What’s the Probability you’ll receive EHR Stimulus Payments?

Posted on 25. Feb, 2010 by Brad Rourke.

Kathleen Sebelius, Secretary Health and Human Services (HHS), was required to issue initial guidance on ‘Certification’ and ‘Meaningful Use’ of Electronic Health Records (EHRs) by December 31, 2009. This requirement is pursuant to the 787 billion dollar American Recovery and Reinvestment Act (ARRA), also referred to as the stimulus plan.

Per the HHS website, on December 30, 2009, the Office of the National Coordinator for Health Information Technology (ONC) issued an Interim Final Rule (IFR) that specifies the Secretary’s adoption of an initial set of standards, implementation specifications, and certification criteria for health record technology.

In short, although there is still much work to be done in 2010, the HHS stimulus program is on track, and therefore the probability is increasing that EHR technology adoption stimulus funds will be available to you in 2011.

What Stimulus Funds are available for Optometrists?
A component of the February 2009 Stimulus Plan was enacted to improve health of all Americans as well as improve the efficiency of healthcare delivery. To this end, qualifying providers (e.g. Optometric Doctors), who demonstrate ‘Meaningful Use’ of a ‘Certified EHR’, are eligible under the Medicare program for up to $44,000 in incentive payments. The incentive payments are meant to offset the cost of acquiring, deploying, training and using EHR technology.

Beginning in 2011, incentive payments will be made to Providers through Centers for Medicare and Medicaid Services (CMS) provided adoption and Meaningful Use of Certified EHR technology is demonstrated. The fundamental terms of payment are as follows:

• Up to $18,000, $12,000, $8,000, $4,000, $2,000 for years 1 through 5, respectively beginning in 2011 paid out via bonus payments of 75% of your Medicare reimbursements.

• Adoption and demonstration of meaningful use of Certified EHR technology is required by 2012 in order to be eligible for the full $44,000 incentive.

• A penalty of 1% per year of your Medicare reimbursements will go into effect if you have not demonstrated meaningful use of Certified EHR technology by 2015; the penalty is restricted to a maximum of 5 years.

• There are no stated restrictions on the use of incentive payments received.

What is Meaningful Use of a Certified EHR Technology?
The Interim Final Rule (IFR) regulation filings of December 30, 2009 bring us much closer to definitively answering this question.

The two IFR regulation documents that were filed with the Office of the Federal Register by HHS are:

1. Medicaid & Medicare Programs; Electronic Health Record Incentive Program; 556 pages in .pdf format.

2. Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; 136 pages in .pdf format.

They are available at: http://www.federalregister.gov/inspection.aspx#special

Much of the content is based on the work done by the Health Information Technology (HIT) Policy Committee. The HIT Policy Committee was created by Stimulus Plan legislation and is charged with recommending definitions of Certified EHR Technology and Meaningful Use.

The first document sets out what will be required to demonstrate Meaningful Use. HHS has deemed it appropriate to define the requirements for Meaningful Use in three stages:

Stage-1 defines what Meaningful Use of Certified EHR technology is for purposes of 2011 or year 1 incentive payments. There are 25 Stage-1 one criteria for Providers, a reliable summary of the 25 criteria along with measures can be viewed at:

http://www.healthcareitnews.com/news/eligible-provider-Meaningful Use-criteria

Stage-1 Criteria Examples include:
• 80% of orders must be computer physician order entry (CPOE).
• 80% of all patients must have at least one ‘electronic documentation’ of allergy and medication or an indication of ‘none’.
• 75% of prescriptions written must be transmitted electronically.
• 80% of patients who request a copy of their health record electronically must receive it with in 48 hours.

Stages 2 and 3, which are not fully defined, will focus on the exchange of clinical data and decision support tools respectively. Stage-2 definitions are expected by the end of 2011 and Stage-3, by the end of 2013.

Are Certified EHRs are available now?
As of January 2010 there are no HHS certified EHRs available for purposes of the stimulus plan incentive payments. It is quite likely there may not be HHS Certified EHRs available until very late in 2010 or perhaps early 2011.

