Author Archives: idata

Pausing for Dollars

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Before you earnestly launch into your “To Do” list you created at the end of 2016, do yourself a favor and PAUSE!

 Surely you’ve created a list (at least in your mind) that more-or-less hits the mark on critical near-term goals, but have you considered that we – the human types – are creatures of habit and often govern our actions based on past experience? We are so engrossed in the weeds, the details, the urgent, that we fail to step back and reconsider the view from afar.  You see, the beginning of a New Year should compel all of us to ask, “What can I do better?”, “What should I do more of?”, and “What should I do less of?” In other words: What should change!

 It is with this posture that I ask you to reexamine your core business relationships with transcription or coding partners (and notice I said partners, not “vendors”).

Definition of Partner (according to Meriam-Webster): noun  part·ner \ˈpärt-nər also ˈpärd-\. Archaic. 1. one that shares. 2a. one associated with another especially in an action. b. either of two persons who dance together. c. one of two or more persons who play together in a game against an opposing side. d. person with whom one shares an intimate relationship.

 Simply put, partners are people that share, do things together, dance and play together. 

 At iData Medical, we are not your stereotypical medical documentation company, and we certainly do not view ourselves as “vendors”; rather we are partners.  Truth is, that many medical documentation companies do a good job.  But what sets us apart? What do we do that’s better? What differentiates us from the rest.  It’s simple: Our people. Companies like ours have software, processes, policies, etc.  But our biggest and most valuable assets are our human assets – our work force. Talented people are our differentiator!

 This forms that basis for our iD3 philosophy.  We have reduced our entire business DNA to three distinct concepts:

Client ID – We will get the right people in place to serve you.

Every organization is different. In one hospital or medical practice, the IT department may be really involved in projects, and in others not so much. The CFO may be hands-on in a hospital system, or the Health Information Managers might be left to make the tough choices. We work to understand your organizational DNA, and we set in place a plan for long-term success.  Our list of gratified clients isn’t only long, but most partnered with us for almost a decade.

Workforce ID – Because great results starts with a great talent.

Based on your identified needs in the Client iD process, we select the workforce that can deliver. We are superlatively selective in our hiring practices: We hand-select professionals from our team of fully-vetted high-gear human assets. We have learned that intelligent and satisfied professionals provide exceptional, consistent, and reliable work.  Exceptional technologies and processes abound. It is our human, intelligent assets that are our differentiator.  Front loading the right team skill level to successfully service your account, and we ensure that ongoing training and support aligns with your ongoing goals. In the end, we prefer (and value the wisdom of) paying now, not later. 

Secure ID – Your standards are our first priority.

 A globally-recognized Information Security Standard like ISO 27001 is not a one-size fits all in a privacy-starved market place. Your IT department or other constituents sometimes have security protocols and requirements that are unique. Your organization also quite likely has different ways of using technology and software. We assess those use cases and your unique requirements, and set a security program in place to give you peace of mind, ensure strict and audit-certified HIPPA compliance, and keep everyone happy.

And to top things off, we very often can do all of this at a decisively competitive price. 

So, how about we talk and see how iData can partner with you? In 2017, do things differently and Leverage the Power of iD3!

Importance of Transcription in the EHR

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This article is written specifically for iData Medical by Darice Grzybowski, MA, RHIA, FAHIMA, President and Founder, H.I.Mentors, LLC and is a certified AHIMA Approved ICD-10-CM and ICD-10-PCS Trainer and Ambassador.

BACKGROUND

The electronic health record (EHR) is still in very much of an infancy state when it comes to accurately being used to tell the story of the patient.  There is much fragmentation in the method of recording information into the record vs. how it is displayed and organized for the end-user (reader) of such information.  Often lost in translation is the continuity from one note to the following report, from one order to the results, and between one caregiver and the next.

