Diabetes Practice Options, March 2011

OPTIONSDIABETES PRACTICE

™

Improving Patient Care Through Increased Practice Efficiency

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MARCH 2011

EDITORIAL

3 | DIABETES STRATEGYCollaborative Care Improves Outcomes inDiabetes Patients With Comorbid Illnesses

6 | CAPITAL IDEASHow to Build a Solid Financial Foundation as a New Physician

8 | CODING UPDATEStart Preparing Now for Implementationof ICD-10 Codes, Says AAPC Vice President

11 | REIMBURSEMENTHow to Increase Collections While Preserving Patient Relationships

13 | MEDICAL HOMESNCQA’s New PCMH StandardsCall for Increased Patient-Centeredness

14 | PRACTICE MANAGEMENT NEWSAMGA Employee Satisfaction Database Exceeds10,000 Health Care Employees

In the near future, all health care providers can look forward to some type of newpayment arrangement for their services. CMS is slated to begin establishing account-able care organizations (ACOs) for Medicare patients in 2012. CMS anticipates that

coordination and cooperation among providers will improve quality of care and reduceunnecessary costs.According to CMS, “for each 12-month period, participating ACOs that meet specified

quality performance standards will be eligible to receive a share of any savings if the actu-al per capita expenditures of their assigned Medicare beneficiaries are a sufficient per-centage below their specified benchmark amount.” The benchmark for each ACO will bebased on the most recent available three years of expenditures forMedicare Parts A and Bservices for each beneficiary.Assignment to an ACOwill be invisible toMedicare enrollees, and won’t affect their ben-

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CONTRIBUTORS

Rhonda BuckholtzCPC, CPMA, CPC-I

R. Paul Wilson, CRPC

Payment Reform Will Soon Affect All ProvidersBy Michael Bihari, MD, contributing editor

Page 3

IN THIS ISSUE

Neil Baum, MDUrologistNew Orleans

Daniel BeckhamPresidentThe Beckham Co.Physician and Hospital ConsultantsWhitefish Bay,Wis.

Harold B. Kaiser, MDAllergy & Asthma Specialists, PAMinneapolis

Nathan KaufmanPresidentThe Kaufman GroupDivision of SuperiorConsultant Co. Inc.Physician and Hospital ConsultantsSan Diego

Peter R. Kongstvedt, MDP.R. Kongstvedt, LLCMcLean, Va.

JohnW. McDanielPresident and CEOPeak Performance Physicians, LLCNew Orleans

Lee Newcomer, MD, MHASenior Vice President, OncologyUnitedHealthcareMinneapolis

James M. Schibanoff, MDEditor in chiefMilliman Care GuidelinesMilliman USASan Diego

Jacque Sokolov, MDChairmanSokolov, Sokolov, BurgessScottsdale, Ariz.

This newsletter is publishedbyPremierHealthcare Resource, Inc.,Morristown,N.J.

©Copyright strictly reserved.This newslettermaynotbe reproduced inwhole or inpartwithout thewrittenpermissionof PremierHealthcare Resource, Inc.The advice andopinions in this publication arenot necessarily thoseof the editor, advisory board, publishingstaff, or the viewsof PremierHealthcare Resource, Inc., but instead are exclusively theopinions of the authors. Readers are urged toseek individual counsel andadvice for their uniqueexperiences.

EditorRev DiCerto845/[email protected]

Art DirectorMeridith Feldman

PublisherPremier Healthcare Resource, Inc.150Washington St.Morristown, NJ 07960973/682-9003; Fax: 973/[email protected]

EDITORIAL

EDITIORIAL BOARD

efits or choice of providers. Patients maychoose their own health care providers,whether or not the provider belongs to yourACO. The organization remains responsiblefor the costs and quality of service. Mostimportantly, all providers in a system mustagree on common goals and communicateeffectively. Without effective health informa-tion technology, ACOs likely won’t be able toconform to cost and quality regulations.

UnitedHealthcare, the nation’s largesthealth plan, is piloting a new cancer-care pay-ment model that attempts to separate oncol-ogists’ income from drug sales. Participatingphysicians are reimbursed upfront for apatient’s entire cycle of treatment.Massachusetts is debating the next step to

improve care quality while reducing costs. Itsprivate health insurance arena has beenexperimenting with global payments for pri-mary care services. With eight hospitals andphysician groups, the state’s Blue Cross BlueShield plan (BCBSMA) is using an “alterna-tive quality contract” that pays a set monthlyfee per patient, adjusted for health status.After one year, BCBSMA reports that allgroups improved care and came in underbudget. At least twice as many patients in theglobal payment plan than in traditional planshad regular checkups, cancer screenings, andcontrolled diabetes or heart disease.Only time will tell if these methods will

work outside pilot projects. But you shouldbe ready for changes in how you are paid.�

STAFF

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2 Practice Options/March 2011

More information is available atwww.DiabetesOptions.net

Michael Bihari, MD

Approximately 70% of peoplewith diabetes have three ormore comorbidities, according

to the Centers forMedicare &MedicaidServices (CMS). The two most com-mon diabetes comorbidities are heartdisease and depression. Yet whenpatients present with a combination ofpoorly controlled diabetes, heart dis-ease, and depression, many physiciansand health care systems treat each dis-ease as a single, discrete condition. Anew study from the University ofWashington and the Group HealthResearch Institute in Seattle suggests abetter strategy formanaging this clusterof diseases: a collaborative, evidence-based, team approach that yields betteroutcomes than single-condition caremanagement.“Disease-specific care programs for

diabetes, heart disease, and depressioncanwork, especially when they involve ateam approach that is integrated intoprimary care,” saysWayneKaton,MD, aprofessor at the University ofWashington and director of the univer-sity’s Division of Health Services andPsychiatric Epidemiology, who workedwith Elizabeth Lin, MD, Michael VonKorff, MD, and other colleagues at theGroup Health Research Institute to

develop and test the collaborative careintervention. “The problem is thatmanypatients present withmultiple comorbidconditions. One approach to improvingoutcomes in primary care patients is tolook at natural clusters of illnesses,which can be defined as illnesses thatcommonly present together, that havenegative outcomes when they exist con-currently, and that are very expensive tomanage. Diabetes, heart disease, anddepression constitute a prime exampleof a cluster of co-occurring illnesses.”

