Patient Engagement Drives ACOs

With patient-centered medical home (PCMH) and accountable care organization (ACO) participation on the horizon, Pradeep Vangala, M.D., president of the eight-provider Orlando Internal Medicine, says that the documentation requirements for his practice were quickly adding up to become overwhelming. That’s why he says his practice implemented patient engagement software, from the Orlando-based PatientPoint, to automate care coordination processes.

“The fee for service model is becoming obsolete with each passing day,” says Dr. Vangala. “It’s fee for performance, so you have to ask patients for all these care coordination [activities], medications, do the depression screenings, if you want to get paid moving forward. If you do all that manually, imagine how long it takes. The system does it all for me [now], and the nice thing is, it doesn’t interfere with the patient flow.”

Two years ago, Orlando Internal Medicine became a beta user of PatientPoint’s patient engagement software and implemented six touch-screen laptop kiosks with credit card scanners in the waiting room for patient check-in and check-out. Patients could now use kiosks to fill out demographic information, verify current medications, verify insurance carrier, pay their co-pay, and answer smoking or depression screening questions if relevant.

Orlando Internal Medicine has a two-way integration between the patient engagement software and its electronic health record (from the Chicago-based Allscripts). The software pulls the appropriate data from the EHR to ask the right screening questions and avoid asking unnecessary questions, and the patient-entered data is sent to the EHR on a screen that is presented to the clinician. The clinician validates the information and acts on the appropriate measures before the patient-entered information becomes part of the medical record. The software also has an online patient portal component that allows patients to log on to request an appointment, pre-register for upcoming appointments, and pay bills.

Orlando Internal Medicine, which sees 60 patients a day and has a total patient population of 8,000, sees many benefits to this software, like decreased patient wait times and increased revenues, according to Vangala. The laptop kiosks streamline the patient check-in process, so multiple patients can check-in at the same time, rather than one by one. Another waiting room benefit is privacy, says Vangala, with this software “you are much more HIPAA-compliant because the patient is not talking, they’re entering the data, so no one can hear.” Time is saved in the exam room as well, two to three minutes per patient visit, says Vangala, since a clinician doesn’t have to ask screening or medication adherence questions and record the answers.

Vangala says the software generates several buckets of revenue for the practice. “Through better care coordination it helps improve patient care, and it does all this with minimal cost to the practice.” Not only does the software do a better job of collecting visit co-pays, Vangala says, but it simplifies the collection of fees associated with the patient screenings. The system auto-generates the appropriate CPT code to bill the payer, as well as helps the practice get reimbursed for certain care coordination activities for Medicare Part D patients. Vandala says that his practice has increased its revenue to upwards of $15,000 per month. Orlando Internal Medicine pays no cost for the software, hardware, maintenance, or upgrades, but instead pays a percentage of its collectibles to the software provider. (PatientPoint handles the practice’s billing as well.)

In the beginning, one challenge the practice faced was patient education and adoption. Their average patient age is 63, so appropriate training was necessary and has since paid off with a more than 90- percent compliance rate. Vangala also says that software integration with his practice’s EHR took considerable time upfront to build, but now upgrades are seamless.

Through the software, Orlando Internal Medicine can also track its compliance with e-prescribing and meaningful use requirements. So far the practice has submitted to the 2011 eRx Incentive Program and received reimbursements. The practice plans to attest to Stage 1 meaningful use before the end of year after tackling the one lacking requirement: offering 50 percent of patient encounters a printed patient care summary.