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EHRs: More Prosperous Practices Tend to be Paperless

April 25, 2008 - If you want to copy the habits of financially successful doctors who don’t have to borrow money to meet payroll, consider implementing an EHR. That’s one conclusion you could draw from survey data from the Medical Group Management Association.

The MGMA classifies practices as “better performers” in three categories: Profitability and cost management, accounts receivable, and productivity, capacity, and staffing. To earn a “better performer” star, you must meet certain benchmarks. In the category of profitability and cost management, for example, you must exceed the MGMA median in your specialty for total medical revenue per full-time-equivalent physician minus operating costs as well as fall under the median for operating costs per medical procedure. Better performers in the A/R category must, among other things, beat the specialty median for total A/R over 120 days.

Every year the MGMA compares better performers to the rest of the medical world to get some clues as to why they’re leading the pack. Turns out that 53 percent of better performers had either fully or partially implemented an EHR by the end of fiscal year 2006 compared to 36 percent for other practices.

Not surprisingly, better performers also invest more in computerization. Among single-specialty primary-care groups in 2006, better performers allocated $3,260 more per full-time-equivalent physician on information technology than other groups. Likewise, better performing multispecialty groups outspent others on IT by $3,525 per doctor.

Source: InfoTech Bulletin by Robert Lowes. Go to http://medicaleconomics.modernmedicine.com/memag/article/articleDetail.jsp?id=511803 to read the article at Medical Economics.

New Codes for Optometry

November 2006 - Seven new or revised ICD-9.CM codes and one new CPT code applicable to optometric practice are listed in the 2007 code sets recently released by the Centers for Medicare and Medicaid Services (CMS). There will be no changes to the HCPCS codes applicable to optometry in 2007. CMS implements changes in the CPT codes set each year on January 1. Health care providers could actually begin using new ICD-9.CM codes on claims effective October 1. Each year, the AOA Eye Care Benefits Centers carefully reviews the CPT code set (including modifiers, HCPCS, Temporary Codes, and E&M codes) as well as the ICD-9 codes for changes pertinent to eye or vision care. All changes will be reflected in the new, revised 2007 edition of AOA's Codes for Optometry, available December 1 through the AOA Order Department. To order, call (800) 262-2210, fax at (314) 991-4101, or log onto www.aoa.org/documents/Order-Dept-Catalog.pdf.

The following text lists the new diagnosis and service does for:

ICD-9-CM 2007

October 1, 2007, is the first available date to start using the new ICD.9.CM diagnosis codes. This means that you'll have seven new or revised ICD.9.CM codes to report from ICD.9.CM 2007—two revised diagnosis codes and four new ICD.9.CM codes.

360.0 Purulent endophthalmitis
Excludes bleb associated endophthalmitis (379.63)
630.1 Other endophthalmitis
Excludes bleb associated endophthalmitis (379.63)

377.43 Optic nerve hypoplasia

New Sub-category
379.60 Inflammation (infection) of postprocedural bleb, unspecified
379.61 Inflammation (infection of postprocedural bleb, stage 1
379.62 Inflammation (infection of postprocedural bleb, stage 2
379.63 Inflammation (infection of postprocedural bleb, stage 3
Bleb associated endophthalmitis

There is one new CPT code effective 1/1/2007:
92025 - Computerized corneal topography, unilateral or bilateral, with interpretation and report

There are no changes to HCPCS codes for 2007.

For more information on the new optometry codes in 2007, go to www.aoa.org.

Electronic Medical Records: A Goal for All Offices by 2014

October 2006 - Many optometrists are slowly, but surely, incorporating electronic medical records (EMRs) into their practices. This shift has been further advanced by a federal initiative to computerize records in the Veteran's Administration offices, as well as a July 2006 report by the Institute of Medicine of the National Academies, which calls for the use of e-prescribing by the year 2010.

According to Ian Lane, OD, FAAO, vice president of professional services for OfficeMate Software Solutions, Irvine, Calif., this objective is part of a larger plan to make computerized records mandatory in all of medicine.

