Where is the Meaning in Meaningful Use?

Monday, 10 September 2012

The new requirements for Stage 2 of Meaningful Use have recently become official. For a quick tip sheet on the new rule and how it affects you, click here. However, with the attention - and in many cases - confusion over the requirements for Stage 2, many hospitals continue to struggle with meeting the current requirements for Meaningful Use (MU) Stage 1. A recent poll conducted by KPMG LLP, the U.S. audit, tax, and advisory services firm suggests that if you have not yet attested for Stage 1 - MU you’re not alone. Here are a few of the reasons some hospitals are not reaching the milestones for MU:

  • 25% - Aren’t sure how to demonstrate MU
  • 20% - Concerned with training & change management
  • 18% - Not confident they could capture relevant data from clinical workflows
  • 12% - Don’t have a dedicated MU team in place
  • 6% - Don’t have the right technology

We've learned that the requirements for Meaningful Use stretch into many areas of the hospital environment – from efficient utilization of an EHR system, to clinical data capture (mobility and device management), and the efficiency of clinical workflows in individual departments. Hospitals are increasingly looking to independent consultants and their technology partners for support in assessing their challenges to reaching Meaningful Use. A successful Meaningful Use assessment focuses on an evaluation of the technical AND operational requirements to meet the core objectives and quality measures required for a successful attestation. All balanced against the stated adoption/quality of care goals of the organization.

Meaningful Use consulting is an opportunity for resellers and other technology partners to build a strategic ongoing relationship with hospital customers and for hospitals to get an overview of where they stand in relation to the measure. Also, don't forget that Meaningful Use has many impacts on IT within the hospital, including:

  • Inpatient and ambulatory EHR/PM
  • Storage, data backup/archive
  • Mobility strategy and devices
  • Hospital's progress to the cloud
  • Privacy & security
  • Clinical workflows
  • Aligning hospitals and physicians

The bottom line is this - MU is here to stay and creates great opportunities for resellers and hospitals to build relationships and both become more profitable.

So, how can we help you?

Our unique core competencies reside in balancing the evolving technical requirements of a hospital's healthcare IT project with the operational realities in which technology needs to operate. We work closely with physicians, hospitals, and state governments to efficiently adopt healthcare IT and empower the seamless exchange of healthcare data. More specifically, we've been engaged by hospitals to address common challenges such as:

  • Helping meet Meaningful Use
  • Expanding an enterprise EHR to ambulatory practices
  • Assessing privacy & security policies and procedures
  • Hospital EHR go-live build, training & optimization
  • Assessing readiness for health information exchange (HIE)

If ambulatory practices are a thorn in your side, we can help. If you are struggling with HIE or interoperability, we have a solution. If your existing EMR is causing you troubles, we've got a team that can step in. If we can help you get more done on your "to-do list" or even attack a few projects on you "wish list" Hielix is here to support you. Contact us today to start the conversation!  

Know Your Terminology: M.D. vs. D.O.

Wednesday, 30 November 2011

Understanding the terminology you will encounter working in the healthcare industry is critical; and the first set of acronyms you face will be on the front door of any medical practice you visit, “Medical Offices of John Smith, M.D. and Jane Doe, D.O.”

What is the difference between a Doctor of Medicine (M.D.) and a Doctor of Osteopathic Medicine (D.O.)? In the past 20 years the lines between the two schools of medicine have become increasing blurred and up until about 15 years ago not all major healthcare organizations credentialed D.O.s into their system. For young people entering medical school the trend indicated those who were not accepted into a MD program turned to and were accepted into the D.O. program. Statistics supported this fact with the difference in GPA and MCAT scores that were recorded between the two entities. In 2010 the average MCAT and GPA for students entering US-based M.D. programs were 31.1 and 3.67 respectively and 26.49 and 3.47 for the D.O. curriculum [Source]. However, the scores do not tell the whole story. It is widely known that osteopathic programs are more likely to accept non-traditional students - who are older, coming into medicine as a second career, and are non-science majors. The D.O. medical schools believe the older applicants are more emotionally sound and culturally competent, thus making them a better candidate to becoming a physician [Source].

M.D.s study allopathic medicine – the practice of conventional medicine that uses pharmacologically active agents or physician interventions (surgery) to treat or suppress symptoms or pathophysiologic processes of disease or conditions [Source].

