Solutions for the Business of Healthcare

Radiology RACs: Get ready to rumble

2010-06-18T08:00:00.001-04:00

by guest-author Richard M. Chesbrough, M.D.
Board-Certified, American Board of Radiology
Medical Director, RadMetrics™

Now that CMS has begun using Recovery Audit Contractor (RAC) auditors to review hospital-based medical care and durable medical equipment providers, auditing of radiology services is on the immediate horizon. In fact, the OIG has placed radiology audits on their 2010 work list. Forward thinking providers and healthcare systems are preparing now, to formulate compliance plans for diagnostic radiology services.

One area of radiology review will be documentation and proper coding of imaging procedures. CMS and OIG audits will likely include evaluation of the referring physician’s order, appropriate CPT coding of the procedure, documentation of medical necessity and a separate written report for each study billed.

The following are compliance issues that providers should consider, in preparation for RAC auditing of radiology services:

1. Physician Order: Is there appropriate documentation that a treating physician or practitioner requested the specific diagnostic test performed? This is an absolute requirement for reimbursement. Records must be maintained by the billing entity, in order to avoid potential conflict.

2. Coding: Based upon review of images and documentation, is the coding correct and proper CPT coding utilized? For example:

a complete abdominal ultrasound is provided, but only the liver and gallbladder are imaged. Therefore, only a limited study should be billed.
a radiological examination consisting of 2 views is provided, but a “complete” radiological examination consisting of a minimum of 5 is was billed.

3. Medical Necessity: Studies must not only be ordered and coded correctly, but they must be medically necessary - used in the care and treatment of the patient. Studies or procedures that are not indicated may be viewed as not reimbursable, and/or subject to recoupment of paid claims. For example:

A CT scan is provided without contrast followed by with contrast. However, based on the patient’s condition, only a CT scan with contrast was indicated. Not only does this represent over-coding (wrong CPT code), but the patient has received twice as much radiation as medically necessary.
Billing for 3-D reconstructions on CT Scans, performed without documentation of medical necessity or separate physician order. In addition, reconstructions must be performed on a separate workstation, and noted in the final written report.
Screening procedures: Ultrasound of the abdominal aorta ordered to screen for aneurysm. However, the patient does not meet appropriate Medicare (or national standards) screening criteria.

4. Imaging Report: Auditors will undoubtedly be reviewing procedures to see that a formal written report has been issued, for cases where there is billing for the professional interpretation (professional component). Such reporting is mandated by;

AMA guidelines
CMS / Medicare regulations
American College of Radiology
American Association of Orthopedic Surgeons
Many other professional organizations

The RACs are coming and it’s time to get into compliance. Medical imaging is one of the areas of great interest, and healthcare providers are well advised to get their policies and procedures in order, and to review their compliance programs in radiology.

Benchmarks: Elusive and Expensive, yet Essential to Improving Health Care

2010-03-02T17:44:00.017-05:00

One of the most common questions we receive is around benchmarks; whether we have one benchmark or another, how to find one, etc. Usually the person asking is looking for such a specific benchmark, it just doesn't exist. Or if it does exist, it's very expensive to purchase (for example, fall rates or radiology turn around times).

In our experience, when a client purchases a benchmark or obtains a third party benchmark in some form, it usually ends up not exactly matching their own data set. Then their analysts usually spend more time explaining the differences between their institution's performance versus the benchmark (for example, they include overhead cost while we do not). Too many times have we seen hospitals spend large amounts of money on these "benchmarks" only to ultimately explain them away as irrelevant -- especially if the hospital doesn't look so good against them.

Despite these challenges, benchmarks remain essential to determining whether our hospitals are performing within a reasonable range. So what can you do to get benchmarks and cost effectively assess your hospital's performance?

Check with your local hospital association. Many, like the Michigan Health & Hospital Association have data sharing, mining and benchmarking systems already in place.
Make your own benchmark. Use data from your organization's best performers and compare them to everyone else. Make sure your population is large enough (i.e. statistically significant) and, if you're using people data (like lengths of stay by physician), consider whether you should keep individual performance private. And probably most importantly, severity adjust your data whenever possible.
Partner with other organizations. Partner with organizations similar to yours to pool data and create a data-sharing co-op. Chances are, they're working on similar improvement projects and could use the same benchmarks. If competition is too fierce between yours and your ideal benchmark organization and you don't feel comfortable approaching them, ask a neutral third party such as a consultant to broker the deal. Make sure you approach organizations of similar size, case mix and acuity and that they are respected by your project's stakeholders. Finally, make sure your organization has something to offer your potential partner organization. Maybe they don't need your lab TAT data but would gladly make an exchange for radiology data.

