M A RY L A N D
Physician YOUR PRACTICE. YOUR LIFE.
ADVANCES IN CARDIOVASCULAR DIAGNOSIS AND CARE GENOMICS: THE QUEST FOR PERSONALIZED MEDICINE ARE YOU READY FOR STAGE 2 OF MEANINGFUL USE?
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VOLUME 4: ISSUE 1 JAN/FEB 2014
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Contents 10
VOLUME 4: ISSUE 1 JAN/FEB 2014
14 F E AT U R E S
10 Advances in Cardiovascular Diagnosis and Treatment 14 Genomics Advances: The Quest for Personalized Medicine 16 Meaningful Use Stage 2: Are You Ready? D E PA R T M E N T S
Cases
| 7 | Rapid Recognition/Evaluation of Ischemic Stroke in Younger Patients
Compliance Living
| 9 | How to Avoid the Legal Pitfalls of Social Media
| 18 | Setting Sail Straight Out of Charm City
Solutions
| 21 | Revenue Cycle Management Improves Practice Performance
Good Deeds
| 22 | Red Dress Sunday Raises Awareness About Prevalence of Heart Disease
On the Cover: Adam Kaplin, M.D., PhD, assistant professor of Psychiatry and Neurology, The Johns Hopkins Hospital
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JACQUIE COHEN ROTH PUBLISHER/EXECUTIVE EDITOR jroth@mdphysicianmag.com LINDA HARDER, MANAGING EDITOR lharder@mdphysicianmag.com
The year ahead
in healthcare will be rich with challenges and innovation, requiring physicians to be especially adaptable to change. What year isn’t? A fair question, but it seems we need to be especially receptive to innovation and change now. The sweeping provisions of the Patient Protection and Affordable Care Act impact almost every aspect of patient care. Healthcare reform is seeking innovative care models that offer novel ways to meet the challenges of improving quality care and reducing costs. In this issue, we offer some tools to help your practice become a more innovative and efficient one in 2014. Cardiovascular disease remains the leading cause of mortality and the number one killer of women in the U.S. Stroke is the fourth leading cause of death for women and kills twice as many women as breast cancer every year. But with growing public awareness of the need for compliance with proper diet, exercise and medications where appropriate, the death rate from heart disease is on the decline. Our cardiovascular experts describe the progress that’s been made in managing ischemic strokes and atrial fibrillation, and share the surprising fact that depression puts patients at risk for heart disease as much as more widely known risk factors such as hypertension, diabetes or smoking (see Cases on page 7 and our cover story on page 10). While preparing for our feature on genomic advances during a recent crosscountry plane ride, I coincidentally met a father and his young son who personally benefitted from advances in genomics (page 14). The adorable six-year old has suffered from unremitting seizures for most of his young life. Using DNA mapping for both parents and the boy at a Maryland hospital, one gene was identified that provided the family and their providers with answers. The boy was identified as the only known case in the world with his unique presentation of epilepsy. The news didn’t offer the family a cure, but it did deliver them a much better understanding of what the boy was suffering from, his prognosis and the risks for family growth. The family grew to include one perfectly healthy baby girl. Are you ready for Stage 2 of Meaningful Use? Do you care? The federal government has given extra time to healthcare providers to meet the next stage of electronic health record Meaningful Use, but the incentives are smaller. The goal of CMS is to increase patient and family engagement while improving patient care through better clinical decision support and care coordination. We’ve asked physicians if EMRs and Meaningful Use do indeed improve care in their practices and if the implementation is worthwhile. Read their opinions in Healthcare IT (page 16). Compliance (page 9) is a terrific adjunct to our HIT feature, tackling the thorny issue of how to avoid legal pitfalls in online physician/patient social media interaction. With that and much more inside these pages and online at mdphysicianmag.com, I wish you a very happy and healthy 2014! And, don’t forget to wear red in February in support of Heart Health Month! To life!
Jacquie Cohen Roth Publisher/Executive Editor jroth@mdphysicianmag.com @mdphysicianmag 4 | WWW.MDPHYSICIANMAG.COM
MANAGER OF DIGITAL CONTENT & SOCIAL MEDIA BUSINESS DEVELOPMENT Jackie Kinsella jkinsella@mojomedia.biz CONTRIBUTING WRITER Tracy Fitzgerald COPY EDITOR Ellen Kinsella PHOTOGRAPHY Tracey Brown, Papercamera Photography DIRECTOR OF FINANCE Kyle Marisa Roth BUSINESS DEVELOPMENT Eileen Nonemaker enonemaker@mdphysicianmag.com Maryland Physician Magazine – Your Practice. Your Life.™ is published bimonthly by Mojo Media, LLC. a certified Minority Business Enterprise (MBE). Mojo Media, LLC PO Box 949 Annapolis, MD 21404 443.837.6948 www.mojomedia.biz Subscription information: Maryland Physician Magazine is mailed free to Maryland licensed and practicing physicians and a select audience of Maryland healthcare executives and stakeholders. Subscriptions are available for the annual cost of $52.00. To be added to the circulation list, call 443.837.6948. Reprints: Reproduction of any content is strictly prohibited and protected by copyright laws. To order reprints of articles or back issues, please call 443.837.6948 or email jroth@ mdphysicianmag.com. Maryland Physician Magazine Advisory Board: An advisory board comprised of medical practitioners and business leaders in diverse practice, business and geographic scopes provides editorial counsel to Maryland Physician. Advisory board members include: PATRICIA CZAPP, M.D. Anne Arundel Medical Center HOLLY DAHLMAN, M.D. Greenspring Valley Internal Medicine, LLC PAUL W. DAVIES, M.D., FACS KURE Pain Management MICHAEL EPSTEIN, M.D. Digestive Disorders Associates STACY D. FISHER, M.D. University of Maryland Medical Center REGINA HAMPTON, M.D., FACS Signature Breast Care DANILO ESPINOLA, M.D. Advanced Radiology GENE RANSOM, J.D., CEO MedChi CHRISTOPHER L. RUNZ, D.O. Shore Health Comprehensive Urology JAMES YORK, M.D. Chesapeake Orthopaedic & Sports Medicine Center Although every precaution is taken to ensure accuracy of published materials, Maryland Physician and Mojo Media, LLC cannot be held responsible for opinions expressed or facts supplied by authors and resources. Printed on FSC certified, 100% PCW, chlorine free paper
Cases
Rapid Recognition/Evaluation of Ischemic Stroke in Younger Patients By J. Wesley Ruffin, M.D.
