According to a new study from CareCloud and QuantiaMD, a variety of issues are resulting in a downward trend in practice profitability. Among the four most commonly-cited obstacles, three are related to government regulations and mandates.

The survey, a partnership between cloud-based health technology provider, CareCloud, and QuantiaMD, the largest online physician’s community, was created to provide a voice to practices across the U.S. regarding issues that impact their financial and operational health.

Out of the more than 5,012 physicians surveyed, 48% consider the Affordable Care Act to be the primary government-driven initiative negatively affecting their profitability in 2013. The looming ICD-10 switch comes in a close second at 44%; followed by the government’s EHR adoption push at 26%.

Affordable Care Act
We’ve all heard the arguments for and against President Obama’s Affordable Care Act. Yet, the prevalent consensus among physicians points to a decline in doctor reimbursements in long run.

As a result of Obamacare’s individual insurance mandate, the Medicaid program is estimated to grow by at least 16 million applicants in the coming years. Because Medicaid reimbursement rates are lower than those of private insurance, many doctors are dreading the influx of new public patients.

Doctors currently earn $20 for each Medicaid patient, versus $260 per privately insured visit. Oftentimes private practices actually lose money on Medicaid patients due to operating costs. This issue hasn’t been adequately addressed by the ACA.

Another ACA provision, the expanded use of bundled payments, is also troubling many physicians.  Bundling is supposed to coordinate care by aligning payments across providers for services delivered through an entire episode of care, such as heart bypass or hip replacements, rather then paying for each service separately.

Many doctors, though, are predicting that bundling may hinder care.

“It may not cover the more expensive regimens,” said Dr. Justin Favaro, an oncologist from the Oncologist Specialists of Charlotte.

“Every time a patient comes through the door, we treat them the way they should be treated. We choose the regimen that is best for them. That may be the… least expensive regimen or most expensive regimen. It really depends on the patient, what their health problems are. We don’t want to be restricted,” he added.

ICD-10
Let’s face it. Many physicians are freaking out over the impending ICD-10 deadline coming October 1, 2014.

Not only is it set to dramatically complicate coding procedures for your staff, if not implemented correctly, ICD-10 could cost you big bucks.

Learning to utilize the roughly 150,000 codes under ICD-10, instead of the 18,000 currently in ICD-9, is estimated to take billers and coders between 50 to 100 hours each. The hundreds of hours your staffers and doctors will spend in training is time they won’t spend performing their usual duties – consequently slowing down productivity.

“ICD-10 demands significantly more specificity in diagnosing and coding, something the healthcare landscape isn’t accustomed to or skilled in effecting at this time,” said Alex Johnson, HIT Consultant and founder of CredentialedCare.

Although the expansion of medical codes is supposed to encourage improved, more detailed reimbursements, expect a decrease in collections until your practice learns how to correctly bill with the new coding system.

“In the short-run, ICD-10 could be highly disruptive to reimbursement patterns.  However, in the long run, the coding specificity will enable the public health system to target health promotion strategies in a more effective way and we predict that claims data will be more meaningful,” added Johnson.

The EHR Adoption Push
For the past few years, CMS has been trying to encourage national EHR adoption by promoting their EHR Incentive Programs.

Through these initiatives, eligible professionals can receive tens of thousands of dollars for demonstrating Meaningful Use of certified EHR technology. However, its been shown the government’s incentive amount does not cover the entirety of costs associated with implementing a new EHR.

A new system can cost thousands of dollars to purchase, not including the cost of new equipment and training required to properly operate new software.

Cloud-based EHRs can provide a relatively inexpensive alternative to client-server EHR systems since there’s no need to purchase hardware. But it will not reduce the time needed to transfer patient records from paper charts to electronic formats.

With these government programs in mind, it’s no surprise 57% of physicians surveyed in the QuantiaMD study cited rising costs as a major financial challenge for 2013. Between the hiring of new staff, re-training of existing employees and purchasing of new equipment to meet technological needs, practices are scrambling to keep up with new legislation.

Yearning for more? Download the rest of the results from the Practice Profitability Index. 

According to a new report released by CareCloud and QuantiaMD, 65% of physicians see declining reimbursement rates as the top issue negatively affecting practice profitability. Not a surprise, since 2013 hasn’t exactly been a banner year for Medicare reimbursements.

