Mortality, costs higher for women with cardiovascular disease

HEART DISEASE SHOULD top the list of women’s health concerns. Women disproportionately fear dying from breast cancer compared to heart disease, dutifully scheduling annual mammography, oblivious to their cardiovascular risks. There is little demand by women and the medical community for an urgent agenda or a “march for the cure” for heart disease in women.

Cardiovascular disease (CVD) is the single most common cause of death in women and men. Despite widespread assumptions to the contrary, women have accounted for more than one-half of the almost 1 million deaths due to heart disease and stroke in the United States annually since 1984. Women, compared to men, especially those under the age of 50 years, experience higher rates of recurrent myocardial infarction, heart failure and mortality after a first myocardial infarction, and are more likely to be misdiagnosed or diagnosed late in the course of their illness.

Annual hospitalizations and mortality for heart failure and total CVD expenditures are greater for women than men. While mortality from cardiovascular diseases has significantly declined over the past three decades, women have not experienced the same reductions in death and disability as have men. This significant gender-related mortality gap persists due to a combination of low awareness, misconceptions by physicians and women, gender-based physiologic differences, and disparities in care.

While these data might initially appear discouraging, improving these measures represents a significant opportunity to improve women’s CVD outcomes as well reduce overall healthcare expenditures by providing optimal screening and preventive services, appropriate and accurate diagnostic tests and timely cardiac care.

LESS THERAPY FOR WOMEN

The underlying causes for these disparities are multifactorial and the solutions complex. Gender-based disparities in preventive, diagnostic and therapeutic interventions are present on multiple levels. Women receive fewer cardiac diagnostic evaluations and less intensive therapy, from preventive interventions, to revascularization procedures to aspirin prescriptions. Even after a diagnosis of heart disease, gender-based differences in provision of care are present.

Women hospitalized with myocardial infarction are more likely than men to be managed by generalists, rather than referred for cardiology consultation, and are less likely to be transferred from community hospitals to centers for advanced care—practices associated with poorer short-term outcomes.

Additionally, societal and individual misconceptions about cardiovascular risk and what a heart patient “looks like,” along with inadequate gender-specific research data on cardiovascular disease and risk factors, contribute to lower awareness and poorer outcomes. While women’s symptoms can sometimes be challenging to address, both women and their physicians can be too quick to attribute potential manifestations of cardiac disease to menopause or aging. It is important to counteract the widely held belief that women do not develop heart disease except at advanced ages by raising physicians’ “index of suspicion” for cardiovascular disease in women.

There is also a growing body of literature documenting important biologic gender differences in CVD that may impact clinical care delivery. There are obvious differences due to the effects of gonadal hormones. However, differences in symptoms, accuracy of diagnostic tests, response to therapy, prevalence and relative risk of cardiovascular risk factors, as well as social and behavioral issues have all been identified. It is not always apparent whether or not these differences warrant a variation in established practice.

Many early cardiovascular clinical trials routinely exclude women or make no effort to enroll women in sufficient numbers to draw gender-based conclusions. With few exceptions, women currently make up only 20% to 30% of participants in cardiovascular clinical trials. Even when women are included as research subjects, it is often difficult to determine their outcomes from published reports. Only a quarter of recent cardiovascular trial results published in major U.S. internal medicine and cardiology journals reported gender-specific outcomes.

The lack of relevant research in women has resulted in a substantial and persistent gender-based knowledge gap about everything from the symptoms of heart attack in women, to the risks and benefits of commonly used cardiovascular diagnostic tests and therapies. Better evidence from properly designed research studies can better serve women with CVD.

An important example is the National Heart, Lung and Blood Institute (NHLBI)-funded multi-center Women’s Ischemic Syndrome Evaluation (WISE) study of approximately 900 women who underwent coronary angiography for chest pain symptoms and a multitude of other investigations designed to better characterize ischemic heart disease in women. We have already learned a great deal from numerous WISE publications that have underscored the value of gender-specific research and fundamentally changed the understanding of chest pain, CVD risk factors, vascular function, hormone interactions and atherosclerosis in women.

Cardiovascular clinical trial design must include women in adequate numbers to provide gender-specific data, and that data must be analyzed and reported by gender.

Systemic contributions to differences in cardiovascular care for women also include physician practice and referral patterns. In the United States, many women receive all or most of their medical care from specialists in obstetrics and gynecology during their reproductive years and continue those relationships well past menopause, or until a significant non-gynecologic illness occurs. Traditionally, there has been a greater focus on reproductive and breast health than on other health risks, and less awareness and self efficacy among these specialists about early cardiovascular risk identification and treatment.

RISK FACTORS ON THE RISE

The rise in risk factor prevalence in younger women, especially smoking, obesity and diabetes, has led to a growing number of individuals at high risk who do not look like typical heart patients. Reducing women’s future burden of CVD will depend heavily on improved preventive measures which currently fall short of recommendations. Simply taking what has been proven effective, and widely and appropriately applying it to women, can markedly improve care and outcomes.

Critical to this effort is continued education about women’s cardiovascular risks, symptoms and the use of appropriate diagnostic tests and therapies.

The most recent guideline, published in 2007 by the American Heart Assn. and endorsed by multiple professional and patient organizations, has simplified the risk assessment and decision-making process for easier implementation in daily practice.

The guidelines encourage clinicians and patients to focus on reducing long-term, rather than 10-year CVD risk. With few exceptions, those therapies that have been shown efficacious in men also prevent CVD in women and should be recommended to women at risk.

Sharonne Hayes, MD, FACC, is the director of the Mayo Clinic Women’s Heart Clinic and associate professor of medicine for the Mayo Clinic College of Medicine.

No-shows at public hearing not making any friends

Massachusetts Governor Deval Patrick appears to be fighting the good fight, even though it’s making an awful lot of healthcare organizations rather uncomfortable. In October, Patrick and the state’s division of insurance began examining drivers of higher coverage costs for small business in order to find ways to make coverage more affordable. But that probe has now led to a broader, stickier investigation.

As you know, Massachusetts has an individual mandate, which has successfully pushed coverage above 90%, but the state continues to struggle with increased demand and associated additional costs. The state has a concentration of academic medical centers and some of the highest costs in the nation, dating back even before the mandate took effect.

As part of the state’s investigation, hospitals and health plans were invited to a series of public hearings to discuss rising costs at the system level. While the invitations weren’t summonses, they weren’t exactly friend requests either.

The Boston Globe slammed the many state hospitals that were invited and overtly failed to show up. In fact, even after a condemning news story identifying the first day’s no-shows by name, only eight hospitals out of the 70 that were invited ultimately showed up for the subsequent hearings.

LONG LIST OF QUESTIONS

I called up Lora Pellegrini, acting president and CEO of the Massachusetts Association of Health Plans, to find out what was going on. She says invitations were sent by the division of insurance in late December, and sample questions were provided in advance. Health plans received 60 questions to discuss at the hearings, such as how they arrive at prices for specific products.

