Transcript Slide 1

Presented by:
Cherilyn G. Murer
Founder and CEO of Murer Consultants, Inc.
February 24, 2009
Prepared By Murer Consultants Inc.
Murer Consultants Inc.
Murer Consultants Inc., is a legal based healthcare
management consulting firm founded by Cherilyn G. Murer,
J.D., C.R.A. in 1985.
Murer Consultants is comprised of consultants who share a
similar background in law, with contributions based on
various areas of clinical, financial and managerial expertise.
The Mission of Murer Consultants Inc. is to promote
problem solving in the healthcare industry based on sound
pragmatic reasoning with development of realistic
recommendations which can be implemented within a given
timeframe.
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Murer Consultants Inc.
Understanding that healthcare is a complex integration of
medical, social, economic, legal and government issues, Murer
Consultants, Inc. brings a unique combination of expertise
skilled in both the macro- and micro-aspects of planning,
organization, development, finance and law. This unique
organizational
matrix
comprehensive
and
produces
result-oriented
the
most
service
informed,
available
in
healthcare today.
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Murer Consultants Inc.
Murer Consultants, Inc. has been
recognized as an expert in healthcare
strategic planning, regulatory oversight,
and implementation management with
more than 25 years of experience working
with more than 500 hospitals and health
systems throughout the United States.
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Principles of Murer Consultants
Murer Consultants was founded
on an axle of:
Finance
Medicine
Law
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Principles of Murer Consultants
Murer Consultants believes there is now a fourth
dimension in the axle -- integration of ……..
Technology
Finance
Medicine
Law
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Health
Information
Technology
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• IT is positioned to improve the quality, safety,
and efficiency of health care
• Drivers of investment in healthcare IT include
the promise of quality and efficiency gains
• Barriers include the cost and complexity of IT
implementation
– HOWEVER : NEW legislation passed by President
Obama in the Economic Stimulus bill provides
incentives for both hospitals and physicians to adopt
electronic health records
– More Discussion to Follow
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• Health IT allows comprehensive management
of medical information and its secure exchange
between health care consumers and providers.
• Broad use of health IT will:
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Improve health care quality;
Prevent medical errors;
Reduce health care costs;
Increase administrative efficiencies;
Decrease paperwork; and
Expand access to affordable care.
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• Interoperable health IT will improve individual patient care,
but it will also bring many public health benefits including:
– Early detection of infectious disease outbreaks around the country;
– Improved tracking of chronic disease management; and
– Evaluation of health care based on value enabled by the collection of
de-identified price and quality information that can be compared.
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• Electronic health record
(EHCR)
• Computerized provider
order entry (CPOE)
• Clinical decision support
system (CDSS)
• Picture archiving and
communications system
(PACS)
• Bar coding
• Radio frequency
identification (RFID)
• Automated dispensing
machines (ADMs)
• Electronic materials
management (EMM)
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• EHRs were originally envisioned as an
electronic file cabinet for patient data from
various sources (eventually integrating text,
voice, images, handwritten notes, etc.).
• Now they are generally viewed as part of an
automated order-entry and patient-tracking
system providing real-time access to patient
data, as well as a continuous longitudinal
record of their care.
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• CPOE in its basic form is typically a
medication ordering and fulfillment
system.
• More advanced CPOE also includes
lab orders, radiology studies,
procedures, discharges, transfers,
and referrals.
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• CDSS provides physicians and nurses
with real-time diagnostic and treatment
recommendations.
• The term covers a variety of technologies
ranging from simple alerts and prescription
drug interaction warnings to full clinical
pathways and protocols.
• CDSS may be used as part of CPOE and
EHR.
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• This technology captures and
integrates diagnostic and radiological
images from various devices (e.g., xray, MRI, computed tomography
scan), stores them, and
disseminates them to a medical
record, a clinical data repository, or
other points of care.
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• Bar coding in a health care
environment is similar to bar-code
scanning in other environments: An
optical scanner is used to
electronically capture information
encoded on a product.
• Initially, it will be used for medication
(for example, matching drugs to
patients by using bar codes on both
the medications and patients’ arm
bracelets), but other applications
may be pursued, such as medical
devices, lab, and radiology.
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• This technology tracks patients
throughout the hospital, and links lab
and medication tracking through a
wireless communications system.
• It is neither mature nor widely
available, but may be an alternative to
bar coding.
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• This technology distributes medication
doses and is widely used
• Examples : Pyxis, Accudose, and Omnicell
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• Health care organizations use EMM
to track and manage inventory of
medical supplies, pharmaceuticals,
and other materials.
• This technology is similar to
enterprise resource planning systems
used outside of health care.
