October, 2013:

Patient Engagement-Not What the Doctor Ordered Anymore


An “engaged” patient is a healthier patient, with fewer medical issues over the course of one’s lifetime. 

“Engaged” patients reduce the overall cost of our nation’s healthcare delivery system and increases financial incentives for physicians and hospitals.

If we truly believe the above statements to be true; then why aren’t more patients “engaged” and why don’t more healthcare organizations make “patient engagement” a priority?

Patient engagement sounds easy.  Most physicians would say they work collaboratively with their patients to achieve mutually agreed upon healthcare goals; but do they really?   In my opinion, the “health” of the relationship between the physician and the patient will determine the quality of the clinical outcome and therefore, is critical to any discussion regarding enhancing patient engagement. 

Patients need to become an active participant in the physician/patient relationship.  Traditionally, patients have taken a passive role; agreeing to whatever their physician tells them they should do.  I vividly recall many visits with my mother to her oncologist.  She never questioned his treatment plan, never asked about side effects, and never fully understood why surgery wasn’t the right solution for her illness.  Yet she would ask these questions of me on the ride home.  This is patient engagement at its worst. 

In order for healthcare organizations to be successful in this new age of Healthcare Reform we must provide our patients with the tools they need to engage.  We need to make it easy for the patient to become more interested and involved in their overall health and medical care.  Technology plays a huge role in facilitating the improved relationship between the patient and their physician.  Here are just a few examples, from a patients’ point of view, for physicians to consider if they have not already done so.

  • Access to care:  Patients do not want to wait weeks for an appointment with a physician.  Whether you are a Primary Care Physician or a Specialist, see me quickly and if you can’t, provide me with an appointment with a qualified alternative.  In the era of Healthcare Reform it is not about the quantity of the services you provide, but the quality of the care you give.
  • Patient Portals:  Give me access to online registration, appointment scheduling and my healthcare records; just like the airlines, restaurants and the hotels do.  Provide information about your healthcare facility to include maps, directions, nearby coffee shops and where I can get a wireless connection for my IPhone.
  • Communicate:  Remind me of my appointment via a communication method of my choice; email, telephone call, text, or all three if that I what I choose.  Speak to me in the language that I understand.
  • Information:  Tell me if I have to pay a co-payment, or my deductible, before I arrive so that I can be sure to have my debit card on hand when I visit your Practice.
  • Courtesy:  Have your receptionist greet me with a smile and say my name.  Be sure this happens for all of your patients.  Say hello to family members and caregivers too.  They have a significant impact on whether your patient returns to your organization in the future.
  • Efficiency:  Do not make me fill out registration and insurance forms in the waiting room if I have already done so when I booked the appointment online.  This redundancy makes me think that your organization does not have its act together.
  • Convenience:  Don’t make me wait more than fifteen minutes in the waiting room, and please provide relevant reading materials, television and wireless Internet access that allows me to access education related to my health.  Don’t make me wait in the exam room for more than ten minutes.  There is nothing more maddening than sitting on your exam table in a paper gown staring at the “Ask me if I washed my hands” sign over the sink?  Better yet, provide me with a cloth gown instead.
  • Collaborate:  During our visit, talk to me.   Speak in a calming, caring manner.  Ask me if I understand everything that you say to me.  Ask me if I have more questions.  Do not rush me.  Give me written instructions should I need to take medication, perform exercises, or change my diet.  Confirm all information with my caregiver or family member if one is with me. 
  • Follow Up:  Have one of your healthcare coaches call me in a few days to ensure that I am following your post-visit instructions.  That’s what my veterinarian does.

Patient engagement does not “just happen”.  As healthcare providers and managers, we need to be more customer oriented than ever before.  Fee for Value is not a futuristic payment methodology that will never happen during the course of your career.  In fact, CMS is calculating Meaningful Use payments for 2015 based upon the quality of the care you are giving in 2013 for physician group practices of 100 providers or more.  Invest in a well-defined Patient Engagement initiative that includes physicians, staff and patients.  Afterall, it’s just not “what the doctor ordered” anymore.


Epic: Clinical Documentation and ICD-10 Readiness

Epic: Clinical Documentation and ICD-10 Readiness

 Much of ICD-10 is focused on the surface-level shift from ICD-9 codes to ICD-10 Clinical Modification (ICD-10 CM) and ICD-10 Procedure Coding System (ICD-10 PCS).  This movement away from ICD-9 codes to ICD-10 involves utilizing crosswalks between the two code sets, training coders, clinicians, and educating your operations on how to properly document, read and code a patient’s chart. 

Epic has provided specific documentation within the Epic Userweb that covers the broad spectrum of how to successfully manage an ICD-10 implementation in order to successfully begin submitting claims using ICD-10 on October 1, 2014.  Within this documentation, Epic’s whitepaper on Enhancing Clinical Documentation Specificity outlines some of the tools that can be used to improve documentation as part of your ICD-10 conversion.

