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MIPS consulting | CareOptimize

Optimize Your Clinic With a Patient Tracking System

By | Blog, healthcare management consulting, MIPS consulting, Patient Tracking System

Ambulatory care surgical centers and urgent care clinics often grapple with numerous patients and clinical activity that need consistent tracking. Failure to streamline the process may affect the efficiency of the clinic or healthcare practice which, in turn, can lead to serious consequences. Greater wait times mean more disgruntled patients and stressed staff and providers. Increased wait times may also endanger a patient’s condition, requiring emergent care.

CareOptimize has developed a solution. Our Patient Tracking System helps clinics and surgical centers keep track of all clinical activity in real-time, boosting operational efficiency and ensuring better patient and provider satisfaction.

The Patient Tracking display is designed to be user-friendly and can be displayed on screens of various sizes. With this tool, the clinical staff is always aware of the location of each patient and provider on your floor plan and the degree of acuity and clinical actions for each case. Furthermore, the tool shows the average and longest wait time, plus the number of patients waiting to be seen, providing the right data to allow concentration of efforts to reduce wait times while, at the same time, offering optimal care.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Target Goals

By | Blog, healthcare management consulting, MIPS consulting

Electronic health records (EHR) assist in the process of collecting patient data and record keeping. However, an EHR has broader implications. Based on what the objectives are, an EHR has the power to alter your entire practice’s workflow, structure, and cultural process. That’s why choosing an EHR that complements and enhances your office operations is so vital.

If you feel your existing EHR isn’t adding value, it may be time to opt for another solution. Moving over to a new EHR is often an extended process. Once all the data has been entered into the new system, your staff must be trained on how to use the different functions and features. This training can take several weeks. Long term needs and goals should drive the process of switching to a new EHR. This lessens the odds of spending the time to transition to a new EHR only to realize that the new solution is ultimately not one that is adapting to the distinct needs of your practice.

Make sure to remain connected with your patients throughout the process as they become familiar with the new EHR, and provide feedback. Identify any problem areas quickly, and take the steps to rectify them, when possible. Patient feedback also shows while you are focused on creating an efficient and effective office, your system also has your patients in mind. You want an EHR solution that follows your new EHR targets for better productivity and delivers as much value to patients as it does to you.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

EHR Optimization Among Seniors May Need Improvement

By | Blog, healthcare management consulting, MIPS consulting

A Journal of the American Medical Informatics Association (JAMIA) study reveals acute care hospital EHR optimization may not be meeting rigid healthcare standards when it comes to older patients. Current optimization for this demographic is not reaching the standards of the “4Ms” Framework, implemented back in 2017 as a way to boost healthcare for seniors. The 4Ms are a series of healthcare preferences and goals: What Matters, Medication, Mentation, and Mobility. 

EHRs could be modified, for instance, to integrate features that tackle the 4Ms by incorporating reminders and fields in the EHR for clinicians to implement standardized treatment, target documentation, or revisit medicines known to affect mobility and mentation (the prevention, identification, and management of mental illnesses like delirium and depression). According to the JAMIA study, however, there may be a lack of awareness among clinicians on ways to integrate certain needs for older adults.

 

The JAMIA findings may suggest that hospitals do not rely on EHR optimization to improve older adult care, while the bulk of the inpatient population is actually older adults. Applying policy and realistic initiatives that concentrate on improving care for this age group may help tackle this problem.

To read more, please visit https://ehrintelligence.com/news/older-population-often-overlooked-during-ehr-optimization.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Transitioning to Full-Risk Capitation

By | Blog, healthcare management consulting, MIPS consulting

Healthcare’s “value movement” is a concept just about everyone comprehends. It’s easier to compensate someone for the value they’re making versus simply doing the job. A situation of affordability sparked value-based care, with the Affordable Care Act contributing heavily. Today, among the few programs that have near-universal political support, value-based care is one. When efficaciously enforced, clinicians are spurred to care for the entire person and tackle the risk factors so essential to the quality of life of patients.

Many value systems are still developed on a fee-for-service basis, where doctors are constrained in what they can do with the conventional method of billing and coding. What’s more, these programs too often measure processes rather than results (for example, checking blood pressure versus improving it and cutting down on hospitalizations). It’s not clear whether calculated actions would result in the true desired outcome of less expensive, more sustainable healthcare, and those acts say little about the experiences of actual patients.

A typical primary care doctor sees about thirty patients daily, generating around $600,000 in a year at $80 a visit. This individual is trying to keep patient visits short, there is a ton of paperwork they need to take care of, and, after covering the costs of running the practice, they are hoping to take home a portion of what specialists earn. There is minimal benefit resulting from value-based care payouts, regardless of their PCP skills.

