January, 2009

In a day or so, I'm going to do an interesting followup on our examination of the impact of the economy on pediatric practices, so something related to tide you over

For reasons I can't explain, our clients have seen their median A/Rs drop significantly in the last quarter.  Note that if there is a negative effect on visit/charge volume as a result of the economy, then this figure should go up.  That it has gone down so much is very interesting.  Any takers on an explanation?  I'd love to see it's our remarkable pediatric practice management software - and perhaps that's part of it - but it has to be something more.  Any non-PCCers seeing the same thing?

In no particular order:

• Here is a great piece from Physicians’ Practice entitled “What Is Your Number?” and one physician’s view on becoming a “concierge” practice.  The message is one that more primary care docs should pay attention to!
• Was alerted of an interesting conference:

Neonatal & Pediatric Nutrition: Update 2009 July 20-22, 2009 San Francisco, CA This conference targets dietitians, physicians, nurses, nurse practitioners and pharmacists from neonatal and pediatric practice settings. Topic areas include the science underlying obesity, probiotics, nutrition for premature infants to maximize outcomes, food allergies, impact of maternal nutrition on the fetus/newborn, nutrition and the brain, and nutrition for the complex pediatric patient. Join nationally recognized experts and explore best strategies to meet the requirements of these special patients. For more information, contact Contemporary Forums at (800) 377-7707, info@cforums.com or online at www.contemporaryforums.com

• CMS has delayed ICD-10 to 2013, to my disappointment.
• If you didn’t know, our next Pediatric Coding and Practice Management seminar will be in just outside Orlando, FL (yes, Disney) in July.  Nothing in stone, yet, but I am hoping/planning for three full days of C&PM events!
• Don’t forget to start reading the blog on pedsource (we’re moving)!  For those of you who use RSS feeds, jump on here or here!

First, a reminder: this blog is moving. You can find the new launching pad over at pedsource.com/chipsblog, or you can subscribe to the RSS feed (Feedburner, direct).  Start looking there, because that’s where we’ll be shortly.

Meanwhile…the 99174.  Eye screening.  Associated with those fancy in-office money making machines.  I’ve had a handful of folks ask for details - how often do our clients use it?  How much do they get paid?

Much to our surprise, we found one client who used the 99174 in 2008.  And not often, either - just over 3 dozen times.  Average charge: $40, average payment: $9 and change.  Many $0 payments.  Given the sample, I almot wonder if the practice is mis-coding.

Anyone out there billing the 99174?!

I was going to write about the 99174 (tomorrow!), but Katy @ PCC wrote this great piece and I thought I’d share it. It’s a message we sent to our clients (aren’t we sweet?).

