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An Article on ICD-10 We Wanted to Share

Posted by Allison on Wed, Sep 02, 2015 @ 05:01 PM

Have insurers established ICD-10 accommodation periods?

Most are mum about plans as deadline draws near

As the Oct. 1 ICD-10 deadline inches closer, many insurers haven't announced whether they have implemented accommodation periods--when they will pay claims that aren't coded correctly as long as they're in the right family of codes, reports Health Data Management.

After Health Data Management contacted seven national insurers, as well as the Blue Cross and Blue Shield Association and America's Health Insurance Plans to learn about their ICD-10 contingency plans, only Humana, Aetna and AHIP responded and none actually addressed whether they had accommodation periods prepared.

Medicare said in July that it reached an agreement with the American Medical Association that it won't deny or audit claims based solely on the specificity of diagnosis codes for the first year after ICD-10 useFierceHealthIT previously reported.

Although private insurers aren't announcing their ICD-10 contingency plans, they're likely still planning to offer some similar concessions to providers. But they don't want make these plans public so providers and vendors continue working to prepare for the ICD-10 compliance date, Pat Kennedy, president of PJ Consulting Inc., which specializes in electronic data interchange and insurers, told HDM.

Kennedy said he expects insurers to announce their accommodation periods within the next month. Part of the concessions they will offer will likely include extra staff to help make the transition to ICD-10 smooth.

He added that large insurers will probably be working hard to accommodate providers for at least six months.

"This is a tough one, tougher than anything we've ever had to do, and the payers and vendors know that," Kennedy said.

To learn more:
- read the Health Data Management article


Tags: healthcare, ICD10, healthIT, Scribe, Medical Scribes

New article on benefits of scribes...

Posted by Allison on Mon, Jul 27, 2015 @ 05:03 PM

Got scribes? Study says they could make ED testing more exact


Querying a health information exchange can lead to significant reductions in laboratory tests and radiology exams, according to a new study of more than 2,000 emergency department visits in three western New York hospitals.

The study was published in the Journal of the American Medical Informatics Association, conducted by the Brookings Institution and supported by HealtheLink, the Buffalo, N.Y.-based health information exchange. 

It began in late March and ran through late May in 2014. It divided ED patients into two groups, one composed of 737 patients whose ED physicians had scribes who queried clinically relevant information on each patient. Members of a second, control group of 1,275 patients were seen by ED physicians whose prior records were not queried through the exchange. 

According to the study results, usage of the HIE was associated with a 52% reduction in the expected total number of laboratory tests and a 36% reduction in radiology examinations ordered per patient at the ED. 

The study's secondary result proved the efficacy of using scribes. 

According to the study's principal researcher, Brookings fellow Niam Yaraghi, scribes were used to ensure 100% of the patients in the study cohort would have queries run through the exchange. 

“If we had asked the doctors to do it themselves, they wouldn't do it,” Yaraghi said. “The HIE access rate is about 6% to 7% of the patient encounters. Physicians don't have the time to do it.”

“The mere existence of them (scribes) point to the user unfriendliness of our EHR systems,” Yaraghi said. “Without the scribes, there are seven clicks that (a physician) has to make to go and find patient information. And also he (or she) has to type in the name and the identifiers of the patient to find it. But if they could just push a button, based on the patient identification information, the query could be automatically run and the information could be loaded on the screen with one button.”

Physicians say they like to use scribes because doctors find EHRs slow and clunky to use, interfering with their interactions with patients. Those complaints have only increased in the years since EHRs have come into broad use.

The costs of scribes range from $10 to $20 an hour, according to a 2011 white paper by the American College of Emergency Physicians. The ACEP paper estimated, based on interviews with scribe service providers, that 1,000 hospitals and 400 physician groups are using them. The ACEP study found a return on investment greater than 100%.

Tags: Scribe

An Article We Wanted to Share

Posted by Allison on Tue, Jun 30, 2015 @ 07:26 PM

Repeat emergency room visits more common than previously thought

New research suggests that ailing people should be more pushy about getting follow-up care.