Much of this was due to the very confusing requirements of the Meaningful Use standards that tried to force practitioners into too heavy use of structured discrete data within template, while EHR vendors simultaneously were limiting physician flexibility due to restrictive designs in format. Adding to this decline of dictation use was the provider organization’s push to eliminate costs associated with the practice of dictation and transcription to justify the expensive purchase of an EHR. The EHR vendors were also supporting this push toward use of templates to build a return on investment case, but with no one considering the impact that the loss of dictation would have on the integrity of the medical record itself.

IMPACT OF TEMPLATE OVER-USE IN THE EHR

When clinicians are forced, or choose to use templated documentation, they fall into bad habits.  These habits include such problematic documentation short cuts such as copy and paste, auto-fill-in of existing templates from previously recorded information, over-use of drop down menus which are pre-populated with erroneous or old data, and data pulled from other sources or records that are not appropriate to be re-copied.

Rushing the act of documentation, or performing template fill-ins may allow the doctor to see more patients, but can result in several problematic and risk prone situations that can result in harm to the patient as well as create legal risk for the organization.   For example:

  1. Copy and paste can create fraudulent billing as coders may accidentally code a situation more than once or bill for something that was documented more than once, but truly only completed once
  2. Automatic filling of templates from previous information from another record or practitioner speeds up documentation, but fails to update current information such as the status of medications, conditions, allergies or other items that change frequently. When relying on old data, a safety risk is present for patients.
  3. Incorrectly populated drop down menus that come from limited diagnostic problems lists can omit critical detail necessary for care of the patient, communication to other providers, and denials for medical necessity.

It is no wonder why physicians are demanding the use of dictation and transcription once again, and why the CMS has come out with statements supporting the use of dictation once again within the EHR and many hospitals are returning to fully transcribed core documents such as history and physicals, operative reports, consultation reports, and discharge summaries.

Please refer to the article “Transcription and EHR’s: Benefits of a Blended Approach” by Jay Cannon and Susan Lucci to understand many of the industry issues that support a return to dictation and transcription as a core strategy for the EHR. http://bok.ahima.org/doc?oid=97974#.WIlUUIcryuU  [i]

Although this article was penned in 2010, very little has changed and it is still relevant today to the need in the physician community for the documentation of clear, concise, complete, chronologic and compliant documentation in the medical record.

USE OF DICTATION AND TRANSCRIPTION

Caring for patients is a very human business. It consists of the simple actions of

  1. assessing a patient
  2. creating differential diagnoses as to the cause of a symptom/condition
  3. ordering diagnostic testing
  4. creating a treatment plan based on results of testing (which may include procedural-surgical components as well as therapeutic/pharmaceutical modalities)
  5. monitoring the patient over time to validate the diagnoses
  6. and then eventually repeating the evaluation, diagnostic, and therapeutic cycle

To describe these stages effectively, the SOAP process was put into place (Subjective, Objective, Assessment and Plan) as a guideline for clinicians to document their care. These principles are still taught in medical schools today as a proper form of documentation that follows language in a spoken format to describe each of these components.   The problem is that EHR’s tend to require discrete templated documentation that consists of fields of drop down choices that do not appear in very SOAP oriented format and certainly don’t convey that phased process when reading the output of the documentation.

It is ONLY in use of dictation and transcription that one can truly read a formatted note within the EHR to help support SOAP charting, and to create the true infrastructure of the medical record content that supports telling the story of the patient during each episode of care.

Disclaimer: This blog represents the opinion of the author and is not to be considered legal advice. Grzybowski is the author of the award-winning book “Strategies for Electronic Document and Health Record Management” (AHIMA, 2014) You can read more about her at http://www.himentors.com/about-himentors/

[i] Cannon, Jay; Lucci, Susan. “Transcription and EHRs: Benefits of a Blended Approach” Journal of AHIMA 81, no.2 (February 2010): 36-40.

 

The ICD-10 coding vacation is over!

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Ever been on vacation?  We all have.  The lead up, ripe with excitement and anticipation. The unknowns. The spontaneous confidence that something big is going to happen.  The day finally arrives. Perhaps a plane trip. Activity-filled excursions. The suntan. Mimosas or a Dark-and-Stormy, garnished with some island music.  Good food, a good book, and lots of rest!  But then, before it even starts, you are back home in the grind. The party is over.