CASE: A 49-year-old female working in food services at a community hospital had an abrupt onset of confusion and loss of recent memory that was noticed by a coworker. This coworker initiated a code emergency response, prompting a rapid evaluation by our ED nurses and technicians in the cafeteria. It became apparent this patient was having an acute neurological event, prompting the ED team to initiate the hospital’s Stroke Alert process. The patient also demonstrated moderate left-sided weakness and paresthesia affecting both upper and lower extremities. She denied recent trauma, headache, blurry vision, chest pain and dyspnea. Her past medical history was significant for hysterectomy and kidney stones only, with no prior history of CVA or known CNS mass. The patient is a married nonsmoker who denies regular alcohol consumption. Within 10 minutes, the patient was admitted to the ED, where her initial physical exam was significant for mild distress due to confusion and anxiety. The patient’s cardiovascular, HEENT, respiratory, and abdominal exams were within normal limits. Her initial NIH stroke score was 5. She received a score of 1 for left motor arm, 2 for left motor leg, 1 for mild to moderate sensory deficit and 1 for mild to moderate aphasia.
The patient’s husband and family arrived at the bedside within 30 minutes of presentation to the ED. The ED physician began the process of obtaining informed consent for possible tPA administration soon after their arrival. The family was given information on tPA and a consent form to review during the patient’s initial evaluation. Stroke alert protocols were followed. Stroke alert head CT revealed no acute findings. Initial lab work-up revealed no clinically significant abnormalities to explain the patient’s clinical condition. As she had no acute contraindications for tPA therapy, the UMMS Brain Attack Team was contacted. The ED physician and consulting neurologist determined the patient was an appropriate candidate for thrombolytic therapy and obtained informed consent. Within 60 minutes of initial presentation to the ED, tPA was administered. After tPA administration, the patient was admitted to the Critical Care Unit for continued observation and frequent neurologic examinations. Her NIH stroke scale improved to 3 while still in the ED, and within one hour of the initial tPA bolus, with much improved speech, clearer thinking and much improved ability to move her left upper and lower extremities on ED discharge.
DISCUSSION: Ischemic stroke is a devastating neurologic disease and a significant cause of death and disability in this country. While recognized in the elderly, disability from an ischemic cerebrovascular accident (CVA) can also be profound in younger patients. Thrombolytic therapy has become a mainstay of treatment. The guidelines for the use of thrombolytic therapy have been established, but are constantly re-evaluated and changed where appropriate. Currently, administration of tPA, as soon as possible, is a Level-1A recommendation of the American Heart Association. Door-toneedle goal of less than 60 minutes is a Level-A recommendation by the American College of Emergency Physicians. It should be recognized that other conditions can mimic acute ischemic stroke, including complicated migraine, seizures and conversion disorders. These conditions can be difficult to differentiate from acute ischemic stroke; however, the suspicion of one of these mimics should not delay administration of tPA. Three retrospective studies demonstrate that between three and 21 percent of patients treated with tPA have no evidence of ischemic stroke on further inpatient evaluation. In each of these studies, there was no significant symptomatic hemorrhagic complication from administration of tPA. This case highlights the need for quick recognition and evaluation of acute CVA symptoms, even in relatively young and healthy individuals. This patient received prompt care, and after administration of tPA within 60 minutes of presentation, and less than 90 minutes from symptom onset, she had significant improvement of her CVA symptoms. The patient’s neurologic symptoms completely resolved by hospital day one, and she was discharged in stable condition on hospital day two. She has returned to work with no residual deficits. J. Wesley Ruffin, M.D., Carroll Hospital Center; director of Pediatrics, Emergency Medicine Associates, www.emaonline.com
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Compliance
How to Avoid the Legal Pitfalls of Social Media
A
By James F. Doherty, Jr.
S PHYSICIAN PRACTICES continue to embrace online social media, they should establish some simple risk management guidelines up front to reduce the chance that these powerful promotional and clinical tools will result in legal or financial liability. The primary areas involving possible legal issues for physician use of social media are: z The use of patient information, which can implicate HIPAA and state confidentiality laws z State Medical Practice Act provision governing the standard of care, permissible advertising and patient confidentiality z State common law actions for professional negligence z Defamation (libel or slander) z False advertising (Federal Trade Commission and state Unfair Trade Practices laws)
z Ask patients for permission to use any identifying information online (e.g., testimonials, success stories, photos, videos). z Review your HIPAA documentation, including the Notice of Privacy Practices, to make sure you are making any required disclosures regarding use of PHI.
There have been numerous documented cases of healthcare providers inappropriately posting “protected health information” (PHI) of patients on sites such as Facebook, Twitter and Instagram. In general, it is inappropriate to post PHI on any site where an unauthorized third party could view the information without the patient’s consent. Take several simple steps to minimize risk: z Treat the PHI the same way you would during cocktail party conversations: Don’t reveal specific patient identifiers, and be careful not to expose the information to third parties without the patient’s consent. z Maintain separate personal and professional online accounts and never involve mixed use or crossover.
Defamation
As in other social settings, providers need to avoid creating unintended treatment relationships through their use of social media. Rendering a medical opinion or providing advice based solely on online interactions with potential patients may create liability issues if the patient relies on the advice and subsequently experiences an adverse clinical event. The patient could allege inadequate examination or treatment, or inadequate response time to an online inquiry. Potential malpractice risk can be significantly reduced by:
Untrue or unsupported online statements that harm a person’s personal or professional reputation or financial interests can be defamatory and legally actionable. They can lead to state court actions for libel (written communications) or slander (oral communications). Providers may be sued for improper statements made about patients or their families online, and they may also be the victims of inaccurate negative online reviews. Providers who believe they have been defamed on social media can contact the website and request that the offending content be taken down, but the policing of the online content varies widely by site, and removing negative items can be a time-consuming and frustrating process. Cite violations of specific provisions of the Terms of Service. If the individual making the statements can be identified, civil action may also be available, but many sites are reluctant to identify users who have not identified themselves online. Pro-active use of social media can provide myriad benefits to a medical practice, and careful planning and implementation can help avoid many of the potential legal pitfalls.
z Using appropriate disclaimers on websites and other communications z Responding to specific patient inquiries offline z Meeting the applicable standard of care for in-person evaluations
James F. Doherty is a principal in the Maryland law firm of Pecore & Doherty, LLC. He can be reached at jdoherty@ pecoredoherty.com. Additional guidance for medical office use of social media can be found at www.healthit.gov and www.ama-assn.org.
If patient PHI is improperly posted on social media, you may be obligated to perform the risk analysis required by HIPAA and notify involved patients of the breach. State laws also may require patient notification if certain sensitive non-clinical patient information (e.g. SSN, financial or insurance account numbers) is improperly posted. Since penalties can be significant and enforcement has increased, you may want to consult with counsel regarding any potential breach situation. Medical Malpractice
HIPAA and Confidentiality
z Maintaining appropriate medical records z Optimizing online privacy settings z Avoiding unsecured Wi-Fi networks z Contacting your liability carrier for social media guidelines or Best Practice recommendations
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ADVANCES IN CARDIOVASCULAR DIAGNOSIS AND TREATMENT BY L INDA H ARDER • PH OTOG RA PH Y BY TRA CEY BROWN
Studies show there’s new hope for treating paroxysmal atrial fibrillation and ischemic strokes, and demonstrate that depression is an independent risk factor for coronary artery disease. Our Maryland experts explain.
