On Tuesday April 24th, CMS released a proposed rule which essentially overhauls the Medicare and Medicaid Electronic Health Record Incentive Programs (also known as the “Meaningful Use” program). The proposed rule includes updates to Medicare payment policies and rates under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). Here are five things you should know about the proposed changes:
In This Issue
- President’s Message
- 2018 House of Delegates
- Parity at the VA: APMA Achieves Major Federal Legislative Success
- ICD-11 is Coming – Take Time to Adjust
- CMS Proposes Overhauling Meaningful Use: 4 Important Takeaways
- “Shadow” Devices Expose Networks To New Threats
- Nanoparticles carrying two drugs can cross the blood-brain barrier and shrink glioblastoma tumors
- 5 Things You Should Know About Painful Toe Deformities
- Lower Vitamin D levels Linked to More Belly Fat
- The Link Between Gut Bacteria And Brain Could Influence Multiple Sclerosis
- Using virtual biopsies to improve melanoma detection
- MultiBrief: Physicians unhappy with EHRs may have unhappy patients, too
- Carri’s Corner: Getting Claims Paid on First Submission Will Save You Money
2018 House of Delegates
Parity at the VA: APMA Achieves Major Federal Legislative Success
May 23, 2018
APMA is celebrating a major legislative victory after the Senate passed S 2372, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or MISSION Act. The legislation provides comprehensive reforms to the Department of Veterans Affairs (VA) health-care system and includes language from APMA’s VA Provider Equity Act. The bill passed the House last week and will now go to President Donald J. Trump, who is expected to sign it immediately.
The VA Provider Equity Act reclassifies podiatrists as podiatric surgeons within the VA Health Administration (VHA), placing them in the same pay band as their allopathic and osteopathic peers. This update to decades-old regulations will go far in addressing the dire recruitment and retention issues in the VHA and ensure our veterans receive the best possible foot and ankle care.
“APMA is ecstatic that Congress has taken action to stem the growing podiatry staffing crisis at the VA while properly recognizing podiatrists for their training and education,” said APMA President Dennis Frisch, DPM. “Most importantly, we can now guarantee our veterans will be taken care of for years to come.”
The passage of this legislation represents the largest advancement for federally employed podiatrists since 1976, and is the first bill specific to podiatry passed by the United States Congress.
The VA Provider Equity Act was introduced by Rep. Brad Wenstrup, DPM (R-OH), in the House and Sen. Bill Cassidy, MD (R-LA), in the Senate.
“As a doctor, my first priority is the patient,” said Sen. Cassidy. “This breakthrough legislation puts veterans first and ensures they have access to the quality care they deserve.”
“I’m glad we are able to get this legislation across the finish line and finally tackle the disparities between the VA and the private sector,” said Rep. Wenstrup. “This [legislation] will increase the VA’s ability to recruit and retain qualified specialists like podiatrists, and ensure that our veterans get the specific care and treatment they deserve.”
Many individuals contributed to this victory, led by APMA Director of Legislative Advocacy and APMAPAC Benjamin J. Wallner. Wallner was in constant contact with the staff of our congressional sponsors and worked tirelessly to create opportunities to move the bill forward. Your APMA Board of Trustees (including recent past presidents), the APMA Legislative Committee, the APMAPAC Board, and APMA staff all contributed countless hours and energy to the passage of this legislation. The Federal Services Component leadership humanized this issue for congressional leaders and provided important support through workforce statistics and persuasive testimony. And APMA would like to recognize all members who have attended a Legislative Conference, contributed to APMAPAC, used eAdvocacy, or through some other means reached out to their elected officials to advocate for podiatry.
“This bill has been a major initiative by APMA on behalf of our profession and our veterans. Your membership in APMA and contributions to APMAPAC allowed us to make the passage of this bill a reality, and I wish to extend my gratitude to everyone who helped us accomplish this effort,” added Dr. Frisch.
The elevation of podiatrists within the VA will bolster APMA efforts to pass the Helping Ensure Life- and Limb-Saving Access to Podiatric Physicians (HELLPP) Act, which seeks to appropriately recognize podiatrists for their care of Medicaid patients. Together, we can use this victory as a springboard to move the profession forward.
ICD-11 is Coming – Take Time to Adjust
February 20, 2018
The new classification is designed as a database and has up to 13 dimensions.