Treating Multiple DiseasesTreatment of each disease singly is oftensuboptimal because physicians may notbe considering the interaction amongdisease states and the total picture of thepatient’s health and functionality. “Up to20% of people with diabetes and heartdisease have comorbid depression,which is associatedwith poor adherenceto the self-care requirements — likesmoking cessation, dietary restrictions,physical exercise, and adherence tomedication regimens — that couldpotentially improve diabetes and heartdisease outcomes,” says Katon.“Depression is also associated with ahigher medical symptom burden,greater functional impairment, and sig-

nificantly higher medical costs. In gen-eral, when patients have both a medicaldisease and depression, they are espe-cially apt to have poorer outcomes. Forinstance, over a five-year period,patients with both diabetes and depres-sion have amortality rate that is approx-imately 50% higher, and a risk of micro-andmacrovascular complications that isapproximately 25% to 35% higher, thanpatients with diabetes alone.”True care coordination is relatively

rare in medical practice today, contin-ues Katon, because of certain inherentchallenges. “The first obstacle is how topay for a team approach,” he states, not-ing that insurance systems in theUnited States have not yet developedmethods for reimbursing many teamapproach services. “Certain nurse caremanager activities, such as telephonecalls to patients and proactively track-ing outcomes, are not reimbursable.”Furthermore, physicians are rarelyreimbursed for time spent supervisingnurse care managers, even thoughusing care managers is a cost effectiveapproach to care. “In our study, onephysician could spend only one or twohours per week supervising a nursepractitioner who provided care toabout 50 patients,” Katon says.A second challenge is that patients

with diabetes and multiple comorbidi-ties are typically seeing several special-ists,making true care coordinationdiffi-cult. “Primary care doctors simply donot have the time to coordinate or dis-cuss a patient’s care with multiple spe-cialists in ameaningful way,” Katon says.He adds that the medical home modelcurrently being developed and testedacross the country intends to reimbursedoctors for coordinating services, butthis model is still in its nascent stages.

Collaborative InterventionThe collaborative care interventiondeveloped by the University ofWashington and tested at GroupHealthis “a really useful way of approachingsome of the most complex and costlypatients in primary care practice,” saysKaton. Patients who have diabetes or

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Practice Options/March 2011 3

DIABETES STRATEGY

Collaborative Care Improves Outcomes inDiabetes Patients With Comorbid Illnesses

DIABETES STRATEGY

heart disease (as evidenced by hemo-globin A1C of at least 8.5%, systolicblood pressure greater than 140 mmHg, or a low-density lipoprotein [LDL]cholesterol greater than 130 mg/dL)and who screen positive for depressionare eligible for the intervention. Everytwo or three weeks, patientsmeet with aregistered nurse with diabetes educa-tion experience who serves as a caremanager. Sessions focus on depressionmanagement, medical illness control,and patient self-care activi-ties. The nurse also helps thepatient identify goals toimprove self-care arounddietary improvements,physical activity, regularblood glucose and bloodpressure monitoring, andmedication adherence. Nurses ensurethat patients’ glucometers are workingand that they know how to use them;patients with high blood pressurereceive self-monitoring blood pressurecuffs to use at home.The nurse evaluates the patient’s

medical indicators and depressionscore using the Patient HealthQuestionnaire (PHQ-9) depressiontool on an ongoing basis. Once apatient achieves targeted levels for theindicators, the nurse and patient devel-op a maintenance plan involvingbehavioral goals and identification ofsymptoms that indicate worsening dis-ease control. During the maintenance

phase, the nurse telephones the patientevery four weeks to follow up, answerquestions, and offer encouragement.Nurses are supervised by a primary

care physician and a psychiatrist, whoreview cases and patient progressweekly. These physicians may recom-mend medication adjustments such asnew medications or dose escalation toimprove disease and depression con-trol.When patients have trouble adher-ing to a complicated medication regi-

men, the nurse and the supervisingphysicians will discuss how the regi-men could be simplified. The nursesthen recommend suggested medica-tion changes to the patient’s primarycare doctor.

Better OutcomesKaton and his colleagues tested theintervention in a randomized, con-trolled trial involving 214 patients from14 Group Health clinics. Patients wererandomized to receive either usual pri-mary care or collaborative care.Patients in the intervention groupexperienced a greater improvement intheir hemoglobin A1C levels. These

patients evidenced a decline in hemo-globin A1C levels from 8.14% at base-line to 7.33% at 12 months, comparedwith a decline from 8.04% to 7.81% inthe control group, representing a statis-tically significant improvement of0.58%. LDL cholesterol declined from106.8 to 91.9 mg/dL in the interventiongroup, compared with a decline from109.4 to 101.4 mg/dL in the controlgroup. Systolic blood pressure declinedfrom 135.7 mmHg to 131.0 mmHg in

the intervention group,but increased from 131.9mm Hg to 132.3 mm Hgin the control group. Intotal, 37% of interventionpatients achieved all threemedical measures belowguideline recommenda-

tions or showed clinically significantchange at 12 months, compared withonly 22% of the usual care group.Patients in the intervention group

were also more likely to receive at leastone adjustment in their insulin or anti-hypertensive or antidepressantmedica-tion. They reported better quality of lifeand higher satisfaction with their care.At 12 months, 90% of interventionpatients reported satisfactionwith theirdepression care and 86% reported sat-isfaction with the care of their diabetesor heart disease, compared with 55%and 70% of the usual care group,respectively.“We speculate that the intervention



The main implications for clinical quality generally, and fordiabetes care quality specifically, to a collaborative caremodel for treating diabetes along with comorbid illnesses

developed by Wayne Katon, MD, the director of the University ofWashington’s Division of Health Services and PsychiatricEpidemiology, and colleagues are that this kind of team modelfor patients with complex illnesses is more effective than usualcare by an individual physician working alone.

“These are often the most complex and costly patients in

primary care,” Katon notes. “In the Group Health system, a typi-cal middle-aged patient costs the system about $1,500 per year.Patients with depression cost about $3,000 a year, and patientswith diabetes cost about $6,000 a year. But patients with bothdiabetes and depression cost about $10,000 a year. Clearly,these patients are costly to our system, but a team approach tocollaborative care has the potential to improve outcomes and,therefore, costs.”

—DJN

TEAM CARE MODEL LOWERS COSTS INPATIENTS WITH DIABETES, COMORBID ILLNESSES

The collaborative care approach wasrelatively easily incorporated into

existing practice patterns.


Wayne Katon, MD, a professor at the University ofWashington and director of the university’s Division ofHealth Services and Psychiatric Epidemiology, and his

colleagues are currently involved in disseminating the collabora-tive care model for treating diabetes with comorbid illnesses toseveral organized systems of care, including groups of primarycare practices in Alberta, Canada, and Minneapolis, Minn.Although the approach developed at the Group Health ResearchInstitute is most easily implemented by organized health care sys-tems, community physicians can try to develop this type of careapproach, or at least mimic some of its elements.

