The Opioid Crisis, PDMP, and Interoperability

opioid-blog-image-1The National Crisis

The opioid epidemic makes the news at least once a day in my neck of the woods.  Patients, providers and the government talk about the problem and how they’re going to solve it. Drug companies advertise Naloxone as something that you should have on hand as a first response to an overdose, just like having an Epi-pen on-hand is recommended to respond to severe allergic reactions. One of the most talked about solutions for physicians and eligible provides is the PDMP or Prescription Drug Monitoring Program.

What is a PDMP?

A PDMP is a state run system that records data on prescriptions for Schedule II to V narcotics. Currently, 49 states plus the District of Columbia have implemented a PDMP. Missouri is the only state without a statewide PDMP. The contents of each can vary based on the laws of the state, but generally the database is populated by pharmacies when a prescription is dispensed and, in some cases, by the dispensing physician or insurance claims. There are some holes in the databases. In some cases, federally operated pharmacies such as those on military bases, are not required to submit data. In other cases, prescriptions paid for in cash are not submitted. And they only contain the data for prescriptions written in your state. For those of you who live in towns that border neighboring states, your patients may have their prescriptions filled in a different state than where you practice.

While not perfect, PDMPs are one of the best tools available today to help practitioners understand their patient’s drug history and the patient’s potential to be an abuser.  There are documented successes with PDMPs. New York mandated the use of PDMPs in 2013, and in that first year, doctor shopping decreased by 75%, the number of opioid doses dispensed decreased by 10%, and the number of prescriptions for buprenorphine, a drug used to treat opioid addiction, increased by 15%.[1] In 2012, Kentucky became the first state in the nation to pass legislation mandating comprehensive PDMP use. That legislation led to a 13% decline in opioids dispensed, a 25% decline in prescription opioid deaths, and an almost 90% increase in prescriptions for buprenorphine, a medication to treat opioid addiction.[2]

Making connectivity difficult

Today, 39 states require a provider to check the state’s PDMP before they write a prescription for an opioid. Since not all states use the same software (some are homegrown), the ability for EHR vendors to connect to these databases is not easy or simple.  Some states, like New York, are simply not ready for EHRs to connect. This makes your workflow and the workflow of your staff difficult.opioid-blog-image-2

Figure 1 Information current as of January 2019

Is Your Prescribing Workflow Optimized?

Working with our partners at DrFirst, SRS Health now provides a seamless workflow to allow providers to check the PDMP for 35 states. Three other states are in process. With just one click, the patient’s medication history is displayed and the date that the PDMP check was performed is recorded in your state’s database and made available within the EHR’s prescribing application.

Interstate checking of PDMPs is also available for 47 participating states so practices in border towns can see not only their state PDMP data but that in neighboring states as well. Practices just need to request access to other states at implementation. If access is available across states, it will be set up as part of the installation.opioid-blog-image-3

Figure 2 Connectivity as of November 2018

What else will help?

PDMPs are one of the tools available for clinicians to help fight the opioid crisis. Utilizing electronic prescribing for controlled substances is another tool. EPCS prevents prescriptions from being altered or copied and refilled multiple times.  Pharmacists tell stories about how a 30-day supply has become a 130-day supply.

MYTH: Not many pharmacies accept electronic prescriptions for controlled substances. FALSE

According to Surescripts, > 95% of pharmacies in the US are EPCS enabled[3],[4] while physician and provider adoption remains low, with only 31% of providers using EPCS. New York leads the nation with 93.8% of controlled substances prescribe electronically. North Dakota, Maine, South Dakota and Minnesota round out the top five with 57%, 41.2%, 37.3% and 34.2%.[5]

While only 5 states require EPCS (Arizona joined the ranks as of January 1), ePrescribing of opioids is coming. Six more states have passed laws that go into effect from January 1, 2020 through January 1, 2022. In October, 2018, the federal government passed the Opioid Response Act[6]. A portion of the act called the “Every Prescription Conveyed Securely (EPCS) Act will require electronic prescribing for patients covered by Medicare and Medicare Advantage plans of all Schedule II-V narcotics beginning January 1, 2021. Earlier in the year, retail giants Walmart and Sam’s Club announced that they will require EPCS for all controlled substances by 1/1/2020 – less than 12 months from now!

How can you prepare?

