Raghu Vir

Healthcare

Elevating Physician Efficiency and Patient Care through Expert Medical Scribe Services

Mar 20, 2023 by Raghu Vir 0 Comments , ,

Medical scribe services have become increasingly popular in recent years, as healthcare providers seek to streamline their workflows and improve the accuracy of their clinical documentation. A medical scribe is a trained professional who works with healthcare providers to document patient encounters in real-time. In this article, we’ll explore the benefits of medical scribe services and how they can improve patient care.

One of the primary benefits of medical scribe services is that they can improve the accuracy and completeness of clinical documentation. Healthcare providers often struggle to keep up with the demands of clinical documentation while also providing quality care to their patients. By working with a medical scribe, providers can focus on patient care while the scribe takes care of documenting the encounter. This can help ensure that documentation is accurate, complete, and timely.

Another benefit of medical scribe services is that they can help reduce the risk of errors and omissions in clinical documentation. Inaccurate or incomplete documentation can lead to serious consequences for patients, such as incorrect diagnoses or treatment plans. By having a medical scribe present during patient encounters, healthcare providers can be confident that all relevant information is being captured accurately.

Medical scribe services can also help improve the efficiency of healthcare delivery. Providers who work with a medical scribe can see more patients in a shorter amount of time, as the scribe takes care of documentation tasks. This can help reduce wait times for patients and improve patient satisfaction. In addition, medical scribe services can help reduce administrative burdens for healthcare providers, allowing them to focus on patient care rather than paperwork.

Medical scribe services can also help support healthcare providers in providing high-quality care. By taking care of documentation tasks, medical scribes can free up providers to focus on building rapport with their patients, listening to their concerns, and developing personalized treatment plans. This can help improve patient outcomes and satisfaction, as patients are more likely to adhere to treatment plans when they feel heard and understood by their healthcare providers.

Overall, medical scribe services offer a range of benefits to healthcare providers and patients alike. By improving the accuracy and completeness of clinical documentation, reducing the risk of errors and omissions, improving efficiency, and supporting high-quality care, medical scribes can help improve the overall quality of healthcare delivery. As healthcare continues to evolve, it’s likely that medical scribe services will become an increasingly important component of healthcare delivery, helping to support healthcare providers in providing the best possible care to their patients.

Clinical Documentation, Clinical Documentation Improvement, Healthcare

Maximizing Inpatient Reimbursement and Quality of Care with Innovative CDI Solutions: A Comprehensive Approach

Mar 20, 2023 by Raghu Vir 0 Comments

Clinical Documentation Improvement (CDI) solutions and services are essential for ensuring that clinical documentation is accurate, complete, and specific. Inpatient CDI services focus on improving documentation for patients who are admitted to a hospital or other inpatient facility. In this article, we’ll explore the benefits of inpatient CDI solutions and services, and how they can improve patient care.

One of the primary benefits of inpatient CDI solutions and services is that they can help improve the accuracy and completeness of clinical documentation. This can have a significant impact on patient care, as accurate documentation can help ensure that patients receive appropriate treatment and monitoring. In addition, accurate documentation can help reduce the risk of errors and omissions, which can lead to incorrect diagnoses, treatment plans, and medication orders.

Another benefit of inpatient CDI solutions and services is that they can help improve coding and billing accuracy. Accurate coding is essential for proper reimbursement and can help ensure that healthcare providers are fairly compensated for the care they provide. By improving documentation, inpatient CDI solutions and services can help ensure that the correct codes are assigned to each patient encounter, which can reduce the risk of denials and appeals.

Inpatient CDI solutions and services can also help improve patient outcomes. By improving the quality of clinical documentation, healthcare providers can more accurately diagnose and treat patients, which can lead to better outcomes. For example, if a patient is admitted to the hospital with pneumonia, but the clinical documentation only mentions respiratory distress, the care team may not realize the severity of the patient’s condition. However, if the documentation is accurate and specific, the care team can provide appropriate treatment and monitor the patient closely to ensure they are recovering.