And so is the ICD-10 implementation that kicked off October 2015.  Debate about its effectiveness, ability to help control costs, and whether there will be enough qualified coders to do the work was in hyper warp mode.  But finally, right or wrong, the standard was codified and required.

As we approach the 1-year anniversary of ICD-10 in the United States (no one is breaking out the Champagne), there will be another (almost) 6,000 codes released (as if the original amount wasn’t enough!). Along the way, experts in the coding world have been busy auditing and assessing program efficacy, as well as the accuracy and specificity of coders and health-care systems nation-wide.

What have they learned?

According to study conducted by ICD10 Monitor, the overall average accuracy during the 1st quarter 2016 for inpatient, ambulatory, and emergency coding types has dipped to as low as 80%, far lower than the 95% industry standard inherited from the days of ICD-9.  Digging deeper, the study revealed that for some coding categories, the accuracy approached a dismal 50%.  While audits indicate an uptick in accuracy during 2016YTD, the industry effort continue to fall short of the mark and has reduced productivity by as much as 15% (Source: Becker’s ASC Review).  Of course this is clearly on the lower end of the scale when compared to pre-October 2015 estimates (10 to 50 percent productivity impact), it is still a downward trend that has substantial monetized effects.

So, what to do? 

Perform you own internal audits. Do them more often.  Conduct them with greater rigor.  Ask yourself these questions:

  1. Does my facility use EMR? Do we dictate?
  2. How is my hospital, clinic, or practice entering the codes? By hand? Drop down lists? Are the lists complete and accurate, or do they enable the coder to derive errors through repetition?
  3. What are the coder knowledge gaps? What is the mixture of highly trained-and-certified in-house coders versus outsourced coders?
  4. Now that ICD-10 is well underway, what are you doing to maintain a robust continuous training program, especially as codes are added, grace periods are depleted, and accuracy thresholds are increased and expected?
  5. Is your clinical documentation complete and accurate?
  6. Are physicians providing ICD-10 quality notations or are there inherent and systemic quality gaps, requiring several iterations, thereby reducing productivity?

Some proforma and upside considerations: 

  1. While you can enter memorized ICD‐9 codes in your search, learning the recommended search strategy for your EHR may yield higher quality results.
  1. Take advantage of specific coding when you have sufficient detail or knowledge to assign a more specific code.
  1. Codes can be refined to indicate laterality, cause, type and chronicity
  1. ICD‐10 codes can now account for disease relationships indicating higher patient acuity (e.g., how many elderly diabetics do you know who actually have no complications?)

Remember that the transition flexibility with the family of code (ICD‐10 three‐character category), is slated to end September 30, 2016.

The upshot? There are a lot of internal, as well as external actions to your medical documentation systems involving accurate transcription and coding.  Doing those things isn’t enough – you must do them accurately and with minimal interference to productivity, maximizing reimbursement and quality of care.

Maybe then we can go on vacation again.  Daiquiris on the house!

For further information about how iData can assist you in the transcription and/or coding space, please contact us at 888-66-IDATA or visit us at www.idatamedical.com to learn more.

Calculating costs of outsourced vs. in-house transcription

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Did you know?
We often take our environment for granted.  At work or at home, whatever it is we’re doing, we tend to keep doing the same thing.  As the old adage says, “things in motion tend to stay in motion; things standing still tend to stay still” – an artifact from thermodynamics.

And so it is with clinical documentation, especially transcription, and today coding as well.  For years, hospitals go about doing whatever it is they’re doing and keep doing it, despite facing increasing economic and regulatory pressures, competition, insurance pinch points, consolidation, and so on.  Sure, we can all agree that we’ve seen many changes over the course of the last 25 years looking at them with the wide-angle lens of critical analysis.  Yet, it still takes a lot of inertia and momentum to move any programmatic train on the rails of progress.

