User login
HIMSS15: Doctors can develop patient engagement platforms through strong partnerships
CHICAGO – For Margaret Mary Health in Batesville, Ind., partnerships were central to the formation of its community-wide patient portal.
In 2012, the hospital launched a portal that combines the records and information of multiple health providers in southeast Indiana and surrounding areas into a single system that patients can access. The approach departs from a standard portal model in which each physician practice has its own portal and patients must assess their health information from multiple sources, according to Dr. Jeffrey Hatcher, a Batesville ob.gyn and medical staff liaison for Margaret Mary Health.
“The whole goal of electronic records was to consolidate and centralize and streamline health care records,” Dr. Hatcher said in an interview. “In a lot of ways, what we’re doing is just building on that process. We’ve eliminated the need for all of those individual portals and connected the patients and their physicians to the health information exchange (HIE). Those practices feed the information through the HIE into the patient’s chart.”
Margaret Mary began efforts to design its portal in early 2011. The hospital partnered with NoMoreClipboard, a company that offers patient engagement tools to health providers, and HealthBridge, a nonprofit corporation that supports health information technology adoption and health information exchange (HIE). The timing was perfect, Dr. Hatcher said, because NoMoreClipboard and Indiana Health Information Technology Inc. (IHIT) had just received a joint $1.5 million grant from the Office of the National Coordinator for Health Information Technology (ONC) to develop, deploy, and pilot test solutions that enable patients to access electronic health information exchange data.
Despite a knowledgeable design team, the road to Margaret Mary’s united provider portal was strewn with bumps and obstacles, Dr. Hatcher said at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS). Developers encountered skepticism from some health providers and received push back from electronic health record (EHR) vendors.
The vendors’ “excitement to participate and help us develop this was not as great because it basically took the place of their product,” Dr. Hatcher said in an interview. “It’s a really slow process to get them to cooperate. They’re just not willing to move things along at a pace that’s rapid enough.”
Dr. Hatcher’s team worked to gain the trust of each participant. One key was ensuring that each provider was comfortable with what medical information would be released and when, and what type of sensitive information should be withheld and for how long, he said. Portal developers also had to create policies for the system and take into account the various data access rules of patients’ home states – including Indiana, Ohio, and Kentucky.
There were privacy issues as well. While the hospital serves a regional population of 70,000, it is situated in the rural community of Batesville, a town of 7,000. Residents in the small community historically have passed down identical first and last names for several generations leading to four or five people in the community with the same name, according to a case study on the project by NoMoreClipboard.
To address the situation, development experts created standards-based policies to securely match consumers with their data, and once authenticated, transport those data into patients’ personal health record.
Since the portal launched in 2012, 18,000 patients have accepted their access codes and about 5,000 patient have used the portal, Dr. Hatcher said. Because the portal links to HealthBridge, patients are able to get data from across the continuum of care, whether or not they receive the care at Margaret Mary. HealthBridge serves southwest Ohio, southeast Indiana and northern Kentucky. Additionally, several Cincinnati hospitals have authorized sharing their HIE data with Margaret Mary patients who use the portal.
No hard numbers on the portal’s impact yet exist, but providers have noted an increase in productivity and a rise in patient satisfaction, Dr. Hatcher said.
“When you look at the care perspective, it’s changed the dynamics of the conversations we’re having,” he said. “When patients get data, we can point them to trusted websites and they can come in prepared. The follow-up appointment becomes more of a discussion and not a lab review. Now you’re spending [more] time planning care.”
Dr. Hatcher encourages other physicians and health systems to participate in such patient engagement efforts, especially as Stage 3 of meaningful use approaches. The Centers for Medicare & Medicaid Services has proposed that all physicians and hospitals meet Stage 3 meaningful use requirements beginning in 2018. The proposed rule also calls for 25% of patients to access their data, although it allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
“As we begin this heath care–sharing process, it’s really important to have patients in a position where they’re more educated about the process that’s going on with them,” Dr. Hatcher said in an interview. “The more you educate your patients, the more it helps them embrace what you’re trying to do. It’ll be hard to meet the upcoming meaningful use measures if you don’t have patients engaged in their health care plan.”
Health providers interested in creating a similar patient portal should review what other health systems have done in the past and build on their ideas, Dr. Hatcher added.
“You’ve got to have the enthusiasm of your medical staff,” he said. “You’ve got to have the support of your organization, and you have to have a vision. Know what you want before you start. If you do that, then you’re well on your way.”
On Twitter @legal_med
CHICAGO – For Margaret Mary Health in Batesville, Ind., partnerships were central to the formation of its community-wide patient portal.
In 2012, the hospital launched a portal that combines the records and information of multiple health providers in southeast Indiana and surrounding areas into a single system that patients can access. The approach departs from a standard portal model in which each physician practice has its own portal and patients must assess their health information from multiple sources, according to Dr. Jeffrey Hatcher, a Batesville ob.gyn and medical staff liaison for Margaret Mary Health.