Finding the perfect benchmark doesn't have to break the bank or consume all of your project hours. Like all health care improvement projects, it just takes a little creative thinking.

Do you have other tips for obtaining or creating benchmarks? Share them here by posting your comments below.

Health Reform: How Hospitals Should Prepare

2009-10-09T14:31:00.002-04:00

In the wake of all the health reform discussion, one important issue is rarely raised: Quality of healthcare. Most of the attention is on health insurance and covering the uninsured. However, we know quality reform is on the President's agenda. From the White House website:

"The President’s plan includes proposals that will improve the way care is delivered to emphasize quality over quantity, including: incentives for hospitals to prevent avoidable readmissions, pilots for new "bundled" payments in Medicare, and support for new models of delivering care through medical homes and accountable care organizations that focus on a coordinated approach to care and outcomes."

You can't count on this going away quietly either, because quality improvement is center in the President's strategy to pay for health insurance for everyone.

This could mean a lot of significant changes will be headed toward providers, especially hospitals. The sooner we prepare, the better. So what should you do to prepare your organization?

We'll focus on readmissions here, since some private-sector initiatives are already in place. First and foremost, start looking at your hospital's readmission rates. Don't track them in all areas? Start. Your quality department might already track readmission rates of open heart patients, but this won't be enough. Surely financial incentives will start with the most common diagnostic groups and eventually be rolled out across the board. For many hospitals, just implementing the ability to track and monitor these readmissions could prove to be difficult. If you're using a manual method, you better start thinking about upgrading your technology and improving your process. Otherwise, it will be very costly to manually track readmissions of large numbers of patients down the road.

Once you have an efficient monitoring system in place, you'll need to develop a methodology to determine whether readmissions were clinically related to the initial admission. Make sure your entire team from physicians to coders are properly recording evidence along the way that clearly indicates when readmissions are not related to the initial admission. This could mean re-evaluation of processes, physician and staff education, and building new rules to hold people accountable. As such, this too could prove to be a difficult task, so the sooner you prepare and practice, the better.

With accurate coding data, you'll be able to weed out the unrelated readmissions and focus on those admissions which are related. Only then will you be able to efficiently determine why readmissions are occurring and how you can prevent them. You'll be able to identify trends and sources (such as nursing homes) and solutions will become evident.

Underscoring the importance of reducing readmissions, the Institute for Healthcare Improvement has already begun an initiative to address readmissions. Reducing readmission rates is important from both a financial as well as quality perspective.

Cut Nursing Home Marketing Costs with Testimonials

2009-09-20T07:54:00.012-04:00

Marketing is expensive. With nursing home reimbursements on the decline, it is more imperative than ever to trim costs. During crunch times, marketing budgets are often among the first to be slashed in favor of direct patient care budgets. However, this can be detrimental to bottom lines when it leads to empty beds. So how do you balance effective marketing while conserving money? One way is the effective use of resident and visitor testimonials.

Notice the use of the word "effective." You already know testimonials are an effective way to connect with consumers and build trust - so let's focus on the best way to leverage these testimonials. It's no longer enough these days to put a couple glowing visitor comments on brochures that sit in your lobby. Consumers see right through hand-picked testimonials and place little value on them...that is, if they ever even come in to see your brochures.

Consumers are savvy these days when it comes to obtaining information to help them make informed decisions. They're accustomed to researching purchases such as automobiles and travel online, comparing vital facts like quality, price, features and consumer reviews. They expect, and get, detailed information on the products and services they need. Now they're beginning to transfer these expectations to their health care decisions as more consumer websites and government agencies spend time and effort educating them. As a result, consumers are turning to the Internet for information. According to Google, they had about a million Internet searches on the phrase "nursing homes" in August 2009 alone.

When these consumers search for nursing homes on the Internet, most pieces of information regarding quality, services provided, and even cost are found relatively easily. Consumer reviews however, are more difficult to find - and that's where your opportunity lies. By participating in and encouraging reviews on third party websites, you differentiate yourself from competitors and you begin to build trust with consumers. Having these testimonials on a third party website accomplishes two things: 1) Your information is more likely to be found and exposed to a wider audience because these sites specialize in driving traffic and 2) Consumers will be more likely to trust the information because it is coming from a neutral third party.

