Challenge of EMR deployment for Small Pediatric Practices

The use of Electronic Medical Records (EMRs) or Electronic Health Records (EHRs) in pediatric practices presents numerous challenges due to the dynamic nature of this particular specially. The reasons for these challenges are myriad and range from the changing nature of the body of children and also the medical care that is provided during childhood. This care can include immunizations, growth tracking, and other critical aspects such as obesity. Another advantage of EHRs is that children over 13 have to record their smoking status which may lead to positive health outcomes. The burden of all this EMR testing and implementation lies with the physicians and their assistance but this is usually possible in bigger settings such as hospitals and small practices have traditionally suffered due to lack of proper EMR facilities. Moreover, taking responsibility of such amount of work in pediatrics is costly as well as time consuming for novices in the field.

It cannot be denied that there are numerous advantages of EHR implementation in pediatrics and the general medical history of the child can be continuously recorded. However, there are numerous challenges as well and these can range from financial to functional. Physicians are finding it hard to dedicate time updating their EHRs which in turn has dropped the productivity. Another factor is that since pediatric patients have a constantly changing BMI (Body Mass Index) and features, recording this also consume resources in the form of time and money. Hospitals are finding it easier compared to small practices to implement EHRs since they have the groundwork in the form of infrastructure to implements such EHR systems.

The challenges faced by pediatrics in implementation of EHRs are similar to those faced by other specialties and these may include lack of adequate funding, lack of training, resistance to change and lack of resources. However, the biggest advantage is that there are numerous types of EMRs available in the market and many of these support pediatric services; but, the adoption of such EHRs/EMRs is not enough. The ‘Meaningful Use’ criterion needs to be met in order to qualify for the incentives offered by the government.

The financial aspect of successful implementation of EHRs is not limited to the incentives provided by the government but is also in the form of increased revenue due to efficient departmental processes. The financial success of the practice depends on a holistic approach by not just implementation of EHRs or EMRs but also through outsourcing such essential departmental processes such as medical billing and coding, interaction with payers, and denial management in addition to other value added services such as pediatric EHRs and research and consultancy that are provided by www.medicalbillersandcoders.com the largest consortium of medical billers and coders in the country.

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Challenges Faced by Diabetic Specialists in EHR Implementation

Electronic Health Records (EHRs) and Electronic Medical Records (EMRs) have started to affect almost all the specialties and diabetes care is no exception. A study by The New England Journal of Medicine finds that EHRs can have a positive impact on the quality of the care that is provided to diabetes patients. The report titled Electronic Health Records and Quality of Diabetes Care clarifies that sites with EHRs have better quality of care compared to those with paper based records. Another survey by the U.S National Library of Medicine, National Institute of Health also presents the advantages of using EHRs for caring for diabetes patients in another case study.

There are approximately 24 million diabetes patients in the country and as the population ages, this number will grow. Moreover, since diabetes is a chronic condition that has no final cure, caring becomes a continuous process with numerous hurdles. These hurdles can be overcome by using EMRS and EHRs which are especially designed in order to periodically monitor the condition of the patient and provide better care due to this approach. The biggest challenge in diabetes is the monitoring and control of blood sugar on a daily basis which can be exhaustive for the patient to check and keep a detailed record of. This is where EMRs and EHRs can be of immense help. EHRs and EMRs can help in keeping a detailed record of blood sugar levels along with other factors such as Body Mass Index and numerous other features. Such reports can be sent to patients in the form of lab reports and assessed by the patient regularly to maintain better health.

Even though EMRs and EHRs help in assisting physicians in taking better care of diabetic patients, EMR and EHR adoption rates in the country are not very encouraging. A yearly survey by the Centers for Disease Control and Prevention (CDC) has released a report containing the EMR adoption rates in late last year (2011). The report finds that only 10.1% of physicians in the country had a fully functional EMR system.  The successful implementation of EMR/EHR system seems to be the biggest challenge in health reforms and also in aspects related to diabetes care. There are numerous reasons that have been presented for this lag in the implementation of EMR/EHR systems. Factors such as the anxiety regarding the financial viability of such systems, a steep learning curve for providers, and the complexity in maintaining such systems are the most common reasons for the reluctance to fully implement systems that demonstrate ‘Meaningful Use’ (MU).

The financial advantages of implementation of EMRs and EHRs are apparent in light of the incentives provided by the government for MU. The advantages for patients are projected and expected to be excellent with the use of EMRs/EHRs; however, the study of the impact of EMRs on chronic conditions is limited yet positive. The ideal solution for proper implementation of EHR systems is to outsource the billing and coding process to professionals who possess experience in assisting in providing solutions for streamlining various processes related to EMRs.

