It seems our money is being spent a little smarter these days.
Remember Target Cities? A ton of money came into our field about ten years ago with the Target Cities grants. A bunch of professionals were hired and nebulous work was performed, and then the money was gone and Target Cities went away. Tom McClellan mentioned this in his January 12, 2010 talk (now a recorded webinar) to NIATx members. Target Cities went away and I forgot about it. Today’s sweeping change in behavioral health & addictions treatment seems better thought out, driven to produce better treatment outcomes and become self sustaining.
We’ll know how effective it is in about ten years.
New York State’s clinic restructuring is a good idea. It changes every ambulatory clinic in the state, it’s driven by the Office of Mental Health, and the incentive is survival. No single adjustment, or small group of business modifications will be enough to improve business processes and make them profitable. It’s truly a change or die situation in New York.
We work in an amazing time, and are driven to excell, to be better at what we do. Goals for the restructure include: • Create a mental health system that is focused on recovery for adults and resiliency for children • Redefine clinic treatment services • Restructure the financing of the mental health clinic treatment system.
In a great part, these changes will be made possible by updating workflows in clinics: • Concurrent Notes: Clinicians are giving in to writing a note while the patient is in a session in the office, and that traditional resistance will be eliminated in the interest of redirecting thousands of hours spent documenting services after the fact into increased revenue generating time. • Central scheduling: Working with APGs requires a knowledge of not only which procedures can be offered, but also what procedures will make a difference in the patient’s treatment outcome; in order to make financial ends meet, two billable procedures will need to be scheduled for each client visit • Enterprise billing and QA automation: Most clinics have at least parts of this effort implemented; in your facility is there a chain of data that reduces paperwork and auditing demands? —o Assessment feeds problems to the treatment plan —o Treatment plans designed with “point and click” libraries for problems (coming from assessments automatically), goals and objectives —o Progress Notes related to the treatment plan and a service record that is automatically created for billing so a person doesn’t have to do that later —o Integrated Scheduling for follow-up visits —o Alerts to Central Scheduling to review the upcoming service and assure an appropriate second procedure is scheduled to encourage the best outcomes for the patient
And the list goes on.
The problem, still, is that everybody in your organization is too busy to make sure this happens. In order to implement these survival measures, a professional is the ticket to success. Click on “About Terry McLeod” above for more.
Read more →Appearing outrageous is a good way to get in the public eye. Tom Corbett, Pennsylvania’s Attorney General and probable next Governor appears to be in the middle of derailing the recently signed Health Care Reform Law, and that’s an attention-getter.
He says nothing could be farther from the truth.
One section of the bill requires Americans to have health insurance or face tax penalties. In our industry, we see indigents who wouldn’t dream of filing taxes, and with no income they’re a low priority for the IRS, so it’s a mute point for them. I’m a Viet Nam Veteran, currently relying on VA benefits for health care. On the surface it looks like I’m not insured, so tax penalties may apply (I’ll confirm this soon, and may have a rant for this publication).
Tom Corbett and other Attorneys General to the rescue! He says the charge of derailing the Health Care Reform Law is bogus; the Attorneys General seek a judicial decision that will relieve Americans from essentially being forced into buying insurance. Some people feel insurance payments, always an expense until needed, would encroach upon their ability to seek a better life. Would Corbett’s successful effort be an amendment to the law? Would it negate the whole bill and force congress to start over? I’m not a lawyer, but I’m asking one to weigh in on this issue.
I’m from Oregon. It’s in my genes to support local control and discourage big government from forcing me to buy health insurance when I don’t want it or need it (most Americans don’t mind helping out a Viet Nam Veteran with VA benefits). To complicate the issue for me, I work with behavioral health and substance abuse treatment agencies, so my living depends to some extent on the EHR projects funded by ARRA; health care reform has opened doors for me to be gainfully employed and some days I want to buy into it hook, line and sinker.
On the surface I must support Tom Corbett. So why am I so mistrustful? Perhaps it’s just because I’m a Democrat, but more likely because of the holes in this post. Perhaps it’s because I see I’m not alone in my skepticism when I Google the issue. Due diligence on my part may clear things up.
I still support Wendell Potter at the Center for Media and Democracy . I wonder if this is simply another angle to keep American seniors frightened and focused on minutia while the recovery is working . Look at the stock market, friend, your IRA and 401K should be growing.
Read more →Apparently we’re not supposed to know what’s happened to Ron Hunsicker, the CEO of the National Association of Addiction Treatment Providers who was suspended almost three weeks ago.