Dr. Reena Duseja, lead author of a study on emergency room visits, stands in San Francisco General Hospital's emergency room. No one wants to make a repeat visit to the emergency room for the same complaint. But new research suggests it's more common than previously thought.
The Associated Press
Dr. Reena Duseja, lead author of a study on emergency room visits, stands in San Francisco General Hospital's emergency room. No one wants to make a repeat visit to the emergency room for the same complaint. But new research suggests it's more common than previously thought. The Associated Press

WASHINGTON — No one wants to make a repeat visit to the emergency room for the same complaint, but new research suggests it’s more common than previously thought and, surprisingly, people frequently wind up at a different ER the second time around.

Already some ERs are taking steps to find out why and try to prevent unnecessary returns. A Philadelphia hospital, for example, is beginning to test video calls and other steps to link discharged patients to primary care.

The new research, based on records in six states, suggests patients should be pushy about getting follow-up care so they don’t have to return to crowded emergency departments.

“You need to make sure the next day, you connect the dots,” said study co-author Dr. R. Adams Dudley of the University of California, San Francisco. “You cannot count on the health system to connect the dots.”

It’s also a reminder of how disconnected our health care system is. Chances are, your primary care doctor won’t know you made an ER visit unless you call about what to do next.

And if your second visit was to a different ER, often doctors can’t see your earlier X-rays or other tests and have to repeat them. While more hospitals and doctors’ offices are trying to share electronic medical records, it’s still far from common.

“It’s frustrating. We’re open 24 hours a day and we don’t necessarily have access to those records,” said UCSF assistant professor Dr. Reena Duseja.

Duseja’s team analyzed records from Arizona, California, Florida, Nebraska, Utah and Hawaii, among the first states to link records so patients can be tracked from one health facility to another. Researchers checked more than 53 million ER visits in which the patient was treated and sent home between 2006 and 2010.

About 8 percent of patients returned within three days, and 1 in 5 made a repeat visit over the next month, Duseja reported this month in Annals of Internal Medicine.

A third of revisits within three days, and 28 percent over a month, occurred at a different ER. Duseja couldn’t tell why – if patients were dissatisfied the first time, or traveling, or for some other reason.

Patients with skin infections were most likely to return, followed by those with abdominal pain.

State rates varied a bit, with 6.2 percent of Arizona patients returning within three days compared with 9.3 percent in Utah.

Revisits may be appropriate, Duseja said. Nearly 30 percent of revisits involved hospitalization, suggesting either patients got worse or emergency physicians felt more scrutiny or testing was warranted.

Also, sometimes ERs tell patients to return. In the ER at San Francisco General Hospital, Duseja sees many Medicaid or uninsured patients who have trouble finding a primary care doctor or specialist.


Tags: healthcare, emergency

EHR and EMR Management - getting data and making sense of it all

Posted by Allison on Thu, May 21, 2015 @ 03:20 PM


A new DOTmed article on EHR and EMR management has some good points on the use of EHR and EMR and the new rules and regulations. This article found some important information about use of EHR and EMR. 

  • Last year, the Centers for Medicare and Medicaid services announced that 257,000 doctors, or about one third, had failed to achieve meaningful use of electronic health records, and would see Medicare payments cut by 1 percent in 2015. 
  • CMS announced earlier this year that it intends to modify requirements for meaningful use in 2015.
  • Hospitals and physician practices are still being required to move down the path to recording and exhanging information in a meaningful way.
  • Health IT companies are responding with new products that promise easier image sharing and workflows, time saving, and interoperability.

While the new IT is great for the advancement of healthcare, doctors are facing new burdens. The documentation burden is present more than ever before, and these doctors need assistance if they are going to provide quality care to patients. Medical scribes are growing in popularity, because they can help with the growing burden these doctors face when it comes to documentation. 

