PHYSICIAN PRACTICE 2.0 TOOLS FOR SUCCESS IN HOSPITAL- OWNED PRACTICES

Transcription

1 1 PHYSICIAN PRACTICE 2.0 TOOLS FOR SUCCESS IN HOSPITAL- OWNED PRACTICES Rosemarie Nelson MGMA Healthcare Consulting Group April 10, 2013

2 AGENDA Technology deployment impact on day-to-day operations The right benchmarks establish practice performance standards Quality reporting The physician champion Managing up 2

3 EFFECT OF IT EXPENDITURES ON PROFITABILITY Total medical revenue after operating cost per FTE physician. Total IT expense/fte physician <$10,000 $10,001- $20,000 $20,001- $30,000 >$30,001 Multispecialty $230,968 $313,900 $320,854 $358,991 Cardiology $574,732 $483,426 $587,402 $648,955 Ob/Gyn $324,286 $407,244 $417,891 * Orthopedic Surgery $584,433 $600,135 $598,869 $675,938 MGMA Cost Survey Data April

4 HOW FAST CAN YOU TYPE? (ACCURATELY!) Not just for your providers Never type your name again! Better than auto text it branches How about the nursing staff? ~ $30 for one year subscription Try it for $5.95! Multi-users: $139.95/year for 5 users 4

5 ONLINE SCHEDULING Eppointments ( Online patient services: forms, messages, confirm appts Internal patient tracking web-based communication channel Employee scheduling $20/month - $33/month employees $500 - $ employees 5

6 KIOSK CHECK-IN AND MORE

7 KIOSK CHECK-IN COST-BENEFIT Range of costs: free to $2,000-$5,000 per tablet/kiosk $3,000-$5,000 installation, training, setup $2,000-$10,000 integration services $250-$400 monthly fee (updates insurance info) Benefits beyond reduced paper: Reduced denials Better performers: 3% of claims denied on first submission (others 5%) $11,520 costs recovered annually 30 claims/day, 4 days/wk, 48 wks/year, $40/claim to rework 7

8 FREE ELECTRONIC FORMS

9 TELE SERVICES: NO MORE LETTERS/CARDS MedVoice PhoneTree TeleVox 43.79% of Better Performing Practices use automated telephone reminder call system to limit no-shows and last-minute appointment cancellations v % of other practices* *Performance and Practices of Successful Medical Groups 2011 Report Based on 2010 Data. 9

10 LAB RESULT INTERPRETATION DELIVERY Patient visits physician Patient has specimen taken Patient is given a card with: Your web site address A toll free number A date to retrieve the interpretation Physician assigns lab result to patient utilizing the phone or Internet Patient goes to retrieve the message Over the Internet Over the telephone Patient sees or hears The Physician s Interpretation of the Lab Result 10

11 GET WILD AND CRAZY Informed consent Webcast for patients v. surgeon s time Online scheduling pick date/time Flu shot clinic 11

12 QR - - QUICK RESPONSE CODES Scan the QR (like bar codes) using smartphone camera to access data that links to web page Add QR code to patient statements that link to your payment page online Free QR code generation: Qrstuff.com Zxing.appspot.com/generator Quikqr.com Create the code, print it, and it s ready! 12

13 PATIENT PORTAL: BUSINESS OF MEDICINE IS COMMUNICATIONS Deliver content Get nurses off the phones with FAQs Physician-authored, peer-reviewed content for patients Description of symptom, injury or condition Guidance on when to call doctor (right away, within 24 hours, during office hours) Advice for self-care or care at home 13

14 FREE PATIENT HELP/EDUCATION LINKS Insert library in frame or have banner w/ link

15 MEDICAL FORMS - MANY LANGUAGES 15

16 AUTOMATE CHARGE CAPTURE Scan encounter forms 30 percent to 70 percent time savings Use the Internet Reduce cycle time for hospital-based services Best practices for charge posting lag time 24 hours for office service charges 48 hours for hospital service charges 16

