Presented by: Cherilyn G. Murer Founder and CEO of Murer Consultants, Inc. February 24, 2009

Presented by: Presented by: Cherilyn G. MurerCherilyn G. Murer

Founder and CEO of Murer Consultants, IncFounder and CEO of Murer Consultants, Inc..

February 24, 2009February 24, 2009

Murer Consultants Inc., is a legal based healthcare management consulting firm founded by Cherilyn G. Murer, J.D., C.R.A. in 1985.

Murer Consultants is comprised of consultants who share a similar background in law, with contributions based on various areas of clinical, financial and managerial expertise.

The Mission of Murer Consultants Inc. is to promote problem solving in the healthcare industry based on sound pragmatic reasoning with development of realistic recommendations which can be implemented within a given timeframe.

Prepared By Murer Consultants Inc.

Murer Consultants Inc.

© Murer Consultants, Inc. 2/09



Understanding that healthcare is a complex integration of

medical, social, economic, legal and government issues, Murer

Consultants, Inc. brings a unique combination of expertise

skilled in both the macro- and micro-aspects of planning,

organization, development, finance and law. This unique

organizational matrix produces the most informed,

comprehensive and result-oriented service available in

healthcare today.© Murer Consultants, Inc. 2/09

Murer Consultants, Inc. has been recognized as an expert in healthcare

strategic planning, regulatory oversight, and implementation management with

more than 25 years of experience working with more than 500 hospitals and health systems throughout the United States.




Principles of Murer Consultants

Murer Consultants was founded on an axle of:



Principles of Murer Consultants

Murer Consultants believes there is now a fourth dimension in the axle -- integration of ……..

Technology





• IT is positioned to improve the quality, safety, and efficiency of health care

• Drivers of investment in healthcare IT include the promise of quality and efficiency gains

• Barriers include the cost and complexity of IT implementation

– HOWEVER : NEW legislation passed by President Obama in the Economic Stimulus bill provides incentives for both hospitals and physicians to adopt electronic health records

– More Discussion to Follow



• Health IT allows comprehensive management of medical information and its secure exchange between health care consumers and providers.

• Broad use of health IT will:

– Improve health care quality; – Prevent medical errors; – Reduce health care costs; – Increase administrative efficiencies; – Decrease paperwork; and – Expand access to affordable care.



• Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including: – Early detection of infectious disease outbreaks around the country; – Improved tracking of chronic disease management; and – Evaluation of health care based on value enabled by the collection of

de-identified price and quality information that can be compared.





• Electronic health record (EHCR)

• Computerized provider order entry (CPOE)

• Clinical decision support system (CDSS)

• Picture archiving and communications system (PACS)

• Bar coding• Radio frequency

identification (RFID)• Automated dispensing

machines (ADMs)• Electronic materials

management (EMM)



• EHRs were originally envisioned as an electronic file cabinet for patient data from various sources (eventually integrating text, voice, images, handwritten notes, etc.).

• Now they are generally viewed as part of an automated order-entry and patient-tracking system providing real-time access to patient data, as well as a continuous longitudinal record of their care.



• CPOE in its basic form is typically a medication ordering and fulfillment system.

• More advanced CPOE also includes lab orders, radiology studies, procedures, discharges, transfers, and referrals.



• CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations.

• The term covers a variety of technologies ranging from simple alerts and prescription drug interaction warnings to full clinical pathways and protocols.

• CDSS may be used as part of CPOE and EHR.



• This technology captures and integrates diagnostic and radiological images from various devices (e.g., x-ray, MRI, computed tomography scan), stores them, and disseminates them to a medical record, a clinical data repository, or other points of care.



• Bar coding in a health care environment is similar to bar-code scanning in other environments: An optical scanner is used to electronically capture information encoded on a product.

• Initially, it will be used for medication (for example, matching drugs to patients by using bar codes on both the medications and patients’ arm bracelets), but other applications may be pursued, such as medical devices, lab, and radiology.



• This technology tracks patients throughout the hospital, and links lab and medication tracking through a wireless communications system.

• It is neither mature nor widely available, but may be an alternative to bar coding.



• This technology distributes medication doses and is widely used

• Examples : Pyxis, Accudose, and Omnicell



• Health care organizations use EMM to track and manage inventory of medical supplies, pharmaceuticals, and other materials.

