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December 28, 2015

Growing Pains

Guest post by Emily Bonham, director of product management for Falcon Physician

Frustration is often the impetus for—and the result of—change. The move from paper to electronic recordkeeping was no exception. As the medical industry was forced to make this switch, physicians often picked a software provider based on limited knowledge and experience. Now, several years and countless upgrades later, many of us feel a new set of frustrations that stem from using electronic health record (EHR) software that hinders productivity and limits patient interaction. When is enough enough?

The transition from one EHR to another can be more intimidating than the initial switch from paper to electronic records, and for good reason. You have spent the last several months or years learning a new system and adjusting to entirely foreign workflows. But is it worth dedicating precious time to learning a new system? And what about the financial investment of breaking your current contract?

Let’s define “worth.” When measuring the value of your time, you must consider not only the reimbursement received while seeing patients, but also the time spent performing redundant and/or cumbersome EHR-induced tasks. This time could be otherwise spent building your practice, seeing patients or furthering your medical education. Additionally, “worth” is relative to investment versus future compensation. Purchasing and implementing EHR software may have been a considerable expense initially, and this cost may not yet have been offset by increased patients.

So in measuring the worth of your EHR, as well as considering switching to a new EHR vendor, consider the following:

  • Are you happy? If your software vendor causes you to lie awake at night with anger, frustration or anxiety, it may be time to consider a new option.
  • Is your EHR software specific to your specialty? EHR is not one-size-fits-all. Software options that are tailored to nephrology, neurology, and everything in between are available.
  • Have you broken even? The ongoing cost of EHR software ought to even out, and ultimately allow you to increase revenue once efficiency is maximized and redundancies are eliminated.
  • Are you willing to relearn it all? If you decide to switch, it will not be easy. You will second-guess your decision, and you will wonder why you ever went to EHRs in the first place. It may be the best choice you’ve ever made, but it will not be without growing pains and patience.

The proactive decision to find an EHR vendor that fits your needs could turn your struggle with EHR technology into an asset at your practice.

Emily Bonham is the director of product management for Falcon Physician, DaVita HealthCare Partner’s nephrology-specific EHR software. Ms. Bonham has 14 years of experience in health care software management and is passionate about solving health care issues and patient needs with technology-based solutions. Directing product management, user experience and marketing at Falcon Physician, Ms. Bonham ensures her teams’ focus toward understanding the ever-advancing nature of health care IT and anticipating the needs of nephrologists to serve patients in the most innovative, effective and compassionate manner possible. Her previous work includes independent physician medical practices specializing in nephrology, bariatric surgery and endocrinology in addition to organizations such as Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Cleveland Clinic, Kaiser and the Blood Institute of Wisconsin.

December 15, 2015

How Bad Can It Be?

Guest post by Emily Bonham, director of product management for Falcon Physician

This may come as a surprise: most physicians are dissatisfied with their electronic health record (EHR) software. Hopefully this statement doesn’t pertain to you. Maybe you adore your EHR software and embrace the multitude of changes, upgrades and government mandates, and you have lightning-fast Internet speed to boot. On the off chance that you do not fall into this category, please read on.

A study performed by Accenture, a multinational technology-services and consulting group, surveyed 601 physicians across the United States for its 2015 Doctors Survey. The survey included questions regarding physicians’ adoption of and attitudes toward EHRs and healthcare information technology. The results indicate that the overall feeling toward EHR technology and usability has not improved considerably since the same survey was conducted in 2012, when many physicians were converting from paper to electronic health records. The negative sentiments still held today surround amount of time spent with patients, as well as overall productivity in day-to-day tasks performed in conjunction with EHR technology. Healthcare providers generally feel that more time is spent entering data than caring for patients.

When will this end? When will the days of data entry, Internet crashes and cumbersome workflows cease? I believe the answer lies within software that is tailored to particular areas of medicine. For example, dialysis rounding workflow, user profiles and clinical measures are unique to the nephrology specialty. Software that intuitively anticipates this workflow could not only reduce screen time; it could also allow physicians more time with their patients. Above all, a tailored EHR could help ease the struggle so many doctors are enduring as they continue to align their profession with ever-advancing technology.

We as physicians are frustrated, concerned and often jaded by the electronic push in healthcare. However, we must also be hopeful that this change will bring about the improved patient outcomes we desire as we care for more and more patients.

Emily Bonham is the director of product management for Falcon Physician, DaVita HealthCare Partner’s nephrology-specific EHR software. Ms. Bonham has 14 years of experience in health care software management and is passionate about solving health care issues and patient needs with technology-based solutions. Directing product management, user experience and marketing at Falcon Physician, Ms. Bonham ensures her teams’ focus toward understanding the ever-advancing nature of health care IT and anticipating the needs of nephrologists to serve patients in the most innovative, effective and compassionate manner possible. Her previous work includes independent physician medical practices specializing in nephrology, bariatric surgery and endocrinology in addition to organizations such as Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Cleveland Clinic, Kaiser and the Blood Institute of Wisconsin.

