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Dictation

Dictation: Giving Physicians a Break While Avoiding Costly Medical Errors

Dec 17, 2018 by admin 0 Comments dictation, EHR

Overworked professionals, regardless of industry, are far more likely to make mistakes. For medical professionals, however, particularly when it comes to documentation, those mistakes risk profound repercussions for both medical providers and their patients. They’re also notoriously difficult to correct once they’ve been made.

Earlier this year, researchers from Johns Hopkins released a report pointing to medical errors as the third leading cause of death in the United States behind heart disease and cancer. From typos to incorrect dosing to misdiagnoses, the consequences of these mistakes can range from mundane to catastrophic—blamed for 250,000 to 400,000 deaths annually. Beyond medical mistakes, documentation errors can also wreak havoc in other areas of patients’ lives, such as when applying for life insurance.

Although completely eliminating such errors would require both industry and regulatory efforts of enormous proportions, providers can leverage a simple workflow strategy to safeguard against many of these mistakes. Dictation allows doctors to spend less of their time on documentation while sharing the workload with trained specialists who can process the records—ensuring accuracy and integrity are maintained.

As we recently highlighted, the advent of electronic medical records (EMRs), which originally heralded a new age of documentation ease and efficiency, actually created more administrative work for doctors. As a result, EMRs are cited in study after study as a leading factor in the twin epidemics of physician and nurse burnout. In many of those same studies, however, dictation and transcription have been highlighted as preferred strategies to make EMRs more physician friendly.

By relying on dictation, which can be seamlessly integrated into the EMR, physicians can get back to the reason they entered medicine—to care for patients. Because, as the Johns Hopkins researchers were quick to note, these errors rarely stem from poor medical care but rather a systemic problem that places undue—and out-of-scope—burden on chronically overworked doctors and providers.

A state-of-the-art dictation and transcription platform can deliver proven benefits to physician practices, hospitals, integrated delivery networks (IDNs) and medical transcription services organizations (MTSOs) of all sizes. To learn more about how these can be successfully integrated with leading EMR systems, read about Doc-U-Scribe or contact Saince.

EHR

EHRs, Documentation Leading to a Physician Burnout Crisis

Dec 11, 2018 by admin 0 Comments

Dictation and Transcription Improvements Cited as No. 1 Fix by Docs

When they were kids thinking about their future career, physicians didn’t dream of taking care of administrative record-keeping. They dreamed about taking care of patients.

But extensive documentation fatigue has become a leading concern for the healthcare industry. Just this week, the U.S. Department of Health and Human Services (HHS) released a draft strategy aimed at reducing the amount of time clinicians spend recording information in electronic health records (EHRs). Now there’s an open 60-day comment period for clinicians and others to provide feedback to the draft strategy.

The healthcare industry is waking up to the reality of doctors’ serious unhappiness with EHRs. Many physicians seems to agree with one emergency room physician who sees EHRs as “predominantly a billing tool, secondarily a compliance tool … [There are] too many boxes to click, too many irrelevant alerts, soft or hard stops which create alert fatigue. [There is] very little useful clinical decision support.”

EHR(Electronic Health Records)

And that unhappiness with the tools is leading to overall dissatisfaction. In a nationwide survey of 254 physicians from different specialties, physicians cite EHRs as the biggest contributing factor to burnout.

Incredibly, the amount of time physicians spend on administrative work has surpassed the amount of time spent with patients. A study published last year in Health Affairs reveals that physicians spend more of their time doing “desktop medicine” as they do seeing patients. Desktop medicine includes “communicating with patients through a secure patient portal, responding to patients’ online requests for prescription refills or medical advice, ordering tests, sending staff messages, and reviewing test results.” The study, which analyzed 31 million EHR transactions over four years by primary care physicians, shows that physicians are logging an average of 3.08 hours with patients and 3.17 hours on documentation every day.

With the demands for a more physician-friendly EHR, doctors have identified dictation and transcription as a preferred part of a better EHR solution. In the same survey where EHRs are blamed as the primary contributor to physician burnout, the No. 1 suggestion (17 percent) for fixing the problem was to add dictation and scribe features to EHRs. The second and third suggestions were not even solutions, but complaints, with 13 percent recommending that less time be spent in the system and 9 percent of respondents recommending that EHRs be replaced altogether.

