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POSTS BY TAG | Charge Capture

In high school, I wrote my programs first on paper before typing them out. It was a habit that came from writing all of my english essays in a notebook. Whether the topic was Shakespeare or Binary Search, paper and pencil somehow helped me organize my thoughts better than a text editor. Over the years, my instincts on when to step away from the computer have continually evolved, but I’ve continued to wonder why different mediums had such a big impact on my thinking.

These days I still use paper to initially sketch out my code when I can’t just Google for a solution. The result is usually some flowchart, pseudocode, and more importantly, a clearer understanding of the problem. The paper makes the problem feel more tangible and concrete, a physical entity that can be held and inspected.

If the problem’s big enough, I don’t quite start typing away at my keyboard right after the paper and pencil phase. In college, I discovered that the visual size of my writing had an ability to get me unstuck somehow. Math proofs that felt insurmountable in my trusty notebook seemed to get a second chance on a large whiteboard. It still puzzles me why the size of the writing makes such a difference. I’d like to think it’s the act of making ideas human-size that helps me see them from a new perspective, and increases the chance of serendipity and insight as you walk past it throughout the day.

There are times however, when I forgo all of the above. Sometimes speed, legibility (I have terrible handwriting), and the ability to cut and paste text quickly is the best choice. In these situations, my text editor excels. The choice of what medium to use isn’t always clear cut. Sometimes I find myself internally debating the pros and cons of going to my notebook, whiteboard, or editor first. Other times, if I take shortcuts and skip the natural progression dictated by a problem, I usually regret it.

A growing volume has been written about “slow programming” and hammock driven development, and I think the common theme is that picking the right medium and slowing down your process (not your thinking) has significant benefits. Bret Victor recently gave an illuminating summary of his recent work in a talk titled “The Humane Representation of Thought.” In it, he attacks the shackles of static representations of thoughts and communication as great inhibitors of our full potential. We are seeing glimmers of this approach with Chris Granger’s Light Table and most prominently Apple’s Swift language with its Playground. How far these ideas can go and provide alternatives to notepads and whiteboards is an open, and exciting question.

At pMD, we’re building out big new functionality in secure messaging, coordination of care, health information exchanges, and charge capture, and we’re facing a lot of interesting engineering challenges. Using the right medium to think about and discuss problems is more important than ever.

“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”

“I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

“I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.”

Doctors begin their careers with The Hippocratic Oath, swearing to uphold moral and ethical standards for the wellbeing of the patient. But the attitude among many doctors has evolved into a modern day version along the lines of "I'll do what I can for the patient, unless it puts myself in jeopardy." There is an ideological shift happening in medicine, and it is keeping doctors from providing the most complete care possible.

Doctors are becoming victims of a litigious society that is changing the way they communicate about patient care. Even though there has been a rise of advanced, secure communication platforms in health care technology, there is an emerging phobia of all information becoming discoverable. Doctors are having to censor their communication lest it resurface in a malpractice lawsuit.

I was recently working with a doctor during a mobile charge capture training for pMD, and he echoed an all too familiar mantra in the industry. He generally doesn’t record anything that he wouldn’t want the world to see. At some point in his career, he had taken a strong stance of never recording any information in his EHR around patient care that could potentially be used against him, even if sharing that information meant helping the patient. Yet the alternative, sending sensitive information in non-secure texts or writing it on pieces of paper or not sharing it at all, is far worse. This reaction points to the hesitation that exists in the health care community to record any kind of informal, candid information about patient care, stemming from a larger “Big Brother” paranoia. So what are doctors not saying that could be jeopardizing patients (and breaking the Hippocratic Oath)?

Advanced communication platforms for sharing health care information are being developed to improve care coordination among providers, allowing them to stay involved in up-to-date patient information more fluidly. The unintended consequence is that providers are becoming more cautious about sharing certain medical information and fostering trust issues with the system at large. Communication is imperative in medicine, and it’s an uphill battle against many different forces to improve and increase the communication in the patient + doctor + administrator intersection.

Doctors pledge that they will apply all measures necessary to care for their patients and gladly share knowledge with each other. It's time that "Big Brother" backs off so doctors can start using technology as it’s intended - as a resource used to save patients rather than avoiding it to save themselves.

Happy Halloween!

The biggest news out of Apple this week wasn't related to devices, but it did reinforce the company's long list of trailblazing. Tim Cook is the first CEO of a Fortune 1000 company to publicly say that he is gay. We're not sure if this is causation or correlation, but Apple devices among pMD's charge capture providers increased this week.

