As we’ve begun our Lean education to Delaware organizations of all shapes and sizes, we’re often asked “how do you get an organization excited and motivated to change?” Other than old fashioned leadership that is required for any change, in many organizations they need a crisis to rally and focus the organization. Are you nearing a crisis yet? Well we think it goes without saying that no one could craft a crisis of the magnitude we’re currently in to motivate change. Our fear is that we’ll let this current crisis go to waste (in all industries and government) without capitalizing upon it. You don’t have to be a futurist to know that other crisis’ in healthcare are on the horizon (rising costs on one side of the equation with rising demand on the other) which loomed even before this current financial mess presented itself. Those issues haven’t gone away.

Lean (Healthcare) focuses on the elimination of Waste to improve customer or patient value (cost, quality, safety, satisfaction), and it puts the value in people. Many Lean practitioners even consider “under-utilized talent” as a form of Waste within itself. In this financial environment we find the perfect time to invest in our people more than ever, and to do more with the same amount of equipment and facilities given the lack of capital. This is what made Toyota, Toyota. They are currently the best equipped to weather this drastic downturn that is effecting the entire auto industry, and the system they developed over many years initially came about as a matter of necessity after WWII with little to no resources. They had no choice but to eliminate Waste and they are much better off today as a result.

In many instances there isn’t a choice of whether or not to change. Yes we know, it isn’t easy to make Lean a way of life, but the alternative is to struggle not only now but for many years to come. Utilize Lean principles and tools to accelerate solving the problems that committees are spending countless hours on that are not producing results right now (Lean is about making change now). Capitalize upon your staff’s ability to solve problems via Lean Healthcare principles, removing waste from your processes, and striving for the IDEAL. In our opinion, those organizations that do will kill the competition as this financial climate improves. This is a capital investment that is proven to provide a positive return in the long term.

For More Information Contact:

Jim Jones DEMEP (302) 283-3135

jjones@demep.org

Sharon Ruth Willis of DE/MSDIS (302) 397-0173

sruth@zutzgroup.com

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I recently read a good article in a magazine that talked about managed care contracts. Hey wait! Come back! This can help you….!!

There is no better time than now to re-evaluate your insurance contracts. So many physicians/physicians offices feel they simply have no bargaining power. Others may just feel that the task of negotiating is too time-consuming and tedious. The article I read is titled “Develop a Game Plan for Managed-Care Contracts” (St. Louis Metropolitan Magazine), and it’s very helpful information. Here’s some tips I gathered:

Negotiating does not mean you will win or not win, rather everyone feeling mutual about your agreement. Always be willing to compromise-and also be willing to say “goodbye”.

Here are some things to consider when you are negotiating your contract:

Do you perform a unique procedure in your specialty?

Are you the only specialist in your area?

Do you have a short patient waiting time?

Do you have an outstanding quality that other practices don’t?

It’s recommended to make a list of all the insurance companies that you contract with. List the plan names, effective dates, contact names and phone numbers, the contract review date, and what they reimburse. Getting this on paper in front of you gives you a birds-eye view of how your insurance company reimbursements compare to one another. Who is at the low-end of the pole? Start with them. Is your cost more than what you are being paid?

The bottom line is: Don’t settle. And remember that negotiation is compromise with both sides feeling they won. Identify what is most important to your practice and be willing to compromise on less important areas of the contract.

So what work’s for you? What are your recommendations on successfully negotiating contracts? We’d love to hear from you….

Any how, I thought that the appointment of former South Dakota Senator,Tom Daschle, by President Elect Barack Obama as Health and Human Services Secretary and especially as Health Reform Czar deserved a mention here.

This certainly is not the first presidential attempt to address issues in America’s healthcare system, however some feel that the effort could not be more timely. Needless to say, there is a lot of stake for many in Delaware’s healthcare community. Not only do we face unknown changes in the quality of healthcare receive as consumers, we face potential momentous changes in our careers. What new responsibilities and requirements an restrictions are to come?

Daschle’s recent book, Critical: What Can We Do for the Health-Care Crisis?, may provide some insight on things to come.  Some feel that he favors a single-payer approach as used in many other industrialized nations. This, according to many critics, is paramount to practicing socialized medicine.  This certainly can open up major flood gates of debate, and perhaps it is time to get the discussion started.  Is real reform coming? Is it best to throw out what we have and start over, or is there some middle-ground that works?  Please register and post your thoughts!