The survey respondents were clear that the EHR workflow was not an innovation. Restoring dictation and transcription would help, respondents say. One orthopedic surgeon commented, “Develop a better and more user-friendly EHR. It shouldn’t take 20 minutes to do something that dictation takes three minutes.”

For help understanding how a state-of-the-art dictation and transcription platform can deliver proven benefits to physician practices, hospitals, integrated delivery networks (IDNs) and medical transcription services organizations (MTSOs) of all sizes, and successfully integrate with leading EHR systems, read about Doc-U-Scribe or contact Saince.

CDI Services

Getting CDI Compliance Right From the Start

Dec 4, 2018 by admin 0 Comments

For decades, countless market observers have warned of turmoil in the healthcare space. The upheaval and endless changes have created a cacophony of compliance requirements that leave healthcare providers—both new players and those pursuing improvements—scratching their heads about where to begin.

Organizations focusing on clinical documentation improvement (CDI) must foster an environment of effective compliance from the outset. If they hope to improve outcomes while also increasing revenues and reducing costs, those organizations must evolve CDI practices in support of shifting trends in reimbursement and its documentation requirements.

Get the Workflow Right, and Quality Will Follow

Outpatient CDI efforts are designed to address a variety of needs, including Hierarchical Condition Categories (HCC) capture, quality improvement, risk adjustment and more. Without thoughtful attention to the development of an efficient and effective workflow, however, these goals will compete as varied teams within the organization focus on different aspects.

For instance, what may appear to be an issue with quality may actually be an issue with documentation, or vice versa. Aligning staff around common goals—ensuring not only that they’re tracking the same metrics, but also prioritizing them in the same order—will help teams more quickly identify operational issues and their true causes.

Understand How CDI Efforts Affect Reimbursement

Whether through HCC capture, risk adjustment or other areas, CDI efforts are helping providers better adjust as the healthcare landscape shifts away from fee-for-service and increasingly toward value-based, alternative reimbursement models. But as noted above, leveraging these capabilities requires that teams align around these metrics and how coding and CDI work synergistically to achieve these ends.

clinical documentation improvement

Although fee-for-service remains the norm in many settings, even those once-reliable revenue streams are increasingly in jeopardy as a result of penalties surrounding poor quality or, conversely, failure on the part of organizations to properly code and capture reimbursement incentives. Capturing HCCs, in particular, is becoming a vitally important CDI task as the high-value diagnoses play a central role in risk adjustment—requiring ongoing, accurate documentation to reflect patient and population health risk.

Under this new payment paradigm, teams need to understand the relationship of day-to-day compliance, accuracy and the longitudinal effects they have on reimbursement and organizational efficacy.

Understand How Outpatient CDI Affects Population

If your organization has decided to address outpatient CDI, then many of the above strategies become even more vital. Streamlining workflows and organizational compliance is more challenging in the outpatient setting, which places a greater emphasis on effective intra-team cooperation and communication.

On the upside, however, by implementing effective outpatient CDI efforts as part of an overall CDI strategy, healthcare organizations can capture opportunities for medical necessity documentation as well as reduce error-driven medical necessity denials for patients.

For more tips on Outpatient CDI efforts, see our previous blog post. For help designing your organization’s CDI efforts or to learn about PracticePerfect, a platform to help you address outpatient CDI, and Doc-U-Aide, a revolutionary platform for inpatient CDI, contact Saince.

Clinical Documentation

Safeguarding Cyber security Amid CDI Efforts

Dec 4, 2018 by admin 0 Comments

Original: Cyber security, Coding and CDI. Best practices to ensure best practices for cyber security are employed.

To say that the present state of healthcare cyber security poses a challenge for organizations undertaking clinical documentation improvement (CDI) efforts is a drastic understatement. Under the ever-present specter of costly cyber attacks, providers across the country continue to grapple with myriad, big-picture challenges such as information governance (IG), highly ambiguous government oversight and unstable compliance landscapes as well as shifting care settings.