“A growing number of doctors are forming primary care col-laboratives, often to achieve economies of scale in business func-tions such as billing,” Katon notes. “These groups could share theinfrastructure for a team approach in offering care to their mostcostly patients. For example, the three nurses we hired andtrained work across 14 clinics. Certainly, nurse care managerscould spread their services across multiple groups in community

practice, although it will take some creativity to figure out how tooptimally spread staff resources across multiple care sites.”

Before the model can be disseminated widely, Katon notes thatinsurance systems will have to incentivize this kind of care.“Certain elements of the collaborative care approach are alreadyreimbursable,” he explains. “For example, patient care providedby diabetes nurses is reimbursable. However, physician supervi-sion of nurses is typically not reimbursable, despite the fact thatit is very cost effective.” Katon is heartened by the fact that someinsurers are agreeing to reimburse for this supervision time. “InMinnesota, eight insurers are working collaboratively to improvethe quality of chronic illness care. In adopting a model to improvedepression care [the DIAMOND program], they have agreed toreimburse for nurses’ time with patients as well as for the timephysicians spend supervising the nurses.” Katon believes thesetypes of reimbursement experiments will increase as the Centersfor Medicare & Medicaid Services continue to seek new models ofcare for patients with chronic illnesses. —DJN

COLLABORATIVE CARE MODEL EASILY ADOPTED,BUT REQUIRES INSURANCE INCENTIVES

worked for two main reasons,” saysKaton. “First, patients increased theirself-monitoring of glucose levels andblood pressure, which promptedchanges in self-care behaviors.” Second,Katon highlights the fact that the col-laborative care teamoften recommend-ed evidence-based medication intensi-fication to patients’ primary care doc-tors, which prompted better medicaland depression outcomes. He notesthat a study of 150,000 Kaiser MedicalGroup diabetes patients found thatabout 20% of poorly controlled caseswere due to lack of adherence to med-ication and other self-care recommen-dations, and about 40% were due tolack of intensification of treatment bythe primary care physician despite thepatient being in poor control.“Patients often do not want to

change medications,” Katon explains.“For example, not all patients agree toswitch to insulin from an oral medica-tion. In this context, a team approachcan be effective because we are able tobetter support and educate patients anduse techniques like motivational inter-

viewing to encourage self-care. Overall,this extra attention and support com-bined with specific recommendationsabout medication intensificationproved to be very powerful.”

Ease of AdoptionKaton notes that the collaborative careapproach was relatively easily incorpo-rated into existing practice patterns.“The approach took some getting usedto, but in general it was readily adopt-ed,” he says, adding that physicians rec-ognized that team care might yield bet-ter care, and that the team was lookingfor help with these complex patients.“Primary care physicians will often saythat the patients with bothmedical andpsychiatric diagnoses are the mostchallenging to treat, and that they facechallenges getting patients referred togood mental health care,” he notes.“Our data from Group Health haveshown that patients with depressionand comorbid medical illness comeinto the office about twice as often asother patients. Their primary carephysician had often felt frustrated that

these patients weren’t managing theircare sufficiently, or that their medica-tion adherence was poor. Of the GroupHealth physicians we approached, 92%agreed to be part of the study.Furthermore, very few doctors refusedto accept a recommendation aboutintensification of medications.”The collaborative care approach can

have other positive business implica-tions for physicians as well. “For exam-ple, in our study, the interventionpatients treated were more satisfied,which has implications for practice loy-alty and a stable patient base,” he says.“Satisfied patients are more likely tosign up with the same health insuranceprogram, and higher patient satisfac-tion scores can mean bonuses forphysicians. Furthermore, across thecountry, a growing number of healthplans are tracking clinical outcomes aspart of pay-for-performance or reportcard initiatives. Therefore, physiciansare finding that their clinical outcomeshave real financial implications.”�—Reported and written by Deborah J.Neveleff, in North Potomac, Md.


CAPITAL IDEAS

How to Build a Solid Financial Foundation as a New PhysicianBy R. PaulWilson, CRPC, and Michael Lewellen, CFP

W hen speaking to youngphysicians across thecountry, financial advisers

are often asked, “What is the mostimportant thing I should be doingfinancially in the first years of prac-tice?” The answer is simple. Youngphysicians need to build a solid foun-dation. However, the concept of afinancial foundation can mean some-thing different for each physician. Justas doctors do with patients, financialadvisers often see common symptomsin their clients’ financial lives repeated-ly. It is therefore possible to make somegeneralizations about what is involvedin creating a financial foundation formany young doctors.

The Biggest AssetFoundation building for any youngphysician will depend on where theyare in their personal life: are they singleor married, do they have children, andother such considerations. The build-ing of a financial foundation needs tobegin before the physician even leavestraining, because establishing the righthabits is an important first step.Most young physicians will see a sig-

nificant increase in their incomes whenthey begin practice. Up to thispoint, they have typically beenliving paycheck to paycheck,and a jump in income by five-fold or more can be euphoric.With a “spend now, plan later”attitude, many young physi-cians will indulge a bit andmake large purchases. Theyoften take this indulgence too far, andfind themselves once again living pay-check to paycheck. In response to thissituation, their attitude then oftenbecomes, “Once I make partner, I’lladdress my financial plan.”The most important factor in build-

ing a foundation is to protect what theyoung physician has already builtbefore tackling the endeavor of build-ing wealth. Many young doctors withlittle savings, and often with large stu-dent loan debts, wonder what they havebuilt. The debt they have accumulatedin their education leaves them feelingas though they have no assets. But they

have actually built a significant assetthat needs protecting: the value of theirfuture income.How to protect this asset depends on

who the physician is protecting it for.Are they protecting it for just them-selves or for others dependent on

them? In either case, the physicianneeds to protect his or her ability toearn this income in the future. For thisreason disability income insurance iscritical, and is the number one tool thatyoung doctors need to implement.

Protecting Future IncomeDisability income insurance is straight-

forward. The insurancewill pay the physician ifhe or she becomes dis-abled. For young physi-cians, and typically doc-tors into their 50s, thistype of protection is crit-ical because they havenot yet accumulated asufficient amount of sav-

ings to support themselves and theirfamilies if they should no longer be ableto work as a doctor.Physicians considering purchasing

individual disability income insuranceneed to determine what their true needis, not how much money they can get.

Permanent (cash value) life insuranceis often selected even by young

physicians as a wealth accumulationand protection vehicle.

R. Paul Wilson, CRPC, is regional manager of private client services forO’Dell Jarvis Mandell LLC, whereMichael Lewellen, CFP, serves as direc-tor of financial planning. They welcome your questions at 877-656-4362 orthrough their Web site, www.ojmgroup.com.