17 SMART PHONE CHARGE CAPTURE Outside the office - nursing facilities, hospitals, surgi centers, etc. MDEverywhere MDAnywhere PocketBilling, ProcLog and more: 17

18 Squareup.com Register online Small hardware device plugs into iphone and reads credit cards Download cost: Free 18

19 NURSING EFFICIENCIES - HANDHELDS Skyscape Taber s Medical Dictiona Davis Drug Guide for Nurses RN FastFacts ABCs of Interpretive Laboratory Data 19

20 FEWER MANUALS: E&M Coder ICD9 Coder CPT Coder Growth BP GRACE ACS Risk Cardiac Clearance and more 20

21 NURSE MOBILITY AND PRODUCTIVITY Wireless headsets PhonePad NotifyMD.com

22 DEPOSIT AND CREDIT/DEBIT CARD PROCESSING Rates ~ 2% plus transaction fees ( 20 ) Online debit less than half that Remote deposits: Stop driving to the bank! 22

23 PASSWORDS MADE EASY RoboForm Saves user name and PW Heavy encryption Master password reboot, sleep mode, inactive time Creates passwords random character generator Inserts a toolbar into your browser $29.95 (free version for up to 10 passwords) 23

24 LAPTOP SECURITY ntracker ( ISP change TheftGuard ( remote recover and destroy data Computrace LoJack software monitoring center and recovery team can remotely delete PHI when stolen computer logs on Internet Caveo Anti-Theft PC Card issues audible signals if PC moved beyond distance specified when on or off SprintSecure Laptop Guardian mobile broadband connection card as ignition key (must insert to use) Encrypt entire hard drive with SafeGuard Easy (preboot authentication) Biometric identifiers 24

25 ALL OR NOTHING IS A LOSING PROPOSITION Accept the incremental benefits. Waiting for the next upgrade or the next release delays all benefits realizations. Use of PDF forms on the web is a precursor to interactive forms get ready to go interactive! Transferring 30% of incoming phone calls to web communications is better than 0%. 25

26 MGMA COST SURVEY 2012 REPORT BASED ON 2011 DATA MULTISPECIALTY GROUPS Per FTE Physician 25 th %tile Median 75 th %tile Months gross FFS charges in AR % of AR > 120 days 9.32% 14.66% 22.86% Support Staff FTE Total RVUs 10,806 14,003 17,687 Patients 1,155 1,640 2,837 Medical Revenue after Operating Cost Operating Cost as a % of Medical Revenue $131,258 $270,348 $386, % 63.94% 61.86% 26

27 QUALITY WHERE S THE CONFUSION? E-prescribing PQRS Meaningful Use And PCMH, ACO 27

28 MEDICARE ERX INCENTIVE* Effective Jan. 1, 2012 Part D prescriptions can no longer be sent to pharmacies by computer generated fax Print, hand to patient or manually fax *MIPPA: Medicare Improvements for Patients and Providers Act of

29 ESTIMATED E-RX PENALTIES USING MGMA COST SURVEY 2010 REPORT FOR UROLOGY Median Net FFS Revenue per FTE Physician Median Medicare FFS of Total Medical Revenue Median Net Medicare FFS Revenue per FTE Physician 1% Penalty 1.5% Penalty $930, % $297, $2, $4,

30 PQRS PHYSICIAN QUALITY REPORTING SYSTEM Voluntary Payment reduction of 1.5% if not participating in 2013 (taken in 2015) % of total allowed charge from Medicare Part B Physician Fee schedule (during reporting period) Three applicable measures, 80% of patients How to submit quality data codes (QDC): On Medicare Part B Claims To a qualified Physician Quality Reporting registry To CMS via a qualified EHR product To a qualified Physician Quality Reporting data submission vendor 30

