frontier neurosciences cody, wy

Allen L. Gee, MD, PhD, FAAN Frontier Neurosciences

Cody, WY

Conflict of Interest

+ Dr. Gee is a partner in Frontier Health Information Technology dba Frontier Physician Services

+ Dr. Gee is an athenahealth Maven

CONFIDENTIAL - Not for distribution without written permission. 2

Figure Out What You Can Do, Can’t Do, and Could Do Better


Optimal Practice Workflow

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– Register patients

– Schedule appointments

– Referral management

– Confirm demographics – Collect co-pays

and deductibles – Scan insurance cards – Collect completed

HIPAA forms

– Appointment reminders

– Enroll provider for EDI, ERA, EFT

– Check patient eligibility

– Identify co-pay amounts

– Process credit cards

– Track HIPAA compliance, global table of insurance

– Ensure accuracy of data entry

– Track, report, coach, and optimize workflow

– Benchmark across the practice, peer group, region, and network

– Collect outstanding balances

– Schedule next visit – Charge entry – Referral management

– End-of-day review process

– Self-pay follow-up

– Review performance monthly

– Embedded rules engine

– Provide coding reference tools and payer responsibility advice (select payers)

– Submit & track all claims

– ERA processing, remittance scanning, and payment posting

– Denial and appeal management

– Generate and mail patient statements

The Revenue Cycle


You Can’t Improve What You Can’t Measure


You need ongoing visibility into your practice’s productivity

Revenue Realization Rate


Days in AR




Pre-process patients to ensure efficient, profitable appointments

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– Provide coding reference tools and payer responsitiblity advice (select payers)














HIPAA forms



About LEAN Methodologies


Lean methodologies were originally introduced by Toyota and have recently been employed by health care providers

such as Massachusetts General Hospital, Beth Israel Hospital in Boston, and others to study patient flow

GOAL Understand the steps in a process and remove or re-

engineer wasted steps while preserving and optimizing steps that add real value

Statistics on 5 Provider Work Styles


Physician Work Style Avg. MD Face Time (stdv)

Avg. Patient Wait Time

(stdv)

Avg. Patient Duration

(stdv)

Avg. Patient Throughput

(stdv)

Truly Lean (n=4 MDs, 49 encounters)

7.2 (3.9)

15.5 (8.0)

32.2 (12.1)

4.1 (0.7)

Patient Processing Machine (n=5 MDs, 89 encounters)

6.6 (4.7)

53.7 (23.8)

72.6 (25.9)

5.0 (0.6)

Crazy Busy (n=3 MDs, 63 encounters)

7.0 (4.1)

39.1 (18.6)

61.5 (22.6)

6.3 (0.3)

Steady but Opportunistic (n=8 MDs, 75 encounters)

12.7 (5.7)

21.2 (15.4)

46.7 (17.4)

2.7 (0.6)

Falling Behind and Frustrated (n=5 MDs, 42 encounters)

14.7 (7.0)

30.2 (18.5)

59.5 (23.5)

2.4 (0.4)

Work Style Time Distribution


Characteristics of High- and Low-Efficiency Providers


There are distinct provider behaviors that distinguish highly efficient providers from less efficient ones

HIGH-EFFICIENCY PROVIDERS

+ Keep busy and focused

+ Solution-oriented – disciplined with their work processes

+ See 4–5 patients per hour and spend ~5–10 minutes per patient

+ Work with cross-trained, flexible support staff

+ Patients may experience longer wait times

+ Finish today’s work in the office

LOW-EFFICIENCY PROVIDERS

+ May appear fully-utilized, but not working to full capacity

+ Likely to complain about being overworked

+ See 2–3 patients per hour and spend ~10-15 minutes per patient

+ Staffed with only one person

+ Patients may experience shorter wait times

+ Bring work home at nights and on weekends

Financial Implications of Different Work Styles


TRULY LEAN Average monthly work RVUs: 509 ~1.134 work RVU per appt Obs. day patient density = 4/hr

FALLING BEHIND Average monthly work RVUs: 316 ~0.798 work RVU per appt Obs. day patient density = 2.1/hr

