Archive for the ‘healthcare consulting’ Category

2012 was a busy year for us here at Derry, Nolan & Associates, LLC. As Barbara and I begin our 10^th year of business, medical practices nationwide have seen their bottom lines erode due to rising costs and declining reimbursement–oncology and cardiology, in particular.

Over the past year, Barbara has right-sized a local oncology clinic by ensuring that staffing ratios are commensurate with the number of providers and their productivity levels, ensured waste-free administration of high-priced oncology drugs (as well as negotiating better prices), plus she formulated a robust marketing plan that generated many new patients.

I answered a call in mid-September that took me to Texas, where I’ve been the interim manager for a large cardiology practice.  I’ve assisted them through a computer conversion, implemented many process improvements and helped the cardiology providers and staff “adjust” to hospital ownership and the loss of their thirty-year independence.

Once again, we’re proud to say we’ve met the goal of leaving our medical practice clients better off than we found them. And we very much appreciate the trust placed in us to implement the recommendations made. Now both of us have begun a new project where we’ll be assisting a large integrated healthcare system in Seattle. For this new multi-specialty project, we’ll use the Derry, Nolan proven business principles that have always served our clients well.

As we swing into 2013, the general state of the healthcare industry hasn’t changed. Healthcare organizations are challenged to eliminate waste, to ensure that people work smarter and to provide quality services that will now be measured—pay for performance!  To achieve those ends, we suggest that you follow our lead by:

1. Looking at year-end financials for the previous year; it’s a great time to consider how to improve the bottom line in 2013!
2. Scheduling ICD-10 Coding training to assure optimum reimbursement & coding compliance.
3. Reviewing staff functions to assure the right person is doing the right work – and is cross trained!
4. Scheduling privacy & security training – both new workforce and a refresher for current staff.
5. Spot-checking or “secret shopping” customer service – how happy are your patients?
6. Querying referring physicians, too—how happy are they with your services and communications?

Wishing you and yours health and happiness in 2013!

Seattle, WA – Derry, Nolan & Associates, healthcare medical practice consulting firm, has announced that associate consultant Melania “Lani” Antonio, Certified Professional Coder, achieved certification through the American Health Information Management Association as an AHIMA-Approved ICD-10-CM/PCS Trainer. The ICD-10 system is a diagnostic procedure classification system developed by the World Health Organization and used in nearly all industrialized nations, except the United States and Italy.

“We are proud of Lani’s achievement,” states Crystal Nolan, partner and principal consultant at Derry, Nolan. “As a CPC, she’s always been at the forefront of helping physician practices gain great strides improving their coding accuracy, which is integral to improving efficiencies and lowering the practice’s overall operational costs.”

As Barbara Derry of Derry, Nolan explains, “Our medical practice consultants commit themselves to helping our physician clients achieve maximum operational efficiency. Lani has over 20 years of experience working with healthcare organizations to help them implement best practices for coding and billing.”

Ms. Antonio, a coding and reimbursement specialist, shares, “My hope is that although there is potential for delay, physicians and their practice leadership will increase efforts to get up to speed on the ICD-10 coding procedures. I look forward to helping our Derry, Nolan clients achieve this next level of efficiency.”

The ICD-10 coding system boasts 68,000 diagnostic codes (over the ICD-9’s approximately 10,000), supporting detailed, accurate diagnosis and procedure coding, and therefore accurate payment (reimbursement), of claims. HHS Secretary Kathleen Sebelius has issued a proposed rule to delay transition compliance for ICD-10 from October 1, 2013 until October 1, 2014, but a final rule has not yet been issued.

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About Derry, Nolan & Associates, LLC

Derry, Nolan & Associates is a medical practice consulting firm based in the Pacific Northwest. Barbara Derry and Crystal Nolan, founders and principals of Derry, Nolan, head the team of healthcare experts. Since 2003, they have helped Pacific Northwest clinics, medical practices, physician groups, hospitals and integrated healthcare systems improve profitability, operations and quality outcomes.