A recent Behavioral Healthcare article shared the particulars that NAATP wanted us to hear, including vague reasons why Hunsicker was suspended. Cathy Palm, the NAATP Board Chairperson, simply said he was being investigated by the Pennsylvania Attorney General.
I attended a NAATP conference a number of years ago in San Antonio, TX, and found it to be a well-run affair. Hunsicker has reportedly revitalized the organization over the past ten years.
What happened? I have searched around and found nothing. I’ll let you know if I feel like turning into an investigative reporter today.
Read more →People wish to avoid change. Implementing an EHR is change on steroids.
I recently attended a NIATx web presentation entitled “How technology can improve your clinical practice”, which presented yet more actual case evidence that an EHR improves efficiency, raises treatment quality, and helps maintain compliance with rules and regulations
…and the results show up in the CFO’s numbers that are reported to the management team and board of directors.
The inevitable conversation ensued about using Dragon and other voice activated software so staff could avoid learning to type. Challenged people have a fuller life if they rise to the challenge, so my solution is to teach the user how to type on company time. It doesn’t take long, and it doesn’t cost much.
There are a number of shareware and freeware typing software packages on the web that teach touch-typing skills. Download one or two and test them out. It’s dull, repetitious learning, and it works. Soon enough, our hands and minds join, and the typing issue goes away.
When I implement software I regularly suggest to customers that they host on-line typing classes, required for users who don’t type and optional for folks who wanted to brush up on their skills. The class is a half-hour or so, three times a week, and pays off in much faster production of progress notes and other written documents, plus, keeps your agency in compliance. Success shows up in key indicators: fewer complaints, a quicker and less expensive software implementation, and better performance metrics once the system is up and running.
Read more →Since the estimate for an average vendor to upgrade their product be certified so their customers can collect Medicare/Medicaid incentives is $2.4 Million, and that expense needs to be met over the next few years, the cost will likely be passed on to the customers in one way, shape or form. Today’s discussion centers on projecting fiscal impact on the provider.
It’s simple to compute what will likely be passed on to your agency in some way.
• How many customers does your vendor have who intend to seek the Medicare/Medicaid incentives?
• Tack on 30% or so (I’m guessing that’s what the market will bear) for profit
• If your vendor is tremendously flush on cash after these past two years of an interesting sales environment, they may amortize this over a few years to lower the up-front investment for you and your peers as well as create a new revenue stream
• EXAMPLE: If your vendor has 30 customers to pay for the average certification cost, somewhere, you will see at least $104,000, probably amortized over a few years if the vendor can afford to do that
• TIP: if you’re not involved with the user group for your software vendor and want to keep costs down while increasing software value, sign up for the next meeting, or facilitate one for your peers
Your best tact is to work closely with your vendor in this matter. If you haven’t upgraded to the latest version, which will probably be a requirement; and that may have a price tag that inflates to accommodate certification. If the vendor just won’t talk about it, arrange a serious C-Level conversation to discuss the likelihoods so you can budget. If you have solid business reasons to consider jumping ship and seeking a new EHR, do it now, one big change is easier on the users than two.
Some providers have invested a ton of money into home-grown systems, and are considering taking certification expense on themselves, rather than switch to a commercially manufactured system. Think about that: it’s an annual expense to get re-certified. Here comes IT budget inflation. The question most providers ask themselves is “is it worth the incentives to invest in certification?” It has to be done sometime, there’s a possible risk losing Medicare/Medicaid funding altogether in a few years. Home-grown systems have worked for many organizations, and will continue to be viable for a number of those folks.
I predict a few more home-grown systems on the market soon. This is not a new phenomenon, and if the agency has deep pockets, the resulting new software company may survive. This would be unlike Betty Ford Center’s SATIS system, which was sold off to a large software vendor at the demands of the board of directors due to lack of profit and an abundance of expense.
If your prescriber(s) spend 30% of their time working with Medicare / Medicaid patients, you probably qualify for the incentives for all your providers. Will the incentives make the upgrade and certification worth while?
Information Technology is an investment, not an expense…software tools are designed to increase efficiency, improve quality, and increase compliance to commandments from folks like JCAHO, CARF and OMIG. If that’s not happening at your agency, click on “About Terry McLeod” above and contact me, because together we can make your EHR pay off.
Read more →For most providers, the certification for meaningful use will cost whatever the software vendor decides to charge. This will be a major effort for most vendors; most will feel it’s only reasonable to spread the cost of certification among the customer base who will benefit from the effort. 