If your expenses are $3,000 per month,but an insurance salesman says you cancollect $5,000 per month, you are over-insuring yourself. While having morecoverage than is needed is not alwayswrong, it is more important to controlexpenses in order to build the properfoundation.Physicians should also make sure

they’re purchasing adequate coverage.The definition of “disability” should beoccupation-specific, so that a physiciancannot be forced to go back to work inanother field. A residualor partial disability rideris another importantpart of the contract.With such a rider, if thephysician suffers a par-tial disability, he or shecan still work part-timein their occupation.Typically for such a riderto be brought into effectthere must be an incomeloss of 20% or more.Also, in the event of a long-term dis-ability, it is important to have a cost ofliving rider to protect against inflation.Young doctors should also beware of

what is available through their employ-er. A hospital will usually providegroup disability income insurance at noor minimum cost to the physician. Theproblem with group insurance is that itis covering a large number of profes-sionals in a variety of occupations. Thiscan lead to coverage that is not occupa-tion-specific, has short benefit periods,does not have a partial or inflation pro-tection rider, and can be cancelled at

any time. While not all employer-pro-vided disability insurance has suchshortcomings, generally group insur-ance is not adequate for a young physi-cian.Often, there are discounts in place

that are connected to the hospital thatallow a young physician to purchaseindividual disability income insuranceat a discount, or with unisex rates. Theunisex rate option is the most ideal andprovides the best benefits for femalephysicians.

Protecting DependentsYoung doctors with financial depen-dents such as children or spouses, butsometimes other family members aswell, need to focus on protecting thevalue of their future income not onlyagainst disability, but also againstdeath. For this reason, life insurance isthe number-two tool typically recom-mended by financial advisers.As with disability income insurance,

the physician must first determinewhat death benefits he or she needs tomake sure they are being cost efficient.

The way to determine a physician’sfinancial needs is to decide whatexpenses would need to be covered fol-lowing his or her death. A physicianshould take into account such expensesas mortgage, children’s education, carloans and other debts, and support forhis or her spouse.Term life insurance is usually the

best option for young physicians con-sidering purchasing life insurance.Term insurance is inexpensive and pro-vides a death benefit for a period of

time (10, 20, or 30 years).This does not mean terminsurance is the only or thebest type of insuranceavailable, but it is generallybest for a young physicianwho has specific needs.Permanent life insurance

can be a tax-efficient sav-ing vehicle that providestax-free growth and tax-free distributions, if struc-tured properly, and can

provide excellent asset protectiondepending on the state in which thephysician lives. For these reasons, per-manent (cash value) life insurance isoften selected even by young physi-cians as a wealth accumulation andprotection vehicle.At the outset of their medical career,

physicians are told, “First, do no harm.”Advisers to young physicians who areat the outset of their financial careersgive similar advice: “First, build yourfoundation.” Disability insurance andlife insurance are two key first steps inthat process.�

Given the significant investment required to become a prac-ticing physician, it should not be surprising that the valueof new physicians’ future income is also significant. A new

orthopedic surgeon, for example, might be offered a startingsalary of $300,000, including benefits. Assuming this physician

plans on practicing for 30 years and 3.5% inflation annually, thepresent value of this annual income is $5,517,613, even if thatphysician never makes more than $300,000 per year. An assetthis valuable is worth protecting.

—RPW, ML

NEW PHYSICIANS SHOULD CONSIDER FUTURE INCOME AS AN ASSET

Up to this point, [young physicians]have typically been living paycheck topaycheck, and a jump in income by

five-fold or more can be euphoric.With a“spend now, plan later” attitude, manyyoung physicians will indulge a bit and

make large purchases.

Effective October 1, 2013, theInternational Classification ofDiseases-9 (ICD-9) code sets cur-

rently being used by medical codersand billers to report health care diag-noses and procedures will be replacedwith ICD-10 codes. While the ICD-9system containsmore than 17,000 indi-vidual codes, ICD-10, between theICD-10-CM (Clinical Modification)and ICD-10-PCS (Procedural CodingSystem, for use with inpatient proce-dures) sets, the number of codes willexpand to more than 140,000. ICD-10-CM, which is most relevant to mostprivate physician practices and prima-ry care physicians, will comprise morethan 69,000 of these codes. Coding willrequire a greater degree of specificityand detail under ICD-10, demandingimproved note-taking by physiciansand staff, and greatly altering the waythat medical practices record patientencounters and interact with providersand insurers.

Broad ChangesBecause the changes that go into effectin 2013 will be so broad, organizationssuch as the American Academy ofProfessional Coders (AAPC) and theCenters for Medicaid & MedicareServices (CMS) recommend that allhealth care professionals who will beaffected by them begin preparingimmediately in order to make the tran-sition. Fortunately, there are a numberof good resources available to helpcoders and other professionals. “Wewant to make sure everybody knowsthat this is a large change and take itstrategically and step-by-step,” saysRhonda Buckholtz, CPC, CPMA,CPC-I, vice president of Business andMember Development for AAPC.“That way they’ll be able to adequately

implement ICD-10 with much less costand headache.”The transition to ICD-10 will affect

every function performed in a medicalpractice, Buckholtz says. “Themanagerwill be affected tremendously,” she says.“Any policy or procedure in the prac-tice that is currently tied to a diagnosticcode or a disease management process,or to Physician Quality ReportingSystem (PQRS) or payer quality reportsor any other initiatives, will have to bechanged. Managers will need to under-stand how to get paid under ICD-10,and will have to renegotiate vendorcontracts accordingly. Practices willhave to put somemoney away, not onlyso the practice will be able to make thenecessary changes for the transition,but also to have reserves to tap in casesomething happens and the practiceisn’t getting paid for a period of time.Plus, everybody in the practice willneed some type of training, the frontdesk through the entire staff.”Clinically, ICD-10 will cause exten-

sive changes to patients’ coverage,Buckholtz says. “Every single healthplan, local or national coverage deter-mination, or any other payer policieswill be revised,” she says. “That meanshow practices operate internally willhave to change. How practices pre-cer-tify patients or do prior authorizationscould possibly change to fit ICD-10’smedical necessity requirements. Rightnow we know health plans are chang-ing policies and writing them in thebackground of ICD-10. Plus, ICD-10coding needs to be budget-neutral.Even though there will be 69,000 diag-nosis codes, not all of them will bepayable.”Practices will have to revise their

super bills, or eliminate paper superbills altogether, Buckholtz says, since

the increased number of diagnosticcodes will make it impossible to listevery code on the bill. “Now you’ll haveto add some sort of reporting featurewhere they can spell out a patient’sdiagnosis,” she says. “We’re going tohave to use our words.“In the physician’s office, it’s going to

become necessary to use real worldnotes,” she continues. “Probably 40% to45% of the time, physicians won’t beable to assign an ICD-10 code based onthe clinician’s current documentationprocess. The level of specificity willchange a lot. Physicians will need to beable to document laterality or stages offeeling, weeks of pregnancy, stages ofthe episodes of care. Laterality seemslike a no-brainer for physicians, butonce they leave the surgical suite orexam room and are in their offices,they tend to be much more lax on theirdocumentation. Sometimes they forgetto document whether something hap-pens on the right side or the left side.”

