Proposed Medicare Cuts Could Slow IT Investments
Proposed Medicare physician payment cuts of approximately 5.1 percent (which, at press time, were still being debated) could slow IT adoption, said former Centers for Medicare and Medicaid Services Administrator Thomas Scully at the Medical Group Management Association conference in Las Vegas. "This is the number one issue facing Congress as it comes back, but I don't think they will get it done," he said, referring to Congress' ability to roll back the cuts before the take-effect date of Jan. 1.
Scully, who held the position of CMS administrator from 2001 to 2003, sang the praises of CMS' desire to move toward a pay-for-performance-oriented system, rather than one that reimburses based on volume.
"We must get rid of price fixing where everyone gets paid the same thing whether they are the best or the worst doctor," he said. "Price fixing has never worked in the history of the world."
He also spoke in favor of CMS' move to transfer some of its beneficiaries from the traditional Medicare plan to privatized plans like Medicare Advantage. "Private payers will do a better job because it will be their money that is at risk" he said. "To be honest, my old employees (at CMS) don't care whether they pay out $330 million or $350 million (in claims), they go home at 5 p.m."
MGMA SESSION HIGHLIGHT: EMR Tech Adoption
Scott Johnson, MBA, administrator, Digestive Disease Associates, Gainesville, Fla.
10 physicians
Vendor: A4 Health Systems, Cary, N.C. (now part of AllScripts, Chicago)
Implementation Start: August 2002
Live: November 2002
Results:
faster chart access (no chart pulls)
electronic messaging between patient/staff, staff/physician
Reduced staff by five people over four years (attrition)
63 percent reduction in transcription costs
physicians gained 60-90 minutes per day in the office
legible prescriptions
Lessons Learned:
don't expect to reduce staff in the first 12-18 months
be ready to establish implementation incentives
reduce RFP to three vendors
ask vendors to do site visits
put positive people in charge
commit the proper resources
Pete Donaldson, MBA, administrator, Digestive Health Specialists PA, Winston Salem, N.C.
6 physicians
Vendor: gMed, Weston, Fla.
Implementation Start: November 2002
Live: January 2003
Results:
faster chart access (no chart pulls)
faxes quick and accurate
handwriting confusion gone
billing processing is faster
electronic backup for data
less hold time for patients
able to conduct 40 percent more business with no additional staff
Lessons Learned:
must have an EHR champion
need an emergency backup plan
the volume of to-do messages that can build up in physicians' inboxes can be psychologically difficult to deal with
implementation was a struggle but system proved to be a "huge, huge" benefit to staff
Kathy Sammis, administrator, Charlotte (N.C.) Gastroenterology & Hepatology PLLC, and president of MGMA GAA
17 physicians in five regional offices (3-5 physicians in each)
Vendor: NextGen, Horsham, Pa.
Implementation Start: July 2004
Live: December 2005 (began bringing up one office at a time)
Results:
financial savings from reduction in storage space (now used for clinical needs)
immediate access to patient's chart
easy to track labs, nurse calls and scheduling
Lessons Learned:
spend ample time working with physicians
administrator must act as a translator for IT staff/physician communication
bring one site at a time live on the system
transition can be a painful one for the physicians (changing habits), office staff is quick to embrace
allow customization only after everyone is familiar with the core system
realize that version seen during vendor demo is full of bells and whistles which require time-consuming customization to enact
build in costs for scanning in old files, which can be expensive and time consuming
All In
It's all or nothing when it comes to implementing an EMR at a medical practice, according to Cecile Katzoff, MGA, director and vice president, consulting services, with the AGA Center for GI Practice Management and Economics, Bethesda, Md. That's because one intransigent doc who refuses to give up his paper chart can destroy the entire cost-benefit scenario.
"You must get rid of all the paper," she said. "You can't do both."
Katzoff also suggested devising a timeline for shredding old files once the information has been ported into the electronic medical record (EMR) and cautioned against allowing doctors to "free text" into the EMR rather than devising standard templates for entering information.
Interoperability, as in all things, came up as a key in EMR success. "Make sure your EMR can talk to your hospital's information system," she said.
Lastly, when structuring a vendor contract, realize that the relationship is a long-term one. "You are going to need ongoing training and physician support," she added. "This is a huge investment."
MGMA Goes Virtual
In an effort to help practices look before they leap, MGMA is offering a medical practice simulation tool.
"It offers real-world outcomes without real-world consequences," said William Jessee, M.D., FACMPE, president and CEO of MGMA.
The simulation uses responsive-modeling technology based on historical data and MGMA survey reports.
The tool allows a 12 physician practice to cram three years worth of developments into a five week simulation period. The program requires the completion of 10 to 15 tasks per week in the areas of leasing space, expanding services, the effects of employee morale on productivity, implementing an electronic health record (EHR), modifying the payer mix and adding a new service or physician.
Tool Promotes Patient Safety
Figuring that practices can only improve patient safety is if they understand their current situation, the Englewood, Colo.-based Medical Group Management Association (MGMA), the Chicago-based Health Research and Educational Trust (HRET) and the Huntingdon Valley, Pa.-based Institute for Safe Medication Practices (ISMP) have released the Physician Practice Patient Safety Assessment (PPPSA).
The new Web-based tool (http://www.physiciansafetytool.org) enables medical practices to evaluate daily processes by studying a workbook produced after they complete the PPPSA.
The PPPSA helps practices evaluate their risk across multiple locations in the areas of:
medications,
handoffs and transitions of patients between clinicians or locations,
surgery and invasive procedures,
personnel qualifications and competency,
patient education and communication and,
practice management and culture.
Data analysis and benchmarking information will also be available (for a fee) to practices that submit their data online. All data submitted are confidential.