Choosing the right EMR vendor is just the beginning because the maintenance of such EMR systems is more difficult compared to just implementation. Vendors should be able to provide basic education about the system and also support the practice in various ways for a period of time after implementation. Medical billers at medicalbillersandcoders.com will not only provide solutions to your billing problems as a provider but also offer other value added services such as assist in implementation of EMR systems after a thorough study of your practice, revenue cycle management, denial management and consultancy services.

The primary care physician shortage in California

State of California is facing an increased shortage of primary care physicians especially – with a rise in the number of elderly population in the State leading to increase in health coverage under Federal Health care reforms. Additionally 30% of primary care physicians in the state are nearing retirement being above 60 or older- the highest percentage in any state.

However compared to the shortage, the State has not significantly increased the number of primary care physicians trained. HHS’s Council on Graduate Medical Education recommends 60 to 80 primary care physicians per 100,000 people to adequately serve a population. Statistics show in fast-growing regions of California such as the Inland Empire there are only 40, whereas in low-income rural communities where care for 25% patients is paid by Med-Cal, there are only 45 primary care physicians.

Even though medical school applications have been high in California, with a high proportion of U.S. medical school graduates filling all of the 2011 family medicine slots, state and federal policy decisions too need to be on the same lines. However the State of California is trying to reduce physician fees by 10% in the Medicaid Program, putting physician payment at risk. According to the California Academy of Family Physicians (CAFP) a comprehensive state and nationwide effort would be able to effectively solve this shortage.

Tackling the shortage issue

Increase the number of medical school – The State and federal policies need to encourage funding for higher education and primary care residency programs. Absence of this funding may lead to students pushed to choose non-primary care specialties or to train in medical schools and residency programs in other states. To provide for increasing needs high quality primary care residency programs are the need of the hour to fill vacancies left by retiring physicians.

Medicaid reimbursements – With Medicaid rates in California being 20% lower than the national Medicaid rate and among the lowest in the U.S, Californians face a severe shortage of physicians willing to cater to them, conversely the California Legislature passed a budget in June reducing Medi-Cal physician payments by 10 %, among other reductions.  This could provide further incentive for students to choose specialties other than primary care. Patient access to care could be hampered as well if practicing physicians opt out of the Medi-Cal program because of the cuts. The state legislature and family physicians needs to work together to remedy reimbursement issues.

California family physicians need a coordinated effort of various entities to remedy this shortage of primary care physicians. In this scenario where primary care physicians need to tackle increased number of patients, cater to shortage issues, physicians may be short of time to give complete justice to their reimbursement strategy and medical billing and coding practices which hampers a steady flow of revenue for smooth running of their practice. Medical billers and coders can not only efficiently interact with insurance providers and increase claims generation but also keep up with health care IT reforms and comply with HIPAA and other guidelines.

Primary care physicians in California need to gear up and face the shortage challenge; moreover they can join a consortium of experts who can provide relevant revenue management services. Medicalbillersandcoders.com  is one of the largest consortiums of Medical Billers and Coders in the United States, our billers and coders in all the major cities of California including Los Angeles, San Diego, San Jose, San Francisco, Fresno can help you settle your requirements through services including- tracking and follow-up on unpaid claims, preparing patient statements and payment posting, customizing billing reports and primary and secondary insurance claims filing.

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Understanding Physician Assistants Reimbursement Environment

“Amidst all these overriding Medicare or health insurance guidelines surrounding the reimbursement for their assistants’ services, physicians would invariably feel exhausted for doubling up as medical billers along with their primary focus of clinical efficiency. Therefore, physicians would be well-off outsourcing medical billing services that are adept at handling their assistants’ reimbursement issue along with their own.”

From what used to be auxiliary to physicians’ main clinical services, services of physician assistants (comprising PAs, NPs, and Clinical Nurse Specialists) have evolved to be substitute to physician services themselves. In fact, in most of the primary care centers and non-surgical clinics, physician assistants’ have become as trustworthy as qualified physicians. Recognizing this phenomenon, majority of the primary care and non-surgical clinics are gradually migrating to an operational model dominated by physician assistants operating under one or two supervising physicians.

Although an alarming shortage of qualified physicians in the face of spiraling patient-population may have been the primary reason behind this changing equation, cost optimization or revenue augmentation (as physician assistants’ services can be bought at a comparatively lesser remuneration than what it can cost for physicians’ services) may also have equally been responsible for the shift towards physician assistants. The clinical or hospital management, on their part, would have happily carried on with this model as long as it seemed feasible but for the nuances of billing for their assistants’ services, which seem as challenging as billing for their own services.

