I was catching up on some reading this morning, and reviewed a January editorial from the NY Times about the increasing role of the feds in supporting Medicaid to meet expanding demands.
It seems that a decade of tipping the income scales has left a bundle of families of four bringing in less than $30,000 a year, which expands the Medicaid culture (a social issue I love to talk about, but won’t today). The political argument is whether the feds or the states pay for the increased Medicaid usage. There are disparities among states in how they pay their share, which leaves shortfalls of billions and billions of dollars. In the face of this problem and increased demand (those families I just mentioned), the dam will burst on capitol hill, something will happen, even if it’s wrong, to increase federal participation in Medicaid funding.
C-level executives of provider organizations that I know are faced with increasing workloads and per-service recompense dwindling at the state level. The states have to adjust their budgets and have passed the problem on to my friends. A number are worried that their agencies won’t be around to offer mental health and social services to this increasing population that needs the help. Think about the resulting world a minute. Overworked surviving agencies serve a smaller percent of the population, poorly, and America has a lot of sick people on the streets. Homelessness increases, crime increases, hospital emergency rooms go nuts and jail population explodes. America the beautiful.
Think it’s not that bad? OK. Perhaps I’m reactive, perhaps not.
I only know only a little: I can help in a small way. I help agencies serve more people and increase their quality of care. More people can be served in an agency that demands its practitioners to use concurrent documentation and other efficiency directed aspects of the Electronic Medical Record. Quality of treatment increases when all practitioners and agencies have instant access to electronic records and the right-hand provider knows with professional certainty what the left-hand provider’s doing with the patient.
You can contact me now at info@ehrsio.com
Read more →It’s a slow news day for Health & Human Services.
So, like any dutiful blogger, I dug and burned till I came up with a great topic: Five Factors for Optimal Software Selection, as shared by Joe Naughton Travers at Open Minds. I liked Joe’s five topics, which are actually the foundation of the list, and added my twist: • Functionality: Having helped many companies to implement software, I can say the key to success is more than just what the software does out of the box…meeting workflow demands in positions from the front desk to counselor to the CFO are key; how flexible is the product? • Company stability and reputation: Has the company made it past the first big “choke point”? Are you comfortable the company can weather a financial storm and not leave you out in the cold, looking for software support? • Vendor customer support and service: Talk with a few customers in addition to the vetted, strong supporters (who might have a marketing agreement with the vendor). • Implementation expertise: Implementing software is a partnership between you and the vendor…your businesses are getting married, and remember, the vendor is a polygamist. Devise a plan with the vendor to bring the software up quickly, one area at a time, starting with the area you can get running effectively first. This increases staff buy-in and keeps the excitement going about the ongoing implementation that can take from a few months to a few years. • Cost: Software’s Return On Investment can be measured. I use a tool that’s tailored to your exact situation to determine potential service delivery that can be added, throw in some marketing plans and come up with a goal. Joe advises a three to five year budget plan, which is what I’ve used and like. Software vendors will offer a significant product upgrade that includes technology they were unable to add to the platform you bought every five years or so. Oh, and by the way, they commonly charge big bucks for these upgrades. There are a boat-load of other factors that need to be considered when purchasing software. For the sake of business success, juggling these elements into a reasonable plan seems to be the approach most providers take. Contact Terry McLeod at info@ehrsio.com for help purchasing, replacing, or upgrading your current software.
Read more →I attended a NIATx webcast supporting their Rapid Change initiative recently, and once again was impacted by the desire of agencies to provide more services with fewer resources…and not wait around a year and a half to discover whether an initiative is working…and if it doesn’t work, get rid of it. The webcast told agency success stories resulting in increased delivery of services.
Rapid Change played a part in this. The concept of Rapid Change has been around a while, and elements of getting staff buy-in, setting goals and proving you can meet the goal in a “pilot” effort to improve practices has been proven to work. Throw in a little Lean Thinking and a few business process analysis and management concepts, and you have a recipe for success. I was glad to see somebody implementing these concepts successfully; it proves the effectiveness of sensible business measures.
What seemed lacking in the efforts was effective use of the EMR to make the process more efficient, record the data, and minimize the effort of data entry and measurement of success.
Forms development & flexible reporting are great EMR tools that enable digital recording of the work performed and reporting outcomes of new processes that are instituted for the sake of process improvement and doing more with less.
Why don’t agencies who institute new processes in the interest of improving business practices use these tools to gather data quickly? It seems reasonable that a project could be abandoned in six weeks if the measures aren’t working as long as the data is available for analysis. If it is abandoned and a new form is involved, most software user tools make it easy to dump new forms or remove data elements that have been added.
