Posts tagged with pediatric

I was on the phone yesterday with a client from Rhode Island who was taking the time to tell me about his practice's search for an EHR. To my surprise, they had flown down to visit another customer of ours in Tennessee to see what they thought of an installation with one of our EHR partners. They gave him some interesting advice: take your time. Even though the TN practice is happy and up-and-running with the EHR, they realized that it has taken them a year or more to figure out what, exactly, they want and expect from it. And that has cost them time and money. [Note: the EHR company in question has served them well; this is a classic practice management issue.]

Which makes me feel that I know what I'm talking about sometimes.

You see, a few weeks ago, I was honored to give a presentation at the VT AAP fall meeting. My discussion was entitled "Choosing a Pediatric Electronic Health Record". Perhaps it was "Preparing for..." In fact, I think I can use Wordpress to post the presentation. In any event, the fundamental point from the entire presentation is:

The single biggest and most common mistake practices make when choosing an EHR is to learn what they need after they purchase the system.

Look at that!

Now, many of you read this blog have heard me speak, but there are plenty of you who haven't. Although common sense and not false modesty tells me that I'm far from the world's greatest speaker, I think I'm often better in person than I am in writing. My brain seems to enjoy the challenge of making things up on-the-fly, which means I sometimes end up saying things in a presentation that I would have never thought to communicate in writing. So, there, in the middle of my talk, I blurted out:

Purchasing an EHR before organizing your practice and knowing exactly what to expect is like having kids to save a marriage. Sometimes it works, but it usually doesn't. And it's always more expensive.

Now, maybe that doesn't ring as true in the middle of a blog as it did 45 minutes into a lecture about the subject, but I saw the lightbulbs turn on in the eyes all around the room, so I thought I'd record that analogy before I forget it. And extend it poorly with some comment about birth control.

So, if you're shopping for an EHR - take your time and prepare. Want some suggestions? Just ask.

All the RVU drama makes it hard for me to get to other things, but here is the latest from my generous and favorite inside source (instead of using an inappropriate 70s adult film nickname, we'll use "Siouxsie"):

1) The new CF for 1/1/08 through 6/30/08 will be $38.0870 [= 0.5% increase from the current CF of $37.8975; what happens after that point is anyone's guess] 2) The work GPCI floor (1.000) will be maintained through 6/30/08 [again, what happens after that point is unknown] 3) The bill did NOT include provisions to "alter or supplant the role" of the RUC

Attached with this cogent explanation was a memo straight from Michael Maves, the E-VP and CEO of the AMA. Now, let's all be tense for six months. Ready? Go! [I can actually update the RVU calculators, now.] Wow, Siouxsie kicks butt and sends me this important AMA Memo about the changes 2 minutes after I post this.

Today's missive has no practice management value.  It is pediatric related, though.

I travel a fair amount for work (how else would most of you know me?).  Which means I spend times in planes, airports, and hotel rooms.  As a result, in addition to my predisposition, I read a lot.

Most of the time, I try to read something of substance.  That is, I try to avoid the schlock...but sometimes, in between flights, you reach for the best seller lists and see what happens.  [Plus, I will admit, some of the schlock is a good break.]

I was coming back from El Paso two weeks ago and I picked up "Tell No One" by Harlan Coben.  It's not one of his Bolitar series, but a one-off about a widower who is suddenly struck with information that his wife may actually be alive.  Typical page-turning, made-for-movie material.  But not bad.  Turns out that it is a well-received French movie, now, too.

The interesting part, however, is that the protagonist is a pediatrician!  He practices at a clinic in "upper Manhattan."  Don't know if he's a pediatrician in the movie, but I have obviously read the "pediatric" moments of the book closely.  You won't be disappointed!

First one to ask me for my copy gets it.

Save the date: April 17.

It's not official yet - we're confirming a location - but we hope and expect to produce a pediatric coding and practice management seminar in the greater Washington DC area on or around April 17.  It will be nearly identical to the one we produced in NYC in August.  We hope to get AAP endorsement again and, if everything works out, we may even be able to acquire an educational grant from a generous source that might lower or eliminate the cost for AAP members!

That last item is a bit of a dream still, but it's not off the table.

Anyway, I thought I'd let everyone here be the first to know.  As soon as it's official - speakers, location, date, and content - I'll post it all here.

I've got a final RVU trick or two coming, a response to the new Physician's Practice fee schedule article, and more.  I need to get this one out of my queue, though.

Back in July, I wrote about using Opensource (or otherwise free) software in a small business office.  Given the low margin in pediatric offices, I have no idea why people continue to purchase products like Microsoft Office when less expensive, more compatible, better suited alternatives are available.  I think it's just a matter of spreading the word.

