The American Society for Clinical Oncologists takes the proposed reforms very seriously and offers educational opportunities to oncologists to understand and prepare for the inevitable changes to reimbursement for cancer patient care.

Oncologists in private practice not only face mounting pressures of administrative costs and staying abreast of the latest compliance regulations, but also now face reimbursement rates falling. Many times, these physicians, who just want to be able to focus on their patients’ cancer care, under prioritize (understandably) business management essentials.

We’ve worked with a number of oncology clinics and consistently find that the billing and coding, revenue cycles and collection are a common source of lost revenue. Correcting bad habits in billing and coding practices, establishing systematic processes, and keeping an eye on reducing general oncology practice expenses all can make the difference in whether your oncology practice succeeds, folds or becomes absorbed in a nearby hospital’s local acquisition efforts.

Derry, Nolan suggests practice managers, executives and billing management meet regularly to review the practices’ income and expense trends. If the net income trend looks more down or flat than up for several months, don’t wait, act! Take these measures to get your practice’s billing and coding house in order before reimbursement changes:

• Call for an external audit of your current billing and coding practices
• Proactively train for transition from ICD-9 to ICD-10 code sets
• Conduct a revenue cycle analysis
• Examine and reduce operational expenses
• Assess and optimize workflow practices to increase efficiency & patient satisfaction

We are heartily grateful to the clients who continue to refer us to other medical offices. Likewise, we deeply appreciate the Derry, Nolan Associates who work alongside us, bringing their specialized knowledge and experience to bear, whether it’s conducting an ICD-10 Training session, finding hidden dollars when running a coding and billing analysis, or helping a practice create a Patient Safety and Infection Prevention program.

Before the music plays us off the stage, we’d also like to thank our friends and family for making it possible for us to keep consulting.

Cheers to Ten Years!

Norming: Even bad workflows in a medical practice become a workable habit. Kind of like wearing shoes that are just a little too short for you. Insidious workarounds, like a sticky-note to pass important information that shouldn’t be lost, or taking 3 messages for the doctor or medical assistant when one would suffice, become the highly wasteful norm. When the specialty practice’s leadership announces a move from paper charts or outdated clunky technology to a new EMR, initially, people embrace the idea. (Of course, that’s because they don’t realize how long they will endure the chaos!)

Storming: Enthusiasm wanes and frustration mounts when staff is saddled with current work while concurrently learning a new system with the deadline of switchover looming. Status meetings and training sessions cause eyes to glaze over, and commonly heard statements like: “The paper chart took less time to document in” (never mind you can’t find it half the time); “Our old EMR took fewer clicks” (and had less flexibility); “What?! I have to re-enter the patient’s demographics and insurance information?! It’s going to take a lot longer to register a patient” (Management is aware and that’s why most clinics substantially reduce the first month or so of appointments, by as much as 50%).

Forming: Cries of alarm fail to sway management and the new EMR is adopted. Reality: some staff, not up to the challenge of change, will not make the transition. But gains are made and the faster aspects, like more in- depth management and clinical reports, outweigh the initially annoying ones. Tools once manual are now automated. Gains begin to outweigh the losses, become appreciated – particularly when physicians and staff can leave work on time for dinner dates with families and loved ones.

Norming: Many live in the “valley of despair” for 2 to 4 weeks post implementation. Old, comfortable ways seem preferable, despite the extra work. Then, something remarkable occurs. You overhear comments like: “Wow, I didn’t know we could get to that level of detail”; “Check out this short-cut!”; “Did you know if you just press the F5 key you get to…” Six months later, people feel proficient using the new EMR, and six months after that, the entire team is optimizing the new workflows.

Norming returns (without the inefficiencies of the past); medical and line staff are content again. My personal reward? Witnessing team spirit. During both assignments, champions emerged and rallied the team. People exhibited technical and creative skills that had been buried due to manual processes or outdated technology. As a whole, both cardiology organizations are experiencing the reward of less medication errors, providers able to easily share information, as well as having access to data off-site and Meaningful Use dollars becoming available. Those forward-thinking physician groups can now further invest in building customer (patient) service to platinum levels and marketing themselves to payors and patients for financial viability in our highly competitive, ever-changing healthcare market.

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!