• This technology is similar to enterprise resource planning systems used outside of health care.





Electronic Medical Record



Benefits of EMRs

1. Speed

The business world of the 21st century is fast-paced. Even in medical practices, speed equals ability to compete, especially when managing information.

In addition, a fast electronic medical record system requires less time invested in trouble shooting and allows more time invested in caring for patients.



Benefits of EMRs

2. Storage

An electronic medical record is an electronic database of information capable of carrying much more information than traditional systems.

An electronic medical record system can manage records from multiple offices as well as multiple types of records.



Benefits of EMRs

3. Security

An electronic medical record system secures records with backup files in case of emergencies.

In addition, only authorized users may access them. This double security system is a "preventative medicine" for record viruses and HIPPA concerns.



Benefits of EMRs

4. Support

Both practices and patients can access customer support from a medical billing specialist provided through the electronic medical record software.

In addition to their support, electronic medical record software provides access to medical codes, including, ICD.9, HIPAA, HCFA 1500, and the latest CPT code books.



Benefits of EMRs

5. Accessibility

The latest electronic medical record technology allows information to be downloaded directly onto a PDA or Palm device.

In addition to PDA access, authorized individuals can access an electronic medical record online from any location.

Individuals also have state to state accessibility to their medical records while on extended job deployment or vacation.



Benefits of EMRs

6. Efficiency

Efficiency is not the same as speed.

Efficiency involves legibility issues and time management issues. EMRs preclude any legibility concerns which ensures timely reimbursement and mitigates liability. Additionally, the money spent on transcription services and other medical record/medical office management can be better spent on EMR.

EMR increases efficiency in the practice of medicine.



Benefits of EMRs

7. Infrastructure

Part of the money-saving nature of electronic medical record technology is the effective utilization of IT infrastructure. EMR optimizes IT infrastructure and promotes the streamlining of multiple databases.

The infrastructure is simplified into one online database, even for multiple offices.



Benefits of EMRs

8. Versatility

Electronic medical record software stores medical SOAP notes and medical codes.

It allows multiple users.

It also connects users to personal and online support sources.



Benefits of EMRs

9. Affordability

This is perhaps the most appealing part of the latest electronic medical record technology. Every business wants to save money while at the same time adopting time-saving technology.

While some EMR providers charge hefty upfront costs for software and implementation, many EMR providers, like Medsphere, are “open source” and the software itself is free.



Electronic Medical Record

Electronic Medical Records:

•Improve Patient Care

•Reduce Errors

•Reduce Costs

•Streamline the HealthCare Delivery System

Healthcare IT was an integral component of the presidential election healthcare reform platforms.

Within the past week landmark legislation was passed, making the push for EMRs stronger than

ever.



• The American Recovery and Reinvestment Act of 2009 was signed by President Obama on February 17, 2009.

• The Act includes the Health Information Technology for Economic and Clinical Health Act (HITECH Act).

• The purpose of the HITECH Act is to promote the use of health information technology with a goal of utilization of an electronic health record for each person in the United States by 2014.



• The Act provides financial incentives to physicians and hospitals to adopt and use certified electronic health records (EHR) technology.

–BASELINE INCENTIVES» $2,000,000 for hospitals» Up to $65,000 for physicians



• During each payment year a hospital will be paid an amount based on an equation that takes into account a base amount of $2,000,000 plus an additional amount based on the number of discharges for such hospital, on a graduated basis. The equation also considers additional adjustments based on other factors.

• There will be a phase down for eligible hospitals first adopting EHR after 2013.

• If the first payment year for an eligible hospital is after 2015, the hospital will not receive an incentive payment for that year or any subsequent year.



• Physicians will be paid amounts not to exceed $15,000 for a physician for the first payment year (or $18,000 for the first payment year if the first payment year is 2011 or 2012) with decreasing amounts during the second through fifth payment years.

• No incentive payment will be made during the sixth and succeeding years.

• An additional incentive is provided for doctors who predominantly furnish services in rural areas designated as “health professional shortage areas.”





• In order to be considered a meaningful EHR user, the eligible physician or eligible hospital will need to meet the following three requirements:








• What exactly does “certified” mean?