In addition to improving patient care and reimbursement, inpatient CDI solutions and services can also help healthcare organizations comply with regulatory requirements. For example, the Centers for Medicare & Medicaid Services (CMS) require hospitals to report quality measures, which are based on clinical documentation. Accurate and complete documentation is essential for compliance with these requirements, as well as other regulatory standards.

One key feature of inpatient CDI solutions and services is the use of technology to improve the CDI process. For example, natural language processing (NLP) can be used to analyze clinical documentation and identify areas where documentation can be improved. This can help streamline the CDI process and improve the accuracy of clinical documentation.

Inpatient CDI solutions and services can also provide education and training to healthcare providers. This can help providers understand the importance of clinical documentation and how to improve their documentation practices. By providing education and training, inpatient CDI solutions and services can help ensure that providers are equipped with the knowledge and skills they need to provide high-quality care and documentation.

Overall, inpatient CDI solutions and services offer a range of benefits to healthcare providers, patients, and healthcare organizations. By improving the accuracy and completeness of clinical documentation, improving coding and billing accuracy, improving patient outcomes, and supporting regulatory compliance, inpatient CDI solutions and services can help improve the overall quality of healthcare delivery. As healthcare continues to evolve, it’s likely that inpatient CDI solutions and services will become an increasingly important component of healthcare delivery, helping to support healthcare providers in providing the best possible care to their patients.

Clinical Documentation, Healthcare

Enhancing Clinical Documentation through Comprehensive CDI Services: Improving Patient Care and Reimbursement Accuracy

Mar 20, 2023 by Raghu Vir 0 Comments

Clinical Documentation Improvement (CDI) Services are an essential component of the healthcare industry, aimed at improving the accuracy, completeness, and specificity of clinical documentation. The goal of CDI Services is to ensure that healthcare providers have access to complete and accurate patient information, leading to better care, improved outcomes, and proper reimbursement. In this article, we will discuss the importance of CDI Services and how they can benefit healthcare organizations.

One of the primary benefits of CDI Services is improved patient care. Accurate and complete clinical documentation helps healthcare providers understand a patient’s medical history, diagnosis, and treatment plan, leading to better patient care. By improving the quality of clinical documentation, CDI Services can also help reduce the risk of medical errors, which can have significant consequences for patients. In addition, accurate documentation can help providers make more informed decisions about patient care, which can improve outcomes and reduce costs.

Another significant benefit of CDI Services is improved coding and billing accuracy. Proper coding is critical for proper reimbursement, and inaccurate coding can lead to denials and appeals, ultimately resulting in lost revenue. CDI Services can help ensure that accurate codes are assigned to each patient encounter, reducing the risk of denials and appeals and ensuring that healthcare providers are fairly compensated for the care they provide.

CDI Services can also help improve compliance with regulatory requirements. Healthcare providers are subject to numerous regulations and requirements, and accurate clinical documentation is essential for compliance. For example, healthcare organizations must comply with regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Centers for Medicare & Medicaid Services (CMS) requirements. CDI Services can help ensure that healthcare providers are meeting these requirements, reducing the risk of penalties and fines.

In addition to improving patient care, coding and billing accuracy, and regulatory compliance, CDI Services can also provide significant financial benefits to healthcare organizations. By improving documentation, CDI Services can help healthcare providers identify areas where they can improve revenue cycle management, reduce denials, and increase reimbursement. In addition, accurate documentation can help healthcare organizations avoid costly litigation resulting from medical errors and omissions.

One of the key features of CDI Services is the use of technology to improve the CDI process. Natural Language Processing (NLP), machine learning, and other technologies can be used to analyze clinical documentation, identify areas where documentation can be improved, and automate parts of the CDI process. These tools can help streamline the CDI process, reduce the burden on healthcare providers, and improve the accuracy of clinical documentation.

CDI Services can also provide education and training to healthcare providers. This can help providers understand the importance of clinical documentation and how to improve their documentation practices. By providing education and training, CDI Services can help ensure that providers are equipped with the knowledge and skills they need to provide high-quality care and documentation.