To abuse the binary term “core competence”, transcription is one of those skills that has never been, nor will ever be, a “core competence” for hospital work space.  Hospitals are for healing the sick, not for typing recorded media. Remember, the operative term is “core” – not that it can’t be done in-house (duh, its done all the time!), but the argument for outsourcing transcription is steadily growing post-ICD-10 implementation. Moreover, the opportunities are just limited to domestic on-shore outsourcing – this area of the industry has gone through time-warp improvements that are worth considering from a life-cycle cradle-to-grave analysis.

The list below is not rocket “surgery” (pun intended), but it’s worthwhile reinforcing the fundamental truths about why your hospital (or clinic) should revisit the idea of outsourcing. Trust us, as we mentioned above, this is the stuff we take for granted:

1. Minimize Carrying Overhead Costs: The amount of effort involved in task-specific and human management, administration, hiring, firing, fringe and all-in labor costs, document and queue management, QA, systems management, etc. can be overwhelming. Partnering up with a qualified and proven transcription provider eliminates these headaches, and internal resources are better spent on health care.  The opportunity to capitalize on wholesale and economy of scale contractual agreements and line costs aren’t left on the table with outsourcing.

2. Improved TAT and Quality: From STATS to run-of-the-mill transcription, using an outsourced medical transcription service provider ensures a continuous stream of coverage, quality, and response – regardless of the volume and variability.  Hospitals and clinics will no longer have to carry the burden of billable hours or lines for light periods.  Without outsourcing, your facility pays for the salary and benefits of your in-house transcriptionists no matter their productivity!  Outsourcing flattens out the utilization and expense curve over the long run to your benefit! Moreover, in the world of ICD-10, it is essential that auditing, quality improvement, training, and quality assurance are employed effectively and are compliant with all stakeholders.

3. Reduced Front and Back-end Capital Expenses: In-house transcription means equipment and software purchasing, systems integration, maintaining, upgrading, securing, and archiving your own transcription – it comes at a headache, laden with liability, and at a cost!  Outsourced transcription reduces budget line items on the capital and expense side, as well as secondary and tertiary softer benefits such as peripheral hospital equipment costs (e.g., copiers and fax machines), IT services, etc. which are desperately needed elsewhere in the growing competitive health care “we-have-to-answer-to-the-investors” environment.

Still, there are many other softer benefits that hospitals and clinics can reap from once an outsourced medical transcription service provider is screened, hired, and integrated into your hospital or clinic environment.  You should be able to easily do a back-of-the-envelope line item cost analysis for your in-house transcription and compare it against an all-in life-cycle whole-sale outsourced medical transcription option.

So, what are you waiting for?  Get out that old envelope from the recycle bin and jot some numbers down.  Then pick up the phone and explore the outsourcing transcription and coding opportunities that have evolved and are waiting to benefit your organization!

And lastly, partner with a US company that can allow you to grow your volume and maintain your target metrics.

Speech recognition volume solution

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Whether you are a Medical Transcription back office supplier, or you a working in a hospital or medical practice, here are some very important thoughts and questions for you to consider around Speech Recognition:

For Medical Transcription providers:

  • Are you struggling as a company to manage SR volume while staying compliant on TAT?
  • If you had more capacity, could you grow your volume with your SR customer?
  • Are you struggling with how to price SR?

For Hospitals and Medical Practices:

  • If you had a proven partner that could provide excellent service at a competitive price point, would you be willing to explore another company?
  • Are you having trouble maintaining TAT on your SR platform?
  • Do you need another company to help hold your existing vendor accountable?

If any of these questions “hit the mark”, please consider contacting iData.  iData has been in the medical documentation space for over 10 years with an exceptional track record that isn’t just fancy words.  We really do deliver high quality results, often exceeding quality and TAT targets at an attractive price.  How? We simply know what we are doing.  Our team has streamlined the work flow process, introduced system efficiencies that other providers simply don’t have, and offer a personalized, customer-and-end-client-focused attention to meet your needs.  We offer a competitive price-points with volume discounts. Wash, rinse, repeat.  Its that simple.Partner with a US company that can allow you to grow your volume and maintain your target metrics.  Contacts us now to discuss running pilot test with your organization.