Learning in StagesBuckholtz stresses the importance ofmedical professionals involved in any


CODING UPDATE

Start Preparing Now for Implementation ofICD-10 Codes, Says AAPC Vice President

Rhonda BuckholtzCPC, CPMA, CPC-I


aspect of coding beginning to preparefor ICD-10 implementation immedi-ately, because the changes are so broadand sweeping. However, she does notadvise learning any actual codes at thistime. “It’s too soon for coders to startlearning the new code sets becausewe’re currently in an unstable learningenvironment,” she says.“The codes are all in draftformat. Just between2009 and 2010 there wereseveral thousandchanges. Everything isgoing to change. Codersneed to wait for a stablelearning environment.Besides, if they learn thecodes now, since theywon’t be using them, they’ll neverretain them.”

New ResourcesCMS has recently announced a freezeto the code sets, Buckholtz says. “Thatmeans when the book comes out forOctober 1, 2011, which will be the 2012codes, the codes will be frozen,” shesays. “They will be completely frozenuntil 2014, only updating for urgent sit-uations, giving the coders a stablelearning environment.”

AAPC has created a number of toolsand other resources to help coders andother professionals get up to speed onICD-10, Buckholtz says. Much of thisinformation is available through theAAPC Web site (www.aapc.com). “Wehave all sorts of information, includingthree free webinars for providers that

go over the 16 steps for implementa-tion,” she says. “There are also two freewebinars for payers.”The webinars are approved for con-

tinuing medical education (CME)credit. “This is a physician licensingyear,” Buckholtz says. “Physicians canget their last-minute CME credits whilegetting ready for ICD-10 implementa-tion.”The CME webinars are available

now, Buckholtz says. “We don’t advisethat anyone take code training early,

but we’ve opened the door a crack forthose people who feel they just have tobe trained in the code sets once the sta-ble learning environment is there,” shesays.A benchmark tracker on the site

walks the user through the 16 steps ofimplementation. The interactive fea-

ture has a “stoplight”feature that indicates bya red, yellow, or greenlight whether a practiceor professional is up-to-date on a given step inthe implementationprocess. There are alsodistance learning pro-grams for health plans.Another useful tool

on the AAPC site is an online transla-tor. Coders can enter an ICD-9 codeinto the translator and will see whatthat codemight become under ICD-10.“It’s an attempt to crosswalk from ICD-9 to ICD-10, and it can go backwardsfrom ICD-10 to ICD-9 as well,”Buckholtz says. “If coders run a prac-tice management report now of theirmost frequently used ICD-9 codes,they can see what the code selectionwill look like in ICD-10. Keep in mindthat these files can’t code. The forward

ICD-10 IMPLEMENTATION WILL BE DEMANDING ON BILLING STAFF

In implementing the new International Classification ofDisease-10 (ICD-10) codes in October of 2013, every part of amedical practice will be affected, says Rhonda Buckholtz, CPC,

CPMA, CPC-I, the American Academy of Professional Coders(AAPC) vice president of Business and Member Development. Thechanges will be drastic in practices’ billing offices in particular,she says.

“All the payers’ policies and procedures will have to be revisedto fit ICD-10’s new medical necessity requirements and billingrequirements,” Buckholtz says. “For every category of code, thereis an unspecified code that coders can pick. I warn all physiciansthat ICD-10 has to be budget-neutral. A lot of payers are indi-cating that they need to refine their policies so they’re not pay-ing for more under ICD-10 than they did under ICD-9.

“The first thing to go will be those unspecified codes,” shecontinues. “If a physician can’t document or tell the differencebetween left side and right side, unless it’s an urgent or emergentsituation, the payers won’t pay for it.

“Billers will have to be trained on the new policies and proce-dures and the ICD-10 code sets,” Buckholtz says. “With the newlevel of specificity that will be required, if you have a coder who’snot strong in anatomy and terminology, now is the time to pre-pare them for the transition and beef up that part of their edu-cation. It’s too soon now to learn the code sets, but they canbegin to make sure they have a strong foundation. That level ofspecificity is going to mean a greater requirement for coders tohave a good understanding of anatomy and the terminologybehind it.” —RD

Continued on page 10

“For this transition to work, it will requireus reaching outside our practices and

working side-by-side with others that we’renot normally used to working with,” says

Rhonda Buckholtz, CPC, CPMA, of AAPC.

mapping from I-9 to I-10 will take youto the unspecified code selectionalmost every time. It couldgive you five possible codes,or it could give you 200. Wecaution providers from try-ing to use it as an actual wayto assist them in-depth withcoding, because it can’t dothat. But it’s a good tool tohelp you see what code setsyou may be using frequent-ly.”

Caution NeededBuckholtz is quick to stressthat ICD-10 will require ahigher level of diligence from all mem-bers of a practice. “Nurses will have towatch their documentation to makesure they help the physicians meet thehigher level of specificity,” she says.“Changes to prior authorization or pre-certification are going to require addi-tional training as well.”The ordering of lab tests is an area

that Buckholtz sees as a potential prob-lem for physicians and lab techniciansalike. “One of the problems that lab andradiology both have right now is thatphysicians don’t given them enoughinformation in ICD-9 for them to ordertests and make sure they’re paid for,”she says. “I see that still being a hugeproblem in ICD-10 because they’llneed a higher level of specificity or

more documentation. There will haveto be a lot of collaboration between the

labs and the physician offices to makethe transition work. It’s going to slow alot of work down.”Effective transition will require

health care professionals across theboard to work together, Buckholtz says.