For SRS Health EHR users, the answer is simple. We’re ready so you can be ready too. With our new Rx application, powered by DrFirst, we deliver an integrated eRx, EPCS, PMDP access and mobile application that allows you to meet all the state and federal mandates and help improve patient care. Just contact your account manager to learn more.

For non-SRS Health EHR users, check with your EHR vendor to see what capabilities they offer. Contact us if you’d like to learn more, our team is ready to help.

Citations:

[1]  Shatterproof, et al. “Prescription Drug Monitoring Programs: Critical Elements of Effective State Legislation.” March 2016.

[2]  Shatterproof, et al. “Prescription Drug Monitoring Programs: Critical Elements of Effective State Legislation.” March 2016.

[3] Electronic Prescribing for Controlled Substances, Surescripts

[4] E-Prescribing Pharmacies

[5] E-prescribing up more than 500% since 2015. Health Information Technology, May 8, 2018

[6] Senate easily passes sweeping opioids legislation, Washington Post, October 3, 2018

Patient Portal: The Gift That Keeps on Giving

patient-portal-blog-v3Gifting season may be over, but there is one gift that you can give to your patients that will keep giving benefits to you and them for years to come. To improve patient engagement, you need a portal that is easy to use, responsive, and allows your patients to communicate with your practice on their terms.

What results when you empower them with the right tool? A gift that keeps on giving—increased patient satisfaction, time and money savings for your practice, and increased quality of care.

Here are the top 3 ways a patient portal could benefit your practice:

  1. Streamlined Patient Registration and Intake Process
    • Registration forms can be downloaded and filled out at home—providing the convenience of being able to complete forms at their leisure and decreasing their wait time
    • Data provided can auto-populate to your EHR—allowing your staff to spend more time interacting with your patients
  1. Improved Patient Engagement and Communication
    • Patients can efficiently and conveniently connect with the portal to schedule  and manage appointments, pay bills, view documents, and communicate  with staff members and physicians via messaging—reducing time spend on back and forth phone calls which oftentimes causes delayed responses and miscommunication
    • Better engagement leads to better patient-physician relationships, ultimately increasing retention and improving clinical outcomes
    • With a mobile solution, the patient has access to all their health data as they communicate and manage appointments on the go—empowering the patient to make their own health decisions
  1. Optimized Operational Workflow
    • With online access, patients can schedule appointments, access their records/tests, refill prescription, pay their bill etc. on their own, which frees up your staff and physicians’ time to focus on other important tasks, as well as allow practices to decrease bad debt and get paid quicker
    • Improved communication efficiencies and automated patient reminders reduce no show rates as well as overall wait time allowing you  to see more patients in a day
    • Patients filling out forms prior to their visit allows the practice to better prepare for the visit, decreases in office wait times and the work involved with scanning paperwork and updating chart data

So not only does providing the best patient portal solution help your patients succeed at their own care, but also helps your practice win! What are your 2019 strategies to improve patient engagement?

 

*Source: Patient Portals: Build Them Well and They Will Come

 

The Essential Elements of Value-based-care Success

For a medical practice to operate successfully, all its constituent parts need to fit together as seamlessly as the atoms in a molecule—because that’s what it takes to succeed in today’s changing healthcare environment.success-blog-image

In a water molecule, for example, the oxygen atom is balanced and supported by the push and pull of two hydrogen atoms. This simple structure nourishes all life on the planet. But remove one of the atoms and the molecule ceases to exist, breaking down into its component elements of hydrogen and oxygen.

In much the same way, a medical practice is held together by the push and pull of different elemental forces. The doctor is supported by—but also has to balance the demands of—the clinical and financial sides of the practice. When this is done successfully, the result is a caregiving structure that nourishes the health of the patient. If the balance is lost, however, the practice begins to break apart, disrupting the equilibrium between the business of medicine and patient care.

Keeping this already precarious balance has become even more challenging with the shift to value-based medicine, which has altered the healthcare paradigm from doctor says/patient does to doctor/patient collaboration—adding another element to the healthcare molecule—the patient. Now, in addition to keeping up with the latest clinical developments and keeping the practice fiscally afloat, doctors have to find ways to bring the patient into the loop.

This year’s User Summit gave healthcare providers a forum for discussing what it takes to succeed in the evolving, value-based healthcare environment, and it gave us a chance to showcase the innovations we have developed to help you keep the right balance between the elements.