“The whole goal of electronic records was to consolidate and centralize and streamline health care records,” Dr. Hatcher said in an interview. “In a lot of ways, what we’re doing is just building on that process. We’ve eliminated the need for all of those individual portals and connected the patients and their physicians to the health information exchange (HIE). Those practices feed the information through the HIE into the patient’s chart.”
Margaret Mary began efforts to design its portal in early 2011. The hospital partnered with NoMoreClipboard, a company that offers patient engagement tools to health providers, and HealthBridge, a nonprofit corporation that supports health information technology adoption and health information exchange (HIE). The timing was perfect, Dr. Hatcher said, because NoMoreClipboard and Indiana Health Information Technology Inc. (IHIT) had just received a joint $1.5 million grant from the Office of the National Coordinator for Health Information Technology (ONC) to develop, deploy, and pilot test solutions that enable patients to access electronic health information exchange data.
Despite a knowledgeable design team, the road to Margaret Mary’s united provider portal was strewn with bumps and obstacles, Dr. Hatcher said at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS). Developers encountered skepticism from some health providers and received push back from electronic health record (EHR) vendors.
The vendors’ “excitement to participate and help us develop this was not as great because it basically took the place of their product,” Dr. Hatcher said in an interview. “It’s a really slow process to get them to cooperate. They’re just not willing to move things along at a pace that’s rapid enough.”
Dr. Hatcher’s team worked to gain the trust of each participant. One key was ensuring that each provider was comfortable with what medical information would be released and when, and what type of sensitive information should be withheld and for how long, he said. Portal developers also had to create policies for the system and take into account the various data access rules of patients’ home states – including Indiana, Ohio, and Kentucky.
There were privacy issues as well. While the hospital serves a regional population of 70,000, it is situated in the rural community of Batesville, a town of 7,000. Residents in the small community historically have passed down identical first and last names for several generations leading to four or five people in the community with the same name, according to a case study on the project by NoMoreClipboard.
To address the situation, development experts created standards-based policies to securely match consumers with their data, and once authenticated, transport those data into patients’ personal health record.
Since the portal launched in 2012, 18,000 patients have accepted their access codes and about 5,000 patient have used the portal, Dr. Hatcher said. Because the portal links to HealthBridge, patients are able to get data from across the continuum of care, whether or not they receive the care at Margaret Mary. HealthBridge serves southwest Ohio, southeast Indiana and northern Kentucky. Additionally, several Cincinnati hospitals have authorized sharing their HIE data with Margaret Mary patients who use the portal.
No hard numbers on the portal’s impact yet exist, but providers have noted an increase in productivity and a rise in patient satisfaction, Dr. Hatcher said.
“When you look at the care perspective, it’s changed the dynamics of the conversations we’re having,” he said. “When patients get data, we can point them to trusted websites and they can come in prepared. The follow-up appointment becomes more of a discussion and not a lab review. Now you’re spending [more] time planning care.”
Dr. Hatcher encourages other physicians and health systems to participate in such patient engagement efforts, especially as Stage 3 of meaningful use approaches. The Centers for Medicare & Medicaid Services has proposed that all physicians and hospitals meet Stage 3 meaningful use requirements beginning in 2018. The proposed rule also calls for 25% of patients to access their data, although it allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
“As we begin this heath care–sharing process, it’s really important to have patients in a position where they’re more educated about the process that’s going on with them,” Dr. Hatcher said in an interview. “The more you educate your patients, the more it helps them embrace what you’re trying to do. It’ll be hard to meet the upcoming meaningful use measures if you don’t have patients engaged in their health care plan.”
Health providers interested in creating a similar patient portal should review what other health systems have done in the past and build on their ideas, Dr. Hatcher added.
“You’ve got to have the enthusiasm of your medical staff,” he said. “You’ve got to have the support of your organization, and you have to have a vision. Know what you want before you start. If you do that, then you’re well on your way.”
On Twitter @legal_med
CHICAGO – For Margaret Mary Health in Batesville, Ind., partnerships were central to the formation of its community-wide patient portal.
In 2012, the hospital launched a portal that combines the records and information of multiple health providers in southeast Indiana and surrounding areas into a single system that patients can access. The approach departs from a standard portal model in which each physician practice has its own portal and patients must assess their health information from multiple sources, according to Dr. Jeffrey Hatcher, a Batesville ob.gyn and medical staff liaison for Margaret Mary Health.
“The whole goal of electronic records was to consolidate and centralize and streamline health care records,” Dr. Hatcher said in an interview. “In a lot of ways, what we’re doing is just building on that process. We’ve eliminated the need for all of those individual portals and connected the patients and their physicians to the health information exchange (HIE). Those practices feed the information through the HIE into the patient’s chart.”
