keegan. “To avoid delays in responding, hold a huddle in the morning to identify specific slots in the day where same-day appointments can be made without involving the nurse or physician and simply slot the patient in the schedule when they call.
  6. Jessica Altman from ZocDoc wants to remind practices that offering 24/7 online scheduling provides a new level of access and convenience to patients. “If you use a service like ZocDoc, both new and existing patients can find you easily online and schedule an appointment at their convenience. You can also provide a link to online scheduling on your own website. It can shorten the time patients have to wait for an appointment.

The main thing to remember is that to stay competitive in these changing times, you need to meet or exceed patient expectations. Tweet this Kareo story

That means spending as much time on improving their experience in your practice as you spend on giving them clinical care or processing their claims and statements. If you are looking for more and better ways to improve the patient experience, download Engage! 10 Powerful Ways to Engage Patients in Every Aspect of Your Practice.

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The Pros and Cons of Using an EHR Scribe

Lea Chatham April 17th, 2014

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Kareo EHRBy Charles Settles

Electronic health record (EHR) adoption has brought new triumphs and new challenges. Coping with these challenges has caused many changes, few more interesting than the rise of the EHR scribe. While there are a seemingly unlimited number of EHR vendors in the marketplace, it’s no secret that not all of these programs have the clinical efficiency providers require. Because of this, many physicians end up looking for a new solution. For some, switching EHRs still isn’t enough because of their unique workflow needs. As a result, EHR scribes have popped up as a strategy to allow providers to structure their workflow the way they want while maximizing the benefits of the EHR.

What is an EHR Scribe?
An EHR scribe is someone employed by the provider to interact with the EHR program on the physician’s behalf.Tweet this Kareo story

According to Dr. Kathleen Myers, CMO and founder of Essia Health, a scribe training/staffing firm, scribes are typically aspiring nurses, nurse practitioners, or physicians. In a patient encounter, a scribe will input all of the physician’s comments and orders into the EHR, as the doctor dictates. Sometimes called “at-the-elbow” support, a scribe follows the doctor from encounter to encounter, to the point of occasionally needing to be told by physicians like Myers, “I’m going to the bathroom, you don’t have to follow me here.”

Scribe Training
According to Dr. Myers, Essia’s scribes are vetted for academics, typing skill, and medical passion before being admitted into the training program. Independent study of medical jargon, how to create encounter notes, and how to create differential diagnoses is followed with 20 hours of classroom training, where they practice charting in the EHR. Following independent study and classroom time, the new scribes progress to an actual encounter. They’re paired with existing scribes and trainers for an additional 80 hours of observation and instruction before becoming a full-fledged scribe themselves.

Scribe Impact on Clinical Efficiency
While scribing might not seem efficient at first glance, according to Dr. Myers and several studies, scribing can actually help some practices. According to a study published in the Journal of ClinicoEconomics and Outcomes Research, physicians who used scribes saw an increase of 1.3 patients per hour, and 2 work relative value units (wRVU) per day. There was even a rise in levels of patient and provider satisfaction of 6 and 50 percent, respectively. Perhaps the most (or least) surprising benefit is the rise in patient satisfaction. Having an additional person involved in every patient encounter might seem awkward, but if the physician is spending more time interacting with the patient instead of a screen, it’s not surprising that patients felt better engaged.

Future of Scribing
As data from the Centers for Medicare and Medicaid Services (CMS) shows, nearly half a million providers have begun to use EHR programs since the Meaningful Use incentive program began, and the number continues to rise. A brief Google search turns up hundreds of companies moving into the medical scribe training and placement business to meet an increasing demand. For providers who can’t seem to find the right workflow efficiency with an EHR, this can be a good solution, but there is a cost. According to Myers, most Scribes make $10-$15 per hour. So, consider carefully if hiring a scribe is the best option. Then, look for someone with experience using your EHR to minimize training and onboarding time.

But keep in mind that the long term goal of an EHR should be to simplify medical workflows, not add additional staff.Tweet this Kareo story

So you may want to balance the option of a scribe against the time and cost of additional personalized training for providers who are struggling to adapt to an EHR.

About the Author

charles settleCharles Settles is a content writer at TechnologyAdvice. He frequently covers topics related to Health IT, business intelligence, and other emerging trends.

 

 

 

 

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Use Patient Engagement Technology to Add Loyal Patients, Earn Profits

Lea Chatham April 15th, 2014

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Part B News logo

By Roy Edroso, Part B News

Push patient engagement with electronic health record (EHR) tools not just to meet meaningful use standards but also to keep patients coming back.

Patient engagement features include patient dialogue with providers that goes beyond the office (e.g., secure messaging) and health interventions that require the active participation of patients, such as diet and exercise monitoring.

Practice managers might consider those features low-impact and not worth pursuing beyond regulatory requirements. Yet some measures are actually what patients say they want, according to Lea Chatham, a content manager and patient engagement expert at EHR company Kareo.

The Optum Institute, for example, finds that most patients want an online relationship with their providers, and Aeffect Inc. finds “access to EMR tools appears to be one of many elements that are likely to contribute to higher levels of satisfaction and patient retention.”