Apple has topped Android in net mobile devices for the week, adding 0.07 percent to its dominance among pMD's mobile charge capture providers. Many of pMD's health care providers use pMD on their iPhone and iPad, taking advantage of the larger screen real estate the iPad has to offer. Apple is still the top tablet manufacturer in the US and earlier this month they released the iPad Air 2 to glowing critic reviews. The iPad Air 2 is significantly thinner, lighter, and overall more powerful, making it a popular Apple mobile device for doctors to use for work.

Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.


iOS: 90.89%
Android: 9.11%%

For the second week in a row Apple took away more of the mobile device pie from Android among pMD's charge capture providers. Apple took a big dip in the month of Sept. but gained it all back by Oct.; see graph below. This comes at a time when Samsung warned that its third-quarter earnings would fall below market expectations. (courtesy of Daring Fireball). Samsung's answer? New mid-range and low-end devices, which would make Samsung's products more competitive in markets like China. In the meantime, Apple seems positioned to continue its control in mobile health and charge capture in America.

Signor Goat reports updates from the front lines of the iOS-Android wars. Each Friday, we report the current device breakdown of our charge capture physician users and identify the net winner for the week. Check back next Friday for your dose of our little medical corner of the platform wars.


iOS: 90.73%
Android: 9.27%

Considered by locals as the best kept secret around, the Florida panhandle and Alabama Gulf coast beaches are the best in the country. Oops, I guess that secret is out of the bag now… The Alabama Medical Group Management Association (AL MGMA) summer conference attendees get to witness that beauty first hand.

Every year, the AL MGMA hosts a summer conference in Sandestin, Fla. The AL MGMA exists as a forum to allow health care professionals to exchange information and ideas and better network to lead their respective practices and organizations. The AL MGMA did a great job hosting the conference, which was primarily attended by administrators, consultants, and vendors.

I attended the conference earlier this month representing pMD as a health care vendor and supporter of the AL MGMA. We help give back to these communities by supporting their conferences, and it provides an opportunity for us to have face to face interaction to learn what is on the minds of health care professionals and how we may be able to help them with charge capture. While I unfortunately didn't have much of an opportunity to enjoy the beautiful beaches, the conference reminded me of a huge family reunion and the importance of staying in touch with others in the industry. The MGMA network in the state of Alabama is a close, family-oriented group – call it “southern hospitality.”

Over the last ten years, focusing on helping practices improve efficiencies through charge capture has allowed me the privilege to meet a lot of great people. At the conference, I put faces to names that I've worked with for years but have never met in person, and I saw other faces that I hadn't seen in over a decade. I enjoy helping others solve problems, and it was great to witness the community of attendees working together to exchange thoughts and best in class solutions and ideas. As health care continues to change at a rapid pace, it's important to learn from your peers' experiences so that you can help lead your organization to be the best it can be. This conference reminded me of the importance of supporting organizations like the local MGMA so practices can continue operating at a high level of proficiency and focus on delivering better care to patients.

I made a couple of new friends, Dwayne and Michelle, from the AAPC that were exhibiting next to me. The AL MGMA hosted a tailgating “lawn party” one evening as a social gathering. You weren’t allowed into the party without these fantastic glow necklaces!

“Work hard, play hard!” The summer conference at the AL MGMA has a laid back environment that allows attendees to learn a lot while having fun doing it. Picture from an AL MGMA attendee. MGMA Alabama Facebook

Well, here it is: the app you never really wanted. A fitness wristband called the Pavlok is due out next year. For $149.99 (pre-ordered) you can receive an electric shock if you miss a workout or hit the snooze button. No word on whether this will turn couch potatoes into fitness buffs or simply crispy fries, but it does make me wonder about negative reinforcement and its positive effects.

The creator of the the Pavlok, Maneesh Sethi, came up with the idea after he hired a woman to slap him each time he checked Facebook during the day. He claims that his productivity quadrupled. After using the Pavlok prototype for a year, he claims to have lost weight.

Shocks and slaps may not be part of an ideal charge capture solution, but these ideas came about because negative reinforcement can be an effective way to change behavior. In a charge capture product, what could negative reinforcement look like? We’ve heard from a group that fines health care providers if charges aren’t submitted to the billing office within 24 hours of the patient visit. The threat of fines motivates providers to submit visit information in a timely manner, and the group is seeing very little lag between the time of visit and time of charge entry. It’s working!

Negative reinforcement to motivate health care professionals to improve an existing charge capture process or secure messaging solution could take many forms. An alarm that rings at a set time everyday until daily charges have been entered? An email blast to administrators about the number of visits entered? Electric shocks would be reserved for texting PHI unsecurely (just kidding!).