The World Health Organization (WHO) will be releasing the 11th Revision to the International Classification of Diseases, or ICD-11, this May. The WHO and many of its 194-member countries have been working on this since 2007. As with ICD-10, ICD-11 will have an impact on coding in all specialties.
One of WHO’s goals for ICD-11 is that it will function in an electronic environment and support electronic health records (EHRs). The classification is actually designed as a database, and it has up to 13 dimensions. Many of our EHRs are already equipped with the SNOMED CT foundation, upon which ICD-11 will link with the Nomenclature of Medicine and Clinical Terms. So the way we think about the code list needs to change; it is no longer a single flat dimension, but rather 3-D virtual reality!
ICD-11 will also be multi-purposed, and the structure is defined in linearizations that incorporate properties and attributes with a focus on mortality, morbidity, the degree of primary care, research, and public health. It is translated in English, French, Spanish, Russian, Chinese, and Arabic. Finally, ICD-11 accommodates many specialties, some quite unique.
But the heartache for all the coders reading this article is the codes. Just like with ICD-9, we have coding professionals that have memorized many ICD-10 codes. They know that A and B codes tie to infectious conditions often requiring antibiotics; C is the cancer chapter; E is the endocrine chapter; and obstetrics-related conditions are listed in Chapter O. We all know that the CM diagnosis codes start with a single alphabetical character. Well, poof! Kiss all that goodbye.
There are 28 chapters in ICD-10. The first character is generally the number of the chapter, but when you get to chapter 10, the first character is alphabetical. There is always a letter in the second position to distinguish ICD-11 codes from ICD-10 codes.
Additionally, there are no alpha “I” (sorry, cardiology) and “O” (sorry, obstetrics) codes. Remember the ICD-10 meaning of hypertension? Forget it! In ICD-11, it’s BA00. “Unspecifieds” also will still exist, so our clinicians will be happy.
Codes will have four (not three) characters before the decimal point, and from what I have seen, up to three characters after the decimal point. There are additional codes to help amplify the base code with specificity, laterality, and anatomy, and to describe associated conditions or manifestations (or to further describe an injury like we do today in ICD-10).
An example of the use of an additional code for a manifestation was offered by Donna Pickett of NCHS, who described a patient with type 1 DM and diabetic retinopathy as follows below:
| 6A10 Type 1 diabetes mellitus MG45 Diabetic retinopathy 6A10/MG45 = type 1 DM with
ICD-11 also has several new chapters:
- Chapter 3: Diseases of the Blood and Blood- forming Organs
- Chapter 4: Disorders of the Immune System
- Chapter 6: Conditions related to Sexual Health
- Chapter 8: Sleep-Wake Disorders
- Chapter 26: Traditional Medicine: This chapter refers to disorders and patterns that originated in ancient Chinese Medicine and are still commonly used in China, Japan, Korea, and elsewhere around the world.
- Chapter 27: Supplemental V Codes: There are not like the ones we know. The V codes will be great supplemental codes for HCCs, rehabilitation centers, and skilled nursing care, because these codes describe a patient’s functional status and disabilities.
- Chapter 28: Supplemental Extension codes: These are the X codes that are used as supplementary or additional codes to identify more detail, such as severity, tumor staging, history, injury, and poisonings, as well as attributes such as differential and provisional diagnoses, presence on admission, or how a condition was confirmed. These may be five alphanumeric codes.
See more information from Donna Pickett online at https://www.ncvhs.hhs.gov/wp- content/uploads/2017/06/NCVHS-June-21-2017-ICD-10-and-ICD-11-Presentation-v-6- 21-17.pdf
I suspect that many of the U.S. specialty groups that added a ton of codes to the virgin version of ICD-10 will find that this new classification allows them to build the codes that accurately describe the conditions they are treating for billing purposes, even if they still select an “unspecified” code. However, more important is the fact that it is her-compatible, which will make its implementation in the U.S. easier and maybe shorter than that of ICD-10.
It is worth health information management’s (HIM’s) time to start exposing its coding and clinical documentation staff to some of the ICD-11 concepts to establish a comfort level as we get closer to implementation over the coming years. Several links to the ICD-11 beta version and training videos appear below.
Beta draft: https://icd.who.int/dev11/l-m/en
- This includes the classification listing by chapter, and under the “info” tab there are links to training videos.
