practice management advisor

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1 practice management advisor Winter 2013 It s time to start thinking about Stage 2 Meaningful Use Office staff overworked? Take the load off by outsourcing certain tasks Why patients change doctors and what you can do about it Rewarding physicians for reducing spending

2 It s time to start thinking about Stage 2 Meaningful Use n August 2012, CMS released new I meaningful use specifications that physicians must implement in their EHR systems to qualify for financial incentives. Meaningful use of certified electronic health record technology (CEHRT) is to be achieved in three stages. Providers that fail to do so by 2015 will see downward Medicare payment adjustments. Those that attested to meaningful use first in 2011 must meet the Stage 2 criteria in 2014 and Stage 3 criteria in All other providers will be required to demonstrate two years at each stage. In the first year of participation, they must demonstrate meaningful use for a 90-day EHR reporting period; in subsequent years, providers will demonstrate meaningful use for a full-year EHR reporting period. So, how do you proceed? Read on. Meeting core objectives All providers must meet the core objectives. There are also a number of menu objectives that providers must select and satisfy in order to demonstrate meaningful use. Most of Stage 1 objectives are now core objectives under the Stage 2 criteria. Altogether, you ll have to satisfy a total of 17 core objectives and three of six menu objectives. Reaching menu objectives The menu objectives require physicians to satisfy three of the following six objectives: 1. Grant access to imaging results via CEHRT (10%). 2. Record patient family health history for 20% of unique patients. 3. Submit electronic syndromic surveillance data to public health agencies. 4. Identify and report cancer cases to the state cancer registry. 5. Identify and report specific cases to a specialized registry. 6. Record electronic notes in patient records. Physicians must also report on at least nine out of 64 clinical quality measures (CQMs). Those nine CQMs must come from at least three of the six health care policy domains from the DHHS National Quality Strategy. Last, CMS defined four hardship exceptions for doctors. The core objectives require physicians to perform tasks such as using computerized provider order entry for medication and lab orders, recording demographic information for 80% of patients, using clinical decision support to improve performance, and giving 5% of patients the ability to view their health information online. 2

3 Abiding by the deadlines Although the Oct. 3, 2012, deadline for beginning your 90-day reporting process to qualify for the full five-year Medicare incentive payment is long gone, you may still receive $39,000 in incentive payments if you attest to Stage 1 by the end of And then it s time to get started on Stage 2. If you fail to attest to Stage 1 by October 3, 2014, you will see a 1% reduction in payment for Medicare reimbursement in 2015, and for each following year that you fail to participate you will see an additional 1% reduction, all the way up to 5%. Getting up to speed Like it or not, Stage 2 is here. For the betterment of your patients and your practice, you must get up to speed on the new regulations as quickly as possible. View the meaningful use thresholds as the minimum acceptable performance not your best performance and try to far surpass the thresholds whenever possible. If you need help deciphering all these new rules, contact your health care advisor. x Preparing for compliance How can physicians prepare their practices for Stage 2 compliance? First, contact your practice s EHR vendor and obtain the schedule for upgrading its system to Stage 2 standards. Also, continue expanding your meaningful use of EHR, and try to exceed the Stage 1 requirements. Then, review the Stage 2 core and menu objectives and begin adjusting your practice s work flow to accommodate them. Several of the new objectives relate to patient engagement, requiring physicians to play a role in getting patients engaged in their care. Select a cadre of active, tech-comfortable patients who will be ready to take advantage of Stage 2 EHR capabilities offered to them. Show them how to exchange secure messages with their physician, as well as refill prescriptions and book appointments online. Other objectives require sending information electronically to other providers. So, conduct at least one successful electronic exchange of a summary of care document with another physician using an EHR platform different from yours; or, conduct a successful test with a CMS-designated test EHR. Then, create a network of entities with which you can exchange information, such as local hospitals. Office staff overworked? Take the load off by outsourcing certain tasks ith the passage of health care reform W come many new rules and regulations that your clinical and office staff need to study and implement. And that s on top of their regular work. If it s obvious that they re having some trouble getting all the work done right and on time perhaps your practice should consider outsourcing certain tasks to outside vendors. Determining which tasks to outsource Of course, you can t make the decision to outsource willy-nilly. It requires performing a costbenefit analysis. For some tasks, the direct cost of outsourcing will be clearly less than that of performing the task in-house. But, for other tasks, the direct 3