“Our member health plans spent thousands of hours preparing for the hearings,” Pellegrini says.

The fact that the hospitals didn’t attend could be viewed as a refusal to cooperate or as a suspicious action among organizations that have something to hide—which is ironic since health plans are often accused, rightly or wrongly, of doing just that.

Here’s a situation where the health insurers were at the table, willing to be reasonably open with policymakers, and the providers were not. Criticizing hospitals and physicians who work passionately to save lives and reduce pain might be seen as distasteful, but they probably deserved it in this case. In their defense, many hospital executives claimed scheduling conflicts were the problem.

For high-level discussions—such as public hearings that the division of insurance and the governor invite you to—it would seem to be in the best interest of all the stakeholders to participate, even if their only motive is to show their faces. Perhaps the scrutiny often directed toward “greedy” insurers will start shifting onto providers.

PROVIDE POSSIBLE SOLUTIONS

Pellegrini says her association’s member plans operate on 2% margins, and 90% of their premium dollars are spent on medical services. Many are not-for-profit companies and all are as transparent as contracts will allow, she says.

She seemed a little frustrated by the hospitals’ lack of cooperation, and recommends that health plans in other states take the high road if faced with a similar situation.

“Try to provide solutions,” she says. “Operate your business in a way that you don’t have anything to hide.”

Julie Miller is editor-in-chief of MANAGED HEALTHCARE EXECUTIVE. She can be reached at julie.miller@advanstar.com [julie.miller@advanstar.com]

Julie Miller

OR Technology: A Glimpse Into The Future

As we move into 2010, a new wave of technology awaits us. Highly-developed health information technology (HIT)-driven systems and equipment are becoming the standard in many operating rooms (ORs), whether they are in a single-specialty ambulatory surgery centers (ASCs) or advanced surgical hospitals. It is important to stay up-to-date on these new technologies which not only reduce medical errors, but improve patient comfort and post discharge follow-up. The following case studies highlight this trend.

Enhancing Communication, Collaboration and Education: An Olympus Case Study

Three years after adopting integrated ENDOALPHA ORs, Penn State Hershey Medical Center is ready for more. As the only teaching hospital in central Pennsylvania, Penn State Milton S. Hershey Medical Center is one of the area’s largest healthcare providers. The hospital is equipped with 23 surgical suites and its department of surgery performs more than 19,000 procedures annually.

Staying Ahead of the Technology Curve

As industry trends move toward minimally invasive techniques, the hospital was quick to understand the benefits of integrated surgical suites as a way to stay competitive with the specialized technology demands of increasingly sophisticated procedures. “Several years ago, we realized we had a need for advanced, integrated technologies in our OR as we anticipated the convergence of laparoscopic and flexible endoscopic instrumentation,” says Randy Haluck, MD, professor of surgery and division chief for minimally invasive surgery and bariatrics. “We also recognized the need for a sophisticated system relative to data acquisition, storage, and transfer.”

Penn State Hershey began the process of integration in 2005, building three new Olympus ENDOALPHA surgical suites in 2006 and then converting two existing ORs to ENDOALPHAs the following year. The hospital anticipates completion of four more integrated ORs, for a total of 27 surgical rooms with one-third of them set up as state-of-the-art ENDOALPHAs this year.

Taking a Comprehensive Approach

True systems integration goes beyond the equipment and operating platform. It also takes into account the ergonomic design, workflow and technology optimization of each surgical suite. This means designing rooms with ceiling-mounted booms for holding imaging equipment and monitors off the floor, allowing for more efficient post-procedure clean-up and ergonomic positioning of monitors during the procedure. It means integrated equipment (scopes, imaging platforms, monitors, video and accessories) that work together and can be easily interchanged during a procedure. And it means a cohesive information management system for patient and procedural data, images, and audio that can be captured, stored, and retrieved from both inside and outside the sterile field. “We needed to have multiple surgical services using the same operating room, between general surgery, urology and minimally invasive GYN surgery,” says Gerald Harkins, MD, medical director for minimally invasive GYN surgery. “We’re all able to function in the ENDOALPHA laparoscopic suites, and it’s been a fantastic platform for that utilization.”

Experiencing the Installation Process

Olympus offers turnkey solutions, working with customers from start to finish on the design, construction and set-up of integrated operating and intervention rooms. “The flexibility of Olympus’ ENDOALPHA system means it can be easily customized to create a right-sized solution unique to each facility,” says David Alexander, Penn State Hershey’s Olympus integration consultant. “We were able to incorporate their legacy equipment along with their pre-existing video-conferencing system and streaming video package into their ENDOALPHA ORs to create one seamless solution. Hershey proved to be very knowledgeable, so it was a highly collaborative effort.”

Taking Centralized Control

The nerve center for each ENDOALPHA OR is a centralized control panel. With audio, video, data and images all controlled via a single touch screen, clinicians have the power to connect, communicate and collaborate with others outside the procedure room. Clinicians can also control surgical and room lighting, in-room observation cameras and all information and imaging systems without ever leaving the sterile field. To further enhance efficiency, the ENDOALPHA system provides preset capabilities so that monitors, lighting and all equipment can be custom-tailored to surgeon preferences and made available at the press of a button.

Communication, Collaboration, and Education

Penn State Hershey Medical Center’s custom-placed displays ensure all team members have the perfect view of live images. They regularly create video networks for sharing, collaboration and education from within and outside the hospital. “There’s no question that the Olympus system has dramatically changed how we teach in the OR,” says Peter Dillon, MD, chairman of Penn State Hershey’s surgery department and surgical director of perioperative services. “We’re now able to broadcast these procedures to first- and second-year medical students, exciting them about the wonders of surgery at a much earlier stage in their training. So it really has changed dramatically and in a very exciting fashion how we teach.” Haluck adds that it also gives the Penn State Hershey team a better way to collaborate with other physicians and share information with patients. “We can educate other physicians and record images for colleagues or bring them in when needed to confer and/or assist on a procedure. We are also able to show patients what their surgery was about and why they were having problems. That’s a great benefit to us, and certainly patients appreciate it as well.”

Interventional Radiology Breaks New Ground: A Skytron Case Study

Philips and Skytron have teamed up to help fully realize the promise of a hybrid angiography suite by implementing new cardiovascular solutions with the latest Allura Xper FD technology from Philips and state-of-the-art surgical lighting and boom technology from Skytron.

For more than a decade, Barry T. Katzen, MD, medical director of Baptist Cardiac and Vascular Institute (BCVI) in Miami, has pioneered the integration of surgical and interventional procedures. Katzen and his team continue to show that surgical procedures in an angiographic environment can be accomplished with the same degree of efficiency as in an OR.