“In order for this transition to work, itwill require us reaching outside our

practices and working side-by-side with others thatwe’re not normally used toworking with,” she says.“Otherwise the physicianwill be completely bom-bardedwith phone calls andrequests for additional doc-umentation.”However, Buckholtz

points out, with theresources available throughAAPC and CMS, alongwith other sources, there isample time for all health

care professionals to get up to speed onICD-10. With enough preparation, thedifficult transition can be made man-ageable.�—Reported by Joseph Burns. Written byEditor Rev DiCerto

CODING UPDATE


Though the transition from International Classification ofDiseases-9 (ICD-9) codes to ICD-10 codes will not takeplace until October of 2013, the broad and sweeping nature

of the changes will require a great deal of preparation on thepart of all medical professionals who are likely to be affected. TheAmerican Academy of Professional Coders (AAPC;www.aapc.com) offers the following online resources to helpcoders, payers, and other professionals prepare:• Introduction webinars• Code set training• ICD-10 connect

• ICD-10 overview, naming conventions, links, news and articles,discussion, and books

• Provider training timeline• Benchmark tracker• ICD-10 code translator (ICD-9 to ICD-10)• On-site, boot camp, and distance learning training for providers

and health plansAdditional information on the transition from ICD-9 to ICD-10

coding can be accessed through the Web site of the Centers forMedicaid & Medicare Services (CMS), www.cms.gov.

—RD

ONLINE RESOURCES FOR ICD-10 IMPLEMENTATION


“Managers will need to understandhow to get paid under ICD-10, and

will have to renegotiate vendorcontracts accordingly. Plus, everybodyin the practice will need some type oftraining, the front desk through the

entire staff.”—Rhonda Buckholtz, CPC, CPMA, of AAPC


In recent years, depressing descrip-tors of our economy such as layoffs,wage freezes, foreclosures, and

depreciating investments have becomecommonplace in our language andcontinue to damage the consumer psy-che. Many patients are worried abouthaving enough money from one day tothe next to pay for basics like food andmortgages. As a result, any obligationsthat can be are being pushed aside withgrowing frequency. That includespatients’ health care debts.

In this volatile environment, medicalpractice staff members who collectmoney at the beginning and end of ser-vice have their work cut out for them.Securing patient-pay receivables is get-ting more difficult by the day.With bad debt currently at around 7%to 10% and expected to increase, suc-cessful collection of these receivableshas never been more important to amedical practice’s bottom line than it isright now. For many practices, thosepatient-pay dollars could mean the dif-ference between bottom-line profit andloss.Given the importance of managing

receivables, many practice managersneed to ask themselves why they con-tinue to rely on marginally effectivecollection strategies to recoup whattheir practices are owed. Whether apractice is using internal resources oroutsourcing, does it have methods inplace that might result in resentment,passive aggression, avoidance, and neg-ative patient relations? Is the office staffbanging its head against a wall usingtechniques that fail to motivate pay-ment? There are strategies available topractice managers that can help themachieve their practices’ ultimate objec-tives of collecting a significant percent-age of outstanding revenue, preservingpositive relationships with patients,and casting the practice in the best pos-sible light.

Changing AttitudesPatients don’t pay outstanding debts fortwo reasons: they either believe thatthey can’t pay them or that they don’towe them. However, research fromKeyBridge Medical RevenueManagement shows that 98% ofpatients with outstanding obligationsbelieve that they owe the money.Nearly 40% of patients with obligationsbelieve they can pay them. That meansthat nearly 60% believe they can’t.

While the office staff can’t changethis situation, the collection team canhelp patients change the way they viewthe situation, which can greatly reducetheir resistance to satisfying their debt.Several patient-friendly steps can helpa practice’s staff to accomplish thisobjective.Good patient relations are crucial to

effective collections. Developing a sys-tem where patient rapport is quicklyestablished at the point of service willmake it easier to collect deductibles andco-pays. For both in-person and phonecollection efforts, use a script with care-fully chosen language that won’t invokea “fight-or-flight” reaction in thepatient. For example, when a patient atthe point of service says, “Just send mea bill,” don’t allow staff to simply say,“Okay” and fail to collect the co-pay.Instead, have your staff respond, “Iknow you’d rather have us send you abill. Everyone would. But I also knowyou probably hate getting stacks of billsin the mail. Wouldn’t you like to avoidthat and take care of this now?”Remember that while nearly all

patients accept and acknowledge thatthey owe the debt and many are ableand willing to pay, many are afraid thatthey can’t. Build a response throughlanguage that promotes empathy,builds rapport and trust, and motivatespatients to pay.Finally, educate the patients. Make

sure they understand their paymentoptions, and work with them toward asuccessful resolution.

Enlisting StaffA crucial component of any bad debtreduction program is the buy-in of apractice’s patient-pay receivables teamand other organization members whohandle point-of-service interactionwith incoming patients. To get officestaff to buy into such a program, thepractice manager must clearly commu-

REIMBURSEMENT

How to Increase Collections While Preserving Patient RelationshipsBy David G.Morrisey, director of development, KeyBridge Medical Revenue Management

David Morrisey, KeyBridgeMedical Revenue Management’s(www.keybridgemed.com) directorof development, has over 30 yearsof experience in health care andmanagement training. He teachesseminars and courses around thecountry on effective communica-tion skills and the keys to motiva-tion. He is a member of theMedical Group ManagementAssociation, the HealthcareFinancial Management Assoc-iation, the Orthopedic ManagersAssociation, the Michigan PatientAccounting Association, and theMichigan Association of Health-care Access Professionals.

nicate and demonstrate that the prac-tice will:• Make self-pay a priority;• Improve front-end training to removeany discomfort among staff in askingfor payment;• Set collection goals and rewardachievement;• Enhance screening of patients for eli-gibility in government programs; and• Improve financial counseling servicesby expanding payment opportunities,providing discounts for patients whopay promptly, setting policies thatsupport upfront payment for electiveservices, and making back-end col-lections a priority.Only when everyone

understands the impor-tance of both point-of-ser-vice collection and follow-up collection will notice-able improvement be seenin a practice’s accountsreceivables.

Outsourcing ExpertiseImplementing an effective, compre-hensive point-of-service collection sys-tem is a big job. It’s critical to develop aprocess that is tailored to the needs ofthe practice, gets the necessary staff

buy-in, and pre-serves patient rela-tionships. Each prac-tice’s managershould consideridentifying a sea-soned accountsreceivable manage-ment partner with aproven track recordof establishing andmanaging point-of-service training and collection as wellas follow-up collection to review thepractice’s collection procedures.Where no one on a practice’s staff is

trained to provide such services, theycan be provided by outside firms thatspecialize in accounts collectable. Suchfirms can provide a practice’s point-of-service and collections teams with thetraining and tools necessary to improvethe practice’s collection effectiveness

while providing a satisfactory experi-ence for the patients. According toresearch done by KeyBridge MedicalRevenue Management, practices that

switched to a patient-friendly script designed tomotivate payment enjoyeda 100% increase in patientaccounts establishing pay-ment plans; a 90% increasein patients making imme-diate point-of-service pay-ments; a 50% decrease in

patient complaints regarding collec-tions; and a 17% increase in patientsacknowledging their ability to pay.Both the practice and the patients ben-efit from these outcomes. In the cur-rent unsettled economy, who isn’t upfor that?�


It would be a mistake for a medical practice manager to thinkthat the major obstacle in health care debt collection stems inmost cases from patients’ inability to pay their outstanding

bills, particularly their deductibles and co-pays. According toresearch by KeyBridge Medical Revenue Management, approxi-mately 65% of bad debt comes from patients who carry insur-ance. About 50% of patients with “written off” accounts actual-ly have the ability to pay in full.