One thing I just saw - OK, it was a few weeks ago - an article in slashdot about OpenOffice being available "online" - that is, you don't have to download or install it, you just run it from your browser.

Quite cool.

To spell it out: a small practice could simply connect to this site here and have all the office software that most practices would ever, ever use...for free!

Try it.  It's not like it costs anything.

I am feeling a little like the Winooski River, when it freezes over and then dams up, causing the water to overflow the banks and wreak havoc locally.

Need proof that this is the best pediatric practice management resource on the planet? Check it out.

Oh, first: major drama at PCC's office last night. Let's hope this post is the closest I come to being a war correspondent. I don't like the proximity of the event to yesterday's message about flooding.

Meanwhile...Igor and I were doing some work on our [secret project, still] and were looking at E&M distribution among pediatricians. Here's a trick question - should 9921X codes that result from an initial well visit be counted as part of your distribution? Most people say yes - but I'm not convinced. Sick codes discovered during well visits should, by their nature, have a different distribution. It's not as if, for example, Mom waits until next week for her scheduled physical to talk about that seizure or red, sore throat (ok, some wacky ones do, but you get the point). 99214s and 99215s come to the office as a rule. I believe that -25 modified codes will have a different distribution. I'll post the results later.

What we did look at, though, is how many pediatricians actually use the -25 modifiers in the first place and how often they do. Here it is, data you can't get anywhere else:

What this shows is that 2% of our clients put -25 modifiers on 40% (or more) of their E&M codes. 12% put it on 20% or more. Get it?

What the chart doesn't show is that 22% of PCC's clients never use a -25 modifier.
That's crazy. Especially when you consider the fact that we have good customers. So, how about you? How many of your E&Ms have -25 modifiers?

I hope to have time to post a good RVU calculation message this afternoon but, before I do, I wanted to share an excerpt from a PedTalk message this AM.  It comes from Dr. Lessin, with whom I often enjoy disagreeing particularly because we often actually share similar viewpoints.

I think the message below captures a growing vision of pediatrics-to-come, the dismay at the direction of the practice of medicine.  It's like [censored]ens' Christmas Story: this is the Ghost of Pediatrics Future.  Everyone whines about the "good ol' days" in just about any context ("When I was in school..." or "In 1956, the New York Yankees..." or "They call that music?"), but I really think we are heading towards a nadir of satisfaction in this profession unless there are some significant changes.
Anyway, here it is.

Unfortunately, with the emphasis on consumer driven health care, we are  becoming even more focused on what people want as opposed to what they  need.  Hospitals design their systems to appeal to the customer.  That is  good, except when it impedes the doctor's work flow and ability to provide  good care.  Patients come in demanding things that they have read about on the internet.  Sometimes, they are right.  Often they are wrong.  But since we are now a volume dependent business, we are terrified that they will go to someone who will give them what they want.  It is coming down to the fact that we might prescribe that useless antibiotic because the guy down  the street will do it and the patient will flame us on the net if we do not., and complain to the insurer about what an awful doctor we are.  It is a sad state of affairs.  I never thought that this profession would devolve  to the decision between paper or plastic.

Herschel Lessin MD

I don't agree with him 100%, but boy that's an excellent summary of the corner into which pediatricians have painted themselves.  Sure, it's easy to pick on the position he takes here (I think of that awesome scene from Malice with Alec Baldwin), but that would miss the point.

Whew.  They are up.  Want to know what the RVU values for the top 30 codes in pediatrics will be in 2008? Want to check any code?  I finished the Build-Your-Own RVU Calculator for 2008 and the Online Pediatric RVU Calculator for 2008.  Please check my work.

Physician's Practice magazine has released, both in print and on-line, the results from their annual Fee Schedule survey. On one hand, I continue to applaud PP's effort. On the other hand, their data continues to diverge from ours considerably. In effect, the fortunes of PCC customers continue to rise while those of PP contributors continue to fall. Is it sample size? Are our clients simply doing that much better than the rest of the world? Does PP measure things different (and somewhat oddly)? I suspect it's a combination of all of the above.

Let's see how the numbers compare. There's so much here that I'll have to split it into a few blog entries, I suspect. Let's start with the big piece, the drop in E&M reimbursement. From the article:

Sorry, but the news is no better today. In fact, it’s disturbingly similar: Another sizeable drop in E&M visit reimbursement.

Here is a quick snapshot of their E&M details:

If you want a closer view, you can find their PDF here.

I took the time and made a similar chart for our clients over the last four years. Check it out. It took me a long time to figure out how to lay this out, so applause is welcome :-)

You'll note that we have a distinctly different pattern of behavior over the last four years. While Physician's Practice magazine reports a distinct negative trend in E&M reimbursement, PCC clients are improving.

In the next day or so, I'm going to zoom in specifically on pediatrics and their results. Anyone here seeing different results?