D.O.s study osteopathic theories which encompass all the benefits of conventional medicine including prescription drugs, surgery, and the use of technology to diagnose disease and evaluate injury; combined with the added benefit of hands-on diagnosis and treatment through a system of therapy known as osteopathic manipulative medicine. D.O. students take approximately 200 additional hours of med school to study manipulation therapy [Source]. D.O.s view the patient as a “total person” and treat the whole body rather than treat a specific illness or symptom.

There are several educational similarities and requirements between the two licenses.

  • Both D.O.s and M.D.s typically have a four-year undergraduate degree prior to medical training.
  • Both D.O.s and M.D.s have spent four-years in medical education. Both take the MCAT and are subject to a rigorous application process.
  • D.O.s, like M.D.s, choose to practice in a specialty area of medicine and complete a residency program ranging from 3-7 years. Some D.O.s complete the same residency programs as their M.D. counterparts.
  • M.D. students take the USMLE exam and D.O. students take the COMLEX exam. Both must pass a state licensing examination to practice medicine.

Understanding the difference between an M.D. and D.O. practitioner is not as significant as appreciating the time and dedication it took these individuals to achieve the status of “Doctor.” Both M.D.s and D.O.s are recognized and licensed in all 50 states. There are 20 schools of Osteopathic medicine in the U.S., 126 accredited U.S. M.D.-granting medical schools, and 16 accredited Canadian M.D. granting schools.

For further reading visit American Association of Colleges of Osteopathic Medicine (AACOM) and the American Association of Medical Colleges (AAMC).

Look for future installments of our primer in medical terminology for VARs! Once we complete the series we will offer a quick reference guide in PDF for for those we are interested, be sure to sign up to receive updates in the right hand column!

Know Your Terminology: Health IT 101

Thursday, 17 November 2011

Understanding the basic terminology is a critical piece of the puzzle towards establishing creditability with a physician and/or practice manager. The medical community is experiencing industry wide changes at a rapid pace and the vendors who have done the research and understand those changes will gain a competitive advantage over their less informed competitors.

Pursuing the development of a robust healthcare vertical can provide fulfillment and opportunity on many levels, but being successful requires knowledge of certain related terms. To perform successfully, healthcare vendors/professionals should have an understanding of key medical-related terminology dealing with the physician, their office and overall operations of the practice. Understanding the various front line terminologies can help with your credibility in the eyes of the practice and ultimately, the sale.

First we'll offer a brief overview for the uninitiated and the delve into some specific terminology. Most vendors typically are working within physician practices to assess their IT hardware infrastructure and are involved in the selection and purchase of an Electronic Health Record (EHR). Incentive money is available from The Centers for Medicare and Medicaid (CMS) as a result of the Health Information Technology for Economic and Clinical Health Act (HITECH) and Meaningful Use (MU).

The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives-such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation. For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.

  • There are 15 required core objectives.
  • The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

(Source: CMS.gov)

Eligible professionals (EPs) are eligible for up to $44,000 per provider if participating with Medicare or up to $67,000 if participating with Medicaid. Eligible professionals under the Medicare EHR Incentive Program include:

  • Doctor of medicine or osteopathy
  • Doctor of dental surgery or dental medicine
  • Doctor of podiatry
  • Doctor of optometry
  • Chiropractor

Eligible professionals under the Medicaid EHR Incentive Program include:

  • Physicians (primarily doctors of medicine and doctors of osteopathy)
  • Nurse practitioner
  • Certified nurse-midwife
  • Dentist
  • Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

For additional requirements please reference: CMS.gov

To be classified as an EP the provider must posses a National Provider Identifier (NPI) which is a unique 10-digit ID number issued to healthcare providers in the United States by CMS.

Physicians who choose to participate with MU must select an EHR that has been certified by the Office of the National Coordinator (ONC). ONC is a division of the Office of the Secretary (OS) who has been tasked with implementing and coordinating the exchange of electronic health information nationwide.

For the past 15 years physician practices have been submitting medical claims through their practice management system (PM) or claims are outsourced to a billing and collections agency. Typically the practice is paying 5-7% of collections to that outside agency. Claims are generated from information gathered from the super bill which is created using documentation from the patients' healthcare visit by the clinician. The information from the super bill is then entered into the PM, which generates a claim. Claims are submitted to a third party entity or clearinghouse. Claims are then "scrubbed" which means they are verified for eligibility, demographics, physician NPI number, and diagnosis codes (International Classification of Disease or ICD-9) are matched with the Current Procedural Terminology (CPT) codes.