Coding Tool: To enter a search term
The Meaningful Use program and Advancing Care Information (MIPS) have been renamed “Promoting Interoperability,” and new changes seek to do just that.
CMS explains in a press release that as part of this proposed rule:
- Hospitals are already required to make a list of their standard charges publicly available, but CMS is updating its guidelines to specify that they must post this information.
- The already existing requirement is reaffirmed that providers must use the 2015 Edition of certified electronic health record technology (CEHRT) in 2019 as part of demonstrating meaningful use. This includes use of application programming interfaces (APIs).
- CMS is asking for comment on what price transparency information stakeholders would find most useful, as well as suggestions for how to make interfaces more patient-friendly.
According to CMS, the intention behind these and other changes is to make the program “more flexible and less burdensome” on providers by focusing on strengthening interoperability and data sharing; to “emphasize measures that require the exchange of health information between providers and patients” (further detailed in our point 2); and to incentivize providers to facilitate patient access to electronic medical records. The name change is meant to underscore this renewed drive toward interoperability.
CMS intends to remove unnecessary, redundant, and process-driven measures from quality reporting and pay-for-performance programs.
The proposed rule removes measures currently required for acute care hospitals, as well as duplicative measures in hospital quality and value-based purchasing programs. CMS writes in their press release:
“This would result in the removal of a total of 19 measures from the programs and would de-duplicate another 21 measures while still maintaining meaningful measures of hospital quality and patient safety.”
CMS proposes a new scoring system for eligible hospitals.
In the past, participants in Meaningful Use were scored under a pass/fail system. Under Promoting Interoperability, providers would instead be rated on a 100-point scale, where anyone scoring over 50 points would avoid Medicare payment adjustments.
Experts warn the stakes may be raised for interoperability.
Jeff Smith, VP of public policy at the American Medical Informatics Association (AMIA), has voiced an interesting concern about an RFI (request for information) within the proposed rule. The RFI seeks information on whether CMS should consider participation in the Trusted Exchange Framework and Common Agreement (TEFCA) a health IT activity, and allow it to count for credit within the health information exchange objective. Provider participation in this initiative is currently voluntary, but Smith warns (via HCInformatics) that providers may ultimately be forced to participate in order to take part in Medicare at all.
CMS Administrator Seema Verma seemed to allude to this possibility in a Tweet, writing: “To avoid a payment penalty, providers will have to provide patients with electronic access to their health information.”
Mari Savickis, vice president of federal affairs at the College of Healthcare Information Management Executives (CHIME), also worries about indications that CMS may mandate participation in TEFCA. She is quoted by HCInformatics as saying: “[…] if CMS says that if you don’t participate in TEFCA, that means you are a data blocker—well that would be a big concern of ours.”
June 25, 2018 is the deadline for submitting comments on the proposed rule and RFI. The rule would take effect October 1. Subscribe to the Healthmonix Advisor to stay up-to-date on this and other developments in the world of value-based care.
The Bako Diagnostics team of dermatopathologists and pathologists emphasize the important role our physician clients play in the early diagnosis and treatment of malignancies. Check out their latest Malignancy Report that includes May 2018, and year-to-date data.
“Shadow” Devices Expose Networks To New Threats
Jun 04, 2018 11:36 am | By: Anne Zieger
A new report by security vendor Infoblox suggests that threats posed by “shadow” personal devices connected to healthcare networks are getting worse.
The study, which looks at healthcare organizations in the US, UK, Germany, and UAE, notes that the average organization has thousands of personal devices connected to their enterprise network. Including personal laptops, Kindles and mobile phones.
Employees from the US and the UK report using personal devices connected to their enterprise network for multiple activities, including social media use (39%), downloading apps (24%), games (13%) and films (7%), the report says.
It would be bad enough if these pastimes only consumed network resources and time, but the problem goes far beyond that. Use of these shadow devices can open up healthcare networks to nasty attacks. For example, social media is increasingly a vector of malware infection, where bad actors launch attacks successfully urging them to download unfamiliar files.
Health IT directors responding to the study also said there were a significant number of non-business IoT devices connected to their network including fitness trackers (49%), digital assistants like Amazon Alexa (47%), smart TVs (46%), smart kitchen devices such as connected kettles of microwaves (33%) and game consoles such as the Xbox or PlayStation (30%).