Jeffrey Banker, M.D., an electrophysiologist and heart rhythm specialist at the Heart Center at Sinai
CLEARER DATA ON MANAGING ISCHEMIC STROKES New clinical trials across the world are providing fresh evidence about the effectiveness of both emerging and existing interventions for ischemic strokes. Treatment advances may be why stroke has dropped to fourth place as the major cause of death in the U.S., but with nearly 800,000 Americans affected by a new or recurrent stroke each year, that guidance is critically needed. tPA Window of Effectiveness Expands
According to the National Institutes of Neurological Disorders and Stroke, patients receiving intravenous (IV) tissue-type plasminogen activator (tPA) within three hours of stroke onset are 33% more likely to recover with little or no disability than those who don’t. While administering tPA within 90 minutes is still preferable, first demonstrated by three large trials in the 1990s, researchers have found that its window of effectiveness is longer than previously believed. Recent clinical trials in Europe have demonstrated that thrombolysis can be effective for some patients up to four-and-a-half hours after stroke symptom onset; after that time, the risks may outweigh the benefits. When Thrombolysis is Contra-indicated
Thrombolysis is contraindicated in patients who are pregnant or who have had major surgery or serious trauma within 14 days, or gastrointestinal or urinary tract hemorrhage, history of stroke or serious head trauma within 21 days. It also is contraindicated for patients with a history of intracranial hemorrhage, brain tumor or known cranial aneurysm. “The average patient has a 3-6% risk of intracranial hemorrhage with tPA,” Amir Zangiabadi, M.D., director of Neuroscience and Stroke Services at Washington Adventist Hospital, says. “Those with high blood pressure, advanced age, a large stroke or a delay in receiving tPA, however, are at higher risk. Patients older than age 80 or patients with diabetes should not receive a thrombolytic if their stroke occurred more than three hours after a stroke. A common myth about thrombolytics is that those aged 50 or younger are at
higher risk, whereas they are actually at lower risk (only about 2%).” Intracranial Ultrasound as Potential Adjunct
The results from CLOTBUST-HF – an initial trial of 20 patients receiving highfrequency (HF) intracranial ultrasound – published October 2013, were promising. “Physicians placed a circular helmet on the patient’s head that provided 2megahertz pulse-waves for two hours, in conjunction with tPA. The ultrasound may stir up the blood near the clot or help bind the drug to the clot. It is also possible that ultrasound waves will help shake up the clot,” Dr. Zangiabadi explains. “The recanalization rates for the middle cerebral artery were higher than with tPA alone, but it’s a small trial and we don’t yet know the impact on disability rates.” A Phase III trial of this approach, called CLOTBUST-ER, is underway, with results expected in the next two to three years. Stenting vs. Carotid Endarterectomy
The Carotid Revascularization Endarterectomy Versus Stenting Trial, published in the New England Journal of Medicine in 2010, found that carotid endarterectomy was safer than stenting in patients older than 70. However, for those under age 70, stenting was marginally safer. “Endarterectomy decreases the risk of stroke but the use of anesthesia possibly increases the risk of myocardial infarct,” says Dr. Zangiabadi. “The implication is that patients with a history of myocardial infarct may do better with stent placement.” The American Academy of Neurology provides the following treatment guidelines: z Symptomatic patients that have >70% stenosis or those with 50% - 69% stenosis, a life expectancy >5 years and risk of stroke or death <6% should be treated with stent or endarterectomy. For stenosis <50%, mitigate risk factors only. z Asymptomatic patients with 60%99% occlusion, 40-75 years old, >5 year life expectancy, and risk of stroke or death <3% should have an interdisciplinary team determine if stent or endarterectomy is warranted.
“Anyone with greater than 60% stenosis should have additional imaging beyond an ultrasound,” Dr. Zangiabadi advises. “MR angiography (MRA) usually doesn’t require contrast and can be appropriate for older patients with lots of calcification or those with kidney problems. CT angiography (CTA) requires contrast. Carotid angiography is the gold standard but carries about a 1% risk of stroke, so it’s only recommended when MRA or CTA are inconclusive.” Interventional Thrombolysis Controversial
Interventional thrombolysis, where a catheter is inserted through the groin to directly deliver a clot-disrupting or retrieval device, is controversial. Newer generations of this approach may improve outcomes, and may be appropriate when pharmaceutical tPA is not effective. “The proven clinical benefit is only in a small population,” notes Dr. Zangiabadi. “The problem is that it takes time to transfer patients to tertiary centers performing this procedure, and it must be performed within six hours. All studies report good recanalization results but the clinical results are less clear. I refer selected patients, such as those with basilar artery thrombosis, where there’s about a 90% chance of mortality, but it should be evaluated on a caseby- case basis.” Stenting Intracranial Arterial Stenosis
The Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) study for intracranial arterial stenosis showed that stenting is not effective for treating intracranial carotid, basilar or middle cerebral artery stenosis. Dr. Zangiabadi concludes, “Stenting does more harm than good, and these patients tend to re-stenose. They should instead have their risk factors aggressively controlled.”
DEPRESSION: AN INDEPENDENT CARDIAC RISK FACTOR Adam Kaplin, M.D., PhD, assistant professor of Psychiatry and Neurology, The Johns Hopkins Hospital, is frustrated by the lack of awareness of the key role depression plays in cardiovascular disease. “Studies show that depression is an independent risk
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“Once you learn about treating depression, it’s incredibly rewarding, because it has such a positive impact on their overall health.” Mood 24/7 App
As an adjunct to in-person counseling, Dr. Kaplin worked with Health Central and Remedy Health to develop Mood 24/7, a simple smart phone app to help physicians track their patients’ moods. Patients can also use this app to track their own moods. The app sends patients a daily text message that asks them to assess their mood on a scale of 1 to 10, then reports the data to approved providers. The goal is to better inform treatment decisions and improve patient compliance. For more information, visit www.mood247.com.