Overall, CDI Services are an essential component of the healthcare industry, aimed at improving the accuracy, completeness, and specificity of clinical documentation. By improving patient care, coding and billing accuracy, regulatory compliance, and financial performance, CDI Services can help healthcare organizations provide better care to their patients, while also improving their bottom line. As healthcare continues to evolve, it’s likely that CDI Services will become an increasingly important component of healthcare delivery, helping to support healthcare providers in providing the best possible care to their patients.

The goal of the Saince CDI services is to increase the quality of patient care through personalized attention and education. Our CDI team is comprised of expert consultants who possess strong clinical knowledge combined with certifications in CDI and medical coding. Our experienced CDI consultants can help you design, develop or maintain your clinical documentation improvement program while increasing hospital and physician group revenue and decreasing costs. Contact us for more information.

Clinical Documentation, Healthcare

Is MIPS really doing what it is supposed to do? Research suggests that it is not.

Dec 8, 2022 by Raghu Vir 0 Comments , , ,

How well does the Merit-based Incentive Payment Program (MIPS) of Medicare measure the caliber of medical treatment that is given? According to the findings of a recent study, not very.

The 2017 introduction of MIPS, which replaced three prior quality measurement programs, aimed to enhance patient care by financially rewarding or penalizing physicians based on their performance on particular “process” and “outcome” metrics in four key areas: cost, quality, improvement activities, and fostering interoperability.

The six metrics that participating physicians choose to report on must include one outcome indicator, such as a hospital admission for a particular disease or condition. Currently, MIPS is the biggest value-based payment program in the country.

Data from Medicare statistics and claims records for 3.4 million individuals who saw about 80,000 primary care providers in 2019 were evaluated for the study by researchers. They compared doctors’ overall MIPS scores with their scores on five process measures, including breast cancer screening, tobacco screening, and diabetic eye exams, and six outcome measures, including ED visits and hospitalizations.

The findings showed there was no consistent relationship between the measures’ performance and the final MIPS ratings. For instance, doctors with low MIPS scores scored somewhat better on the other two process measures, while having much lower average MIPS scores than physicians with high MIPS scores on three of the five process measures examined.

Low-scoring doctors performed much worse on the all-cause hospitalizations per 1,000 patients metric than they did on the other four outcome measures, although they performed significantly better on the metric of ED visits per 1,000 patients. Similar to this, 21% of physicians with high MIPS scores had outcomes that were in the poorest percentile, compared to 19% of those with low MIPS scores who performed in the top quintile for composite outcomes performance.

The findings suggest that the MIPS program’s accuracy in identifying high- versus low-performing providers is really no better than chance.

For these findings, the authors provide a number of interpretations. Among them are the challenges in making meaningful comparisons when doctors are free to select the metrics they report on, the fact that many program metrics, as other research has shown, are either invalid or of dubious validity and thus may not be linked to better outcomes, and the possibility that high scores may simply be an indicator of a program’s capacity for data collection, analysis, and reporting rather than of higher quality medical care.

They claim that the latter conclusion is supported by the discovery that participants with low MIPS scores were more likely to work in independent, small practices even though their clinical outcomes were frequently comparable to those of medical professionals in large, system-affiliated practices with high MIPS scores.

This research was released in JAMA on December 6. https://jamanetwork.com/journals/jama/article-abstract/2799153

Clinical Documentation, Clinical Documentation Improvement, Outpatient CDI

Hospital Outpatient Departments: Effective July 1, 2020 you must request prior authorization for certain hospital Outpatient Department (OPD) services

Jun 25, 2020 by Raghu Vir 0 Comments

For dates of service beginning July 1, 2020, you must request prior authorization for the following hospital Outpatient Department (OPD) services:

  • Blepharoplasty
  • Botulinum toxin injections (when paired with specific procedure codes)
  • Panniculectomy
  • Rhinoplasty
  • Vein ablation

Medical necessity documentation requirements remain the same and hospital OPDs will receive a decision within 10 days.