“The specialties of interventional radiology and vascular surgery bring more to each other when we work together,” Katzen says. “Procedures that help drive this relationship include aneurysms of the thoracic aorta and abdominal aorta. Having an environment where we can use a surgical option allows us to think out of the box for individualized patient solutions.”

In 2008, Philips Healthcare and Skytron entered into a collaborative agreement to provide comprehensive, integrated solutions for the cardiovascular environment. Katzen seized the opportunity to refine the surroundings. Based on a well-coordinated plan from Philips and Skytron, a room at BCVI underwent a significant upgrade to enhance hybrid functionality.

“One of the great advantages of the new room design is it’s so spacious that we can all function effectively without being in each other’s way. Information can be transferred to the head of the bed — to the anesthesiologist — down to where we’re working very easily,” says James F. Benenati, MD, medical director of the peripheral vascular laboratory.

A Room That Works

BCVI’s surgical team appreciates the changes made. Katzen believes the upgrade has created a better environment for all involved. A recent experience demonstrated how the teams successfully combined surgical access with an interventional solution. A patient presented with critical narrowing of an artery to the brain and chest, and a narrowing of that same artery in the neck. “It was a very complex situation,” recalls Katzen, “but we combined our skills. The surgeons removed the plaque in the neck with an endarterectomy and we used that same access to go down and stent the chest.”

Installation With Minimal Impact

“We’re a busy lab and taking a room down for a period of time is always an inconvenience,” says Katzen. “The one thing everybody remarked upon was how fast this upgrade was accomplished.” In two and a half weeks, Philips and Skytron, working closely with the implementation team at BCVI, completed the staging and upgrade. The new room reflected the input of interventional radiologists, surgeons and anesthesiologists, with each group helping to define the clinical specifications to make it a multi-disciplinary environment.

OR Technology Update: A Steris Case Study

The epitome of surgical technology today is one OR in which surgeons can perform image-guided, catheter-based interventional procedures; minimally invasive endoscopic procedures; extremely precise robotic surgery; or full open surgery, depending on the case load or discoveries made in surgery. In this type of hybrid OR, integrated imaging, computerized patient information and live video routing technologies instantly display test results and critical real-time information on high-definition monitors in the sterile field. This allows surgeons and staff to ascertain the most timely and accurate diagnosis and treatment for the patient. It also helps them achieve the most flexible and effective uses of the room and optimize scheduling and utilization.

These are also the types of rooms in which medical leaders and pioneers train residents and other clinicians, develop new minimally invasive procedures, such as natural orifice trans-luminal endoscopic surgery (NOTES) and trans-catheter heart valve replacement and master new surgical devices.

These highly advanced rooms can incorporate advanced communications, connectivity, LED surgical lighting and high-definition visualization such as intra-operative fluoroscopy, intra-operative computerized tomography, magnetic resonance imaging, image-guided navigation, 3D software extrapolations of the imaging, robotics and many other technologies. Each of these tools are important in today’s hybrid OR, but when integrated correctly they form a seamless whole that is greater than the sum of its parts.

To accomplish this synergy, STERIS collaborates with leading manufacturers to design and install customized, integrated HD360°™ Hybrid ORs for healthcare facilities. STERIS project design managers configure STERIS’s open infrastructure Harmony® Lighting and Visualization systems, equipment management systems and advanced integration technologies with interoperative imaging, robotics, endoscopic and video technologies and more. The result is a suite that enables fully informed staff, highly efficient procedures, extremely flexible room use, successful surgeon recruitment, medical education, ongoing surgical innovation, leading edge robotic surgery, telemedicine, and new possibilities yet to be imagined.

OR Technology Update: A Berchtold Case Study

Problem

Before hybrid ORs existed, imaging and communications capabilities were not an option during cardiovascular and neurosurgery operations, resulting in patients getting diagnosed and treated in two different visits. Separate procedures and imaging consultation can be costlier for patients and surgeons, can result in additional stress, more down time and longer hospital stays for the patient, and are not conducive to emergencies that sometimes arise during surgery.

Solution

Combine minimally invasive and interventional surgical technologies with medical imaging and communications equipment in one operating room: the hybrid OR.

A growing trend involving endovascular procedures during cardiovascular and neurological surgeries requires equipment to accommodate open and closed procedures in the same room, even at the same time, although this is not necessarily planned from the start. The new hybrid OR model provides the surgeon flexibility in performing a variety of interventional, imaging and surgical services in one setting, eliminating the need to transfer the patient.

For example, two of the most popular hybrid ORs are for cardiovascular and neurosurgical procedures:

» Neurosurgical hybrid ORs can include magnetic resonance imaging (MRI); computed tomography (CT) and angiography equipment within a neurosurgical operating room.

»Cardiovascular hybrid ORs often features: Fixed ceiling- or floor-mounted C-arms, ultrasound and endoscopy equipment, coupled with cardiac catheter laboratories.

Because a hybrid OR is specifically designed for endovascular procedures, careful planning from the beginning can help to ensure all rooms are equipped with necessary tools. Some tips to consider while creating a specially designed hybrid OR include:

»Identify factors that are important to the hospital team, such as, should all equipment hanging from the ceiling (surgical arms, flat panel arms, etc.) be able to cover the whole patient in all orientations?

»Think as far ahead as you possibly can to “future proof” the room, reducing the need to renovate the OR moving forward. For example, what is the most extreme type of procedure the team might do in the OR? Then outfit the room in preparation for the procedure.

»Involve the end user at the very start of the project to give a real world perspective for offering scenarios, as well as discussing needs and concerns. This can include nurses, surgical technicians and staff, as well as anesthesiologists.

»Consult with the vendor providing lights, booms and imaging equipment to accommodate all of their needs. For example, many imaging companies have different requirements for ceiling heights.

Hybrid therapies enable hospitals and clinicians to provide less invasive care that is safe and cost-effective for the patient. Careful planning can lead to an effective hybrid operating room design that offers the following benefits:

» Cost-effective operations for patients and surgeons, with better outcomes.

» Reduced stress, faster recovery and reduced hospital stays for the patient.

»Safer procedures, especially in the case of an emergency.

New Bair Paws® Gown Brings “Flex Appeal” to Patient Warming: An Arizant Case Study

The recent Centers for Medicare and Medicaid Services (CMS) adoption of the SCIP-Infection-10 normothermia quality measure has made it more important than ever to simplify the process of warming every surgical patient. Arizant Healthcare’s latest innovation in forced-air warming, the Bair Paws Flex gown, does just that by incorporating a surgical warming product — Bair Hugger blankets — into a comfortable patient gown that warms before, during and after surgery.

While clinical versatility is a key benefit of the Bair Paws Flex gown, so is the practical economic approach of standardizing multiple warming capabilities into one gown that can accommodate most perioperative warming needs. While helping to improve outcomes and boosting patient satisfaction, the Bair Paws Flex gown may save facilities money by supplanting multiple OR warming blankets and the warmed cotton blankets and gowns often used to comfort patients.