The numerous guidelines that govern reimbursement for physician assistant services have tended to weigh rather heavy on physician practices. Amongst many such guidelines, the following are noteworthy:

• Medicare requires the services provided by physician assistants (PAs) be reimbursed at 85 percent of the physician fee schedule unless specific billing exceptions such as ‘incident to” and “shared visits billing” apply. Further, PAs need to bill Medicare at the full physician rate, and be necessarily carrying a National Provider Identifier (NPI) number to alert the carrier to implement the 15 percent discount.
• NPIs need to be updated with name changes and changes in employer. PAs must enroll with any new employer.
• Services provided by PAs are reimbursable by Medicare when provided in offices or clinics, nursing facilities, hospitals, and ambulatory surgical centers.
• Only services falling under the “Incident to Physician Services” are reimbursable at 100%. Otherwise, Medicare or insurance carriers are obliged to honor only 85% of the bill.
• Medicare maintains a list of approximately 1,900 Current Procedure Terminology (CPT) codes for which a first assistant at surgery will not be reimbursed. For these codes, Medicare determined that a first assistant is not needed and will not pay for the services of any medical professional acting as a first assistant
• Medicare restricts coverage of physicians, PAs, NPs, and Clinical Nurse Specialists for first assisting at surgery only. There are no restrictions for other services PAs provide in teaching hospitals.

Amidst all these overriding Medicare or health insurance guidelines surrounding the reimbursement for their assistants’ services, physicians would invariably feel exhausted for doubling up as medical billers along with their primary focus of clinical efficiency.  Therefore, physicians would be well-off outsourcing medical billing services that are adept at handling their assistants’ reimbursement issue along with their own. Medicalbillersandcoders.com – whose credibility and competence for providing comprehensive medical billing services, comprising Patient Scheduling and Reminders, Patient enrollment, Insurance Enrollment, Insurance verification, Insurance Authorizations, Coding and audits, Billing and Reconciling of Accounts, Account Analysis and Denial Management, AR Management, and Financial Management Reporting ranks amongst the best in the industry – may well be the preferential recourse to physician practices seeking the right answers to billing their assistants’ services.

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Uninsured population rate percentage vs. Physician’s density ration in Texas, Mississippi & Oklahoma

Physicians work scope is expected to change with millions of Americans to gain health insurance through the Affordable Care Act in 2014. On the upside Physicians especially primary-care provider will experience higher demand transforming to higher reimbursements and job security. However, on the  other hand other healthcare reform initiatives would require better quality patient care at subsidized costs and hence the pressure of catering to a larger number of patients along with quality and cost targets will build up for physicians.

Physicians in certain locations are likely to face a tougher time compared to others, most probable providers in states currently facing physician shortages, will face the biggest challenge fitting in new patients into their busy schedules. Moreover states currently possessing the highest number of uninsured individuals will experience the highest increase of new patients.

According to 2011 Reports including rankings of states based on physician density and the 2011 insured population data:

Four states with the worst density/uninsured combination are:

State	Uninsured population rate %	Least physician-dense
Texas	27.2%	One of the least physician – dense State
Mississippi	24.5%	Third least physician-dense State
Oklahoma	22.5%	Second least physician-dense State
Arkansas	21.0%	Seventh least physician-dense State

The physicians in these states are likely to struggle the most in 2014 due to a high influx of patients and shortage of doctors with healthcare reforms demanding quality and cost benefits.

States with the most favorable density /uninsured combination:

State	Uninsured population rate %	Most physician-dense
Massachusetts	5.3 %	One of the most physician-dense State
Maryland	11.4%	Second most physician-dense State
Connecticut	10.3 %	Fourth most physician-dense State
Vermont	9.2 %	Sixth most physician-dense State

Physicians tackling the patient influx:

Even though the Obama administration has relaxed rules limiting the use of nurse practitioners and physician assistants, Physicians need to gear up for the expected patient influx especially in the states facing a physician shortage. Higher reimbursements and incentive may drive physicians to take on more patients; conversely insuring maximum claim generation while trying to maintain quality of care, dealing with new standards like HIPAA 5010, ICD-10, etc and government and private payers could seem as an insurmountable task to most of the Physician practices. However, services of skilled service providers possessing the requisite credentials can be availed by hospitals and medical practitioners.

Medicalbillersandcoders.com experts being constantly updated with the requisites of the industry and healthcare reforms are the right choice for physicians. Our team trained on ARRA 2009, ICD 9, ICD -10, HIPAA 5010 and handling Revenue Management Cycle for various clients, are highly motivated to provide you with the right course of action to take in the current challenging healthcare industry – right from EHR selection, increased data management, increased patient registration right up to denial claims management. 

Maximizing your office’s efficiency and cutting your costs are some of the priorities of medical billing and coding specialists located in Texas, Mississippi, and Oklahoma we also serve across the other 47 states in US.