In many cases, exploits can take total control of these devices, with serious potential consequences. For example, one can turn a Samsung Smart TV into a live microphone and other smart TVs could be used to steal data and install unwanted apps.
Of course. IT directors aren’t standing around and ignoring these threats and have developed policies for dealing with them. But the report argues that their security policies for connected devices aren’t as effective as they think. For example, while 88% of the IT leaders surveyed said their security policy was either effective or very effective, employees didn’t even know it was in effect in many cases.
In addition, 85% of healthcare organizations have also increased their cybersecurity spending over the past year, and 12% of organizations have increased it by over 50%. Most HIT leaders appear to be focused on traditional solutions, including antivirus software (60%) and cybersecurity investments (57%). In addition, more than half of US healthcare IT professionals said their company invests in encryption software.
Also, about one-third of healthcare IT professionals said the company is investing in employee education (35%), email security solutions and threat intelligence (30%). One in five were investing in biometric solutions.
Ultimately, what this report makes clear is that health IT organizations need to reduce the number of unauthorized personal devices connected to their network. Nearly any other strategy just puts a band-aid on a gaping wound.
Glioblastoma multiforme, a type of brain tumor, is one of the most difficult-to-treat cancers. Only a handful of drugs are approved to treat glioblastoma, and the median life expectancy for patients diagnosed with the disease is less than 15 months.
MIT researchers have now devised a new drug-delivering nanoparticle that could offer a better way to treat glioblastoma. The particles, which carry two different drugs, are designed so that they can easily cross the blood-brain barrier and bind directly to tumor cells. One drug damages tumor cells’ DNA, while the other interferes with the systems cells normally use to repair such damage.
In a study of mice, the researchers showed that the particles could shrink tumors and prevent them from growing back.
“What is unique here is we are not only able to use this mechanism to get across the blood-brain barrier and target tumors very effectively, we are using it to deliver this unique drug combination,” says Paula Hammond, a David H. Koch Professor in Engineering, the head of MIT’s Department of Chemical Engineering, and a member of MIT’s Koch Institute for Integrative Cancer Research.
Hammond and Scott Floyd, a former Koch Institute clinical investigator who is now an associate professor of radiation oncology at Duke University School of Medicine, are the senior authors of the paper, which appears in Nature Communications. The paper’s lead author is Fred Lam, a Koch Institute research scientist.
Targeting the brain
The nanoparticles used in this study are based on particles originally designed by Hammond and former MIT graduate student Stephen Morton, who is also an author of the new paper. These spherical droplets, known as liposomes, can carry one drug in their core and the other in their fatty outer shell.
To adapt the particles to treat brain tumors, the researchers had to come up with a way to get them across the blood-brain barrier, which separates the brain from circulating blood and prevents large molecules from entering the brain.
The researchers found that if they coated the liposomes with a protein called transferrin, the particles could pass through the blood-brain barrier with little difficulty. Furthermore, transferrin also binds to proteins found on the surface of tumor cells, allowing the particles to accumulate directly at the tumor site while avoiding healthy brain cells.
This targeted approach allows for delivery of large doses of chemotherapy drugs that can have unwanted side effects if injected throughout the body. Temozolomide, which is usually the first chemotherapy drug given to glioblastoma patients, can cause bruising, nausea, and weakness, among other side effects.
Building on prior work from Floyd and Yaffe on the DNA-damage response of tumors, the researchers packaged temozolomide into the inner core of the liposomes, and in the outer shell they embedded an experimental drug called a bromodomain inhibitor. Bromodomain inhibitors are believed to interfere with cells’ ability to repair DNA damage. By combining these two drugs, the researchers created a one-two punch that first disrupts tumor cells‘ DNA repair mechanisms, then launches an attack on the cells’ DNA while their defenses are down.
The researchers tested the nanoparticles in mice with glioblastoma tumors and showed that after the nanoparticles reach the tumor site, the particles’ outer layer degrades, releasing the bromodomain inhibitor JQ-1. About 24 hours later, temozolomide is released from the particle core.
The researchers’ experiments revealed that drug-delivering nanoparticles coated with transferrin were far more effective at shrinking tumors than either uncoated nanoparticles or temozolomide and JQ-1 injected into the bloodstream on their own. The mice treated with the transferrin-coated nanoparticles survived for twice as long as mice that received other treatments.