What if the individual assumed “full” risk for these patients? If the doctor took the reins and was responsible for everything about their patients? Things shift radically. Presuming the payor negotiations have been taken care of, this same doctor may have somewhere around $12 million (average $500 per patient per month), about twenty times the money. There is the danger the $12 million is expended, and the doctor incurs a loss. But primary care is worth more than five percent ($600,000 of the $12 million) of overall costs collected by the doctor in the fee-for-service environment because PCPs will redefine the “downstream” treatment use. To stop wasting the other 95 percent of preventable, avoidable, and wasteful treatment, everything now becomes how to maximize patient health. It’s about working with patients, encouraging them to do what’s needed to have a positive effect.

To read more, visit https://www.linkedin.com/pulse/full-risk-capitation-model-why-make-change-christopher-chen/.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

COVID-19 Waivers Boost Medicare Telehealth Access

By | Blog, healthcare management consulting, MIPS consulting

Per a recent study, Medicare Advantage Plans and other stakeholders indicated that during the coronavirus pandemic, CMS exemptions proved successful in allowing access to Medicare and Medicare Advantage telehealth. However, there are still hurdles to overcome.

After reviewing the data from 2017, the researchers discovered that, particularly in metropolitan areas, internet coverage was primarily targeted towards younger Medicare beneficiaries with income deemed medium to high. Standard Medicare beneficiaries were more likely to use the internet than beneficiaries of Medicare Advantage, in all the groups analyzed.

CMS provided several telehealth flexibility plans for Medicare and Medicare Advantage, including broadening coverage to Medicare telehealth visits, virtual check-ins, and e-visits, and finally, audio-only services.

Policies that shared risk-bearing payment structures assisted with the rapid adjustments of plans and providers to the pandemic. These models let Medicare Advantage plans employ telehealth services and grow in a brief time to current platforms.

Fee-for-service payment programs proved trickier for both traditional Medicare and Medicare Advantage patients as they navigated the adoption and expansion of telehealth.

Certain factors that increased the adoption and growth of virtual care included promoting home-based telehealth, removing the requirement for providers to have a previous relationship, and increasing the eligibility requirements for provider and service reimbursement.

To read more, visit https://healthpayerintelligence.com/news/covid-19-waivers-improved-medicare-advantage-telehealth-access.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Appropriate Use Criteria Guidelines In Effect January 1, 2021

By | Blog, healthcare management consulting, MIPS consulting
As of January 1, 2021, providers who serve Medicare patients will be required to consult a Clinical Decision Support Mechanism (CDSM) and obtain a determination as to whether the test conforms to the Appropriate Use Criteria (AUC) before the test can be administered.

Advanced diagnostic imaging services are crucial tools for ensuring accurate diagnoses and planning suitable treatment. Examples of CDSM imaging services are CT (Computed Tomography), PET (Positron Emission Tomography), Nuclear Medicine, and MRI (Magnetic Resonance Imaging). Any time any of these services are ordered, providers are required to consult the CDSM and receive a determination whether or not the order follows AUC guidelines.
All physicians and other providers who treat Medicare patients and any facility that furnishes those services in a physician’s office, hospital outpatient department, ambulatory services department, or independent diagnostic testing facility will be required to adhere to the regulation. The program is now in the educational and operational testing phase, so no payment consequences will result from not following the recommended workflow. Providers should take this time to familiarize themselves with the process, however, as any practitioner who treats Medicare Part B beneficiaries will be required to abide by this rule from January 1, 2021 on.
The CDSM is a tool within your certified EHR. (All CEHRT systems should be on the 2015 certified version.) This tool must be enabled to be incorporated into the workflow. Ideally, this consult should be done at time of ordering, so the test will not be denied later. Embedding the AUC requirement into your workflow will ensure you are following prescribed guidelines and avoiding any payment penalties.
CareOptimize is ready to help any practitioner with any questions about this new rule. Our value-based experts can assist with:
• Ensuring your workflow is adjusted to accommodate the AUC requirement

• Enabling the tool within your EHR

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

What to Consider as Telehealth Legislation Moves Forward

By | Blog, healthcare management consulting, MIPS consulting

The Protecting Access to Post-COVID-19 Telehealth Act introduced last week is aimed at broadening the use of telehealth beyond the current health situation. One of the many things it will address is the removal of geographic restrictions permitting a patient’s home to be used as an originating site. It will also make permanent the Department of Health and Human Services waiver authority for emergencies. As the legislation proceeds, what do healthcare organizations, hospitals, and providers need to keep in mind?

Organizations and providers must assess whether the method of delivery of telehealth services for patients is clinically appropriate and safe versus a visit in person. Providers and organizations should also ensure Medicare has reimbursed providers the same amount for telehealth services throughout the public health crisis as it would pay for a visit done in person. An important question is whether this trend will continue.

