Doctors Lounge - All Comments

re: Under utilizing your EMR?

GlenBernstein — Wed, 24 Jan 2007 20:31:25 GMT

I find that physicians (in general, as a group, dangerous over-generalization) usually know very little of what happens around their office (except where it directly involves them, such as the actual office visit and chart and lab results).

For example, one physician friend thought that his staff was doing patient callbacks for all visits only to find out (when I challenged that assumption) that his staff only called new patients, not existing. Why did I challenge this? He was complaining about how many of his follow-ups were no-shows (They were usually 6 or 12-week follow-ups).

This issue transfers directly into the emr utilization, or the lack thereof. No offense to the office staff, but many of them are not going to try new things on their own - even if it will ultimately save them time / make their lives easier.

One interesting suggestion would be to follow the microsoft and intuit models of noticing when a feature could be used, but isn't and informing the user about the new feature.

Another possibility would be to produce feature utilization reports that get sent to the office manager and physician(s) on a regular basis. If nothing else, it might get someone to ask, "What is feature xyz, and should we be using it?"

re: What the heck is ‘PVRP’?? And why the heck should I care???

Dr.Corley — Fri, 29 Dec 2006 20:49:51 GMT

The problem with the PVRP (one of many) for EMR users is that you would have to add all of the G codes to your billing software, write logic in your EMR to translate the quality measure or exclusions into the appropriate G code and then have it transfer to your billing software. Thats a lot of work for a few cents when you can easily report the quality data directly from your EMR. They decided to use this program as there are a minority of physicians using EMRs and CMS if not ready to receieve quality data directly where they are already set up to receive billing codes. They do have a pilot for EHR users with financial rewards ~15K per provider max or $150K per practice max) but only in California, Utah, Arkansas, and Massachusetts, only in practices with 10 or fewer physicians and if that is not restrictive enough, the practice had to already have signed up with their state QIO for the DOQIT project.

re: What the heck is ‘PVRP’?? And why the heck should I care???

Linux — Fri, 15 Dec 2006 02:32:08 GMT

OK, after taking a closer look at this PVRP it hardly seems worth it. For primary care, Docs must answer (up to) 7 questions for every pt using 28 new G-codes as answers which are then submitted with the claim. The typical 99213 allowed is $55.97 times 1.5% bonus equals 84 cents. ??

re: What the heck is ‘PVRP’?? And why the heck should I care???

eyesIT — Thu, 14 Dec 2006 21:24:39 GMT

@Contrarian: From everything I've read so far, the cost of reporting may well outweigh any increase in reimbursement. Medicaid is a broken, broken system, and our practice cannot survive on their 'payment' system. We have been forced to cap new primary Medicaid patients, yet do not turn away those with Medicare as primary despite the loss. I actually spoke to the director of Medicaid in my state regarding their huge (six figure) debt to us in unpaid claims. He asked accusingly how I got his number, sent out some minion to hear us out, and they never paid anything. Tax payer fraud through and through. Their agency was 200m in the hole that year, too.

On topic:

For Ophthalmology, I can only see "Antibiotic prophylaxis in surgical patients" as a consistant measure, with some cases of checking HgA1C and BP for diabetics, and a few fall related injuries. Anyone care to comment? (I am not a doctor) Do we have to report 'not eligible' for every other exam, or cases where the PCP has those conditions in good control?

The surgery part seems doable w/o EMR.

re: What the heck is ‘PVRP’?? And why the heck should I care???

Contrarian — Thu, 14 Dec 2006 15:51:02 GMT

Here in Indiana, many practices no longer accept Medicaid patients. (Same rate schedule since 1996) This is a form of rejecting patients. In addition, physicians who choose to see Medicare patients who have Medicaid must accept 20% less than the Medicare rate schedule for full payment. There is one thing that I learned in all my years of practice and that is that you can’t practice good medicine if you are poor.

I'm not against anything the will bring reimbursements up to a level that matches the service provided, and I accept the fact that physicians will likely never receive 100% of every dollar that they are worth, but it is undeniable that low reimbursements already restricts access and thus we are seeing a decrease in the health of our population.

I actually must commend Congress in attempting to increase reimbursement for physicians in an indirect manner. PVRP might be acceptable to their constituents who would otherwise be against seeing this group of individuals receiving a pay raise.

re: What the heck is ‘PVRP’?? And why the heck should I care???

Linux — Thu, 14 Dec 2006 06:18:12 GMT

Low reimbursements? Where do ya'll live? Our's just goes up. Actually, diabetes with renal manifestation (250.40) describes the sicker diabetic (than just 250.00) and the payor systems capture this and pay us more for the "curve wreckers."