You can spend time and money on traditional marketing that may go unnoticed, or you can start building trust and relationships with consumers already searching for nursing homes by participating with an independent ratings website.

WhereToFindCare.com can help nursing home operators incorporate testimonials in marketing efforts at no cost. Visit http://www.wheretofindcare.com/PatientSatisfaction.aspx to learn more.

Improve Patient Satisfaction by Learning from Restaurants

2009-09-16T15:03:00.008-04:00

Patients usually rate providers in relation to some standard, namely their expectations. Therefore managing those expectations can be a critical way to improve patient perception and thus, patient ratings.

Some hospitals are managing patient expectations by posting their ER wait times online. Much like popular restaurants who tell patrons upon arrival how long they should expect to wait for a table.

Why would this work? Picture the alternative. Can you imagine waiting for a table not knowing how long you'll be there? The second-guessing at each seemingly eternal, passing minute ("should I have gone to a different restaurant? I've already waited this long, I might as well stay. But what if it's another hour? What if they call my name right after I leave and I'm starting over and stuck waiting at another restaurant for a table?!") All the while, other people with reservations (or as in the case of the ER, more serious conditions) walk right by you and are seated right away. You can't help but wonder..."did they forget about me?" And then you become irate. Suddenly you begin to look forward to completing the customer satisfaction survey you know you'll get when this is all over. This is what patients in waiting rooms go through every day.

Sounds like a nightmare doesn't it? Restaurants know that if a patron knows in advance that she will be waiting 30 minutes for a table, she will be less likely to complain about that wait. It's all about managing expectations. Start managing your patients' expectations by letting them know when you're behind schedule and give them an approximate wait time. Make sure you under-promise and over-deliver!

High Failure Rates Warrant Improvement of Test Result Management Systems

2009-06-23T11:57:00.006-04:00

A recent study by the Archives of Internal Medicine looked at the number of times practices failed to inform patients of abnormal test results. It found that failure to inform occurred in on in 14 cases. It also found that failure rates varied widely among practices - from 0% to 26%. Does your practice have a 26% failure rate? You can imagine the implications to your patients and your business.

Besides the obvious implications, not notifying your patients of test results will also increase inbound calls from patients looking for results. Your office staff will then be forced to handle inquiries in an disorderly and inefficient manner. It is much more efficient to process test results at the same time by the same person. And how satisfied do you think your patients will be if they have to follow up with you for a result?

Root causes uncovered in the failures include lack of processes or poor processes. The best practices had efficient processes in place to notify patients. Those practices with the highest failure rates did not have clear processes, did the work when they found the time and did not have official policies in place.

What you can do:

You can do a chart review to determine how often your practice has failed to notify patients of abnormal test results. However, if you have a "no news is good news" policy of not informing patients of test results, it is highly suggested that you reassess your process. The AHRQ advises patients to never make this assumption, and common sense says that you'll very likely have more inefficient inbound calls than necessary.

Flowchart your test result management process and identify weak points, redundancies and hand-offs. Set aside blocks of time and assign key staff to handle test results in batches.

If you need assistance, contact Enovasis Healthcare Solutions. Our experts can streamline your process and reduce failure rates with minimal disruption to your practice.

Guarantee Project Success by Getting Team Members Invested

2009-06-22T13:40:00.006-04:00

Getting your team truly invested in the outcome of your project greatly increases the chance of success. Team members who are invested are naturally inclined to work harder and to remove barriers within their control.

Getting everyone invested can be difficult, especially if you have members who were assigned to your project and don't even want to be involved. That's why we've compiled a few tips to help you:

1. Make it their idea. Who wouldn't want their own genius idea to succeed? you can do this by guiding your team in a brainstorming session. Plant a few ideas and watch them develop before your eyes. For example, if you know color coded flags outside patient rooms will improve flow, throw out an idea like "maybe some sort of visual cue would help nurses...." If they're awake, they'll take the lead and run with it.

2. Figure out what's in it for them. Obviously, if your project's success negatively impacts them, team members won't want it to succeed. Think about what will change for a team member, her department or her workload as a result of your implementation. Any negative (perceived or real) changes should be addressed. Sometimes simply discussing the issues will alleviate fears, but be prepared to make minor changes to your project if necessary.