Temporary exemptions allow Medicare providers to operate across state lines during the emergency, while each state is required to apply for specific Medicaid exceptions. Although there is a movement toward proceeding with such efforts supported by organizations like the American Nursing Association and the American Medical Association, the process remains complex.

Since telehealth needs an investment in technology, incentives may need to be provided to promote spending on technology.

To read more, please visit https://www.healthleadersmedia.com/innovation/7-things-consider-new-telehealth-legislation-proposed.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Telehealth Still Has Room for Improvement

By | Blog, healthcare management consulting, MIPS consulting
Three-quarters of patients that received telehealth have stated they would like to see it incorporated as a standard care component in the future. However, a significant portion of patients also said that they did not know how to proceed following the telehealth visit, suggesting healthcare providers may need to implement standard follow-up care measures.
It may not be surprising to learn that, given the surge in telehealth visits, the majority of patients had not taken advantage of virtual care prior to 2020. Close to three-quarters made use of telehealth because they’d had an original appointment delayed or canceled, and more than 70 percent of respondents also had a previous appointment canceled or postponed, either voluntarily or due to the actions of the healthcare provider.
Statistics prove the interest in continuing healthcare with a telehealth option is attractive to patients, yet only 35 percent of patients stated their healthcare provider contacted them for a follow-up, and a little over 40 percent said they were aware of how they could receive future telehealth access.
The opportunities to attract even more patients to telehealth have definitely been brought to the forefront with the pandemic. Beyond canceled in-person appointments being rescheduled as virtual, there are many other chances for practices not only to retain patients but also to attract new business with a telehealth option. Comprehensive retention procedures need to be in place to keep those patients interested in telehealth from falling through the cracks.
This update is provided by CareOptimize. We provide healthcare management consultingservices and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Telehealth Results in a Safer Future for Healthcare

By | Blog, healthcare management consulting, MIPS consulting

Until recently, the main obstacles facing the general implementation of telehealth were geographical limitations and the originating point of treatment. CMS had narrowed Medicare’s payment to telehealth services that met certain criteria including using a location within a specified area of skilled rural health care shortage or that the patient received treatment at an approved facility such as a provider’s office or hospital.

COVID-19 ‘s declaration has led CMS, at least for now, to use waivers to remove those obstacles. Telehealth, though, has other challenges ahead of it.

Many people still lack access to the fundamental infrastructure that makes a virtual doctor visit feasible. Technical issues could also be problematic for those providers who likewise lack infrastructure enabling such visits. Additionally, a major challenge has been widespread reimbursement of these programs.

Hospitals and healthcare facilities with a patient-centered approach to treatment require an effective communication plan for their patients conducive to a successful telehealth program. There have also been initiatives to utilize technology networks for the healthcare sector capable of secure, real-time virtual visits to meet more patients, easily trial them, and enhance the quality of treatment. In addition, during the pandemic, virtual visits have the ability to save resources. Increasing the adoption of telehealth in a prearranged manner can make an important contribution to the efforts to screen, test, and treat coronavirus.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.

Embracing Telehealth Demands as a Small Practice

By | Blog, healthcare management consulting, MIPS consulting

The COVID-19 pandemic resulted in many healthcare providers unexpectedly needing to turn to virtual treatment solutions. The transition may have been relatively smooth for larger healthcare providers with greater resources, but smaller practices had to deal with even more challenges. It wasn’t until the government instituted regulatory changes to broaden reimbursement for virtual visits that the smaller practices began to believe they, too, could move in that direction. As patients began seeing their local practices offer telehealth, their interest also increased.

The very makeup of a smaller practice forces it to think more creatively in planning and adopting emerging telemedicine needs. Some items to keep in mind include patient needs, where they come from, and what technologies they and the medical staff might use to reap the most benefits. Telehealth does not necessarily have to completely replace in-person visits, but practices could offer after-hours consultations to patients or asynchronous services for patients that require ongoing care.

Smaller practices may also wish to seek out telehealth resource centers. In addition to federally funded programs, private companies such as CareOptimize offer comprehensive telehealth services. Providers should also ensure that whatever telehealth solutions they use are compliant with HIPAA regulations, even if those regulations are being temporarily relaxed.

The future of telehealth post-pandemic remains to be seen, but many of the pieces are now in place to give all size practices the ability to institute and maintain successful telehealth programs.

To read more, please visit https://www.healthcareitnews.com/news/heres-how-smaller-practices-can-prepare-continuing-telehealth-demands.

This update is provided by CareOptimize. We provide healthcare management consulting services and products, managed care solutions, value-based expertise, Nextgen EHR utilities, MIPS consulting, and more. CareOptimize has helped numerous healthcare organizations succeed for more than a decade. For more information, please call 855.937.8475.