Oh, and here's link:

http://www.cms.hhs.gov/PVRP/

"Third, to make reporting as straightforward as possible, the PVRP uses G codes (and when they are available, CPT II codes) on the claim form to pass data to CMS."

re: What the heck is ‘PVRP’?? And why the heck should I care???

Contrarian — Wed, 13 Dec 2006 23:36:45 GMT

In a medical world, which is becoming increasingly "goal oriented", are we running the risk of "patient rejection" by doctors

Low reimbursements have already brought this about. The question is whether this will exacerbate an increasing trend to treat only those cases that make economic sense.

re: What the heck is ‘PVRP’?? And why the heck should I care???

Robert Gleeman — Wed, 13 Dec 2006 16:03:29 GMT

During my recent interview with Dr. Winn, he mentioned something rather frightening regarding the "grading" of doctors.

Some doctors take the toughest cases. They are going to look bad if you just measure outcomes, because these doctors begin with the sickest patients, then try to keep them alive--and out of the hospital--as long as possible, even though the hope for a positive outcome looks pretty grim.

I think one such doctor is Cyath, who has described some of the most hopeless medical situations I've ever heard about.

In a medical world which is becoming increasingly "goal oriented", are we running the risk of "patient rejection" by doctors who don't want a sick-as-hell patient who will be a "curve wrecker"?

Already, many medical device makers are moving out of the U.S. because of the potential for devastating lawsuits. I would hate a system that makes the best and bravest doctors look bad because they tackle the toughest medical problems, whereas a doctor who only treats mild colds looks lke a miracle worker.

re: What the heck is ‘PVRP’?? And why the heck should I care???

Contrarian — Tue, 12 Dec 2006 23:56:14 GMT

I am sure that this just the latest fade in medicine. It will eventually become fiscally unaffordable for the healthcare system to tackle this new administrative cost. All physicians that I know want to practice quality medicine. If it is proven that these items improve quality, then this information should and will become part of our board certification process. Under the new standards of maintenance of certification (MOC), a chart review is mandatory. I recently completed my office record review (ORR), which is performed online with immediate response as to how I was meeting the standards of care. I even had to pay $750 just to participate in the ORR part of my board (re)certification. This process was relatively painless since I have an EMR with health maintenance guidelines, forced entry of documentation and the ability to pull records quickly from anywhere. Once interoperability is achieved, such information can be electronically submitted in real time to the Board/CDC/CMS/FBI/DEA.

I ask, why does Congress want to pay a paltry amount to check for quality and add significantly to the administrative costs of healthcare when physicians already have methods of performing similar tasks as part of board certification? It seems like another layer of unnecessary healthcare spending. Does this render American Board of Medical Specialties useless once a report card is made available to the public concerning this data?

I should note that even with an EMR, it is likely that submitting this data will be a break even propsition at best. With paper, this is a loosing proposition. $40 x 1.5% = $0.60. A little more than the current cost of postage. On the other hand if you are going to pay me $650 x 1.5% = $9.75 for antibiotic prophylaxis in surgical patients, then I guess I would race to report this information. (I'd rather be paid a bonus for going the whole year without a post-operative infection as is takes more than just a simple antibiotic to prevent an infection.)

re: What the heck is ‘PVRP’?? And why the heck should I care???

Linux — Tue, 12 Dec 2006 20:20:19 GMT

thanks for the links to CMS site.

re: Under utilizing your EMR?

EMR Advocate — Tue, 17 Oct 2006 18:36:05 GMT

EMR stagnation is extremely common. I have seen many practices Go Live with the intention of implementing features "in a few months'. A year later they still haven't turned on the lab interface or spent the time to clean up the qualtity of their outbound notes. The motivation it takes to decide, purchase, and implement an EMR needs to be present for the ongoing development of the system.

re: Under utilizing your EMR?

Contrarian — Fri, 13 Oct 2006 18:55:20 GMT

The lack of full utilization stems from the decline in return from learning the additional new feature. This should not come as a surprise. Pareto principle & Emrupdate

www.emrupdate.com/forums/thread/35553.aspx

re: Under utilizing your EMR?

DrMurdoch — Wed, 11 Oct 2006 19:29:34 GMT

I suppose the classic underutilization is when doctors just choose to dictate because the EMR is too slow for them.

It is certain that many EMR endusers do not use all the features that they could. I think part of the problem is that most EMRs are SO bloated that many of the features are really not what every group wants.

re: How NOT to get financially suckered

digital-doc — Sat, 09 Sep 2006 15:26:09 GMT

Superb wake up call. I'd like to find a vaccine for the "Lazy Write-Off." ;-)

re: Handling incoming Faxes in your EMR

digital-doc — Tue, 08 Aug 2006 15:35:31 GMT

Great article Naveen! I'm glad I stumbled into the lounge or I would have missed it!