3. Appeal to their intrinsic needs. Monetary rewards are rarely successful motivators in the healthcare field. Fortunately, your team members are probably in healthcare to help people. So help them understand how their work will improve the lives of your patients.

Employing these techniques with your team should quickly get you the level of investment you need from your team members for your project to be successful. Giving them ownership of ideas, alleviating their fears and appealing to their intrinsic needs will get your team members invested in and working for your project, not against it.

Do you have a tip? Share them by leaving a comment, we'd love to hear them!

If you need help with your team, contact Enovasis Healthcare Solutions for project management or team building assistance.

Secret Shoppers to Improve Your Healthcare Business

2009-06-22T12:53:00.013-04:00

Any health care business can benefit from implementing a secret shopper program. Hospitals, nursing homes, assisted living facilities, medical clinics and doctors' offices can improve not only patient satisfaction, but also quality, efficiency and profitability.

A healthcare secret shopper program is unique from retail programs in that the shoppers may have to undergo clinical testing to gain the full experience. Some programs go so far as to subject the shopper to diagnostic tests such as MRIs and blood draws, but rarely further than that. Your program need not go quite that far to reap the rewards of a secret shopper program; that's a choice you can make and depends on how far into the patient experience you want to evaluate.

Obviously, you'll have to weigh the cost of unnecessary procedures against the knowledge you'll gain from delving into those experiences from a patient perspective. If you're evaluating an imaging center's patient satisfaction, undergoing an exam is a major part of the patient experience. You should take that into consideration before you decide. On the other hand, if you're evaluating an emergency room, undergoing clinical procedures and exams might not be your primary concern (and they are more costly in this setting). You might prefer to evaluate just the triage experience and ask your shoppers to refuse treatment once they're sent to the back.

Whatever you decide, we've compiled a few tips to get you started on designing a successful healthcare secret shopper program.

1. Involve employees from the beginning. Secret shopper programs can be devastating to employee morale if executed poorly. Avoid this by simply keeping them informed. Better yet, involve them in the design process. For more information, read our previous post about getting your team invested in a project.

2. Set measurable goals and make them clear. Before you design your secret shopper program, identify your organization's goals. And don't pick goals like "improve patient satisfaction" or "reduce wait time." Make them specific and measurable so you'll know if the program is working. "Improve ER patient survey scores by 15%" is a good start. Make sure you clearly communicate your goals to employees before the program starts.

3. Evaluate strategically. Think carefully about what you measure and how you measure it. Include the visitor's perspective as well as the patient's. Establish a consistent grading system so you can compare units and departments. Measure on the same scale and use standard dimensions like "service," "process," "friendliness" and "professionalism." Don't use employees as secret shoppers. You run the risk that they'll be recognized and perhaps more importantly, you don't want to allow bias in the evaluation (or even the perception of bias). Finally, consider measuring process as well as experiential data. Have your shopper track wait times and how long it takes to accomplish key tasks like registration.

4. Analyze, report and share the results with employees. Post the results of every secret shopper encounter for all employees to see and to learn from. Consider creating friendly competition with contests and always reward positive outcomes.

5. Make improvements and educate staff. When outcomes aren't so positive, learn from the results, make improvements and educate staff. Do not make it punitive. Again, involving staff is very important and this is another opportunity to do that. Gather your team and identify solutions together.

6. Publicize your work. Let the public know what you're up to; it's a great way to show your commitment to your patients and visitors. Plus you could win over some new fans and increase your market share.

Our healthcare consultants can help you design and implement a successful secret shopper program. Contact us to learn more.

Update: Pay-For-Performance Coming to Nursing Homes

2009-06-09T16:06:00.004-04:00

Nursing homes in AZ, MS, NY and WI had until May 1, 2009 to apply for participation in the Nursing Home Value-Based Purchasing demonstration project. Award letters are expected to be sent out around June 1st 2009 to 50 selected nursing homes in each state. Each nursing home then has 30 days from the date on their acceptance letter to accept. The project will begin in the summer and last for three years.

Even if your nursing home is not participating in CMS's demonstration project, you can still benefit by learning more about it. If the program is successful, it will be expanded to more states and participation will likely eventually become mandatory. Understand the quality measures used in the project and identify areas of improvement for your facility now so you'll be ready. This will give you the advantage of extra time that your competitors might not have had.

