Category Archives: Healthcare

A senior doctor using a smartphone

Mobile charge capture: A simple change to your business practices with significant outcomes

By Michelle McCleerey, PhD, MA, MEd, MBA, RN  /  19 Jul 2016

While there are conflicting perspectives on the physician shortage, there is resolute agreement that the demand for primary and specialty care is growing due to the expanding older population. Concurrently, the challenges for physician practices, which are needed to provide that care, are also increasing. Older patients require 2–3 times the amount of specialty and primary care to treat and manage chronic conditions and age-related illnesses. Unfortunately, in today’s ever-changing healthcare environment, many practices are struggling to survive.

As has never been experienced previously, practices are facing daunting obstacles to care delivery due to rising operating costs, regulatory burdens and barriers to receiving pay/reimbursement. The cost to operate a practice has increased at twice the rate as the consumer index due to increasing rent, malpractice insurance, liability coverage, health insurance and personnel expenses. Mounting regulatory requirements have not only served to increase overhead, but have also consumed valuable patient care time with oppressive documentation and administrative requirements for HIPAA, Meaningful Use, prior authorization and quality mandates.

Now in the wake of the time-consuming and costly protracted transition to ICD-10 and EHR implementation, physicians are struggling to get paid. In part, this is due to the ACA which has introduced reimbursement cuts and increased penalties. Last year, the Centers for Medicare & Medicaid Services (CMS) began to apply the value-based payment modifier to adjust reimbursement amounts to reflect the quality and cost of care provided. Those practices not meeting performance standards will receive less reimbursement. In addition, this year, the penalty for non-participation in the Physician Quality Reporting System (PQRS) increased to a 2% reduction in the CMS market basket update. Further, the increased number of patients with insurance provided through state exchanges or the Federal marketplace has exacerbated the payment problem. These patients typically have very high deductibles, along with a 90-day window to pay premiums, posing more obstacles to the collection of co-pays and out-of-pocket expenses. Notoriously, it should be noted that the CMS also takes longer to reimburse physicians as compared to private payers. Moreover, the ICD-10 transition has resulted in increased claims denials, resulting in labor-intensive, time-consuming efforts to overturn the same.

Confronted with these challenges, paradoxically, many physicians have had to reduce the number of patients they see, further eroding financial return. However, for those struggling practices, indiscriminate cost slashing is not the answer as physicians must finely balance improved operational efficiency with the achievement of the aims of quality patient care. This is where innovative technology can play a key role. Smart investment needs to target technology that is able to:

  • Reduce operational expenses
  • Ease regulatory compliance and the documentation demand
  • Facilitate physician workflow
  • Increase patient care time
  • Generate more revenue

One such technology that meets the above criteria is mobile charge capture functionality within a secure messaging application. This would enable physicians to quickly and easily capture charges at the point of care and automatically and securely communicate this information to billing staff or a billing application.

To ensure there is no increased burden to physicians, this process must only take a couple “clicks” or a matter of seconds. For example, the application must have immediate accessible “favorite” codes composed of those services and diagnoses used most frequently and denoted by the terms most familiar to that particular practice, rather than formal codes and code definitions. Additionally, when needing to find a rarely used code not contained within favorites, the application should provide decision-support enabling the easy selection of the right ICD-10 code to be associated with the CPT code. Also, there should be code bundles available so multiple code combinations can be assigned to a patient in a single click.

This prompt and speedy process replaces the manual paper-and-pencil method in which physicians retrospectively attempt to make a note of the procedures performed —sometimes days or even weeks after the encounter. Consequently, quite often, not all services that were provided are recalled. These “notes” were then provided to the practice billing team who then must interpret the right procedure and identify the correct codes for billing purposes. Often because of the lack of detail within the notes, the specific details of the procedure are lost, reducing the amount of reimbursement received on top of the lost charges due to poor memory.

These issues could be virtually eliminated with smart mobile charge capture functionality. Additionally, this functionality enables the ability to easily add and document PQRS codes while facilitating patient rounding, with a customized patient list and direct access to previous charges, and with the ability to rapidly “clone” them for the day’s visit. This information would also be visible across the entire group of physicians, if desired.