Just One Gown Warms From Start to Finish

Before surgery, patients appreciate the Flex gown for its controllable warmth; they can simply dial the temperature of the air flowing through the gown to a level that’s comfortable. The surgical warming products built into the gown are unknown to the patient because they are deployed only by surgical staff.

In the operating room, the same Bair Paws Flex gown offers clinicians the ease and convenience of having multiple patient warming options available during surgery. Seamlessly integrated into the gown are: a head drape, adhesive tape to isolate the surgical field, and deployable arm extensions to transition into a Bair Hugger upper body blanket with tie strips. A second insert in the lower portion of the gown may be used to prewarm before surgery and then warm again as a lower body blanket once in the OR. The gown’s design allows upper or lower body warming for any surgical positioning — supine, prone or lateral.

After the procedure is over, the upper body blanket arm extensions, head drape and surgical tape strip perforate off, returning the garment to a standard warming gown for post-operative use through the lower warming blanket insert.

The Bair Paws Flex gown is comfortable for patients, convenient for clinicians and warms from pre-op to the OR to PACU. Best of all, it’s also economical. One gown handles almost all your warming needs, including contributing to quality goals like SCIP-10 and improved patient satisfaction. It incorporates a highly effective surgical warming device directly into a soft, comfortable hospital gown that does something positive for patients and hospital staff. It’s not just a gown. The Bair Paws Flex gown is a patient warming and patient satisfaction tool. It’s the future of patient warming, and it’s available today.

Practicing Arthroscopic Surgery on Computers, Not People: A Toltech/Sensable Case Study

Learning diagnostic knee arthroscopy is not unlike learning to play the violin — both art forms require a mixture of cognitive and proprioceptive skills that can only be developed through rigorous practice. And while both require intensive mentoring, surgical apprenticeship is unique in its resulting increase in operating room time and potentially patient risk. Just as with a violin that makes no sound, little can be learned from surrogate surgical environments having no objective feedback, including costly and labor-intensive cadaver training. And little transference of either skill can be expected from computer based training lacking the feel of the instrument(s).

In late 2009 the University of Michigan Medical Center’s Orthopaedic Surgery department, led by James Carpenter, MD, became an early adopter of the Knee Arthroscopy Surgery Trainer (KAST) from Touch of Life Technologies (ToLTech). This simulator was co-developed with the American Academy of Orthopaedic Surgeons (AAOS), Arthroscopy Association of North America (AANA), and the American Board of Orthopaedic Surgery (ABOS). It provides both cognitive and haptically-enabled skills training for the proper and efficient techniques required for diagnostic arthroscopy of the knee as done on an outpatient basis — including training to competency, and a modality for complete evaluation of residents’ skills.

In the KAST simulator, trainees hold a customized stylus in each hand — emulating the probe and camera used in actual surgery — that are attached to PHANTOM® force-feedback haptic devices, made by SensAble Technologies. The haptic devices allow trainees to navigate in true 3D space while interacting with high-resolution models that are viewed on-screen, as if through an actual arthroscope. The force feedback devices are programmed to push back on the user’s hand to deliver the “feeling” of the soft tissue, cartilage, and ligaments involved in knee arthroscopy.

The “Virtual Mentor” in KAST guides, critiques, and scores the resident on each part of the procedure. In one module, trainees must perform three steps for examining the medial meniscus with a probe. The Mentor requires the trainee to score 100 percent on each step before attempting subsequent tasks, and finally a time-trial. A special “cheater view,” only available at the novice level, shows the outside image of the knee (seen in the right hand portion of the Mentor screen), to help residents understand where the tools they are using are located with respect to the anatomy. KAST switches seamlessly between a right and a left knee, forcing the trainee to be ambidextrous with respect to the camera and probe.

Haptically-enabled surgical simulation provides cognitive and skills-based training — freeing up the outpatient facility’s attending physicians to teach higher-level skills, and giving residents unlimited autonomous practice opportunities. It allows residents’ skills to be objectively measured and validated before they undertake procedures on patients. The University of Michigan Health System’s Orthopaedic Surgery department plans trials comparing beginning residents who have trained on KAST, against a control group. Separate validation studies led by the AAOS using KAST are underway nationwide during 2010.

5 Tips for Growing ASC Volume from David Daniel, CEO of Lakeland Surgical & Diagnostic Center

Over the past several years, Lakeland (Fla.) Surgical & Diagnostic Center has steadily increased its case volume by 8 percent annually, and in 2009 the ASC performed nearly 19,000 cases and more than 31,500 procedures. LSDC’s large volumes can be attributed, in part, to its ownership structure which includes two large multi-specialty group practices. However, it is the center’s dedication to patient and physician satisfaction that keeps the center growing, says David Daniel, CEO of LSDC.

“Currently, the LSDC has 80 active providers on its staff and they are very loyal to LSDC and much prefer to bring their patients to us over admitting them to the hospital, which is located next door,” says Mr. Daniel. “We keep expanding by keeping all our physicians, patients and staff happy and satisfied, but we are careful to not over build or over extend.”

Here are five suggestions Mr. Daniel gives for how other ASCs can experience similar volume growth.

1.  Ensure staff and operations are top-notch. The first step to maintain and grow volume is to distinguish your ASC from competitors through friendly, experienced staff and efficient operations, says Mr. Daniel. “The secret to increasing volumes at an ASC is ensuring you have the proper physical plant, state-of-the-art equipment, operational procedures, management and experienced, specialized staff to support using the physicians and surgeons to the optimal extent possible,” he says. “If you do this the physicians will come, the patients will follow and your volume will grow.”

2. Only add specialties that make financial sense for the center. Although adding additional specialties and physicians is usually an easy way to increase volume, Mr. Daniel warns that ASCs must first examine their local markets to see if there is demand for the services. “We evaluate if this specialty is profitable for an ASC or not, and if it will be a good fit for the organization,” he says.

At LSDC, the physician groups that own the center lead the recruiting efforts by bringing additional physicians to their groups who can in turn practice at the ASC, but ASC administration provides input and suggestions throughout the process, says Mr. Daniel. 

3. Consider hiring a full-time marketing point person. Mr. Daniel says that LSDC’s marketing efforts play a significant role in contributing to its high volumes. LSDC employs a full-time director of marking who is devoted to expanding the business. Her duties include maintaining the center’s Web site, ensuring seamless appointment scheduling, meeting weekly with community groups to promote LSDC, following up on all patient comments and spearheading process improvement efforts, he says.

4. If a physician reduces his or her case load, investigate why. LSDC leadership monitors the number of cases each physician brings to the ASC, and if cases begin to drop, the leaders go directly to the physician to investigate why he or she is not using the ASC as frequently.

“For the most part the physicians prefer the LSDC over the hospital for outpatient procedures due to our exceptional efficiency, low infection rate and very high patient satisfaction scores,” says Mr. Daniel. However, if the physician was to identify a problem, it would be immediately addressed, he says.