For more information about the demonstration or the quality measures used, visit http://www.nhvbp.com or contact Enovasis Healthcare Solutions.

National Hospital Week Giveaway May 10-16

2009-05-11T12:00:00.002-04:00

The week of May 10-16 was designated as National Hospital Week to recognize hospitals and their employees and volunteers for all the good that they do for their communities.

Enovasis Healthcare Solutions is celebrating by giving away consulting hours and a WhereToFindCare.com Premium Home Page to one lucky hospital.

For the free consulting hours, we'll analyze a data set (up to 1,000 patients) and identify areas to improve revenue, cost or quality. These projects typically yield a return of $250,000 to $500,000 in opportunities.

The free Premium Home Page is a 1-yr subscription and is a great way to share testimonials of satisfied patients and display your marketing message to consumers choosing a hospital and comparing hospital quality/satisfaction performance.

To enter the drawing, just contact us or DM @bjoconnell by 5pm Friday 5/15/09 and mention the Hospital Week Giveaway. We'll draw one winner Monday 5/18.

Good luck and happy hospital week!

Pay-For-Performance Coming To Nursing Homes

2009-04-02T18:12:00.010-04:00

CMS is kicking off a five state pay-for-performance (P4P) demonstration project that will help them design incentives for quality improvement in nursing homes. They're calling it Nursing Home Value-Based Purchasing.

Arizona, Mississippi, New York and Wisconsin have been chosen to be the host states. Nursing homes in these states are invited to participate.

Basically how the demonstration project will work is over the next couple years CMS will collect quality data on participating nursing homes, assign scores based on performance and compare those scores to other nursing homes in the state overall and over time.

CMS will determine how much money is saved as a result of nursing homes' improvements and then allocate those cost savings to the best-performers in the form of incentive payments.

However if it is determined that nursing homes in a particular state did not improve overall, no incentive payments will be disbursed...no matter how well a particular nursing home performed.

If you're considering participating in the demonstration and would like assistance, Enovasis can guide you through it. Enovasis can also identify and implement improvements to increase the likelihood of receiving incentive payments. Contact us today.

For more information about the demonstration or to apply for participation visit www.nhvbp.com.

Lean Healthcare, Simplified

2009-04-02T08:42:00.001-04:00

Applying lean concepts to health care is all the rage these days, but you don't necessarily need to hire high-priced consultants to get started. The essence of "lean" is finding and eliminating "non-value added" work, or "waste." To get started, just follow these five simple steps:

1. Look closely at each of the tasks performed in a particular process (drawing blood, processing an MRI order, etc.) This is done by carefully documenting each step either in flowchart or list form. Your goal is to have a list of steps that is so complete that a new employee could use it as a guide. Sometimes the best way to accomplish this is to have someone unfamiliar with the process do it. They are unable to make assumptions and tend to ask more questions, resulting in fewer missed steps and more detail. Also, estimate the amount of time and/or cost is associated with each step.

2. Once each step is documented, ask this question of each: Does this task directly contribute to the service being performed or the patient being treated? In other words, does it add value to the patient? For example, if you're looking at a lab draw process ask, "is this directly related to testing the patient's blood? Does the patient care about it?" Indicate whether the task is value added or not next to each.

3. Now that you've identified the non-value-added steps in your process, your goal is to eliminate or reduce the amount of time spent on each. Think creatively and approach each step with an open mind. Are each of these steps absolutely required? Are they essential to the entire process? Is there a way to perform them more efficiently? Is there improved technology that can help you perform the task faster and more efficiently? Can you automate the task? Cross out all the steps you can eliminate and note changes next to steps that can be improved.

4. Document your new, highly-efficient process and compare it to the old. Determine how many steps, how much time and how much cost you saved by eliminating the waste.

5. Implement the new process and monitor the results. Check periodically to make sure the process is working and that staff are adhering to it. If there are problems, reassess the process and make corrections.

See, lean isn't so complicated! Sure, some complex processes can be daunting, but break them down into smaller processes whenever possible. Follow these basic steps and you'll be on your way to improving your organization's bottom line in no time.

If you need any help, our process improvement experts can guide you or tackle the project for you. Contact Enovasis Healthcare Solutions to boost your profitability.

