HealthCo Information Systems

Last week, as you probably saw HHS secretary Kathleen Sebelius announced the pushback of the ICD-10 compliance deadline from October 1^st, 2013 to a “later, unspecified date”.  Really?  I can’t understand the thinking that compelled them to make this decision.  After all, they have managed to force the implementation of technologies into the market, guided often times by “consultants” and appointed/funded resources who have often never worked in clinics, are not clinicians nor implemented these complex technologies.  They have mandated the use of the 5010 format for claims submissions and as a result basically killed all innovation by the vendors because all they can do is code to compliance instead of code for practicality.

What were they thinking?

They have asked the physicians to carry the financial risk and burden of all of the changes, so the insurance carriers, including Medicare can collect even more data on the physicians and not only scrutinize their practice habits more closely, but aggregate data to grade physicians on their ability to compel patients to comply with health guidelines, again at their own expense.  Then they can penalize those same physicians for lack of compliance, raise their rates to employers and blast the tops off of their Wall Street forecasts, so those same lawmakers can get inside knowledge and hedge their bets on the profit margins of the insurance carriers.

What were they thinking?

Stage 2 for meaningful use is just around the corner, and yes, I know you are just getting your arms around stage 1.  You now have additional requirements to meet so you can be a good steward of the process and get your carrot.  Stage 2 expands many of the requirements of stage 1, plus it has a much larger focus on the access of the data by the patients, through a portal or other means, exchanging patient information during transitions of care (Continuity of Care), but you are also going to be required to document why you did NOT follow guidelines in the care of the patient, because the regulations know best you know.  You are just the doctor.

What were they thinking?

As you ponder your EMR decision, and Centricity really needs to be part of that decision process because of its maturity and robustness, you have to wonder what the next 5-7 years are going to bring.  ICD-10 is just another component to the “transformation” of healthcare, or what I call, compliance based medicine.  It is inevitable, and thinking it’s going to “go away” or “won’t fund” is a pipe dream, only realized after engaging in other pipe based activities.  Centricity EMR allows for your staff to capture, with ease, much of the compliance data, and the EZ Access Patient Portal we offer enables your patients to provide that data without staff intervention.  Then you, the physician, knowing all of the T’s have been crossed, and I’s dotted, can actually get back to the practice of medicine.  The big difference is the infrastructure necessary to comply in the next several years is now in place.

What exactly are they thinking with the announced delay of ICD-10?

I believe they don’t want to completely break your spirit.  They need the independent physician and the fiasco of 5010, the burden of stage 1, the financial strains on your practices has left you battered and bruised.  If they implement ICD-10 now, then they have no big sticks to use for a number of years and it would drive more physicians out of business or into an employee relationship with the hospital.  It’s a difficult time right now, but being commanded by the hospital CIO-CMO won’t give you back your freedom to take care of patients.  Only choosing a feature rich, functional EMR with depth for upcoming requirements will give you a baseline on which you can grow.  There will be hiccups along the way, but you’ll have the tools to survive.  The hospital promise isn’t as attractive as you might think either as once the dust settles, you will be judged on value, not skills provided to the hospital system.  Value is cost.

We are glad the ICD-10 was delayed, but will prepare and train our staff as if it had not been.  We owe it to you our customers and prospects to be fully prepared and knowledgeable on the topics to come, so we can ease the burdens placed on you as much as possible.

If you have not made an EMR decision yet, look in the mirror.  Ask that person for a rational reason why.  If you have but are just skimming the surface of use, get depth.  If you are a strong user, get stronger and plan for driving efficiencies in your practice.

I see a major cross road coming in healthcare, but one thing I know is it won’t go away.  Regardless of who gets elected, what gets passed or repealed the path we are on is a one lane road with no exits.  It may go slow, it may go fast but it won’t roll back now.  Physicians are in a position where they either need to open the car door and bail to the hospital or stay along for the ride.  It will have a good ending.  Maybe not the ideal ending, but I believe there will be long lasting benefit to these changes, and even to your offices.  You however hold the key to your individual success.  What do you think?

One of the big challenges clinics have is collecting the patient balances due to them.  Obviously one of the reasons this is more important than years past is the increased liability the patients bring when they come into your office.  Deductibles are higher, shared liability is higher, and the patients wither don’t know the changes, or know you don’t know, so they don’t have to pay at time of service.

If you don’t have a solid financial policy that each patient and responsible party signs, you need to do so.  I have had the “joy” of attending a number of small claims situations for collecting debt, and this document needs to be in place and clearly spell out the patient’s responsibilities.  This need to be both on the patient’s responsibility to provide good insurance information and their responsibility for paying the balance.

Getting upfront payments is a very difficult task for those unknown amounts, like a deductible or patient percentage, but copay amounts ought to be a no brainer.  If you aren’t measuring the % of copays collected up front, that is an area I would encourage you to do.