Adam Kaplin, M.D., PhD, assistant professor of Psychiatry and Neurology, The Johns Hopkins Hospital
factor for cardiac morbidity and mortality as large as, or greater than, any other risk factor, including diabetes, hypertension and smoking,” he exclaims. “And in the 12 months following a cardiac catheterization, it’s the single greatest predictor of having a major cardiovascular event.” “Depression affects the brain, which in turn impacts the autonomic nervous system, and that affects the heart,” he adds. “Yet, in most residency programs, physicians get three years of internal medicine training without a single day of psychiatric training. We need to increase awareness of the importance of mental health on cardiovascular health.” Mechanisms Behind the Linkage
The relationship between depression and coronary artery disease isn’t completely understood. A 2011 article in Vascular Health Risk Management noted the following contributing factors: z Interleukin-6, an inflammatory biomarker associated with heart disease, was found in a small study to be significantly higher in those with major depression than in a control group. z Depression creates an imbalance of the sympathetic and parasympathetic systems, which is associated with great morbidity and mortality. z Platelet reactivity is higher with depressed patients, affecting atherosclerosis and thrombosis. z Genetic polymorphism in the serotonin transport promoter region gene was associated with a higher risk of depression and CAD.
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Screen for Depression
Dr. Kaplin advises primary care physicians to screen for depression as they would screen for hypertension or any other risk factors. He suggests that physicians can use Patient Health Questionnaire 2 (PHQ-2), the first two questions from the well-documented and highly effective Patient Health Questionnaire 9 (PHQ-9) to provide quick insight. “Using PHQ-2, you can ask patients two quick questions related to their mood over the past two weeks,” he says. “First, ‘how often have you felt little interest or pleasure in doing things?’ And second, ‘how often have you felt down, depressed or hopeless?’ If the patient answers ‘not at all’ to both questions (for a score of 0), no further follow-up is needed. If they indicate that either has been an issue, however, ideally the next step is to administer the full PHQ-9 or another depression screening tool.” A July/August 2010 study in the Annals of Family Medicine found that a score of 2 to 6 in the PHQ-2 had a specificity of 50% and a sensitivity of 90%. “Ideally, all of your patients should be screened for depression, using any of your favorite tools,” Dr. Kaplin recommends. “At the very least, physicians should screen everyone who has had a myocardial infarct.” He cites the rise in U.S. suicide rates, and the finding that two-thirds of individuals who go on to commit suicide visited their primary care physician in the month prior to their demise. Clinicians need to monitor patients’ moods outside the office, too,” he adds.
Barriers to Treatment
Dr. Kaplin notes that it’s challenging to demonstrate a statistically significant cardiovascular benefit to treating depression. “The problem is that, like investing money in the stock market, if you lost 50% of your money in Year 1, you have to increase your earnings by 100% in Year 2 to get back to zero. Similarly, it’s harder to demonstrate that a treatment for depression improves cardiovascular health (and thereby decreases risk by a certain percentage) than it is to prove that something is a risk factor , with the resulting increased risk. The SADHART study [Sertraline Antidepressant Heart Attach Randomized Trial] found that this antidepressant could safely treat patients with a recent MI or unstable angina, but it wasn’t statistically significant because the numbers were so small.” Another barrier to effective treatment is the lack of coordinated care between providers. While Dr. Kaplin believes electronic medical records are important to improving care coordination, he laments the small percent of hospitals that are storing psychiatric records electronically. “We did a study last year of the top 18 hospitals in the country, and found that only four of them stored their psychiatric records electronically. Those who did, however, saw a 40% drop in readmission rates among psychiatric patients.” Yet another major barrier to proper mental health treatment is the lack of compensation for time spent on those issues. The push for more accountable
and coordinated care provides some hope that these barriers will be better addressed going forward.
NEWER TECHNIQUES IMPROVE ATRIAL FIBRILLATION OUTCOMES If there’s one point to take away from a conversation with Jeffrey Banker, M.D., an electrophysiologist and heart rhythm specialist at the Heart Center at Sinai, it’s that paroxysmal atrial fibrillation is more dangerous than most physicians appreciate. “Most don’t realize that the five-year mortality rate reported in the AFFIRM trial that studied the pharmacologic management of atrial fibrillation in 4,000 patients was about 24%,” he cautions. “Anti-arrhythmic drugs maintain the sinus rhythm only about 10% to 20% of the time. The good news is that newer ablation techniques significantly improve the maintenance of sinus rhythm and therefore limit the progression of the condition, which carries a significant risk of stroke and worsening heart failure.” Paroxysmal atrial fibrillation (PAF) is believed caused by irregular electrical signals originating in the pulmonary veins. Ablating the tissue in these veins was found to stop or reduce these abnormal rhythms that then cause the atria to pump erratically and inefficiently. Fire and Ice
Catheter ablation is appropriate for many symptomatic afib patients who have failed cardioversion and antiarrhythmia medications. The original radiofrequency (RF) approach, available for more than a decade, uses a catheter that emits radiofrequency energy that renders atrial tissue participating in the afib no longer electrically active. Dr. Banker notes that this technique has drawbacks. “A limitation of the ‘fire’ approach to ablation is that it creates a set of tiny dots in a circle that are like Pointillism – from far away, they look complete, but when you get close, you see that the dots don’t connect.” That issue, plus the fact that the burned tissue may heal over time, allows the faulty electrical signal to resume in 10% to - 20% of cases within 24 months, and in half the cases within five years. And the procedure is time consuming, typically taking four to five hours. In contrast, a newer technique utilizes ‘ice’ rather than ‘fire’ to ablate tissue.
Amir Zangiabadi, M.D., director of Neuroscience and Stroke Services at Washington Adventist Hospital
Physicians insert a cardiac cryoablation catheter through the groin into the atria, where they deploy a balloon that freezes tissue in the pulmonary veins. “It’s like inserting an inflatable ping pong ball that fully covers the opening of the pulmonary veins,” Dr. Banker explains. “The cryoablation takes only about three minutes to get to minus- 3040 degrees Celsius and freeze a ring of tissue around the pulmonary vein. Experience has shown that tissue should be frozen and thawed twice to ensure tissue death. The whole procedure takes only about an hour.” For patients who have failed a cardioversion and two trials of antiarrhythmia drugs, it’s better to do the ablation procedure sooner rather than later. He remarks, “PAF can end up causing heart failure, and the cumulative risk of stroke, even with anti-coagulants, is 1% per year.” Ablation Far Safer Today
Dr. Banker notes that the evidence for the safety and efficacy of both types of ablation procedures has been mounting in the past 10 years. “The cryoballoon approach is proving to be highly effective and safe. The STOP AF [Sustained Treatment of Paroxysmal Atrial Fibrillation] trial found it effective in nearly 70% of cases, while antiarrhythmia drugs were only 7% effective. However, there’s no good long-term data yet to suggest that ‘fire’
is better than ‘ice’ or vice versa. A new European trial will be the first head-tohead trial. A laser and new RF device also will soon be available.” New techniques employed during ablation also make it far safer than it was a decade ago. “We now use intracardiac echo to avoid perforation and subsequent cardiac tamponade. We also avoid injuring the esophagus, which lies directly posterior to the left atrium, by inserting a temperature probe into it. We pace extensively so we can delineate and avoid injuring the phrenic nerve, which can cause diaphragmatic paralysis. Lastly, harm to the pulmonary veins can be minimized by ablating well outside them.” As a result, morbidity and mortality rates experienced from 2001 to 2010 have fallen significantly. “It takes extensive training to do these procedures well,” acknowledges Dr. Banker, “but patients who undergo PAF ablation now have a risk of stroke, heart failure and death that’s comparable to a similar population that does not have PAF.”