The second document filed with the Federal Registrar, mentioned above, which covers the Interim Final Rule of certification criteria for EHR technology must be finalized before you will see HHS certified EHRs.

The IFR document makes an important distinction of ‘certified EHR technology’ as apposed to ‘certified EHRs’. The distinction is important because providers can use multiple vendors of EHR technology to satisfy the 25 stage-1 criteria rather than adopting one certified EHR that satisfies all 25.

What should ODs be doing?
Before CMS will cut you a check, you’ll need to demonstrate you are using certified EHR technology in a “meaningful way”.

First, I recommend you become familiar with the 25-Stage 1 Meaningful Use criteria. To do this you can read the Health Care IT news above or other similar summary sources. As an alternative you can work your way through the Interim Final Rule. The latter is a daunting task, but it is certainly more reliable to obtain the information from the original source versus reviewing another’s summary.

Secondly, although there are no HHS certified EHR technologies available now I still recommend, if you haven’t done so already, that you adopt a Practice Management system with an embedded EHR. The EHR should be from a reputable vendor who is moving toward certification, and it’s critically important that you have an indefinite contractual right to access patient data with the EHR software. The benefits and advantages of using electronic health records over paper records are well documented.

As a final point on this subject, using Certified EHR Technology is not a legislated requirement that requires your compliance. The stimulus plan legislation explicitly sets out that adoption is voluntary (Section 3006, Title VIII), but as mentioned above, providers that do not adopt will be charged a 1% penalty of Medicare reimbursements.

What is the Williams Group / Practice Director Doing to help you?
I’d like to assure you we will follow Meaningful Use and Certification developments closely. We will do our best to help our clients and interested parties understand what is involved and what must be done to satisfy EHR certified technology requirements. The integrated EHR that is embedded into Practice Director’s practice management software system is developed to help you with this endeavor.

For more information contact:

Brad Rourke, CPA

http://twitter.com/bradleyrourke

Vice President, Williams Group
Practice Director Software
Optometry EHR & Practice Management Software
www.practicedirector.com
brourke@practicedirector.com
1-800-676-9096 ext 38

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Practice Director Version 2.2, Ready for Beta; Release Notes

Posted on 25. Feb, 2010 by Brad Rourke.

Practice Director 2.2   Beta Release Notes
Enhancements & Bug Fixes:

Keyboard shortcuts have been added to the application in several locations.  Major screens have been given the following shortcuts:

Ctrl-D              Patient Demographics
Ctrl-S              Scheduling
Ctrl-N              Insurance Payments
Ctrl-I               Invoicing
Ctrl-L               Ledger
Ctrl-P               Patient Payments
Ctrl-F               Refunds/Voids
Ctrl-T               Returns
Ctrl-Y              Dispensary
Ctrl-M             EMR

Hitting those key combinations anywhere in the application wil take you to those screens.

Additionally, the Insurance Payments screen has some added keyboard shortcuts internally. <em>Alt-left arrow</em> and <em>Alt-right arrow</em> now move from claim to claim in the navigation table. When editing the Payment Posting table, <em>enter</em>, <em>tab</em> or the <em>arrow</em> keys move from field to field. When on the “Rollover Disallowed To” field, hitting the <em>F2</em> key will open the drop down.

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First Impressions. Lasting Impressions, by Sheila Hayes

Posted on 25. Feb, 2010 by Brad Rourke.

 Are you starting a practice from the ground (or cement floor) up? Have you just purchased a practice that is in definite need of getting into the right century? Do you just need to update a tired look?

 The visual image of a practice is how you are perceived by your patients. If you have an antiquated look, patients will perceive that your care is antiquated as well. While that new Electronic Heath Record (EHR) Software or those new chairs in the reception area can not be billed on a CMS1500, there is no question that these types of investments will generate revenue through creating an environment with the right perception—a high level of care and customer service.