“This is yet another example where the combination of nanoparticle delivery with drugs involving the DNA-damage response can be used successfully to treat cancer,” says Michael Yaffe, a David H. Koch Professor of Science and member of the Koch Institute, who is also an author of the paper.
In the mouse studies, the researchers found that animals treated with the targeted nanoparticles experienced much less damage to blood cells and other tissues normally harmed by temozolomide. The particles are also coated with a polymer called polyethylene glycol (PEG), which helps protect the particles from being detected and broken down by the immune system. PEG and all of the other components of the liposomes are already FDA-approved for use in humans.
“Our goal was to have something that could be easily translatable, by using simple, already approved synthetic components in the liposome,” Lam says. “This was really a proof-of-concept study [showing] that we can deliver novel combination therapies using a targeted nanoparticle system across the blood-brain barrier.”
JQ-1, the bromodomain inhibitor used in this study, would likely not be well-suited for human use because its half-life is too short, but other bromodomain inhibitors are now in clinical trials.
The researchers anticipate that this type of nanoparticle delivery could also be used with other cancer drugs, including many that have never been tried against glioblastoma because they couldn’t get across the blood-brain barrier.
“Because there’s such a short list of drugs that we can use in brain tumors, a vehicle that would allow us to use some of the more common chemotherapy regimens in brain tumors would be a real game-changer,” Floyd says. “Maybe we could find efficacy for more standard chemotherapies if we can just get them to the right place by working around the blood-brain barrier with a tool like this.”
Does one of your toes appear to bend in an awkward way or curl under painfully? If so, you may have a hammertoe, a toe deformity characterized by shortening and hardening of muscles, tendons or other tissue.
A hammertoe is a term that describes symptoms and joint changes involving the toes. However, there are several other types of toe deformities, including:
- Mallet toe
- Claw toe
- Adductovarus deformity of the 5th digit
“The deformity classification depends on where on the toe the contracture is,” says orthopedic surgeon Nicole Nicolosi, DPM.
These deformities sometimes need surgery, but there are several less invasive ways to ease pressure and relieve the pain they cause.
If you have one of these, here are five things you should know:
1. There are two types of toe contractures:
- Flexible: Affected toes can still move at the joint
- Rigid: Surrounding tendons and tissues permanently tighten and the joint becomes fixed and immobile
Without treatment, a flexible hammertoe sometimes becomes a rigid hammertoe, Dr. Nicolosi says.
2. Muscle imbalance causes these deformities
“A toe deformity occurs when the muscle operating the toe becomes weak and another muscle overpowers that muscle,” says Dr. Nicolosi. “This results in contracture of the toe.”
This muscle imbalance sometimes has a genetic or intrinsic component. If you have a high arch or flat feet, this can cause inherent instability in your foot when you walk.
Extrinsically, an injury to the toe, often caused by the shoes you choose, also sometimes causes the imbalance.
“One thing that can cause injury is long-term inappropriate shoe wear, which can compress the digit and cause muscle imbalance to occur,” Dr. Nicolosi says. She lists high heels and unsupported flip-flops as examples of inappropriate shoe gear.
3. Hammertoe can interfere with daily activities
The digital contracture can result in rubbing on the top of the shoe.
“That can cause formation of callus tissue, which can be painful,” Dr. Nicolosi says. “The callus can then increase pressure in shoe gear, which then increases pain and therefore limits activity.”
4. You may not need surgery to ease the pressure and pain in your toes
Doctors can treat flexible hammertoes conservatively, Dr. Nicolosi says.
They may suggest a crest pad or a Budin splint; each has an elastic band that goes around the crooked toe to bring a flexible hammertoe back into the corrected position.
“Another option is an in-office flexor tenotomy, which is used to cut the overpowering tight muscle tendon to correct the muscle imbalance and reduce the deformity,” she says.
For a rigid hammertoe, your doctor may suggest wearing a shoe with a deeper, fuller toe box to ease the pressure on the deformity. If this doesn’t solve the problem, however, surgery to straighten the toe likely is needed, Dr. Nicolosi says.
5. Wearing the right shoes can prevent symptoms from worsening
“Toe deformities develop due to unsupported motion,” says Dr. Nicolosi. “So one thing you can do to prevent symptoms from worsening is to avoid non-supportive shoes, such as high heels and unsupported flip-flops.”
She recommends a supportive shoe insert to control abnormal foot motion, as well as a supportive shoe.
