EHealth Matters

With the recent outbreak of fungal meningitis, the TMA is helping notify physician practices that received potentially tainted medication from the New England Compounding Center (NECC). We are all concerned for the patients who were treated.  All the facilities, including hospitals, outpatient surgery centers and physician offices, must now stop using NECC products, and identify and notify any patients who received any potentially tainted medication from this lab. Time is of the essence as notification and instructions need to be quick, consistent and accurate. The task is the same for all; however, the ease and speed with which that information can be verified and notification can be sent depends very much on how that information is stored.

 

For providers who have an electronic medical record, the process can be much more streamlined; they can run a report for all the patients who received that medication and dosage in question during a defined timeframe. For those who store all clinical information in a paper chart, the task becomes much more time consuming.  Once identified, patients will likely need to be notified by telephone call or by mail. If your office utilizes an EHR with patient portal, you can send a secure message notification that includes all the information you need to share with your patients.  An EHR patient portal also allows the office to post educational information for their patients who have concerns, and allows patients to communicate back to the office, securely and directly.

 

Read the alert the TMA recently sent to members regarding what practices should do if they received medication from the NECC facility. And if you have questions about how technology can help you in a crisis, contact me at any time. 

When I think of my experience receiving healthcare services, I am typically consumed with the thoughts of time spent in the exam room, what advice or topics were discussed with my physician, and how I would apply that to my real life when I returned back to home and work.  That is what I expect and have been conditioned to expect from a visit to my physician.  At least until the day I woke up with extreme joint pain and swelling.  Imagine my surprise when, after a visit to see a new physician because mine was on vacation, I received a call two days later from that new physician’s office asking if I was feeling better and if the medication and care plan we discussed were improving my condition.  I am sure this call was facilitated by a care coordination process as part of an electronic health record system put in place to improve the patient experience. I know this is just another business workflow process but I still thought, Wow, this doctor not only REMEMBERS me from two days ago, but actually CARES about my recovery. 

In many business models such as the travel, services or food industries, customer satisfaction is a game-changer.  So should health care be run like any other business?  There are many compelling reasons to think that it should:

1. Statistics show the percentage of malpractice cases are reduced less by the type of medical decisions made in a case and more by the “overall experience” of how a patient was treated and the amount of connection created during the doctor/patient interactions of care.
2. Payers will be factoring into the physician’s fee schedule a determination of patient experience and satisfaction.
3. If government incentive programs continue on their current path, many will focus on patient involvement in their care decisions and foster creating care “teams” with their primary care physician in the quarterback position.

It is never too late to set goals for your practice that may fall outside of what happens in the exam room.  The Tennessee Medical Association has tools for you to assess your patient’s satisfaction with all areas of your practice so you may begin on your path to improving the patient experience.   Check it out. 

http://www.tnmed.org/patient-survey/

One thing my grandmother used to always say is the only thing that stays the same is change.  Why then is change generally so hard for most of us?  All of us who watch closely the world of eHealth, data exchange and Tennessee’s HIPTN could feel it coming, however; this week marked the official announcement that our statewide health information exchange project would wind down.  The original network of networks could not make any traction.  For many of us, it is the death of a dream we had huge hopes for.  What we need to do is pick ourselves up, dust ourselves off and define what can be done today that will help physicians to have access to the information they need when they need it. 

Several months ago, I blogged about the gap in this approach to HIE with my “Spaceships and Boulders” post.  I said trying to relate HIE in its current form to what doctors do every day in their practice was like trying to sell them a spaceship.  While there are a plethora of reasons for the lack of progress in health information exchange, the most glaring one is that in the 2-3 year time frame of defining processes until today, technology and theories have all evolved.  Gone are the days and business model for exchange between ER systems alone.  We are thankful for all the lessons learned from those pilot projects, but utilization never grew.   That model could not be priced or replicated to meet the needs of healthcare where the majority of anyone’s care is provided, which is at the physician office.   The State Office of eHealth Initiatives, as receiver of the federal funds to implement exchange within Tennessee, promises to look at additional, more scalable forms of secure data exchange and continue to promote and make those available to healthcare providers.   

TMA decided to focus the majority of our resources on EHR adoption as we recognized that for many physicians, fully functioning HIE in the form of a network of networks might be several years away with many steps toward that goal in between.  Stay tuned for HIE version 2.0 for Tennessee.   

You may have read in the headlines that the federal government recently levied its first HIPAA civil money penalty against a small medical practice with a fine totaling $100,000, signaling that no matter the size of the practice, the U.S.  Dept. of Health and Human Services’ Office for Civil Rights (OCR) takes HIPAA violations seriously.  The CHC behind my name means that I am Certified in Healthcare Compliance.  I will take off my e-Health hat and put on my compliance hat for a minute.  I have worked for a physician practice and consulted with many other practices so I know that most do not have the large detailed formal compliance plan that you would expect to see at a hospital facility. 