5. Sweat the small stuff. Often, it’s the small things that keep physicians and patients coming to your ASC. “It’s the smaller things that set you apart and make the physicians feel welcome. Offering lunch if they’re working over those hours, having the types of scrubs they prefer and reserving parking spaces — all of these things go a long way to make the physicians happy,” says Mr. Daniel.

Learn more about LSDC.

#1 Priority for Your Front Office Team

A surgeon can be the best surgeon in the area or the world, for that matter. But, if his/her front office isn’t doing its job right, this expertise means nothing. It’s the equivalent of having the best quarterback on the field, but the front line can’t block, the running back can’t run and the receivers can’t catch. A team simply can’t win, with only one effective player. So how effective is your team?

As in football, a front office must know the drills and apply them daily. First, they need good people skills. It’s a MUST that they always put the patient first. As the saying goes, “if Mama ain’t happy, ain’t nobody happy!” How does this apply to your patients? Think about it, if your staff mishandles an issue in the front office, they’ve not only upset the patient, but the patient’s family/friends and everyone sitting in your front office, i.e. other patients and potential customers. If you can do one thing for your staff, teach them how to handle difficult situations. First, train them to live and breathe the two rule standard as an initial reaction to a disgruntled patient: “Rule #1 – The patient is always right, Rule #2 – If the patient is wrong, refer to Rule #1.” By making the patient feel that they are right, the anger and emotions surrounding the situation are diffused immediately. Second, in resolving a patient issue, take them to a private area and work through the patient’s issue in a positive manner. If a staff member has done something wrong, require that the staff resolving this issue with the patient do 4 things: (1) admit wrong doing, (2) openly acknowledge what was done incorrectly, (3) apologize for the mistake, and (4) come up with an action plan that you will implement immediately to ensure this doesn’t happen again. If your staff does this, it’s a guarantee that your patients will come back, as well as become life-long customers and most importantly, tell their family and friends of the great experience they had at your office and/or surgery center and what a top notch ophthalmologist you are.

The second most important duty of front office staff is how they treat each other. The Golden Rule is always a good place to start. This rule is “treat others, as you would like them to treat you.” If you instill this in each and every one of your people and let them know that you expect them to live this daily, your personnel issues will be minimal. In the last year, one of cataract outsourcing team members violate this rule. Rather than treat it as an isolated incident and address with only this particular staff, the supervisor gathered the entire group together the day after the episode and presented them with a one page statement. He read it out loud and had discussions with them what this meant on an individual level, as well as a team. He went over points about how our society, as a whole, has become less professional and respectful of each another. They discussed this and it was agreed that the team needs to work harder in making sure these types of behaviors/attitudes don’t permeated their work environment. They discussed how they could have handled the situation differently. In the end, the supervisor, along with each staff member, signed this document acknowledging their pledge to treat each other professionally and with the utmost respect, at all times.

Another aspect of front office service applies to your facility staff. If you haven’t already done so, you need to encourage, promote, and require your facility staff to treat your office staff with the upmost respect and view them as a key customer. In addition, they need to do the same for all surgeon users’ office staff. Your people must view these groups of people as key customers, i.e. same top notch customer service, as the staff gives the patients. Granted not all physician offices have the greatest customer service-oriented people working their front desks. But, encourage your staff to look beyond this and to keep reminding themselves that a surgeon’s staff is the gatekeeper of the facility’s patients. Again, if these key people are happy, I’ll guarantee you the facility case load will increase.

Finally, your staff needs to be dutiful in completing the tasks of scheduling, pre-certing, registering, preparing patient for surgical protocol and expectations, billing and collecting payments. However you might remind them that if poor customer service exists and/or prevails, there will be no need to pre-cert, register, etc…, as customers will be non-existent. Therefore, the #1 priority must always be customer service to both external and internal customers.

ZirMed and HSTpathways Reduce Bottlenecks at Pacific Surgery Center Despite Volume Increase

Pacific Surgery Center in Poulsbo, Wash., upgraded its core practice management systems to solutions from HSTpathways and ZirMed and experienced reduced bottlenecks despite volume increases of 15 percent, according to a ZirMed news release.

Pacific Surgery Center now uses HSTpathways, HST’s dedicated ASC clinical and financial management software. The center uses the entire HSTpathways core suite of applications, which includes scheduling, registration, workflow management, claims, accounts receivable control, statement processing, collections, materials management, clinical logs, case costing and chart management.

At the same time, the center adopted ZirMed’s Web-based revenue cycle management services to complement HSTpathways. Today, Pacific Surgery Center uses ZirMed’s professional and institutional claims management as well as its eligibility verification, electronic remittance advice and print services.

Thanks to ZirMed and HST, Pacific Surgery Center’s receivables performance has undergone a dramatic improvement. “Our A/R days run between 22 and 24 on average, where we used to be near 60 days with our previous system,” Fran Gregory, business office manager for Pacific Surgery Center, said in the release. “All eligibility verifications are usually completed electronically within an hour — rarely do we have to call a payor.”

Other features of HSTpathways, such as case costing, which allows a center to map every consumable item in the facility, have even made the center’s purchasing more efficient.

“Despite the 15 percent increase in volume this past year, our billing personnel have been able to keep up without a problem,” Ms. Gregory said in the release. “No bottlenecks anywhere. That’s how much smoother things have gone with HST and ZirMed.”

Learn more about ZirMed.

Teamwork and Talent Drive the ASC of Union County

Teamwork is a way of life for the 21 staff members and 50 physicians at the ASC of Union County, a two-OR, multi-specialty, physician-owned ambulatory surgery center in Union, N.J. At the heart of that teamwork lies a commitment to patient care that exceeds expectations and a family spirit that pervades everything at the center, which opened in 2000. And helping to drive that commitment are two individuals who work as the facility’s dynamic duo — Marcy Sasso, director of operations, and Debbi Holley, RN, BSN, director of nursing.

Nominating the duo for this year’s Who’s Who in Ambulatory Surgery is Glenn Davison, DPM, FACFAS, a board-certified podiatrist who is one of the owners of the center. He credits Sasso and Holley with leading the team to a number of notable achievements, including growing the physician pool and the center’s staff while cutting costs and increasing collections, as well as driving down the infection rate and causing patient satisfaction scores to skyrocket.

“Recruiting physicians is always challenging for any ASC,” Sasso acknowledges. “In New Jersey there are 300-plus ASCs so that translates into most doctors having their own place. We were fortunate in retrospect that our area hospital closed; we hired an outside marketing person to assist with recruitment. In 2008 we were at 80 percent capacity of our 7 a.m. to 3 p.m. block time so that marketing ended. Since then I found that word of mouth to other doctors was really our best means of recruitment. We have had several requests for credentialing packets every month for the past two years. I have a nice marketing packet put together that includes a brochure with our owners’ information, a physicians guide, all of our specific booking forms and criteria, information on our center from transportation to patient instructions, not to mention the give-aways such as letter openers, rolodex cards, sticky notes and pens. We also market all of our credentialed physicians on our Web site, and we place their business cards in our waiting room. When they come to tour the center we promote cross referrals and they meet with one of our financial coordinators to assist in educating their patients about our billing procedures.”

