Hospitals and the Recession

Everyone has been impacted by the recession, in one way or another. Whether it be job loss, budget cuts, decrease in sales, etc. every industry across the board has been impacted and every consumer has been affected.

According to this article, “Health care is the only private-sector economic activity that has added jobs continuously since the recession began.” Does that mean that healthcare has not been negatively impacted by the recession? Of course not. We are all feeling the pain, in one form or fashion.

Written by Jeff Goldsmith, Hospitals and the Recession was featured in HHN Magazine online on July 6, 2009.

“The reality is that, despite the employment growth, the U.S. health system is in recession. Inpatient hospital admissions and elective surgery, as well as physician office visits and prescriptions filled, are all down by low- to mid-single-digit amounts. Colleagues in health insurance report that 2008-2009 health costs are trending in the 6 percent or 7 percent a year range. Only during the mid- 1990s post-Clinton-reform, managed-care panic have we seen this cost trend lower for a longer period of time.”

“Health care demand actually began softening before last fall’s thunderous financial market collapse. The downturn began in 2007 and may have been a leading indicator of a spreading family-cash-flow crisis….Most hospitals report rising bad debt and charity care, as people lose health insurance coverage along with their jobs. It should concern hospital leaders that the customer is less and less able to afford their product.”

Money is of great concern for consumers, providers, insurers, etc. Consumers are less and less able to afford healthcare. Hospitals’ case volume is down. Hospitals are also going to face challenges in Medicare funding reductions and might have to run their hospitals on “regular gas”. {Be not dismayed…}

“Demand for our services, while softened, has not collapsed. Unlike the real estate and financial services sectors, we have not squandered the confidence of our customers. People in crisis appreciate that we are a vital part of their safety net, and know that we are there for them when they need us. If we can accomplish the urgent task of health reform, we can affirm that promise for all of the people of our country. The hospital industry will enter the next decade chastened by this economic crisis, but stronger for it.” {But, be wise….}

So where does this leave us? We need to do the best with what we’ve got. Hospitals need to maximize their resources. Budgets are getting tight; capital spending budgets, especially. But spending can’t just automatically stop. With healthcare, you’ve got to keep moving forward, especially in the world of technology solutions. So providers must ensure they are spending wisely.

Spend some to get some. Spend money on solutions you know are going to provide cost reductions. When possible, spend on solutions that can provide revenue increase. ComplyMD is a great budget-friendly solution for these tight times. Decreasing your cost of transcription, while building better DRG’s with comprehensive documentation, ComplyMD can save you valuable dollars while helping ensure you’re not ‘leaving money on the table’.

Round 1’s Definition of “Meaningful Use” for EHRs

As we discussed the governmental push {Stimulus} towards EHR, the definition of “meaningful use” came to surface; rather the lack of definition arose. EHR companies and healthcare facilities alike have been waiting to hear from the HIT Policy Committee on “What exactly defines ‘meaningful use’ of an EHR?”. On June 16, the committee released its initial recommendations for the definition.

Health Data Management reported this “First Look at ‘Meaningful Use’” article, which lists 15 of the 22 objectives for EHRs in 2011. Here’s the list:

* Use CPOE for all order types including medications
* Implement drug-drug, drug-allergy and drug-formulary checks
* Maintain an up-to-date problem list
* Generate and transmit permissible prescriptions electronically
* Maintain an active medication allergy list
* Send reminders to patients per their preference for preventive and follow-up care
* Document a progress note for each encounter
* Provide patients with an electronic copy or electronic access to clinical information such as lab results, problem list, medication lists and allergies
* Provide clinical summaries for patients for each encounter
* Exchange key clinical information among providers of care
* Perform medication reconciliation at relevant encounters
* Submit electronic data to immunization registries where required and accepted
* Provide electronic submissions of reportable lab results to public health agencies
* Provide electronic surveillance data to public health agencies according to applicable law and practice
* Comply with federal and state privacy/security laws and the fair data sharing practices in HHS’ Nationwide Privacy and Security Framework, released in December 2008.

Once this first round of definition and standards were released, we read in Modern Healthcare where

“the group invited feedback on whether the balance it sought to strike was ‘overly aggressive based on the current state of technology and the demands on new provider workflows, or not challenging enough to result in significant transformation.’”

Some believe the group did a nice job of establishing a decent framework for the standards. Some believe the objectives have set the bar a little too high, which could slow the adoption of EHR. The jury is still out.

“For better or worse, it is now the starting point for what surely will be months of debate on ‘meaningful use’ before the federal rulemaking is completed. That is expected to happen sometime early next year. Even then, the meaning of ‘meaningful use’ will remain fluid throughout the life of the EHR subsidy program, which is now slated to run through 2015.”

Here’s a helpful matrix that the group developed that outlines the Goals, Objectives and Measures of “Meaningful Use”.

There is one thing you need to be sure of: Make certain that your EHR not only meets the governmental standards and objectives, but also shows measurable results in your facility with positive feedback from active users. Make sure that your facility sees improved patient care, increased safety, reduced medical errors, and a healthier bottom line. To do this, you must be sure that your EHR covers all your bases.