By automating and expediting the charge capture process, there is a direct impact on the practice’s financial homeostasis:

  • The elimination of lost charges and improved coding specificity directly translates into higher revenue.
  • The coding decision support and the inability to mismatch CPT and ICD-10 codes mean reduced potential for costly and time-consuming audits and claims denials.
  • The easy documentation of PQRS avoids the 2% CMS penalty and facilitates compliance.
  • The immediate transmission of charges to billing staff speeds the time to billing, reducing the amount of time to payment received.
  • The number of FTEs required to support the coding and billing process can be dramatically reduced markedly decreasing operational expenses.

Most importantly, such technology can allow physicians to spend more time doing what they want to do and what we need them to do—caring for and treating patients.

Terry Hayes

Building an effective care team collaboration strategy: 4 focal points

By Terry Hayes, MSN, CPNP, CNOR  /  23 Jun 2016

Part 2 of a 3-part series in conjunction with our nurse leadership webinar series.

The need to unify physicians, nurses and other care team members through effective communication at the point of care is growing in significance. According to a 2015 Gartner report, 80 percent of providers report deploying fragmented communication technologies, which results in degraded care team communication and collaboration.

Collaboration is both a process and an outcome. It affects the patient experience, outcomes and care occurring across a variety of settings in an increasingly complex and mobile environment.

To resolve the fragmented and non-secure communication encountered in healthcare, true care team collaboration is dependent on consolidating disparate technologies into a single solution capable of directly addressing the communication obstacles degrading patient care today.

To some, this may sound like an unachievable goal, but with a strategic plan focused in areas that facilitate workflow processes and communication leading to improved patient care, it is attainable.

You may wonder, where do I even begin? Many organizations, in response to specific challenges, have deployed single-point technologies that provide only incremental gains. True communication and collaboration requires a comprehensive strategy, and to begin you must carefully evaluate your entire communication landscape. You’ll need to assess your current technologies, HIPAA compliance plan, near miss or sentinel event occurrences, nursing time to reach providers and consult notifications procedures – all of which will highlight your communication strengths and weaknesses.

Developing a comprehensive care team collaboration strategy spans four major areas of consideration. Failure to address any one of these areas may leave you with an incomplete solution. Each organization is unique, certainly, but departments and organizations must work together to create an environment ripe for collaboration.

  • Clinical – Mobile technologies are becoming more prevalent in healthcare settings, thus the need to leverage these technologies to facilitate secure communication amongst the care team is becoming increasingly important. A clinical communications solution should enable communication-driven workflows to facilitate timely care team communication. The solution should facilitate direct conversations among nurses and physicians via the preferred mode of contact – be it a mobile phone, pager, email or office land line. By triaging incoming calls and applying personalized algorithms for call placement, care team members reach the correct physician without searching through call schedules.
  • Operational – Once your plan is in place, bringing it to life warrants consideration and considerable forethought. A well-defined adoption strategy will be key to a successful implementation. Clinical champions help drive decisions and engage end users. Leadership engagement is often the most essential driver of adoption of any initiative, plan or policy. You should also consider and plan around timelines, specific tasks and resource requirements.
  • Technical – To achieve success, understanding and addressing technical infrastructure is a must. The strength of your Wi-Fi and cellular networks should be evaluated. Does your organization have a device strategy or do you have a BYOD policy? Do you desire integration with clinical systems and is the solution you are considering interoperable?
  • Financial – In any financial consideration, ultimate ROI and total cost of ownership are needed to justify approaches. When you close communication gaps across the extended care team to facilitate patient care collaboration, you can potentially improve referral revenue, decrease readmissions and avoid penalty costs. The ability to do mobile charge capture at the bedside, and to quickly and fully document exam and procedure details at the point of care will result in revenue recognition and improved cash flow for physicians.

There is no short list of considerations when it comes to building an effective care team collaboration strategy. However, if you focus on these four areas, gain support of leadership and identify a solution that hits these marks, you will be well on your way to effectively addressing your communication and collaboration needs.


Interested in learning more? Read part 1  and part 3 of this series on nurse leadership in care team collaboration.

Medical background with heart and icons Medicine

Nurses need innovative care team collaboration technology

By Michelle McCleerey, PhD, MA, MEd, MBA, RN  /  16 Jun 2016

Part 1 of a 3-part series in conjunction with our nurse leadership webinar series.