November 11, 2015

Using the CMS Five-Star Quality Rating System

Nephrologists are being handed a big challenge by Medicare’s insistence on a more integrated and comprehensive approach to kidney care. The expectation is clear: Deliver better outcomes at lower costs.

Fortunately, a new tool from the Centers for Medicare and Medicaid Services (CMS) is making it easier to help educate dialysis patients and their families.

The federal government’s newly updated guide, the CMS Five-Star Quality Rating System for dialysis, helps simplify the decision of where to receive treatment by giving patients and caregivers an easy way to compare kidney care centers. Yes, really! We, as physicians, can help with the education process, especially if we understand how the system works.

Read more…

October 7, 2015

Big Data, Big Deal

This is a guest post by Emily Bonham, director of product management for Falcon Physician, DaVita HealthCare Partner’s nephrology-specific EHR software

It seems to be everywhere: in the news and on TV, referenced by politicians and tech experts. And now it’s infiltrating healthcare. “Big data” is more than a trend—it has the potential to change the way physicians interact with and treat patients.

What exactly is big data? Essentially, it is the concept of gathering and curating massive data sets to track trends over time. Within the healthcare space, this is of particular interest for harnessing patient data to predict—and potentially prevent—issues before they become chronic conditions. It sounds like a physician’s dream: knowing a patient’s kidneys are going to fail before it happens could save thousands of lives.

The development of electronic health record (EHR) technology has allowed for continuously flowing, ever-growing patient data to become centralized and usable—not only to a specific doctor, but to physicians across the country and in all specialties. The devil, as usual, is in the details. In this case, that means how to leverage all this data into something tangible, usable and beneficial.

The EHR industry is shifting toward data-driven tools, rather than data collection measures. These tools will offer physicians new analytical insight when making treatment decisions at the point of care to reduce the overall cost of patient care. Data trend models, analytics and tracking features will potentially allow physicians to better treat patients’ ailments, and even avoid illnesses in the first place.

While these concepts are currently in development and will depend on a number of factors, including the interoperability between countless EHR systems and data sets, it is encouraging to know that all data being collected through EHR systems can be used for  a purpose beyond simply ticking a Meaningful Use box. This data is destined to improve the nature of the healthcare system, as well as aide physicians in making the most informed care decisions possible: definitely a big deal.

Emily Bonham is the director of product management for Falcon Physician, DaVita HealthCare Partner’s nephrology-specific EHR software. Ms. Bonham has 14 years of experience in health care software management and is passionate about solving health care issues and patient needs with technology-based solutions. Directing product management, user experience and marketing at Falcon Physician, Ms. Bonham ensures her teams’ focus toward understanding the ever-advancing nature of health care IT and anticipating the needs of nephrologists to serve patients in the most innovative, effective and compassionate manner possible. Her previous work includes independent physician medical practices specializing in nephrology, bariatric surgery and endocrinology in addition to organizations such as Blue Cross Blue Shield of Massachusetts, Tufts Health Plan, Cleveland Clinic, Kaiser and the Blood Institute of Wisconsin.

July 16, 2015

S61.451A and My Trip to the Denver Zoo

Not being a native to Denver and fancying myself a connoisseur of city zoos, I made my first visit to the Denver Zoo this past Sunday. I must admit I was impressed! Bigger than I imagined, clean, well kept and easily accessible with a broad representation of flora and fauna, it was everything a city zoo should be. While there I observed something I had not previously seen: a zookeeper hand-feeding a hippopotamus! I wondered; does that seem safe? Heaven forbid there should be an accident. As a physician my mind quickly shifted to the hand/arm trauma inflicted from the potential bite of a hungry hippo.

Hippopotamus

This morning I returned to work and the anxiety surrounding preparation for ICD-10. Remembering my experience on Sunday, I couldn’t help myself. I searched to see if an ICD-10 code exists for a Hippopotamus bite. The good news is, no worries, CMS got it covered: code S61.451A, “Hippopotamus bite, right hand, initial encounter.” Now for you obsessive coders out there, that is different from S61.451D, “hippopotamus bite, right hand, subsequent encounter.” Can that really happen twice? If so, ICD-10 has it covered!

This seems so silly. Understandably CMS is concerned with public health, and therefore is using ICD-10 to monitor health trends, but really – how many hippo bites happen each year?

What about code R46.1, “bizarre personal appearance” or code Z73.1, “type A behavior pattern?” Are these diagnoses public health concerns? That’s a lot of people! Better yet, code W56.22XA, “struck by Orca, initial encounter” or yes, W56.22XS, “struck by orca, subsequent encounter.”  With 68,000 codes, the ICD-10 update has everything covered from falling from a tree to being sucked into a jet engine. And yes, sucked into a jet engine, subsequent encounter is there, too!