Amir Zangiabadi, M.D., director of Neuroscience and Stroke Services at Washington Adventist Hospital Adam Kaplin, M.D., PhD, assistant professor of Psychiatry and Neurology, The Johns Hopkins Hospital Jeffrey Banker, M.D., electrophysiologist and heart rhythm specialist, The Heart Center at Sinai
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G E N O M I C S A D VA N C E S :
Quest
The for Personalized Medicine PERSONALIZED MEDICINE is hardly a new concept. For decades, physicians have sought to identify inherited risk factors to better predict and prevent disease. Nonetheless, major advances in the field of genomics are paving the way for a far more sophisticated and widespread approach to personalized medicine. Claire Fraser, Ph.D., director of University of Maryland School of Medicine’s Institute for Genome Sciences, acknowledges, “Nothing has been more important in medicine than the family history. But because DNA sequencing has advanced so much in the past seven to eight years, and the cost of genome sequencing has come down to the point where we’ve crossed a price barrier. It’s not science fiction to think that genomics-based tests will be available in every hospital and many doctors’ offices in the future.” Dr. Fraser foresees a time when people routinely may have their DNA sequence analyzed as children or young adults, and then refer back to that information in their medical records for life. “The biggest bottleneck today is finding DNA sequence variants that are actionable,” she says. “But that will change. In the future, physicians will likely go back into their patients’ DNA sequence data on an ongoing basis for guidance on the most effective treatment for each individual.” GENOMICS’ ROLE IN PERSONALIZING TREATMENT There are a number of areas where genomics is bringing added value by identifying the best treatment for a given 14 | WWW.MDPHYSICIANMAG.COM
patient. Dr. Fraser remarks, “The low hanging fruit has been in cancer treatment, where specialists are folding in genomic information to better diagnose and treat many cancers. We’ve learned that not all prostate or breast cancer is the same, and that women with BRCA1 and 2 genetic variations are also at higher risk for ovarian cancer. But we have a long way to go. The decision about lumpectomy versus mastectomy may be easier in 10 years. “We’re using genomic tools to do molecular profiling, to further subclassify specific tumors,” she adds. Although we don’t always have enough information to know when to recommend a specific treatment based on the underlying genetic variants associated with a specific tumor yet, we will.” Where Dr. Fraser sees genomics making the greatest contribution is as a set source of additional information to help physicians make decisions. She explains, “If a physician sees two 40year-old patients, both of whom repeatedly have elevated cholesterol levels, which one should be started on a statin? If the genomic information is available, it could be revealed that one patient has five to six DNA sequence variants that put them at higher risk for an adverse cardiovascular event, thus indicating they should start treatment with a cholesterol-lowering drug sooner, while for the other patient, watchful waiting is appropriate. In most situations, genetic data doesn’t provide a black and white answer, but it should allow for more informed treatment decisions.”
THE MICROBIOME One burgeoning area of genomics research is the human microbiome – the plethora of microorganisms found in the gut, skin and vagina. The human genome is comprised of about 23,000 genes, while our gut microbiome alone contains an astonishing 3.3 million genes from bacteria and viruses. This field is one of Dr. Fraser’s particular areas of expertise. She points out, “Over the past 10 to 15 years, we’ve developed new approaches to study our microbial partners. Only 10% of cells in and on the human body are actually human – the other 90% are non-human microorganisms.” Research is just beginning to uncover the role of these microorganisms in health and disease, and reveal how their influence extends beyond our gut. In contrast to old-school thinking that the immune system evolved to control microorganisms, there is now evidence that these microbes co-evolve with, and contribute to, immunological, metabolic and neurological processes. “One theory is that the gut microbiota in healthy individuals exist in perfect equilibrium, and keep inflammation in check,” explains Dr. Fraser. “An imbalance in this equilibrium may trigger a cascade of events that affects immune cells circulating throughout the body. For example, a change in microbial colonization of the gastric tract has been found to be associated with celiac disease and inflammatory bowel disease.” Dr. Fraser notes, “The bacterial composition of our gut may protect against or contribute to many disorders. Currently, several clinical trials are investigating the effects of probiotics. I think in the near future, we’ll look at the microbiome as an important measure of health, and patients will provide a routine fecal sample at their annual history and physical for evaluation of the status of the gut microbioma. COMMUNITY TYPES OF MICROBIOTA “We’ve found that two to three community types are present in the human gut,” she continues. “Each human has one of these community types, which share common functional capabilities such as the metabolism of carbohydrates and fats, but which may differ in the ways in which they metabolize drugs and other compounds that we ingest, including potential carcinogens. These microbial
communities are very active metabolically, and large numbers of bacterial metabolites likely serve as signals to us as their hosts. If we eat glucose, for example, we suspect that our gut microbiota contribute to the overall response to release insulin. As discussed in “Stopping Infectious Diseases” in the November/December 2013 issue of Maryland Physician, fecal transplantation is emerging as an accepted method to restore healthy microbial communities in patients with Clostridium difficile-associated diarrhea, and perhaps eventually other inflammatory bowel diseases. Says Dr. Fraser, “This opens up an alternative approach to treating immune diseases that may complement drug therapies that modulate immune pathways.” Even plant viruses, which contribute as much as 95% of the viral DNA in the human gut, may be involved in human health and disease. In the future, they may help explain why smokers’ risk of certain neurodegenerative diseases, such as Parkinson’s or Alzheimer’s disease, is lower – one of the few pieces of good news for smokers. Dr. Fraser speaks to the link between our microbiome and nutrition, explaining, “As we better understand how our gut microbes function, we can move towards a nutrigenomic approach to diet and health. Incorporating all of this genomic data into one’s medical practice has huge potential, but is also hugely challenging.” AMERICANS SUFFER DIMINISHING MICROBIOME DIVERSITY A number of microbiome studies show that following use of a broad-spectrum antibiotic, some individuals’ gut communities are never restored to what they looked like prior to administration of the antibiotic. The hypothesis is that the complexity of the human microbiota is diminishing due to the collateral damage that occurs following exposure to antibiotics in our food supply, growing use of antibacterial soaps and sanitizers, and limited exposure to bacteria early in childhood. “Unfortunately, we appear to pass this reduced diversity in our microbiota on to our children,” laments Dr. Fraser. “Studies have compared U.S. infants to those in developing countries and found that our microbial communities are far less diverse, and therefore inherently less stable than theirs. The first few years of life are a critically important time
because the immune system is maturing. If we’re not exposed to microbes, our immune systems may come to view them as foes and we can develop problems such as asthma later in life. For example, studies have shown that the best way to decrease asthma in children is to have a dog or cat. “There are even some intriguing links between gut microbiota and autism,” Dr. Fraser adds. “Perhaps the rise of ADHD will be found to link, at least in part, to microbiomes.” IDENTIFYING POSITIVE GENES While most of the focus today is on identifying genetic factors that increase our risk for disease, there is a growing search for genetic factors that keep us healthy. “We tend to think about genetics’ negative effects,” observes Dr. Fraser, “yet it also has positive impacts. One of my University of Maryland colleagues, Dr. Scott Devine, is studying a group of centenarians in a search for longevity genes. They’ve found a few hundred sequence variants that may contribute to longevity. Some of these have been mapped back to known pathways with the very real possibility that we can find protective alleles. At least one protective allele for breast cancer has been identified.” Studies by the Einstein Institute and Boston University also have identified favorable alleles, such as variants of APOC3, IGF-r and CETP, that are associated with a lower risk of heart disease, diabetes and dementia. With the potential for genomics to do everything from replacing amniocentesis to understanding the environmental triggers for rheumatoid arthritis, Dr. Fraser sums up the current state of genomics by noting, “The field is moving quickly, so stay tuned. Physicians will soon begin to incorporate all of this genomic data into their practice.”