Providers are required to adhere to strict security laws like HIPAA and HITECH while simultaneously acceding the regulatory demands of fluid information sharing contained in the 21st Century Cures Act—all while adapting to the logistical reality of increasingly frequent outpatient care delivery. Further intensifying those challenges, the shift to outpatient care means that greater volumes of protected health information (PHI) is being routed through ambulatory and other non-hospital settings, making them increasingly attractive targets for hackers. Additionally, a recent survey of medical coders also found that roughly one-third reported working remotely at some point, highlighting the potential vulnerability many providers face.

Healthcare Cyber Security

As they approach this challenging future, however, smart organizations can balance conflicting security and compliance concerns as well as inpatient and outpatient CDI initiatives by sharpening their focus in a few key areas.

Staffing and Training. In CDI, overwhelmed and under-trained teams are more apt to make costly mistakes. The same is true for cyber security. A misaligned and overworked team is a liability and leading cause of security breaches, but one with the tools, training and cohesion to efficiently manage their workflow is a powerful safeguard. The quickest way for any organization to promote quality and compliance—as well as security—while executing CDI efforts is to ensure its staff is trained well. Fostering alignment between providers, coding and other administrative staff must include education on common security risks, drills to identify weak points and emphasis on a culture where anomalies, breaches and prevention are openly discussed and addressed.

Emphasis on Accuracy and Clarity. Just as optimized CDI and streamlined organizational compliance—from the point of care to the submission of a claim—can reduce error-driven medical necessity denials, that same focus on accuracy and clarity can reduce security errors as well. As provider organizations seek to improve overall IG while also contending with growing troves of clinical data, enhanced CDI workflow is a necessary component strategy, intricately linked with all others.

Encryption of All Devices. Loss of mobile devices is a major cause of healthcare data breach, particularly in outpatient settings. As mobile devices become increasingly common tools in clinical documentation, ensuring that these devices and all computers are encrypted is an important, albeit not-HIPAA-required, step for organizations to take.

Vetting Vendors. An organization must safeguard its own internal protocols, but it must also ensure that its vendors—particularly those offering Software as a Service (Saas)—are taking all reasonable steps to protect data, confidentiality and security as well. It’s a must to understand a vendor’s risk assessments and require indemnification provisions and cyber security insurance in business associate agreements.

Designing your organization’s CDI efforts is a significant undertaking. To learn about PracticePerfect, a platform to help you address outpatient CDI, or Doc-U-Aide, a revolutionary platform for inpatient CDI, contact Saince.

CDI Services

4 Factors to Consider for Optimizing CDI Workflows and Reporting

Nov 13, 2018 by admin 0 Comments

In recent years, the evolution of healthcare regulations has driven care away from the inpatient setting, while simultaneously increasing administrative and clinical documentation burdens for providers. As a result, many healthcare organizations have started expanding their clinical documentation improvement (CDI) efforts to outpatient settings by finding opportunities for increased reimbursement, enhanced quality, and improved patient satisfaction. However, this process also brings with it new challenges, far different from those faced with inpatient CDI.

Among the most explicit challenges that organizations face when pursuing outpatient CDI efforts are larger case volumes and markedly shorter clinical visits, which in turn generate far less usable data per patient. Additionally, that data is often collected by multiple team members during a narrow window, increasing the opportunity for costly errors. This dynamic underscores the need for efficient workflows that enable accurate, timely and comprehensive documentation.

Outpatient

As organizations explore optimizing outpatient CDI efforts, here are four factors to consider:

Timely collaboration is crucial. Outpatient CDI efforts require a higher level of physician engagement, as well as an increased emphasis on workflow efficiency to ensure that accurate documentation is produced concurrently with the provision of care.

Fostering collaboration between providers, coding and other administrative staff is vital to any CDI effort’s success. These team members must understand how their roles align in order to support, create and sustain a culture of operational efficacy.