Data on what it costs the government to design and implement this update is difficult to locate, but I am painfully aware that it costs physician practices way too much. Come October 1, 2015 practices will face another government payment uncertainty if there are any glitches in the transition from ICD-9 to ICD-10. There are several potential risks to your practice, including the following.

  • CMS has warned that your denial rates could soar to 100-200%
  • The American Health Information Association has reported that the majority of providers have not yet conducted ICD-10 testing[1]
  • If you do not have a bank line of credit, your cash flow may vanish thanks to potential payment or processing glitches with new codes, meaning there will be no payments made to your practice

So despite the comical nature of many ICD-10 codes, what physicians are facing is no laughing matter. There is still time to prepare. For helpful resources and more information on the services Nephrology Practice Solutions (NPS)* provides to help practices prepare for the transition to ICD-10, check out the NPS website.

*Dr. Provenzano consults with NPS.

[1] http://www.ihealthbeat.org/articles/2015/6/18/survey-providers-lag-in-icd10–testing-ahead-of-transition#.VYgnTGsuq9o.twitter

December 30, 2014

Top Two Landscape Changes for Nephrologists in 2015

2015

As we find ourselves on the precipice of another new year, it seems only fitting to take some time to reflect on the past year and ponder what lies ahead.

How is the landscape changing for nephrologists in 2015?

Undoubtedly, there will be new trends in treatment methodologies and shifting government regulations. More than anything, I believe time will remain one of the top concerns for nephrologists in the coming year. Slow charting and manual documentation will continue to be the cause of many late nights working to get caught up. In addition, we are now expected to meet more complicated reporting measures, which will likely continue to increase. Though the task seems daunting, and converting to electronic methodologies may be bumpy at first, once the systems are up and running, documenting encounters can become a faster, easier and more efficient endeavor.

Another noteworthy finding in the field of nephrology is the shortage of up-and-coming nephrologists. According to an analysis from the  American Society of Nephrology, interest in nephrology as a career has been on the decline for quite some time, which is quite discouraging when considering America’s aging population and the associated increased need for nephrologists. The reasons for the diminishing nephrology workforce are numerous, but one large factor is thought to be Medicare’s interest in a more integrated approach to patient care. In 2015 and going forward, nephrologists will need to be knowledgeable about so much more than kidney care. Nephrologists will need to converse more with other doctors and become experts on transition of care.

While the pressures on our profession mount with an aging population, increased regulations and declining number of physicians choosing nephrology, we need to be proactive in the way we manage our practices in the future. We will likely need to completely abandon paper documentation and choose nephrology-focused electronic tools that will help increase our efficiency, productivity and reporting capabilities. We will also need to expand our knowledge base so that we can properly care for patients. The coming year may prove to be a pivotal one in the field of nephrology; hopefully we will have the time to appreciate it.

October 28, 2014

It’s All About the Numbers

Numbers

As nephrologists we are all “about the numbers.” It’s how we make our living; it’s what distinguishes us from our colleagues. It’s what makes us different, special.

BUN, creatinine, anion gap, electrolytes, blood gases and on and on—we’re the experts, and patients depend on our knowledge and expertise. We rock!

But what about the numbers we don’t know (or the ones we ignore)? The numbers we depend on others to manage. The numbers that make the difference between a successful practice and a failing one. The numbers that put food on our tables!

As a physician you know a few numbers going in the wrong direction can dramatically impact a patient’s outcome. Same with your practice. Knowing the numbers that influence the financial health of your practice can mean the difference between good and great. A thorough understanding of some key metrics can help you assess if your practice is operating at peak performance or if there is room for improvement.

Days in Accounts Receivable (DAR)

The DAR is the average number of days from when a claim is entered into a system until it’s paid. The national average is 45 days; the longer a claim is in limbo, the higher the risk of it not being paid. You have done the work and should expect to be paid in a timely manner, but you must have the right processes in place or you will be leaving money on the table.

It’s nothing to be embarrassed about; it’s not what we were trained to understand or deal with. But like any other responsible business owner, we must see to it that we have delegated practice management to competent individuals.

You deserve the highest return you can get on your hard work; that takes talented people with specialized skills. What should you focus on? What are the numbers?

Revenue Realization Rate (RRR)

This is simply the percentage of claims that are paid to your practice, also known as the net collection rate. The higher this percentage the more cash flow your practice is driving. When claims are denied or go unpaid someone in the practice must address it in a timely manner. Wait too long, and you will miss your window of opportunity for payment.