– Who certifies?

• The ONC will turn over $20M to NIST who will define the test standards, implementation specifications, and testing infrastructure for a certified EHR

• There is also language regarding the testing NIST will manage referencing “including a program to accredit independent, non-Federal labs to perform testing”

– While it is not spelled out as CCHIT (Certification Commission for Healthcare Information Technology), it certainly sounds like this is to whom they are referring

– Why the need for “certification”? Do not need “certified EHR” to get the job done.

– Monopoly versus open market?

– Innovative vendors shut out?



• Adoption of EMR under 10% currently – are there enough IT professional trained to deploy more IT?

• Will the demand for HIT professionals far out-strip supply making it nearly impossible to adopt, install, train, and demonstrate “meaningful use”?





• Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred via telephone, the Internet or other networks for the purpose of consulting, and sometimes remote medical procedures or examinations.

• Telemedicine may be as simple as two health professionals discussing a case over the telephone, or as complex as using satellite technology and video-conferencing equipment to conduct a real-time consultation between medical specialists in two different countries.

• Telemedicine generally refers to the use of communications and information technologies for the delivery of clinical care.





• Receive education from the specialist/provider • Better health outcome for their patients • Enhanced community confidence in local healthcare • Attend continuing medical education courses from their clinic



• Reimbursement structure under Medicare• No funding to support capital equipment investment• Reimbursement limitations from third party payers• Mechanics of accountability



• Greatest impact of telemedicine:– Rural health integration– As portal to medical tourism



Quality Measure Reporting and Pay for Performance

A good idea??



Quality Measure Reporting

In its efforts to transform Medicare system into a prudent purchaser of health care services, beginning October 1, 2008, Medicare has instituted the following:

•Hospitals must report quality measures for full payment updates

•Revision of payment policies to create financial incentives through pay for performance initiatives



CMS is making these changes as part it its commitment to improving the efficiency and quality of health

care delivered to Medicare beneficiaries.





Benchmarking



Benchmarking

Benchmarking, in simplistic terms, is the process where you compare how well your facility is doing in comparison to others.

By making comparisons the facility strives to improve quality of care.

Benchmarks can incorporate a number of key areas including: clinical, financial and regulatory.

Murer Consultants works with its clients to develop benchmarks which are meaningful to each particular facility.



Benchmarking Examples

Benchmark Month One Month Two Month Three Average

Maintain an average reimbursement per patient discharge of $7,500

Minimize recidivism to short term acute hospital to no more than 5% of re-admissions

Maintain basic nurse competencies including at minimum ACLS certification

Maintain a case mix index of 1.9 or greater reflective of patient acuity

Maintain a cost per patient day of $1,250 or less

Maintain average daily census as per budget projections (Budget | Actual)

Maintain Direct Nursing Hours at Target. 7.25 DNR for general ………………………………………16 DNR for CCU

Minimize agency nursing to no more than 20% of Nursing Expense (Salary plus benefits) for RN, LPN, CNA.

Maintain an average length of stay of less than 5.5 days for all

patients and 6.25 days for Medicare only patients.



Benchmarking Examples

BenchmarkMonth

OneMonth

TwoMonth Three

Average

Maintain a cost per patient day of $1,250 or less

Ensure that from time of discharge to completeness of chart is within 15 days

Ensure that within 20 days of discharge all bills are dropped

Ensure that within 30 days of discharge Medicare payment is received

Maintain medical supply ancillary services at $100 per patient day or less

Maintain pharmaceutical ancillary services at $135 per patient day or less

Maintain radiology ancillary services at $40 per patient day or less

Maintain laboratory ancillary services at $80 per patient day or less

Ensure that time from chart completed until submission of chart for coding is within 48 hours




facilitates administrative improvement and clinical facilitates administrative improvement and clinical systemization; and systemization; and

provides several reimbursement enhancement provides several reimbursement enhancement opportunities to providersopportunities to providers




Murer Consultants, Inc.

58 North Chicago StreetJoliet, Illinois 60432

Telephone (815) 727 3355Telefax (815) 727 3360

Web Site: www.murer.com

Documents

Presented by: Cherilyn G. Murer Founder and CEO of Murer Consultants, Inc. February 24, 2009