And due to April’s budget sequester, Medicare payments have been slashed by 2% across the board. These cuts are estimated to cost providers $11 billion in Medicare payments each year. This leaves many practices wondering if there are any ways to effectively counter these reductions.

Thankfully, the answer is yes. While there isn’t much you can do to stop reimbursements cuts, a proactive approach will help you negate the potentially disastrous effects of declining reimbursement rates.

Increase Your Patient Base
If you’ll be making less money per patient, a natural solution is to treat additional patients to make up for the loss. Finding patients to treat shouldn’t be a problem as 32 million patients are expected to join the healthcare system in 2014.

A solid EHR will augment practice workflow and help you take on the upcoming patient influx without having to add more staff. EHRs increase efficiency with features like appointment scheduling and patient tracking. And with incentives like Meaningful Use and PQRS, EHRs can almost pay for themselves.

Outsource Medical Billing
Outsourcing billing makes up for declining reimbursement rates by bringing in higher net collections after cost. Software Advice calculated outsourced billing to bring in $1,496,000 after cost for a typical three-physician practice, compared to only $1,241,800 for in-house billing.

The savings of outsourced billing come primarily from a decrease in staff costs plus the ability to bypass purchasing billing and collections software/hardware.

Reduce Claims Denials
If you opt to keep billing in-house, battle declining reimbursement rates by reducing claims denials as much as possible. On average, denials cost practices $25 to $30 each. There are a couple routes you can choose for reducing claims denials.

One is going with a practice management system that reduces denials through patient eligibility checks and code reviews. This is the speedier and more effective route to correct claims.

The other is to be meticulous when submitting manual claims. There are plenty of opportunities for your billers to make costly mistakes. It can be something simple like misspelling a patient’s name or something more complex like misusing CPT modifiers.

Maximize Your Tax Deductions
Tax-deductible expenses are identified as almost any purchase that helps with operating a business. This article by Inc. cites home offices, business-related travel, the first $18,000 of equipment purchases and employee benefits as expenses that should be written off.

Maximizing deductions can be a balancing act. For example, offering disproportionate benefits to your employees may reduce taxes, but may also be outweighed by the extra costs of benefits. Striking the right balance can mean an increase in revenue for your practice.

Being proactive about overcoming declining reimbursements is essential for the success of your practice. Remember, inflation didn’t suddenly go down along with reimbursement rates. The problem will only get worse if not confronted right away.

Check out the Practice Profitability Infographic for more results from the QuantiaMD and CareCloud report. 

Frequent readers of PYP already know that we have a thing for health IT. Some may call it an obsession, but we prefer the term intense fondness. And this week, our fondness was on full display.

We not only covered what to look for in an EHR, but also how to make implementation go as smoothly as possible. Just for kicks, we gave you technologies that will make practice management easier.

Don’t become fixated solely on features. The design of your EHR is just as important when trying to become a paperless practice.

Does your practice need medical scanning software? Solaris Imaging, a medical scanning software company, provides expert insight.

66% of CIOs report achieving Meaningful Use at their organizations as a result of ongoing health IT efforts. This is just one statistic from the HIMSS 2013 survey showing that health IT investments are paying off.

Involve nurses in the EHR implementation process to make for a smoother transition.

Managing a practice can be stressful, but these 5 gadgets will help make it a little easier.

That’ll do it for this week. Keep it real.

A typical day managing a medical practice can really test the amount of stress one can take before bursting a blood vessel. In addition to serving all of the patients that pour through your door, you now have to start preparing staff for big changes like the upcoming ICD-10 switch. You may even be in the process of implementing a new EHR.

With so much going on, making practice management as easy as possible is vital. Just like the iRobot Roomba saves you from slaving over a vacuum cleaner or the Hutzler 571 makes slicing bananas a breeze, the following gadgets and technologies can simplify practice management tasks, both large and small.

Digital EHR Pens
Pens like this one from AssistMed have a built-in camera that captures information written on specialized paper. The information can then be converted into a file showing the information in written form or be converted into typed text and placed into an EHR.

EHR pens are great for practices having a tough time transitioning from paper-based records to an EHR solution. You get the familiar feeling of paper with the advantages of fast data input.

