Surgery centers are increasingly adopted information technology to integrate their processes with their physician practices and keep up with hospitals and ASC competitors. Here Robert Brownd, Surgical Notes' director of business development, discusses five technologies surgery centers should consider implementing within the next few years to stay competitive.
1. Transcription services to complement a practice management system. Mr. Brownd says while surgery center's business needs do not match the functionality that a full-blown electronic medical record provides, centers could immediately benefit from a transcription product to improve quality of operative notes. "A lot of times, surgery centers consider transcription a commodity product," he says. "It's not — rather if treated as a commodity, surgery centers will likely engage with an inferior transcription service that provides poor quality, which will create time waste through unneeded management of this inferior service. This time waste and sub-par transcription quality is guaranteed to have negative impacts on your revenue cycle."
He says that in order to keep these negative impacts off your revenue cycle, it’s very important to partner with an industry established transcription vendor that can provide quality and timely (next day turn-around-time) transcriptions. "Secondly, you want a vendor that can equip your physicians and business office staff with a web-based transcription management tool that is interfaced with your core practice management system," he says. "That's exactly the type of service and technology that we equip our surgery center clients with and they stay automated."
He says if a surgery center does not invest in quality transcription services, the ASC will likely submit inaccurate claims to payors and have to wait for reimbursement while they handle the appeals process. "Leveraging a transcription technology that interfaces with your core practice management system will ensure the ADT and report content is accurate the first time around," Mr. Brownd says. "Converting to a vendor that has this type of technology will shave off AR days, from your current vendor that might be providing poor quality transcriptions that lead to these submissions of inaccurate claims." He adds that using a full service transcription product might eliminate the need for a full-time employee — who costs the center salary plus benefits — and saves money. "Instead of a transcription vendor that doesn't deliver reports back for two or three days, or a full-time employee expense, you can have technology working to save you time and preserve data integrity," he says.
2. Coding and transcription handled by a single vendor to leverage their technology platforms. Mr. Brownd adds that surgery centers should look into ASC vendors that provide both transcription and coding services. He says some vendors tailor their business model to provide both services, because they can integrate both their transcription and coding platforms through one interfaced and highly streamlined system. This product arrangement works particularly well for surgery centers because it removes the need for the center to single out both their coding and transcription operations to separate vendors or in-house FTEs. If both services can be consolidated under one specialized vendor, you gain from their economies of scale and unique technologies. "Therefore, the codes are turned around the next day as well, so within 24 hours, you have the coding and the transcription turned around in a digital format for seamless charge entry," he says. "The quicker you get those claims processed, the more money you are adding to the bottom line."
He says many surgery centers may not realize they can combine transcription and coding services with one vendor. He says it's also worthwhile to contract a transcription vendor that has a great reputation for providing consistent quality and technology, instead of viewing transcription as a commodity to save a little money by contracting with subpar vendor. "You can save $200 a month with a cheaper company, but if you err on one claim with your insurance companies, that easily could be thousands of dollars you leave on the table," he says. "The real scenario is multiple claims start having issues, due to poor transcription quality, which further damages your bottom line much more so than spending a few hundred extra dollars a month with a transcription company that is considered the 'gold standard.'"
3. Customizable EMR. It is not a smart business or clinical decision for surgery centers to implement the same type of electronic medical records software as hospitals, because surgery centers have vastly different needs, Mr. Brownd says. For example, hospitals may need to track patient blood pressure or cholesterol levels over several days/weeks, whereas ASCs focus on outpatient type procedures and bypass most of the value and functionality points that tablet-based EMRs were intended to provide.
"What surgery centers need is software to keep their existing paper workflows that their doctors and clinical staff are so used to charting on, but eliminate the task for employees to manually prepare and store these patient charts," Mr. Brownd says. "This type of simple technology will enable their staff to remain efficient without losing the quality of patient care. The solution has to also be highly customizable to their practice and very easy to use." Overall, he says the software should not change the clinical workflows, with the exception of reducing clinical chart retrieval time.
While a hospital with employed physicians can dedicate significant time to EMR training, a surgery center may find it more difficult to allocate training hours for its surgeons. Because of this, an EMR or electronic document management system should be easy-to-use and customized to the surgery center, so that most of their workflows and forms remain the same. Mr. Brownd says a good motto with technology to have is: "you have to crawl before you walk before you run."
He says the key is to implement a solution that can achieve a moderate level of culture change. If the EMR technology requires too much change to existing workflows, physicians and staff will likely resist the change entirely, and the technology will become a quick failure or long-term struggle at a hefty expense. Fortunately, he says there are solutions tailor-made for the ASC market that have a proven track record of successfully changing business office and clinical cultures to improve operations. "You just have to get out and evaluate these solutions against your business needs," he says.