The real problem is that both the patient and, to a large extent,the practice’s staff are uncomfortable with the process ofcollecting these deductibles and co-pays up front. The staff aren’tused to doing it; to them it seems almost patient-unfriendly.Even though it might be the practice’s policy, in many practicesthey haven’t been trained to collect deductibles and co-pays

effectively. As a result, the practice’s internal collection mandatesaren’t enforced.

The patients themselves can exacerbate this difficulty. Theyhave not been conditioned through experience to being asked topay for health care at the point of service. In this situation, beingasked to pay up-front triggers the fight or flight response.Combative patients are likely to accuse the institution of caringmore about collecting money than treating the patient.

The primary challenge for the practice manager is two-fold.First, he or she must change the way the patient thinksabout the financial obligation, moving them from being ablebut unwilling to pay to being willing. Second, the managermust make certain the office staff is adequately trained andprepared to handle patients’ responses to their efforts tocollect payments. —DGM

SUCCESSFUL COLLECTIONS REQUIRE A TWO-PRONGED APPROACH

REIMBURSEMENT


In this volatile environment, medicalpractice staff members who collectmoney at the beginning and end of

service have their work cut out for them.


T he patient-centered medicalhome (PCMH) is a care modelthat places an emphasis on care

being easily accessible to patients, coor-dinated, comprehensive, and continu-ously improved through a systemsapproach. One of the most importantagencies in establishing the criteria forthe formation and credentialing ofPCMHs is theWashington, D.C.-basedaccreditation and benchmarking groupNational Committee on QualityAssurance (NCQA). According to apress release on the NCQA Web site(www.ncqa.org), “Research shows thatmedical homes can leadto higher quality andlower costs, and improvepatients’ and providers’reported experiences ofcare.”The NCQA on January

31 released its revisedstandards for the estab-lishment of PCMHs,PCMH 2011. BecausePCMH recognition is one of NCQA’slargest andmost rapidly expanding ser-vices, the updated standardswill affect alarge number of physicians and prac-tices that have already received recogni-tion. “As of the end of 2010, almost7,700 clinicians at more than 1,500 sitesacross America used NCQA standardsas a roadmap to become high-qualityprimary care practices and receiveNCQA recognition as patient-centeredmedical homes,” the press release says.

What Has ChangedAccording to the NCQA press release,PCMH 2011 will require PCMHs to beeven more patient-centered, placing anemphasis on the use of patient feed-back. “To an unprecedented degree,PCMH 2011 directs practices to orga-nize care according to patients’ prefer-

ences and needs,” the release says. Thisincludes involving patients and theirfamilies to a greater degree in the man-agement of patients’ care, providingmultilingual services, aiding andencouraging patients to participate intheir own self-care, and making caremore accessible both during and afterthe practice’s office hours.“NCQA is collaborating with the

Agency for Healthcare Research andQuality to develop amedical home ver-sion of the Consumer Assessment ofHealthcare Providers and Systems(CAHPS) Clinician & Group Survey”in order to facilitate the collection of

patient feedback, NCQA reports.CAHPS should be released in the sec-ond half of 2011, and patients will beable to receive additional NCQADistinction when they report patientfeedback voluntarily, the report says.PCMH 2011 also includes new stan-

dards for parental decision-making forchildren, and for privacy for teenagers.The new standards are designed toreinforce federal “meaningful use”requirements for health informationtechnology, the report says. “The stan-dards’ alignment with meaningful usecreates a virtuous cycle: practices thatmeet PCMH 2011 requirements will bewell prepared to qualify for meaningfuluse, and vice versa,” it says.The new NCQA standards can be

downloaded through the NCQA Website. The electronic publication can be

downloaded for free at www.ncqa.org/view-pcmh2011.

NCQA PCMH ResourcesIn addition to the document listing thenew PCMH standards, NCQA hasnumerous PCMH resources on its Website. These include links for PCMHpro-gram information such as the recogni-tion process, a PCMH 2011 Contentand Scoring Summary, a PCMH 2011overview, a training program, and apricing fee schedule. The overview,which is in the form of an 11-page PDFdocument, analyzes growth trends forPCMH recognition, geographic distrib-

ution, and consumerand public perceptionsof PCMHs. In additionto listing the standardsfor PCMH recognition,it includes a compre-hensive breakdown ofthe six levels of recogni-tion, with a detaileddescription of what each

level entails.Additional resources on the site

include links to a GovernmentRecognition Initiative for PCMHs andthe Health Resources ServicesAdministration (HRSA) and HRSAFAQs. Links to the Centers forMedicare & Medicaid Services (CMS)and Military Health Services (MHS)are coming soon.PCMH2011 publications can also be

ordered. These include a free PDF ofPCMH2011 Standards andGuidelines,application materials for PCMH 2011,and a PCMH survey tool, which mustbe purchased. Physicians and practicesseeking to form PCMHs will find thatthe NCQA is able to provide most ofthe guidance they will need to get start-ed with the process.�—Editor Rev DiCerto

MEDICAL HOMES

NCQA’s New PCMH StandardsCall for Increased Patient-Centeredness

Because PCMH recognition is one ofNCQA’s largest and most rapidly expandingservices, the updated standards will affect alarge number of physicians and practicesthat have already received recognition.


T he American MedicalGroup Association (AMGA;www.amga.org) announced in

January that the database of its EmployeeSatisfaction and EngagementBenchmarking Program recently sur-passed 10,000 employees from 20 differ-ent medical groups. Launched in 2009,the program provides medical groupswith a cost-effective tool to measure andbenchmark the job attitudes of back- andfront-office personnel and non-physi-cian professionals. Participating groupscome from across the country and varyin size from 100 to more than 2,500employees.The programwas designed by AMGA

staff using input from an advisory com-mittee composed of medical group rep-resentatives. The Web-based surveyincludes questions focused on tendimensions: employee engagement,growth opportunities, health benefits,leaves, pay, personal relationships, physi-cian interactions, rewarding work,supervision, and workload. Thesedimensions and AMGA’s survey meth-

ods result in a detailed report starting atthe overall organizational level and pro-viding breakouts at the supervisor, jobcategory, and site levels. This reportallows participating medical groups toeasily identify where improvements canbe made.Findings since the survey’s inception

include:• Overall, 28% of responding employeesindicated they were very satisfied withtheir jobs. Additionally, 26% agreedthat they would highly recommendtheir company to friends and family.• Employees over 30 years old weremoresatisfied with their jobs than youngeremployees. Overall job satisfactionwas also significantly higher foremployees in management than non-managers. Employee engagement wassignificantly higher for managers thannon-managers.• Employee engagement and overall sat-isfaction were strongly correlated withone another. The best predictors ofindividual satisfactionwere the reward-ing work and supervision dimensions.