Here are some recent facts on the growth of medical scribes and EMR: 

Tags: healthIT, Scribe, EMR, EHR

New Center for Healthcare Transparency Can Transform The Industry

Posted by Allison on Sat, May 02, 2015 @ 04:29 PM

There is a newly formed Center for Healthcare Transparency (CHT) that is part of Centers for Medicare & Medicaid Services (CMS).

This new center aims to strengthen quality and cost information when it comes to healthcare. The program has ambitious goals, including, wanting half of the U.S. population to have access to reliable cost and quality information by 2020. Many healthcare leaders have been looking for something like this, because now is the time for changes that can improve efficiency. Without a doubt, the healthcare system is going through a transformation. According to the chief data officer for CMS now is the time for this new program and the new changes. He states, "A few years ago, you could've put everyone interested in transparency in a closet, and there would've been room left over." 

Recently, CMS took a major step in the direction of transparency in healthcare processes. It released data on Medicare Part D that indicated that the program spent $103 billion on prescriptions in 2013. The AMA criticized this, stating, "troubled by the lack of context provided with that could help explain physician prescribing practices and pharmacy filling practices before conclusions are drawn." So, there are clearly some issues with transparency, and in particular price transparency; this issue of price transparency is gaining some importance due to the rise in medical options and increase in consumerist healthcare trends. It is clear that this industry is changing at a rapid rate. Anytime there is change, in any situation, transparency can help aid any new challenges and can provide good insight into just how effective the changes have been. The CHT will be a good step in the right direction.

CHT can help tackle the issue of accountability in this ever-changing healthcare industry, and this is vital now especially, because of new technologies and new ways of practicing medicine that are different than they have been historically. Value-based payment models are a hot topic related to this, and there will be more information and more programs rising out of these new models. David Lansky, CEO of Pacific Business Group on Health, summed up the importance of transparency, saying, "if we're going to pay everybody based on value, we better be measuring it in a sensible way." 

What does this mean for medical scribes and EMR? Having a medical scribe in the picture helps track patient data more effectively and accurately. This goes to together with transparency, because accuracy and transparency are linked. It seems that more transparency is inevitable, and scribes already contribute to transparency, because of their documentation expertise. EMR use has been shown in many instances to increase productivity and efficiency by keep more accurate records of patients medical visits and history. 

Information gathered from FierceHealthcare article, "Center for Healthcare Transparency aims to strengthen qualilty, cost information" 

Tags: healthcare, Improve Efficiency, healthIT, EMR

The Hot Growth Area That is EMR and Scribes

Posted by Allison on Tue, Apr 14, 2015 @ 08:30 PM

A few years ago, one of the first big whitepapers on EMR as a hot growth area for staffing came out, titled "The Electronic Paper Trail: Why EMR is Staffing's Hot Growth Area", and this piece identified the EMR growth in healthcare. But, with this "hot growth area" that is EMR staffing for implementation comes another piece to the puzzle, one that our team at Scribe Solutions is very familiar with: the medical scribe. The article says, "healthcare information technology is the new big thing in staffing, thanks to the growing need for healthcare organizations to implement electronic medical record (EMR) systems. While this article is correct in saying that there is/was a growing need for healthcare organizations to implement EMR systems, since this article was written in 2011 some of that has changed and the new need is for data entry. There was an initial wave of EMR systems implementations following the Affordable Care Act becoming effective in 2010.

While some organizations still have a need for EMR systems implementation, there is a new need tied to Health IT, as mentioned above, and that need is for data entry into these EMR systems. Patient records need to be properly documented online, especially with meaningful use requirements in place, and often times this documentation  adds extra hours of work to doctors' already busy work schedules. Here is where scribes come in: scribes take away this burden, and as the meaningful use deadline approaches, hiring scribes is more important than ever for these busy physicians. 