4. Scanning technology with a barcode. Surgery centers that aren't interested in adopting a full electronic medical record might consider technology that simply scans the patient chart and indexes an electronic copy. This process eliminates the need for paper record storage and retrieval, which is part of the intention of electronic medical records. "This type of product is the best of both worlds because it allows you to keep the familiar paper chart for your physicians and clinical staff, but eliminates the need to have to manually pull forms and prepare the chart with sticky labels," Mr. Brownd says. With this technology, the physicians maintain the use of a paper chart while with the patient, and postoperatively, the business office scans it to an electronic .PDF format through a proprietary barcode technology.
He says while some surgery centers have adopted tablet EMR technologies, he would recommend seriously evaluating other software options and calling at least two reference surgery center sites to see how their implementation and "go live" were executed. "Some hospitals have seen many secondary effects from implementing a tablet based system," he says. "One of those noticed effects has been that nurses are still filling out the paper chart and then having a second layer of employees typing the information into the EMR. This workflow has slowed down the delivery of patient care and has established redundant charting practices." He says some centers have found it very difficult for center management to achieve 100 percent physician compliance with a tablet based EMR, which leaves a half-paper and half-electronic based medical records environment.
5. Preparation for possible EMR mandates. While Mr. Brownd doubts the federal government will mandate electronic medical records for surgery centers any time soon, he says surgery centers should still prepare for the possibility by familiarizing themselves with technology. "I urge facility administrators and business office managers to not be afraid to take a look at technologies readily available to them," he says. "Some of these 'lighter' EMRs afford a return on your investment within the first year." He says if the government did mandate something for ASCs in the same manner as hospitals, surgery centers would also likely be allowed a five year "grace period" to implement software before any mandates and penalties took effect. He says it's worth evaluating these technologies now to increase profitability and prepare your center for any mandates that might arise in 5-10 years.
He says while mandates are a possibility, he doubts surgery centers will receive incentives like hospitals have for implementing EMRs that meet meaningful use requirements. "The Budget Control Act of 2011 was passed to increase the borrowing authority of the United States to reduce the deficit and prevent default, provides $841 billion of immediate reductions in federal spending and more than $2.5 trillion in budget cuts over the next 10 years," Mr. Brownd says. "The likelihood that ASCs will receive incentives in this economic climate are slim." He says since the government has not mandated EMR for surgery centers, ASCs have the advantage of evaluating and hand-picking a system that fits their needs. He says he believes on a "big picture" level, the ASC market is better off without government intervention.
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1. Transcription services to complement a practice management system. Mr. Brownd says while surgery center's business needs do not match the functionality that a full-blown electronic medical record provides, centers could immediately benefit from a transcription product to improve quality of operative notes. "A lot of times, surgery centers consider transcription a commodity product," he says. "It's not — rather if treated as a commodity, surgery centers will likely engage with an inferior transcription service that provides poor quality, which will create time waste through unneeded management of this inferior service. This time waste and sub-par transcription quality is guaranteed to have negative impacts on your revenue cycle."
He says that in order to keep these negative impacts off your revenue cycle, it’s very important to partner with an industry established transcription vendor that can provide quality and timely (next day turn-around-time) transcriptions. "Secondly, you want a vendor that can equip your physicians and business office staff with a web-based transcription management tool that is interfaced with your core practice management system," he says. "That's exactly the type of service and technology that we equip our surgery center clients with and they stay automated."
He says if a surgery center does not invest in quality transcription services, the ASC will likely submit inaccurate claims to payors and have to wait for reimbursement while they handle the appeals process. "Leveraging a transcription technology that interfaces with your core practice management system will ensure the ADT and report content is accurate the first time around," Mr. Brownd says. "Converting to a vendor that has this type of technology will shave off AR days, from your current vendor that might be providing poor quality transcriptions that lead to these submissions of inaccurate claims." He adds that using a full service transcription product might eliminate the need for a full-time employee — who costs the center salary plus benefits — and saves money. "Instead of a transcription vendor that doesn't deliver reports back for two or three days, or a full-time employee expense, you can have technology working to save you time and preserve data integrity," he says.
2. Coding and transcription handled by a single vendor to leverage their technology platforms. Mr. Brownd adds that surgery centers should look into ASC vendors that provide both transcription and coding services. He says some vendors tailor their business model to provide both services, because they can integrate both their transcription and coding platforms through one interfaced and highly streamlined system. This product arrangement works particularly well for surgery centers because it removes the need for the center to single out both their coding and transcription operations to separate vendors or in-house FTEs. If both services can be consolidated under one specialized vendor, you gain from their economies of scale and unique technologies. "Therefore, the codes are turned around the next day as well, so within 24 hours, you have the coding and the transcription turned around in a digital format for seamless charge entry," he says. "The quicker you get those claims processed, the more money you are adding to the bottom line."