In my time, I’ve seen a gap in the ability of EHRs to capture surgical documentation at the point of service. This is exactly where ComplyMD comes into play and fits seamlessly with most any EHR on the market. You’ve got to engage physicians. You’ve got to capture their attention at the point of service, when their knowledge of the patient encounter is most fresh. You’ve got to ensure they give accurate, comprehensive documentation. You’ve got to have ComplyMD’s Surgeon Notes™ solution.

How Far Does Your Facility Go for Documentation Assurance?

In Hospital Case Management’s recent article “Does Your Documentation Assurance Program Stop Short?” (March 1,2009), the following quote caught our eye:

“If your documentation assurance program focuses on reimbursement alone, you’re not going far enough. With pay-for-performance initiatives on the rise and increasing mandates for public reporting of hospital data, it’s critical that the medical record accurately reflect the severity of illness and the services provided to your patients.”

If we really think about it, the quote above is totally true. Many facilities have implemented Documentation Assurance Programs, such as Clinical Documentation Improvement initiatives. And these programs oftentimes measure ‘success’ in terms of dollars and cents, rather than by quality documentation of severity of illness, continuity of care, level of acuity and risk of mortality.

“Many times, documentation specialists do a great job of picking up the complications/comorbidities (CCs) and major complications/cormorbidities (MCCs) but stop right there and miss the opportunity to add additional documentation, which will affect the drivers of acuity level and risk of mortality.”

Documentation Specialists are trained professionals who are taught to look for those CCs and MCCs. In an attempt to build the best DRG, they must capture these important conditions. But, they shouldn’t just stop when they’ve gotten to a certain DRG level. A good Documentation Specialist will not be focused on getting the patient into the highest paying DRG, but will be focused on painting the most comprehensive picture of the health of each patient.

This is exactly where ComplyMD comes in. In attempt to paint the most vivid picture of (1) the health of the patient and (2) the procedure(s) performed on the patient, we aid physicians and staff in capturing the most documentation about each patient encounter.

Efficiency, Comprehensiveness and Cost-effectiveness when comparing Dictation and Electronic Templates for Operative Reports

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1560865

Here’s a great article comparing dictation to electronic templates. The results are pretty amazing. Looking at the time, efficiency, comprehensiveness and cost-effectiveness of the two could turn some heads towards electronic templates.

The study was done in Wishard Memorial Hospital’s (Indianapolis, IN) OB-GYN Department. During the four four-week study blocks, they performed 478 procedures on 440 patients corresponding to 5 selected study procedures. They evaluated the effects of templates on timeliness of completion, comprehensiveness and costs, and effort required vs. standard dictation. 

Most in the healthcare industry would agree that: “Dictated reports are frequently incomplete or delayed.” However, it could take some results like the ones in this article to show that: “Electronic note templates could potentially improve this process.”

“Templates resulted in dramatically faster times to the presence of a verified operative report in the medical record compared to dictation services (mean 28 v. 22,440 minutes). Templates increased overall compliance with national standards for operative note documentation and avoided transcription costs. Documentation with templates took slightly more time than dictation (mean 6.77 v. 5.96 minutes; P=0.036), not including the additional time necessary to subsequently verify dictated reports. We conclude that electronic note templates can improve the timeliness and comprehensiveness and operative documentation while decreasing transcription costs and requiring minimal additional effort on the part of the surgeons.”

How To Avoid Careless Coding: Proper Documentation

“Careless coding jeopardizes reimbursement, and can also lead to fraud and abuse issues. One of the most common mistakes results from poor OP report documentation. And, another involves miscoding procedures due to misunderstanding of the correct coding initiatives edits.”

“Avoid The Four Most Common & Costly Coding Mistakes” Ambulatory Surgery Compliance & Reimbursement Insider. May 2007

Careless coding is not always the direct result of the coders’ mistakes, but rather an error in the physician’s documentation. Basically, physicians and coders speak two different languages – coders speak code-book language and physicians speak clinical language. One would assume that code-book language would rightly align with clinical language; however, that is not the case in the healthcare industry. With such a vast language barrier, how can we expect coders to make accurate decisions of assigning codes when the physician documentation does not match the code-book language they’re required to speak for accurate, compliant documents sent to their third-party payers?

Point-of-Service Documentation: Do you know the value?

“IPA’s should use point-of-service methods to increase quality and ensure the collection of quality data, by central distribution of prompts containing quality codes. Prompts and reminders are important tools to assist physicians in addressing care that may be overlooked or missed.”

“Medicare Quality Codes & Their Impact on Physicians” ICLOPS, LLC. December 2005

Independent Practice Associations (IPA’s), along with other types of healthcare organizations should use point-of-service methods to capture quality data. Capturing quality codes is vastly important. How will physicians know what and how to capture if they don’t have the knowledge and the tools to do so? ComplyMD’s point-of-service documentation solution allows physicians to properly document their procedures and diagnoses, in a code-ready format.

The software doesn’t necessarily ‘prompt’ physicians; however, it provides them with an ‘other procedures/diagnoses to consider’ suggestion box.