More literature has come out on the need for scribes, and the benefits of hiring scribes are becoming more evident. The American Academy of Orthopaedic Surgeons boldly highlights these benefits in its published paper on the benefits of using scribes. On the top of the AAOS paper it is clearly stated in the header:Physicians can spend more time with patients; charting accuracy is increased. 

The AAOS paper's author, a physician himself, makes a strong case for hiring scribes, and who better to hear this news from than a practitioner himself. G. Klaud Miller, MD, the author of the paper, is a member of the AAOS Practice Management Committee who is in private practice in Chicago. Miller highlights the reasons why scribes are key to success in the age of required documentation using EMR, advocating:"...using a scribe saves time. The physician never has to do after-hours dictation in the office or bring charts home to dictate. The chart is completed when the physician leaves the examination room. A physician who sees 20 patients a day and spends 5 minutes per chart dictating or writing the notes saves more than an hour and a half of time by using a scribe. Independent of any of the other benefits, how much would you pay to get an extra hour and a half or more per day?"

He says it best when it comes to summing up just how helpful hiring scribes is and how using scribes is the way of the future, stating, "Although using a scribe may sound like a luxury to some, I have found that scribes more than pay for themselves in numerous ways, and I would never practice without one."


Tags: healthcare, meaningful use, healthIT, Scribe, EMR

ICD-10 On the Radar: It's Time to Get Ready

Posted by Allison on Sun, Mar 15, 2015 @ 11:50 PM

ICD-10 is really here. Yes, for real. After three delays and much discussion and deliberation, ICD-10 is near. 

This October ICD-10 will really happen. Here's the deal: 

  1. The ICD-10 deadline was first set for October 2011, then for October 2013, then for October 2014. 
  2. But, it seems that the fourth time just might be the charm. 
  3. Recent proceedings in the House Energy and Commerce Health Subcommittee hearing on ICD-10 featured seven witnesses, with only one of these witnesses opposing the transition to the new code set. 
Another Matrix Code v2 0 by luttman23
This hearing was preceded by the publication of a Government Accountability Report that determined that the Centers for Medicare and Medicaid Services (CMS) has taken positive steps to help the healthcare industry prepare for the switch to ICD-10. Despite delays and opposition, the switch to ICD-10 is on its way due to government activity this time around. ICD-10 has been included i another doc-fix bill, and lawmakers will be on record this time around as having discussed ICD-10. But, why do some people still raise concerns and oppose the switch to ICD-10? Some concerns, which are valid, center around encountering obstacles following the transition to ICD-10, especially barriers related to practice management since medical practices are not one-size-fits-all. Related to these concerns are questions related to scope and size of medical practices and new requirements mandated by government legislation.
ICD-10Watch author Carl Natale had some key comments on this topic, explaining that if Congress were to find a way to fund implementation costs for small medical practices and independent physicians, than the transition wouldn't be nearly as much of an issue. 

Tags: healthcare, ICD10, EMRs, healthIT, Medical Scribes

Healthcare Woes? Hospital Inefficiencies and Possible Solutions

Posted by Allison on Fri, Feb 27, 2015 @ 11:08 AM

Workflow and organization management are important concepts to healthcare as a whole, but specifically these concepts are key to hospital management. Not only can flaws in workflow hinder the activities of hospitals, but also it can cost a great deal of money to correct flaws. 

A recent survey by the Ponemon Institute of 400 plus healthcare providers discovered that poor communication on its own has an estimated economic impact of $1.75 million per U.S. hospital. Also, the survey found that this inadequate communication alone has an estimated annual economic impact of more than $11 billion industry-wide.  

It is clear that many of these costly issues are complex in nature, but some quick fixes can be implemented to decrease inefficiencies. 