He says many surgery centers may not realize they can combine transcription and coding services with one vendor. He says it's also worthwhile to contract a transcription vendor that has a great reputation for providing consistent quality and technology, instead of viewing transcription as a commodity to save a little money by contracting with subpar vendor. "You can save $200 a month with a cheaper company, but if you err on one claim with your insurance companies, that easily could be thousands of dollars you leave on the table," he says. "The real scenario is multiple claims start having issues, due to poor transcription quality, which further damages your bottom line much more so than spending a few hundred extra dollars a month with a transcription company that is considered the 'gold standard.'"
3. Customizable EMR. It is not a smart business or clinical decision for surgery centers to implement the same type of electronic medical records software as hospitals, because surgery centers have vastly different needs, Mr. Brownd says. For example, hospitals may need to track patient blood pressure or cholesterol levels over several days/weeks, whereas ASCs focus on outpatient type procedures and bypass most of the value and functionality points that tablet-based EMRs were intended to provide.
"What surgery centers need is software to keep their existing paper workflows that their doctors and clinical staff are so used to charting on, but eliminate the task for employees to manually prepare and store these patient charts," Mr. Brownd says. "This type of simple technology will enable their staff to remain efficient without losing the quality of patient care. The solution has to also be highly customizable to their practice and very easy to use." Overall, he says the software should not change the clinical workflows, with the exception of reducing clinical chart retrieval time.
While a hospital with employed physicians can dedicate significant time to EMR training, a surgery center may find it more difficult to allocate training hours for its surgeons. Because of this, an EMR or electronic document management system should be easy-to-use and customized to the surgery center, so that most of their workflows and forms remain the same. Mr. Brownd says a good motto with technology to have is: "you have to crawl before you walk before you run."
He says the key is to implement a solution that can achieve a moderate level of culture change. If the EMR technology requires too much change to existing workflows, physicians and staff will likely resist the change entirely, and the technology will become a quick failure or long-term struggle at a hefty expense. Fortunately, he says there are solutions tailor-made for the ASC market that have a proven track record of successfully changing business office and clinical cultures to improve operations. "You just have to get out and evaluate these solutions against your business needs," he says.
4. Scanning technology with a barcode. Surgery centers that aren't interested in adopting a full electronic medical record might consider technology that simply scans the patient chart and indexes an electronic copy. This process eliminates the need for paper record storage and retrieval, which is part of the intention of electronic medical records. "This type of product is the best of both worlds because it allows you to keep the familiar paper chart for your physicians and clinical staff, but eliminates the need to have to manually pull forms and prepare the chart with sticky labels," Mr. Brownd says. With this technology, the physicians maintain the use of a paper chart while with the patient, and postoperatively, the business office scans it to an electronic .PDF format through a proprietary barcode technology.
He says while some surgery centers have adopted tablet EMR technologies, he would recommend seriously evaluating other software options and calling at least two reference surgery center sites to see how their implementation and "go live" were executed. "Some hospitals have seen many secondary effects from implementing a tablet based system," he says. "One of those noticed effects has been that nurses are still filling out the paper chart and then having a second layer of employees typing the information into the EMR. This workflow has slowed down the delivery of patient care and has established redundant charting practices." He says some centers have found it very difficult for center management to achieve 100 percent physician compliance with a tablet based EMR, which leaves a half-paper and half-electronic based medical records environment.
5. Preparation for possible EMR mandates. While Mr. Brownd doubts the federal government will mandate electronic medical records for surgery centers any time soon, he says surgery centers should still prepare for the possibility by familiarizing themselves with technology. "I urge facility administrators and business office managers to not be afraid to take a look at technologies readily available to them," he says. "Some of these 'lighter' EMRs afford a return on your investment within the first year." He says if the government did mandate something for ASCs in the same manner as hospitals, surgery centers would also likely be allowed a five year "grace period" to implement software before any mandates and penalties took effect. He says it's worth evaluating these technologies now to increase profitability and prepare your center for any mandates that might arise in 5-10 years.
He says while mandates are a possibility, he doubts surgery centers will receive incentives like hospitals have for implementing EMRs that meet meaningful use requirements. "The Budget Control Act of 2011 was passed to increase the borrowing authority of the United States to reduce the deficit and prevent default, provides $841 billion of immediate reductions in federal spending and more than $2.5 trillion in budget cuts over the next 10 years," Mr. Brownd says. "The likelihood that ASCs will receive incentives in this economic climate are slim." He says since the government has not mandated EMR for surgery centers, ASCs have the advantage of evaluating and hand-picking a system that fits their needs. He says he believes on a "big picture" level, the ASC market is better off without government intervention.
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