Building relationships is also key to working well with a diverse group of patients, physicians, colleagues, payors and vendors, and Sasso says the secret is “letting each person bring their unique talent and personality to work everyday. Really believing in their talents and bringing out their strengths that may have been dormant.” She adds, “The clinical staff here by far makes a lasting impression on our patients. The patients are greeted with a warm smile and often leave with a great cup of coffee and a hug. Our three administrative staff members multi-task as if they were a team of five and always with a smile and a kind word. They always look for ways to improve patient care and outside office communications.”

Sasso says that what she and her colleagues enjoy about the ambulatory care environment in part is the autonomy allowed by the center’s owners. “It allows Debbi and me to use our creativity, common sense and charitable side to run the ASC of UC so efficiently,” Sasso explains. “Being a smaller facility, we are able to cross-train and be a part of every day-to-day occurrence here. We have the opportunity to get to know our patients and they get to know us. Debbi and I don’t have to micro-manage in any way because when you come to an ASC setting you know you become part of a team and most days we consider our team our second family. It’s a positive and enthusiastic environment that one won’t find in the hospital setting.”

The ASC made a true believer out of Holley, who says, “My background was always in a hospital setting and the fear of joining an ASC was quite scary. I always believed that ASCs took away business from the hospital. When the local hospital closed, I had no choice but to jump in feet first to an ASC. I now see that the ASC has a warm and relaxing atmosphere. Nurses have enough time to spend with their patients to make them feel comfortable. They can have that idle chit-chat and not feel rushed to get onto the next patient.” Holley continues, “ASCs make it easier for the patient from arrival to discharge. Since our OR scheduling is close to or on time, patient scheduling is more convenient for patients and their family members. The patient has a specific OR scheduled time and they come in, their family member can sit with them in pre-op while waiting to go into the OR. After their procedure, the patient is offered coffee or juice cookies or muffins, then they go home. The patients feel more relaxed and comfortable before going in for their procedure and leave in a positive state of mind for a successful recovery.”

Sasso says the center’s team spirit and reliable retention rate are attributable to a number of factors, including treating everyone with fairness, equality and honesty, promoting a true open-door policy, as well as mentoring, coaching and supporting each other.

“A center can only work as well as their team,” Holley says. “To me, I am only one piece of the pie. Without the other pieces, there would be no pie. I feel that I would not be able to run a smooth and efficient center when one piece is missing. Our consistent reputation and positive work environment is cause for employee retention and terrific patient satisfaction. Positive feedback to the staff for all that they do on a daily basis is essential. No one wants to hear only the negative things that happen during the day.

“We also have pride and ownership, and we celebrate our successes,” Sasso says. Those celebrations of success range from an annual holiday party and bonus to a family picnic, staff birthday celebrations and a staff appreciation day, plus employment perks such as a retirement plan, paid health coverage and continuing education for all staff members.

The center had much to celebrate when they achieved accreditation with the Accreditation Association for Ambulatory Health Care (AAAHC). “Due to Marcy’s and Debbi’s leadership, we have received the highest accreditation from the AAAHC for a three-year term,” Davison says.

“Accreditation was something we had been putting off for several years for fear of the unknown,” Sasso explains. “When our medical director, Dr. Thomas Ragukonis told us we were ready and deserved to be in this prestigious category we took his suggestion and plunged in. During the pre-accreditation process we were able to review and improve many of our ‘stale policies.’ We split into sub groups to tackle the process; empowering all staff to take ownership along the way. We repaired some cracks in our foundation and Debbi wrote 65 new policies and re-vamped more than 100. Our staff philosophy has been treating each day as if the inspection were to happen and there is no need to worry when it does. Our two-day survey was intense and thorough, as they ought to be, and during our exit interview they told us that ‘we should be very proud of what we do here’ and we were rewarded with a three-year accreditation. Going through the process was an outstanding learning experience for all staff. Now we routinely review the assessment manual to be sure we keep this prestigious accreditation.”

Davison says that Sasso and Holley “believe in and promote continuing education, and every staff member has attended at least one or more courses last year. All staff members take the BLS course and all of our nurses take the ACLS course which we sponsor right here in the center.”

It is this focus on patient safety that has propelled the ASC of Union County in everything it does, including making ambulatory care the best option for healthcare professionals and patients.

“It is proven by all of the benchmarking statistics that ASC’s provide a cost-effective, top-notch setting for patients as opposed to the standard hospitals,” Sasso says. “The physicians feel that the latest technology is more available here and we are more patient-friendly. The doctors are able to perform more cases in one day here than they would be able to in the hospital. ASCs don’t have the ‘I am a number’ mentality, and patients are referred to by name and are remembered when they return for an additional visit. The infection control rate of most centers is 1 percent or less, and hospitals cannot offer that same optimistic statistic. (Ours, over the past eight years, is less than 1 percent). ASCs typically have better control of the flow over their patients, less red tape than a hospital from the registration process to the patient discharge much faster and fewer mistakes!”

Holley concurs, adding that ASCS must be prepared to face unique clinical challenges such as patient safety practices, especially proper identification. “What we do here is at registration, the patient is asked for the last four numbers of their Social Security number, birth date and a picture ID,” she explains. “In the pre-op area, the patient again is asked for their last four digits of their Social Security number, their birth date, what procedure they are having and where will be the incision site will be. The last four numbers of their social security number is on their identification band. This same list of questions is asked again during the consent period. Another challenge is having the patient bring in a list of medications that they are currently taking in order to complete the medication reconciliation at their time of discharge. Both the nurse and physician must sign the completed form at discharge. ASCs may find identifying the correct patient and information a little more difficult than in a hospital setting but with our process in place, we have not encountered any problems. We feel confident that we have the right patient here for the right procedure.”

Holley says that the ASC enhances patient satisfaction through positive encouragement and communication. “During our pre-op admission we instruct the patient that their discharge instructions and survey is in their envelope and hope that they will help us serve our community better by their comments. When patients are discharged we know something about them and we make a mention about this to let them know we heard them. We wheel or walk out every patient and wish them well. By the time they are leaving at least four people have said goodbye to them. We encourage patients to send back the survey when we make our next day post-op calls. We treat every patient as if they were a family member from start to finish.”

Holley adds that the ASC’s low infection rate is another accomplishment. “The most important part of keeping infections down is hand hygiene,” she says. Nurses must wash their hands immediately before and after touching a patient to prevent cross-contamination. We have constant monitoring; we have a full-time RN trained in infection control who runs in-services and is routinely changing signs in the patient/visitor areas. We also book 15-minute intervals between cases to clean and sterilize the ORs between cases.” Holley adds that in order to prepare for impending inspections, the ASC has a staff member do spot checks to ensure handwashing is done properly, and they also conduct mock surveys frequently to observe and educate staff on potential problems.