Colorado State University researcher Jesse Wilson is accelerating research to improve imaging and detection of melanoma, the most deadly form of skin cancer, and the fifth most common cancer in the United States.
With Skin Cancer Awareness Month upon us, Colorado State University researcher Jesse Wilson is accelerating research to improve imaging and detection of melanoma, the most deadly form of skin cancer, and the fifth most common cancer in the United States.
Wilson, an assistant professor in the Department of Electrical and Computer Engineering (ECE) and in the School of Biomedical Engineering (SBME), is one of 15 researchers selected for a Young Investigator Award from the Melanoma Research Alliance.
The award will allow Wilson and his team to go a step further in their research to make early detection of melanoma faster and cheaper, without the need for a biopsy. It will also open the door to partnering with CSU’s College of Veterinary Medicine and Biomedical Sciences to test new imaging applications on canine patients.
“The mantra for melanoma has always been, ‘when in doubt, cut it out,’” said Wilson. But cutting away skin lesions is inconvenient and invasive, and often impractical for high-risk patients with a host of suspicious moles.
Advancing noninvasive virtual biopsy techniques
Wilson is developing a virtual biopsy tool that could give physicians a view into the cellular structure of the skin, allowing them to perform molecular analyses to guide patient care without having to cut away living tissue. His idea could represent a breakthrough in noninvasive in vivo imaging of melanin, the skin pigment that’s made by cells called melanocytes, which can become cancerous.
“Right now there are a handful of virtual biopsy tools available in the United States, but the devices are imperfect because they produce grainy images that bear little resemblance to a traditional biopsy,” said Wilson.
A step closer to clinical practice
Building on preliminary data from his grant from the Colorado Clinical and Translational Sciences Institute, Wilson’s research harnesses the power of multiphoton microscopy, an imaging technique that has produced “exquisite contrast” between normal tissue and melanoma in laboratory settings. But these microscopies rely on an exceedingly expensive short-pulse laser – a major barrier to commercialization. Wilson aims to bring multiphoton imaging closer to clinical practice by removing the need for these costly short-pulse lasers through machine learning and digital signal processing techniques.
Partnership with College of Veterinary Medicine and Biomedical Sciences
When it comes to melanoma, dogs and humans have a lot in common. Because of the similarities between canine oral melanomas and human melanomas, Wilson is collaborating with Doug Thamm, director of Clinical Research at the Flint Animal Cancer Center, to validate and test the new technology.
Using a handheld wand about the size of a marker, Wilson’s proposed technique will allow clinicians to scan a laser beam across a suspected canine melanoma to create a real-time image that shows melanin-specific contrast to inform a diagnosis. As part of the research trial, a surgical biopsy of the dog’s lesion will also be taken, and the traditional biopsy results will be compared with the noninvasive virtual images during a blind review.
Researchers in the Walter Scott, Jr. College of Engineering are serving as mentors on the project, including Kevin Lear, associate director of the School of Biomedical Engineering and professor of electrical and computer engineering; Stu Tobet, director of the School of Biomedical Engineering and professor of biomedical sciences; and Matt Kipper, assistant professor of chemical and biological engineering.
Wilson earned his bachelor’s, master’s, and Ph.D. in electrical engineering from Colorado State University. Prior to joining the faculty at CSU, he was a postdoctoral researcher in the Warren Group Laboratory at Duke University, where his work in melanoma imaging and detection began.
MultiBrief: Physicians unhappy with EHRs may have unhappy patients, too
Physicians unhappy with an EHR system could pass that sentiment on to their patients — in the form of lower patient satisfaction scores, so says a new study in the Journal of the American Medical Informatics Association.
That makes complete sense, of course. How many times have you expressed discontent about some object or form of technology only to see those same sentiments reflected in the attitudes of your spouse or partner, children or co-workers?
Your individual perceptions become other people’s reality, as long as your relationship with said person contains enough respect of them for you to be swayed by your opinions. This is the obvious case in most physician-to-patient relationships. What the doctor does or says has an impact on their patients, even if the effort is only subconscious.
For this particular study, the researchers examined how electronic health records were installed at OB-GYN practices, and the subsequent interactions with an inpatient perinatal and how the EHR impacted doctors’ satisfaction with the flow of clinical information and “patient feelings about their care.”