"The federal government is looking at a date of 2014 for everyone to go electronic," Dr. Lane said. "This might sound a bit aggressive, but I can tell you by the adoption rate of doctors, by the way everyone is ramping up, if it doesn't happen by 2014, it will be close."

To read the full article in Primary Care Optometry News (Volume 11, Number 10) by Jennifer Byrne, go to www.pconsupersite.com.

Breaking the Habit: How to Start Your Journey to a Paperless Office

May 2006 - For those O.D.s still on the fence when it comes to bringing your practice into the paperless mode, James K. Kirchner, O.D., of Lincoln, Neb., has some advice: "The longer you wait, the more difficult and expensive it will become. We ar in an electronic world and that is not going to change."

Practitioners who have already bitten the bullet regarding replacing the written record with an electronic one say the bumpy transition was well worth it. They count increased efficiency and productivity–not to mention profitability–among the benefits. The last may come as a surprise to some, given the cost of computer hardware and software. These pioneers will help you embrace the inevitable by explaining what you should look for, as well as how much better electronic technology can make your practice.

To read the full article about journeys to paperless offices and EMRs, read the May 2006 Optometric Management magazine or go to their Web site (http://www.optometric.com/index.aspx).

Wait Grows Longer For Medicare Paper Claims

March 20, 2006 - Beginning this month, health care practitioners who use paper claims to bill Medicare will have to wait at least two additional days to receive payment. 

Carriers, effective March 13, will begin paying paper claims no sooner than 29 days after receipt. Carriers now process paper claims a minimum of 27 days after receiving them.

The U.S. Centers for Medicare and Medicaid Services (CMS) notified carriers of the Congressionally authorized change in the “floor date” for Medicare paper claims processing in a Feb. 10 change request (CR4284). (The change requests can be found on the CMS Web site at www.cms.hhs.gov/Transmittals/downloads/R850CP.pdf.)

Providers with questions regarding the change should contact their respective Medicare carriers. Their toll-free numbers can be found online at www.cms.hhs.gov/apps/contacts.

Source: AOA News (http://www.aoanews.org/x5391.xml?AOAMember)

Protect PHI With De-Identification

June 2005 - Optometrists are blinking at the complexity of the HIPAA privacy rule. What, exactly, qualities as protected health information (PHI)?

PHI includes any individually identifiable health information that comes from a healthcare provider, says Julie Simas, insurance coordinator for the Center for Total Eye Care in Westminster, MD. A patient's name and phone number by themselves are not PHI, but a patient's name and phone number sent by a particular doctor is.

Any record or other information in your office that contains two or more of the following items is subject to the HIPAA privacy rule. You must remove these identifies in order to "de-identify" the information.

  • Patient's name
  • Address information other than city, state, and ZIP code
  • Geographic subdivisions smaller than a state
  • Home or work telephone number
  • Fax number
  • Any e-mail address
  • Social Security number
  • Medical record number
  • Medicare or Medicaid number
  • Health plan beneficiary number
  • Account number
  • Certificate/license numbers
  • Vehicle identifiers
  • Device identifiers
  • Device serial number
  • Web site addresses
  • Biometric identifies (e.g., fingerprints)
  • Full-face photograph
  • Dates (except for years) related to birth, death, admission, or discharge
  • Any other unique identifying number, code, or characteristic, unless otherwise permitted

Source: "Standards for privacy of Individually Identifiable Health Information; Final Rule," section 164.514, Department of Health and Human Services. Reprinted in Optometry Coding & Bill Alert (http://codinginstitute.com/sample/opt_sample.pdf).

HHS Launches National Health Information Technology Program

October 2005 - With federal health officials declaring the "Decade of Health Information Technology," AOA is launching an aggressive new effort to ensure that optometry has input when Congress and the Bush administration make decisions on a nationwide electronic health records system.