Contributing to the ASC’s clinical success is staff’s investment in the center and in their work. “I think ‘team’ and ‘ownership’ are the two words that describe our staff,” Holley says. “Each staff nurse has a specific job that they take ownership of. One nurse will be in charge of all the contracts for the center; it is her responsibility to update expired contracts on a monthly basis. Another nurse is responsible for the QA projects; she does monthly audits and chart reviews. Another staff nurse is responsible for keeping abreast of any OSHA problems and updates. This nurse will give monthly reports on any OSHA criteria. The nurses feel a sense of pride and accomplishment in their specific area. We also have two OR techs in nursing school and the other RNs take time to mentor them.”

Bringing staff together is the ASC’s quality assurance program, which also serves to audit physicians and their time in the OR. “Many book a case for a specific amount of time, and we are detecting some run-over in their allotted time and push other physicians back in their start time,” Holley explains. “This leads to physician and patients becoming frustrated with wait time. To improve patient satisfaction, we need to determine which physicians need extra allotted time for certain procedures. Dialogue between physicians and staff has improved by having an open communication policy. Physicians are asked on a monthly basis if anything needs to be improved or if they need a specific piece of equipment. The physicians educate the staff on procedures that are new or unfamiliar, and physicians allow any staff nurse to observe their cases. And during monthly staff meetings, they are encouraged to think of new ideas to make the center run smoothly.”

“Our staff enjoys coming to work and seeing the patients get well and leave happy,” Davison confirms.

The ASC staff echo this sentiment. Clinical coordinator Kathy Melnick, RN, BA, CCRN, emphasizes, “I have been a nurse for more than 40 years and I have never worked anywhere where the patient satisfaction surveys have come back with such glowing accolades; from the admitting process to the discharge, every staff member tries to make the patient stay as pleasant as possible. The staff prides themselves on a professional, compassionate and friendly demeanor which is demonstrated on a daily basis with every patient. A great percentage of our patients are repeat customers and we hear over and over again how they only want to come here for their procedures! It is an honor for me to be associated with a surgery center that provides exceptional patient care for the surgical patient.”

Jan Marsh, RN, says she appreciates the center’s dynamic environment. “Having worked in a hospital setting for most of my professional career, transferring to the ambulatory setting was a new experience for me. I truly enjoy the atmosphere at the ASC, which is professional yet patient friendly. The doctors and nurses work together as a team to deliver the best possible patient care for every individual.”

One of the center’s orthopedic surgeons, Clifford A. Botwin, DO, observes, “I don’t ever remember any institution receiving the accolades and satisfaction from patients, families and staff that have been attributed the ASC of Union County. Led by an outstanding administrator, Marcy Sasso, and staff this facility although relatively small has been in the forefront of community health and relations in our area.”

The center believes that participating in philanthropic efforts is a worthy way to give back to the community.

“Marcy organized and brought in more than 3,000 brand new toys for the local police holiday drive, and had more than 10 pallets of medical and child care items sent to Louisiana for Hurricane Katrina-related needs,” says Davison.

The local community in central New Jersey also benefited from the center’s generosity through its free health fair held last year.

“Our physicians came out in full support of this endeavor, with more than 15 doctors representing various specialties were available for the over 350 attendees,” says Mary E. Koch, RN, BSN, CNOR, the center’s OR supervisor. “In light of our current healthcare situation, there are many people who have no access to healthcare. This provided a unique opportunity for the public to speak with a physician. This is one of the many wonderful ways we care for our community, from Toys for Tots, Katrina relief supplies, Walk for Autism, and breast cancer awareness. I am proud to work in a surgery center that gives so much to the community in addition to the exemplary care we provide for our patients.”

“At our community health fair we saved and changed more lives in that one day than any of us ever expected,” Sasso says. “I believe you get what you give, so giving back was our motive for the health fair. The local hospital used to put on a health fair and since they closed several years ago the community was no longer afforded that special day. It seemed like the perfect opportunity to market our ASC and give back at the same time. It took just two days to get a commitment from our 15 owners, and we had six weeks to organize the fair. I called every one of our vendors, every local non-profit group, the blood bank, physical therapy, imaging centers, and the local chamber of commerce. The ‘give back’ message took hold with them and we had an overwhelming response. We had our 15 doctors on site talking to the public about their specialties — orthopedics, GI, general surgery, bariatric, pain management, podiatry, gynecology and chiropractic — as well as body fat screenings and all the give-aways a visitor would hope to find at a fair. We had 350-plus guests, gave away four glucomoters, took 185 blood pressure readings, and had 11 blood donors. Giving is so contagious, you can’t help it sometimes. That fair was one of the greatest achievements in my career.”

To read more about the ASC of Union County’s involvement in ASC advocacy and politics, don’t miss the January 2010 issue of SurgiStrategies.

Q&A with Marcy Sasso

What can other ASCs do to emulate the success of your center?

If ASCs strive to continually evaluate their actions and decisions in light of patients’ best care and treatment, they will automatically discover the path to success. Make safety your No. 1 priority, and put it on the agenda for every committee meeting. Monitor your patient surveys closely, as they will be valuable assessment tool; share them with all of your staff and physicians. Our surveys have been outstanding with some wonderful comments regarding our exceptional staff and comfort of our ASC, and 100 percent of our patients have indicated that they would return should the need arise. When we saw a comment about discharge instructions, we immediately held a brainstorming meeting and made a change as to when and to whom instructions were given. If an employee has drive and ambition, take a look at how they can bring additional value to the center. For example, Lauren, our OR tech, mentioned that it would be great to be an OR nurse and really admired our RNs. Mary is now her mentor while she is going to nursing school in the evenings. Our staff attends conferences and we encourage them to share their knowledge. Look inside your team, as you may find the next surgeon just waiting to be mentored!

How do you stay current in the industry?

I read at least nine trade publications weekly, and I have signed up for every “alert” there is. I attend the annual ASC conference and send many of my staff to specialty courses. I forward at least three or four “FYI” e-mails to my center’s owners on a weekly basis to be sure that they are kept up to date in the ASC world.

Potential Fraud Issues for ASCs

Does your ambulatory surgery center (ASC) struggle with procedure coding and billing? Do you realize that the management and owners of ASC are responsible for correct and payor-compliant billing? Are you confident that your billing is compliant? If you ever wonder about compliance, this article will help you know what areas you can check on in your coding/billing processes to increase compliance.

Some common billing mistakes that can cause compliance problems in the ASC include:

» Billing Medicare for services provided in the ASC that are not covered in the ASC setting.

