Medical people are not very tech savvy and they are often daunted by the software terminology and technology. The task of understanding the IT technology is made complicated due to the inherent culture of software people in inventing new terms at a faster pace than anyone can comprehend.
The research shows, medical people are often a late adopter of IT technology, be it social media or software to enhance practice. In practice management, it all started with various billing software that continued to add features for medical practice. Thus the early software of medical practice management were born. Soon many doctors adopted the electronic medical record (EMR) systems, shifting most of the paper information on electronic media, with some added features to manage patient scheduling, integration with billing, helping to monitor patient care, easy access to patient’s health history.
From EMR to EHR
The early EMR systems did help to manage the practice more efficiently, though they were not always easy to learn and had limited advantage over the traditional paper format. In fact, some of the doctors found them even slower than paper work. Thus leaving a bad taste in the mouth of some medical professionals.
But as the technology evolved, software improved at a quick pace, taking advantage of a better understanding of needs, improved connectivity. Modern practice management software understands the need of involving the patient and other healthcare partners, this gave birth to similarly sounding, yet much feature rich concept called electronic health record (EHR).
EHR is the big brother of EMR, and if a doctor is using EMR then there are serious reasons to upgrade. As the cell-phones have become smarter in a last decade or so, so have the practice management software. Now most of them would take the advantage of cloud technology, easy sharing of data between departments and locations. The patients also have access and control of their medical records. Integration with partners mean that results of lab tests can be directly added into the medical record of the patient by the lab. Use of connectivity means, better scheduling, reminding, information sharing. Newer practice management software is a completely new concept, thus not implementing the latest EHR is similar to refusing from the usage of the smart phone.
Basics of EHR
Good EHR does not have to be expensive
Cost is the first thing that comes to our mind whether we are implementing the EHR or looking for an upgrade. But things have changed a lot in last five years. These days EHR systems are not expensive, with many offering trial periods or even free versions to start with. You mostly pay for the premium features, and they will surely result in cost saving for you in the long run.
Know the platform
It is important that the solution must be available for use on the maximum number of the platform, on your computers and laptops, mobile phones. These days cloud based solutions are quite common, meaning that they are not dependent on the platform or location, and data sharing is also easier. So you will have your EHR system available even if you are on your tab or phone and attending the conference. With every technology do come to some challenges. With cloud based platforms it is very important to know about the security and data privacy. Some of the companies offering cheaper or free service may be making money by selling the patient’s data.
Know the scope of EMR for your practice
One size does not fit all, each EMR is made by keeping in mind different categories of users. Some systems are better for hospitals while other for ambulatory conditions. Size of practice also matters a lot, some systems are made for large teams, while other are better suited for the individual independent practitioner.
Most sought after EMR features
Below is the list of features that most practitioners find useful, this it is important that good EMR system should include each of them;
- Easy access to patient information
- Allow other team members to access and edit patient information
- Allow for drug interaction and allergy check
- Incorporation of data from clinical lab test results
- Provide clinical summaries of visits to the patients
- Billing system integration
- Document scanning
- Medication tracking
What to know before buying or changing your EMR/EHR
Below is the list of things you must know and ask yourself and the vendor before you choose a EHR system for your practice or institution, these questions are based on the recommendation of American Medical Association;
1. What are your exact needs?
It is you who have to identify the exact needs and expectations from the EHR, you should have a clear understanding of problems that you expect EHR system to solve. You need to carefully analyze your workflow, know the needs of integration of EHR with pre-existing systems being used in billing, lab, colleagues.
2. Does EMR offer all the functions for your needs?
Know about the features, and ask about the customization options and costs related to it.
3. How will you transfer your existing data to the new platform?
Does the vendor provide such services, or it can be done easily and automatically, or all have to be transferred manually?
4. Does vendor provide fully functional trial?
This will help you to test the features in real life conditions, after testing you can identify the missing features.
5. What is vendor’s experience in providing such services?
For how much time vendor has been in business? who are the important clients who could recommend their product? Who are the clients of the vendor (hospitals, private practitioners, their specializations)?
6. Are real costs of the product understood?
Pay special attention to the hidden cost, like product may not be expensive but customization may be very expensive. Per user license fee, maintenance costs, costs of future upgrades.
7. Is training cost included in the products?
8. Where does your data reside, and as per agreement who has the access to the data?
9. What happens if the system fails or you are not satisfied?
10. What are the warranties?
So before attending the sales call from any vendor, you must do your own research and be prepared with the questions and information so that nothing is missed.
There’s a lot to absorb in the proposed rule for implementing “MACRA”—the sprawling, bipartisan law passed in 2015 aimed at moving Medicare physician payment from rewarding volume to rewarding value. One question attracting scrutiny is whether the reforms will favor larger practices at the expense of smaller ones. This debate was partly prompted by the Centers for Medicare and Medicaid Service’s own projections that the law would reduce payments for most solo practices.