31 GPRO (GROUP PRACTICE REPORTING OPTION) Required to report 29 quality measures Patient-Assessment- Instruments/PQRS/Group_Practice_Reporting_Option. html Required to report through web-based interface Single TIN with 25 or more individual EPs (identified by NPIs) Must self-nominate 31

32 MEANINGFUL USE STAGE 2 - GOOD NEWS Extra time! Stage 2 is 2014 Special 3-month reporting period for providers attesting to Stage 2 in 2014 Ability to use a batch reporting process for MU submit attestation info for all EPs in one file Hospital-based specialties can apply for incentive if can demonstrate that they fund acquisition, implementation, and maintenance of CEHRT (including supporting hardware and interfaces needed for MU) without reimbursement from an eligible hospital and use such CEHRT at hospital in lieu of using hospital s CEHRT 32

33 STAGE OF MU CRITERIA BY PAYMENT YEAR First Payment Year Stage 1 Stage 1 Stage Stage 1 Stage Stage 1 Stage 2 Stage 2 Stage 3 Stage 3 Stage 2 Stage 2 Stage 3 Stage 3 Stage 1 Stage 2 Stage 2 Stage Stage 1 Stage 1 Stage 2 Stage Stage 1 Stage 1 Stage Stage 1 Stage Stage 1 For 2014 only, providers that are beyond the first year of demonstrating meaningful use will have a 3-month quarter reporting period to allow an additional up to 9 months to upgrade certified EHR technology to the 2014 edition. 33

34 FAILURE TO BECOME MEANINGFUL USER Medicare EPs that demonstrate MU in 2013 will avoid a payment adjustment in Medicare provider first attesting in 2014 will avoid the adjustment if attestation is before Oct. 1,

35 PCMH Intent Coordinated/integrated care across all types providers and locations Care planning process with use of evidence-based medicine Informed by patient s participation in decisions Enhanced through processes assure access and use of technology Elements (NCQA Recognition) Access during office hours Use of data for population management Care management Support for self-care processes Referral tracking and follow-up Implementation of continuous quality improvement steps 35

36 ENHANCE ACCESS AND CONTINUITY Access during office hours Same-day appointments (sample policy, procedure, control) Clinical advice by phone Clinical advice by electronic messaging After-hours access After-hours care After-hours availability of medical record After-hours clinical advice by phone After-hours clinical advice by electronic messaging Electronic access Continuity Medical home responsibilities Culturally and linguistically appropriate services The practice team (sample job description and Team Huddles) 36

37 IDENTIFY AND MANAGE PATIENT POPULATIONS Patient information Clinical data Comprehensive health assessment Use data for population management 37

38 PLAN AND MANAGE CARE Implement evidence-based guidelines Identify high-risk patients Care management Medication management Use electronic prescribing 38

39 PROVIDE SELF-CARE SUPPORT AND COMMUNITY RESOURCES Support self-care process Provide referrals to community resources 39

40 TRACK AND COORDINATE CARE Test tracking and follow-up Referral tracking and follow-up Coordinate with facilities and manage care transitions 40

41 MEASURE AND IMPROVE PERFORMANCE Measure performance Preventive care, chronic care, acute care measures Utilization measures affecting healthcare costs Vulnerable populations (disparities of care) Measure patient/family experience Implement continuous quality improvement Demonstrate continuous quality improvement Report performance Report data externally Medicare s erx, PQRS, EHR incentive programs Use certified EHR technology 41

42 42 STATUS QUO If we keep doing what we ve always done, we ll keep getting what we always got.

