The pMD Blog

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where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.


New research has found that Electronic Health Records don’t reduce the administrative costs of medical billing. In a large academic health care system with a certified EHR, “costs for processing a single bill ranged from $20 for a primary care visit to $215 for an inpatient surgical procedure, or up to 25 percent of revenue.” That’s a staggering drain on the bottom line.

Worse yet, the researchers did not find any obvious process issues within the institution’s central billing office that could be streamlined. They said that “the high costs were not caused by wasteful, inefficient processes, duplicate or redundant tasks, or the inappropriate use of high-wage personnel to perform low-skilled tasks.” So what gives?

One factor to consider is the quality and the timeliness of the information that reaches the central billing office. If the institution is relying on EHR software to capture billing information as part of the patient’s progress note or op report, then it may take days or weeks for the physician to finalize and sign that note. Additionally, it may be missing information that is needed for billing. For example, it may have the patient’s complete problem list, but a coder may be required to determine which specific ICD-10 diagnoses this physician was addressing during their visit on this date of service. Charge entry lag and requiring coders to look at every charge would both contribute to billing overhead that can’t be streamlined away on the back end. In other words: garbage in, garbage out.

This is where mobile charge capture software is like delicious revenue peanut butter that complements the EHR’s clinical chocolate. It can get complete and accurate billing information to the central billing office in less than a day, regardless of how long the EHR progress note takes to complete. And that charge already has just the ICD-10 and charge codes that are specific to the physician’s specialty and to the date of service. The charge even acts as a “ticket” to find missing notes and thus lost revenue.

Desktop EHRs were never meant to be mobile charge capture systems, and they don’t reduce the cost of billing for medical services. And it’s expensive to try to patch up and work around issues with charge lag and coding, especially when those originate on the front end, with getting accurately and timely information to the central billing office. Fortunately, pMD Charge Capture and MIPS Registry solves this problem at its origin and results in a much faster and less expensive billing process.

 If you'd like to find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, care navigation, and clinically integrated network software and services, please contact pMD.

Image: Luciano Lozano/Ikon Images/Getty Images

Here's The Latest in Health Care:

•  Doctors are reimbursed for everything ranging from office visits to lab work to medical procedures. But what about the tasks that pull allocated time away from actual face-to-face visits? Data suggests that doctors are spending a significant amount of time on desktop medicine tasks. The data also highlights a reduction in time spent with patients and yet, physicians are not reimbursed for their EHR time.  Read More

•  Do you find yourself zoning out in the middle of one-on-one conversations? Do you procrastinate more often than not? There are, according to the World Health Organization, six simple questions that can reliably identify whether you have adult attention-deficit/hyperactivity disorder (ADHD). It's important to note that the questions should be looked at in their totality, not individually. No single question stands out as an indicator of ADHD.  Read More

•  The federal government settled on an average rate increase of 0.45% for its finalized 2018 payment rates for Medicare Advantage (MA) plans. The rate announcement gives MA organizations the incentive to develop innovative provider network arrangements, encouraging enrollees to access high-quality healthcare services.  Read More

•  A report published Tuesday by the Centers for Disease Control and Prevention found that 1 in 10 pregnant women in the continental U.S. with a confirmed Zika infection had a baby with serious birth defects or brain damage. There is also more evidence that birth defects were a bigger risk in women who were infected in the first trimester of pregnancy.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.
The industry-leading electronic health records (EHRs) were not designed with mobile devices in mind. Targeting the vast majority of physicians who are office-based and largely stationary, they fill a computer's screen with nested menus and rows of buttons. With the added requirements of Meaningful Use certification, there's simply no way to fit all their bells and whistles into a user-friendly smartphone user interface - nor, for the typical primary care practice, is there any great need to do so.

Meanwhile, certain pMD customers who see patients in skilled nursing facilities (SNFs) or dialysis clinics have told us that their EHR requirements are actually pretty straightforward. They mainly want to have consistency in their clinical documentation across all the various facilities that they go to. These facilities use their own proprietary EHRs, or even paper charts in some cases.