Six Survival Tips for Cardiology Groups

1. Eliminate manual processes. Achieve maximum Meaningful Use dollars; be sure your staff performs value-added work and optimizes your EMR.*
2. Build interfaces that transfer demographic data post-admission verification at the primary admitting hospital (not from the ER visit). That ensures your system gets correct data.
3. Authorize only appropriate tests (not every single one). Rather than medical office staff becoming bogged down in unnecessary authorization processes instead of revenue-enhancing work like researching denied claims and educating providers on non-covered diagnoses.
4. Cross-train staff. Beside obvious redundancy benefits, respect for your counterpart’s workload increases when you realize the scope of their responsibilities. Teamwork improves.
5. Streamline workflows – starting with the phone! A patient-friendly phone menu that allows the caller to bypass lengthy menus with a “0” or to enter a known extension improves satisfaction. Lines that “hunt” for available staff assure better customer service. Front-desk and clinical huddles each morning and at midday helps anticipate patients who may take more resources, and assures you stay on time.
6. Implement a service recovery plan that acknowledges lengthy patient wait times (>30 minutes) and empowers staff to give coupons to the local coffee shop or eatery along with a sincere apology.

With these simple strategies you not only help defuse effects of the 2013 CMS coding and bundling cuts but also improve patient satisfaction – making them happy marketers on your behalf!

*Resource(s) CMS eHR Tip Sheet

New Codes & Payment Levels for PCI and Ablation-EP studies

As part of ongoing efforts to evaluate potentially mis-valued services, new CPT codes have been created to report PCI as well as to bundle EP studies with ablation. The physician work RVUs that CMS finalized result in physician work RVU reductions of roughly 20% to the family of PCI codes and roughly 27% to the family of EP/ablation codes. The impact will vary depending on practice patterns. CMS reduced payment for new ablation add-on codes and bundled PCI add-on codes into the base procedures.

Multiple Procedure Payment Reduction

CMS finalized its proposal to expand a multiple procedure payment reduction to cardiovascular services, so that if more than one cardiovascular service is provided on the same day to the same patient, the technical component of the less expensive service is reduced by 25 percent. This reduction does not apply to office visits but applies to most cardiovascular diagnostic and therapeutic services. It also does not apply to services billed under the hospital outpatient prospective payment system.

PQRS and E-prescribing Incentivized

CMS finalized provisions related to the Physician Quality Reporting System (PQRS). Physicians that successfully participate in PQRS in 2013 will receive a 0.5% bonus. They will also avoid a 1.5% penalty in 2015. Similarly for e-prescribing, successful participants will receive a 0.5% bonus for participation in 2013 and avoid a 1.5% reduction in 2014. New hardship exemptions for the Electronic Health Record Incentive Program allow participants to avoid the payment adjustment for e-prescribing, but a request must be filed with CMS first.

Value-Based Modifier

CMS finalized its proposal to begin to adjust payment for quality and cost of care starting with groups of 100 or more professionals in 2015. Because of data collection requirements, this payment adjustment will be based on performance in 2013. Physicians in large groups will have an option to participate in the payment adjustment but must participate in PQRS as a group to avoid being penalized as a low quality provider.

Need to get up-to-date on the latest CMS rules for cardiovascular service? The American College of Cardiology has announced a Cardiovascular Summit from Jan. 10-12, 2013 in Las Vegas – it will feature several sessions related to changes in the final rule. Registration is now open.

Diving deeper, other subtle yet insidious challenges come to light. When signing the employment contract, physicians may not have considered the loss of being able to make decisions that affect their schedules—remember, there’s accountability to hospital administration for strict productivity measures. Mundane tasks, like proof of insurance for mileage reimbursement, or adhering to per diem rates for Continuing Medical Education courses (which could make the difference between first and business class seating) are SOP. Specialists, long accustomed to informal yet collegial respect, might face arbitrary “higher” behavioral standards that if “not met” will find them facing a hospital disciplinary board.

Specialty practice staff face different sets of challenges. Rather than cost of living raises or performance bonuses, now their pay is tied to elaborate formulas. Myriad in-services not necessarily applicable to their specialty are suddenly required attendance. Manageable email traffic becomes a daily deluge to delve through.

If healthcare reform is sustained after this election, the trend for employment over independence will probably continue. Specialty physicians, such as cardiologists or oncologists, held to particular standards and paid on measures of quality outcomes, hospital readmissions and patient satisfaction will likely run to hospitals as their salvation, looking to them to provide the infrastructure needed to meet the standards.

An era of medicine is coming to an end, one where physicians held hospitals at arm’s length rather than asking to be embraced. Of course, the honeymoon will end, too, when the hospitals that promised high salaries and excellent benefits have to adjust compensation formulas to accommodate their own loss of state and federal funding.

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Derry, Nolan & Associates works with medical practices and specialty groups to create revenue gains through expense reductions and efficiency improvements. The firm provides interim executive practice management, compliance assessments and program development, revenue cycle analysis, coding and billing audits, and customer service training, among other medical practice consulting services.

• HHS Strategic Plan FY 2010-2015
• Entities performing Part B Claim Reviews
• Strategies for Prevention

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“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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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