It only makes sense.
If a professional or professional healthcare team provides a consumer with two services during a visit, the consumer wins because they don’t need to delay getting the help they need and the professional’s revenue increases. I love a win-win scenario.
For the consumer this might mean that a nurse checks her blood pressure, heart rate, etc, and then after a short chat, sends her to a psychologist or other professional to discuss that or another condition. Many apparently physical symptoms like nausea or aches and pains are discovered to be in the realm of a mental health professional’s responsibility; with a root cause of something like grief. This is where an Electronic Health Record (EHR) can really show its stuff in efficiency by electronically alerting other professionals the consumer needs a service and in making sure somebody’s available to help by using the EHR‘s Scheduling Module.
When this sort of thing happens, CFOs love it, process managers love it, and sometimes the treatment professionals may balk at entering a note and charge into the Electronic Health Record (EHR), simply because they’re unsure about the value of that second service and taking the time to record it (some insurance companies and states’ Medicaid won’t pay for the service). We’re all busy people, and it’s possible a second service might not get recorded as an oversight. Today’s EHRs are loaded with reminder systems to make sure scheduled services are addressed, and proper documentation and charges are filed.
Conceivably, since a counseling session can last longer (and pay more) than a short nurse’s visit, only that more profitable service may even make it into the EHR, and therefore the billing system. That could be terribly inconvenient to fostering team spirit, as a professional assigned to diagnosing the patient may want to see the note from the original person who noticed the problem and have a little chat with them before proceeding to treatment for this additional diagnosis. Oh, by the way, depending on who diagnoses the problem and other factors, we may have added to the list another service related to filing the diagnosis itself.
If it’s not in the EHR, the record believes it didn’t happen. It might not be serious, but a secondary service might affect future treatment, so it’s better to record everything.
There are a number of places that second services can be noticed in the EHR, from the front desk checking in, through visits with different professionals, and even at check-out when the consumer gets back to the desk again. A front desk person could notice a limp when a person comes in for a counseling session, or another staff member might notice a consumer with tears in their eyes or who’s behaving oddly. When all staff is mindful about a consumer’s overall health and everybody is acting like a team, more services are rendered. And in the end, even in not-for-profit environments, that can make the difference between replacing somebody who’s left for a different opportunity and giving a salary increase to other staff at the end of the year.
If an organization doesn’t have this sort of mindfulness in place, with the team looking for additional ways a consumer might need help, concentrating on the idea in a staff meeting may be a good idea. Staff education regarding what sorts of symptoms to watch out for can increase vigilance to assure the consumer gets the best care possible. As a bonus to increasing the number of services provided, the revenue of the facility can go up at a time when increasing revenue is critical.
With all that said, there are still operations out there who are stuck with “threshold” billing (where the payor pays one rate for the day, regardless of how many services are provided) for some insurance payors, wherein all services provided during a single day’s visit must be included in that day’s bill for a fixed fee. No extra charge. Others will only pay for explicitly defined additional services under specific conditions. In some cases, payors may seem to make it difficult to charge for additional services. As in anything that has to do with business, you gotta be sharp and make the time it takes to optimize revenue. That may require some help from a consultant or moving a staff member into a position that’s primarily responsible for increasing revenue and assuring documentation and billing are on-track in order to provide the best care possible. With that resource in place, the EHR can be both a guide to making sure needed services are provided to the consumer, and a police officer to assure the billable record is recorded.Read more →
On June 21st, I published my comments on Facebook for business…I just didn’t know it had become so important to augment a business site with a Facebook presence. Now I know. Interestingly, the visits to my website jumped by fifty percent for the month. I believe that was simply because Facebook is so doggone popular and my blog came up in the search engines more.
I recently attended the NIATx conference in Boston, and H Westley Clark, Director of CSAT (http://www.samhsa.gov/about/csat.aspx) was a featured speaker. He mentioned in his address that one of the difficulties in delivering treatment documentation to consumers is that it may end up on Facebook. This brings up aspects of confidentiality that are important not only to the consumer, but also to the professional and even the organization they work for.
The Electronic Health Record (EHR) is becoming more and more expansive these days. In addition to the assessments, treatment plans and progress notes, you might see brain scans or even recordings of telemedicine sessions. I asked Jim Mountain, a vendor of telemedicine software, about recording sessions. He advised that it can certainly be done, however, would a professional want to do to that when there’s a danger it could end up on YouTube? All the systems I’ve seen (and I’ve seen a ton) have proven secure, and hackers are not likely to effectively plumb for health information, however, all health records are available to consumers, who might make a decision to share portions of the record on social media. If you’re a professional, consider how you’d feel if your notes were shared that way, or your sessions broadcast.
I believe the consumer’s health record is their property as much as the professionals and the organization they work for. It needs to be guarded, and is. A friend of mine manages a business that protects the consumer identity of methadone treatment recipients from the state…42 CFR prohibits even the state from knowing the identity of consumers they are paying for with Medicaid. The point of this is protection. It’s pretty good these days as long as records aren’t accessed on a lost laptop computer or published on Facebook or YouTube. I doubt it’s likely to happen, but it could. Perhaps an agreement between the consumer and the professional to keep the record that’s provided to the consumer confidential is in order.
This is a huge issue. A couple years ago, Duke FUQUA School of Business published their take on just how huge it is. And they’re not the only ones who’ve been debating, just search of the web on this subject, and you’ll find no shortage of opinions.