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A much-touted HHS/OCR ruling regarding a small Arizona cardiology practice underscores the importance of strong compliance with HIPAA privacy and security regulations. As we mentioned in our recent post “Physicians & Social Media: Responsible Online Patient Interactions” – protection of ePHI is paramount when communicating with patients via mobile technology. Note that the HHS Resolution Agreement mentions text messaging specifically (p. 8 & 9).

The Arizona practice failed in several key areas, not the least in training their employees properly on privacy and security compliance. The patients paid the price of privacy infringement, and the practice has paid much more than the $100,000 penalty fee – their violations have been referenced in a multitude of online publications and short blogs for over a month, now. For a small practice, such a blow to reputation can be devastating.

Healthcare, and indeed, any organization handling PHI, must assure the proper safeguards and vendor agreements are in place. HHS is paying attention to organizations of all sizes, not only the large health systems and insurance carriers.

Source: http://www.hhs.gov/news/press/2012pres/04/20120417a.html

With the NYSE resembling a roller coaster ride, 2011 was another tumultuous year for the global economy. It put us much in mind of Derry, Nolan’s own beginnings in 2003. The economy was less than ideal and President Bush had declared war on Iraq. Despite those challenges, we remained focused on our goal to help medical practices.

In the first six years of business, we did a lot of medical practice assessments. We were busy helping physician practices eliminate wasteful processes, streamline staff and improve their bottom line through clean-claim submissions–on the first attempt! Many times we recommended consolidation of resources, right-sized the staff to productivity and restructured practice billing departments.

Over the past couple of years, however, we’ve witnessed a disconcerting trend of physician specialty groups running for cover and entering into employment agreements with hospital systems. We’ve also seen several hospital systems merge—the recent purchase of Swedish Medical Center by Providence, for example. Is the entrepreneurial, independent physician spirit being squashed by such threats as 27% Medicare cuts? (Particularly in light of thirty-three million baby-boomers readying to apply for Medicare benefits!)

Never before has it been more important for physician practices and hospital systems to work as efficiently as possible. If recent trends lead to that, it will be a good thing.

We wonder, though, if hospital leadership can keep promises made, as their institutions face continued dwindling reimbursement. We well remember how in the mid-90s, the trend of HMOs and hospitals purchasing primary care practices resulted in an average loss of $90,000 per physician. Then, many physicians went back into private practice; whether this will happen with specialty services remains to be seen. One thing is certain, whatever form healthcare reform takes, all healthcare providers will need to meet the challenge to deliver quality-driven services, because their reimbursement will be based on outcome measurements.

As for Derry, Nolan, for the past eight years, our initial business goals have not wavered. We hope that medical practices choosing to remain independent will continue to assess how they perform daily work to ensure it is meaningful and value-added.

We end 2011 with fondest wishes to you and your families for a wonderful holiday season. We hope that 2012 will be a better year economically for all of us and that you achieve any New Year’s resolutions you set for yourselves!

Barbara and Crystal

P.S. As you plan 2012 business activities, check to see the last time you had a practice assessment. We’re scheduling operational “check ups” for our physician clients now!

As the summer draws to a close, it seems as though everyone is already thinking about the holiday season, pushing forward to next year. Hold up – we’re not yet done with this one! There’s plenty still coming down the pike for 2011. Let’s look at your goals – what is there yet to achieve for yourself (and your healthcare organization)? And how are your professional relationships? Have you been able to build and strengthen those?

There are a couple of posts that may help as you continue to work on those 2011 goals. For instance, when it comes to professional relationships, we like one from January about connecting, which included these three tips:

1. Be nice to everyone. Make the effort and never underestimate the value of being nice!
2. Listen to every voice. When we build teams and redesign workflows, our belief is that every voice matters.
3. Bring your ‘A’ game to work – every day.

Now, look at what you planned for this year – not only for your healthcare organization or medical practice, but also for you, personally and professionally. What’s the status? Is it time to revisit those plans and make some course corrections back to where priorities truly lie? Remember these tips from another January post:

Clarify your priorities. It is the first and most essential step to achieving a well-balanced life. Here’s a simple 3-step exercise to use as a tool:

1. Write down your Top 5 priorities. Not what you think your priorities should be, but the ones you want!
2. Next, analyze where you spend the majority of your time. Does it align with your Top 5?
3. Finally, those that don’t align, consider how to eliminate them. After all, if they didn’t make it into the Top 5, perhaps it’s time they go away.