Improved quality, care, and reimbursement go hand-in-hand. Streamlining organizational compliance from the point of care to the submission of a claim allows outpatient clinics and physician groups to optimize efforts with diagnosis coding and Hierarchical Condition Category (HCC) capture. It also helps them improve the Physician Quality Reporting System (PQRS) and Group Practice Reporting Option (GPRO) scoring and reduce error-driven medical necessity denials for patients.

It’s critical to analyze and agree on goals and targets. A central component of fostering collaboration and improving metrics is first understanding specific organizational needs and identifying areas that need the most improvement. By focusing on collaborative resources in these areas, outpatient CDI efforts can be organized to ensure desired outcomes.

Every organization’s needs will be unique. Key areas of improvement will vary from one organization to the next. Operational needs—from staffing to education to technology—will likewise be unique.

Designing your organization’s outpatient CDI efforts is a significant undertaking. To learn more about PracticePerfect, a platform to help you address outpatient and ER CDI, contact Saince.

Outpatient CDI

Better Outpatient CDI For Emergency Care, Wound Care and Total Knee Replacement

Nov 8, 2018 by admin 0 Comments

As care is increasingly delivered in an outpatient setting, it is critical that clinical documentation improvement (CDI) programs are developed to ensure compensation for care. “Clinical documentation is at the core of every patient encounter,” says the American Health Information Management Association (AHIMA). The association goes on to say that a meaningful documentation process must be accurate, timely and comprehensive of the services provided. The process should also engage physicians, so that they begin to associate documentation with a higher quality of care delivery rather than an interference in care delivery.

A recent presentation from the 90th Annual AHIMA conference showcased best practices for ensuring better outpatient CDI in the areas of emergency medicine, wound care and total knee replacement procedures. The presenters outlined these key practical considerations for documentation:

Emergency Room (ER)

Better ER documentation centers around four key questions:

Does documentation support the most appropriate visit level?
Does documentation support the billable services?
Does documentation accurately report staff present for care provided?
Does documentation accurately report the amount of time staff spends with critical patients?

When it comes to supporting the most appropriate visit level, what severity is being documented?

Self-limited or minor
Low severity
Moderate severity
High severity, requires urgent evaluation by the physician but does not pose threat to life or physiologic function
High severity, poses an immediate significant threat to life or physiologic functions

Supporting documentation is required for all elements of an ER visit, whether that means documenting the need for extra resources to deal with an intoxicated and combative patient, or the documenting the presence of a nurse in the room during a pelvic exam. The timeframe of patient time with nurses is a key element in being able to bill for critical care, with a requirement that at least 30 minutes of critical care services are provided and documented.

Wound Care

When it comes to wound care delivered in an outpatient setting, it is important to have clear and consistent documentation. Here are the key elements needed in documentation:

Describe the type of wound, location and size
Describe if the wound is a partial or full thickness wound
Describe stages of pressure ulcers
Describe depth of pressure ulcers
Any undermining/tunneling/sinus tract
Drainage, type, amount or odor
Various types of tissue in wound bed
Wound edges and surrounding tissue
Indicators of infection and pain
Document interventions for healing and conditions that would affect healing
Current topical treatment plan, response to treatment, modifications to plan, implementations of new orders, reasons for not changing treatment plan, referrals
Document any education given to patient and caregiver

Total Knee Replacement

With total knee replacement procedures, it is important to note in the documentation that the procedure is appropriately offered in an outpatient setting. In order for the procedure to be taken off of the inpatient-only (IPO) list, it must meet the following criteria, all of which should be documented:

A low anesthesia risk
Few or no comorbidities
Family at home to support
Patient can tolerate rehab in an outpatient facility or at home
Physician expects the patient to need fewer than two nights of hospital care

For more information, contact Saince about PracticePerfect, a platform to help you address outpatient and ER CDI.

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.

Clinical Documentation, Clinical Documentation Improvement, EHR, Healthcare

Physician Fee Schedule Final Policy for Calendar Year 2018

Nov 3, 2017 by Raghu Vir 0 Comments

On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.

The overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014. After applying these adjustments, and the budget neutrality adjustment to account for changes in Relative Value Units, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89.