Claire Fraser, Ph.D., director of University of Maryland School of Medicine’s Institute for Genome Sciences. IGS uses large-scale, cuttingedge experimental and computational tools to better understand gene and genome function in health and disease, to study molecular and cellular networks in a variety of model systems, and to generate data and resources of value to the international scientific community.
JANUARY/FEBRUARY 2014
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Healthcare IT
M EANINGFU L U SE STAGE 2:
Are You Ready? Providers Grapple with Diminishing Incentives
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OR PROVIDERS WHO HAVE been on the leading edge of the curve, 2014 brings an opportunity to attest for Stage 2 of Meaningful Use. Maryland Physician asked several Maryland physicians what it may entail and whether attesting is worthwhile. Starting this year, providers who have met Stage 1 for two to three years are eligible to attest for Stage 2 – a delay of one year from the planned start date. This year only, providers can wait until the last three months of 2014 to attest. The structure of Stage 2 is similar to that of Stage 1, where providers report on a series of ‘core’ measures, as well as selecting from ‘menu’ objectives. Stage 2 involves 17 core and three menu objectives. The stated goal of the Centers for Medicare and Medicaid is to increase ‘patient and family engagement’ and to ‘improve patient care through better clinical decision support and care coordination.’ (See the sidebar on page 17 for highlights and visit www.cms.gov 16 |
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BY LI N DA HA RD ER
for a complete listing of Stage 2 requirements, as well as other resources.)
Stage 2 Incentives and Penalties Joseph Weidner, Jr., M.D., FAAFP, a family practitioner at Stone Run Family Medicine, a two-physician practice in Rising Sun, says, “If you’ve had two to three years of payments under Stage 1, you’ll have to weigh the expense of attesting to Stage 2 against the payments. If you started receiving payments in 2011 for Stage 1, payments for attestation in Stage 2 will only be $4,000 in 2014, and $2,000 in 2015.” Jesse Sadikman, M.D., is a managing partner of Family HealthCare, a sevendoctor family practice group with offices in Germantown, Rockville and Olney. His practice has had electronic medical records (EMRs) since 2006, and four of their physicians have attested to Meaningful Use for three years. He says, “The Meaningful Use dollars have helped offset many of our costs to
date, but it won’t be sufficient going forward. Some of the changes have made us more efficient, helping to mitigate our expenses, but although we’ll likely move forward to attest for Stage 2, I can understand physicians who question the benefit.” Most providers can’t afford to ignore Meaningful Use, however, as, with some exceptions, most physicians who don’t meet Meaningful Use by 2015 will be subject to a 1% penalty that will increase in subsequent years.
Will Stage 2 and PQRS Measures Be Aligned? The Physician Quality Reporting System (PQRS) allows physicians and groups to earn incentive payments equal to 0.5% of their total estimated Medicare Part B Physician Fee Schedule allowed charges. The Affordable Care Act created several upcoming changes to the PQRS program, including 1.5% payment penalties for non-participating physicians in 2015, and 2% in 2016 and
beyond. Since 2010, physicians have been able to earn their incentives using an EMR-based reporting system or through data extracted from their EMR vendor to a qualified EMR submission vendor. “Under PQRS,” Dr. Sadikman notes, “doctors who don’t participate will be penalized moving forward, with a decrease in payments beginning 2015. Hopefully, PQRS and Stage 2 measures, which have some of the same measures today, will be aligned going forward.”
Challenges and Rewards “In Stage 1,” says explains Dr. Sadikman, “we’ve had a number of challenges and workflow issues. Printing out a summary of the patient’s visit takes time, but it’s good for patients to be able to access their medical records – after all, the goal of all this is to improve accuracy and coordination of care. Personally, my goal going forward is to use our system to better analyze our data and better define high-risk patients. We’re in the Carefirst Patient Centered Medical Home program, and the care managers assigned to us have been a huge benefit. Patients benefit.” Like many of the providers interviewed by Maryland Physician, Dr. Sadikman has found the data from CRISP (Chesapeake Regional Information System for Our Patients), the state Health Information Exchange, to be extremely helpful. He states, “We’re getting encounter notification data from CRISP real-time, which will hopefully decrease readmissions and improve care coordination.” In late 2013, his group began importing continuing care documents (CCDs) via the CRISP network. “We’re able to download them, and it’s very exciting to get these documents from the hospitals where our patients are being discharged,” he enthuses. Dr. Weidner points out that reporting on some measures may be a challenge, even when providers are performing them. “Take smoking cessation, for example. I may look at the chart and note that the patient does not smoke, but fail to record that information into the patient record for that visit. Depending on your system and your capacity, you may need front desk staff to help meet some of the Stage 2 requirements, including merging lab information.” Another factor influencing a practice’s
ability to meet Stage 2 is patient participation. Dr. Weidner’s practice has used Allscripts Pro for many years and is generally happy with the system. “I see where the faults are, but I’m not miserable enough to change EMRs. We’ve had a patient portal for about a year, and have seen some efficiencies and improvement in patient satisfaction. However, while patient usage of the portal is rising, still only about 30% of our patients use it. “Our workflows would be more predictable if that rate were higher,” he continues. “We can send a web message to patients when their lab results are in, for example, but about two-thirds of the time, the patient isn’t on the portal so it doesn’t get to them electronically.” According to Dr. Weidner, “What helps a lot is to have some structured reporting in your EMR. I can see where I stand pretty easily, or see where I need to change.” In his opinion, those who are looking to purchase or change an EMR would do well to consult the American Academy of Family Practice’s website, which has a Family Practice Management collection of articles on EMRs. “It’s the best EMR guide for family practice out there,” he says. Dr. Sadikman anticipates that the most onerous aspect of Stage 2 will be reporting to the state registries. “We’re concerned about some of the requirements to report cancer cases to the state registry. Will it be practical to
set it up, given the cost on our end? Our costs aren’t insignificant – licensing software, ongoing maintenance of hardware, the patient portals, etc. – it’s a lot of money.” “Do EMRs and Meaningful Use improve care?” Dr. Sadikman asks. “Probably. The concept in general is good. But connecting all of the disparate systems is the next challenge, and to me, the most exciting piece.” He concludes, “My staff wouldn’t go back to paper. The EMR has streamlined our messaging, and we’re truly paper-free. Meaningful Use, to me, is less important than the EMR itself. If you’re using the EMR correctly, you’ll likely meet Meaningful Use. And that helps you attest for the state EMR measures, which provide additional incentive dollars.2” Joseph Weidner, Jr., M.D., FAAFP, is a family practitioner at Stone Run Family Medicine. Jesse Sadikman, M.D., is a family practitioner and managing partner at Family HealthCare. 1 Adapted from www.cms.gov information on Stage 2 requirements 2 The State-Regulated Payer EHR Adoption Incentive is a one-time incentive for eligible primary care practices, which can receive a Base incentive up to $7,500 and an additional incentive up to $7,500 for a total maximum of $15,000/practice/payer. The Base incentive is calculated by the number of payer members treated by the practice on a per member amount. Incentives are calculated at $8 per Maryland resident on the practice panel who is a member of the payer at the time a practice requests payment. The deadline for submitting an application to the state is Dec. 31, 2014. For more information, contact Sarah Orth, chief, Health Information Technology, at 410-764-3449 or sorth@mhcc.state.md.us.