The current ICD-9 code set is changing effective January 1, 2013 and clinicians will be expected to generate claims using the ICD-10 code set. Because the ICD-10 code set is more specific and detailed oriented, the adoption of a certified EHR prior to tackling a coding change can make this a much smoother process for the practice. Evaluation and management codes (E&M) are a subset of CPT codes that specifically address the level of care given to the patient. For example, an established patient who had 15 minutes of "face" time with the doctor for the follow up care of an infection could bill an E&M code of 99213. This code indicates to the health insurance carrier that the presenting problem was low to moderate in nature. Documentation off the patient visit is critical in the event of an audit. Most clinicians follow a structured set of documentation guidelines called SOAP notes. "The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing" (Source: Wikipedia).

The Place of Service Code (POS) is a key indicator on a claim that designates whether or not an EP qualifies for the incentive money and also determines the level of reimbursement. The POS is noted on the claim, this informs the health insurance carrier where the services were rendered. For example, 11 - indicates physician's office, 21 - in-patient facility (patient is admitted into the hospital and is staying longer than 23 hours), 22 - outpatient facility, 24 - urgent care facility. If over 80% of the physicians care is administered to patients with a POS 21, the physician does not qualify to participate with MU.

A benefit to having an EHR is Computerized Physician Order Entry (CPOE), an application that enables providers to enter medical orders such as treatment plans, prescriptions, labs and referrals into a computer system. E-prescribing (eRX) is another application that works with the EHR to help reduce medical errors. eRX allows physicians to electronically send an accurate, error free, legible medication order to the patient's pharmacy of choice. Utilizing the eRX feature will help satisfy one of the MU requirements.

Look for future installments of our primer in medical terminology for VARs! Once we complete the series we will offer a quick reference guide in PDF for for those we are interested, be sure to sign up to receive updates in the right hand column!

How to Stay Informed in the Healthcare Industry

Monday, 24 October 2011

Deadlines are looming, incentive requirements are changing and overall the healthcare industry is in a constant state of flux. So how do HIT resellers and healthcare professionals both clinical and administrative stay on top of the changes and demands that are being introduced into the healthcare arena?

In the world of HIT resellers staying current is critical to the success of the organization. The ability to stay ahead of the curve and anticipate the needs of healthcare clients is certainly a challenge but one that can be met with the help of a few different websites. A good place to start to become familiar with the specifics that pertain to your client’s specialty is the site of the ONC or The Office of the National Coordinator for Healthcare Information Technology, the premier site for updates regarding changes in the healthcare industry. The next stop is the Centers for Medicare and Medicaid Services. Search under “Meaningful Use”, “EHR Incentive Programs” or “Physician Incentive Programs” for updates that are specific to physicians. Additional places for top line information would include:

For clinical personnel it is always a wise decision to become a member of your specialty association, register and request weekly or even daily updates be sent to your email. For example: Nurses can access the American Nursing Association (@nursingworld), this website offers government policy updates and addresses the needs of nurses in their professional settings as well as patient care. Another website dedicated to nursing is the American Academy of Nursing Executives (@tweetAONE). Nursing has become so specialized that there are resources available directed to the different specialties. Nurse.org provides multiple lists of websites dedicated to these specialties and are listed by state.

The resources available to physicians are endless and again our recommendation would be to first join the association related to your specialty. One example would be the American Academy of Family Physicians (@aafp). This is site is dedicated to Family Practitioners and offers: updates on clinical practices and research; continuing medical education opportunities and certification; tips on how to run a practice; the opportunity to become a member of advocacy groups; and updates on healthcare reform.

For non-clinical personnel whose primary focus is information systems in the healthcare environment, I recommend becoming a member of HiMSS, Healthcare Information Management Systems Society. From the site: "HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare."

Additional resources that could meet the needs of all of the above listed professionals include:

All these sites offer insight into the healthcare industry, provide crucial information surrounding the industry and government changes as well as additional resources.

As a side note, the Medical Group Management Association (@mgma) is a very involved organization dedicated to non-clinical personnel whose primary focus is practice management. This group is very proactive and provides support to various government advocacy programs through their Government Affairs Department.

Finally, there are a number of focus groups via LinkedIn that will open doors for education and professional affiliations. Trying to stay informed and involved can become a full-time job but when you take the time to do the legwork and get connected you will discover the sites and associations will provide a great benefit your day-to-day responsibilities.