“Patients are starting to view health care like other consumer services,” Chatham says. “They begin to expect the same kind of access that they get from retail. They want tech notifications—balance due, service reminders, the ability to use electronic communication.”

Along with giving patients what they want, the EHR tools can help your practice meet stage 2 meaningful use measure 7 (portal access to health records) and measure 17 (secure messaging with patients) (PBN 1/13/14).

Use tech to improve your image
Patients’ perceptions of tech-savvy practices also have changed, says Robert Tennant, senior policy adviser for the Medical Group Management Association (MGMA) in Washington, D.C.

“I think it used to be that Medicare patients were tech-averse, but now they’re coming in with smartphones themselves,” says Tennant. “For a practice to be seen using tech like this is to be seen as cutting-edge in clinical standards too—and an older, paper-based office may not seem up to the latest clinical standards. Look at Kaiser Permanente’s ads: They’re about patient engagement and technology now—they position themselves as tech leaders, therefore health care leaders.”

The further you go with patient communications, the more tightly you bind them to your practice, suggests Todd Searls, director of Wide River LLC in Lincoln, Neb.

“If the patient communication tool is one way only—like an email stating that a lab result is in—then not much is changing from how we do things today,” says Searls. “However, if the email leads the patient to a portal where they can schedule appointments, review educational resources, upload their own medical history then you are starting to really build a portal for patient engagement that can transform patients from ‘audience’ status to ‘participant’ status.”

How simplification saves money
As these technologies develop and patients get used to using them, their financial advantages will become easier to see, says Tennant. He anticipates your skepticism: In the meaningful-use era, physicians who’ve been spending bundles to come up to standards may find that hard to believe anymore.

But Tennant expects the next tech wave will show savings through administrative simplification. For example: “A pretty significant number of medical claims are rejected on transcription error,” says Tennant. Practices lose more than $3 per claim that they have to rework, according to a 2013 AMA report (PBN 7/1/13). “That would be reduced by a smart health card.” Also, he says think of the phone calls and unnecessary office visits that will be headed off by a more robust online communication link between providers and patients.

3 tech tips to do now
The smart cards are a ways off, but take advantage of technological advances that are now available:

  • Use text messaging with proper HIPAA security standards. Studies show that many doctors already are using text messaging to communicate with patients. Several companies have developed texting systems that they say meet HIPAA standards to protect patient’s information (PBN 6/24/13).
  • Find apps that work specifically for your practice. “There are tens of thousands of health-care-related apps out there — and most of them are useless,” says Tennant. But some are effective, especially for patients with chronic diseases like diabetes, he says. “We’re looking forward to practices leveraging that type of tech, and maybe even having their own apps,” says Tennant. “An endocrine practice with a lot of diabetics could get an info feed from their patients, for example, that goes directly into the EHR system. And they can use the same tech to push out information—on healthy living, things to avoid, things to do, news … there are a lot of opportunities.”
  • Handle over-communicators. As your online patient communications improve, some patients will expect an immediate response, even when they only have a sore elbow, Tennant notes. “Typically Medicare will not reimburse for that service, so you have to be cautious opening that up,” he says. “Also, you don’t want to diagnose via text”—even if the patient sends a picture. The model is for the patient to make an off-hours call to your phone service; generally the answer will be to have the patient go to an emergency room or come to the office in the morning.

This article was reprinted with permission from Part B News. To subscribe to Part B News, click here.

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Successfully Implement Patient Portal for Meaningful Use

Lea Chatham April 10th, 2014

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Register NowPatient Portal: Meaningful Use, Engaged Patients & More
Wednesday, April 16, 2014
10:00 AM PT, 1:00 PM ET

Practices that have invested time and money in choosing, implementing, and converting to electronic health records are ready to reap the benefits—and patients portals are an important key to success. A well-implemented patient portal will help you achieve Meaningful Use incentives AND improve patient engagement and compliance while also simplifying time-consuming office tasks like reporting lab results and medical records requests. In addition to the financial and workflow benefits, patients are actually eager to connect with their physicians electronically. You just need to know how to make it all happen

In this webinar, Laurie Morgan will share strategies to help you:

• Successfully implement your patient portal
• Improve patient engagement, compliance, and outcomes
• Meet some requirements to attest for Stage 2 of Meaningful Use

You’ll leave this webinar able to realize more of the benefits of your EHR and patient portal!

Who should attend? Practice managers, healthcare providers, and anyone else who is interested in using and make the most of a patient portal

Register now to learn how to make the most of your patient portal

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Great Meaningful Use Updates in Kareo April Newsletter

Lea Chatham April 9th, 2014

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The April edition of the Kareo Getting Paid Newsletter is packed with Meaningful Use tools and tips to help you attest along with our latest infographic on making increasing demand for healthcare services an opportunity for your practice. The newsletter also provides a chance to discover upcoming events, news, and resources from Kareo and links to connect with Kareo on social media. Plus, you’ll learn about how to register for our upcoming free educational webinar, Patient Portal: Meaningful Use, Engaged Patients & More, presented by Laurie Morgan. Read all this and more now!

April Kareo Getting Paid Newsletter

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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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