  • In addressing lack of effective communication methods: the use of secure text messaging could increase productivity and minimize economic loss by about 50 %
  • Looking at duplicate documentation requirements: eliminating inefficiency here can allow for more patient time and higher quality patient care and management can fix this by surveying the system to find duplicates and then can address EHR issues with the vendor; next the duplicates can be reconciled with the EHR provider
  • Dealing with patient flow: address processes and review occupancy and manage ORs and facilities by providing a process for scheduling date and time of patient discharge at least one day in advance
  • Ensure appropriate hospital admission: provide practitioners with resources, for example options such as social workers, nursing homes, behavioral health centers, skilled nursing centers and rehab services to eliminate inappropriate hospital stays
  • Avoid incomplete medication reconciliation: try to obtain adequate information from patient, but also use EHR effectively to ensure accuracy 


Tags: healthcare, healthIT, patient satisfaction, employee engagement, Scribe, EMR

EMR as a Tool for Teaching

Posted by Allison on Wed, Feb 18, 2015 @ 03:18 PM

As electronic medical records take their place in modern medicine, new questions arise as to the use of EMR, medical education and technology, and the use of electronic documentation as a tool for teaching. 

Now, first year medical students are tech-savvy and able to be on top of the times when it comes to health IT. EMR is starting to be included as part of medical curriculum.  This new addition to many medical education programs adds value. EMR is relevant to medical education because electronic documentation is becoming a necessity, especially with new meaningful use requirements and the shift to ICD-10. 

EMR education can be beneficial to not only medical students, but also to nurse practitioners, physician assistants, and physicians. The electronic medical record can be useful in guiding through the process of assessing the patient. The EMR helps give insight into the background of the patient and can help lead to the key facts and information to reach a potential diagnosis. EHR use can help in listing red flags, risk factors, and warnings about potentials risks for the patient in reaching a diagnosis. For example, EMRs can warn about patient drug allergies or interactions and assist in addressing patient treatment programs. This can help providers to limit their liability. For medical students and healthcare professionals learning the new technology and where technology intersects with patient care, EMR teaching can be truly beneficial. 

Information gathered via LinkedIn post:Using the Electronic Medical Record as a Teaching Tool

Tags: EMRs, Improve Efficiency, healthIT, patient satisfaction, EMR, EHR

Are You Ready for ICD-10?

Posted by Allison on Fri, Feb 13, 2015 @ 11:15 AM

Is your practice or organization ready for ICD-10? 

It is clear that ICD-10 needs to be taken seriously. Experts are weighing in, and they are noting that ICD-10 should not be underestimated. For example, Health IT policy director for the Medical Group Management Association, Robert Tennant, wrote on ICD10monitor.com that, "Any organization that looks at the past delays for the coding system and doesn't take the upcoming compliance date seriously is putting their revenue at risk." 

So, since it is vital that your organization take ICD-10 seriously, what can you do to ensure readiness? 

Here are some ways to prepare for the implementation of ICD-10:

  • Have an impact chart - conduct an impact assessment and obtain information discovered by this; assessment will show the area impacted and what changes to organization processes will need to happen, and will bring to light impact on coding and billing and vendor management 
  • Complete Documentation - Make certain that patient documentation is accurate and up-to-date; ensure accurate codes, and most accurate information has been included in patient records. This will facilitate changes tied to ICD-10 and will help make certain no payments are delayed or denied
  • Test - Testing and practice can ensure preparedness; providers can practice billing and coding in old systems but can make sure the information is right to assign the most specific ICD-10 codes

Practices need to maintain systems and continue to improve on implementing technological changes. EMR use can be beneficial, but if not used properly or in the most efficient manners, EMR can be a hassle to organizations. It is important to be prepared and to stay updated on CMS news and continue proper billing and coding and patient record documentation. EMRs benefit practices and organizations by maintaining an electronic paper trail of patient visits and medical conditions and history. Using EMRs can be overwhelming and now with ICD-10 it is clear that physicians and their staff are swamped with work. Hiring a medical scribe could be helpful to your organization. If interested in hiring a medical scribe to help with the proper documentation of patient records please feel free to submit an inquiry on scribesolutions.com. 


Information gathered from FierceHealthIT feature on ICD-10 readiness

Tags: ICD10, healthIT, employee engagement, EMR