Blue Button…it’s Heading Your Way!

Posted in Uncategorized on April 4, 2013 by mfisher527

Every healthcare entity is required by law to allow patients access to their own health information. Previously it wasn’t as simple as utilizing  the “Blue Button” tool to electronically transmit records. Paper copies were harder to get a hold of, especially if the patient relocated or saw multiple physicians. Blue Button is giving patients all over the country easy access to their own medical records.

Currently Blue Button is available to Medicare beneficiaries, veterans and service members.  In August 2010, President Obama released news that Veterans could soon use a tool called “Blue Button” to access their medical history. The Department of Veteran Affairs launched Blue Button in October 2010 (around the same time Meaningful Use went into effect).

Slowly but surely other companies are getting on board and offering Blue Button, United Healthcare  and Aetna are among them.  United Healthcare anticipates 26 million patients will have access to “Blue Button” by the end of 2013. Blue Button users can view or print records in PDF and text formats, or even save to a thumb-drive.

With easier access, patient’s are more apt to be involved in their care, keeping track of their medical history and be “in the know” when it comes to preventative care. Patients, ask your healthcare provider if they offer “Blue Button”.

Healthcare Provider’s, if you don’t offer it, what are you waiting for? Licensing is no longer required to use the “Blue Button” logo and brand. You just need to follow these guidelines, put out by the U.S. Department of Health and Human Services.

Veterans and service members, click here to access Blue Button

Medicare beneficiaries, to access Blue Button


EHR Interoperability

Posted in HIT on April 1, 2013 by mfisher527

What does “interoperability” mean?  ” The ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiable, when and where needed.”

Electronic Healthcare Records are not a one size fits all. With the variety of healthcare facilities, it is a given that each EHR option is not created equally. EHR interoperability is a work in progress. With that being said, the goal is for them all to be able to communicate with each other, making healthcare for the patient and the providers much more efficient, safe and transitional. Exchange of documents between EHR’s is also a big part of meaningful use stage 2. Several states have started to mandate EHR Interoperability.

Cerner, McKesson, Allscripts, Athenahealth, Greenway and RelayHealth, a McKesson subsidiary make up about 40% of the EHR market. These vendors announced the launch of CommonWell Health Alliance at a recent conference (HIMSS). Allscripts signed on last minute, while EPIC has yet to jump on board. The goal of the alliance is to make sharing data a possibility and to enable  interoperability.

EHR/HIE Interoperability Work Group  includes 19 EHR suppliers, as well as  18 vendors of health information exchange software. Similar concept as CommonWell Health Alliance, only smaller EHR systems. Their goal is to have interfaces between EHRs and HIEs be compatible.

What are the advantages to EHR interoperability? There is no wait time for transferring charts between specialties, up-to-date information will be easily accessible.  Avoiding keying information in manually or scanning it in will save valuable time and money. Patient care and safety will greatly increase with EHR interoperability.

Why are there so many challenges with EHR interoperability?  Technical barriers, time and the expense of setting up interfaces are the major  challenges.

Seeking New Benefits within an EHR

Posted in HIT on April 1, 2013 by Matthew Levy

It is known that screening for colon polyps with colonoscopy can decrease the rate of colon cancer, the second leading cause of cancer death in both men and women. And yet, many people are never appropriately screened. This was highlighted by the recent “Love your Butt” campaign designed to encourage people to be screened.  While putting “Love your Patooty” signs in the metro is one attempt to increase screening rates, a recent article published in the Annals of Internal Medicine described a more focused approach using EHR’s to identify candidates for focused interventions. The study observed 4 methods for tracking this approach, each adding one additional element to the care provided. These included a “usual care” control group, an EHR-based addition that automated reminders and selected the patients that needed mailings sent, a further group that received mailings plus “assisted” telephone calls from an MA to follow up and schedule screenings, and a final group that received “navigated” assistance from an RN to help them with more complicated decision making.

The results of this study were interesting. On top of the “usual care” group, patients in the EHR-automated group were twice as likely to be current for CRC screenings within 2 years. The more advanced groups received notable steps up from there, but not as impressive as the automated group. This can be very useful. It shows that a system set up to fully automate the process, with the EHR handling everything except requiring staff to put messages out with regular mail. If the office wants to go further, it can, through phone calls and expert advice.

EHR’s have been criticized for being expensive and time consuming, but in this study, the ability to use structured data to identify patients who were eligible for, but had not yet received, colonoscopy allowed the investigators to target just these people for more aggressive, and ultimately often successful, interventions. The fact that the vast majority of the task could be done without provider oversight is more interesting. This same type of structured data and related processes could also be used to identify other groups of patients such as those who need vaccines or other tests. A good system can be set up to allow providers to easily check both the dates and results of screening but also prompt users if screening is overdue. Structured data can also be used to identify patients who have received prescriptions which might have had warnings issued, such as the recent one regarding Ambien in women. These types of uses for an EHR are just beginning to be investigated and utilized and everyone should look forward to seeing more such investigations.