While only the hospital OPD service requires prior authorization, CMS wants to remind other providers that perform services in the hospital OPD setting that claims related to/associated with these services will not be paid if the service requiring prior authorization is not eligible for payment. These related services include, but are not limited to, anesthesiology services, physician services, and facility services. Only associated services performed in the hospital OPD setting are affected. Depending on the timing of claim submission for any related services, claims may be automatically denied, reviewed, or denied on a postpayment basis.

For botulinum toxin injections, consult the list of codes that require prior authorization for more details. Generally, the use of botulinum toxin injection codes paired with procedure codes other than 64612 or 64615 will not require prior authorization under this program.

Artificial Intelligence, Clinical Documentation, Clinical Documentation Improvement, Dictation, EHR, EHR, Healthcare, Healthcare Technology, Morning musings from a CEO, Outpatient CDI, Radiology

Saince announces the launch of tele-medicine feature within its clinical documentation solution

Jun 15, 2020 by Raghu Vir 0 Comments

Doc-U-Scribe clinical documentation solution now comes integrated with tele-medicine workflow. Physicians and administrators can create tele-consultation sessions with patients seamlessly from within the application. This process eliminates the need for providers to use separate solutions – one for clinical documentation and another for video session.

The COVID-19 public health crisis has accelerated the use of tele-medicine solutions among healthcare provides across the nation. However, many small hospitals and physician offices do not have access to a single solution that takes care of all their needs. Physicians are forced to use multiple solutions to complete their tele-medicine workflow. They are often finding this process frustrating and cumbersome.

Doc-U-Scribe clinical documentation solution which is used by hundreds of hospitals and physician offices across the country provides an integrated and seamless workflow for clinical documentation as well as tele-medicine.   This new HIPAA compliant tele-medicine solution can cut costs, increase efficiency, and improve physician satisfaction significantly.

Saince announced that this new feature will be available to all their existing customers immediately. Saince also announced that with their plug and play model, any new hospital or physician office can be up and running with their tele-medicine program within 48 hours.

Morning musings from a CEO

Pandemic – Peril and the promise

Jun 15, 2020 by Raghu Vir 0 Comments

The world right now is hurting. And it is hurting really bad. There is a lot of physical, emotional, and economic pain all around. This pain is accentuated with fear. Fear of facing the unknown. Fear of being helpless. Health workers are helplessly watching their patients die in front of their eyes. Children are helplessly watching their parents succumb on FaceTime. The world is now firmly in a grip of fear and gloom.

But behind all this fear and sadness I see hope. I see promise.

I see hope because whenever humanity faced a calamity in the past, either natural or man-made, when it came out on the side, the world became a much better place. For everyone. Each and every event that we faced in the past, be they world wars or natural disasters, brought a lot of pain along with them but after the event they also elevated humanity as a whole.

The Gita, the holy book of Hindus, says that good and bad are two sides of the same coin. One cannot exist without the other. Sort of Yin and Yang of the Chinese philosophy.

This pandemic brought a lot of pain. It pushed a lot of people out of business. More than 40 million Americans lost their jobs. Food lines were unimaginably long.  Everyone is scared. Everyone is hurting in some way or the other. But coming out of all this suffering and pain, I’m seeing an increased feeling of compassion among people. Out of this common suffering I see camaraderie that I never saw before. Unemployment made people look deeper within themselves. The whole climate was emotionally charged.

Then George Floyd died. That triggered an outpouring of emotion. People spontaneously took to the streets, not just in big cities but also in small towns and remote corners. Not only here but all over the world. It united us as a humanity. We felt other person’s pain like we never felt it before. We felt compassionate. We saw the long-standing inequalities in the system. We started on a path to fix it. Events like George Floyd’s death happened before the pandemic too. But the reaction was sporadic. It was temporary. But this time it is different. There is something in the air this time that smells different. We are embarking on a path to make America a better nation than it already is. As a human race, we are starting to feel more united than before.