On the back end, where I’ll focus some time, that is where you really need to identify the rule of the clinic.  An example might be, you need to pay 100% of you patient balance within 30 days.  Another might be you have to pay at least 50% of your balance in 30 days.  Then you have to consider the”What if”, in other words, what if they don’t pay 100%, “then what” needs to be considered.

So start with the rule like this.  “All patients need to pay at least 50% of their patient balance within 30 days of liability.”  That’s a good start.  Consider these factors now;

• What if the balance is below $50 dollars?  You still good with a 50% payment?

• What if they send a check for less than the 50%?  Do you cash it or send it back?  Check with your state, but often, if you accept and cash 3 payments in a row, you just made an unwritten contract with that patient.  Could be a bad thing if you cashed 3 $10 payments on a $3400 balance.

• What if they call for a payment plan, which is really what you probably want, is to get a commitment?  What do you have in place to track that?  What is the policy there?  Who makes those decisions?

• What happens with a missed payment or no payment on your initial statement? What message goes on the bill? What letter gets sent?

• How many chances do you give before further action is taken, such as a call from your staff?

• Do you send pre-collection letters telling them you are going to send them to collection if they don’t pay?  Did you know that if you send that letter, and then you do NOT send them, they have an excellent chance of walking away from the balance with no liability?  Again check your state, but I have seen that happen because you just threatened your patient with action you did not follow-up on.

• At what point do accounts go to collections?  What is the mentality of the physician?  If your physician never wants to send someone to collections, then having a solid process with good follow-up is really important to prevent them from getting written off.

Once you have a process in place, beginning to implement it is another thing.  One of the biggest mistakes I see if setting an aggressive process and policy, you spend hours setting your system to help automate that process, and then you turn it on.  “Boy, if they owe us $25 or more, we are going to hit them hard!”  Then you get 95% of your patient’s accounts popping up with alerts, so many account fall into your collections queue your staff can’t manage it, and all of the sudden you have a bigger mess than you started with.

Start with manageable goals and know you data.  Also communicate to your staff about the changes so they know what to expect and do when they see an alert.  When I saw manageable, I mean for example, only send balances into the collections queue with a balance greater than $2500 to start.  You pick a number, but more that 50-75 accounts to start will be tough to manage at first.

Make sure your process works, then lower the threshold to $2000, or $1750 to increase the volume of accounts and be able to modify your process when you forgot a “What if”.

Remember it’s like a diet.  If you go cold turkey and try to change your habits overnight, you will fail.  It’s a slow, iterative process and your goal need to be long term.  Yes, you’ll begin to see some short term benefits by focusing on the big balance accounts, but it’s about building a framework that can be built upon, is long lasting and is effective.  Your patients will need to be trained as well.  Blame it on the computer if you need to, but implementing a good process now will pay huge dividends for your clinic for years. 

I have had the privilege of working in physician offices for the better part of 25 years now, and through the years as you can imagine the different philosophies I have heard about how to run an office has been amazing.  The skills sets, patience and persistence to make it run smoothly are different in each setting I walk into.

One area though that I have always held strongly in my position about is the closing of your financials each day.  Let me give you a little background on my history before we get too deep.  Before I got into healthcare, I was a manager for a nationally known fast food restaurant here in Denver.  I used to be brought into stores that were either under-performing, needed overhauls or even were close to being closed by the health departments for violations (yes, I have stories that will slim you down in weeks!)

One of the things that I used to always be on guard for was theft, both monetary and product but let’s focus on the money first.  When you stand at those registers day in and day out, you ring up the same combinations of menu items, and it becomes very easy to remember the cost of a burger, fries and drink.  When the whole $0.99 menu came out, it made it even easier because so much of what was ordered was the same base price.

One tactic used quite often was an operator would place a penny next to the register for every order that was 3 X $0.99 items.  They knew that each penny represented $3.18 in cash.  They would take the order, but not ring it up (we didn’t use the monitors like they do today).  Instead they would collect the cash, place a penny next to the register, and before the end of the shift, if they had 15 pennies, they know to pull $44.55 from the register, before the manager counted the drawer.

These were people tempted by the same things almost every other person is tempted by, but home situations sometimes made the draw of an extra $45 in cash each day something hard to pass up.

Many times I have walked into physician’s office as well, and heard stories of “Oh, we fired so and so because she stole money.”  Sometimes the amount of money was a few hundred dollars, sometimes in the tens of thousands.  Centricity and almost every other credible system out there allow for very tight controls of your financials.  Security from entering adjustments, entering of copays and not just collecting them, but one area that is missed often is the rigor around the end of day close process.

End of day closes, mean that any transactions entered have been balanced, should have been checked by two people, and the “numbers” which include all charges, payments and adjustments have been accounted for and are now unchangeable.  The argument I often get is “what if we make a mistake”.  Mistakes are the best opportunity to learn, in everything we do. 