Apps
Smartphones now play a crucial role in most office environments, medical practices included. And with the rise of the smartphone came apps that ease the burden of menial practice management tasks.

Lemon is a perfect example. This app lets you organize paper receipts and analyze purchase trends. Simply take a picture of any paper receipt and categorize it. Lemon then arranges the receipts based on category and type of spending. A breakdown of purchases can be viewed on the vendor’s website.

Super-Scanners
Typical scanners take printed text and convert it to digital images that can be stored on a computer. Scanners like NeatDesk take it to the next level by using intelligent character recognition technology to read information and create organized digital files. Users can then search through the files by keywords.

This is especially useful for practices implementing a new EHR. It makes the redundant task of scanning all your patient information into the EHR much easier by organizing saved files automatically.

Tablet Printing
iPads are becoming increasingly important in the medical practice because of the great mobility and accessibility they provide. Now, with wireless print servers, physicians can print reports directly from a tablet for added convenience.

The xPrintServer is one such device that allows this. It simply connects to the office printer, giving physicians and other office staff the ability to print documents from their mobile iOS devices.

Encrypted USB Drives
Keeping patient data secure is a huge responsibility of practice management. Compromising electronic protected health information (ePHI) can lead to hefty HIPAA penalties. That’s why ePHI can’t be stored on standard USB drives.

Encrypted USB drives like LOK-IT protect you from the risk of HIPAA penalties. Data stored on a LOK-IT drive is automatically encrypted and uses hardware authentication to access data. Information on the drive can only be retrieved on the computers at your practice, helping avoid a security nightmare.

Practice management doesn’t have to be as stressful as it is. By adopting technologies like these, it should be easier to keep your practice running smoothly. Don’t hesitate to use technology to your advantage.

If you’re looking for other ways to increase the simplicity of practice management, sign up for our newsletter.

Nurses play a crucial role in the medical practice. They have their hands in almost every aspect of care and can provide invaluable insight on the inner workings of the office. That’s why vendors consider them to be an integral part of the EHR adoption process.   

Drawing upon their unique perspective early in the process can influence their attitude towards the EHR and affect how easily they embrace it.

The Relationship Between Nurses and EHRs
Physicians are not the exclusive users of EHRs. According to MGMA Consultant Rosemarie Nelson’s figures, nurses account for almost 75% of chart use while physicians make up the other 25%.

Including nursing staff in selection, implementation and optimization decisions will help avoid workflow issues and encourage staff to embrace the new technology as well.

“A successful EHR implementation focuses on how the nurses can assist the physician in the integration of the EHR into clinical workflow,” added Nelson. “Too often, a committee is created in a medical practice, and there’s no nursing representative. Bring in the nurses.”

In May of 2008, the AC Group conducted a survey of 137 practices to determine the EHR implementation success rate when a nurse is involved. The survey found an 83% higher success rate of EHR adoption when the group assigned a nurse or medical assistant to track physician clinical protocols.

Now, let’s take a look at the points in the EHR implementation process where nurses can provide the most insight.

Security
Most nurses are very familiar with HIPAA standards. Nurses can provide input to the development of EHR security measures that keep personal health information protected at all times.

Location
Seeing as nurses will using the EHR most of the time, it’s best to ask them where the system should be installed.  Cloud-based EHRs provide an inexpensive way to access patient charts from any computer or tablet.

Notes and Templates
Nurses should be utilized in the review of visit note templates and the development of other note templates and forms. The nurse and physician should decide if there are any specific notes that only a nurse can approve.

Training
Nurses should be deeply involved with the core team during staff training. Nurses are “super users” and can provide a great deal of help to doctors during the early stages of adoption.

Simulation
Prior to going live, scheduling practice run-throughs of the new EHR will offer a great opportunity to adjust workflows and tweak the system.

Encourage nursing staff to provide insight into workflow processes such as how exam room locations will be entered, updating the past medical and social history, phone call logging, and charting procedures of all nursing functions like injections, blood pressure checks, and dressing changes.

Prescriptions/Medication
Nurses should be involved with the workflow setup for ordering and refilling medications through the EHR.

Once the implementation process is underway, nurses serve as a valuable resource to physicians, assistants and other staff through the adjustment period. But the process shouldn’t end there. When the system is in place, nurses can optimize EHR use by providing experienced feedback.