Thank goodness we’re in the business of making doctors happy. The alternative is shocking. I must be getting to the gym now.

Source: Pavlok
At pMD, we have always loved our characters and illustrations - our most notable being Dr. Mustachio. Before we had our How It Works video, we had a simple page with images and descriptions explaining the pMD charge capture process. To many newcomers of our website, especially individuals looking to us as a potential employer, the term “charge capture” was a foreign one. Our descriptive images illustrated charge capture in a simple and cohesive way, allowing for an easy understanding.

I recently came across these images and put them together as a Slideshare. To this day, they still offer a great explanation of charge capture and pMD. Enjoy!

Today is a special day, a marvelous day, a miraculous day… Well, it is if you enjoy numbers, charts, and everything about Apple. July 22 marks the end of Apple's third quarter, meaning that it's time for their much anticipated Q3 Earnings Report.

As a mobile charge capture company, we have to stay informed on the latest smartphone developments and their manufacturers. Our very own Señor Goat has been reporting on pMD’s mobile market share every Friday, and it’s our quarterly opportunity to see how our biggest slice of the pie is doing. Let's take a look at pMD's mobile device breakdown between Apple’s last earnings call in April and today. Perhaps we may have a correlation between Apple’s numbers and pMD’s.

Although, before we get to the numbers, which I know you're super anxious to find out, let’s consider some rumors that have been flying around Apple lately. First off, it’s expected that the iPhone 6 will take the stage in September of this year, with a larger screen, new form factor, and a variety of new functionality. Also expected is the iWatch, possibly announced within the coming months. Currently, the iWatch is a rather mysterious and elusive device, but it could prove to be a game changer in the mobile sphere.

Now to the numbers from today:

Looking at the charts, Android took away 0.3 percent from iOS market share among doctors and other health care providers using pMD. Given these numbers, the Q3 story looks uncertain for Apple. But let’s look at this from another angle: considering that the market is expecting Apple to lose market share, our numbers show that Apple is, in fact, still holding steady. So, given our logic, this should indicate that we’ll see an upside surprise during Apple’s earnings report. Will our numbers correlate with Apple? We’ll find out at 2 p.m. PDT.

Each specialty experiences unique challenges in the area of charge capture. Cardiologists often interpret the results of ECG, echo, and stress tests performed at hospitals. The cardiologist sits down in front of 30, 50, or 100 test results and quickly analyzes them, spending no more than a few minutes on each.

The reimbursement from insurance payers for each interpretation is quite small - for example, Medicare's 2013 fee schedule lists an average of $8 per ECG interpretation, of which Medicare pays 80 percent, or $6.40. The remaining $1.60 can theoretically be collected from the patient or from a secondary insurance carrier.

To complicate things further, the majority of these patients aren't even associated with the cardiology service at the hospital. They aren't, strictly speaking, cardiology patients - and if their tests come back normal, they may never be! A hospitalist, ER physician, or another specialist ordered many of these tests to be performed to rule out cardiac issues.

This puts the cardiologist in a pickle. Typically the physician's effort to capture all the necessary information for billing and get that information to the billing staff will significantly exceed $6.40 worth of time - especially when combined with the billing staff's time spent filling in any missing demographics, registering a new patient, checking the diagnosis and billing codes, and creating a claim.

Several cardiology groups that I've spoken with have told me that due to these challenges, they just didn't bill at all for interpreting the lower-reimbursement tests. Simply put, it wasn't worth it. They would spend more time and money trying to get paid than the reimbursement was worth, and they had bigger fish to fry. This seems like sound business sense, but they were left with a lingering feeling that money was being left on the table and that they weren't being paid for all of their work.

Depending on the capabilities of your charge capture software, it is possible to capture this reimbursement with no physician effort and minimal time required by billing staff to create each claim. Cardiology Consultants Medical Group in Los Angeles worked with pMD charge capture to create a proprietary feed directly from the cardiology system in which they were submitting their reports. This system could produce electronic data for each test result as the physician interpreted the test. It turned out that this report also contained the necessary information to create a billing claim. By working with CCMG and with the hospital, pMD automated the process from end to end.

In an era of declining reimbursements and increasing time pressure on physicians and their staff, any new source of revenue is very welcome, as is this kind of deep automation that eliminates paperwork from a practice.

The message for all providers, not just cardiologists, is clear: choose a software company for charge capture that supports your specialty-specific needs and that will work with you to find additional revenue. With declining reimbursements, every $6.40 counts!