Margaret Mary began efforts to design its portal in early 2011. The hospital partnered with NoMoreClipboard, a company that offers patient engagement tools to health providers, and HealthBridge, a nonprofit corporation that supports health information technology adoption and health information exchange (HIE). The timing was perfect, Dr. Hatcher said, because NoMoreClipboard and Indiana Health Information Technology Inc. (IHIT) had just received a joint $1.5 million grant from the Office of the National Coordinator for Health Information Technology (ONC) to develop, deploy, and pilot test solutions that enable patients to access electronic health information exchange data.
Despite a knowledgeable design team, the road to Margaret Mary’s united provider portal was strewn with bumps and obstacles, Dr. Hatcher said at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS). Developers encountered skepticism from some health providers and received push back from electronic health record (EHR) vendors.
The vendors’ “excitement to participate and help us develop this was not as great because it basically took the place of their product,” Dr. Hatcher said in an interview. “It’s a really slow process to get them to cooperate. They’re just not willing to move things along at a pace that’s rapid enough.”
Dr. Hatcher’s team worked to gain the trust of each participant. One key was ensuring that each provider was comfortable with what medical information would be released and when, and what type of sensitive information should be withheld and for how long, he said. Portal developers also had to create policies for the system and take into account the various data access rules of patients’ home states – including Indiana, Ohio, and Kentucky.
There were privacy issues as well. While the hospital serves a regional population of 70,000, it is situated in the rural community of Batesville, a town of 7,000. Residents in the small community historically have passed down identical first and last names for several generations leading to four or five people in the community with the same name, according to a case study on the project by NoMoreClipboard.
To address the situation, development experts created standards-based policies to securely match consumers with their data, and once authenticated, transport those data into patients’ personal health record.
Since the portal launched in 2012, 18,000 patients have accepted their access codes and about 5,000 patient have used the portal, Dr. Hatcher said. Because the portal links to HealthBridge, patients are able to get data from across the continuum of care, whether or not they receive the care at Margaret Mary. HealthBridge serves southwest Ohio, southeast Indiana and northern Kentucky. Additionally, several Cincinnati hospitals have authorized sharing their HIE data with Margaret Mary patients who use the portal.
No hard numbers on the portal’s impact yet exist, but providers have noted an increase in productivity and a rise in patient satisfaction, Dr. Hatcher said.
“When you look at the care perspective, it’s changed the dynamics of the conversations we’re having,” he said. “When patients get data, we can point them to trusted websites and they can come in prepared. The follow-up appointment becomes more of a discussion and not a lab review. Now you’re spending [more] time planning care.”
Dr. Hatcher encourages other physicians and health systems to participate in such patient engagement efforts, especially as Stage 3 of meaningful use approaches. The Centers for Medicare & Medicaid Services has proposed that all physicians and hospitals meet Stage 3 meaningful use requirements beginning in 2018. The proposed rule also calls for 25% of patients to access their data, although it allows for third-party providers to access a patient’s account as a means of satisfying the requirement.
“As we begin this heath care–sharing process, it’s really important to have patients in a position where they’re more educated about the process that’s going on with them,” Dr. Hatcher said in an interview. “The more you educate your patients, the more it helps them embrace what you’re trying to do. It’ll be hard to meet the upcoming meaningful use measures if you don’t have patients engaged in their health care plan.”
Health providers interested in creating a similar patient portal should review what other health systems have done in the past and build on their ideas, Dr. Hatcher added.
“You’ve got to have the enthusiasm of your medical staff,” he said. “You’ve got to have the support of your organization, and you have to have a vision. Know what you want before you start. If you do that, then you’re well on your way.”
On Twitter @legal_med
AT HIMSS15
VIDEO: Patients with female genital cutting experience inadequate care
CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.
Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.
During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.
In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.
Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.
During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.
In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO– Inappropriate treatment by physicians of women who have undergone female genital cutting (FGC) can block access to further care and harm patients psychologically, according to Dr. Nawal M. Nour, director of the ambulatory obstetrics practice at Brigham and Women’s Hospital and founder of the African Women’s Health Center in Boston.
Doctors who are unfamiliar with patients who have FGC can say or react to patients in ways that harms, rather than helps such women, Dr. Nour said at the annual meeting of the American Medical Women’s Association. Dr. Nour is the lead author of Female Genital Cutting: Clinical Management of Circumcised Women, published by the American Congress of Obstetricians and Gynecologists.
During her presentation, Dr. Nour shared cases in which doctors made teaching examples out of FGC patients, provided inaccurate information about vaginal deliveries, and focused on the FGC procedure, rather the woman’s reason for seeking medical attention.
In this video, Dr. Nour shares some common ways that physicians inappropriately respond to women who have undergone FGC, and how doctors can act more sensitively.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT THE AMWA ANNUAL MEETING
AMWA: Recognizing human-trafficking victims
CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.
Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.
“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”
The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.
The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.
Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.
In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.
“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.
Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.
Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.
Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.
“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.
Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.
The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.
Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.
More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.
All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.
In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.
“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”
*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.
[email protected]
On Twitter @legal_med
CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.
Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.
“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”
The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.
The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.
Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.
In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.
“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.
Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.
Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.
Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.
“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.
Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.
The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.
Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.
More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.
All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.
In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.
“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”
*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.
[email protected]
On Twitter @legal_med
CHICAGO – Physicians can play a leading role in identifying patients who are human trafficking victims by knowing the signs to watch for during visits and taking immediate steps to address their suspicions, according to Dr. Holly G. Atkinson.
Key indicators include discrepancies between history and clinical presentation, multiple sexually transmitted diseases, and the accompaniment of a controlling third-party who is not a guardian, said Dr. Atkinson, director of the human rights program at Arnhold Global Health Institute at the Icahn School of Medicine at Mount Sinai in New York City.
“This is an underground problem,” Dr. Atkinson said. “We have a number of issues that we need to address in the medical profession. Health care providers are missing the opportunity to intervene.”
The prevalence of U.S. citizens being trafficked is higher than some people may think, Dr. Atkinson said at the annual meeting of the American Medical Women’s Association. In 2014, the National Human Trafficking Resource Center, operated by the antislavery organization Polaris, received 3,598 reports of sex-trafficking cases inside the United States. And Homeland Security Investigations of the U.S. Immigration and Customs Enforcement in fiscal 2013 opened 1,025 investigations involving possible human trafficking, an increase from 894 from 2012.
The National Center for Missing & Exploited Children estimates that 1 in 6 endangered runaways reported to their organization in 2014 were likely sex trafficking victims.* The average age of entry into the commercial sex trade for girls is between 12 and 14 and for boys between ages 11 and 13, Dr. Atkinson said. Factors that contribute to a higher risk for human trafficking include childhood sexual abuse, involvement in the foster care system, and poverty. Runaway and minority youth also are at higher risk.
Research and personal accounts show human trafficking victims regularly come in contact with health providers during the course of their exploitation. In a 2014 survey of domestic sex-trafficking victims, 88% said they encountered one or more health professions during the period in which they were being trafficked, yet none was identified as a victim by physicians during the visits.
In another 2014 survey of survivors, 39% of victims reported having contact with emergency departments; 29%, with primary care physicians; 17%, with ob.gyns.; 17%, with dentists; and 3%, with pediatricians, according to data cited in Dr. Atkinson’s presentation.
“This really points out that we all need to pay attention to it across the entire span of the health care system,” Dr. Atkinson said during the meeting.
Physicians should pay close attention to physical signs that could denote the possibility of patients being trafficked, she added. This includes visible tattoos with “daddy,” “property of,” or a trafficker’s street name. Perpetrators often brand their victims so that they are easily recognizable and can be returned if they escape, Dr. Atkinson explained.
Dehydration, malnutrition, multiple sexually transmitted infections, and multiple pregnancies or abortions could also be clues. Doctors should watch for a history of discrepancies and confusion in how patients answer questions, for example, the inability to provide an address, confusion about their current location, an appearance younger than the stated age, and answers that sound scripted.
Signs of human trafficking may also be apparent in the relationship between patients and third-party visitors, Dr. Atkinson said. A controlling third party who does not let the patient answer questions or who interrupts or corrects the patient is a red flag. Other indicators include a patient who appears fearful or avoids eye contact.
“Understand that there is a lot of fear and distrust,” Dr. Atkinson said.
Several health care centers and medical systems have started developing protocols for health providers to follow to address possible human-trafficking victims.
The Via Christi Health system in Wichita, Kan., recently published guidance for clinicians on how to proceed if they suspect a patient is a victim of human trafficking. Steps include following child abuse or domestic violence protocols; separating the patient from the controlling third party; providing the patient a comfortable, safe area; and ensuring a patient interview is performed by a trauma-informed social worker or nurse.
Some questions physicians may want to ask patients include: Have you ever exchanged sex for money, food, or shelter? Have you been forced to have sex against your will? Have you been asked to have sex with multiple partners? If the patient answers yes, physicians should follow child abuse protocols and mandatory reporting requirements. If the patient is aged 18 or older, doctors should obtain the patient’s permission to call law enforcement or assist the patient in calling 911.
More efforts are underway on the state and federal levels to fight human trafficking, Dr. Atkinson said.
All states have criminal laws that address human trafficking, and 14 states now have educational laws specifically about trafficking. In late April, the U.S. Senate passed a measure that would increase penalties on human trafficking.
In addition, AMWA recently launched Physicians Against the Trafficking of Humans (PATH) to help educate health providers about trafficking in their communities. The PATH website includes resources for physicians and an online video about trafficking that doctors can share with their practices and colleagues.