This time it is different. The scientific community is breaking down borders and collaborating in an unprecedented manner.  They are tearing apart bureaucracies. Putting aside their personal agendas. Working fearlessly and tirelessly towards a common goal for the benefit of humanity. They are realizing the power of cooperation and sharing. Governments are as usual trying to put brakes on this by making it a competitive race. I am hoping that better sense will prevail.

The earth is healing as well. We are now more open to noticing how we have been plundering the natural resources all these years. We have already reached the tipping point in climate change. We were almost at a point of no return. With this pandemic, we hit the pause button. We are seeing palpable change even in this short period when we hit the brakes on our emissions. I am hopeful that as a human race we can continue to let the planet heal.

Families are healing as well. Families are spending time together. They are talking with each other. They are having verbal conversations instead of texting to each other from across the room. They are eating together, playing together, staying together and coming together. When families stay together, communities stay together. When communities heal, nations heal.

Fighting and terrorism across the world has come down quite a bit. In this process a lot of lives has been spared. I hope they use this time to introspect and come together because the virus does not play favorites. When there is a common enemy, everyone comes together.

Hence, I see promise on the other side of this pandemic. To deliver a bundle of joy, the mother goes through a lot of pain.

I am optimistic. I am hopeful. I am human.

Healthcare Technology

CMS Announces Release of 2018 National Impact Assessment of Quality Measures Report

Mar 14, 2018 by Raghu Vir 0 Comments

Center for Medicare and Medicaid Services (CMS) conducts and publishes an assessment of the quality and efficiency impact of the use of endorsed measures in CMS programs every three years as required by statute.  The first report was published March 1, 2012 and the 2018 Impact Assessment Report is the third such report.   The data-driven results of this Report support the use of measures implemented in CMS reporting programs to drive improvement in the quality of care provided to patients in facilities and across settings nationwide.  This report is used by the measure developer community, patients and families, clinicians, providers, federal partners, and researchers.

The 2018 Impact Assessment Report demonstrates that performance on CMS measures contributed to better care and reduced expenditures, and identified critical areas of improvement across settings with respect to six CMS quality priorities:  patient safety, person and family engagement, care coordination, effective treatment, healthy living, and affordable care.

Highlights include these main findings:

  • Patient impacts estimated from improved national measure rates indicated approximately:
    • 670,000 additional patients with controlled blood pressure (2006–2015).
    • 510,000 fewer patients with poor diabetes control (2006–2015).
    • 12,000 fewer deaths following hospitalization for a heart attack (2008–2015).
    • 70,000 fewer unplanned readmissions (2011–2015).
    • 840,000 fewer pressure ulcers among nursing home residents (2011–2015).
    • 9 million more patients reporting a highly favorable experience with their hospital (2008–2015).
  • Costs avoided were estimated for a subset of Key Indicators, data permitting. The highest were associated with increased medication adherence ($4.2 billion–$26.9 billion), reduced pressure ulcers ($2.8 billion–$20.0 billion), and fewer patients with poor control of diabetes ($6.5 billion–$10.4 billion).
  • National performance trends are improving for 60% of the measures analyzed, including a majority of outcome measures, and are stable for about 31%.
  • Overwhelmingly, hospitals (92%) and nursing homes (91%) surveyed reported they consider CMS measures clinically important. Likewise, 90% of hospitals and 83% of nursing homes agreed that performance on CMS quality measures reflects improvements in care. Respondents also described barriers to reporting, including burden; barriers to improving performance; and unintended consequences of CMS measures.
Clinical Documentation, EHR, Healthcare Technology

CMS introduces new payment model for both inpatient and outpatient care

Jan 10, 2018 by Raghu Vir 0 Comments

The Centers for Medicare & Medicaid Services (CMS) announced the launch of a new voluntary bundled payment model called Bundled Payments for Care Improvement Advanced (BPCI Advanced). Under traditional fee-for-service payment, Medicare pays providers for each individual service they perform. Under this bundled payment model, participants can earn additional payment if all expenditures for a beneficiary’s episode of care are under a spending target that factors in quality.