Six years ago, the National Academy of Medicine (NAM), formerly the Institute of Medicine (IOM), recommended that nurses lead inter-professional collaboration and healthcare delivery improvement and redesign. They noted that nurses are uniquely positioned to do this since, given the care setting, they are quite often the primary patient caregiver. As such, they serve as the virtual linchpin of care—connecting the various care providing professions while coordinating patient care across the entire care team. Toward that end, nurses are responsible for over 90% of physician communications while directing over 80% of their own communications to the broader care team.

While some inroads have been made in regard to this IOM recommendation, there are formidable challenges impeding significant progress. As the industry transitions to value-based-care, nurses are being held increasingly more accountable for patient outcomes and experience. Paradoxically, they are concurrently being asked to perform more indirect and non-patient-care tasks which reduce the amount of time at the patient bedside—one of the strongest predictors of positive patient outcomes and experience.

One such activity is care team communication.

Specifically, nurses have reported that difficulty communicating with the care team has decreased direct patient care time. One survey study found that 75% of nurse respondents reported wasting valuable care time just attempting to communicate with physicians and other care team members. In part, as 50% of the respondents acknowledged, this is because they are unaware of the right care team member to contact for the clinical situation at hand. The latter explains why the majority of physicians reported being frequently erroneously contacted when not the right physician for the situation.

These recalcitrant obstacles to care team communication and collaboration have served to delay patient care and prolong patient wait times. No one is more acutely aware of this than the nurse.

Nurses quite often find themselves waiting for physicians to return phone calls/pages while their patient needlessly suffers. As the nurse struggles to coordinate care, no one is more cognizant of the impact of missed care or delayed transitions on the patient and the patient’s family. Moreover, no one is more handicapped by the limits of fragmented communication technologies that have not successfully overcome these challenges because they only address a small component of the overall problem. And no one is in more need, than the nurse, for innovative technology that is able to immediately connect the right care team members to facilitate timely collaboration.

The good news is that this technology is now available. However, when evaluating the various care team collaboration platforms, it is important to avoid common pitfalls. Here are a few guiding principles to keep in mind:

  • While secure messaging is a salient feature of the platform, it is not wholly sufficient to address these communication obstacles since it is dependent upon two flawed assumptions.
    1. The recipient, such as the physician, must desire to be contacted at all times for all situations every day of the week.
    2. The sender, for example, the nurse, knows who to contact in every single situation.
  • All of the care team must be on the same platform. As the IOM noted, “True inter-professional collaboration can be accomplished only in concert with other health professionals, not within the nursing profession alone.” This holds true for any other profession.
  • Most importantly, the technology must be purposefully designed to overcome the known referenced obstacles. To do this, it must be able to automatically identify and provide immediate connection to the right care team member for that particular clinical situation. This type of complex logic requires that for every single communication by every care team member, the contextual variables of the particular message must be analyzed in real time to ensure the communication is routed to the correct individual.
  • The care team collaboration platform capabilities must transcend the walls of any one facility. Nurses, as well as physicians and other care team members, quite frequently need to contact team members who work in and across other facilities and locations. The platform must be able to support this communication and the intelligent routing capabilities must extend to provide immediate identification and connection to these care team members when needed.
  • Ultimately, the care team collaboration platform must have proven functionality to reduce communication cycle times. Reducing the time to connect and close the communication loop translates into care team efficiency and increased patient care time. As every nurse knows, this means speed to treatment, improved patient experience and improved patient outcomes.

Nurses are indeed perfectly positioned to lead inter-professional collaboration and healthcare delivery improvement. However, it is critical that they are provided with the technology that will allow them to overcome all the challenges this entails.

Let us not repeat the mistakes of the past—providing nurses with inadequate technology in response to which, they must find a work around—increasing their effort and workload in the endeavor. Quite sincerely, healthcare improvement and reform depends on it.


Interested in learning more? Read part 2  and part 3 of this series on nurse leadership in care team collaboration.

Julie-Mills

A nurse’s intuition: Filling the gaps technology can’t

By Julie Mills, RNC  /  05 May 2016

As prevalent and useful as technology is in healthcare today, there are still areas and issues technology can’t effectively enhance, solve or replace. Each patient is unique, and comes with his or her own set of symptoms, pain points and responses, which can’t always be deciphered by even the most state-of-the-art technology.