The Red Flags Rule and Your Practice Recently, we’ve been hearing some questions about the Federal Trade Commission’s privacy and security requirements, called the “Red Flags Rule,” and how it may affect your practice. We have put together a summary of information about these new requirements with links to more information to help your practice learn about the issue and make informed decisions. What is the Red Flags Rule? Last year the Federal Trade Commission (FTC) introduced new privacy and security requirements for banks and creditors called the Red Flags Rule. The requirements are designed to help prevent identity theft. The Red Flags Rule states that financial institutions and creditors must develop and implement written identity theft prevention programs, as part of the Fair and Accurate Credit Transactions (FACT) Act of 2003. When will enforcement begin? The Red Flags Rule was first announced in January of 2008, and required that programs be in place by November 2008. A six month delay has been enacted, with the compliance date now set to May 1, 2009. Financial institutions and creditors are required to have these programs established and they must provide for the identification, detection, and response to patterns, practices, or specific activities- known as “red flags”-that could indicate identity theft. Who must comply with the Red Flags Rule? The Red Flags Rule pertains to financial institutions and creditors with “covered accounts.” The term creditor under the rules is defined as “any entity that regularly extends, renews, or continues credit; any entity that regularly arranges for the extension, renewal, or continuation of credit; or any assignee of an original creditor who is involved in the decision to extend, renew, or continue credit.” The FTC has said that accepting credit cards as a form of payment does not in and of itself make an entity a creditor, but where an entity defers payment for goods or services, they are then considered to be creditors. A “covered account” is defined by the FTC is an account used mostly for personal, family, or household purposes, and that involves multiple payments or transactions. Covered accounts include credit card accounts, mortgage loans, automobile loans, margin accounts, cell phone accounts, utility accounts, checking accounts, and savings accounts. A covered account is also an account for which there is a foreseeable risk of identity theft - for example, small business or sole proprietorship accounts. So, are physicians considered “creditors”? There have been a number of conflicting points of view as to whether or not a medical office is considered a creditor. The MGMA has joined the AAP and other medical organizations in responding to the FTC about this rule, saying that it does not seem appropriate to consider a medical office a “creditor.” To our knowledge, the FTC has not yet responded to the MGMA’s position on this issue. What we’re seeing right now is articles appearing in various journals which are speculating as to what might happen. What action, if any, should pediatricians take? We encourage you to learn about the Red Flags Rule and make an informed decision for your practice. We have heard of several instances where customers are being approached by vendors selling services to address these rules. In some cases, the sales tactics are high-pressure and the solutions costly. We want pediatricians to be aware, before rushing out to purchase potentially costly services, that there is an active dispute as to whether the rule even applies to medical offices. PCC agrees with the AAP and MGMA that it does not seem appropriate to consider a medical office a “creditor” and thus the Red Flags Rule should not apply to medical offices. We also agree that protecting against identity theft is very important. PCC has been in contact with health care lawyers and has read the Red Flags Rule, MGMA response, and other industry articles about this topic. We believe identity theft concerns may be addressed by your existing HIPAA policies, which are designed to prevent the theft, sale, or distribution, of protected health care information. The information covered by the Red Flag Rules is a subset of the protected healthcare information. However, this may be a good opportunity to review your office’s policies to make sure you are in compliance with all aspects of HIPAA–Privacy, Security, Transactions and Code Sets, and National Provider Identifier Standards. PCC can help you achieve compliance with our collection of sample policies and forms. You can also refer to our selection of helpful HIPAA resources to learn more about the standard requirements. Web Resources: http://www.ftc.gov/opa/2007/10/redflag.shtm http://www.ftc.gov/bcp/edu/pubs/business/alerts/alt050.shtm http://www.mgma.com/policy/default.aspx?id=22230

I forgot to mention last week that I updated the Build Your Own RVU calculator for 2009.  You can find it and the instructions in the PedSource library.

To make a long story short, for those who don’t know it - I really don’t like the fact that do do any proper RVU analysis of your practice, you have to pay for expensive software.  Especially for software owned by organizations who have admitted to ripping off the very people they claim to serve.  So, I designed a free tool that, using the license for which you are granted permission to access CPT codes (thanks, greedy AMA), you can do the calculation work you need.

Share and enjoy.  Flash-based pediatric coding tool coming soon, I hope.

I am, again, in the back of the room at our Coding and Practice management event and listening to Dr. Tuck. I have to steal a line or two from him, he’s got some good ones. Dr. Lander is next.

I’ve noticed some real changes in the audiences I speak to over the last few years. Today, when I ask, “Who uses RVUs to set prices?” most of the hands go up. Even 2-3 years ago, almost none went up. I like that.

Oh, I did get to make the first official announcement of our Disney C&PM event!  Woohoo!