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Electronic Medical
Record
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Benefits of EMRs
1. Speed
The business world of the 21st century is fast-paced. Even in
medical practices, speed equals ability to compete, especially
when managing information.
In addition, a fast electronic medical record system requires less
time invested in trouble shooting and allows more time invested in
caring for patients.
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Benefits of EMRs
2. Storage
An electronic medical record is an electronic database of information capable
of carrying much more information than traditional systems.
An electronic medical record system can manage records from multiple
offices as well as multiple types of records.
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Benefits of EMRs
3. Security
An electronic medical record system secures records with backup files in case
of emergencies.
In addition, only authorized users may access them. This double security
system is a "preventative medicine" for record viruses and HIPPA concerns.
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Benefits of EMRs
4. Support
Both practices and patients can access customer support from a medical
billing specialist provided through the electronic medical record software.
In addition to their support, electronic medical record software provides access
to medical codes, including, ICD.9, HIPAA, HCFA 1500, and the latest CPT
code books.
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Benefits of EMRs
5. Accessibility
The latest electronic medical record technology allows information to be
downloaded directly onto a PDA or Palm device.
In addition to PDA access, authorized individuals can access an electronic
medical record online from any location.
Individuals also have state to state accessibility to their medical records while
on extended job deployment or vacation.
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Benefits of EMRs
6. Efficiency
Efficiency is not the same as speed.
Efficiency involves legibility issues and time management issues. EMRs
preclude any legibility concerns which ensures timely reimbursement and
mitigates liability. Additionally, the money spent on transcription services and
other medical record/medical office management can be better spent on EMR.
EMR increases efficiency in the practice of medicine.
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Benefits of EMRs
7. Infrastructure
Part of the money-saving nature of electronic medical record technology is the
effective utilization of IT infrastructure. EMR optimizes IT infrastructure and
promotes the streamlining of multiple databases.
The infrastructure is simplified into one online database, even for multiple
offices.
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Benefits of EMRs
8. Versatility
Electronic medical record software stores medical SOAP notes and medical
codes.
It allows multiple users.
It also connects users to personal and online support sources.
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Benefits of EMRs
9. Affordability
This is perhaps the most appealing part of the latest electronic medical record
technology. Every business wants to save money while at the same time
adopting time-saving technology.
While some EMR providers charge hefty upfront costs for software and
implementation, many EMR providers, like Medsphere, are “open source” and
the software itself is free.
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Electronic Medical Record
Electronic Medical Records:
•Improve Patient Care
•Reduce Errors
•Reduce Costs
•Streamline the HealthCare Delivery System
Healthcare IT was an integral component of the
presidential election healthcare reform platforms.
Within the past week landmark legislation was
passed, making the push for EMRs stronger than
ever.
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• The American Recovery and Reinvestment
Act of 2009 was signed by President Obama
on February 17, 2009.
• The Act includes the Health Information Technology for
Economic and Clinical Health Act (HITECH Act).
• The purpose of the HITECH Act is to promote the use of
health information technology with a goal of utilization of an
electronic health record for each person in the United States
by 2014.
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• The Act provides financial incentives to
physicians and hospitals to adopt and use
certified electronic health records (EHR) technology.
–BASELINE INCENTIVES
» $2,000,000 for hospitals
» Up to $65,000 for physicians
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• During each payment year a hospital
will be paid an amount based on an
equation that takes into account a base
amount of $2,000,000 plus an additional amount based on
the number of discharges for such hospital, on a graduated
basis. The equation also considers additional adjustments
based on other factors.
• There will be a phase down for eligible hospitals first adopting
EHR after 2013.
• If the first payment year for an eligible hospital is after 2015,
the hospital will not receive an incentive payment for that
year or any subsequent year.
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• Physicians will be paid amounts not
to exceed $15,000 for a physician for
the first payment year (or $18,000 for the first payment year
if the first payment year is 2011 or 2012) with decreasing
amounts during the second through fifth payment years.
• No incentive payment will be made during the sixth and
succeeding years.
• An additional incentive is provided for doctors who
predominantly furnish services in rural areas designated as
“health professional shortage areas.”
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• Need to be considered a:
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• In order to be considered a meaningful
EHR user, the eligible physician or
eligible hospital will need to meet the
following three requirements:
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:
Demonstrate that the physician or hospital
is using certified EHR technology in a meaningful manner,
which shall include the use of electronic prescribing
– Legislation leaves “certified” open ended and up to NIST (National Institute of
Standards & Technology) and ONC (Office of National Coordination for HIT) to
define
– Certification process is typically cumbersome, time consuming and rarely, if ever,
keeps pace with technology developments
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: Demonstrate
that the certified EHR technology is
connected in a manner that provides for
the electronic exchange of health information to improve the
quality of health care in accordance with the standards and
criteria adopted under the Act
– IMPACTING ISSUES
• Compatibility
• HIPAA
• Other privacy and public policy concerns
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: Submit information on clinical
quality measures and other measures in a form and manner
that will later be specified by the HHS Secretary
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• What exactly does “certified” mean?