Reduce Readmissions by Discharging to Better Nursing Homes

2009-03-18T15:16:00.010-04:00

In our experience, a common cause of hospital readmission is urinary tract infection (UTI) associated with catheter placement. This is especially true in the elderly and stroke populations discharged to nursing homes.

The belief is that a hospital treats a patient, sends her back to the nursing home from which she came, only for that nursing home to leave her catheter in too long which subsequently causes a UTI and associated symptoms such as "dizziness and giddiness" that look like they could be stroke related. Thus, the patient is admitted to the hospital, treated and the cycle continues.

Meanwhile, the hospital is unable to cover the cost of the admissions for various reasons: failure to document "present on admission," too many resources were used to diagnose the problem and rule out a stroke, the patient didn't meet admission criteria or payment for the billing DRG simply was less than the cost of the admission.

You can prevent these admissions quite simply by knowing more about the nursing homes to which you're discharging patients. We recommend looking at two pieces of quality information and sharing with families when choosing a nursing home:

1. Percent of long-stay residents who have/had a catheter inserted and left in their bladder (the national average is 5%)
2. Percent of long stay patients who had a UTI (the national average is 9%)

A quick search on nursing homes in our neighborhood yielded surprising results. We found one in Taylor, MI where 20% of long stay patients had a UTI. That's 11% above the national average! One might find that hospitals in that area discharging to this nursing home have higher than average readmission rates and are losing needless amounts of money.

If that is the case, these hospitals should quickly implement a procedure to present these simple pieces of information to families as they are making long term care choices. Armed with the right information, families can find better care for their loved ones and help you improve your bottom line.

Both of these indicators can be found on nursing homes across the country at WhereToFindCare.com. Simply search for nursing homes, click on the nursing home desired, click the Quality tab, then "See Details..." next to the Long Stay condition.

WhereToFindCare.com is working on a free tool to help you with this process. Join our mailing list to receive an update as soon as it is available.

Expediting Payment of Insurance Claims

2009-03-18T10:58:00.006-04:00

by Jeff Smolen

If you are reading this, you don’t need to be told that the bulk of your revenue is dependent on the major insurance companies, BCBS, HAP, Aetna, etc… Millions of dollars are spent by practices and hospitals on software to “scrub” the claims before they are submitted to insurance companies, but they don’t get you paid. Now tens of millions more are spent on FTEs to follow up and find out why these claims haven’t been paid.

Usually these FTEs are overworked, inexperienced, and turn over frequently. They also tend to be the lowest paid member of any practice. They spend a lot of time on hold, following up on these unresolved claims which are parked in the 90day+ column. Yet these employees fill a need since they try to get money on the 10%-20% of claims which are rejected, lost or “held in review.”

There is, however, another way to effectively handle the follow up on non responsive insurance companies…harness the power of third party impact.

The reason this approach works for hospitals and practices is that Insurance carrier by-laws and internal policies typically require immediate response to licensed third party contacts. In addition, third party demands move the responsibility for the claim from a clerk to a supervisor, who generally settles the claim more quickly. Even if the claim is rejected, the practice can more quickly move the bill to patient responsibility and resolve the balance issue. Bringing in a licensed 3rd party to pursue delinquent claims leads to a quicker resolution of claims, reduced FTE expenses, increased cash flow/profitability and lower office stress.

Jeff Smolen represents GreenFlag Profit Recovery by Transworld Systems. TSI has been providing medical practices, clinics and hospitals with cost effective A/R solutions for over 38 years. TSI has achieved Peer Reviewed status with HFMA, and has been an Adminiserve Partner with MGMA for 10 years. Jeff can be reached at 313-617-7360 or at jeff.smolen@transworldsystems.com.

4 Tips to Improve Hospital Bottom Lines

2008-12-17T17:19:00.002-05:00

Not even health care is immune to current economic conditions. Hospitals are reducing staff to control their increasing loses. But is this the best strategy?

Sure it’s a good time to reassess staffing levels but reducing staff costs money and hurts morale—critical to patient satisfaction scores. So what else can be done? Some ideas that can save at least a few FTEs:

1. Make sure Medicare is not unnecessarily penalizing you with transfer DRG payment reductions. For example CABG patients sent home too early and with homecare will not earn full payment. Be mindful of Medicare’s expected lengths of stay.

2.Take steps to ensure proper documentation of critical criteria for DRG assignment and avoid DRG downgrading. For example with PTCA patients, documenting the use of drug eluting stents or the presence of major cardiovascular diagnoses is imperative to the correct DRG assignment. Consider modifying the physician operative note to include reminders or create a new document that will trigger proper documentation.