While Dr. Lander now explains how to collect money, let me share a few things we learned recently. Igor and I have been working on our “clinical benchmark” for PCC clients. Essentially, we’ve defined a series of pediatric specific measurements that even non-PCC clients can generate to get some sense of their clinical effectiveness. To do this, we started by making some assumptions and then ran the data. Then, we reviewed the results to confirm or deny our suspicions. We turned up some interesting results:

• There is a strong negative correlation between the percentage of Medicaid patients in a practice and how many of their asthmatics are caught up with their flu shots.  [Note, this is, in part, due to those patients getting their shots elsewhere.]
• There is also a strong negative correlation between Medicaid presence and patients being up to date for their physicals.
• There is no correlation, however, between Medicaid and the Sick:Well visit ratio among our clients.  I found that fascinating.  It flies in the face of the “Medicaid clinic” stereotype, and it also shows that our clients are preventive care focused across the board.

Andrew Cuomo, you are my new friend.

It’s also nice to feel vindicated.  Lynn Cramer, pay attention - this relates to your questions to me about St. Anthony’s RVU values.  For anyone who is using St. Anthony’s or Ingenix to set prices, etc., pay attention here!

Ingenix, owned by United, settled with the state of NY and will be overhauling its data-gathering effort. I wrote about how my experience with their data made me feel like they were cheating.  And now we know they were.

Here’s a highlight from the article below:

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

You can read the entire thing at the NYTimes here, I’ll excerpt the first part of the article below (I recommend reading the entire thing, it’s quick).

In a settlement with one of the nation’s biggest insurers, New York’s attorney general, Andrew M. Cuomo, has ordered an overhaul of the databases the industry uses to determine how much of a medical bill is paid when a patient uses an out-of-network doctor.

A statement from Mr. Cuomo’s office said the industry had engaged in “a scheme to defraud consumers” by systematically underpaying the nation’s patients by hundreds of millions of dollars over the last decade.

The move, to be announced Tuesday, is part of a settlement with the insurance giant UnitedHealth Group, which operates the industry databases. It results from a yearlong investigation by Mr. Cuomo’s office that concluded the data had understated the true market rates of medical care by up to 28 percent.

The settlement will have a nationwide impact because UnitedHealth, the biggest health insurer in New York, operates the databases used by the entire industry, through its Ingenix business unit. The deal calls for creation of a new independent database, to be run by a university that is still to be selected…(keep going)

Finally, don’t forget: we are moving to pedsource.com/chipsblog!

This is the kind of news that is too much at the cross section of the things that interest me that I can't pass up sharing it.  Now, if only I can get Iron Maiden to do a flu shot PSA, I'll be set.

Onto business: I understand that the AAP has been gathering data about the pot-pourri of immunization purchasing organizations across the country, but I haven't seen any of the results, yet (ironically, the AAFP has public reviews of the GPOs). I get a lot of calls from folks looking for advice about the different groups and, worse, I keep meeting practices who use no purchasing group at all!

So, over the next few weeks, I am going to run some quick free promotion for the handful of groups I know.  I can't recommend one over the others, as they each have strengths.  Some have national vision, some are quite local.  Some have education and practice management issues as part of their mission, others don't.  I am simply going to highlight each of these folks and encourage practices to get in touch with each of them to see which one "clicks" for you.

First up, Main Street Vaccines.  MSV is run by Dr. Allen Menken, one of PCC's long-time customers in NJ.  He may not remember, but I first met him in 1991 or 1992 when he gave me a big lecture about why capitation was such a good idea (his concepts were right on; capitation as practiced by the insurance companies is another matter).  I asked him to give me a little personal background and description of Main Street Vaccines, here it is:

I built Main Street Vaccines to be a highly centralized business operation with a very pragmatic goal....to try and save money for practicing docs by getting group prices and terms on vaccines.

 

Almost everything goes through my hands (I have someone doing payables, a bonded accountant drafts and sends out rebate checks and audits the books.)  I am putting a part time field person on in January to service some of our accounts a little more intensely.  There is no political agenda, no spin.

 

Almost all my communication is by internet.  Newsletters such as you receive go out about quarterly or whenever something important happens.  As you know, I just put us on Google (which incidentally has done amazingly little to date.)