D I F F E R E N C E P E R M O N T H

Based on a CY 2009 Conversion Factor of $36.0666 per RVU



Examine post-visit process

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– Provide coding reference tools and payer responsitiblity advice (select payers)



Swiftly review and appeal denials and underpays

Clinical Cycle


Pre-treatment

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Post-Doctor Office Activity

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Optimal Practice Workflow

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– Provide coding reference tools and payer responsibility advice (select payers)





Health Information Acquisition and Utilization (HIAU)


In order for physicians to run practices that give great

patient care and are financially stable several steps can

be put into place to assess, modify, and continuously

improve HIAU. This presentation lays out several

strategies that physicians and their staff can use to

achieve operational efficiency from the perspective of a

small practice physician, but the lessons shown here

can be applied to practices of all types and sizes.


Standard Background Medical Data + Staff entered and reviewed

+ MD is NOT Medical Data-entry

+ Data Verification

+ HIE

+ Digital data transfer

Data Abstraction Patient Portal


Health Information Exchanges (HIE)



Health Information Acquisition Physician Tools

Health Information Utilization


+ Diagnostic order sets

+ Integrate best practice guidelines

+ Procedure templates

+ Assessment templates

+ Intelligent systems

+ Tracks most used

+ Tracks orders to completion

+ Presents data and modifies plans (future fx)

Health Information Utilization


+ Completion of records at end of patient visit

+ Need efficient process to enter information

+ Staff reviews

+ Provide patient with summary

+ Using technology meaningfully easily exceeds meaningful use standards

The Provider Productivity End-Goal


Close all patient encounters by the end of the day

Why by End-of-Day?


+ Because… – All encounters are then moved into the administrative phase

where they can be billed

– Patient charts can be shared with others

– It clears the deck for patients coming in the following day

+ And… – It helps providers strike a work-life balance

How Do You Impact Clinical Efficiencies? (Drain the Swamp)


+ Get the right people on the bus

+ Get them in the right seat

+ Delegate tasks and data abstraction

+ (MD = medical doctor not medical data-entry)

+ Be conscious of the ALL the stakeholders in your business and ensure all get value

+ Communicate (patient portal)

+ HIE


Work with Cross-Trained Staff that Can Handle Intake and Documentation

Work with Cross-Trained Staff that Can Handle Intake and Documentation


Truly lean providers make use of multiple staff resources in the first hour and throughout the day:

– Providers should work with whichever staff member is available rather than always relying on a certain one

– Staff should be responsible for inputting certain patient documentation

– A more efficient workflow (like the 5-Stages) allows for more efficient handoffs of tasks between administrative staff, clinical support staff, and providers

Your EHR System Should Be Able to Provide Data on the Following Questions


Are my providers closing all

patient encounters every day?

How does my practice stack

up against comparable

practices across the country?

Is my practice routing

documents efficiently

and delegating

responsibility for document

handling appropriately

?

How much time do my

providers spend on

documentation while a

patient is in the office and

how much after the

patient has left?

How much time do my

providers spend

documenting each patient encounter?

Are my providers

maximizing staff use

during intake?

Permits Benchmarking Across an Entire Client Base


Same Day Encounter Close Rate Provider Documentation Time

(distributed across stages) Delegation: Intake

Provider Documentation Time (ave across all encounters)

Real-time vs Post-visit Documentation

Delegation: Document Actions

Computing is Following an Evolutionary Path to the Cloud


How Can You Use Technology to Facilitate Efficiencies?


+ IT is a tool and only a tool

+ Any benefits of technology depends on how you use it

+ Purchasing software does not guarantee results

+ Must know how to use the tool

How to Interpret/Access Expertise


+ I have had to accept the reality that I am not a business expert

+ Small practices can rarely afford the cost of a high trained Practice Administrator

+ Expertise within the office vs. MSO/Physician services

Management Services Organization (MSO)/Physician Services Organization


+ Not necessarily consultants/partners in the process

+ Access to just the right amount of support for your budget

How to Survive in Private Practice?


+ Partners in the process

+ Be able to prove it

+ Automated reports/data

+ Advocate for compensation

Allen L. Gee, MD, PhD, FAAN

Frontier Neurosciences

Cody, WY

frontier neurosciences cody, wy

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