This is great food for thought about security, and while the consumer’s privacy is paramount in the business of mental health and substance abuse treatment, it seems to me that the professional’s privacy deserves some respect. And I think that’s the point, professionals spend a considerable amount of time and energy learning their craft, and the subtleties of what they do may be lost on a casual reader, followed by misconceptions that could affect the professional’s business or reputation.
I found these revelations fascinating comments on how our world is changing and Facebook is taking over the world. It will be interesting to watch this issue escalate.Read more →
A post on Linked In shared a consultant’s opinion that enterprise software breeds evil.
Well, now, that’s just nonsense. Enterprise software is designed for an agency, in my interest an Electronic Health Record (EHR) for mental health or substance abuse treatment organization, and the software helps people get their jobs done, meet regulatory requirements, assure billing gets done so everybody gets paid, and another very important thing. It may be tempting to rely on memory of a case record rather than go to the chart room to review the consumer’s chart prior to a session. That can be not-so-good; the EHR eliminates trips to the chart room to see previous assessments, progress notes and treatment plans, conceivably bringing a more educated professional into a session and improving the consumer’s likelihood of getting better.
Where does this perception of enterprise software’s evils originate? If I rely purely on anecdotal information, it comes from the customer’s experience with poor implementations. I’ve implemented, been cursorily involved with, and heard of a few EHR implementations, where not every person on the team followed all the advice that ultimately has the professional/consumer relationship in mind. And that shortcoming includes both vendor and agency. Poor planning is the usual culprit.
Over the weekend I went to scenic Boston, MA and attended the NIATx/SAAS conference and was able to sit in on a couple consultants’ sessions about implementing EHRs. I also talked with several vendors, and made an interesting discovery. The “middle tier” of software vendors has come of age. These are software companies that aren’t so big that they’re priced out of a medium-sized agency’s market, or so small they can’t support what they sell. I was particularly interested in the address by keynote speaker David Spong. Another speaker that held my attention was an old friend to substance abuse, H Westley Clark, the director of the Center for Substance Abuse Treatment (CSAT). The consultant’s sessions were interesting insomuch as the questions coming from the audience were the same questions professionals were asking fifteen years ago and before. • How do we pick a software company when there are over 100 vendors out there manufacturing EHRs? • Once we pick an enterprise system, how do we install the doggone software in less than a year and a half? • How do we get professionals to use the system (some are pretty resistant)?
The vendors I talked with in the display area were cordial, very nice guys. I wanted some information that’s key to my business, as it had been a year since I’d updated my records on these vendors. I asked some simple questions, including: • How long have you survived in this tough business? • How many customers do you have, in how many states? • Is your software certified to meet Meaningful Use requirements?
There were more questions, and I plan to address these industry concerns in upcoming posts. Who knows, I may even include some actual information on how to avoid implementation pitfalls and make the experience transparent to consumers…techie consumers are likely to be the only ones interested in this, but for professionals, I think it’s a good subject. I’m thinking about a few reviews of vendors, and sharing my process for narrowing the field of vendors to a manageable few that can be included in a software search.
All in all, the NIATx/SAAS event is a good experience, filled with people who actually care enough about the consumers to stay in business and serve them. I’ll likely attend next time.
…and I software and vendors aren’t evil.Read more →
Is treatment quality dropping because of requirements to use the Electronic Health Record (EHR)?
Professionals who hang their own shingle already know that you gotta do the paperwork. If they don’t keep their assessments, treatment plans and notes up to date, they may not be able to bill a consumer’s insurance. Another reason to keep up with the paperwork is that in these documents lie solutions to mental health and addictions problems.
Those working exclusively for agencies may resist spending the time on the paperwork, and that hurts billing, which hurts the paycheck and the organization they work for. Since it’s a key to the paycheck, why do some professionals persist, buying into this old problem and have trouble keeping up with the paperwork?
Lately I’ve been working with a moderately resistant staff that has taken a while to acclimate to using the EHR. After months of work, the professionals are writing the notes to chronicle short, significant activities with consumers that were not previously required. Consumers’ records are up to date and include the new documentation requirements, and billing is on target.
The objective for performance in this particular clinic was determined by analyzing what needed to be done to reach the revenue that would enable the clinic to survive. We discovered a couple interesting things.
All the work was being done before the mandate to record the notes in the EHR became critical (in this case, the progress note triggers a record to the billing system to bill for the consumer’s treatment). Staff felt they didn’t have time to write the notes for these short sessions. They felt the longer sessions were where the meat of treatment was found and really the important thing to document. Were morsels of these shorter sessions ever lost? Who knows. The fact is, they are not lost now.
Prior to the requirement to use the EHR’s progress note to kick off the bill for the session, you might have seen professionals reading the paper or balancing their checkbook in their downtime. No more.
The other day a friend I’ve been working with on this project told me she was pleased with staff’s performance in getting the notes done, and the charges for this work they’ve always performed with consumers, but never been paid for.
There may be a downside.
This clinic, like a lot of clinics, tries to engender a “family atmosphere”. The staff members are all caring professionals, well trained in helping people. My friend’s fear is that their attention to this aspect of the clinic identity is slipping, and consumer treatment may decline in quality. Staff is focused on survival of the clinic. They feel that without writing a ton more short notes to generate more revenue, their jobs may be in jeopardy. So, the solution to this is to broaden attention to include consumer treatment, while still writing a ton more notes. A management issue that may be a constant companion for a while.
To put it simply, this is just a matter of getting used to a new way of doing business. Right now, it may be true that the staff is taking the paperwork and billing quite seriously, perhaps too seriously. I said earlier they are “caring professionals”. As such, they can’t help but help the consumer.
My guess is it just takes time and attention to the details.Read more →