The U.S. Department of Health and Human Services (HHS) recently announced the start of a 10-year program to construct a national electronic health information infrastructure which, the agency predicts, will virtually transform health care in America .

The AOA Board of Trustees has appointed an AOA Health Information Technology Study Group to assess the impact of the proposed electronic health records system on optometry and make recommendations to the government on the development of the system.

"Optometry will not be a spectator when federal officials consider how to build our nation's electronic health information infrastructure. AOA members will be active and involved in the process at every step," said AOA President Richard L. Wallingford, O. D. "With the formation of our own Health Information Technology Study Group at this critical moment, AOA will be heard loud and clear in Washington, DC, on this issue right from the start."

HHS's health information technology (HIT) plan calls for every American to be given the option of having an electronic health record (EHR). Health care providers would access the records from their offices through a dynamic, electronic gridwork, called the National Health Information Network, when providing care. Patients would be able to access a consumer-friendly version of their own records and keep track of preventive health measures from regular examinations to diet and exercise recommendations.

The national HIT effort was touted by President George W. Bush during his State of the Union Address earlier this year. The White House began moving toward an EHR system last year when President Bush named David Brailer, M.D., the National Coordinator of Health Information Technology. The President has since also appointed a 17-member commission to work out details of the electronic health records system.

More than a half dozen HIT bills have been introduced in the 109th Congress, where various committee hearings have been held. The U.S. Department of Defense (DOD) and Department of Veterans Affairs (VA) have already implemented EHR systems. Experts and members of Congress, as well as AOA's new Health Information Technology Study Group believe the electronic health records network may be modeled, at least in part, on those networks.

HHS officials formally announced the launch of its HIT efforts in July, a public-private endeavor in which they see the government's role as coordinator and facilitator.

Several press reports followed, noting that HHS's Centers for Medicare and Medicaid Services (CMS) was planning to offer physicians free Vista-A electronic health records software, similar to that used by the VA, in an effort to encourage electronic health information processing.

Medicare, like many private insurance plans, has strongly encouraged electronic claims filing for years. However, HHS, until now, has not placed the same emphasis on electronic patient records.

Electronic health records are already being used in a number of large health institutions as well as some small health care practices, members of the AOA Health Information Technology Study Group note. Hospitals in a number of areas around the country have already begun developing regional file sharing networks independent of the government effort.

Electronic health records programs for small health practices—including optometric practices—are already available, AOA Health Information Technology Committee members note. Over the past several years, at least three EHR programs, specifically for optometrists, have been introduced: OfficeMate's ExamWRITER, CompuLink's Eye Care Advantage program, and MaximEyes 6.0. MediNotes offers a version of its EMR program for ophthalmologists.

However, while many health care providers are now filing insurance claims and performing other practice management functions electronically, relatively few are now using EHRs, AOA Health Information Technology Study Group members note.

Electronic health records can potentially provide optometrists and other health care providers numerous advantages, including cost savings, improved office efficiency, and even more efficient claims filing, AOA Health Information Technology Study Group members note.

However, the planned national electronic health records system could also pose a number of challenges for both individual optometrists and optometry as a profession, Study Group members say.

Implementation of electronic health records will also generally involve some expenses for software purchases, training for office staff, and a transition period as a practice changes from paper to electronic records, say Study Group members.

In addition, Study Group members note, it is unclear if the EHR software that will be used by the government will provide the information necessary for eye and vision care practitioners or whether the EHR programs presently available for small health practices will be accepted by the planned national information network.

Attached is a detailed discussion of the planned electronic health information network (see "Toward the Paperless Practice" from the Practice Strategies section of the September edition of Optometry: Journal of the American Optometric Association).

Katrina Shows Need to Computerize Records

September 13, 2005 - Federal health officials are working to open a database of prescription drug records to help Hurricane Katrina evacuees piece their health care back together.

The project, still developing three weeks after the disaster, underscores the glaring reality that the hurricane destroyed medical records of untold numbers of people, possibly complicating treatment decisions for years to come.