What they found was the outpatient OB-GYN physician satisfaction increased with “automatic data flow from perinatal triage units, but they tended to be underwhelmed with the EHR’s impact on work processes. Patient satisfaction fell after the EHR was installed and did not rebound when the systems were integrated.”
Alternatively, the outpatient OB-GYN providers were more satisfied with their access to information from the inpatient perinatal triage nurses once system capabilities included automatic data flow from triage back to the OB-GYN offices. However, researchers say that these same physicians were likely less satisfied with how the EHR affected their work than other clinical and nonclinical staff.
Per the report’s summary, patient satisfaction dropped after the initial EHR installation, and the researchers said they can we find “no evidence of increased satisfaction linked to system integration.”
Likewise, researchers said that dissatisfaction of providers with an EHR system and difficulties incorporating EHR technology into patient care may negatively impact patient satisfaction. “Care must be taken during EHR implementations to maintain good communication with patients while satisfying documentation requirements,” they said.
According to separate reporting from Healthcare Dive, EHRs may be leading to the burnout and professional decline of physicians.
In a cited Medscape survey, the site reports that more than half of U.S. doctors reported burnout and half of those said “computerization of work with electronic records” was partially to blame. Those with the highest burnout rates were family physicians, neurologists and OB-GYNs.
Another study in 2017 found that primary care doctors spend more than half their workday on EHR tasks, which impacts the doctor-patient relationship. Patients pickup on this disconnect, which doesn’t help their relationships with their caregivers, which, in turn, can create an even more stressful environment for physicians.
This dissatisfaction among patients further disconnects them from their physicians, the study suggests, with the patients viewing the technology that comes between them and their doctor negatively.
Carri’s Corner: Getting Claims Paid on First Submission Will Save You Money
by Carri Garbus
June 12, 2018
If you find that many claims are simply not getting paid, getting returned, rejected or denied, you are not alone. Once a claim is not paid on the first submission, the price of getting that claim paid increases instantly. It is a tedious and meticulous process to get these initial claims submitted without errors. Attaining the correct information, inputting it, refiling the claim and reviewing the new remittance statement is time consuming. It is double the work and someone will be getting paid to do the same thing twice. Can you imagine how much money is lost for multiple claims having to be refiled?
The key to avoiding this expense, is to train your staff to work deliberately and carefully, preventing any inaccuracies that may cause these claims to have to be recreated. Even the best of medical billers run into these avoidable mistakes. You may find the following suggestions to be the fine-tuning your office needs to assure your claims are filed accurately the first time, therefore increasing your revenue directly.
- Incorrect Insurance and transposing numbers and letters
The front desk must work diligently to enter the correct insurance company, and not to transpose numbers or letters, when checking in a patient. Implement a workflow where this information is verified another staff member. Scanning the insurance card is essential and will aid in the double-checking of information. Some practice management systems can import this information directly through the patient portal or an iPad in the office. These small steps may save the practice from having to resubmit claims.
- Confirm and verify insurance
The front desk must be vigilant and ask to see patient’s insurance card and verify the coverage at each visit. These days, people’s insurances change much more often than they used to. No one wants to see claims returned because a policy has been terminated. Unverified insurance coverage can be one of the leading reasons claims get rejected. Many effective practice management systems can do this electronically and in real time.
- Prior authorization
Be sure your front desk person is familiar with which insurances require pre-authorizations for your specialty or procedures. It can be a very costly mistake if a patient is seen, or a procedure completed, only to find out that it will not get paid because there was no prior authorization given. If the patient arrives with the proper authorization, be sure that number gets put on the claim form for that visit prior to filing the claim. Make patients aware that they need to have their authorization numbers with them before they come for their visit.
- Omitting proper paperwork
Many times, claims simply cannot be processed. Forgetting a vital document as with a worker’s compensation or a no-fault claim, will stop any claims activity dead in its track. If you know you need the documentation, be sure to send it with the first claim submission.
- Stay informed by insurance notices
Receiving insurance bulletins is fundamental in avoiding the nonpayment for a procedure. One person in the office should be appointed to sign up for notifications from all the insurance companies the practice accepts and be on the lookout for announcements regarding billing, coding and coverage changes. Even if the policy is the same, the benefits may have changed, and the plan may not cover all the procedures it had in the past. Occasionally, codes may change and that needs to be recognized immediately to evade all the work it takes to correct and resend that claim.