ibles can be as much as $2,500, which patients often assume are covered by their insurance. In response, practices began educating physicians, staff, and patients about patients’ obligations to pay their deductibles. Staff also focus on collecting those payments within the first few months of the patient’s plan year.
Ms. Jones says that whenever possible, Stephenville Clinic works with patients on payment options to accommodate their care. “But we try to help our patients understand that we have to collect to pay our bills.” Ms. Waltemath added that the prompt pay legislation TMA won in 2003 has improved the cash flow at ABCD Pediatrics by allowing the practice to pursue payers that don’t pay claims on time and to recoup penalties and interest in addition to what they are owed for physicians’ services. The pediatric practice also is looking forward to keeping more dollars in physicians’ pockets thanks to 2013 legislation TMA fought for that allows practices who pay Texas’ franchise tax to deduct the cost of vaccines they stock, no small amount of money for a pediatric practice.
That’s money that also helps the practice grow, whether
adding a location, hiring another physician, providing new services, or taking on additional patients. But ABCD does not make those decisions rashly. “We put a lot of effort into making sure we make the right decision at the right time and being clear on what the need is for our patients,” Dr. Arnold said. For example, the clinic puts some restrictions on taking new patients in winter at the height of flu season, when practices often find themselves short on staff and vaccines to keep up with the demand. “We want to keep it manageable and be comfortable that we can get through the flu season, and that’s not the time to focus on bringing in new patients,” Ms. Walte- math added.
Technology counts
On the other hand, better-performing practices say that now is the time to adopt the technology they will need to ensure their long-term sustainability, an investment Mr. Evenson says is becoming more critical as the health care system shifts to so-called value-based delivery and payment models driven not by the number of services performed, but by patients’ over- all health. “Successful groups continue to invest in technol- ogy, recognizing that having sound, quality information to make business and clinical decisions is becoming increasingly important.”
Some of the characteristics of EHR systems that better-per- forming practices use include the ability to integrate with bill- ing systems, support medication orders, maintain up-to-date lists of patients’ diagnoses, track physician compliance with specialty rules, and report quality measures to payers. And most physicians in those practices reported using such features. (See “Not Just Any EHR,” page 23.) Seventy-five percent of better-performing practices are gear- ing up for Stage 2 of the federal government’s meaningful use incentive program to encourage EHR adoption. (See “Mean-
ingful Deadlines,” December 2013 Texas Medicine, pages 45–79. As this article went to press, Stage 2 deadlines were extended to 2016.)
That doesn’t mean there aren’t frustrations. Stephenville Clinic switched to an EHR system two years ago and still has growing pains. With each update, physician productivity drops because it slows physicians down, Dr. Mc- Million says. Ms. Jones adds that whatever money the practice might have saved on medical records staff has been spent on information technology staff. Despite the financial bonuses from the federal government, “there is no cost savings. We’re just spending in other areas.” On the other hand, Thomas Spann’s five-year experience
with an EHR system suggests that result could change over the long haul. “You have got to embrace it, or you will be a dinosaur real quick,” Dr. Carmichael said, adding that Medi- care also will start dinging payments to physicians not using an EHR system.
The clinic’s CFO Ms. Chism said that “technology plays a
huge role in the management of accounts receivable. Physi- cians may not be aware of this benefit immediately because of the difficulties in switching to an EHR system. However, along with a knowledgeable staff, I see technology as a positive change that has allowed us to be more efficient.” The practice integrates its billing system with its EHR sys-
tem, and the latter allows Ms. Chism to set rules on specific items. If a physician enters a certain diagnosis code but the lab test he or she orders is not covered under that diagnosis, the system raises a flag before a claim goes out and signals the staff to research it.
ABCD has used an EHR system since 2003, which also en- hances patient convenience and practice workflow, Ms. Walte- math added. Parents can access their children’s medical files via a web-based patient portal, print immunization records to take to school, and schedule flu shots and appointments, sav- ing staff precious time. “Patients appreciate what these technologies can do to help them in their busy lives. There is a cost to this, but we feel like it pays off,” Ms. Waltemath said. Dr. Arnold said that from a documentation standpoint,
EHRs “are becoming more of a burden” for ABCD physicians. “But we understand [the technology] is part of the way medi- cine is going.”
Tracking patient satisfaction Nearly 80 percent of the better-performing practices surveyed
by MGMA are also looking ahead by assessing patient satisfac- tion, another emerging focus of value-based care. Medicare, for example, will begin penalizing physicians who do not report certain quality data, including patient satisfaction measures, under the Physician Quality Reporting System. (See “Penalties Add Up,” May 2013 Texas Medicine, pages 35–39.) Patients and the public also will be able to access the information through the Medicare Physician Compare website. The practices MGMA surveyed use assessment tools to gauge patients’ overall experience and perceptions of staff
February 2014 TEXAS MEDICINE 21
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