So how do we involve patients more deeply in the healthcare process? How do we make sure that they are informed and engaged with their care team, that they understand and comply with their care plan, and that they are financially supported in maintaining care?

For us at SRS Health, the challenge is to develop solutions that reduce the barriers between the patient and the practice. This means providing practices with tools that:

  • offer both speed and flexibility,
  • improve both the clinical and patient experience,
  • remove physician and clinical team distractions while still providing true mobility,
  • streamline the efficient collection of relevant data and corresponding intelligence at the point of care, and
  • address the healthcare consumer’s role in driving patient satisfaction and practice financial health.

In other words, finding practical innovations that support all of the elements of healthcare in achieving success.

How Your Practice Should Compete in the Digital World

As technology has changed the way people receive information, it has also changed the way patients determine a care path for an injury or condition. Most significantly though, it has changed the way patients choose a specialist to treat their condition.  Practices must adapt their patient acquisition strategies to reflect this more informed and more digitally savvy audience if they want to remain profitable in the coming years.

This is especially true for practices that wish to remain independent as hospitals and health systems continue to acquire referring practices, such as Primary Care and Family Medicine.  However, too often practices do not understand the need to implement a cohesive digital strategy until they begin to see a decline in patient volume or an increase in competition.  It is important to understand the impact the digital shift has had on patients and how to use it to remain profitable.  Below are some of the basic strategies practices should be using:

A Mobile Responsive and Unique Website 

Statistically, almost 70% of medical journeys begin online with patients searching for conditions and a provider to treat that condition.  What’s more, 60% of all internet traffic now comes from a mobile device (phone, tablet, etc.).  What this means is that the majority of potential patients are researching a condition or searching for a provider on a smartphone or tablet. This is where your practice’s website becomes one of the most important tools in patient acquisition.

By now most practices have a website – but that may not be enough.  In 2014, Google began to penalize websites that did not meet the standards of a “mobile responsive” website.  What this means is that the website had to be updated to use a theme or platform that automatically detected whether the potential patient was using a phone, tablet or desktop computer and automatically reformatted the layout and navigation of the website to ensure a better user experience.  If your website does not meet these criteria, Google began to push your website further down in the results if a search came from a phone or tablet.  If patients have to spend time pinching and scrolling to be able to read the content on your site, they are far more likely to leave your website and go to a competitors’ website to find the information they are looking for.

In addition to the mobile responsiveness of your site, Google bases your placement in search results based on the content within your site.  Too often practices make the mistake of simply listing the conditions they treat or procedures that they perform.  Not only does this lack of content hurt your placement is Google search results, but it also hurts your new patient acquisition.

In a world where a wealth of information on any medical condition is accessible instantaneously, the modern patient needs more than just a bullet point on your website to ensure that you are the right doctor for them.  To increase patient acquisition, your website should have individual pages for each treatment you provide, condition you treat and procedures you perform.

A Google Pay Per Click (Adwords) Strategy

A Google Adwords Strategy gives your practice the ability to target your message to patients in your area looking for your services at that very moment.  Google Adwords allows your practice to “bid” on relevant search terms in your area and shows your results at the top of the page. Google Adwords is statistically the highest ROI digital marketing effort a practice can utilize.

The most important aspect of Google Adwords to remember is that these ads allow you to outrank your competitors for only the most relevant searches and keywords related to the services of your practice for those searching in your area.  Also, these ads are shown above the organic search results, so even if a competitor’s website outranks yours, your ad can be shown above their website.  

But, running a Google Adwords strategy on your own may be more complex than it seems and can result in wasting a large amount of dollars if not implemented and monitored correctly.  Knowing what kinds of phrases indicate a patient is simply doing research versus those terms that a patient is specifically looking for a physician can be the difference of hundreds or thousands of dollars in a month.

Social Media Marketing

According to a 2017 Pew Research Study, 67% of all Americans get at least half their news from Social Media sites.  This represents a significant shift from print and TV being the primary news sources, but does not seem all too surprising considering that the average American spends almost two hours per day on social media sites.

The likely reason for these shifts is that social media sites like Facebook serve as aggregate news sites where users can get information from all their trusted news sources, from local newspapers to national TV networks, in one single place.  Platforms like Facebook recognized very early on how to monetize the time users spent on the site or app by allowing for highly targeted advertisement being shown to their over 1 billion users.