The answer may lie in manpower. Resistance to change results in staff “noise” and over coming that is a skill in itself. Having instituted many systems that deliver results of increasing services without increasing staff to provide them, I’m sure I can help your agency develop and implement “practices” that become “best”. Connect with me at info@ehrsio.com.
Read more →I was invited as a guest to a group meeting of CFOs who meet on Long Island, and shared my insights about the conversation.
One topic I mentioned prompted note-taking: Marketing.
Once all the efficiencies of the EMR are introduced and measures are taken to shorten the time between the inquiry and delivery of service, staff will have time to provide more services. The methods of gaining referrals for Health & Human Services agencies that rolled off my tongue in closing were to establish relationships at the local Hospital Emergency Room and Police Precinct (not with CEOs and Captains, but the people who actually tell prospective patients where to go for help).
Coincidentally, this morning I was pointed to three reasons why patients may not refer others to an agency’s vital services. This observation from a chiropractor can be applied in many healthcare environments; see the article “The 3 Reasons Patients Don’t Refer “.
1. Patients will refer you to others if you ask them to. It’s a simple matter to have the front desk person smile at the person as they exit and exclaim “Be sure to tell folks we’re here to help!…or something of that ilk. Remind the person at the front desk in your EMR, or even with a billing system pop-up if the patient owes a co-pay.
2. Patients don’t feel comfortable referring you to others. Is this a treatment issue for the patient? A quality assurance issue for the agency? A suggestion aimed at building business could start with the person at your agency who knows the patient best, hopefully their counselor. This sort of discussion extends to the entire staff, and can be repeated with every patient visit. It should be simple enough to set up a reminder for the counselor in your EMR, perhaps to appear during concurrent documentation of the session.
3. Patients are reluctant to share with friends & acquaintances that you’re helping them. This could be an issue ranging from confidentiality to not liking somebody who needs help. We want to “do good” in this business, and the appropriate staff could help the patient overcome this reluctance with patient coaching. Staff would help their charge do some good, and it shouldn’t hurt the patient to help others. Another simple reminder to the appropriate staff in the EMR or billing software would help.
Staff may be unwilling to help…They can be sold on it. Company policy must be upheld for an agency to survive, and staff should want the agency to survive and thrive, not shrink. An employee joins the team when they’re hired, so engage them.
Staff may just plain forget to mention it at the end of a session. Remind them with your EMR and build in redundant impressions for the patient, like posters. Message repitition is a big key to advertising.
Staff may be opposed to helping build business: it’s not their job, man!. Everybody on the team needs to pull for the team.
Optimization of the EMR can help with these details, and we always need to provide more services with fewer resources.
Contact me if you need help.
Read more →What a joy it is to spend a day digging through New York OMH materials to make sense of the new clinic model for reimbursement. It was truly a test for the Attention Deficit Disorder that wants to take over my life. It is, however, something we need to concentrate on, and fast.
I just received a correction in my simple understanding of the restructure of billing, boiling it down to the lowest common denominator. I had thought CPT codes needed to be in the same APG to be reimbursed for a given day, however, I was told that’s not the case.
In order to get reimbursed under the new model for a day’s service,
– Multiple CPT codes can be billed for that day o e.g. 96118 (psych testing) and 90853 (1 hr group therapy) o Two services is supposed to be the daily limit, but OMH is still working on this – The CPT codes must be contained in separate APGs for a day’s billing o Per the example above o There will be exceptions, which haven’t been mapped out yet – The OMH provided spreadsheet-calculators rule regarding rates o They’re available on the OMH website, search for Clinic Restructuring – The provider simply bills for their base rate for appropriate APGs, to be reimbursed according to the weighted rate for each CPT code.
That being the case, the foundation work for clinics lies in scheduling the proper procedures for every patient visit in order to maximize revenue. These allowable procedures are designed to encourage better outcomes of treatment. Does your scheduling process include a person who can make these decisions, or appropriate logic built into your scheduling software?
These thoughts relate back to the October, 2009 David Lloyd presentation, Workshop A – Proven Strategies for Improving Clinic Operation, Profits and the Quality of Care. It’s almost like somebody had a plan.
Naturally the devil is in the details. It can be easy to loose track of foundation objectives and become embroiled in busywork…I think the point of the restructure is to eliminate that sort of wasted effort, be more productive and produce better outcomes.
OK, so once we understand the best way to maximize revenue for the resource spent to earn it, who implements this plan in the clinics? After all, people in the clinics already have jobs.
Terry McLeod stands ready to help.
Read more →By now, your Electronic Medical Record (EMR) should be changing out of necessity, and fast, to keep up with requirements.
