The reorganization of funding for our broken health care system has taken some interesting turns. ”Interesting” meaning “costly”.
Incentives offered for meaningful use of the electronic medical record could make the difference between survival and failure for a number of Health & Human Service provider agencies. More interesting news: the Meaningful Use incentives plummet in value after 2011, as the efficiencies, quality enhancement and patient safety measures start to pay off.
It’s tough to get ahead these days.
The Meaningful Use world is rife with acronyms: CMS, ONC, HIT, HITECH, PHSA and EHR to bring up a few. The EP is the Eligible Professional, and as I currently understand, the EPs who write prescriptions can be a godsend by making licensed Community Mental Health Centers eligible to participate in receiving Medicaid and Medicare funding that could amount to millions of dollars a year, depending on the size of the organization (CMHC inclusion is being drafted as you read this, and isn’t included at this time). Each EP could mean $100,000 or so in incentives through the five year program. There are rules and stipulations creating stumbling blocks, but this is the short story.
Meaningful Use incentive details are still being settled, moving at the speed of government and likely won’t give providers any breathing room to organize the agency and take advantage of the incentives once the dust settles on the rulemaking level. The aspect of Meaningful Use incentives that is certain is that provider agencies should be moving fast. • Get ready to institute the Meaningful Use criteria in 2011 and be collecting data for the whole year: 2010 could be a busy year • Get ready in 2012 to use the data you’ve collected to improve quality because in 2013 you’ll need to prove you’re making a difference in the care provided, and need to share electronic patient health data with others providing shared care responsibility for patients • In 2015, Stage three begins. Get ready to prove the improvements all this has meant.
As I uncover more details about how Meaningful Use incentives work, I’ll let you know. One thing’s for sure, it’s a lot of work, and you may need help. That’s why I’m here.
Read more →In the recent post “Wellness and Capitol Hill”, I agreed that the health reform bill was actually a health insurance reform bill. The Legal Action Center’s blog, Policies and Politics commented on the bill in the post “Details on Expanded Health Coverage as Obama Signs Bill”.
In the interest of updating my opinion, I discovered two elements of the bill not about insurance coverage that deserved my immediate attention:
• SUD/MH workforce in health workforce development initiatives. The final bill includes the capacity of the MH and “behavioral health” workforce as high-priority topics in the bill’s National Workforce Strategy section.
• SUD prevention, treatment, and MH service providers to be eligible for community health team grants aimed at supporting medical homes. The final bill lists SUD and MH service providers among entities eligible for community health team grants.
So, curious guy that I am, I searched the web for the bill. It’s hard to find. So hard, I couldn’t find it this morning. This brings out the persistent guy in me, so I’m asking experts, searching government web sites, and asking readers to send me a link to the bill.
Where is it?
Read more →Gaining user trust is a special skill, and sometimes the project managers from software companies just don’t have it.
Software companies love bean counters as project managers because they keep track of billable hours. It’s always good to get paid. It’s better to gain the users’ trust, have a successful rollout with some aftercare, and get paid more. Some software companies’ solution to this is to insist on a person from the provider’s staff as an internal person to do the touchy-feely work with the users.
Sometimes the separation of implementation resources in to “us” (provider) and “them” (software vendor) causes problems.
Recently, a CFO friend’s boss has been getting testy about the EMR not being on line a few years after buying an expensive enterprise software system that’s expensive to maintain. Not his fault. Not even the vendor’s fault or the software’s fault. Some people simply have trouble relating to humans on a human level when it comes to business, and I think that’s what’s happened in their implementation.
The thing that strikes me as the most important thing to do is gain the trust of the users and get it up and running before they have a chance to think about it. There are always Negative Nelly’s around, and if given a chance, they will unwittingly sabotage the effort with negative rumors. Once you quietly design the software, move fast to implement. Having elements of the EMR, like progress notes, successfully operational creates a fabulously positive buzz in the organization, so be ready to roll something else out, quick!
There are a ton of experts out there who tout Rapid Cycle Implementation and other systems for making your software work. Mostly, they’re good and embody the ideas we pioneers had about getting software up and running years ago. They also add a bundle of good ideas every project manager should steal.
That said, gaining trust of the users is the one foundation that deserves more attention than it gets. Is that because there’s no line item in the budget for that?
I’m available at info@ehrsio.com
Read more →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 →