In most cases, medical practices conceptualize social media as a place where people post pictures of their children, pets and food.  While that may be what you see externally, internally Facebook and Instagram have an incredible amount of data about their users that can be used to target specific ads to potential patients in your area.  These platforms track data points that include your age, gender, location, purchases you make, websites you have visited, interests you have and thousands of other data points.  All of this data can be used to create a behavior profile of a patient that may be in need of your services and target them with ads both on social media and on other websites they visit.

Facebook and Instagram ads are imperative for brand awareness and have become the modern newspaper or magazine ads and are far more cost effective.

What digital healthcare marketing strategies are your practice implementing to help build brand awareness with your patients?

 

daniel-goldberg

About the Author 

Daniel Goldberg is the CEO of Gold Medical Marketing and has been a thought leader for almost a decade in the field of Healthcare Marketing. Daniel has also lectured at some of the most esteemed medical conferences in the country and has contributed to many healthcare industry publications on the topics of Medical Marketing and Direct to Patient Marketing.  Daniel and his team at Gold Medical Marketing have helped practices around the country implement unique marketing strategies based on their specialty and unique patient demographics.

3 Proven Ways to Improve Practice Profitability and Clinical Performance Using Outcomes

outcomes-blog“Why should we collect data?”

“What’s the ROI of PROs?”

“How do providers and practices use outcomes data most effectively?”

These are great questions, and we get them all the time. Prospects, clients, and partners constantly look for the most valuable and effective ways to utilize outcomes data. Our answers and advice typically vary, but we inevitably reply with a question of our own: “What are your goals?” Clinic goals, quality goals, business goals, marketing goals and others factor into play when utilizing quality data.

This article focuses on the three that, in our opinion, provide the most significant ROI potential for a PRO collection program:

  • Negotiating with payers
  • Internal physician quality reviews
  • Marketing

At OBERD, we know our role: we’re the data collection experts. And for good reason: Our clients likely don’t think about data collection nearly as much as they’re thinking about how to improve their practice, how to differentiate their providers, and how to grow margin by negotiating more favorable reimbursements from payers. Outcomes data plays a role in all three. Let’s dig in.

Below, we identify three core initiatives common at most orthopaedic institutions and discuss how quality data plays a key role each.

Payer Negotiation

When preparing for payer negotiations, administrators, QA staff and physicians can gather and utilize outcomes and satisfaction data that highlight the practice’s attention to quality and demonstrate its continuous improvement in outcomes scores.

Armed with quality data relating to patients and procedures, administrators can drill down and have data-driven negotiations with payers to gain more favorable reimbursement rates in contracts.

And it’s worth it to payers. If they know a provider has high (and predictable) quality metrics, they know the provider will, more than likely, get it right the first time. They can hedge against re-admissions and complications because they have the data that demonstrates low risk.

This is especially useful in larger metropolitan areas where competition for the patient population is fierce. Providers and institutions who can demonstrate quality and value, backed by data, are a safer bet for payers.

Physician Reviews

Administrators and quality managers may struggle with physician quality reviews if they’re not armed with data-driven quality and satisfaction metrics. PRO data, especially when blended with Satisfaction data, can give an administrator a quantified view of the quality a physician provides.

Practical use cases include identifying why a surgeon’s quality scores are high for a specific surgery (or even a specific patient cohort), and utilizing that data to refine methods for other under-performing providers.

Imagine the following conversation between an administrator and surgeon: “Dr. Smith, can no longer perform a total knee for patients with a BMI over 20 because outcomes scores are too low and it makes the practice vulnerable to margin if it affects our payer contracts. Dr. Smith needs to adjust your process, perhaps by adopting Dr. Jones’s approach because Dr. Jones’s scores are above average on benchmarking reports. Or we can change workflow triage that patient cohort (<20 BMI) out of Dr. Smith’s patient schedule.”

Data-driven Marketing

It seems like every time we hear about an orthopaedic surgeon, you also hear, “he’s the best” or “she’s the best.”

Surely not every surgeon is the best, even among their local market or patient population. But practices and providers have benefited from anecdotal reputations like, “he’s the best” for years. In the future, a claim of being, “the best” needs to be backed up.