The ONC stated that the Medicare/Medicaid incentives were intended to pay for the software improvements.
It’s been years since CCHIT certification was created for the benefit of providers and patients, and most software vendors serving our Health & Human Services niche market still haven’t become certified. That’s because behavioral health standards development has lagged behind physical healthcare efforts. A couple of larger companies in our sector got tired of waiting (and could afford the effort), so they became certified for ambulatory environments, but most companies were reluctant to lay out over $25,000 in hard-earned cash for certification that wasn’t even required for our sector yet. And that didn’t include the additional programming effort that few companies have staff to perform, which could push the CCHIT certification into many more hundreds of thousands of dollars.
Now, with the advent of the Medicare/Medicaid incentives becoming a reality, software vendors are playing a waiting game and saving their pennies. The certification effort will be substantial, reducing support resources for most manufacturers. It’s going to be interesting to see who bothers with this and who doesn’t, simply because they can’t see the payoff.
Here is the short story of particulars about what certification for eligible professionals will cost a software vendor (outpatient environments): •With previous certification o One time cost: $50,000 – $150,000 •Without previous certification o One time cost: $1,200,000 – $3,600,000
Based on the costs for vendors who have not previously become certified, the estimated average upgrade cost is $2,400,000 per software vendor (except for the two who are already certified in some capacity).
Next time, I’ll wrap up this discussion topic with tips on how to get the ballpark estimate you need to budget and consequently determine whether you want to continue considering taking advantage of Medicare / Medicaid incentives.
Read more →After all the definitions, foundations, policies and standards embraced by the ONC are discussed, explained and re-discussed, the meat of the matter comes down to two concerns: – What do I have to do to receive Medicare / Medicaid incentives? – What’s it cost?
Here’s the big picture of what needs to be done, and in Meaningful Use 6 I’ll explain the elements of cost, and share some ideas of what it could cost your agency.
Elements of criteria for certification of the EHR are clearly explained in the tables of the Federal Registry document I’ve been analyzing in this series. My MU_Criteria document contains the tables with details your agency should be concerned with. A bundle of the requirements that must be met to collect the incentives are met by your vendor or even your home grown system just by being HIPAA compliant and compliant with the HITECH act requirements.
Table 2 A in the linked document concerns standardizing electronic data interchange and language used across different health care environments, and yes, there’s a plan to help us all speak the same language.
Table 2 B is all about data security and maintaining confidentiality. That’s as it should be. Electronic encryption and decryption has been around a long time. Not all software vendors are conversant in this technology, so be sure to ask your vendor what it will take to get you there (usually a major modification or product upgrade will be required)…it’s not likely you’ll want to tackle this yourself.
Here are some elements you will want to review with your IT department and software vendor very soon. These requirements are coming, and somehow need to be met. If your vendor won’t certify this sort of functionality, your agency will need to take responsibility for the one-time and ongoing costs in order to collect the incentives. Let me know if you need help determining the value of doing this yourself. – CPOE: Order entry and tracking is not just for medications: Lab results, radiology/imaging, provider referrals are required. Not all electronic prescribing tools do this. – Medication Library: Pop-ups abound! Make sure the specific rule-based “pop-up” alerts are to be included in your software for interactions, etc. Some software vendors will insist you do this yourself, using tools that come with your system…and that may require an upgrade the vendor may charge for if you’re not running on their latest and greatest version – This type of programming amounts to telling the programmers how to program, so there may be some resistance, but the ONC document is firm and clear, so be firm in your dealings with your vendor – Electronic Transmission of medication orders, presumably to the pharmacy; this may require a subscription and business arrangement with a company like Sure Scripts – Electronic submission of reports to CMS or your state Medicaid agency…most vendors will not want to take this cost on for themselves – Decision Support: Make sure your agency’s top 5 rules in this regard are included in the software…there may be different procedures in following of the decision tree for your various programs, so be sure to have plans for all programs – Patient Portal: Ooooooh! A number of hospital systems and insurance companies already have this technology. It’s pretty new to our sector; The technology may or may not be included by your vendor already; if not, there may be a way to connect to Google Health or Microsoft Health Vault…Creativity may win the day on this issue
That’s not the whole story, but I hope it gives you enough to think about for the time being. Next installment: How much does this certification cost, and who pays for it?
Read more →I worked for Jim Gargiulo, Executive VP at Netsmart Techonologies for a number of years, and he would become frustrated when we discussed the EHR in static terms. “It’s a journey!,” He’d exclaim. 