I’ve been a registered nurse with a specialty in perinatal care for 14 years, and I’ve learned that nurses in particular play an irreplaceable role in getting to the heart of clinical nuances that are ever present in healthcare. Since we’re often the caregivers who have the most connection with our patients from end-to-end, we bring unique insight in viewing the patient holistically – which makes our perspectives and instinctive judgments important as it relates to patient care, and difficult for any machine to replicate.

As critical thinkers with a deeply grounded knowledge in providing care, nurses have the ability to take the various aspects of care and form a conclusion that technology may not be able to see. For instance, there are advances in technology that play a large role in the accuracy of patient observation; however, the observations from patient interactions made by nurses can share an equal amount of valuable information. This kind of thing can’t always be replicated by predictive analytics, sensors, monitors, etc. While protocols may dictate how I administer a medication, every patient is uniquely different in his response. The science of executing a protocol is not enough. In the art of nursing, nurses must evaluate the dynamic response of the patient and make slight adjustments that lead to the desired outcome–this is not something that is taught in a textbook or that can be ordered in the EHR.

As another example, if a patient has lab work done and the report is flagged as critical, it may go through the steps of an established protocol whereby notifications are made the appropriate physicians, regardless of context. A nurse who is familiar with the patient’s full history in this case, however, would be able to review the report differently by evaluating the context and then sharing that information as needed. By looking at the big picture, it could be determined this response is normal due to the specific treatment or condition – a judgment that could save valuable time and resources.

When caring for patients, there will always be a place for a nurse’s judgment. That human interaction is extremely important. While some might call this instinct nurse’s intuition, it’s a skill that continues to be valuable in the midst of all the technology that is coming into play. Combining nurse’s intuition with innovative technology is essential to providing safe, efficient, cost-effective patient care. Nursing truly is a work of art.   

Terry Hayes

A patient’s advocate: Nurses and technology

By Terry Hayes  /  07 Apr 2016

It’s easy for patients to feel lost in our healthcare system. Between multiple doctors, nurses in and out of exam rooms, tests, re-tests, a handful of prescriptions—not to mention the complex web of how to actually pay for care—patients can feel like they’re caught in a convoluted situation, with rules they don’t understand.

Patients shouldn’t have to feel this way. They should feel empowered to ask questions, express preferences on treatments and costs, and request their caregivers take time to explain a procedure. Of all of the care team members, nurses play the biggest role in making sure patients have a strong voice to be their own advocates in our complicated healthcare system.

I became a nurse practitioner because my passion is caring for people and advocating for them. A nurse is often the caregiver who has the most connection with the patient from end-to-end, allowing them to observe a patient’s care holistically. In some ways, the move to value-based care is really a switch in mentality to the way a nurse approaches healthcare: it’s about prevention rather than treatment of illness.

However, as the delivery of care shifts, nurses are facing an increase in responsibilities and patients, threatening to erode the core responsibility of advocating for a patient. It may seem counterintuitive, but technology can actually help nurses be more efficient so that they can still provide that critical role as patient caregiver.

For example, many nurses spend a significant amount of time in their day coordinating care, leaving less room for patient advocacy. Nurses often have to notify a full care team, which could require up to a dozen calls to identify the right clinicians. Technology makes it possible for nurses to send just one call or text to notify a full care team. For example, perhaps there’s a patient who is having a stroke. Instead of spending a half hour to find the correct care team members, a nurse can use technology to send a smart alert to all medical staff overseeing that patient – the neurologist, the pharmacist, the EEG technician – and mobilize the care team instantly.

Technology, too, can help transmit information in real time, so less time is spent in the back-and-forth of communicating. For instance, when I volunteered as a pediatric nurse practitioner for a homeless shelter, I occasionally came across a condition that I wasn’t familiar with. Video technology helped me quickly transmit images directly to a physician so that we could collaborate right then and there on what I was actually looking at so that I could continue to advocate for patients.

Adopting and implementing new technologies can be both time and cost intensive, but healthcare executives should consider the benefits and ROI the technology provides, especially as it relates to patient care. Nurses, who often know their patients best, should advocate for the technology they need and then provide leadership with first-hand testimony as to how it contributes to positive patient outcomes and recovery.