– Who certifies?
• The ONC will turn over $20M to NIST who will define the test standards,
implementation specifications, and testing infrastructure for a certified EHR
• There is also language regarding the testing NIST will manage referencing
“including a program to accredit independent, non-Federal labs to perform testing”
– While it is not spelled out as CCHIT (Certification Commission for Healthcare Information
Technology), it certainly sounds like this is to whom they are referring
– Why the need for “certification”? Do not need “certified EHR” to get the job
done.
– Monopoly versus open market?
– Innovative vendors shut out?
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• Adoption of EMR under 10% currently – are
there enough IT professional trained to deploy more IT?
• Will the demand for HIT professionals far out-strip supply
making it nearly impossible to adopt, install, train, and
demonstrate “meaningful use”?
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• Telemedicine is a rapidly developing
application of clinical medicine where
medical information is transferred via
telephone, the Internet or other networks for the purpose of
consulting, and sometimes remote medical procedures or
examinations.
• Telemedicine may be as simple as two health professionals
discussing a case over the telephone, or as complex as using
satellite technology and video-conferencing equipment to
conduct a real-time consultation between medical specialists in
two different countries.
• Telemedicine generally refers to the use of communications and
information technologies for the delivery of clinical care.
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•
•
•
•
Receive education from the specialist/provider
Better health outcome for their patients
Enhanced community confidence in local healthcare
Attend continuing medical education courses from their clinic
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•
•
•
•
Reimbursement structure under Medicare
No funding to support capital equipment investment
Reimbursement limitations from third party payers
Mechanics of accountability
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• Greatest impact of telemedicine:
– Rural health integration
– As portal to medical tourism
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Quality Measure Reporting
and Pay for Performance
A good idea??
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Quality Measure Reporting
In its efforts to transform Medicare system into a prudent
purchaser of health care services, beginning October 1,
2008, Medicare has instituted the following:
•Hospitals must report quality measures for full payment
updates
•Revision of payment policies to create financial
incentives through pay for performance initiatives
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CMS is making these changes as
part it its commitment to improving
the efficiency and quality of health
care delivered to Medicare
beneficiaries.
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Benchmarking
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Benchmarking
Benchmarking, in simplistic terms, is the process where you compare
how well your facility is doing in comparison to others.
By making comparisons the facility strives to improve quality of care.
Benchmarks can incorporate a number of key areas including: clinical,
financial and regulatory.
Murer Consultants works with its clients to develop benchmarks which
are meaningful to each particular facility.
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Benchmarking Examples
Benchmark
Month One
Month Two
Month Three
Average
Maintain an average reimbursement per patient discharge of $7,500
Minimize recidivism to short term acute hospital to no more than 5% of readmissions
Maintain an average length of
stay of less than 5.5 days for all
patients and 6.25 days for
Medicare only patients.
Maintain basic nurse competencies including at minimum ACLS
certification
Maintain a case mix index of 1.9 or greater reflective of patient acuity
Maintain a cost per patient day of $1,250 or less
Maintain average daily census as per budget projections (Budget | Actual)
Maintain Direct Nursing Hours at Target. 7.25 DNR for general
………………………………………16 DNR for CCU
Minimize agency nursing to no more than 20% of Nursing Expense
(Salary plus benefits) for RN, LPN, CNA.
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Benchmarking Examples
Benchmark
Month
One
Month
Two
Month
Three
Average
Maintain a cost per patient day of $1,250 or less
Ensure that from time of discharge to completeness of chart is within 15 days
Ensure that within 20 days of discharge all bills are dropped
Ensure
time
from chart
Ensure that within 30 days of discharge
Medicarethat
payment
is received
completed until submission
of patient
chartday
fororcoding
is within 48 hours
Maintain medical supply ancillary services at $100 per
less
Maintain pharmaceutical ancillary services at $135 per patient day or less
Maintain radiology ancillary services at $40 per patient day or less
Maintain laboratory ancillary services at $80 per patient day or less
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Health IT
facilitates administrative improvement and clinical
systemization; and
provides several reimbursement enhancement
opportunities to providers
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Murer Consultants, Inc.
58 North Chicago Street
Joliet, Illinois 60432
Telephone (815) 727 3355
Telefax (815) 727 3360
Web Site: www.murer.com
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