 

The HIPAA audits are underway. Enforcement and stiff penalties are occurring.  You can’t wait any longer to ensure that your organization has an effective HIPAA compliance program in place! Large facilities generally create and develop their own proprietary training courses for all their new hires and yearly refresher training using their in-house legal and compliance personnel. So where does the physician office turn for easy, comprehensive and effective training for all your employees on demand?

 

The Tennessee Medical Association has created a course designed to provide HIPAA training to all healthcare staff and will provide a certificate of completion documentation for their employee folders.  This course provides an overview of the HIPAA privacy and security laws as well as real examples of how they apply to normal scenarios that occur every day in medical practices.

 

Visit the TMA’s Education Section of the website to learn more.  www.tnmed.org/hipaa.  You may preview a portion of the training, purchase the course or purchase a block of classes at one time for your staff.  To group purchase (entire staff) under one transaction, please contact customer support at (877) 880-1335 to learn how to get started.

 

The e-Rx incentive program has been around for over 4 years now.  When Congress chose to override the president’s veto of H.R. 6331, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA), it approved not only critical Medicare payment provisions, but also an important set of financial incentives to encourage practices to adopt electronic prescribing (e-prescribing).  I believe the carrot and stick approach to implementing this program, where the parameters of incentive payments and financial penalties change every year, is the biggest barrier to practices.  We are now into the second year of penalties for practices and understanding of the guidelines is critical to the bottom line of your practice.

 

The Tennessee Medical Association has resources located on the e-Health webpage www.tnmed.org/ehealth that outline the program parameters, provide resource information and point you to additional clarification of exemptions of penalties.  If you are looking for answers to the e-Rx program and are a member of the Tennessee Medical Association, please feel free to contact me at angie.madden@tnmed.org.

We all had our marching orders and a looming implementation date for ICD-10, then we received the delay notice. All the industry leaders are telling us that even though ICD-10 implementation is over two years away (October 2014), we should still be moving forward with preparation. As I have been tasked with providing useful education topics to our members on this transition, I was struggling with what content to provide to our physician members that would be useful more than two years out, especially when the ICD-10 codes have not even been finalized. 

 

Physicians have long since been accustomed to new code revisions and updates. Granted, this is not just a new code update but a new code structure that will change every code they have likely memorized by their specialty type. Even with a whole new code structure, if you can look up words in a dictionary, you can look up a new code by the medical term. So then what really is the big deal?  

 

The truth is that ICD-10 is more than a set of new codes; it is an opportunity to get more specificity behind the codes that are reported and to provide a way to learn things about how we treat patients at various stages and severity of disease. The implications on the physician’s office are wide reaching, including implementation of new payment structures based in large part on how providers report the diagnosis of their patients versus the outcome of that care. Even if we do not yet have that final codes set, helping clinicians understand, especially in their areas of specialty, what that documentation needs to include is something we can begin today.  Physicians will need education about how payers are analyzing the codes that are submitted. Receiving feedback to improve that process is fundamental. If we can actually begin to improve our coding documentation now under the ICD-9 codes, moving to ICD-10 during the transition will be far less chaotic. 

 

The Tennessee Medical Association is committed to providing educational series to help physicians in Tennessee improve their coding and documentation and to ease the transition to ICD-10. Look for our coding and documentation webinar at www.tnmed.org/education this fall.

I have one of the best jobs ever, one where my mandate is to help physicians be aware of opportunities to improve their practices and to provide them with resources, advocacy and knowledge. I believe in the ability of technology to be a tool for physicians to provide the best possible care to their patients. I believe in the right information, at the right time for the right outcome … but how do we get there?   

Most physicians are working long hours, fighting to see enough patients to offset reduced fee schedule payments, keeping up with pay for performance administrative hoops, and not letting any patient’s care slip through the proverbial crack. So talking with physicians about health information exchange and adopting electronic health records is a little like trying to sell them a spaceship. Sure, in theory it might be enticing, but tell them again why they need it and how they will find the time to implement anything new?  

I often visualize it like pushing a boulder uphill. Once it gets to the summit, going downhill it will pick up speed.  Admittedly, it’s not easy: doctors will have to continue doing the daily tasks required to get paid for quantity, even as they adopt the technology that will eventually allow them to be paid for quality. Currently, payment is based on CPT codes and RBRVUs (Resource Based Relative Value Units) that measure the value of services performed in the exam room. However, physicians have long known that true patient care goes beyond what can be billed for in that face-to-face meeting. Once we have data in structured, searchable formats, physicians can begin to show the true quality care they already provide, and can expect to be paid for all the extras that go into that care.  

So, how do you sell a doctor a spaceship … or get them to push a heavy boulder uphill? By proving it will get them where they want to go. So what can health technology help you with today that would be worth the time you will expend to adopt it? If the industry is being encouraged to move toward quality-based medicine and subsequent reimbursement, what are the first tasks that could be incorporated to help meet physicians where they are, and help them to push that boulder up the hill? Please share your thoughts with me.