The controversy over MACRA (the Medicare Access and CHIP Reauthorization Act) raises broader questions. How has physician practice size evolved in recent decades, and what has been driving these changes? And, more generally, would it be a problem if the number of solo and small practices dramatically diminished, or even if they mostly disappeared?
How is practice size changing?
A quick glance at the historical record shows that solo practice has been on the wane for most of the past three decades, so the decline can’t be attributed wholly to MACRA, or the Affordable Care Act (Exhibit 1). Between 1983 and 2014, the percentage of physicians practicing alone fell from 41 percent to 17 percent. Over the same period, the percentage of physicians in practices with 25 or more doctors grew fourfold (5% to 20%).
And yet, despite these changes, small practices remain common. Four of 10 physicians are in practices with fewer than five physicians. These are especially common in rural areas, where lower demand can make larger practices less viable.
What’s driving the decline of solo and small practices?
In part, the shift from small to large practices reflects what social scientists call a “cohort effect”—younger doctors are 2.5 times less likely than older doctors to be in solo practice, and so as solo practitioners retire they are not being replaced. Younger physicians appear to prefer larger practices for the more predictable income and work–life balance they can offer. They may also shy away from the business and entrepreneurial responsibilities demanded by solo practice.
But this generational shift is not the end of the story. There is a secular trend away from small practices among physicians of all ages.
Market dynamics partly drive this development. Practices feel pressure to grow in order to compete with other local providers, and to strengthen their negotiating position with insurers. These pressures can create an arms-race mentality, leading to ever greater consolidation. This leads not only to larger practices, but also to the distinct but related trend of hospitals buying up physician practices to shore up their position.
In addition, public and private actions that create more administrative burdens play a role in the decline of small practices. Employers, insurers, and government are requiring levels of transparency about cost and quality – including through laws like MACRA – that are difficult for small groups and solo practitioners to manage. They often lack the infrastructure needed to collect, manage, and report data, particularly in the age of digitized health information.
Finally, care coordination requires a higher level of organization and new personnel, both of which can be difficult for small practices to afford. As patients and insurers demand seamless, integrated care, larger practices may increasingly gain the upper hand.
How much of a problem would the disappearance of small practices be?
The evidence on whether quality is better in large or small practices is mixed. On one hand, larger practices are more likely to adopt quality improvement strategies that benefit from economies of scale, such as health information technology, multidisciplinary care teams, and after-hours access.
But an important study by Lawrence Casalino et al., funded by The Commonwealth Fund, revealed that patients of physicians practicing in solo and small practices have lower rates of preventable readmissions than those in larger practices. Furthermore, many patients and physicians deeply value the personal relationships that smaller settings can cultivate.
Regardless of the pros and cons, small practices are likely to remain common in rural areas, and some doctors and patients will always prefer them. They will continue to have a role in our health care system.
So the question becomes how to help small practices transition to the new paradigm being created by MACRA and other changes in the health care system. There are several strategies available to both policymakers and private stakeholders, including:
- Encouraging physician networks (e.g., independent practice associations) that enable small practices to share resources.
- Providing technical support to solo and small practices, as the HITECH Act did through a system of regional extension centers.
- Developing payment models that include upfront grants or loans for practices to invest in necessary infrastructure.
- Improving health information technology so that it reduces—rather than increases—the burdens of solo practice.
In recent statements, CMS has affirmed it is looking for ways to help solo physicians and small groups adapt to MACRA, including making $100 million available for technical support. In the coming years, special attention will need to be paid so that small practices are able to keep up with changes that will, hopefully, raise the performance of medical providers of all sizes.
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With all that is going on in healthcare today, it can be hard to stay abreast with the changes. With that being said, we are now four months into ICD10. This is the optimal time to assets your current billing and account receivables to ensure you are get the most out of ICD10 code. With the ICD10 transition you want to make sure your denials and rejections have not increased. You can optimize your revenue cycle management by analyzing reports, performing a coding audit and reviewing your A/R processes.
You can run denial reports on a quarterly basis to look for trends and patterns for why claims are being denied. Some denials can be prevented by simple staff education. Auditing your code against your medical records for accuracy and specificity on a regular basis will also help with this. This should also be done on a quarterly basis to keep it manageable. With the changeover to ICD10 this is an ideal time to do this.
Did you know that medical practices never collect on an estimated 18% of claims. 70% of claims are paid the first time they're submitted. 30% are either denied (20%) or lost or ignored (10%). 60% of those 30% are never resubmitted to payers. It is advantageous for a practice to keep or with their A/R weekly.
This is where Elite Management Solutions would like to help. Give us a call or contact us here and let us see how we can improve your revenue cycle.