3. Verify that Medicare’s “3-day rule” is being implemented correctly by your automated billing rules. Services unrelated to the inpatient admission do not apply and may be billed separately, thereby increasing revenue.

4. Reduce infections, complications and fall rates (see Falls article, this issue)

Don’t like these tips? There are plenty of other options. You can find new ways to improve profitability by performing methodical and thorough data analyses. Start by assessing the profits and losses on each of your service lines, drilling down to the DRG, physician and even patient levels while looking for patterns.

Need help? Find out how we can support you for as little as $100.

Measuring Patient Satisfaction Doesn't Have to Be Expensive

2008-12-17T15:20:00.000-05:00

Measuring patient satisfaction and loyalty traditionally has been extremely expensive. Because it is such a necessity, we've been forced to incur the high costs involved including survey development, maintenance, distribution, collection and postage.

On a mission to reduce the overhead cost of health care, our partners at WhereToFindCare.com developed a real-time solution to measuring patient satisfaction - for free.

To take advantage of the free survey tool, simply direct patients and visitors to WhereToFindCare.com where they can find and rate your organization.

Already have a patient satisfaction tool? Supplement it with non-patient data by using this tool. Capture data from family members and visitors who tend to influence health care choices. Custom patient satisfaction solutions are also available.

5 Tips for Handling Patient Pay Accounts Receivable

2008-12-17T15:12:00.002-05:00

By Jeff Smolen

Cash flow is the lifeblood of any practice. Here are five tips to maximize your patient pay efforts and increase your cash flow.

1. Collect Money Quickly–Have your front desk staff become great at collecting co-pays from every patient. $20 or $30 doesn’t seem like a lot of money, but it adds up quickly. Patients know that most practices won’t do anything to collect on those small balances. These balances end up hanging out there until the patient comes in again or the balance is written off.

2. Make Invoicing a Priority- Invoice as soon as the work is complete. The longer you wait, the longer you put your balance at risk.

3. Follow-Up! Be the Squeaky Wheel- As soon as a statement is past due, make a courtesy call. That means a bill due on day 30 should be contacted on day 31. Following-up early puts you near the top of their bills and most importantly, quickly identifies patients who need to be moved to the next phase of A/R management.

4. Know when to fold ’em… Know the true price of what it costs to send out each patient statement. Identify the point when continued billing by the practice starts to cost the practice money.

5. Use a third Party sooner- If you have asked for your money more than 3-4 times and have not been paid, you probably won’t be paid if you continue to do the same things. Third party contact gets results.

Jeff Smolen represents GreenFlag Profit Recovery by Transworld
Systems, which provides A/R solutions to medical practices, clinics
and hospitals. Jeff can be reached at 313 -617-7360 or
jeff.smolen@transworldsystems.com .

Effective Fall Prevention Programs

2008-12-17T15:06:00.001-05:00

By Dana Strong, Strong Consulting LLC

Does your facility have an effective fall prevention program as required per JCAHO patient safety requirement 9B? Is your program an effective one in view of the fact that Medicare no longer pays for "never incidents" such as patient falls in your facility.

If your facility has an existing fall prevention program that needs improvement, or is looking to start a new program, here are some important points to consider:

1. What is the true cost of having your PTs do a fall risk-assessment on all new admissions? Why not use Admissions or ER staff to do a fall risk- assessment instead?

2. Have you implemented a program that measures patient progress and outcomes both objectively and scientifically, eliminating human error?

3. Can your existing assessment program increase O/P revenues?

These are good points to consider when establishing a new or improved fall prevention program at your facility. Please contact us anytime for more information about fall prevention.