» Billing procedures with a code that does not describe the procedure properly. For instance, billing a “new” procedure that does not have a specific CPT code using an existing code.

» Billing improperly for “cancelled cases” vs. “terminated cases.”

» Upcoding, or billing a procedure code that is more extensive than what actually was performed, or billing codes for procedures that were not performed.

» Insufficient documentation to support all services were performed.

» Undercoding — While less of a fraud risk, if the procedure codes billed do not represent correctly the procedures performed, the facility may lose significant revenue. With chronic undercoding, the coding on your claims will not match the physician’s claims, causing unnecessary denials.

» Failure to refund credit balances to patients and payers in a timely manner.

» Waiving co-pays/deductibles, “courtesy” discounts or “insurance-only.”

» Improper unbundling of procedure codes by not observing Medicare’s NCCI Edits correctly.

» Overuse/misuse of Modifier -59.

» Performing procedures without medical necessity.

» Violations of Stark laws, the anti-kickback statute, false claims act, HIPAA, safe harbor legislation, etc.

Following are suggestions for how to avoid these problems and help assure your facility’s billing is compliant and correct:

» Never bill for a procedure or items that were not rendered. Never bill from the facility’s surgery schedule — always be sure cases actually were performed and there is adequate documentation of the procedure before billing. Medicare directs that only those procedures documented in the body of the OP report are billable.

» Never change a code to get paid. If the code is not on Medicare’s list of ASC covered procedures, you still must bill the code for the procedure performed, rather than one that is covered. If there is not a code that fits, use an unlisted code and send in the OP report with the claim. Perform vigorous appeals in the event of a claim denial.

» Anticipate at the time of scheduling those procedures for Medicare patients that must be billed with CPT codes not on Medicare’s list of ASC covered procedures, require the use of an unlisted procedure code, or require an overnight stay. Such procedures are not covered by Medicare in the ASC. Be sure your ASC is billing properly for terminated cases — follow Medicare guidelines and use the -73 and -74 Modifiers appropriately. Never bill for cancelled cases where the facility did not expend “significant resources.” Do not bill the case to Medicare if it was cancelled prior to the patient being placed in the OR or procedure room where the surgery was going to be performed (i.e., in the pre-operative holding area).

» Avoid upcoding and undercoding procedures — code correctly based on the documentation.

» Avoid improperly billing Medicare patients for procedure codes that are not on Medicare’s List of ASC covered procedures. If the code is not covered in the ASC setting but is covered in another place of service (hospital, doctor’s office, etc.), the ASC cannot have the patient sign an ABN/waiver and charge them.

» Keep up-to-date with credit balances and provide refunds in a timely manner (monthly is best; don’t go longer than quarterly). Do not waive co-pays/deductibles, offer “courtesy” discounts, or allow “insurance only” — these are all HIPAA violations.

» Avoid unbundling of procedure codes, and use good judgment about when an unbundled code may be billed with a -59 modifier.

Stephanie G. Ellis, RN, CPC, launched Ellis Medical Consulting, Inc. (EMC) in 1992. EMC specializes in coding chart audits, business office operational assessments, litigation support, reimbursement research, difficult/challenging coding questions, outsourced coding, coding/billing training and compliance programs for ASC facilities, physician practices, hospitals, IDTF radiology facilities, and clinics nationwide. Ellis is an accomplished speaker and gives seminars around the country; she is a certified coder through the American Academy of Professional Coders (AAPC).

McKesson and eClinicalWorks Complete Nuance’s Dragon Medical EHR Program

Burlington, Mass.-based Nuance Communications, a leading supplier of speech solutions, announced that eClinicalWorks, a privately held leader in the ambulatory clinical systems market, and McKesson Practice Partner, a leading integrated electronic health record, medical billing and appointment scheduling software, have successfully completed Nuance’s Dragon Medical EHR Certification Program, according to a Nuance news release.

The program was developed to facilitate collaboration between Nuance and EHR vendors by optimizing clinician use of EHRs through the introduction a new standard of speech recognition interoperability.

To become a Dragon Medical Certified EHR, eClinicalWorks and McKesson completed testing that focused on how a provider would use Dragon Medical within the physician documentation portion of a given application, according to the report.

The main goal of the Dragon Medical EHR Certification Program is to optimize the EHR experience of clinicians by testing core competencies within each EHR, including:

• Dictation in the EHR
• Correction in the EHR
• Audio preservation
• Navigation throughout text
• Native Dragon Medical edit box support
• Copy and paste support
• Formatting support
• Input control
• Hidden dictation mode support

Part of the Dragon Medical EHR certification process also entails the completion of a joint evaluation procedure, according to the release. In this process, eClinicalWorks and McKesson worked with Nuance engineers and product teams to optimize Dragon Medical software’s interoperability with each company’s EHR.

Read the release about the Dragon Medical Certified EHR Program.

Paperwork deters routine wellness visits

Paperwork could deter people from making regular wellness visits to their physicians, according to a new study commissioned by IBM.

According to the study, one in four U.S. residents had not scheduled a wellness visit within the last year. Of those who have not had a wellness visit in the last five years, 33% say they waste time filling out repetitive paperwork at the doctor’s office. Seventeen percent of those who have had a wellness visit in the last year also noted that paperwork was problematic.

“As indicated by the IBM study, consumers/patients are frustrated with the duplicate paperwork that they’re required to deal with for every physician visit,” says Lilian Myers, CEO of Allviant, developer of consumer-centric tools and network for healthcare.

Myers cites a recent Consumer Reports health plan survey that echoed IBM’s results with its own conclusions that the time required for multiple calls to schedule visits and understanding benefits and claims were some of patients’ biggest complaints.

“This inconvenience and aggravation has discouraged many patients from scheduling wellness and other preventative or non-urgent medical appointments,” Myers says. “As the surveys show, healthcare is filled with unknown and unmet patient expectations—and expectations are what drive satisfaction in a customer-oriented world. Too often, however, healthcare providers and payers equate patient satisfaction exclusively to the care rendered and not to how quickly the phone is answered, how long the wait for service is, how easy it is to get an appointment, and how proactively the organization is engaging with the patient with reminders for preventive care—particularly when it is covered at 100%.”

Myers points out that in industries such as banking where privacy and security are also tremendously important, organizations have seen the online evolution in response to consumer demands for real-time electronic access, transactions and communications.

“Healthcare is on the verge of being more confusing and more competitive,” Myers says. “This leap into the 21st century will drive patients to embrace proactive wellness and prevention behaviors, which will reduce costs and improve care—a benefit to all healthcare stakeholders in the long run.”

Access to high quality information about patients is critical, agrees Rob Gillette, CEO of Click4Care, an Ohio-based care management software vendor.

“Using technology to enable patients, physicians and payers to know what steps they need to take and when they need to take them is long overdue,” Gillette says. “Analogous tools and technologies have been available for decades in virtually every other industry—the time for integrating them into the healthcare value chain is now.”

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