“As physicians, we are trained to act, and we’re trained to solve problems,” AMWA Immediate Past Resident President Kanani Titchen said in the video. “It’s important in these situations to remember that we are not going to fix this person’s life in one visit. Many of these patients have been in their situations for years, and many times the path to recovery is a long one, and we are one stepping stone in that path. It’s important to listen to our patients, to provide the information that they need, the resources that they need, and it’s important for us as physicians, to know what those resources are.”
*Clarification, 6/3/2015: This story was updated to reflect a more accurate estimate of children at risk for sex trafficking.
[email protected]
On Twitter @legal_med
AT THE AMWA ANNUAL MEETING
SHM VIDEO: Provider continuity, workload reduction improves patient throughput
NATIONAL HARBOR, MD.– Clogs in patient throughput often are caused by top-heavy workloads, poor staffing models, and unbalanced patient to provider ratios, said Dr. Dean Dalili, vice president for medical affairs at Hospital Physician Partners, a practice management company based in Hollywood, Fla.
Hospitalists can manage such patient flow challenges by analyzing staff capacity and developing creative approaches to patient demand, Dr. Dalili said at the annual meeting of the Society of Hospital Medicine.
In this video, Dr. Dalili shares common reasons for patient throughput holdups and strategies that hospitalists and other doctors can employ to alleviate the problems. He also discusses how physician documentation can affect payment, performance and length of stay.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
NATIONAL HARBOR, MD.– Clogs in patient throughput often are caused by top-heavy workloads, poor staffing models, and unbalanced patient to provider ratios, said Dr. Dean Dalili, vice president for medical affairs at Hospital Physician Partners, a practice management company based in Hollywood, Fla.
Hospitalists can manage such patient flow challenges by analyzing staff capacity and developing creative approaches to patient demand, Dr. Dalili said at the annual meeting of the Society of Hospital Medicine.
In this video, Dr. Dalili shares common reasons for patient throughput holdups and strategies that hospitalists and other doctors can employ to alleviate the problems. He also discusses how physician documentation can affect payment, performance and length of stay.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
NATIONAL HARBOR, MD.– Clogs in patient throughput often are caused by top-heavy workloads, poor staffing models, and unbalanced patient to provider ratios, said Dr. Dean Dalili, vice president for medical affairs at Hospital Physician Partners, a practice management company based in Hollywood, Fla.
Hospitalists can manage such patient flow challenges by analyzing staff capacity and developing creative approaches to patient demand, Dr. Dalili said at the annual meeting of the Society of Hospital Medicine.
In this video, Dr. Dalili shares common reasons for patient throughput holdups and strategies that hospitalists and other doctors can employ to alleviate the problems. He also discusses how physician documentation can affect payment, performance and length of stay.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT HOSPITAL MEDICINE 15
VIDEO: Leadership, transparency key to hospitalist-hospital alignment
NATIONAL HARBOR, MD.– Taking leadership roles and searching for strategies to improve transparency are top ways that hospitalists can create stronger alignments with hospitals, said Dr. Chi Huang.
He spoke at the Society of Hospital Medicine annual meeting about improving care efficiency through stronger communication among health providers and stakeholders, broader partnerships and better delegation of duties. Dr. Huang is hospital medicine department chair and associate chief medical officer for Lahey Hospital & Medical Center in Burlington, Mass.
In a video interview, Dr. Huang discussed the importance of good leadership and how to encourage more transparent hospital environments. He also shared how Lahey was able to reduce overutilization of some services through innovative approaches.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
NATIONAL HARBOR, MD.– Taking leadership roles and searching for strategies to improve transparency are top ways that hospitalists can create stronger alignments with hospitals, said Dr. Chi Huang.
He spoke at the Society of Hospital Medicine annual meeting about improving care efficiency through stronger communication among health providers and stakeholders, broader partnerships and better delegation of duties. Dr. Huang is hospital medicine department chair and associate chief medical officer for Lahey Hospital & Medical Center in Burlington, Mass.
In a video interview, Dr. Huang discussed the importance of good leadership and how to encourage more transparent hospital environments. He also shared how Lahey was able to reduce overutilization of some services through innovative approaches.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
NATIONAL HARBOR, MD.– Taking leadership roles and searching for strategies to improve transparency are top ways that hospitalists can create stronger alignments with hospitals, said Dr. Chi Huang.
He spoke at the Society of Hospital Medicine annual meeting about improving care efficiency through stronger communication among health providers and stakeholders, broader partnerships and better delegation of duties. Dr. Huang is hospital medicine department chair and associate chief medical officer for Lahey Hospital & Medical Center in Burlington, Mass.
In a video interview, Dr. Huang discussed the importance of good leadership and how to encourage more transparent hospital environments. He also shared how Lahey was able to reduce overutilization of some services through innovative approaches.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT HOSPITAL MEDICINE 15
VIDEO: Building strong ACOs takes physician engagement, collaboration
CHICAGO – In 2013, Mission Health in North Carolina launched Mission Health Partners, a physician-led accountable care organization of independent physicians, hospitals, and other health providers that focuses on reduced costs, more efficient care, and population health.