Select hospitals and chain pharmacies will provide uploads of records and patients can research info on their conditions and physicians. There are a few other tools to track medications and users control the exchange of information with healthcare providers.

On some levels this may seem a bit shocking. Putting your own medical records on the internet seems a little risky at first. However, considering that Google is not just any internet company, one would think that the developers did their homework before rolling this out. Obviously, if you choose to use the service, you’ll need a password more robust than your pet’s name. That being said, I know attorneys who have been uploading very sensitive legal docs to GoogleDocs for a few years.

Is this something that will gain wide acceptance? Will this create a whole new class of medically-aware patients? Who knows?

Please post your thoughts….

======Undercoding-Should You Be Afraid?

I had come across a physician who consistently was undercoding so as not to initiate a Medicare audit. He had heard many horror stories about audits and did not want to be a part of it. If I undercode, he thought, I’m getting paid and staying under the radar. I’ll just have to see a bit more patients to make up for the lost income. Actually, his undercoding could be deemed Medicare fraud.
Many physicians are in this category and often downcode E & M claims to avoid claim rejections and increased inspection from payors. Based on Medicare compliance regulations, undercoding can result in an audit just the same as overcoding. However, I have yet to hear of a case in which CMS has come back to audit and reimburse for undercoding.
Undercoding also destroys any proper reporting of services that the physician has actually performed. This physician may have been at a low level, when in fact, their data for services performed should show a nice bell shaped curve. Since CMS uses claims data to revise annual reimbursement rates, undercoding can seriously influence and lower payments.
Proper coding and billing is necessary to insure maximized revenues and increased profits. Many providers do not have the proper knowledge of the coding system and also do not have the proper billing processes in place. The coding is often left to the office staff who have very little training in coding guidelines. Many times the staff will miss procedures based on the fact that they are not the ones actually providing the service and the physician does not properly communicate what they did.
The key phrase that should be kept in mind is: “Code what you document and document what you code.” If a physician has documentation of a certain level of service and codes to that level, he/she should never be afraid that he is undercoding or overcoding. When a physician provides a service, he/she is entitled to the proper compensation as set by the insurance payors. I have seen some practices coding at a higher level and CMS comes back to them saying that they their billing patterns are outside the averages of their peers. These practices have seen an audit or two and have passed them with flying colors. They happen to code at a high level because they deal with patients in critical care and of a high complexity.
It is a big help when you have a certified coder, who has gone through Medicare auditing education, look at sample notes to see if they support the level of service billed. The precision of the coding and billing can also be increased by utilizing an outside billing company.

Myths of E and M coding
1 – All E and M visits are billed based on time (5 minutes for a level II, 15 minutes for a level III,etc)
2 – Nurses notes cannot be attached to the physicians’as part of the service
3- A program will tell me what to code
4 – If my office staff incorrectly codes something it is not my fault as a provider
5 – Procedures and E & M visits cannot be billed together on the same day

If you have any coding or billing questions, or need consulting or billing advice, please feel free to call me at 302 239-4743.

Rohan D’Souza, BS, CPC-CARDIO, GASTRO, PAYOR, E/M, is the Vice President of D’Souza & Associates, a healthcare management company based in Hockessin, Delaware. He has successfully gone through Medicare Audit education and classes for the last 5 years. He is a certified coder and has passed the hospital payor exam, specializing in Cardiology, Pulmonary, and Gastroenterology billing.

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I’m starting my third year of DMGMA membership and look forward to contributing to this important group in a new and exciting way. My goal for this blog is to make it a place to share ideas and educational content to benefit members of Delaware’s medical community, as well as to provide an introduction of DMGMA to prospective members.

I welcome your comments and suggestions to make this blog useful and relevant. Please don’t be surprised to hear from me in the near future seeking educational content to post. Thanks in advance for your help!

The answer is simple. Increase our membership!  Some members have had great success with several initiations to increase membership, and DMGMA’s visibility in the healthcare community. At the June half-day meeting, a drawing was held, and two prizes were awarded to members who helped the recruitment efforts. There is never a bad time to help us grow the membership at DMGMA!  And membership growth helps us add fresh ideas and new programs.

If you know someone in the health care industry who is not a member of the DMGMA, talk to them about the benefits and what you have gained by being a member.  If they are interested in taking the next step, please forward their contact info to the DMGMA.  People in our “prospect” list will receive periodic postcards and email newsletters updating them on what’s happening at DMGMA, and encouraging them to join us.

Thanks for making this a wonderful organization!