Every choice has a consequence. Each leads us down a particular path.  There’s still time to listen to every voice, including your own. If you need some assistance to complete a few “to do” items, give us a call!

Patient Rights. We all have them. But what do they entail? When we walk into an ASC, what notifications should we receive?

Patient Rights is perhaps the most neglected of the CMS Guidelines, unintentionally. These rights state the responsibilities that ASC staff has towards patients and their families during care in their facility. A patient has the Right to Treatment with respect, the Right for an Informed Consent, the Right to have an Advance Medical Directive, the Right for Privacy and Confidentiality. Plus, the ASC must disclose if the physician has a financial interest or ownership in the ASC. All rights must be provided before the date of service. ASCs need to post patient rights in the facility and gain confirmation, by signature, from the patient that all information was given prior to the service-date.

Use these suggestions to help your ASC avoid overlooking and under-documenting the Patient Rights process:

• Implement a simple form that lists the Patient Rights requirements, and obtain the patient’s signature. Some ASCs include the opportunity for the patient to listen to the rights and notifications via a recording, to assure understanding. Post the recording on your website, too, under the Patient Rights section!
• Routinely ask the patient if they understand their rights and answer any questions promptly.
• Contact the Washington State Medical Association for Advance Directive informational brochures.
• Create small packets covering the Notice of Rights, Financial Disclosure and Advance Directive to mail to the patient prior to surgery. Include signature pages and collect them the day of surgery.
• Reiterate “any questions” on the day of surgery, maybe even include one final sign off!

Our Washington State ASCs have a choice. Either do nothing and risk everything ASCs have worked so hard to achieve. Or be proactive; recognize that we have fallen behind and need to get up to speed on regulations ASAP. The do-nothing approach simply isn’t feasible for any ASC committed to patient safety and quality. Frequent DOH visits affect morale and potentially the ASC’s reputation. The pro-active approach means a serious look in the mirror – assessments and very likely, corrective activities and training. But in the long run, your ASC, your staff and your patients win.

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Is your ASC Compliant with CMS? Contact Derry, Nolan & Associates; we can get you there.

Catching up or revisiting those updated CMS Guidelines? Great! Now let’s move on to Quality Communication. If you want your team to be the “most likely to succeed” in achieving a successful CMS/DOH survey, you need a firm foundation – which begins with Quality Communication. Only then do you begin to build the high performance team to take you into the future. Plus, communication excellence is critical to unlocking team performance and quality outcomes.

Ask yourself: “Does my ASC leadership team demonstrate these attributes?”

• Thoroughly understands principles and rationale of the CMS guidelines.
• Provides ongoing constructive communication with ASC staff.
• Conducts frequent, relevant staff meetings that discuss the quality improvement (QI) process and successes.
• Holds quarterly meetings that cover QI, infection control, peer review, fire drills, incident reports, sharps injury log, etc.
• Elicits ongoing feedback from the ASC team.

If your ASC Leadership lacks these attributes, expect communication barriers. Communication barriers prevent achievement of quality communication and successful outcomes. Quality Communication begins with the ASC Governing Body, particularly the medical director, administrator, nursing supervisor and physicians, who must take the time to read and thoroughly understand – and here’s where we continue to beat the drum – the updated CMS Guidelines.

It’s a lot to take in, and it often takes assistance to interpret. Don’t hesitate to ask for help – either from DOH, knowledgeable colleagues or ASC consultants who have experience working with the guidelines. After all, your ASC’s success and your patient’s safety and satisfaction rely on it.

Next, we’ll run through the Top 3 – Infection Control, Patient Rights & Quality Assessment and Performance Improvement.

Contact us if you need help getting in compliance with the updated CMS Guidelines. We can set you on your way to a successful survey!

ACOs are a type of payment and delivery reform model that begin to tie provider reimbursements to quality metrics (measures of quality indicators) and reductions in the total cost of care (performance and process improvement) for an assigned population of people; i.e. Medicare patients.