 A recent conversation with a client validated the above statement. This particular doctor was in the process of purchasing an existing practice. Over the last year, the practice numbers had steadily declined, both from patient numbers/production booked, to sales and revenue numbers. This is not uncommon. The practice was in the decline stage of their practice life cycle. There had been no money reinvested in the practice in a number of years. The décor was outdated, the equipment was old and the overall impression of technology was non-existent.

 Last month I was reading an on-line review written about another Williams Group client. “The first thing one will notice is that the office doesn’t resemble the typical medical office. Instead of industrial carpet and uncomfortable, standard chairs found in most waiting rooms, this office has wood floors and plush lounge chairs. If it weren’t for the frames and sunglasses, it could be a Starbucks. In fact, one of the assistants inquired whether I’d like coffee.” The Revenue Per Patient in this office? An impressive $492 average in 2009.

 Let’s face it. People love new stuff. Our clients report an immediate growth rate of 10 to 20% by moving their practice.  Relocating may not be in your near future, but what about a 5% to 10% growth rate with a remodel? That’s a pretty solid return on your investment.

 Keep in mind that your staff enjoys new things as well. Watch the results with a new frame line or frame style. These changes keep staff excited about their jobs, create better job satisfaction, and as a result of the energy, a better experience for the patient.

 Whatever your project, it can be an overwhelming and daunting task. Do your research. Know and understand your market.

 Where to Start?

1. Assess the situation.

Evaluate the appearance of your office. View it as though you are a new patient. Take time to sit in the reception area, exam rooms and dispensary. Get other opinions as the familiarity may prevent you from being objective.

Paint.

A fresh coat of paint is an easy way to have immediate results. Strip down the old wall paper. Investigate new color options. Seek the help of a professional if interior design is not your forte.

 De-Clutter.

The trends have moved toward clean and simplified environments. Clutter = brochures, magazines, vendor placards, counter cards, etc. Cut them in half.

 Lighting.

Proper lighting just makes everything look better. Pendant lights are very popular right now and have a sleek, attractive, unobtrusive look.

 Reception area.

The flat screen makes a big impression. You have a captive audience in the reception area. Educate your patients sending the messages that you want them to hear while using the latest technology. Capitalize on any windows with displays, eye-catching banners and seasonal displays. This is inexpensive marketing, particularly for walk-by traffic.

 Optical.

You can find a number of options to give an updated look to this area of the practice. Replace old frame boards with glass shelving, shelved display units and unique wall-mounted frame displays. Bring in a new frame line or two. Add some excitement! And yes, merchandise your products. There has been a lot of information written about this topic and for very good reason. Displays capture the attention of the consumer. Creating more of a shopping experience can result in more sales and greater profitability.

Think outside the box and use unusual and creative props. Pay attention to merchandising trends in home stores and department stores.

Beyond the Walls

Time to freshen that yellow pages ad? Replace some old photos on your website? Update your external signage? Make sure to maintain a cohesive look in all of your external marketing that is in line with the high level of care patients perceive in your office.

Sheila Hayes – Senior Consultant
Sheila has been a part of the Client Services Division of Williams Group since May 2001. Her career has included experiences in operations, budgeting, marketing, human resources, and staff training. Prior to joining the company, Sheila acquired an in-depth knowledge of patient care and operations management by spending nearly two decades in private optometric practices.  Sheila is responsible for assisting clients with implementation of consulting programs, as well as marketing and customer service presentations for Williams Group.

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Keep’em Home – By Dr. Brad Williams, O.D.

Posted on 25. Feb, 2010 by Brad Rourke.

How are things going these days?  With this economy having a bad hair day, there is one thing for certain – nothing is certain.  Rather than wringing your hands and being on the verge of wigging out, I’d hope you are proactively seeking ways to keep your practice incomparable to your competition.

After all, these economic conditions will drive some of your patients and potential patients towards inferior eye health and vision care.  Rather than getting the best, so to speak, they may settle for less and go else where.  Needless to say, patient retention and getting new patients are certainly a greater challenge in these down times.  That’s why now is a good time to review how you can keep’em home.    

