Allscripts PM

Lessons Learned – Allscripts PM V14 Upgrade

Culbert recently engaged with a client who requested assistance to successfully accomplish their Allscripts PM V 14 upgrade. It was a great opportunity for them to assess current practices and incorporate optimization of workflows, policies and procedures to ensure consistency across their large, multidisciplinary organization.

As with any project, there were lessons learned along the way revolving around preparation, planning and execution. Some of those learnings included:

  • Preparation – establish your PM support team

Who will assist in understanding the new functionality and its impact on your system set up and current workflows? This team needs to be comprised of members across all departments in your organization.  IT may lead, but you will benefit most by including Finance and Operations.  Reach out to Finance to establish those that are responsible for standard reporting.  Work with operations managers, supervisors and front end users to identify the potential impacts on day-to-day activities.  Also, make sure your Allscripts application support is in place when discussions regarding upgrade begin.  In our most recent experience, the Practice Management application support was not identified early enough and was inconsistent throughout the implementation process.  Having a single source to work with would have significantly streamlined things.

  • Planning – establish your upgrade database

Establish your own plan regarding implementation and testing. Don’t rely solely on the vendor.  In addition, know the database where you want your testing to take place.  During our implementation, the decision between TEST and TRAIN databases was a back and forth issue for some time.  Ultimately, the decision to load the upgraded version into TEST was made by IT and Allscripts agreed to update the database with a current copy of PROD.  This was helpful in training users, and duplicating some automated processes.  Unfortunately, there were few options available to allow complete testing of interfaces.  Based on your organization’s number and complexity of interfaces, be prepared to address issues at go-live that could not be properly tested.

  • Testing – create your testing plan

Have a testing plan and issues-tracking process ready for your team to implement as soon as your testing environment is established. Since Allscripts does not provide, nor recommend any formalized testing plan, be as thorough and specific as possible when identifying items to be tested and re-tested and how issues will be documented and quantified.   Ask your PM resource for a list of previously-identified issues and bugs from the version being implemented and ensure those that impact your organization are included in the testing plan.

  • Execution – go-live date

Choose a go-live date that works for your organization. Give yourself enough time, based on your available resources, to completely test all functionality and document current issues.   Ensure your issues list establishes a “no go” threshold that would push your go-live date until resolved or that the work-arounds provided are acceptable to your organization.  Remember to assess the workflow, manpower and financial implications of any work-around, and establish a reasonable time frame for resolution.

Lastly, if you are performing both EHR and PM upgrades concurrently, as this organization did, ensure that your voice on the upgrade team is heard. Underscore your importance in the process and insist on specific follow up dates and people responsible for resolution and assistance.





Performance Reporting Using Allscripts PM

Physicians and their practice managers need an efficient and systematic way to monitor financial performance.  The standard “bottom-line” measures focus on provider productivity and aged accounts receivable (A/R).  Additional operational measures are useful to identify and respond to common problems in the revenue cycle, such as missing charges or claim denials related to insurance eligibility.  How can practices best use the reports and functionality available in Allscripts PM?

Practices may track productivity based on charges, payments, or work relative value units (wRVUs), depending on their provider compensation formula.  For payments and charges, we recommend the Productivity Analysis report, which is run by monthly reporting period based on updated transactions.  For wRVUs, we recommend the Procedure Analysis report – which is also useful to show the detailed visit volume by CPT code.  Only the Performance Management report can show productivity by service date;  however, the data are computed based on the original charge (not updated transactions) so the numbers change when that report is run at different times, as payments and voids are entered.  Also, it should be noted that none of the reports count unassigned payments until they are applied to charges.

The Aged Trial Balance report shows A/R in 30-day aging bracket, and is usually formatted by insurance category (Blue Cross, Medicare, etc.).  It can be run three different ways – by service date, billing date, and original billing date reflecting transfers.  While the first best reflects overall cash flow, the third best reflects billing office performance.  The limitation of the second is that, when a claim is rebilled (for example, to appeal a denial or correct a claim format error), the billing date changes to the new one and the A/R bracket is adjusted accordingly.  We recommend creating a spreadsheet to compile the data and compute percentages, to make it possible to track performance trends.  Monthly tracking is sufficient if A/R is mostly current (< 30 days), but weekly or biweekly is better if there is significant old A/R.  The A/R Analysis report computes average A/R days, a good indicator to compare with other practices.

In addition to those statistical reports, a few key operational reports are well-worth monitoring.  The Appointment Analysis report can be used to compute utilization of the scheduling template by provider.  The Encounter Tracking report identifies missing charges for scheduled visits;  if this is a significant problem, the data can be exported to a spreadsheet-file for analysis and distribution to providers.  The Reimbursement Comment Analysis report summarizes claim denial reasons;  categories can be set-up and linked to simplify reporting (for example, coding or insurance eligibility) and provide feedback and follow-up training for providers and practice staff.

The Office Manager module is also a valuable tool for monitoring operational performance in real-time.  Automated work queues and work groups can be set-up for staff to facilitate their assigned follow-up work (for example, referral authorization or denied claims).  Managers then have a simple transparent way to oversee workloads and progress in working-down backlogs.  In our experience, the Workflow Organization option to prioritize queues is advantageous, especially for clients with significantly old A/R.

Scheduling Optimization Using Allscripts PM

Physicians usually prefer to set-up their scheduling templates in ways that help manage patient flow and their own workload.  Allscripts PM Software is readily customizable to accommodate such preferences – for example, by defining what time-slots are available for certain appointment types or by restricting the number of new patients or physicals in a day.  The first step in optimizing schedules is always to clarify the physicians’ productivity expectations, goals and rationale.  The next step is to consider how best to structure the schedule to maximize utilization while facilitating patient access – especially urgent appointments for primary care and new patients for specialists.

To design the optimal schedule, it is helpful to have an understanding of demand vs. capacity, as well as utilization trends.  Given the unpredictable nature of health care, 90% is a reasonable target for most physicians and 85% for mid-level providers, based on our empirical experience working with clients.  It is better to adopt an “open access” approach – allowing patients to book any appointment type at any time.  Otherwise, physicians risk having more unused slots and managers waste more time micro-managing schedules, especially when there are cancellations on short-notice.

Large medical groups face an extra challenge:  how to strike a balance between enabling flexibility for physicians while maintaining an overall system that is efficient, error-proof, and manageable for the lead administrator and central IT support staff.  In our consulting view, Allscripts PM has the functionality to work well – as long as the administrator plans the scheduling set-up process properly, following clear organizational standards to simplify and streamline options.  This management discipline is crucial if there is a centralized scheduling staff.  And if the system is not designed right at the start, it’s twice as hard to redesign later!