But the road to developing Mission Health Partners ACO was not without its challenges, said Dr. Robert Fields, Mission Health Partners ACO quality committee chair and quality director for Mission Medical Associates.
To form a strong organization, physician leaders and administrators first had to gain stakeholder buy-in, build a population health infrastructure, and identify physician champions to support the approach, Dr. Fields said during the annual meeting of the Healthcare Information and Management Systems Society.
In a video interview, Dr. Fields discusses how the Mission Health Partners ACO was formed and how leaders overcame obstacles along the way. Dr. Fields also shares guidance for other doctors who are interested in developing such models.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – In 2013, Mission Health in North Carolina launched Mission Health Partners, a physician-led accountable care organization of independent physicians, hospitals, and other health providers that focuses on reduced costs, more efficient care, and population health.
But the road to developing Mission Health Partners ACO was not without its challenges, said Dr. Robert Fields, Mission Health Partners ACO quality committee chair and quality director for Mission Medical Associates.
To form a strong organization, physician leaders and administrators first had to gain stakeholder buy-in, build a population health infrastructure, and identify physician champions to support the approach, Dr. Fields said during the annual meeting of the Healthcare Information and Management Systems Society.
In a video interview, Dr. Fields discusses how the Mission Health Partners ACO was formed and how leaders overcame obstacles along the way. Dr. Fields also shares guidance for other doctors who are interested in developing such models.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – In 2013, Mission Health in North Carolina launched Mission Health Partners, a physician-led accountable care organization of independent physicians, hospitals, and other health providers that focuses on reduced costs, more efficient care, and population health.
But the road to developing Mission Health Partners ACO was not without its challenges, said Dr. Robert Fields, Mission Health Partners ACO quality committee chair and quality director for Mission Medical Associates.
To form a strong organization, physician leaders and administrators first had to gain stakeholder buy-in, build a population health infrastructure, and identify physician champions to support the approach, Dr. Fields said during the annual meeting of the Healthcare Information and Management Systems Society.
In a video interview, Dr. Fields discusses how the Mission Health Partners ACO was formed and how leaders overcame obstacles along the way. Dr. Fields also shares guidance for other doctors who are interested in developing such models.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT HIMSS15
VIDEO: Episode-bundling program generates success, satisfaction in Arkansas
CHICAGO – Bundled care payments are a hot topic among physicians as the Centers for Medicare and Medicaid Services continues to roll out its bundled payment pilot program.
But does the method really improve quality and enhance care delivery?
Physician leaders with the Arkansas Health Care Payment Improvement Initiative may have the answer. Arkansas was the first to implement a statewide payment reform initiative that rewards doctors for quality care and enables them to access data about overall care quality delivered during a set time period.
Dr. William Golden, medical director of the Arkansas Division of Medical Services, Department of Human Services, spoke about the initiative and its impact at the annual meeting of the Healthcare Information and Management Systems Society.
The initiative was launched in 2011 and includes partnerships between the Arkansas Department of Human Services, Arkansas Blue Cross and Blue Shield, and QualChoice of Arkansas.
The program enables physicians to share in the savings or excess costs of an episode, depending on their performance for each episode. For some episodes, health providers submit information through the billing system’s provider portal, a HIPAA-compliant online tool that collects data about overall care and performance. The portal allows hospitals, physicians, and other providers to submit a set of quality metrics data that will to be tied to the initiative’s financial incentives.
The tool also allows doctors designated as principal accountable providers to access reports about their average quality, costs, and utilization for care episodes.
During the payment initiative’s first phase, insurers introduced five episodes of care, including upper respiratory infections, total hip and knee replacements, congestive heart failure, attention deficit/hyperactivity disorder, and perinatal.
In a video interview, Dr. Golden discusses the initiative, the road to build its design, and how the program has affected physicians and patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – Bundled care payments are a hot topic among physicians as the Centers for Medicare and Medicaid Services continues to roll out its bundled payment pilot program.
But does the method really improve quality and enhance care delivery?
Physician leaders with the Arkansas Health Care Payment Improvement Initiative may have the answer. Arkansas was the first to implement a statewide payment reform initiative that rewards doctors for quality care and enables them to access data about overall care quality delivered during a set time period.
Dr. William Golden, medical director of the Arkansas Division of Medical Services, Department of Human Services, spoke about the initiative and its impact at the annual meeting of the Healthcare Information and Management Systems Society.
The initiative was launched in 2011 and includes partnerships between the Arkansas Department of Human Services, Arkansas Blue Cross and Blue Shield, and QualChoice of Arkansas.
The program enables physicians to share in the savings or excess costs of an episode, depending on their performance for each episode. For some episodes, health providers submit information through the billing system’s provider portal, a HIPAA-compliant online tool that collects data about overall care and performance. The portal allows hospitals, physicians, and other providers to submit a set of quality metrics data that will to be tied to the initiative’s financial incentives.