The goal is to brand a perception of unforgettable and incomparable value in the minds of present and potential patients at every cycle of service.  You want them to perceive the value they received from your services and products exceeded what they paid.  Let’s go back to the basics and then provide a format to fulfill that goal.

I’ve heard our VP of Client Services, Bill Nolan, ask many audiences, “Colleagues, what kind of business are you really in?”  After several incorrect answers, he will tell them, “You are in the people business!”  In other words, you are in the perception business.  When patients go through your primary cycle of services listed below, they are developing a perception in their mind of the value they received for your services and products.

1.         Gate Keeping (Phone Reception)          6.         Treatment/Prescribing

2.         Physical Reception/Welcome    7.         Product Selection

3.         Data Collection/Case History                8.         Patient Dismissed

4.         Pre-Examination                                   9.         Follow-Up                              

5.         Examination                                         10.       Recall

I’ve heard our VP of Sales, Tom Bowen, tell audiences, “It’s not what you do when the patient goes through your cycle of services; but it is what they understand you’re doing.”  Thus, educate, educate and educate!  After a patient has been through your cycle of services, a perception of value will be branded in their mind one of three ways.  I know you’ve heard or read this before, so bear with me and read on;

1. They will be excited and tell relatives, friends, co-workers, your garbage man, etc., what a wonderful experience they encountered in your practice.  They will encourage and refer others to visit your practice.
2. Others, when asked, “How was your eye exam today”, will respond in a rather “oh hum” manner.  The perception of their experience was just okay and nothing special to brag about.  They may or may not return some day to your practice but don’t expect new patient referrals.  No loyalty of any significance was branded in their brain.
3. Some will be upset about the bad experience that occurred at one or more cycles of your service.  Their hair will be on fire!  They will tell anybody blind, crippled or crazy (including the garbage man) about their bad experience.  Many times you or any staff member may or may not be aware a patient is not happy.  One thing for certain…they ain’t coming back.

There is an old AOA statistic out there that is probably fairly accurate to this day.  It basically points out over sixty percent of the patients leaving your practice do so because of a negative attitude or indifference of a staff person!

Don’t take me wrong because most staff personnel are wonderful.  Besides, doctors are just as guilty for making this statistic what it is as well.  We are all human and make mistakes.  My intent with this article is to help you and staff members minimize these kinds of mistakes.   

We all want to prevent those last two perceptions from being branded in your patient’s mind.  In order to fulfill your goal of branding unforgettable and incomparable value in the minds of present and potential patients, try this on for size. 

Take the time to develop a “Perception Training Manual” for your practice.  This will become a tool you will utilize for the rest of your practicing years.  Your reward will be an increased perception of value, increased revenue/patient, more patient referrals and better patient retention.  Here is the format for getting it done:

1. A.                 Dedicate some time completing this project.
   1. It may take several weeks to compete.   
   2. Meet periodically with your staff approximately 30-45 minutes each time until it is finished.
   3. Finish it!  Don’t let it slide.  I promise your time and effort will be repaid over and over again for years to come.  It will put you in the

best position  to be more incomparable to your competition.

B          Develop your Cycle of Service Objectives

1.         First, using a flip chart or white board, simply list your perception objectives for each cycle of services.  In other words, what do you want your patients to perceive at each cycle?

2.         Define the desired final product at each stage/cycle.  Define what is valuable to your patients.

3.         Determine exactly what is to be said/done and by whom at every stage/cycle.  You should already have some of this information in your Office Policy and Procedures Manual, Office Training Manual, etc., so just take it to the next level.    

You say you don’t have a good or complete Training Manual?  This project will help you either up-date or complete this invaluable task.  Complete this assignment once, and all you do is up-date it once a year.

1. Develop scripts for rehearsing and training.  Put the final product into a “Perception Training Manual” for continued use throughout your practicing years.
2. Finally, use your finished product for training/reviewing purposes; definitely for all new employees and current staff when needed.