Further Readings:

“’Love Your Butt’ Ads Try To Conquer Colonoscopy Fears”

Study Abstract

Overcoding vs. Proper Coding

Posted in HIT on March 13, 2013 by Matthew Levy

During a speech at last weeks Federation of American hospitals conference, acting CMS administrator Marilyn Tavenner discussed the CMS concern about the practice of upcoding, in which providers consistently code at a higher level of service than justified by the service actually provided. It has been argued that EHR usage makes this activity easier, because providers can copy old data from notes and document alarge amount of the physical exam with a single click. Many EHRs have a function that can keep track of what was documented within a single visit and calculate the appropriate billing level. CMS and others are concerned that EHR’s are partly responsible for a dramatic increase in the number of higher-level visits being billed by providers. Between 2001 and 2008, hospitals increased billing by about a billion dollars for emergency room visits. A similar increase has been seen with billing of outpatient office care. CMS has announced that they will be instructing healthcare organizations about Electronic Health Records and conducting small, targeted audits to ensure electronic billing is done properly.

But is the CMS concern entirely warranted? The advantage to an EHR is that the documentation is clearer than the potentially illegible handwritten note, making it easier for coders and providers to quickly review what they’ve covered and realize that they can bill for a higher level of services. With paper records, if a provider wanted to safely bill at a higher level, they needed to ensure that all the proper documentation (often repetition from a previous visit) was re-documented. Often this leads a provider to simply consider billing at a slightly lower level, given the time commitment needed to fully document a visit from a very complex patient. With EHR’s, however, not only are some systems built with technology capable of capturing and measuring an estimated billing level, but the ability to quickly import past histories and document that a system was reviewed without major changes enables a provider with a very complex patient worthy of a higher level of service to document that service without spending an overly excessive amount of time doing so.

At the same time, some providers are undoubtedly using these advantages to code at a higher level than is appropriate. The ability to clone an old note means that a less honest provider could simply assume that a patient in for one problem is fine in every other system and document a full review without actually spending the time doing so.  There is likely a mix. Many providers have used the advantages of an EHR to move billing to an appropriate level of service. Others, however, have taken this a step too far and taken even the simple visits a level up, expecting that nobody will notice. But this is exactly how payers identify practices worth auditing. If a doctor codes frequently enough at a level outside the normal range of distribution, that is the sort of activity that will draw the attention of payers to investigate further. If EHR usage is bringing coding to an appropriate level and reducing under coding, this activity should hold true through all providers, forming a sort of bell curve.

An EHR is never responsible for fraudulent billing. The provider is ultimately responsible for an accurate assessment of the level of service provided. In this regard, it is important to remember that detail of documentation is only one factor that is considered in evaluating the level of service. Severity and complexity of the problem(s) addressed at the visit is also critical.  Providers should look to EHR’s to facilitate documentation and improve patient care, but not primarily to allow them to increase level of service.

Further Readings:

CMS Audit Program Guidelines

AAFP: Data Show Upward Trend in Medicare CPT Codes Key to Primary Care

Dallas/Fort Worth Healthcare Daily: Cracking Down on Overcoding and Upcoding in the ED

Thoughts on the Cost of EHR Implementation

Posted in HIT on March 8, 2013 by Matthew Levy

There are many healthcare-changing initiatives being talked up these days. These include promotion of technology through HITECH and changing the way medical doctors code for problems through ICD-10. In selling these efforts to hospitals and providers, the people responsible will couch their arguments in benefits to the providers and the patients: EHR’s are supposed to make keeping track of patients records more efficient and enhance quality initiatives, e-prescribing is beneficial because it allows for automated interaction checks, ICD-10 allows description of medical conditions and procedures to be more thorough.

In the latest issue of Health Affairs, there is a study from Julia Adler-Milstein, Carol E. Green, and David W. Bates that explores the effect that implementing a new EHR has on profits for medical offices and practices. In “A Survey Analysis Suggests Electronic Health Records Will Yield Revenue Gains For Some Practices And Losses For Many” the authors reveal a mixed result that in theory (and in the title of the article) seems to confirm some of the worst assumptions about EHR use that physicians may hold.

But EHR implementation, despite the way it is presented in Health Affairs, is not meant to increase profits to hospitals and providers. It is primarily about improving quality of care and office efficiency. This is not to imply money plays no role in the process. Healthcare is, after all, a business. But the changes to the system have not been designed with increasing profits as a primary goal.

The amount of money being spent as part of Medicare and Medicaid has skyrocketed as healthcare has gotten better at keeping people alive and treatments have gotten more complicated. All payers, both private and public, are looking for ways to reduce payments, which has providers and hospitals left scrambling for ways to control their own costs. The Centers for Medicare and Medicaid Services (CMS), which oversees the Meaningful Use attestation program, is pushing ICD-10 implementation for various reasons, but admits that the primary goal is enabling it to have greater data on what treatments providers are billing.

