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ICD-10… PCMH… EMR Optimization… ACA 2014 Impact… Meaningful Use… Who’s on First?

October 21, 2013

ICD-10… PCMH… EMR Optimization… ACA 2014 Impact… Meaningful Use… Who’s on First?

It never stops.  New opportunities, new threats, changes to our personal and professional life… it is almost unceasing. The old Abbot and Costello baseball routine comes to mind as we can hardly keep pace with the meaning of the acronyms, never mind keep up with the “to do” list that keeps expanding seemingly exponentially.

This past week while performing a state wide PCA training I was asked by a CHC CEO… “How do I prioritize all that has to be done?” We had just completed a discussion about ICD-10 and the tumultuous impact this new code set will have on CHCs and health care in general. With the anticipated disruption of patient flow, expected “Y2K”-like fees from EMR and practice management system vendors (who have to spend significant money updating their products), and straight expense for training (both consultant fees and salary of staff who are not “producing” while training)… ICD-10 is daunting at best. Most CHCs have not begun and I heard a PCA leader tell me a large and well respected CHC in her market just told the head of her PCA that they were essentially going to ignore ICD-10 and “just see what happens…” This is reckless at best and a legal/fiduciary liability at worst.

We had also discussed earlier in our day the fact that the Affordable Care Act (ACA, also known as ObamaCare) would result in CHCs in most states transitioning 20% to 30% or more of their patients who were previously “uninsured” or “self pay” to now being eligible for third party billing. Not only will CHC billing teams have to be prepared to expand claim volume capacity but front desk and financial support staff will have to learn how the new health products work, what services are covered, and even what the new insurance cards will look like. This does not begin to address what Massachusetts saw happen after their healthcare reform took effect; i.e., wait times for new patients to see a doctor extended nearly six months as all these newly-insured patients suddenly wanted to use their insurance vs. before when it was a very intentional avoidance of visits which most could ill afford.

If your CHC is not one of the 500 pilot PCMH programs, you know it is coming. Between ACOs (think of these as “neighborhoods” of PCMH) and other burgeoning PCMH… it seems clear this “case management” style of practice is how the compensation system is moving. How well your teams function to manage patient panels will determine your success. Optimal efficiency of information exchange and management of patient care remotely will be areas of critical focus if you are to succeed in a world very different from the flat encounter rate and fee for service compensation in which optimal reimbursement resulted from “face to face” contact with the patient vs. managing patients from afar.

Finally, this CEO was also struggling with final Meaningful Use (MU) requirements. The MU payout opportunity began back in 2011 affording a $44,000 maximum pay out to individual doctors (NOT the CHC employer… so if the doctors work for you make certain they sign something that says the MU money will be assigned to your CHC or else (as they say) the chase is on). Even if you join as late as 2014, there is still up to $24,000 that can be earned BUT you have to meet all the performance and reporting standards or that money could be recovered by the government. Again, more to do with too little time.

So back to that question… what is first on the list??

  1. Take care of your staff and they in turn will take care of your patients. Sounds easy but we know it is not.  Staff need to understand what your organization is doing to address these changes to the health care system. When staff are well managed and treated with respect, they in turn will take better care of your patients.
  2. Take care of your patients.  This is not just essential to the CHC mission but critical to your longevity and survival. Make no mistake, at some level, especially if your currently uninsured patients receive ACA coverage from a plan with a reasonable fee (payment) schedule, you will be in competition with local private practices who suddenly want to see these patients (because suddenly they are a payment stream vs. a resource drain).
  3. Get your EMR Up to Speed. You can’t stop getting your EMR up to speed. In fact, as we’ve discussed in these pages before, making the EMR do all it is supposed to do (especially automating provider work flow such as charge capture transfer to billing) will allow your providers to make time to master ICD-10 and all the complexities that go along with it. And, aside from EMR mastery improving odds for success around ICD-10 implementation, Meaningful Use monies should follow as a result.
  4. ACA patient influx preparation. Not much you can do about this other than make the current revenue cycle management process as fluid and successful as able. If your billing team can’t keep up with the work now, it will NOT get better when the claim/billing volume increases by 20-30%+.

As Mark Twain said “Worrying is like paying interest on a debt you may never owe.” Making your leadership team aware of these competing priorities and assigning a designee to each with an expectation of a monthly report to the team… that can’t hurt.  In the end, control the things you can control and prioritize your team’s efforts in this regard. Not much more you can do.

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