The physician groups need the ability to do coding audits internally using the doctors' progress notes, and to respond to any external requests for documentation from insurance companies. It turns out that none of those things require a Meaningful Use certified EHR. These highly mobile doctors can adopt something more elegant and fast that has been designed from the beginning for the same smartphones that they're already using for charge capture. After all, the stimulus money is gone and there's a hardship exemption for groups who see most of their patients at multiple outside facilities.

As specialists, their templates can be small and specific to the type of encounter. Integrated quality measures that are highly context-sensitive keeps data entry to a minimum while preparing for 2019, when quality and efficiency will account for most of the MIPS program which will replace Meaningful Use and will include a value-based payment bonus from Medicare as well.

It's exciting to be working with our forward-thinking customers to build the lightweight, mobile-first EHR that meets the under-served needs of geriatricians, rehab specialists, and nephrologists. The first EHRs were designed by physicians simply to improve their record keeping and to reduce the administrative burdens on their practices. Returning to this idea, it's liberating that we can focus our energy on what the doctors actually need and want from an EHR rather than the bureaucratic requirements imposed by the government and by insurance companies.

As someone who works at a company that creates user-friendly charge capture and messaging software for doctors, I find it slightly ironic that the latest in Electronic Health Record (EHR) technology has led to the resurgence of one of the world’s oldest professions: scribes. These modern day medical scribes aren’t exactly recording hieroglyphs, but they are instead helping doctors tackle EHR systems that have become all too complicated and non-user friendly.

What is a medical scribe?

Medical scribes shadow doctors at each patient appointment and enter the documentation from the patient encounter into their EHR system. In doing so, the scribes free the doctors from having to do this task themselves for each patient visit. Many scribes are pre-med students who are eager to gain valuable experience and make a couple of extra dollars on the side. Demand for scribes is growing rapidly at a national level as doctors become more aware of this service and scribe staffing companies become more widespread.

Why are scribes re-emerging?

The answer is simple: scribes are re-emerging because of the inefficiencies of EHRs. It’s no secret that many physicians are less than keen on using their EHRs, which have begun to develop a stigma in health care. A recent survey found that 41 percent of health care providers nationwide are dissatisfied or indifferent to their current EHR. This discontent stems largely from a variety of factors with EHRs: the amount of information that doctors have to record for each patient visit has increased, the software has become more complex, and EHR integration with other systems is still limited. Given these inefficiencies, provider productivity is consequently affected - many doctors contend that they are seeing fewer patients each day because of the overwhelming amount of time that EHRs require of them.

To scribe or not to scribe

There are some compelling arguments regarding the use of scribes for patient visits - both for and against the scribe.

Pros: Scribes save doctors valuable time by taking over tedious EHR clerical duties, and they thus improve doctors’ work-life balance. They arguably lead to more focused patient care during a visit, and also give medical students valuable experience and exposure to a high volume of patient visits.

Cons: Scribes are expensive and add to the high cost of practicing medicine. They are also arguably an intrusive and distracting presence for the patients during visits. But most importantly, scribes are the product of a larger failure of current EHR technology.

There is great debate among health care professionals about whether or not scribes are the answer to their EHR problems. Medical scribes may be a good temporary solution for EHR use, but this isn’t a long-term answer to EHRs. We cannot let EHR vendors off the hook by hiring additional staff to use their unusable software. And coming from a company that develops truly user-friendly software, I think it is completely backward thinking.

The use of scribes should be a wake up call to EHR vendors; doctors are so averse to using their already expensive software that they are now paying other people to do it for them. The health care industry needs to increase its focus and resources on improving health care IT to become more efficient and usable for doctors. These complicated but important EHR systems desperately need to become easier to use, intuitive, and streamlined, and to ultimately become a doctor’s ally. Let’s hope we don’t see a comeback of the carrier pigeon any time soon...