Bundled payments create incentives for providers and practitioners to work together to coordinate care and engage in continuous improvement to keep spending under a target amount. BPCI Advanced participants may receive payments for performance on 32 different clinical episodes which are listed below.

Of note, BPCI Advanced will qualify as an Advanced Alternative Payment Model (Advanced APM) under the Quality Payment Program (QPP). Under Advanced APMs, providers take on financial risk to earn the Advanced APM incentive payment.

BPCI Advanced will operate under a total-cost-of-care concept, in which the total Medicare fee for services (FFS) spending on all items and services furnished to a BPCI Advanced Beneficiary during the  Clinical Episode, including outlier payments, will be part of the Clinical Episode expenditures for purposes of the Target Price and reconciliation calculations, unless specifically excluded.

Clinical Episodes

BPCI Advanced will initially include 29 inpatient Clinical Episodes and 3 outpatient Clinical Episodes. Participants selected to participate in BPCI Advanced beginning on October 1, 2018, must commit to be held accountable for one or more Clinical Episodes and may not add or drop such Clinical Episodes until January 1, 2020.

Inpatient Clinical Episodes – 29

  • Disorders of the liver excluding malignancy, cirrhosis, alcoholic hepatitis *
    *(New episode added to BPCI Advanced)
  • Acute myocardial infarction
  • Back & neck except spinal fusion
  • Cardiac arrhythmia
  • Cardiac defibrillator
  • Cardiac valve
  • Cellulitis
  • Cervical spinal fusion
  • COPD, bronchitis, asthma
  • Combined anterior posterior spinal fusion
  • Congestive heart failure
  • Coronary artery bypass graft
  • Double joint replacement of the lower extremity
  • Fractures of the femur and hip or pelvis
  • Gastrointestinal hemorrhage
  • Gastrointestinal obstruction
  • Hip & femur procedures except major joint
  • Lower extremity/humerus procedure except hip, foot, femur
  • Major bowel procedure
  • Major joint replacement of the lower extremity
  • Major joint replacement of the upper extremity
  • Pacemaker
  • Percutaneous coronary intervention
  • Renal failure
  • Sepsis
  • Simple pneumonia and respiratory infections
  • Spinal fusion (non-cervical)
  • Stroke
  • Urinary tract infection

Outpatient Clinical Episodes – 3

  • Percutaneous Coronary Intervention (PCI)
  • Cardiac Defibrillator
  • Back & Neck except Spinal Fusion
Clinical Documentation, Clinical Documentation Improvement, EHR, Healthcare

Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes for 2018

Nov 3, 2017 by Raghu Vir 0 Comments

On November 1, CMS issued the CY 2018 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule with comment period, which includes updates to the 2018 rates and quality provisions and other policy changes. CMS adopted a number of policies that will support care delivery; reduce burdens for health care providers, especially in rural areas; lower beneficiary out of pocket drug costs for certain drugs; enhance the patient-doctor relationship; and promote flexibility in healthcare.

CMS is increasing the OPPS payment rates by 1.35 percent for 2018. The change is based on the hospital market basket increase of 2.7 percent minus both a 0.6 percentage point adjustment for multi-factor productivity and a 0.75 percentage point adjustment required by law. After considering all other policy changes under the final rule, including estimated spending for pass-through payments, CMS estimates an overall impact of 1.4 percent payment increase for providers paid under the OPPS in CY 2018.

CMS updates ASC payments annually by the percentage increase in the Consumer Price Index for all urban consumers (CPI-U). The Medicare statute specifies a Multi-Factor Productivity (MFP) adjustment to the ASC annual update. For CY 2018, the CPI-U update is 1.7 percent. The MFP adjustment is 0.5 percent, resulting in a CY 2018 MFP-adjusted CPI-U update factor of 1.2 percent. Including enrollment, case-mix, and utilization changes, total ASC payments are projected to increase approximately 3 percent in 2018.