HIGHLIGHTS OF KEY CHANGES UNDER MEANINGFUL USE STAGE 2 ‰ Use computerized provider order entry (CPOE) to record > 60% of medication and 30% of lab and radiology orders. ‰ Provide > 50% of patients the ability to view online, download and transmit their health information within four business days of the information being available to the eligible provider. ‰ Provide > 50% of patients with clinical summaries within one business day of each office visit. (vs. three business days in Stage 1) ‰ Incorporate > 55% of clinical lab test results into the EHR as structured data. ‰ Generate lists of patients by specific conditions to use for quality
1
improvement, reduction of disparities, research or outreach. ‰ Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients reminders. ‰ Compare > 50% of permissible prescriptions to at least one drug formulary and transmit them electronically. ‰ Implement five clinical decision support interventions related to four or more clinical quality measures, if applicable. ‰ Successful ongoing submission of electronic immunization data.
JANUARY/FEBRUARY 2014
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Living
Setting Sail Straight Out of Charm City By Tracy M. Fitzgerald
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OMETIMES THE PROCESS of getting away to a place that is warm, sunny and tropical starts with the “hustle and bustle” of navigating through a busy airport, or two or three, depending on the flight itinerary that will get you to your final destination. Other times, getting to that sweet spot in the sand, with crystal clear blue water straight ahead, requires nothing more than a quick drive to the Port of Baltimore, where you can hop aboard one of the massive cruise ships, docked and ready to set sail out of Charm City. The Port of Baltimore was established over 40 years ago, but the city’s more official mark on the map of east-coast cruise terminals came about in 2006, when Cruise Maryland opened, creating a larger and more robust space for major cruise lines to call home. In 2014, Royal Caribbean Cruise Lines’ “Grandeur of the Seas” and Carnival Cruise Lines’ “Carnival Pride” will sail year-round from Baltimore, giving residents of Maryland and the surrounding states a convenient access point for cruising to some of the world’s most sought after vacation destinations. “Sailing from the Cruise Maryland terminal saves money and time for travelers,” said Cindy Burman, general manager for Cruise Maryland. “It’s an easy, affordable and exciting vacation option, and we pride ourselves on the ease of cruising from Baltimore.” Passengers who sail from Baltimore can choose from a number of itineraries, with Bermuda, the Bahamas, and the eastern and western Caribbean among the destination points available throughout the year. A limited number of north-bound voyages are also available, taking passengers to hot spots in the New England and Canadian 18 | WWW.MDPHYSICIANMAG.COM
The Carnival Pride and Royal Caribbean’s Grandeur of the Seas sail year-round out of the Port of Baltimore.
territories during the cooler months. As cruise vacations have grown in popularity, Cruise Maryland has implemented a number of facility and customer service enhancements, to improve the passenger experience and encourage more Marylanders to consider cruising for their next vacation. “We have in-terminal seating for 1,000 and recently invested in a temperature-controlled boarding bridge to improve passenger comfort and convenience,” said Burman. “We also make parking and luggage handling very easy and convenient. Once you pack your bags into your car, you don’t have to touch them again until you get to your stateroom. It can be as heavy as you want and you can pack as many bags as you need; our porters are great and will take care of unloading them and getting them onto the ship for you.” The list of benefits associated with choosing a cruise vacation is nearly as lengthy as the itinerary choices. For starters, cruising allows passengers to see multiple destination points, and to experience a diverse range of geographical locations, as opposed to a more traditional vacation that is centralized in one spot. Many are also drawn to the “all-inclusive” nature of the cruise industry, which packages accommodations, unlimited food,
entertainment and many on-board activities all together at one price point. Others rave about the flexibility of cruising and all the choices that are available for those long days at sea (a major pro for families or groups with varied interests). While one person may choose to pack their day with activities ranging from rock climbing and dancing, to rolling a few spins on the roulette wheel, another may prefer to kick back and relax at the spa, in a hot tub or with a good book in hand, snuggled up in an ocean-view lounge chair on the top deck of the ship. “Cruising is the best way to vacation for a family, a couple or a single person because it offers something for everyone, at every level,” said Burman. “You will experience an unbelievable, unforgettable stress-free vacation with excellent entertainment, dancing, spas, shore excursions and of course the best in casual and fine dining, just to name a few reasons why so many people love to vacation this way.” The Cruise Maryland terminal is located just off Key Highway in Baltimore. For more information and a complete listing of sailings scheduled to depart from Baltimore in 2014, visit the Maryland Department of Transportation’s Port Authority website at www.cruisemaryland.gov.