The tool also allows doctors designated as principal accountable providers to access reports about their average quality, costs, and utilization for care episodes.
During the payment initiative’s first phase, insurers introduced five episodes of care, including upper respiratory infections, total hip and knee replacements, congestive heart failure, attention deficit/hyperactivity disorder, and perinatal.
In a video interview, Dr. Golden discusses the initiative, the road to build its design, and how the program has affected physicians and patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
CHICAGO – Bundled care payments are a hot topic among physicians as the Centers for Medicare and Medicaid Services continues to roll out its bundled payment pilot program.
But does the method really improve quality and enhance care delivery?
Physician leaders with the Arkansas Health Care Payment Improvement Initiative may have the answer. Arkansas was the first to implement a statewide payment reform initiative that rewards doctors for quality care and enables them to access data about overall care quality delivered during a set time period.
Dr. William Golden, medical director of the Arkansas Division of Medical Services, Department of Human Services, spoke about the initiative and its impact at the annual meeting of the Healthcare Information and Management Systems Society.
The initiative was launched in 2011 and includes partnerships between the Arkansas Department of Human Services, Arkansas Blue Cross and Blue Shield, and QualChoice of Arkansas.
The program enables physicians to share in the savings or excess costs of an episode, depending on their performance for each episode. For some episodes, health providers submit information through the billing system’s provider portal, a HIPAA-compliant online tool that collects data about overall care and performance. The portal allows hospitals, physicians, and other providers to submit a set of quality metrics data that will to be tied to the initiative’s financial incentives.
The tool also allows doctors designated as principal accountable providers to access reports about their average quality, costs, and utilization for care episodes.
During the payment initiative’s first phase, insurers introduced five episodes of care, including upper respiratory infections, total hip and knee replacements, congestive heart failure, attention deficit/hyperactivity disorder, and perinatal.
In a video interview, Dr. Golden discusses the initiative, the road to build its design, and how the program has affected physicians and patients.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
On Twitter @legal_med
AT HIMSS15
ICD-10 prep: Reduce claim backlogs, develop contingency plan
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
AGA Resources
AGA has collaborated with leading organizations to provide you with various resources to help ensure your smooth transition to ICD-10. Visit our ICD-10 Resource Center at www.gastro.org/practice-management/coding/icd10 to learn more
On Twitter @legal_med
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
AGA Resources
AGA has collaborated with leading organizations to provide you with various resources to help ensure your smooth transition to ICD-10. Visit our ICD-10 Resource Center at www.gastro.org/practice-management/coding/icd10 to learn more
On Twitter @legal_med
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
AGA Resources
AGA has collaborated with leading organizations to provide you with various resources to help ensure your smooth transition to ICD-10. Visit our ICD-10 Resource Center at www.gastro.org/practice-management/coding/icd10 to learn more
On Twitter @legal_med
EXPERT ANALYSIS FROM HIMSS15
ICD-10 prep: Reduce claim backlogs, develop contingency plan
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
On Twitter @legal_med
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
On Twitter @legal_med
CHICAGO – Between now and the Oct. 1 ICD-10 transition, physicians should examine their past claims, reduce backlogs, and develop contingency plans to address unforeseen challenges, Betty Gomez said at the annual meeting of the Healthcare Information and Management Systems Society.
Physicians “think about Oct 1, 2015, and we think, ‘OK, all of my [preparations] are done. Great,’ ” said Ms. Gomez, a regulatory strategy consultant based in Louisville, Ky. But “Oct. 1 really marks the beginning of you ‘operationalizing’ your work and living in an ICD-10 world. It doesn’t stop there. It’s just the first milestone.”
Over the next 6 months, physicians should assess their coding systems and ensure they are fully prepared to work efficiently when ICD-10 goes live, Ms. Gomez said. A first step is getting a handle on the number of pending and denied claims. If an excess of pending claims exist, work immediately to lessen that excess.
“With the transition, there are going to be unforeseen obstacles and challenges,” she said. “You don’t want to have a pile and then be piling on top of that.”
Ms. Gomez recommended creating ways to monitor performance and develop thresholds for success. Benchmarks can help determine what success looks like and what issues should trigger concern. As Oct. 1 approaches, have a checklist in place to ensure all necessary tasks are completed. Questions might include: Do I have a response team or designated staff member in place to address potential problems that arise on or after Oct. 1.? Are staff members educated on when to use ICD-9 and when to use ICD-10 codes after the transition?
“You need to make sure you can continue to use both ICD-9 and ICD-10 codes, based on date of service or date of discharge,” Ms. Gomez said. “Verification is so important. You can never go wrong with making sure everything is in order.”