 Several master files that will need to be updated for enhanced specificity are listed below:

  • VCG – Diagnosis Groupers
  • LGL – Best Practice Advisories
  • HBD – Block Definition Records
  • EAP – Procedures
  • ETT – Text Templates
  • LPP – Extensions / Programming Points
  • LQH – Visit Navigator History Template Definitions

In addition, any (ETX) SmartTexts, (ETL) SmartLists, or (HH1) SmartPhrases that reference free text ICD-9 codes must be updated to now refer to the appropriate ICD-10 codes.  For a full list of master files, contact your Epic representatives.

 In addition to clinical documentation, clinical content must also be updated for alerts, suggestions and other logic leveraging ICD codes.  Be sure to review and evaluate your content as part of the ICD implementation plan.  The October transition date is coming quickly; many providers report being unprepared for training or the transition.  Be sure to focus on usability and documentation tools as part of your ICD transition.



Improving EHR Clinician Adoption


Clinician adoption is essential to system usability, optimization success, change management, informatics programs and progression across the HIMSS stages of EHR use.  Focusing on adoption creates an opportunity to educate clinicians on benefits from technology, influence patient satisfaction and drive improved clinical and financial outcomes. 

 Having successful clinicians who are educated on the tools and given the operational support to improve system features, functions and personalization will drive enhancements and allow them to be the best stakeholders in the organization.

 Below are select steps to follow when growing clinician adoption:

  • Governance Alignment (MEC, P/T, Clinician Champions, CMIO, CMO, CNO, etc.)
  • Functional SME workgroups empowered to influence personalization
  •  Support responsiveness and local feet on the floor
  •  Balance of voice recognition, SmartTool and Notewriter use
  • Tablet deployment in select practices and in the ED
  • Upgrade usability testing
  • Evidence-based content deployment
  • Consistency of content across continuum (IP, AMB, LTC, Home Health)

 Having a strong marriage of clinical user stakeholders with your operations brings success to clinical improvement initiatives such as MU, Value Based Purchasing, CMS demonstrations, PQRS, and many additional programs. 



ICD-10 Six Tips for Taking a Holistic Approach


Denial Management- In a Nutshell

Today’s healthcare environment is more data driven than ever before; driving many groups to work towards capturing performance information within all aspects of the revenue cycle. One area in particular where hospitals and physician groups are focusing is to utilize data analytics to enhance workflows for denial management.

Elements of denial management:

1)       Denial management starts with denial mitigation through:

  1. A robust charge/claim editing process
  2. Engaging a clearinghouse to streamline payment processing
  3.  Engaging a clearinghouse to streamline claim submission routines by including additional levels of claim editing
  4. Posting up front payer edits for early detection of provider credentialing, claim formatting or patient identification issues
  5. Dedicating staff responsible for coordinating the dissemination of payer updates and changes to reimbursement policies

2)       Denial Management is most effective when the level of detail is sufficient to provide meaningful, focused feedback to the front end.

  1. This requires maximizing the utilization of HIPAA-compliant 835 remittance posting; which provides the broadest range of denial detail in a standardized format suitable for trending and analysis.
  2. Posting both ANSI remark codes, in addition to the more general reason codes, in order to minimize research required for understanding the underlying significance of the rejection (WAITING FOR INFORMATION FROM PATIENT  vs. just DOCUMENTATION REQUIRED ), thus enabling the claim in question to be routed more efficiently to the appropriate work queue.
  3. Refine the level of detail by posting all rejections at the line item (procedure) level required so that meaningful feedback can be provided not only to the appropriate Registration and Credentialing departments but to coding and clinical staff regarding compliance and medical necessity issues.
  4. The enhanced trending and analysis capabilities referenced above allow methodical feedback which then informs the front end processes and becomes part of the denial mitigation initiative.

3)       Goals of denial management

  1. Eliminate re-work
  2. Achieve first pass claim acceptance rate of 97% (industry standard)
  3. Maximize customer satisfaction

4)       Carrier Take-backs

  1. Not often seen as part of the denial management process
  2. Effectively constitute a retrospective denial of the claim
  3. Provide opportunity, where appropriate, to reach out to patient for timely resolution of potentially erroneous retroactive terminations of coverage
  4. Provide opportunity to improve the front end operation regarding other reimbursement (ex., missed surgical discounts) or claim integrity (ex., procedures normally bundled submitted on different claims) issues.

Understanding Patient & Provider Engagement- Webinar Oct 16th 1:00-2:00pm EDT

Johanna Epstein-VP for Strategic Services , Culbert Healthcare will be joined by 2 other panelists offering 3 perspectives.

Join us for a webinar that addresses the emerging trends in patient and provider engagement and gives you practical tips for increasing technology adoption.