EMR....Here Comes the Stimulus Money, Now Spend It Wisely

[NRSKarenRN, BSN, RN]

from healthleaders media it - february 24, 2009

[color=#ba0c35]here comes the stimulus money, now spend it wisely

kathryn mackenzie, technology editor

now that the $787 billion american recovery and reinvestment act has been signed into law and billions of dollars are about to be funneled into hit, the promise of improved care through technology has become something of a mantra: if you implement an electronic medical record, you will save money and more of your patients will survive. [read more]

...the study compared 41 urban hospitals in texas using an instrument created by the researchers that measures physicians' interactions with information systems. the researchers examined the rates of inpatient death, complications, costs, and length of stay for 167,233 patients older than 50 who were admitted to the hospitals for a variety of conditions during the same time frame in 2005 and 2006.

what they found was that, for all of the medical conditions studied, increased automation of notes and records was associated with a 15% decrease in the odds of in-hospital death. at hospitals with higher order entry scores, those patients with myocardial infarction had 9% lower odds of death and those undergoing coronary artery bypass graft had 55% lower odds of death....

[NRSKarenRN, BSN, RN]

i was newly appointed central intake manager in a homecare agency on 9/1/2002 ---the day of infamy---as our emr started the same day.

did i have any say or knowledge of the build? nope.... as prior manager reassigned 6 months prior to a sister agency never to return. seven years later, i've almost mastered the system ---till the next upgrade in 2 weeks, (after jcaho leaves on friday).....

i love the system most days as can access info back to 2002 with a few magic keystrokes. one thing i've learned is the need to run weekly reports to ensure data properly entered/updated.

today was the day on emr "issues":

1. medicare billing notified me unable to get prior claims paid for 11 patients as missing msa county codes ---going back to 2004.

pulling up records revealed that instead of end dating old address and adding new one, staff wrote over prior address and changed to later episode admission date. :angryfire

to correct had to go to plan of treatment and check what address was listed, printed out info----- need to correct back to 2002 for some patients 8 episodes of care (left am clerk 7 patients to reenter prior address).

2. ran weekly reports:

a. only had 12 out of area zip codes listed as primary

homecare can only bill if patient lives in our service territory....so all our florida snow birds who got sick while

visiting family in philadelphia, have to correct home address to their temp philly location.

b. insurance plans: 5 patients without insurance plan listed cause start of care date not correctly entered ---insurance verification to to clean up.

c. clinical manager: 3 pages (50 names.page) without start date --clerk will fix

d. referral source code: 4 patients listed: data base quirk knocks out facility type and name if field staff enter referral info faster that my clerks can enter info from paper referral.

e. attending physician: 3 note listed---date issue for 2, i corrected. one pcp not listed in database so staff will need to check state websites for verification of active license, npi site for national provider number and verify address listed and perform sanction check to enter

since 12/31/2008 was end physician license prior renewal period, we need to re-verify physicians license status, perform sanction check clearance and verify address still correct and they didn't move office........

for over 6,000 doctors in my data base. nice biannual project.

get caught billing for services with a physician without a current active license at time of care: get to pay back all the money to insurance company and get a nice $35,000.00 fine too.

f. insurance authorizations: yearly i have the pleasure of checking all managed care health plans to see what their benefit is for home care: do they require preauthorization or have copays. one medicare hmo changed language for 2 of their plans to "may require preauth" ---i spoke to their preauth director who assured me memo came out 12/15/09 that preauth not required; company would review again on april 1, 09 so reps declined to give preauth.

got a lovely email from branch manager that her rn was told 2/19 that these plans now required prior authorization effective 1/1/09 -------- so i called yesterday and had lovely conversation with same prior auth director who apologized "didn't you get the provider memo sent in january???" :angryfire:angryfire:angryfire:angryfire:angryfire:angryfire

"i'll give you back auths---just send me a list" off the top of my head know we have at least 30 patients who's records i'll have to pull, check # visits each discipline made then write up auth paperwork min 3 pages each + referral + 2-3 page plan of treatment.

fired off missive to contracts director re issue....ran report today have 197 patients with this insurance from 1/1/09 starts of care----along with 100 patients from 2008 that continue to be visited in 2009.

so until i can get back auth, we can't get auth for this week and next weeks care so ot will be spent loading this into database.

we've gone from 2002: 14,000 new patient episodes/yr to 20008: 24,000 episodes/yr. averaging 80 patients/day being entered. can only imagine headaches hospital hit directors have.

i've decided going after stimulus moneys to implement scanning technology for referrals so instead of having to call medical records to get original facility/hospital paperwork to fax to insurance companies, i can just retrieve from storage on our shared it drive that's backed-up offsite daily. met with health system cio 2 weeks ago and expects cost to be about $30,000- 50,000 to implement.....has to be better than hundreds of individual paper forms that float through my staffs hands daily.

[rninformatics, DNP, RN]

Greetings Karen,

I hate to burst your bubble, Karen.

Although HR1 the American Recovery and Reinvestment Act of 2009

http://www.rules.house.gov/bills_details.aspx?NewsID=4128

AKA the "Stimulus Plan" includes some grants and loan funding, most organizations will have to purchase systems on their own and them recoup their orginal investment via extra payments from Medicare or Medicaid.

Implementation of a "meaningful" health record will qualify hospitals and physician practices for a total of 17.2 billion worth of incentive payments from Medicare and Medicaid over a five year period. To obtain the max amount providers must have a qualifying records system in place by 2011 and beginining in 2015 if physicians and hospitals do not have a "qualifying" EHR system in place they will face progressive cuts in their payments from Medicare.

Per the Stimulus Plan a "qualifying" EHR/EMR must include: clinical decision support, CPOE, the ability to capture heathcare quality data and

last but not least - the ability to support the exchange of clinical data with other organizations ........true interoperability............a far cry from the "scanning technology" you referenced.

I've decided going after stimulus moneys to implement scanning technology for referrals so instead of having to call medical records to get original facility/hospital paperwork to fax to insurance companies, I can just retrieve from storage on our shared IT drive that's backed-up offsite daily. Met with health system CIO 2 weeks ago and expects cost to be about $30,000- 50,000 to implement.....has to be better than hundreds of individual paper forms that float through my staffs hands daily.

[NRSKarenRN, BSN, RN]

Scanning technology is only for the skilled nursing facilities, doctors offices and hospitals not affiliated with our health system ---faxes received will be sent directly to computer server....these places will never get onboard to single system until Medicare/Medicaid demands it. Some doctors even refuse to allow us to fax info; so we have clerks make rounds of doctors office, hand turns page by page to get doctors to sign our plan of treatment.

Our own Health system connectivity is already in the works.... CPOE and med bar coding implimented late 08 continuing into 09 till all 5 hospitals up and running.