And it's focusing new attention on the need for computerized medical records, accessible in an emergency even if the patient is far from home or their doctor's office no longer exists.

"There may not have been an experience that demonstrates, for me or the country, more powerfully the need for electronic health records ... than Katrina," Health and Human Services Secretary Mike Leavitt told The Associated Press on Monday.

"This is not going to be a short-term problem," he said, pledging to help Gulf Coast states rebuild better records systems.

The federal government's goal is to give most Americans computerized medical records within 10 years. But it's so expensive and technologically challenging, since systems must be compatible so the records can be read by competing clinics and hospitals, that only a fraction of health providers today are paperless.

To read the full article by Lauran Neergaard, go to http://www.lasvegassun.com/sunbin/stories/thrive/2005/sep/13/091300268.html.

Electronic Medical Records: A Clean Bill of Health

July 27, 2005 - Most U.S. consumers believe that electronic medical records (EMR) can provide valuable benefits, especially during medical emergencies, and can improve overall medical care. Also, they are less concerned with security issues than in other industries, according to the results of a survey released by Accenture this week. Ninety-three percent of the 500 U.S. health care consumers surveyed believe that electronic medical records can improve the quality of care, while 92 percent believe that they can reduce the number of treatment errors in hospitals. In addition, 65 percent responded they are concerned that they might be rendered unconscious in an accident and unable to report vital information to emergency personnel. Ninety-three percent said they would support emergency room doctors having access to EMRs.

Read the full article by Colin Beasty at http://www.destinationcrm.com/articles/default.asp?ArticleID=5314&ml=3.

Frist, Clinton Introduce Health Technology to Enhance Quality Act of 2005

June 16, 2005 - Washington, DC - U.S. Senate Majority Leader Bill Frist, M.D. (TN) and Senator Hillary Rodham Clinton (NY) today introduced the "Health Technology to Enhance Quality Act of 2005" (Health TEQ) at a press conference at George Washington University Hospital. The bipartisan legislation creates an interoperable health information technology (IT) system through the adoption of standards that will help reduce costs, enhance efficiency and improve overall patient care.

"This innovative legislation will help launch America's transition away from outmoded pen-and-pad medicine by encouraging the creation of an interoperable, secure and technology-based system of medical care," said Frist. "Grounding our health care in information technology can cut out waste and redundancies that drive up costs, hamper efficiency and cause medical errors. I'm proud of this bold, bipartisan and forward-thinking legislation. It will generate meaningful action that confronts tomorrow's health care challenges, and help ensure high quality health care is available and affordable for all Americans."

"This legislation marries technology and quality to create a seamless, efficient health care system for the 21st century," said Clinton. "By creating national interoperability standards, we will give health care providers the confidence that an investment in health IT is an investment in the future."

The Health Technology to Enhance Quality Act of 2005 implements health information technology standards that would guide the design and operation of interoperable health information systems. The legislation codifies the Office of National Coordinator for Information Technology and establishes standards for the electronic exchange of health information. The bill also authorizes grants to local and regional consortiums to implement health information technology infrastructure that is compliant with national standards and establishes measures to assess the quality of care. Finally, it establishes standard quality measures to better assess the value of federal programs.

Senators Frist and Clinton are cosponsoring this legislation along with Senator Mel Martinez (R-FL), Senator Barbara Mikulski (D-MD), Senator Jim Talent (R-MO) and Senator Barack Obama (D-IL).

To read the full details of this act, go to http://clinton.senate.gov/~clinton/news/2005/2005616707.html.

Check out this video clip from the CBS Early Show and hear more about this proposed act.