In terms of financial preparation, discuss with the practice’s top payers what kind of contingency plans are needed to ensure their revenue remains sufficient after Oct. 1, said F. Phil Cartagena Jr., ICD-10 program manager for Partners Healthcare System in Boston. The general recommendation is that practices have a minimum of 3 months of cash flow on hand, Mr. Cartagena said in an interview. However, it’s beneficial for practices to work out agreements in which payers match or partially match physicians’ current monthly run rate during the transition. Such arrangements can help mitigate claim denials that take time to be adjudicated, thus delaying cash flow.
“Your business isn’t going to change,” Mr. Cartagena said. “The patients that you’re seeing and the things that you are doing aren’t going to radically change, but if the ability to properly account for them and get paid for them changes, you don’t want it to have a major impact to your bottom line.”
Mr. Cartagena also suggested that physicians start more extensive patient documentation now, rather than waiting until ICD-10. As most physicians know, the nearly fivefold increase in the number of codes also requires more specific documentation than did ICD-9.
“The more specific that you can be, the better it is, whether it matters for actually coding the record correctly, or if it’s for stratifying your patient mix or having a better understanding clinically of how the diagnoses of your patient population break down,” he said. “It all comes back to the more information you have on the patients, the better they can be coded, and the better information you get at the end of all of it to understand your mix.”
On Twitter @legal_med
EXPERT ANALYSIS FROM HIMSS15
Diagnostic Errors Top Malpractice Claims Against Emergency Physicians
More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.
Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.
A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.
“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.
Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.
The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)
The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.
Communication breakdowns between physicians and patients also can be catalysts for legal claims.
“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”
Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.
“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”
The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.
“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”
More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.
Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.
A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.
“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.
Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.
The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)
The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.
Communication breakdowns between physicians and patients also can be catalysts for legal claims.
“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”
Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.
“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”
The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.
“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”
More than half of medical malpractice lawsuits against emergency physicians involve allegations of diagnostic errors, according to a study by national medical liability insurer The Doctors Company published online April 13.
Darrell Ranum, vice president for patient safety and risk management for The Doctors Company, and his colleagues, analyzed 332 emergency medicine claims in the insurer’s database that were closed from 2007 to 2013. Most claims (57%) were diagnostic related; they included allegations of failure to establish a differential diagnosis, failure to order diagnostic tests, failure to address abnormal findings, and failure to consider available clinical information.
A key lesson from the study is the importance of a thorough differential diagnosis by emergency physicians, Dr. David B. Troxel, medical director for The Doctors Company said in an interview.
“Our hope is that as physicians review the findings of this study, they will scrutinize their own systems and processes and determine whether the weaknesses identified in the study exist in their organization,” Dr. Troxel said.
Among the other claims, 13% related to improper management or treatment, 5% claimed improper performance of treatment, and 3% alleged failure to order medication.
The study also analyzed top factors that contributed to patient injury in the ED. Problems with patient assessments, such as failure to address abnormal findings, were the most common contributor at 52%. Patient factors, such as physical characteristics and noncompliance, were the second-most-frequent contributor at 21%. Other factors were lack of communication among physicians (17%), poor communication between doctors and patients (14%), insufficient or lack of documentation (13%), and workflow/workload issues (12%). (Claims could have more than one contributing factor.)
The study shows how important strong communication is in the emergency department (ED), said Mr. Ranum. He pointed out one claim in which a patient’s vital signs had changed during the course of a visit. The changes were not communicated to the emergency physician, and he inappropriately discharged the patient. In another case, a patient’s history of overdoses was not conveyed during a patient hand-off, which resulted in an overdose that was not treated in a timely manner, he said.
Communication breakdowns between physicians and patients also can be catalysts for legal claims.
“Sometimes, we find that patients don’t always understand instructions,” Mr. Ranum said. “If patients don’t understand the communication from their providers or if patient receives inadequate information, such as in situations where you have a language barrier, you can have problems there as well.”
Other injury contributors, such as workflow problems, are difficult for emergency physicians to control alone, said Dr. Roneet Lev, director of ED operations for Scripps Mercy Hospital in San Diego.
“We are all struggling with the right balance of staffing and really dependent also on hospital staffing,” Dr. Lev said in an interview. “We’re able to control on the physician end, how many doctors are there, but we’re not in control of how many nurses are there, how many techs are there, how many secretaries are there. That’s a huge part of the workflow. [Physicians are] only a small piece of the bottleneck.”
The study provides helpful information that emergency physicians can use to assess their own systems, Mr. Ranum said.
“Sometimes physicians feel like we’re beating up on them because we parade this whole line of cases where in many [instances], a physician’s care was not adequate,” he said. “We recognize that the systems that are used in hospital emergency departments are complex systems. When those systems fail, there’s an increased chance that a patient will be harmed a result. When physicians read the study, we would ask that they look at their own situation and organization and say, ‘Could these problem occur here?’ And if so, we would encourage them to undertake review of their own processes.”