We have always been aware of the costs to effectively implement EHR’s. This is why Meaningful Use incentives exist. Essentially, CMS believes that it will do better in the long run if providers keep and use electronic records and is willing to pay providers, after the fact, if they make that change.  The other problematic element within the study is that EHR implementation isn’t just failing to result in a profit, but that in practices with fewer than 6 providers, money loss is occurring. In essence, the cost to implement the new technology is not outstripped by gains in productivity over the long haul.  The study noted possible reasons for this. Almost half of offices were still maintaining paper records. Others will still maintaining and paying for staff to handle tasks that were rendered obsolete by new technologies, including transcriptionists and staff to maintain the aforementioned paper records. On the other hand, some practices increased efficiency and were able to see more patients; others improved billing and had fewer rejected claims. Larger practices (with more than 5 providers) were more likely to recoup costs than smaller ones.

This study was not designed to look at improvements in patient care, but does confirm that some, but not all, practices may benefit financially from the adoption of EHR’s, especially larger practices and those that use the change to improve efficiency in their offices. The final result of the article, despite a misleading title, is to point out a few important things. Practices who commit fully to using an EHR can see more effective billing practices leading to higher coding levels and fewer rejected claims. On the other side, those groups not interested in breaking from the past will end up wasting most of these potential advantages. In our experience, commitment to a successful implementation process should lead practices to not only improve their business model, but do a better job with their original mission: helping their patients.



HIT Learning Center Webinars

Posted in HIT, Learning Center with tags , , , , , , , , , , , , , , , on March 7, 2013 by Matthew Levy


As part EHR Evolution’s upcoming HIT Learning Center, we are offering FREE Webinars explaining the changes to the healthcare system as part of the HITECH act. Whether you are a provider, administrator, IT professional, or have any other role in healthcare, you can join us to learn more about some of the requirements for Meaningful Use Stage 2. Additionally, we will begin to show you some tips for making this change as painless as possible.

Join us throughout March to learn more about how EHR Evolution can help you transition to a more effective computer-based system for managing your practice.

To sign up, click on one of the links below.

ICD-10 Implementation

Posted in HIT on March 6, 2013 by mfisher527

We have discussed at length many of the changes to healthcare practice and policy that are currently being proposed or implemented. Most of these are driven by new advantages in technology that allows us to take advantage of new technologies to improve the way we treat and interact with patients.

Currently ICD-9 (International Statistical Classifications of Diseases) codes are in place to report medical diagnoses and inpatient procedures.  Several chapters in ICD-9 are full and new codes can not be added. The practice of medicine has changed dramatically in the last couple of decades. The years since ICD-9 was implemented in 1977 have seen new conditions and diseases discovered, new treatments developed, and dramatic changes in medical devices and resource roll outs. As a result, new problems, conditions, and updates and expansions of known medical issues cannot be separated as we discover new medical knowledge. This severely limits billing and treatment options.  ICD-9 can not keep up with all these advances and changes in the system are inevitable. ICD-10 is rolling out and will replace ICD-9 on October 1, 2013, the compliance date is October 1, 2014.

What is the difference between ICD-9 and ICD-10? ICD-10 provides more  specific and in-depth diagnosis codes and procedures. The new set of codes will describe precisely what procedure was done to the patient, what body part, what method and what medical device was used. The format and structure of the ICD-10 codes varies greatly from the previous diagnosis codes.

ICD-9 codes are 3-5 characters in length and the first digit may be alpha (E or V) or numeric. While ICD-10 are 3-7 characters in length and digit 1 is alpha,  digits 2 and 3 are numeric, digits 4-7 are alpha or numeric. This means that ICD-9 was limited to 17,000 diagnoses, whereas ICD-10 allows billing for over 140,000 distinct diagnoses and procedures, based on statistics provided by the U.S. Department of Health and Human Services:.

Information Technology and software will see the biggest impact on the transition. Healthcare billing departments will also have a large impact and further training will need to be done during the transition to ICD-10. Patients will not see an impact.

This sounds too complicated. Do I have to upgrade to ICD-10? Yes, this is mandatory. If you do not upgrade, you can not bill charges. The transition is required by everyone covered under HIPAA.

Why? ICD-10 exists to move your coding and billing practices forward in the 21st century. As comfortable as you may be with ICD-9, those codes are more than 30 years old, and are missing critical information, such as accurate anatomical descriptions, and differentiation of risk and severity among several issues.

How can I go about this change?  While understanding the structure of a basic ICD-10 code is important, a great deal of the change is understanding how to bill more for more complex conditions, as well as to allow payers and providers to keep better track of what they are paying and billing for. You may be concerned about the difficulty of switching to ICD-10. But it doesn’t have to be as hard as you think it might be.

Most new EHR systems have already begun the transition, and when diagnosing a patient using Certified EHR Technology, you will be able to see medical conditions and problems that are new to ICD-10, as well as the ICD-10 codes that match to old ICD-9 conditions. You should be able to use these comparisons to quickly learn the changes, and with the help of a powerful EHR and a good support team to help you implement change, learning ICD-10 should be incredibly easy, likely much simpler than learning ICD-9 was.

There are several resources for implementing ICD-10 on the internet. The American Medical Association has published a checklist online. This is a good start for implementing ICD-10 in your practice!

Further Readings:

Centers for Medicare and Medicaid Services ICD-10 Factsheet

ICD-10 Implementation Guide for Small and Medium Practices

American Health Informatic Management Association: ICD-10 Implementation Basics