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Kaiser Permanente Research: Computers In Exam Room Help Patient And Doctor Communicate

June 9, 2005 - Researchers with Kaiser Permanente find patients are more satisfied with their care and communicate better with their doctors when computers are available in examination rooms. The study is published in the June 6th issue of the Journal of the American Medical Informatics Association. Compared with visits prior to installation of the computer, overall patient satisfaction, communication about medical issues, and patient understanding about their condition all improved after the computer introduction. Patients also felt that their doctors were more familiar with their personal medical history and their lives."Patients were more satisfied with their doctors after computers were installed in exam rooms," says lead author John Hsu, MD, of Kaiser Permanente's Division of Research in Oakland, California. "The patients felt their doctor was more familiar with their medical history. Patients also felt more involved in decisions about their care and had a better understanding of diagnoses and treatments." Dr.Hsu and his colleagues in Kaiser Permanente's Northwest region conducted a longitudinal study of 313 patients and their 8 physicians, including clinic visits before computers were available in the exam room, and visits one month and seven months after the introduction. After the introduction of computers:

  • 63% of patients reported excellent overall satisfaction, from 55%

  • 61% reported excellent satisfaction with discussions about their treatments, from 47%

  • 57% reported excellent understanding of their treatments, from 46%

  • 59% reported their doctor's being very familiar with their lives, from 48%

  • 50% reported their doctor's being very familiar with their medical history, from 42%

"When a physician is familiar with computers, and uses the technology to share information with patients, the doctor-patient relationship improves in many ways," says Dr. Hsu. "Patients feel more involved, understand their diagnoses better, and are happier with their care."The study used questionnaires filled out by both the patient and the physician at three different visits to evaluate what effect a computer terminal might have when the physician uses it during an exam. Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a not-for-profit, group practice prepayment program with headquarters in Oakland, California. Kaiser Permanente serves the health care needs of 8.2 million members in 9 states and the District of Columbia. Today it encompasses the not-for-profit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Permanente Medical Groups. Nationwide, Kaiser Permanente includes approximately 138,000 technical, administrative and clerical employees and caregivers, and more than 11,000 physicians representing all specialties.


Wireless Internet Access in Practice Offices

April 14, 2005 - Crutchfield Dermatology, a solo physician practice in Eagan, Minn., is offering patients and visitors free Wi-Fi access throughout its facility. The practice, which doesn't use wireless technology to manage patient data, decided to implement a Wi-Fi network for patients to enhance their experience while at the facility, says Charles E. Crutchfield III, M.D., medical director.

"We're always trying to think outside the box and provide a superb experience for people who come to our office," he says. "This is not just about patients. We have parents or friends who bring patients here. Now they can get work done by accessing our wireless network."

About two months ago, Crutchfield Dermatology enlisted the help of its I.T. services provider, Next Level Café, Savage, Minn., to help create the network. The company installed a TZ170 wireless access point from SonicWALL Inc., Sunnyvale, Calif., at the practice.

The access point can support up to 25 users at a time--plenty for the number patients and visitors the provider expects to access it simultaneously, Crutchfield says. The device also enables wireless coverage throughout the entire facility. The provider paid the I.T. services company about $1,000 for the technology and implementation.

Crutchfield Dermatology began offering wireless access to patients via the access point about six weeks ago. Now patients and visitors can bring in Wi-Fi-enabled notebooks, PDAs and other hardware to the practice to access e-mail or other Web-based applications, Crutchfield says.

Crutchfield Dermatology advertised its free Wi-Fi network to patients via signs in exam rooms and its reception area, in recorded messages while patients were on hold, in its electronic newsletter for patients, and from nurses when patients were making appointments. Though the provider hasn't determined how many visitors have been using the network, Crutchfield says several patients have thanked him for offering wireless access.

"I've seen some people surfing the Internet in our waiting room and others doing work," he says. "If coffee shops can do it, why can't we?"

The provider isn't allowing staff to use the wireless network because it wants to keep it "clear" for patients to use, Crutchfield says.

It also isn't using encryption technology to secure the network because the practice wants to ensure patients and guests can access it easily, says Matt Meinke, senior technician at Next Level Café.

Read the full article at www.crutchfielddermatology.com/news/pdf/worldJuly2005.pdf.