Have nurses assisted your EHR implementation? Let us know how in the comments section below. 

According to a March HIMSS survey, implementing IT systems that attest to Meaningful Use standards is still a top priority for hospitals. In fact, 66% of CIOs report achieving Meaningful Use at their organizations as a result of ongoing HIT efforts.

In recent years, the federal government has been pushing the adoption of healthcare technologies, specifically those aimed to help medical professionals meet Meaningful Use and successfully convert to ICD-10. These efforts are often questioned by critics who wonder whether health IT investments are really paying off. A recent HIMSS survey suggests they have.

Nearly 300 hospital executives completed an online survey between December 2012 and February 2013 – and health IT gains were reported in the following areas:

• Meaningful Use: 66% reported having achieved MU Stage 1, and 75% said they planned to attest to Stage 2 in 2014.
• Health Information Exchanges: 51% reported their organization was participating in an HIE.
• ICD-10: 87% said they were on track to be ICD-10 compliant by 2014; and 47% indicated that ICD-10 compliance was their top financial IT focus.

According to a statement by Jennifer Horowitz, senior director of research at HIMSS Analytics, “It seems that we have reached a tipping point where initial government investments are beginning to pay off and Meaningful Use is becoming ingrained in the healthcare industry.”

Despite this, healthcare officials continue to share a common preoccupation: IT staffing shortages. More than half of survey respondents reported an intention to increase IT staff over the next year, but 21% fear they may not be able to find qualified technicians to help them meet their IT objectives. High demand areas include clinical application support, network/architecture support and clinical informatics.

Top Health IT Priorities
Aside from Meaningful Use and ICD-10, the top IT priorities reported by hospital execs, administrators and IT directors include:

• Optimizing the use of currently installed systems (20%)
• Leveraging information housed in data warehouses and business intelligence systems (17%)
• Focusing on clinical systems (11%)
• Interoperability (6%)

Interestingly, despite growing concerns over data breaches and patient privacy – and the fact that 19% of CIOs reported having experienced a data breach in the past year – only 1% of respondents named “securing patient information” as their top priority. Having IT systems that can increase efficiencies, reduce costs and improve the quality of patient care is important, but ensuring that those technologies are secure is just as crucial.

Amanda Guerrero is a content writer specializing in EHR, healthcare technology and Meaningful Use. In addition to maintaining her own health IT-related blog, she contributes to websites such as HealthTechnologyReview and HITECHAnswers.net.

Thanks to the ARRA’s HITECH Act of 2009, US medical practices must make the switch to a paperless practice by way of electronic health records adoption. The deadline is 2015 if they don’t want to face penalties.

While it’s generally accepted that the switch to EHRs will lower costs and save time – a 2011 Healthcare Financial Management study estimate hospital benefits range between $37M to $59M during a five-year period in addition to Meaningful Use incentive payments –  there are still mounds of printed documents and charts that need to be incorporated within your new EHR system.

High-speed medical scanning is an oft-mentioned solution to your practice’s paper woes. And if the company you contract has developed software to help you meet the difficulties associated with digitizing medical charts, then it sounds like a match made in heaven. Here we speak with Solaris Imaging, a South Florida-based medical scanning software company, for more insight into the arduous transition from paper to digital.

Tell us about Solaris Streamline. Story, concept, goals.
Like hundreds of other scanning companies, we discovered there was a problem to be solved when we entered the market a year ago – doctors need help scanning their charts. Although providing scanning services to the doctors was the obvious solution, we quickly realized the actual scanning of charts was not the only solution.

Some issues we discovered were:

1. Doctors would get sticker shock when they got a scanning quote of $18,000 to $40,000 from a scanning company.

2. In most cases, doctors would receive a cluster of PDF images on a drive from a scanning company, which they would then have to manually import patient by patient and section by section into their EHR system. This was obviously very time consuming.

3. The risk of losing the charts, or even worse – some company may ship charts off shore to scan. Also, some companies use temp workers who might steal information from charts to sell for tax return purposes.

How we are solving the issues:
We redesigned our production software to be a cost effective and extremely useful tool for all physician practices that prefer to utilize their staff to scan their charts. This allows physicians to avoid the potential problems a third party could cause, such as higher financial cost and the potential for lost or stolen charts/patient information.