The Office of the National Coordinator is taking this evolving view for the EHR.
The ONC promises that the requirements of certification will need to be updated as times, treatment methods and tools evolve, and change seems to be the only real constant in this universe.
The ONC says that some policies and standards will come into play, then later be phased out or replaced. In order to accommodate this way of doing business, the software industry has included tools to modify your EHR to suit a changing environment. The tools are sometimes inadequate. Some companies don’t want to give up control of your EHR. Usually tools would work fine to whip up a screen and include a report to reflect new policies & standards, as long as you have somebody on staff who has the wherewithal to use them. When they’re inadequate, you pay money for a programmer to help, and her baby needs shoes, Billy needs braces, and Sally’s going to college next year.
Wake up, my friends. Provider agencies need somebody working for them who can do a few things: • Design forms and reports (and if tools enable it, Electronic Data Interchange files) • Include workflow processes at all levels of the agency in updates • Implement using a rapid cycle change methodology or something like it • Incrementally update and implement the design when changes come • Roll out changes EFFECTIVELY to staff requiring them, and be savvy in convincing the staff to look forward to changes
If you need help with this, click on “About Terry McLeod” above…my contact information is at the bottom of that page.
Installment 5 of this series will discuss more about certification options and your decision to maintain an enterprise system or opt for a modular approach.
Read more →There are three stages in proving Meaningful Use of your EHR to the Office of the National Coordinator and CMS in order to receive Medicare and Medicaid incentives amounting to around $100,000 per provider over a five year period.
Stage 1: In my MU 1 post, I shared this needs to be addressed in 2011. That means getting ready this year, and the year’s 25% gone, and depending on where you are in your evolution to the EHR and how your vendor responds, it could be a big job.
Next year your EHR will need to be not only collecting the demographics and services rendered that are usually in place for billing purposes, but also tracking and electronically communicating patient clinical matters (like assessments, treatment plans, notes and medications). Moreover, you will need to be using your EHR for clinical decision support.
Stage 2: In 2013 the EHR will need to expand into areas like order entry for medication and other practitioners orders. This is a big concern; a number of software vendors in our sector are just getting around to developing these modules, and they can be clunky for the users in their first iterations. The system will need to provide electronic transmissions of data like using approved formats for labs, pharmacy and other ancillary services used in patient care.
Stage 3: On a national scale, elements of healthcare come into the spotlight on a regular basis. Beginning in 2015, these concerns will need to be tracked. The EHR will also need to expand to include quality improvement (and proof thereof), and provide patient access like the portals you see in Microsoft Health Vault and Google Health. Software vendors have been developing these tools for patient use for a while, and that development has already expanded into our sector.
It’s only rocket science, and we’ve done that.
Contact me if you need help.
Read more →The last rumor I heard was that it will cost $1 million $2 million to certify an EHR, and Certification of the EHR is a major part of what meaningful use is all about at the nuts and bolts level.
Small providers can have a problem justifying the expense of assuring their EHR is certified, especially if the increased payment for services (mentioned in volume 1 of this series) is not sufficient to show true value. Without value, the certified EHR falls by the wayside.
One objective in my work is to help folks arrive at the best EHR option for their agency, whether purchasing a new one or optimizing their current product. So, you’ll see a recurring theme in this series of seeking EHR options with that in mind. Foremost in my mind right now is discovering affordable certification alternatives.
The certification of the EHR in order to receive Meaningful Use incentives is built on previous action, like HIPAA for security and code sets, electronic prescribing standards set forth in NCCD Script 8.1, and the HITECH certification provided by the Office of the National Coordinator (ONC). In and of themselves, these elements are not enough to prove Meaningful Use.
Initially, the HIT Policy Committee was charged with eight areas of responsibility in building the standards, implementation specifications and certification requirements. Elements that jumped out at me included
• Protection of privacy • Nationwide IT infrastructure • EHR for all patients by 2014 • Tracking health info disclosures • Coordination of health care • Transmission encryption for health data • Specific race / ethnicity / gender demographics • Special needs technology
These elements are further defined in a couple sources I’ll cover in future installments. The concepts are not new, it’s just crunch time to use this technologe on a widespread basis.
The time element is critical. It’s March, and Stage 1 needs to be in place by 2011. If your agency hasn’t implemented your EHR sufficiently to capture clinical data (assessments, treatment plans and progress notes), perhaps it’s time to try something new. Contact me if you need help.
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