Just like so many other consumer purchasing decisions, prospective patients are first turning to the internet for reviews and fact-finding about a surgeon prior to going for a consult. Practices and providers who collect data can also demonstrate quality by leveraging data in data-driven marketing messaging.

Savvy practices have already begun advertising their data collection initiatives. Advertising shows how providers collect quality data using patient questionnaires in order to tailor care to a unique patient, or make recommendations based on “patients like you.”

That line of advertising instills a sense of ownership in the patient. They intuitively understand that the questionnaires they complete play a role in the care they receive, giving them an onus of control in the process. Therefore, data collection is an effective, credible way to market value-based care.

As seen in OBERD’s Insights Blog.

2.02% Reward for Perfect 2017 MIPS Score

final-score-100The results are in! We now know how providers will be rewarded for their 2017 MIPS efforts. You may be disappointed to see that with a perfect score of 100, the 2019 payment adjustment will max out at just slightly above 2%. And, unless a provider exceeded the exceptional performance threshold, thereby qualifying for a share of the $500 million bonus pool, the reward for successful MIPS performance is no more than an approximately 0.3% positive payment adjustment.

A survey of a few SRS Health customers revealed the following correlations between scores and payment adjustments:

2019-positive-payment-adjustments-v3

To summarize, MIPS Medicare payment adjustments fall into the following categories:

chart3

So what happened to the 4% positive payment adjustment “carrot” that the MACRA legislation appeared to offer (even before the bonus)? It vanished when CMS eased the requirements and reduced the threshold for penalty avoidance. Under the mandate of budget neutrality, with fewer providers receiving negative payment adjustments, there will be less money to share among the many providers who merit positive payment adjustments.

This was not unexpected, and a similar result should be anticipated for the next few years. The 2020 payment year (2018 performance year), offers a carrot of 5%, which will be similarly elusive. And the challenge of how to sufficiently motivate and reward providers will continue over the next few years, now that Congress has extended the transition period and relaxed the previously aggressive timetable for increasing the performance threshold.

 


 

Note:  To find out your individual or group’s 2017 final score and precise payment adjustment, log in to the QPP portal and follow the “QPP Performance” prompt. Your final score will likely be what you expected based on your attestation and/or other submission(s). If there is a difference, it could be due to new information reflected in the Quality component of your score, for example:

  • If, based on sufficient volume, you were subject to the All Cause Hospital Readmission measure, that data would be included in both the numerator and denominator of your Quality score.
  • If one of your CQMs was CAHPS for MIPS, that score will now be reflected.
  • If you reported a CQM for which no historical benchmark had been available at the time of submission, a benchmark may have been created subsequently, based on 2017 performance data.

If you believe that there is an error in CMS’ calculation of your final score—and therefore your payment adjustment—you can request a “Targeted Review” by September 30, 2018.

Are You Preparing for Appropriate Use Criteria Compliance?

auc-blogAppropriate Use Criteria (AUC) is a lesser-known government law that will affect everyone who orders advanced imaging procedures—a staple of orthopaedic practices. AUC is part of the Medicare Physician Fee Schedule regulations.

The law will impact the ordering, performing, and payment for advanced imaging procedures beginning January 1, 2020. The initial year (2020) will be an educational and testing year that will not affect payment.

Included in the advanced imaging procedure category are MRI, CT, PET, and nuclear studies. While certain specialties may not order many PET or nuclear studies, MRI and CT are staples in the diagnostic pathway and help determine care.

How does the law work?

The government is mandating that before any advanced imaging procedure is ordered, the ordering provider must consult an approved Clinical Decision Support Mechanism (CDSM). The CDSM will consider multiple factors on the patient and provide a recommendation as to whether or not the ordered procedure is appropriate or whether an alternative would be better.

At this point, providers have the choice to continue with the original order or to follow the CDSM recommendations. Information provided in the CDSM recommendation must be provided to the furnishing provider (imaging facility). The imaging facility must then include this information on the claim to the payer, and data on the choices made by the ordering provider will be stored in the CDSM for future auditing purposes.

Those who do their own in-house imaging will be impacted on the ordering and furnishing side. Your EHR, Radiology Information System (RIS), and claims management system will all need to be updated with new software to manage this.

We encourage you to speak with your EHR vendor to make the process of remaining compliant and meeting the requirements as seamless and minimally invasive as possible.