Solaris is the only software designed to be a springboard for all doctors meeting the challenge of digitizing their medical charts.  It was designed to streamline the process of adopting an EHR.

Organizations are often scared of processes that take up too much staff time. How can practices streamline the scanning process?
We provide a comprehensive training program with the installation of the software.  Two representatives (or more if needed) are placed on site to train and help with the scanning.  During the training phase, our representatives train medical assistants on the process for scanning current charts, as well as how to maintain the daily scanning after the initial project is completed.

We also provide one or two high speed scanners (scan up to 120 ppm) for the duration of project. The process only takes an average of 60 days to complete.

How does a company like Solaris improve the patient encounter?
Solaris eliminates the process of pulling charts off the wall for appointments.  Physicians and staff now can pull a patient chart from Solaris just by their patient ID, SNN or name. Therefore, the practice saves time looking for charts resulting in patients spending less time in the waiting room.

Also, when a patient calls in, they won’t have to be put on hold just so that the medical personnel can go find his or her chart from the wall; in some cases the charts might be off site at a storage facility.

With the documents in Solaris, the office staff can access the charts immediately and provide the information the patient, or another medical facility, is seeking.  This is extremely helpful in an emergency situation.

Briefly, what strategies do practices need to employ to go paperless? Is scanning software like Solaris their best option?
Start small. We suggest that a practice scan in stages.  Start by scanning your most recent charts first (last 2 years), then scan your 2-5 year range charts, and scan your archive charts (inactive) later, unsorted.

Stay focused on your desired outcome. Our doctors take action and reach their goals because they stay focused on the benefits of going paperless and knowing their charts can be easily accessed, and that they are safe in Solaris. Sometimes, reminding yourself what you want and why you’re doing this can help you take the next step.

What kind of data mining capabilities do medical scanning software offerings boast? Can they accumulate and organize patient data efficiently?
Because it is fully customizable, Solaris can capture as many fields as desired.  The client can choose whatever fields they want to setup into Solaris, such as name, date of birth, etc. Solaris always correlates the patients’ information from the client’s practice management system before it is entered into the Solaris database.

If we don’t have direct access to the practice management system, Solaris can also use a data list, that contains the patients demographics, such as an excel file, csv file, or text file exported from the practice management or other system.

Imagine a practice where the receptionist doesn’t have to stand up every time she needs to access a patient’s file. Instead, a few simple clicks of the mouse bring up the patient’s medical record instantly on her monitor. It’s almost magical.

Well, EHRs are supposed to bring this into fruition and, in turn, launch the dawn of the paperless practice.

A recent study in the Journal of the American Medical Informatics Association showed instead of properly using their EHRs, primary care practices were using 10 out of 11 previously identified paper workarounds. If we’re supposed to be in the midst of the EHR revolution, what happened?

Overlooking functionality happened. Cramming as many features as possible into the EHR without regard to usability happened. It’s a design issue. This is why we recommend paying attention to EHR design just as much as its capabilities when looking to purchase.

The JAMIA study cites lack of efficiency, memory and awareness factors as the most consistent reasons for practices using paper-based workarounds instead of EHR functionality. Today, we look at how a well-designed EHR helps in all of these areas.

Efficiency
Increased efficiency is the key to a more productive practice. The problem is that some EHRs simply aren’t designed to be easy to use. According to a 2012 American College of Physicians survey, 37% of physicians say they were dissatisfied with their EHR system’s usability.

Some form of training will be needed for any EHR, but well-designed software will integrate naturally. Opening of windows and number of clicks should be kept to a bare minimum. Also, it helps if clinical encounters can be documented on a single screen, saving time and effort.

Memory
According to the JAMIA study, one major memory-based workaround for practices  was the writing down of notes as a reminder for future tasks. Particularly pervasive was the use of post-it notes instead of recording upcoming tasks in the EHR.

EHR design needs to provide a clear, organized view of all upcoming tasks.

Patient flow should also be shown in a way that you know where a patient is in the process at all times — this way they’re are never left waiting.

Awareness
Staff at paper-workaround practices reported writing down vitals or other data on health screening forms so physicians would have information available during patient encounters.