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Solutions
Revenue Cycle Management Improves Practice Performance
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By Kem Tolliver
EVENUE CYCLE MANAGEment (RCM) is the supervision of all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue.*
Key Components of RCM:
z z z z z z z
Intake/Time of Service Collections Charge Capture/Order Entry Charge Description Master/Coding Billing Pre-Audit Claims Submission Claim Adjudication/ Explanation of Benefits (EOB)/ Electronic Remittance Advice (ERA) z Payment Posting z Accounts Receivable Collections Maryland is in a unique healthcare reimbursement environment: The Health Services Cost Review Commission controls reimbursement. Eight percent of Maryland’s GDP derives from healthcare and social assistance, and reimbursement is shifting from fee for service to pay for performance. It is more important than ever to take a fresh look at the management of your revenue cycle and capitalize on improvements. Intake/Registration
Leverage technology to streamline intake. Ensure that intake forms collect all necessary information for accurate claims filing and medical record documentation.
eligibility, benefits, co-payments and co-insurance. Charge Capture/Order Entry
Consider automating the entire charge and order entry process. Entering and reconciling all charges by the close of business each day minimizes errors and payment delays. Charge Description Master/Coding
With ICD-10 effective on October 1, 2014, the Charge Description Master (CDM) will increase from 14,000 to 67,000 codes. Initiate discussions with your EMR and practice management vendors to determine their capability of accurate electronic diagnosis coding. Updating the CDM should coincide with annual coding changes and follow National Correct Coding Initiative edits.
Payment Posting
Selecting the appropriate posting codes allows tracking and trending of denials and payments. During payment posting and EOB analysis, staff can avoid posting errors by accurately calculating the correct insurance payment, contractual adjustment and patient liability. Accounts Receivable Collections
Billing Pre-Audit
Have staff review and correct information being sent to payers for reimbursement. Areas for review PRIOR to claim submission include: z z z z z z z z z
Spelling of patient’s name Member ID and subscriber info Diagnosis, CPT and HCPCS codes Rendering and referring providers NPI/provider numbers Medical claims address/EDI number Referral/authorization number Medical record documentation Patient’s address and contact information
Time of Service Collections
Your staff and patients should be aware how much is owed prior to providing services. Keep up-to-date payer fee schedules at the front desk for co-insurance collection. Since many employers are selecting high-deductible plans, insurance verification plays a major role in determining deductibles,
payments should be reconciled daily. ERAs greatly increase cash-flow and minimize posting errors. As most insurers will electronically pay an electronic clean claim within two weeks of submission, signing up for electronic payments is recommended. Proper filing and recording EOBs permits future retrieval and accounts receivable (A/R) followup.
Claim Submission
The clearinghouse provides a claim submission report. Have errors corrected and resubmitted ASAP. Keep claim submission reports for proof of timely filing. EOB/Electronic Remittance Advice (ERA)
Explanation of Benefits (EOBs) and
*(Source: AHIMA. 2009. Principles of Healthcare Reimbursement)
Medical practices need a written policy for writing off A/R. Depending on your corporate structure (S Corp, C Corp, LLC) and accounting preference (cashbased or accrual), A/R may play a factor in taxable income. When prioritizing accounts for follow-up and collections, consider aging, dollar amount, payer, service, and resolution complexity. Snapshot of Aging Accounts Receivable
0-30 days: Pending insurance payment 60-90 days: Contact payer/initiate resolution 90-120 days: Past due/collections actions The revenue cycle is not complete until a claim is resolved – preferably by payment. Every patient contact is an opportunity to gather information that may enhance your revenues and make your practice more profitable. Kem Tolliver is the president of Medical Revenue Cycle Specialists. She can be reached at kem@medrevenuecycle.com.
JANUARY/FEBRUARY 2014
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Good Deeds
Red Dress Sunday Raises Awareness About Prevalence of Heart Disease By Tracy M. Fitzgerald
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efforts. Each church independently plans a series of activities for Red Dress Sunday, ranging from mini health fairs or blood pressure screenings, to cooking and exercise demonstrations, guest speakers or specially selected readings or hymns that Saint Agnes Hospital has been promoting Red Dress embrace the “heart” theme. Sunday in area churches for the past 10 years, with a goal “We hear a lot about to raise awareness of the prevalence of heart disease and cardiovascular disease and the to inspire women to make healthy lifestyle choices to importance of maintaining prevent the development and progression of the disease. good heart health during Blood Institute, the American Heart American Heart Month in February, Association, the American Diabetes which is great,” said Dr. Winakur. Association and the Baltimore City “But we need to keep the message alive Health Department are represented, throughout the year. Our hope is that as well as councilwomen, delegates and women take the information they learn other local VIPs. on Red Dress Sunday, share it with “These activities are crucial to the others, and apply it to their lives every health of our community. Heart disease day, every week and every month of is a prevalent and growing health crisis, the year.” specifically right here in Baltimore where As Saint Agnes celebrates the 10th some of the highest premature death anniversary of Red Dress Sunday, the rates are seen,” said Carlos Ince, M.D., hospital’s leadership team is looking chief of Cardiology at Saint Agnes Hospital. “You really start to understand “Through Red Dress Sunday, we are helping the impact of what we are doing when a people understand their risk factors and educating patient tells you that they came in to be the women in our community about the steps screened because of what they learned they need to take to live healthier and protect on Red Dress Sunday, or because they received information about heart health their hearts.” Shannon Winakur, M.D. from someone who serves on our Honorary Committee. It’s powerful. for ways to engage more people, “Through Red Dress Sunday, we are It’s helping save lives,” he concluded. evolving it from an event that is held helping people understand their risk For further information and tools in area churches to a program that factors and educating the women in our about cardiovascular health and wellness is available to and embraced by the community about the steps they need to community at large. A Red Dress Sunday from Saint Agnes Hospital, visit take to live healthier and protect their www.RedDressSunday.com. “Honorary Committee” was established hearts. The more people we connect this year to give local community with, the more impactful we can be.” leaders, who share a common interest in Local churches that participate in Maryland Physician would like to cardiovascular wellness and community Red Dress Sunday have access to an hear about your “Good Deeds.” array of materials and tools, provided by health, an opportunity to come together Please share your ideas with us at and share best practices. Organizations Saint Agnes, to help support their event news@mdphysicianmag.com. such as the National Heart, Lung and planning and ongoing health education
ACH YEAR, MORE American women die from heart disease than any other chronic illness or health condition. Saint Agnes Hospital is on a mission to change that statistic. Ten years ago, the hospital launched Red Dress Sunday, a faith-based program designed to educate the community about the prevalence of cardiovascular disease and the critical importance of early detection, while motivating women to make positive lifestyle choices and changes to keep their hearts healthy. This year, over 130 congregations will take part in Red Dress Sunday, exposing thousands of local women to the lifesaving message that Saint Agnes originally set out to deliver. “Heart disease is sometimes called ‘the silent killer’ because in many cases there really are no signs or symptoms to indicate a problem, until a heart attack or other life-threatening incident occurs,” said Shannon Winakur, M.D., medical director of the Women’s Heart Center at Saint Agnes Hospital.
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