4 4 cost of outsourcing may be close to or even exceed that of performing the activity in-house. The question then is whether outsourcing those tasks will improve results that positively affect the practice s bottom line, reduce indirect costs or provide other valuable benefits. An effective outside billing service or professional management firm, for example, may help increase the practice s cash receipts and reduce its accounts receivable. Any cash that your practice generates from more effective billing and follow-up may easily exceed the incremental direct cost increase of an outside billing service. Two tasks that can usually be outsourced so smoothly that it s virtually seamless are payroll and billing. In other situations, factors such as tax consequences, savings in capital expenditures or other financial trade-offs may make a significant difference. For instance, the cost of an outside billing service may be expensed on your practice s income statement, but the cost of a computerized billing system acquisition is generally a capital expense that the practice must depreciate over an extended period of time. The 3-factor test Regardless of the task your practice is considering outsourcing, there are certain factors that will help you determine the initial feasibility. First, look at the size of your practice and the level of internal expertise that s needed to effectively perform the task. Second, take into account your physicians interest and commitment to participating in management decisions and oversight of the task. And third, consider the availability of expert external sources that can perform the task well and at a competitive rate. Make sure you consider all three of these factors in relation to your practice. How outsourcing can work for you Outsourcing offers three primary benefits: 1. Improved results from a company specializing in a particular activity, 2. A potential for reduced costs, and 3. The elimination of responsibilities and hassles for physicians and administrators. Two tasks that can usually be outsourced so smoothly that it s virtually seamless are payroll and billing. Most medical practices currently outsource these functions and agree that doing so is cost effective. However, don t forget that the practice is responsible for reporting and paying payroll taxes, so choose a payroll provider carefully. Many other functions can be outsourced, depending on the specialty of the practice. For example, hospital-based specialists, such as radiologists and pathologists, frequently outsource office

5 and administrative functions to other organizations. Hospital-based groups often need only limited staff, which makes outsourcing attractive because it eliminates personnel administration responsibilities. More important, outsourcing office functions can eliminate retirement plan contributions for employees that, in a practice composed mostly of physicians, can be expensive under today s requirements of parity in contribution rates between physicians and employees. Not just admin But outsourcing doesn t necessarily have to be limited to administrative tasks. Specialty group practices performing diagnostic and therapeutic services may outsource not only the administrative responsibility and equipment maintenance, but also the technical personnel or the entire technical component of those services to a niche company that specializes in them. A cardiology group may, for instance, choose to outsource its cardiac stress tests. This type of outsourcing can provide expansion opportunities often without the risk, capital expense and lead time required to develop comparable in-house capabilities. It s a win-win situation As you can see, outsourcing certain tasks to an outside vendor can help lighten the load on your likely overworked staff. But outsourcing can also help make your practice more efficient and, therefore, get better results. Of course, you ll still need to do your due diligence to ensure the firm you re outsourcing work to is top-notch. And make sure you bring in an attorney to ensure the service agreement is lock-tight. x Why patients change doctors and what you can do about it hile it s somewhat common for doctors to W fire uncooperative or nonpaying patients, the reverse can happen, too: Patients can become dissatisfied with their current doctors and switch to new ones. Obviously, this isn t good for a physician s pocketbook or reputation. Sometimes, there s nothing you can say to departing patients besides wishing them well. But, in other cases, you can take control over the issues driving them out the door and make needed changes. 7 reasons for a switch So why do patients switch to a new doctor? Here are seven reasons you should know about: 1. Declining confidence. Most patients take their physicians competence for granted. But if, after an office visit, a patient feels uneasy about the doctor s decisions and recommendations, he or she may head for the door and not return. It s hard to admit one s professional shortcomings. Yet if you feel as if you re not projecting an air of certainty when making diagnoses, it may be time to brush up on your communication skills. 5