 

I can only estimate the number of doctors we have, because we only register practices.  There are over 1800 practices, some of them are solo, many of them are groups, some in 20-100 doctor range.  Best gestimate is about 5000 doctors.  We are heavy in NY, NJ, PA with spread into Mass, Maine, and the Southeast.  We have a handfull of practices in very distant places and I am not really sure how we got them.

 

Our contracts are exclusively with Sanofi Pasteur and Merck. Members are encouraged to be on both contracts, but they can pick either/and/or.  I am not delusional enough to think we can make policy for companies that size, but we have developed enough of a business relationship that I can at least get their ear and sometimes there minds and checkbooks. I have entertained other companies at times, but they can't match the product line, prices, terms, service. 

 

We have a discount credit card processing service;  a general office supply contract is in the works but will not be signed before Feb. 09. The main things that I think set us apart are a commitmentment to near instantaneous response and responsibility (someone is getting our prices within two busines days of the time they contact me), a lot of personal contact, a boots on the ground perspective (Plaza lives and dies by these contracts) and a great track record.  I have a strongly held fiduciary responsibility to our members and never forget it.   We have met or exeeded our annual rebate for six consecutive years.  We work on a voluntary compliance basis.  I have to remove less than 1% of our members for non-compliance annually  and our member retention rate...outside of the practices I remove is over 99%, so we must be doing something right.

 

Thats about it.  Just doing the best I can to get us big without getting us fat. Thanks for the help,

 

Allen

This was a good summary and I appreciate Dr. Menkin letting me use him as a test subject.  After I write up the 4 or 5 other folks I know well, I'll place all of their contact info together.

To find out more details, contact Main Street Vacs here:

MAIN STREET VACCINES
15 SAUNDERS LANE
HACKETTSTOWN, NJ  07840
Phone: (908) 581-3931
FAX: (908) 979-4916
drmenkin@mainstreetvacs.com

OK, pardon us as we switch mics.

Took a little hiatus, there, as we work on major improvements to thesite.  To make a long story short, we will shortly be moving thisentire shindig over to pedsource.com/chipsblog.  Part of our effort to distinguish more clearly between what PCC does and our consulting.

If you use any RSS, blog-watch, etc., tools to follow this blog, please point them pedsource.com/chipsblog now!

Thanks!

As a result of not posting, I have a HUGE backlog to get through.  Iwill attempt to amend that now as I prepare for our AAP-endorsed coding an practice management event in Dallas later this week.  Speaking of, mark your calendars for July 22-24 or so.  Think Orlando, FL (is there anything to do there…?) and a two-day pediatric event.

I’ll have another entry out shortly.

I've taken the last week or so off and, technically, I am still off asI sit at home in the kitchen to help keep the new puppy company. I havesome long overdue content to get out, but I'll toss up these gems fornow.

First, here's a great linkon NPR featuring Dr. Lander! The media is starting to pick up on theissue of vaccine costs. I love how the insurance spokewoman blames itall on the government. I want to get ahold of the study mentioned inthis month's Pediatrics, but you can see our attempt to measure the impact of vaccine overhead here on this magic blog. It's substantial.

Before I leave you today, here's a list of the top 10 posts, based onhit volume, from the blog in 2008. The "readership" has nearly tripled(I can get a few hundred a day, now) and I am very grateful for eachand every one of you. Especially those who send me great information.So...thank you!

• After-Hours Codes And Other Scheduling-Based Codes (99050, 99051, 99053, 99058)
• Effect of 2009 RVU Changes on Pediatrics
• AAP NCE Boston and Mythbusters
• More Practical CCHIT Information
• CCHIT and OSS
• 2009 RBRVS Update And Impact On Pediatricians
• The Recession and Pediatrics
• ICD-9 Update, ICD-10 Update (+Interesting Times At School)
• Tricare and Immunizations
• Pediatric Compensation Models