Consider this example: an RRR of 85% means you are making only 85 cents on the dollar—yikes! That along with other practice income erosions (risk contracts, Medicare, Medicaid and commercial cuts) could put you in more trouble than you may realize.

Denial Rate

This term describes the percentage of claims denied by the payor. The industry average is 5-12%. Numbers beyond this range usually stem from challenges with billing procedures (i.e., your billers are doing a poor job). Billing correctly the first time will speed up cash flow and reduce work on the back end (and save you money).

A good practice-management system can detect coding errors and missing information early on (called scrubbing of claims). Reworking a denial claim is costly. The Medical Group Management Association (MGMA) found the average cost to rework a denied claim is more than $25! A hundred denied claims cost your practice $2500 in administrative costs! Additionally, MGMA says 50-65% of denials are never reworked. Do you know how many of your claims are being denied? Reworked? Again, more financial opportunity lost.

Missed Billing Entries or Slips

This refers to tracking of patient encounters and/or services you provide. Encounters not tracked immediately following the patient visit (or misfiled) can result in payment delay or missed payment opportunity. Educating your staff, revising your procedures and having a good practice-management system in place are a few ways to help manage this.

Overhead (OH) Percentage

A well-run nephrology practice has an OH of ~42%. Each practice is unique and there is a bell-shaped distribution of OH costs. Your OH percentage does not necessarily mean your practice is successful or is failing. Some practices with high OH are very successful (maybe their OH is due to costly deliverables or equipment) while simply having low OH does not guarantee success (low OH could be due to such measures as cutting back on staff who could deliver more of your billings). What is important is to track this number over time, know what it represents and understand its positive or negative impact on you business.

We are entering a new era in the business of medicine: an era where professional management of your business has become much more attractive, if not a necessity. Successful management can drive your bottom line, sending the savings directly to the practice. You can reach out to me or any teammate at Nephrology Practice Solutions if you would like to discuss your concerns or ask any questions. Or stop by the DaVita booth, #601, at ASN and ask for us.

July 24, 2014

Socioeconomic Impact on ESRD?

Before I get started opining about my observations of the socioeconomic impact on end stage renal disease (ESRD), let me state that I am not an expert on this critical science and its implication on healthcare. Rather—after practicing 25 years in Detroit, once a proud city boasting the highest per capita income in the world (in 1960)—I am, as a physician, a keen observer of the impact of a failing city, its resources and its support systems on our most vulnerable citizens.

Priorities. We all have them, right? Family. Work. Church. Oh yes, and healthcare. Of course it’s there if or when you need it, right? That little card in our wallet is our safety net. Our focus on healthcare as a priority changes as we age or if we develop a chronic condition requiring attention.

One may argue that the above image is a concocted anomaly predicated on employment and therefore a vision held by the employed. So what of others, the chronically unemployed or even the recently unemployed, the less fortunate among us? What happens when the support system collapses around them?

Read more…

December 13, 2013

Working Can Benefit Those Suffering with a Chronic Illness

Physicians are trusted resources for patients. We have the ability to reinforce patients’ understanding of how they may live longer, healthier and happier lives. Assisting them in deciding whether to continue working when they start dialysis falls within the realm of being a resource. We can help patients evaluate many factors, such as the health conditions surrounding their kidney disease, dialysis modalities appropriate for them, their family life etc. Take Robert Gandy (mentioned below) for instance. Robert was able to fit dialysis into his lifestyle and continue working. He states, “Going to my job takes me away from the fact that I have end stage renal disease”—a sentiment that’s been echoed by many of my patients over the years. After reading about Robert and the benefits of working on dialysis, I hope you’re able to approach your next patient, the one after that, and so on and so on with the dedication and care of an educator. Read more…

December 3, 2013

NEWS: School Bus Driver and PD Patient Gets Kidney Transplant

It’s no secret that dialysis patients who continue to work while on dialysis are two times more likely to get a kidney transplant(1), and the story of former DaVita patient Stephanie Carson is a great example. I’m happy to be able to share this coverage of Stephanie’s transplant with all of you and hope to see more news like it moving forward.

The Daytona Beach News-Journal
South Daytona mom thankful for health, daughter’s kidney donation

My FOX Orlando
Daughter gives mother a kidney
FOX 35 News Orlando

Our patients are a part of a fragile population and this kind of news plants seeds of hope and determination that many of them need in order to maintain their jobs and make it through the rehabilitation process of dealing with kidney disease. However, I’d be remiss not to mention the other side of this topic. Please keep in mind that there are many medical reasons why people do not work and those same reasons can keep these individuals off the transplant list.

Have you seen any stories lately that you’d like to share? Paste the link below and this blog post can serve as a wall of reminders about the benefits of staying employed during dialysis.

  1. Source: http://onlinelibrary.wiley.com/doi/10.1111/ctr.12177/abstract

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