Category Archives: Physician Workflow

Supervision and Incident-to Guidelines

In past blogs, I’ve written about a variety of E&M services and how to code those visits. In case that seemed straightforward, many years ago mid-level providers were added into the mix. You will see these types of providers abbreviated as MLP (mid-level providers), NPP (Non-physician practitioners), NP (Nurse Practitioners), PA (Physician’s Assistants), and some others. For the purpose of this blog, I’ll use MLP. The introduction of these types of providers created a new education opportunity for all of us. CMS created “Incident-to” guidelines and published them in the Medicare Benefit Policy Manual (S60.1-S60.4). This means that an MLP can provide services to a patient and report those services under the physician’s name when those services are provided incident to an established plan of care for that patient. Continue reading

Alert Fatigue: The Implications for Reducing Preventable Hospital-Acquired Conditions

Blog post by Krysten Brooks, RN, BSN, MBA

Hospitals across the country have launched a wide-range of initiatives to reduce hospital-acquired conditions (HACs), but despite their efforts, a quarter of the nation’s hospitals face reimbursement penalties according to a preliminary analysis released in June by CMS that scored hospitals based on rates of acquired conditions and patient complications. While Medicare’s HAC Reduction Program plans to release final scores later this year, the healthcare organizations facing penalties can expect to lose approximately one percent of each Medicare payment from October 1, 2014 through September 30, 2015, translating into billions of dollars in lost reimbursement.

The Medicare penalties will undoubtedly hit some organizations hard, and these hospitals are moving quickly to analyze avoidable complications and intervene to improve quality. Facilities are also auditing clinical documentation for completeness and accuracy and examining documentation workflow to analyze process breakdowns and problems. Continue reading

Top 5 Report Creation Annoyances in Radiology

It’s about productivity and accuracy – anything else is a distraction

Guest blog by Dr. Arnold Raizon, MD, a physician consultant with 3M ChartScriptMD for Radiology.

One of my biggest frustrations as a radiologist is dealing with the quirks of the software tools I must use to create my reports. Some applications look like they were not really created from the ground up for radiology use, but merely a collection of patches over generic software that frustrate busy radiologists like me. Let’s examine in more detail some of the common annoyances that hinder radiologists’ ability to stay productive and, more importantly, how to address them.

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Healthcare’s Efficiency Challenge

I’ve started reading a book by William Baumol called The Cost Disease, which raises an interesting question. Why in 2014 can I buy a laptop computer that is smaller, more powerful, and most of all, much cheaper than one I could have bought just ten years ago, but healthcare costs have risen from ten years ago? Why are some industries able to become more efficient, and produce more of their goods or services, faster and cheaper, while other industries are stuck in a spiral or are continually raising costs with stagnant efficiency?

I won’t give a full, in-depth review of the book, but in short, the analysis lays out the premise that in some industries, such as with computers or automobiles, manufacturers are able to continually improve on both their manufacturing processes and the quality of the goods they are manufacturing. This enables these manufacturers to produce better goods at lower costs. These lower costs then enable them to pass some of these savings on to their customers, as well as to pay their employees more money. Continue reading

Delivering on the Promise of an “E-Health” Revolution

As more and more hospitals and healthcare organizations convert more and more of their paper medical records to electronic health records (EHRs), an interesting dynamic has begun to emerge, as well as an interesting challenge.

The dynamic is that while the conversion from paper to electronic records was promised to provide time and cost savings for healthcare, the adoption of EHR systems by physicians has led to a number of perhaps unforeseen consequences. One of the chief consequences, which could also be considered a chief complaint, is that physicians who document on their patients electronically make less eye contact with their patients and have lower patient satisfaction ratings, vs. physicians who document on paper. Continue reading

Making Use of Data

In his book Blink, Malcolm Gladwell writes about Dr. Brendan Reilly’s work at Cook County Hospital in Chicago from back in the late 1990s. At that time, the hospital was stretched thin, running low on resources and struggling to deal with roughly 250,000 patients coming through the Emergency Department every year. Patients routinely waited hours to be seen. One of the hospital’s key struggles was determining which patients coming into the Emergency Department with complaints of chest pain were actually having a heart attack and thus required expensive, resource-intensive care.

It’s an interesting case study if you get a chance to read it, but I’ll just give a brief summary here. Dr. Reilly used work that had been done from back in the 1970s by a cardiologist named Lee Goldman. Goldman took the data from hundreds of cases and ran it all through a computer program to identify what kinds of symptoms and clinical findings actually predicted a heart attack. Continue reading

For or Against – Which Side Will Providers Choose in the Big Data Revolution?

The healthcare industry, and specifically the healthcare provider segment, is moving towards a rather interesting and potentially dangerous intersection in the near future.  As electronic health records expand and allow for more digitized patient data to be analyzed by an ever-increasing array of analytical processing power, we’re going to see a huge growth in the amount of “information” that can be returned to healthcare providers.  At the same time, we’re seeing the well-known-but-often-ignored issue of “alert fatigue” and EHR workflow frustration becoming a major problem for healthcare providers.

Just browsing through any healthcare industry websites or taking a quick look at the PR coming from healthcare software companies, you can easily see what the McKinsey Company outlines in a recent article, “The big data revolution in healthcare: Accelerating value and innovation”: big data is on its way.  Continue reading

Building Walls vs. Building Doors

A book came out several years ago that has continued to resonate with me and that I still reference in conversations and discussions.  The book, What Would Google Do?, by Jeff Jarvis, delves into how the Internet has evolved, and continues to evolve, and why some companies like Yahoo and AOL became has-beens while Google has flourished.

If you think about how Google operates, they focus on giving their users control, while other internet companies focus on trying to control users.  The example that illustrates Google’s strategy most clearly is to just go to and look at what you see, and then go to or and compare these two to Google.

Go ahead, check it out. Continue reading

EHRs and Vendors: Is Bigger Better?

Who has recently logged in to Facebook to see what your friends are up to?  (Anyone still have a MySpace account?) Anyone purchased something online at Amazon this holiday season?  When’s the last time you searched for something online and didn’t “Google” it?

It’s interesting that there are a select group of companies who have come to dominate our online, internet lives, and as a recent December issue of The Economist (1) points out in “Survival of the Biggest,” this comes with some positives and negatives.  Facebook owns the world of social media, aside from the Twittersphere, and is looking to capitalize on all that personal information and preferences it knows about us.  Amazon is dominant in online retail, with a third of online buyers starting their product search on Amazon, and two-thirds of all e-books downloaded coming through Amazon as well.  Apple dominates online music sales and the growing tablet market.  Google has long been the far and away leader in search and online advertising, though it is now under scrutiny having been accused of favoring search results to promote its own products and services. Continue reading

EMR Workflows Leading to a Paper Revolution?

In the August 1st issue of the Journal of the American Medical Association, Robert E. Hirschtick, MD, wrote an article entitled “John Lennon’s Elbow.” In the article, Dr. Hirschtick writes about how the quality of progress notes created within EMRs during patients’ hospital stays has consistently declined as these notes have become longer and longer from carry-forward and copy/paste usage.  Progress notes have lost most of their value in updating other providers about the current status of the patient, and no one seems overly concerned about this. Continue reading