Group Practices

A case management department implements time saving technology that overturns nearly $700,000 in denials.

For years, providers have sought a reliable, automated solution to the time-consuming and error-prone process of claims reimbursement. On the front end of patient care, countless hours are spent working to notify and secure authorizations from differing payer organizations, each with its own set of unique processes and criteria. On the back end, collections will spend equally large amounts of time struggling to supply evidence necessary to overturn denied claims. All too often, the difficulty prevents any attempt at overturning the denials.

In recent history, catastrophic disasters have dramatically highlighted the need for business continuity planning. Modern statistics indicate that if an organization is prohibited from accessing mission-critical data for more than 48 hours, it may go out of business within a year.

Disaster recovery focuses primarily on risks, data protection and planning. However, business continuity planning takes this one step farther by designing the means to keep an organization operational during and after an event. While large-scale disasters are fairly rare, most facilities will, at some point, experience localized events such as fires, power outages or flooding. Although data recoverability/protection is a regulatory requirement for healthcare providers, rapid access to that data also is an essential aspect for any healthcare provider. It is not sufficient to replicate data from one site to another—the data needs to be accessible and usable as well.

Healthcare providers and IT supplier in New England simulate a disaster situation to test a Web-based EMR for regional and maybe national adoption.

Is there anyone who doesn’t remember Hurricane Katrina and the heart-wrenching TV images of traumatized New Orleans residents being herded onto busses and then disbursed and displaced into Utah, Texas, Arkansas and Georgia? More than any political speech or legislative initiative, Hurricane Katrina drove home the hardest of healthcare lessons: The time to prepare for disaster is before it strikes.

The healthcare industry suffers from an inability to systematically fix its incomplete and inaccurate provider data. This problem not only prevents the industry from achieving optimal efficiency and automation, but also has larger-scale implications in terms of hindering healthcare initiatives, such as consumer-directed healthcare, pay-for-performance reimbursement and establishment of effective treat­ment protocols.

With pilots aplenty behind it, e-prescribing is a technology on the verge of widespread adoption.

It has come time in the healthcare industry to take stock and examine where e-prescribing has been, where it is headed and, more importantly, how all industry players can come together to make it a success. Over the past few years, several large, statewide e-prescribing programs have been launched and are in various stages of deployment and optimization. The programs often have been referred to as “pilots.” To date, the results have been uniformly positive, in a variety of markets, so much so that one can comfortably reach the following conclusion: The industry’s pilot has been completed, and e-prescribing improves patient care, adds efficiency to practices and pharmacies, and reduces overall pharmacy costs by encouraging on-formulary and generic script writing where appropriate.

Additionally, the legislative activity surrounding e-prescribing at the state level continues to be encouraging with recent activity demonstrating an increasing pace of state support for e-prescribing. We are entering the next phase of this technology as we move beyond pilots into widespread adoption. As with any initiative, it is important to weigh the pros and cons and learn from these pilots about best practices in adoption.

For one Midwest imaging organization, integrating a new PACS into an existing RIS solves workflow issues while providing excellent ROI.

Today’s providers of outpatient diagnostic imaging services face increasing challenges in managing information systems technology and costs, especially when considering rapid growth patterns, increasing cost containment pressure from insurance companies and never-ending complexities of Medicare and CMS. Meridian Regional Imaging, Mundelein, Ill., has been a regional provider of professional radiology interpretations, and related radiology billing and management services since 1999. From its inception, the organization has been a technology-driven practice, with a vision of a streamlined workflow that maximizes radiologist productivity and provides premier subspecialty interpretations with high-end customer service.

Today’s PACS must not only deliver images and store them, but also lower the cost of doing business.

Many healthcare facilities today grapple with the issue of replacing a legacy or older picture archiving and communications system (PACS). While reasons vary, it is not uncommon for early PACS adopters to eventually need more functions and expanded capability. Gary Wildfong, director of technology at Axcess Diagnostics, believes that changing to a newer PACS was a requirement for their continued expansion and operational stability.

Midwest healthcare system achieves demonstrated efficiency and quality improvements with an automated bed management system coupled with wholly redesigned internal processes for using it.

Oftentimes, a phrase like, “…and patient care improved dramatically” is sandwiched into the recounting of a healthcare organization’s positive experience with information technology, but without much to justify its presence. Making a real dent in the quality of healthcare delivered to patients is, most often, not the result of simply deploying IT. Rather, it results from larger scale organizational changes in strategic planning, process improvement and training coupled with IT—and none of those occur without a lot of forethought and elbow grease.