PRACTICE MANAGEMENT NEWS

AMGA Employee Satisfaction DatabaseExceeds 10,000 Health Care Employees

The Taconic Health Information Network and Community(THINC) in January announced the launch of a series of edu-cational events to explore care delivery and reimbursement

under accountable care organizations (ACOs). Supported by agrant from the New York State Health Foundation, ACO Insightsis a training and technical assistance program designed to offerphysician practices, health plans, hospitals and other health facil-ities in the Hudson Valley an opportunity to explore the key con-cepts of and consider the development of ACOs.

Beginning in 2012, Medicare will fund pilot projects to test themodel for its beneficiaries. Across the nation, provider groups,hospitals and insurance companies are exploring how to success-fully structure these new models. ACO Insights webinars will

feature high-level discussions based on a framework of ACOmodel components: financial and legal, leadership and opera-tions, quality measures and improvement, and engagement.

ACO Insights will begin with a series of free 90-minute webi-nars offering opportunities for registrants to ask questions ofnationally recognized experts. THINC is a not-for-profit organiza-tion that seeks to convene providers, payers, employers, publichealth agencies, quality organizations, consumers and local lead-ers to improve the quality, safety and efficiency of health care forthe Hudson Valley community.

More information about ACO Insights is available athttp://thinc.org/aco-insights.html.

N.Y. ORGANIZATION OFFERS ACO LEARNINGAND TECHNICAL ASSISTANCE EFFORT FOR PROVIDERS

Most commercial health insur-ance markets in the UnitedStates are dominated by one or

two health insurers, the 2010 edition ofCompetition in Health Insurance: AComprehensive Study of U.S. Markets,released February 1 by the AmericanMedical Association (AMA; www.ama-assn.org), indicates. Based on 1997U.S. Department of Justice and FederalTrade Commission Horizontal MergerGuidelines, 99% of U.S. health insur-ance markets are “highly concentrat-ed,” indicating a significant absence ofcompetition among insurers, the reportfinds. In 48% of metropolitan areas, atleast one insurer had a market share of50% or more, it says. “When insurersdominate a market, people pay higherhealth insurance premiums than theyshould, and physicians are pressuredto accept unfair contract terms and cor-porate policies, which undermines thephysician role as patient advocate,”said AMA President Cecil B.Wilson, MD.

AMA STUDY FINDSMOST MARKETSDOMINATED BYONE OR TWOHEALTH INSURERS

Many patients express confu-sion over the qualificationsof different health care pro-

fessionals, according to survey resultsannounced in January by theAmericanMedical Association (AMA). Although83% of patients surveyed want a physi-cian to have primary responsibility fortheir health care, many are confusedabout the qualifications of health careprofessionals, the survey indicates. Thetelephone survey was conductedamong 850 adults nationwide byBaselice &Associates. The overall mar-gin of error is +/- 3.4% at the 95% level.“A physician-led team approach to

care with each member of the healthcare team playing the role they are edu-cated and trained to play is key to ensur-ing patients receive high quality care,

and most Americans agree,” said AMABoard Member Rebecca Patchin, MD.“Although 90% of those surveyed saidthat a medical doctor’s additional yearsof education and training are vital tooptimal patient care, the survey foundmuch confusion about the qualifica-tions of health care professionals.”The survey also finds that 87% of

respondents would support legislationrequiring health care advertisements todesignate the qualifications of the pro-fessionals promoting their services. Inan effort to help alleviate confusion, theHealthcare Truth and TransparencyAct of 2011, introduced in January,prohibits misleading and deceptiveadvertising by health care profession-als. Several states have already enactedsimilar legislation.

Survey: Patients Want Physicians to LeadCare, Express Confusion OverQualifications


The American Medical Association (AMA) in January announced that to help physi-cians receive reimbursements for the Center for Medicare and Medicaid Services(CMS) Physician Quality Reporting Initiative (PQRI) program, it is working with

health information technology provider Covisint to allow eligible physicians to usethe DocSite PQRI Web application (www.covisint.com/web/guest/healthcare/docsitepqri). The self-service Web application enables physicians to securely submitdata for 2010 PQRI reporting. AMA members are eligible to subscribe to this service ata discounted rate.

“Covisint DocSite helps physicians easily apply for PQRI incentive payments bycutting through administrative and technological complexity,” said AMA SeniorVice President Bob Musacchio. CMS offers incentives for eligible physicians whosatisfactorily report data on quality measures for covered professional services toMedicare beneficiaries. Participation is voluntary and 2010 is the last year for whichCMS will pay 2% of Medicare fees for PQRI participation. In 2011, the incentivepercentage is expected to decrease.

AMA, HEALTH IT FIRM FACILITATEREPORTING OF PQRI DATA

Primary care and specialist physi-cians have different views abouthow often their colleagues com-

municate with them, a study byresearchers at the Washington, DC-based Center for Studying HealthSystem Change (HSC;www.hschange.com) published in theJanuary 10 Archives of InternalMedicine indicates. Among primarycare physicians (PCPs), 69.3% report-ed “always” or “most of the time”sending a patient’s history and the rea-son for the referral to the specialist,but only 34.8% of specialists said theyregularly receive such information, thestudy found. Among specialists, 80.6%said they regularly send consultationresults to the referring PCP, but only62.2% of PCPs said they received theresults, it found.

Physicians who did not receive time-ly communication regarding referralsand consultations were more likely toreport that their ability to providehigh-quality care was threatened, thestudy found. For both PCPs and spe-cialists, adequate time with patientsduring an office visit was the mostimportant factor in whether physicianswere more likely to report sending andreceiving information about referralsand consultations, the study found.

The study, “Referral andConsultation Communication BetweenPrimary Care and Specialist Physicians:Finding Common Ground,” is based onHSC’s 2008 Health Tracking PhysicianSurvey, which collected informationfrom 4,720 practicing physicians. Thesurvey had a 62% response rate andwas funded by the Robert WoodJohnson Foundation.

STUDY: COMMUNICATIONDISCONNECT BETWEENPCPS, SPECIALISTS

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