Trust me, it is one of the best training tools you can have for practice success.  Nothing good is ever easy.

Here are a few examples to get you started….The most time consuming part is developing scripts, etc., to implement the Branding Impressions, but once they’re done, you’ve got’em forever.

In summary, brand your patients loyalty.  If you finish and implement this perception training tool, your goal of branding their hearts and minds with an unforgettable perception of excellent eye health and vision care is practically assured.  They won’t think of going anywhere else.  Keep’em home… 

 Brad Williams, O.D., F.A.A.O.

CEO
Williams Group
402.488.2020 x13
800.676.9076 x13
f 877.648.8938
www.TheWilliamsWay.com or www.PracticeDirector.com

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Save with the Section 179 Tax Deduction

Posted on 10. Nov, 2009 by Brad Rourke.

You can elect to recover all or part of the cost of certain qualifying property, up to a limit, by deducting it in the year you place the property in service. This is the section 179 deduction. You can elect the section 179 deduction instead of recovering the cost by taking depreciation deductions.

If you have any questions don’t hesitate to contact us at info@practicedirector.com

What Property Qualifies?

To qualify for the section 179 deduction, your property must meet all the following requirements.

• It must be eligible property.
• It must be acquired for business use.
• It must have been acquired by purchase.

Eligible Property

To qualify for the section 179 deduction, your property must be one of the following types of depreciable property.

1. Tangible personal property.
2. Other tangible property (except buildings and their structural components) used as:
   1. An integral part of manufacturing, production, or extraction or of furnishing transportation, communications, electricity, gas, water, or sewage disposal services,
   2. A research facility used in connection with any of the activities in (a) above, or
   3. A facility used in connection with any of the activities in (a) for the bulk storage of fungible commodities.
3. Single purpose agricultural (livestock) or horticultural structures. See chapter 7 of Publication 225 for definitions and information regarding the use requirements that apply to these structures.
4. Storage facilities (except buildings and their structural components) used in connection with distributing petroleum or any primary product of petroleum.
5. Off-the-shelf computer software.

Off-the-shelf computer software.   Off-the-shelf computer software placed in service during the tax year is qualifying property for purposes of the section 179 deduction. This is computer software that is readily available for purchase by the general public, is subject to a nonexclusive license, and has not been substantially modified. It includes any program designed to cause a computer to perform a desired function. However, a database or similar item is not considered computer software unless it is in the public domain and is incidental to the operation of otherwise qualifying software.

Tangible personal property.   Tangible personal property is any tangible property that is not real property. It includes the following property.

• Machinery and equipment.
• Property contained in or attached to a building (other than structural components), such as refrigerators, grocery store counters, office equipment, printing presses, testing equipment, and signs.

How Much Can You Deduct?

Your section 179 deduction is generally the cost of the qualifying property. However, the total amount you can elect to deduct under section 179 is subject to a dollar limit and a business income limit. These limits apply to each taxpayer, not to each business. However, see Married Individuals under Dollar Limits, later. Also, see the special rules for applying the limits for partnerships and S corporations later. For a passenger automobile, the total section 179 deduction and depreciation deduction are limited. See Do the Passenger Automobile Limits Apply in chapter 5.

If you deduct only part of the cost of qualifying property as a section 179 deduction, you can generally depreciate the cost you do not deduct.

Dollar Limits

The total amount you can elect to deduct under section 179 for most property placed in service in 2008 generally cannot be more than $250,000. If you acquire and place in service more than one item of qualifying property during the year, you can allocate the section 179 deduction among the items in any way, as long as the total deduction is not more than $250,000. You do not have to claim the full $250,000.

The amount you can elect to deduct is not affected if you place qualifying property in service in a short tax year or if you place qualifying property in service for only a part of a 12-month tax year. After you apply the dollar limit to determine a tentative deduction, you must apply the business income limit (described later) to determine your actual section 179 deduction.