These good accounting based PM applications have provisions for mistakes, but those provisions also created detailed auditing of the process so there isn’t a chance to cover up a mistake and have someone walk out your door with 5 patients copays, or a surgical check that got adjusted off a patient’s balance without cash being entered.

If you are a physician or an office manager, when is the last time you reviewed in detail your money handling policies?  Does one person have complete control? Is trust making you blind to warning signs?

I would encourage every office to review in detail these processes and policies at least once a year.  It tells your staff it is being watched and prevents questions later on.  Learn the proper way to handle the mistakes.  Talk to your accountant and talk with your trainers if you need to understand the right way to handle errors, take-backs, interest payments, wrong account postings.    They can all be done according to standard accounting guidelines.  However if you are not closing your days every day, you are leaving a big door open wide for the opportunity of theft.

As you may have seen or heard, GE Healthcare has decided to cease the operations of the Centricity Advance division.  GE will continue to offer support for this product until June 30, 2012.  GE is offering an upgrade to GE Centricity Practice Solution (CPS) to all of their Centricity Advance (CA) customers.

Centricity Advance customers who migrate will move to a hosted version of Centricity Practice Solution with competitive monthly fees, and all licensing fees will be waived for those that desire to migrate to Centricity Practice Solution.

HealthCo has been a Value Added Reseller (VAR) for the Centricity Practice Solution  for over 13 years, and will work closely with those Centricity Advance clients that are affected.  Centricity Practice Solution is a very robust and complete system and will provide a foundation upon which your clinic can be assured of continued growth, depth and functionality for years to come.

What does this mean to current Centricity Practice Solution customers?  There will be no impact on the current CPS client base.  Centricity Advance is a completely different business unit, code set and product from the Centricity Practice Solution division of GE.  Now, GE will concentrate 100% of its development effort in the CPS product.  Your support and updates to CPS will continue as normal, and no service interruptions will occur.

Centricity Advance customers in the following states, AK, AZ, WA, OR, ID, MT, NV, ND, SD, NE, IA, and IL may get further information by http://www.healthcois.com/#!__contact-healthco and indicate in the comments area you are a current Centricity Advance customer.  HealthCo has proactively phoned each affected CA customer in these states, however if you have not received or have missed a call, please fill out this form and you will be contacted immediately.

While a very unfortunate situation for those customers currently using Centricity Advance, over the next few years, you will see many companies with multiple solutions make the same tough choices.  GE recognized early into the venture that the Centricity Advance solution did not resonate with the market, and made the tough decision.  CPS is a tried and true solution, which provides end-to-end capabilities across as wide a spectrum of specialty clinics as there is in the market.  It’s nearly 2 decade long history and roots means clinics can implement a solid foundation to their future, and grow with an application by extending its use to every process within the clinic.

CPS will continue to meet regulatory requirements, listen to its customers and meet or exceed functional expectations for years to come.  If you are a user of Centricity Advance, or another EMR product where you have fears of the same fate as Centricity Advance, contact us here at HealthCo for honest and complete answers to your questions, and solutions that meet the market needs.

Paperclips are an amazing tool.  Just a small piece of wire, twisted and shaped to make our lives easier.  If you go to the office supply store, you’ll see there are literally dozens of types of clips.  Big, small, colored, plastic coated.  Then there are a myriad of other paperclip like tools.  Some are packaged in a plain plastic refill case, some in fancy colored and clear plastic boxes with magnetic tops.  All that marketing for a paperclip!

Kids like to tinker with paperclips too.  They make great necklaces, bracelets, suspension bridges.  I’ve seen them used as zipper pulls, earrings, and if you give a kid a strong magnet and a pile of regular paperclips, you have occupied at least an hour of their time.

Paperclips have played a big role in healthcare too.  If you look at your desk, you probably have one, two or more of them within your reach right now.  They’re probably holding a contract, message, note or invoice of some type.  It might be holding the sales persons business card, maybe a description of the items you’re buying, maybe it’s just too much information to fit onto one piece of paper, and you don’t want them separated.

I have always looked at paperclips a little differently though.  A long time ago the paperclip was used as a mental image of what a good leader was.  Here is how it was presented.  Link 5 paperclips together and lay them flat on your desk.  Now place your finger on a paperclip on one end, and push it toward the other 4.  You’ll notice that all it does is scramble the other 4 and itself into a bit of a jumbled mess.  No order, no organization. No real anticipated outcomes.

Now, take those same 5 clips, and place your finger on a clip at the end, and pull the other 4 behind it.  Notice, the other 4 follow along like train cars on a track.  Neat and tidy rows.  You can anticipate where the 5^th clip is going to end up because of the path the first one is taking.

Now imagine you’re a paperclip, and your office is about to implement a significant change into your office, like an EMR.  Which clip are you going to be?  What outcome would be best for everyone?  Now I am willing to bet you look at them differently too.

Chris Connor

Director Sales and Marketing

HealthCo Information Systems, Inc.

chrisc@healthcois.com