These physicians presumably didn’t use the EHR to access this data because the EHR design wasn’t conducive to workflows. Before buying an EHR, find out how much testing from actual physicians was performed on the product. There can often be a huge disconnect between software developers and practicing physicians.

Overall, your EHR needs to be designed in a user-friendly manner. If not, this can lead to the same lack of use found in the practices in the JAMIA study. And if you’re going to purchase an EHR, it might as well be one you‘ll actually use.

Feel like you need more tips to help purchase your EHR? Then you may enjoy our Definitive EHR Buying Guide. 

With Mother’s Day coming up on Sunday, let’s take a moment to think about what mothers do. They nurture, provide food and give comfort. Sometimes they nag. But perhaps most importantly, they provide you with guidance. In that way, PYP is like the health IT mother you never had.

In fulfilling our parental duties, this week we prepared you to make the right health IT decisions for your practice.

Are you in the market for a new EHR solution? If so, you’ll want to look for an EHR with these 8 features to make the choice to go paperless well worth it.

More than 32 million Americans will enter the healthcare system in 2014. This makes it a near certainty that your practice will need to be able to handle an increased patient base. Thankfully, the right EHR will make it easy for you to handle additional patients.

The raucous about ICD-10 is near deafening. You need to use any resource at your disposal to prepare for the transition. This includes your vendor.

With the implementation of prepayment Meaningful Use audits in March, the chance of being audited by CMS has nearly doubled. Luckily, this Thursday’s free webinar with noted Meaningful Use expert Jim Tate will help you survive and prepare for an audit.

Use of ePrescribing rose 8% in 2012. Here is a list of the 8 best practices to to help optimize your eRx workflow.

That’s all the guidance we have for this week. Happy Mother’s Day to all of the mom’s reading PYP.

Sign up for our newsletter for more from PYP. 

With ePrescribing’s clear advantages and strong government backing, it’s no surprise electronically transmitted prescription use rose 8% in 2012. According to a Surescripts report, 44% of all prescriptions filled last year were electronic, and it’s only expected to keep growing. 

As a decision-support tool, ePrescriptions (eRx) give providers immediate access to an individual’s medication history and details of their prescription insurance coverage – all in order to make better informed choices about patient care.

But like most IT enhancements in healthcare, implementation and proper use aren’t always as simple as they’re intended to be. So here is a list of the 8 best practices to to help optimize your eRx workflow.

1. Familiarize your team with all of the features in your software, including prescription benefits, medication history and routing.
Using prescription benefit information will ensure selected medications are covered by the patient’s drug coverage. Bi-directional prescription routing saves you time and money by automating prescription renewals, which reduces phone calls and faxes.

2. Avoid batching or queuing prescriptions before transmitting them to pharmacies electronically.
This reduces the chance of a patient arriving at the pharmacy before the prescription is ready.

3. Adhere to DEA regulations and confirm your system’s capabilities for sending controlled substance prescriptions electronically.

4. Designate an eRx expert at your practice.
The eRx expert will be focused on expediting the process and training coworkers less experienced in ePrescribing procedures. 

5. Encourage independent pharmacies in your area to register for ePrescription services, especially those frequented by your patients. 

6. Immediately report technical issues to your ePrescribing software vendor.
For example, if a patient shows up at the pharmacy and their prescription is not found, report this to the vendor so their technical team can identify the issue and retrain pharmacy staff if required.

7. Educate patients on ePrescribing and the implementation process.
Make sure they know it’s safer, more efficient and can save them money. 

According to a study by Decision Resources, a health care consulting firm in Massachusetts, 75% of doctors surveyed said they pay more attention to patient costs when they ePrescribe.

“Most eRx systems will alert a physician to the availability of a generic form of a drug they want to prescribe,” said Roy Moore, author of the study and product manager for Decision Resources’ U.S. Physician and Payer Forum. “Some physicians use the information to help make the best decisions, while others use the data as talking points to discuss care plans with patients.”

8. After implementing eRx software, remember to inform patients they need to come prepared for their next visit by bringing their preferred pharmacy contact information.
Let them know they’ll need to call the pharmacy and not the practice for their renewals from now on.

With CMS providing incentive payments to eligible providers who demonstrate successful use of electronic prescribing, it’s a good idea to become as well acquainted with your software as possible.

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