These indicators and data derive from 5 Key Areas:

1. Patient and providers’ experience of care (patient and staff satisfaction scores)
2. Care coordination (information sharing across the continuum of care)
3. Patient safety (reporting, analysis and error prevention)
4. Preventive health (treatments to minimize illness and hospital admissions)
5. At risk population, frail and elderly health (using proven care standards to assist with care provision)

The overall quality performance score will be calculated on 65 quality metrics within the 5 defined key areas, equally weighted. CMS will define the quality performance benchmarks based on Medicare Fee-For-Service (FFS), Medicare Advantage or ACO perfomance data over time.

Note that the ACO is eligible for monetary compensation only if it demonstrates to CMS that it has fulfilled the required quality performance elements and achieves the other regulatory performance criteria.

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“Quality is remembered long after the price is forgotten.” —Gucci Family Slogan

I don’t know about you, but if somebody asked me if I provided quality care, I would say “Absolutely!” I suspect every healthcare provider would say the same thing. If they asked me how I know, I might say, “Well…I don’t see many complaints. I get thank you notes. My patients keep coming back and I am very skilled at what I do.”

But what if they then ask, “Do you have data to support your claim of quality care?”

Now I’m a bit less confident in my response, more like, “Can I get back to you on that?”

Healthcare reform is about us “getting back to them on that.” The Center for Medicare and Medicaid Services (CMS) is asking healthcare providers to be accountable for the care we provide. Accountability is the acknowledgment and assumption of responsibility for our actions, products, services, decisions, and policies. That includes administration, governance, and implementation either within the scope of our roles or in our employment positions. It also encompasses the obligation to report, explain and be answerable for any resulting consequences.

While we currently may not have a large panel of Medicare patients, that’s soon to change. As we hear repeatedly, the retirement of the baby boomers affects everything – with a big emphasis on provision of medical care. History also shows us that as Medicare goes, so go the private payers. Now is the time to make quality a habit.

Stay tuned for Accountable Care Organizations (ACO) and quality.

by Loy Maslen, RN, MSN, NNP-BC, CPUM

“Quality is not an act, it is a habit.” — Aristotle

Please join us in welcoming our newest associate, Loy Maslen, NNP-BC, CPUM. She brings over 30 years of diverse healthcare experience to inpatient and outpatient organizations. A TeamSTEPPS™ Master Trainer and VitalSmarts™ Crucial Conversations Master Trainer, Ms. Maslen helps healthcare clients learn effective evidence-based communications with the goal of improving teamwork, and thereby performance outcomes. Her targeted group facilitation assists with development and enhancement of quality programs, quality indicators and data collection that drive improved patient outcomes, as well as satisfy PQRS requirements. Ms. Maslen’s training techniques also show clients how to improve documentation to capture charges that may otherwise face denial in utilization review. 

In addition to significant revenue improvements, her clients gain more efficient workflow systems, greater patient safety and customer service satisfaction. She is able to assess for survey readiness such as NCQA, Joint Commission and AAAHC, identify areas requiring improvement, and work with staff to develop a certification achievement plan.

Ms. Maslen’s past roles range from clinic manager to clinical educator, quality program manager to clinical care management, as well as project management with notable healthcare organizations such as Evergreen Healthcare, Valley Medical Center and Qualis Health. Her highly successful “lean thinking” facilitation for rapid process improvement projects draws on extensive experience with state and national regulatory agencies, as well as the Washington State Medical Home Collaborative.

She holds the firm belief that an Accountable Care Organization (ACO) begins with partnerships between patient, family, providers and staff, applying standard structure and process to drive improved quality outcomes while simultaneously decreasing costs and eliminating waste. Ms. Maslen, a passionate teamwork advocate, sees human creativity, clear communication and effective training to be essential for comprehensive patient-centered care that is accessible and coordinated, while also supportive of physician leadership and staff.

In addition to an MSN, Ms. Maslen is a Board Certified Neonatal Nurse Practitioner and Certified Professional Utilization Manager, as well as holding certifications in Advanced Cardiac Life support, Basic Life Support, Pediatric Advanced Life Support and Neonatal Resuscitation.