43 THE HUMAN FACTOR: BARRIERS TO CHANGE 43 How it s always been done Provider attitudes and preferences Organizational culture Facility design Reluctance to change due to fear of the unknown Complacency 43

44 ORGANIZATIONAL GOVERNANCE Executing the organization s strategic plan Data analysis and planning Partnering with physicians to achieve accountable results (managing up) Developing the practice s physician champion Mission and culture achieve performance expectations 44

45 Change is inevitable except from a vending machine Robert C. Gallagher 45

46 LEADING THROUGH CHANGE Change management considerations Is there a compelling reason(s) for change? Are top administrative, physician, and clinical leadership committed to change? 46

47 SUCCESSFUL STRATEGIES FOR CHANGE MANAGEMENT A compelling reason is needed. Redesign (change) must address issues people are battling. For providers, compelling reasons are: Improving their ability to provide care. Improving the quality of patient care. All stakeholders need to be at the table. 47

48 ASSESS CURRENT ENVIRONMENT Can champions be identified and developed? Is the culture committed to data and information sharing? Do employees have the needed skills and tools to accomplish redesign? Does the organization have the resources to undertake the redesign process? 48

49 YOUR ORGANIZATIONAL CULTURE The culture of a group is a pattern of shared basic assumptions that the group learned as it solved problems that has worked well enough to be considered valid, and therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems Edgar H Schein 49

50 CHANGE MANAGEMENT IDEAS TO REALITY Change management is a learned skill Common barriers to change include: Vice-like grip on the status quo No perceived need for change Lack of a shared vision Corrosive effect of cynicism and pessimism 50

51 SIGNS OF RESISTANCE Confusion Immediate Criticism Denial Malicious Compliance Sabotage Easy Agreement Deflection (change the subject) Silence In-Your-Face Criticism Maurer, Rick, Beyond the Wall of Resistance, 2 51

52 CHANGING CULTURE You cannot create a new culture. You can immerse yourself in studying a culture... Until you understand it. Then you can propose new values, introduce new ways of doing things, and articulate new governing ideas. Over time, these actions will set the stage for new behavior. If people who adopt the new behavior feel that it helps them... The organizational culture may embody a different set of assumptions, and a different way of looking at things... Edgar Schein, in Senge, Peter, The Dance of Change 52

53 LEADING THROUGH CHANGE Introduce change effectively Build awareness of the need for change Why change is needed Current performance level Objectives for this particular change The nature of the change 53

54 MANAGING THROUGH THE TRANSITION Develop individual change action plans for each individual Manage change with the team As an assessment As a guide for actions How do I build desire, knowledge and ability 54

55 REINFORCE AND CELEBRATE SUCCESSES Collect and analyze employee feedback Conduct audits and measure performance Reinforce change with the team through Accountability systems Root cause analysis and corrective actions Celebrations, recognition and rewards 55

56 LEADERSHIP FOR CHANGE Change is hard work Leadership begins with values Real changes takes real change Leadership is a team sport Expect to be surprised Today competes with tomorrow Better is better Learning from doing Grow people Sullivan and Harper, Hope is not a Method 56

57 SUCCESSFUL STRATEGIES FOR CHANGE MANAGEMENT Communication plan Key message easily understood Expect and communicate failures, holdups, etc. as well as successes Education and training are essential Sustainability requires transformation Inability to go back to the old way is the best approach to sustainability 57

58 MANAGING CHANGE LIKE SEARCHING FOR THE WIZARD OF OZ Hold On: It s Going to be a Bumpy Ride It is challenging to communicate and train enough. Don t Be Afraid to Ask Directions Confer with others that have done it. Pick Up Some Friends Along the Way Outsource and use consultants where possible: don t do it alone. Enjoy the Emerald City Parade and Spa Pampering: It s About to End Don t let the sales pitches keep you from seeing reality. Fireballs and Flying Monkeys Are Part of the Deal Have contingency plans for expected problems and a problem evaluation & resolution process for the unexpected problems. Don t Discount Heart Over Courage and Intelligence: You Need All Three The human factor in the change management process trumps the technical aspects. In the End, You will get Home! People and processes come together and you work things out. 58

59 59 TRUST YOURSELF. YOU KNOW MORE THAN YOU THINK. Dr. Benjamin Spock, 1940 s