In Health & Human Services, we can agree that software vendors are responsible to offer functionality and services that meet demands of major payors like Medicaid and Medicare, which change continuously. What about meeting “meaningful use” of the expensive software you own or are about to purchase? It seems commonly accepted that providers need to take responsibility to assure successful software implementation and its evolution for their agency.
For decades vendors have heard from users that the software they purchased doesn’t do what the users want. In many cases the software contains functionality to meet the need as expressed in an RFP, but fails in the trenches due to a configuration that doesn’t meet workflow requirements of the customer. Arguments over who’s responsible to fix problems can drag on for years.
There are likely as many ways to resolve EMR optimization problems as there are agency and software product combinations. The solution takes time, expertise, and some money.
The best place to start is when you purchase your system, and consultant Rich Temple has some good advice in his recent article “Vendor Viability Assessment – Financial/Strategic“. If you have a system that provides the essence of your enterprise system needs, and you wish to extend its value to your organization, it takes specialized work dealing with your vendor, your executives, supervisors and users to glue the project together. Mr Temple talks about the “seismic changes” in our industry, and what that points out to me is a lot of work most agencies are not staffed to carry out.
EMR optimization takes not only a specialized tool set, but also time that your staff probably can’t spare and complete their day job…the one you hired them to do. This is a new “hole” in the market where people like Terry McLeod come in.
That would be a shameless pitch for your host and his peers…I’m here to help.
Read more →New York judges have saved New Yorkers $41 Million by testing the Rockefeller drug law reform statutes.
In a recent paper “Drug Law Resentencing: Saving Tax Dollars with Minimal Community Risk”, the Legal Aid Society’s Criminal Defense Division in New York City says that drug law sentences have been proven too long, and that shorter re-sentencing is effective and less expensive.
Lesser sentences for lesser offenders is apparently working by saving millions of dollars and returning citizens to productive lives after the wake up call in jail. Meanwhile, major offenders who are determined by the courts to continue to give New Yorkers trouble remain behind bars a long time.
Naturally, addiction treatment providers are charged with a number of these lesser offenders, which just may lead to recovery….good news for all, and as an added “plus” I see a growing revenue stream.
Sounds good to me, what do you think? Is this version too good to be true?
Read more →The law firm of Moritt, Hock, Hamroff & Horowitz, LLP just won a landmark case for people in early recovery in Suffolk County, NY.
Judge Joseph F. Bianco of the United States District Court for the Eastern District of New York decided for the benefit of Oxford House, annulling Suffolk County’s local law regulating substance abuse houses on the basis that the law was facially discriminatory and was preempted by the Federal Fair Housing Act. The decision was a huge victory because upholding that law would deprive people disabled by alcohol and substance abuse problems of their ability to maintain recovery housing.
I’m from Oregon, and as far as I know, they don’t have sober houses there. Insomuch as recovering alcoholics and addicts are extremely vulnerable to that first drink or drug in their early sobriety, and it’s the first drink or drug that sets the monster loose, sober houses may be a good environment for a group of recovering folks to try to stay clean.
That being said, alcoholics do relapse, early recovery is a struggle to change the mind. The outcome of this case is a baby step in attempts to make laws more reasonable with regard to addiction and disease, from which nobody’s immune. Better to support recovery than not.
Sober Houses are a controversial subject, and your thoughts count.
Read more →The emergence of computer games as treatment appears to be sensible and effective according to experts like Henry W Mahncke, VP of Research & Outcomes at Posit Science.
I was at Starbucks yesterday, and a woman was there with her grade school-age son. In the Long Island way, she was talking with the boy, loud enough for all to hear, about his upcoming use of a computer game as treatment for his ADHD. As a former aficionado of Duke Nuk’em and Doom, I’ll vouch for the need to pay attention if you’re going to play. It caught my interest.
In a recent presentation I received from Open Minds, a consulting group, Dr Mahncke shared the statistical proof that his game-treatment works with schizophrenics. The more they play, the more it pays off.
So since computer game therapy, or rather “applied brain plasticity”, appears to increase in effectiveness with more hours of play, how will that be charged? Should it be charged? We can bet the insurance companies, funding sources like Medicaid, will resist paying for this.
Read more →Apparently, substance abuse treatment has an advocate in President Obama. His recently released budget request contains modest increases for a number of program budgets. Programs that disappeared have been combined with others to benefit “Successful, Safe and Healthy Students” and included in the proposed budget.
It’s only the first step of the budget process, so to assure the gains aren’t turned into losses you may want to get active.
Here are the budget figures I received.
Please let me know if my source is faulty.
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