6 2. Practice knowledge is out of date. It s daunting for physicians to keep up with the latest findings in their fields of medicine. Nevertheless, you must do so and convey your efforts to your patients. Beginning a recommendation with I just read in the New England Journal of Medicine that can make a big difference. 3. Doctor doesn t listen. An office visit shouldn t leave a patient feeling that he or she has no choice but to accept the doctor s recommendations. Patients should have your undivided attention and feel comfortable raising questions. Something is wrong if the patient feels demeaned or foolish for speaking up. Be sure that you re welcoming each patient as an active participant in managing his or her health, and listen to what your patients have to say. 4. Practice seems disorganized. Physician practices can be very busy places, but they shouldn t appear disorganized and confused. For example, telephone calls shouldn t be returned late (or go unreturned). Or it shouldn t take several calls to make an appointment or request a prescription refill. If, after an office visit, a patient feels uneasy about the doctor s decisions and recommendations, he or she may head for the door and not return. In some practices, patients spend too much time in the waiting room and then sitting alone in the examining room. Another big no-no is having error-ridden personal records and insurance forms. And your staff needs to be clear and consistent regarding your practice s policies for everything from making appointments to paying bills. 5. Desired amenities are missing. The quality of the practice s medicine may be excellent, but lacking just a few key features may alienate some patients. The office location, for example, may be difficult to reach by public transportation. Or perhaps it has inadequate parking. Some practices may have inconvenient office hours or no extended hours. Maybe the doctor is unwilling or unable to communicate by . In the future of patient-centered medical homes, such amenities may be mandatory. 6. Doctor has poor bedside manner. The way a doctor deals with patients is critical. Patients aren t likely to stick with a physician who s unsympathetic or disrespectful. They want a doctor who understands not only how to treat their medical condition, but also how it affects other areas of their lives. With time, it s possible to improve one s bedside manner. An understanding, empathetic demeanor will help you both retain patients and improve their adherence to your medical directives. 7. Practice doesn t accept health plan. Many patients won t stay with a practice that charges more for the same care offered by another physician. This can happen if the practice doesn t accept the patient s health plan or charges excessive out-of-pocket fees. If you haven t already, establish a strategic goal of signing contracts with all major health plans typical to your market. A benchmark comparison of your practice s fees will indicate whether you need to adjust them. Turning bad to good If you ve noted any of the above issues in your practice, take corrective action as soon as possible. Start by becoming more alert to what patients are saying both verbally and nonverbally about their experiences. Send out regular patient satisfaction surveys and note specific problems and trends. Also consider hiring an independent consultant to conduct periodic patient focus groups. Just as retail stores use mystery shoppers to uncover customer grievances, consider arranging visits by mystery patients. x 6

7 Practice notes Rewarding physicians for reducing spending ne of the most talked-about new ideas O in health care is rewarding providers for reducing medical spending by giving them a share of the net cost savings. The concept is currently being tested by many payor and provider organizations across the United States. The early results are so promising that providers including physicians may see contracts offering this arrangement in the near future. The demonstration projects The shared savings payment idea has been applied mainly in primary care practice medical home programs and accountable-care-like programs. There are wide variations in the characteristics of the demonstration projects testing the new concept, regarding: x Patient population included: primarily commercial, but also Medicare Advantage and Medicaid managed care, x Basis of savings payments: cost savings, compared with control group, reducing complications associated with chronic conditions, compared with budget, compared with negotiated target, x Adjustments for patient risk: high-cost claims, stop-loss provision, services excluded, adjusted clinical groups, x Support for providers: training (care coordination, evidence-based medicine), data support and analysis, share best practices, tools for tracking and analyzing performance, x Percent of savings shared: 30% to 50%, up to 75%, average of 50%, and x Performance targets: quality measures, use of highcost services (ED, hospital readmissions). Further testing of this new payments concept is necessary to establish the most effective model and features. Most of the demo projects have been of relatively short duration; some two-thirds of them had 2010 or 2011 start dates. Tweaking needed A few critical issues have been identified and require resolution. A relevant sample of solid evidence will be needed to show that genuine savings have been achieved. Providers must receive tools to help them succeed, such as timely, trended performance data with targets and benchmarks. And performance measures must be aligned across multiple payors serving the same providers. Two things are already clear: Payors are willing to cover the costs of deploying and sharing tools for measuring health care performance and cost savings. But shared savings programs must eventually include a degree of shared risks among providers and payors. For more on the government initiatives, go to x This publication is distributed with the understanding that the author, publisher and distributor are not rendering legal, accounting or other professional advice or opinions on specific facts or matters, and, accordingly, assume no liability whatsoever in connection with its use RXwi13 7