Dana Strong is Principal at
Strong Consulting, LLC. Reach
him at 207-883-8790 or visit
strongconsultingllc.com

Clinical Coding and Physician Documentation Improvement Tips

2008-09-25T16:36:00.001-04:00

By Mary Mills RHIT, CCS President & CEO of Documentation Solutions, LLC

Inpatient Coding Tip: Acute Myocardial Infarction

The following are five excluded Major Complications and Comorbidities (MCCs) for AMI patients that expire - MS-DRG 283-285. Review the medical record for alternative MCCs and CCs:

1. Cardiac arrest (code 427.5) – review for PSVT Coding Clinic, 3Q, 1995, p. 9

2.Ventricular fibrillation (code 427.41) – review for ventricular tachycardia (CC) or ventricular flutter (MCC)

3.Cardiogenic shock (code 785.51) - review for acute CHF diastolic/systolic (MCC)

4.Other shock without trauma (code 785.59) – review for sepsis (MCC)

5.Respiratory arrest (code 799.1) – review for acute respiratory failure or pneumonia (MCC)

Inpatient Physician Documentation Improvement Tips
Query physicians concurrently to document
1.The underlying cause of a high or low BMI – Dx: obesity, malnutrition
2.ECHO findings for a) diastolic or systolic dysfunction in CHF patients; b) significance of low EF with only hypohypokinesis documented; c) (? cardiomyopathy)
3.Diagnoses for administration of medications
4.Clarification on diagnoses that were POA
5.Etiology and severity of anemia
6.Significance of abnormal x-ray and lab findings
7.Pathological findings
8.Dehydration with low sodium levels(hyponatremia)
9.UTI patients with chronic indwelling Foley catheters
10.Urosepsis – is patient septic from urosepsis?
11.Etiology of skin ulcers, and specify the site of decubitus ulcers
12.The relationship between pneumonia and organisms on a sputum cultures

Resources: “2008 MS-DRG Workbook” by Documentation Solutions, LLC. (800) 419-6847

www.DocSolutionsLLC.com

Patient Satisfaction Data: Healthcare Improvement Goldmine

2008-09-25T16:22:00.004-04:00

There are no shortage of improvement projects to be done, but how do you know which ones are the most important? Ask your patients.

Health care is becoming increasingly competitive every day. Providers are trying to steal market share as overall volumes decrease. As any good business course will tell you, it is far easier and cheaper to retain customers than to obtain new ones. So how do you retain patients? One way is to keep them and their visitors happy.

Patient surveys can be immensely valuable in identifying trends or even uncovering unknown issues. Yet many organizations still have very separate patient satisfaction initiatives that rarely coordinate with improvement experts. Often patient satisfaction initiatives are led by a customer service department that doesn’t have the training or tools required to be successful.

Improvement experts and consultants can make a big impact on their organization’s performance and improve the efficiency of their customer service counterparts by incorporating patient satisfaction data in their opportunity analyses.

Doing so may reveal new or previously unknown issues before they become larger issues. Patients will tell you if that new check-out process designed to improve throughput is actually more difficult for them.

Patient satisfaction data will also help you prioritize projects. Why would you want to spend time and money shaving a few minutes off your billing process when your patients’ discharges are delayed 45 minutes because no wheelchairs can be found?

Some advice on using patient satisfaction data to identify improvement projects: Do identify trends, but don’t ignore comments. This experiential data is harder to mine, but is often better at identifying root causes. Categorize comments to speed up the process. Also, save money and increase response rates by using free web-based survey tools. Another source of experiential data is secret shoppers. These trained professinals pose as patients and record how they were treated as well as process issues.

CMS Update: 13 New Quality Measures

2008-09-25T16:03:00.002-04:00

CMS has adopted 13 of their 43 proposed new quality measures for FFY 2010. One measure, pneumonia oxygenation, has been retired, bringing the total to be reported to 42 (full list of CMS quality measures).

Two additional measures are expected to be approved next year, bringing the total up to 44. These are AMI and Pneumonia Readmit rates. Enovasis analysts expect one new measure in particular may be of concern for many hospitals: The Heart Failure 30-day Risk Standardized Readmission Measure.

According to MedPac, readmissions cost Medicare $15 billion every year—$12 billion of which is believed to be preventable. Almost 18% of Medicare patients are re-admitted to a hospital within 30 days of discharge. The Heart Failure re-admission measure, to be calculated automatically using Medicare claims data, may prove to be a source of many improvement efforts, time and resources. With this information becoming publicly available, hospitals should start monitoring and improving this rate as soon as possible.

Many hospitals have initiatives to reduce length of stay in the high-volume, high-cost heart failure category, but few monitor the repercussions of those initiatives closely. One major repercussion being a high readmission rate. If this rate is high at your hospital investigate your use of home care or other post-discharge treatment. Also analyze readmits by discharge day of the week or by post-acute provider to find clues as to what is causing returns.

Contact Enovasis Healthcare Solutions if you need assistance.