The above content was taken from: http://www.irs.gov/publications/p946/ch02.html#en_US_publink1000107413

If you have any questions don’t hesitate to contact us at info@practicedirector.com

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EHR & the Stimulus Plan

Posted on 19. Oct, 2009 by Brad Rourke.

Over the next several months through December 31, 2009, the Secretary of Health and Human Services through the Office of the National Coordinator (“ONC”) will be issuing initial guidance on certification and meaningful use of Electronic Health Records (“EHRs”). The Stimulus plan legislation is fast tracking initiatives and incentives for the adoption of EHRs to, among other objectives, reduce health care costs and improve coordination of care. Below is a summary of the primary processes and incentives for EHR adoption along with steps we at Practice Director are undertaking to ensure you are well prepared.

So the meaningful use, 2011 deadline, has our attention in a very, very important way. The second important issue that we have to deal with is certification. We can only compensate providers if they’re using certified records in a meaningful way.” Dr. David Blumenthal, Chair, National Coordinator for Health IT, Policy Committee Transcript, May 11, 2009.

Here’s what Practice Director is Doing

We are closely monitoring the source of the Electronic Health Record (“EHR”) certification standards, the decisions of the Health IT Policy & Standard Committees.

The Health Information Technology (“HIT”) Standards Committee is charged with making recommendations to the Office of National Coordinator (“ONC”) and Heath and Human Services (“HHS”) Secretary in order to establish EHR standards and certification. The inaugural Policy & Standards Committee meetings were held May 11, May 15, June 16, and June 23, 2009.

• We have developed and continue to enhance Practice Director’s EHR with open (non proprietary) technologies to ensure flexibility to meet and exceed privacy, security and electronic exchange of health information standards as they are established.
• We are confident Practice Director is already ahead of the curve for certification purposes to help you meet your requirement of ‘meaningful use’ of EHR technology by 2011.

“You know I believe that when we declare the standards, we shouldn’t set the bar so high, that we will leave all of rural America behind and we will leave the small doctor’s office without the ability to reach the bar, but nor should we accept the status quo.” John Halamka – Harvard Medical School – Chief Information Officer, Vice Chair, HIT Standards Committee Transcript, May 15, 2009.

Electronic Health Record Certification & Meaningful Use

• The process for the adoption of Electronic Health Record (EHRs) certification standards and ‘meaningful use’ standards will be accomplished through the recommendation of two ONC committees, the HIT Policy Committee and the HIT Standards Committee
• The HITECH legislation requires that not later than December 31, 2009, the Secretary shall, adopt an initial set of standards, implementation specifications, and certification criteria.

“So under the expedited process, HHS is required to publish an interim final rule with our initial set of standards implementation, specifications and certification criteria by December 31st of this year which if anybody, for folks who are aware of regulatory process, that’s really fast. Fortunately it is an interim final rule” Jodi Daniel – HIT – Director of Policy and Research ONC, May 15, 2009

American Recovery & Reinvestment Act (“ARRA”) Incentives for Meaningful use of
Certified EHR’s

ARRA Context

• The Health Information Technology for Economic & Clinical Health (“HITECH”) Act titles are a significant component of the ARRA. The titles affect Optometric Doctors who by definition are “covered professionals”.
• The Office of the National Coordinator (“ONC”) for Health Information Technology is tasked with administrating $19.2B of stimulus plan funding earmarked for the development and promotion of health information technology.
• The ONC is headed by the National Coordinator, Dr. David Blumenthal, who in turn reports to the Secretary of Health and Human Services Kathleen Sebelius, a member of President Obama’s cabinet.

The team at Practice Director is working diligently to stay abreast of the latest developments in this process to ensure your regulatory needs are met and exceeded through the use of Practice Director’s EHR. If you have any questions, please don’t hesitate to contact us.

Please contact Tammi Sufficool or Brad Rourke at 1-800-676-9076  or brouke@practicedirecotor.com  for information on our EHR Incentive Plan Savings and for more information regarding EHR Certification & Meaningful Use.

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