Tag Archives: provider efficiency

Physician Mobility?

Distracted practice

In my day to day, I am Queen Multitasker. I look like the guy in the photo trying to balance phone calls, note taking, and all the multimedia gadgets required of someone in my administrative position. Unfortunately, I know a fair number of colleagues look like this guy instead of the fitted one button coat, they are in their lab jackets in a hospital or office near you.

So what should happen to reduce the juggling of the gadgets? Can we balance accessibility and still practice efficiently? Can we foster 2-way patient interactions and still respect provider downtime? Yes, Yes, and Yes.

I believe it’s a combination of having multiple platforms integrated and optimized for the use of a busy and efficient provider. So what’s out there? We are an iOS world for now(Apple Rules, Android Users just get over it) If most consumers are like me, Steve Jobs’ company has gotten lots of my money over the years. There is the Apple watch, an Apple phone, as well as a tablet either surface or iPad Pro(The gold Ipad Pro is pretty but the verdict is still out on its usage in-house) but do any of these devices make the physician more efficient? Which front end dictation tool should be utilized and optimized? Nuance ™  apps it particularly Dragon Anywhere™ which I’ve been experimenting with more in the previous several weeks is particularly useful input tool.  I found in comparison to previous forms of Dragon™, Siri on my iPhone actually worked better than the previous iterations of the front end dictation tool really previously released by the company Nuance™. But there has been a marked improvement with the release of the Dragon Anywhere tool™. For a nominal subscription fee you have a hardware light version of Dragon™ on your phone. It has a more robust command structure as well as powerful editing tools in which you can enjoy the accuracy in the hardware heavy version of this tool.  I find that my ability to transfer and copy text into a Word document and then easily save it to my cloud Dropbox is almost seamless and then I can actually update the text and repeat that within less than 30 seconds. It has made my ability to post my blog a lot easier. I  still have to go back to my laptop/tablet to make the final corrections and formatting just because I find it easier but it actually has been a godsend as far as my ability to be able to create this post. (FYI, I’m using Dragon Anywhere™ to create this post.) I would suggest that you number 1, have the latest updates on your phone, have a subscription to office 360, and you can ensure that the embedded mic within your phone actually works well. The microphone on the iPhone has excellent noise canceling capabilities however what I have found is my Bluetooth, the accuracy has been affected by the LG 750 even up to LG 760 with a Bluetooth device.  You may actually have a better chance with a wired Beats™ as well as the white earbuds that actually come with your iPhone. I would also ensure that your screen saver or power saver mode is set to a minimum of 15 minutes or so before the  screen locks.

I am a iOS geek through and through.  However, the Surface 3 with Windows 10 and Citrix 14.3 from a healthcare information systems perspective actually affords the end-user the best experience and will truly increase their efficiency. And is also necessary to have a tool either like Dragon 360™ medical or Dragon Direct™. When Windows 10 was released someone told me you will experience a loss of functionality, but could not tell me exactly why. If the device is correctly imaged, with properly formatted applications, and Office 2016, it will only enhance your experience not detract from it. I just wish people that don’t have the full story and can’t give you clear directions on how to change something,  they need to take Madea’s advice and go and sit down somewhere and be quiet. We providers are under pressure from a regulatory standpoint to document thoroughly to tell the full story and to allow proper charges to be created and submitted in a timely manner. And from a business stand point, we are tasked to see as many patients as possible but still provide quality healthcare.  We should have the properly configured tools to allow us to maximize our time interacting with our patients and fellow staff members,  not inputting data into the EMR. Futuristic Complex

 

FYI Insurance Companies and Medical Providers: Medications, Prior Authorization,Insurance Review

aid1978379-728px-Use-an-Inhaler-Step-1Bullet1For the past year, I’ve worked as a third-party medical insurance reviewer.   I’ve reviewed a variety of cases for pediatric clients as it relates to  their hospital stays, therapies, and prior authorization for medications as medically necessary.  I have come in direct conflict with physicians, insurance companies,  and the reviewers for this company.  It was during my review of a pediatric case today I had the following thoughts.  Before I go on,  I wanted to thank the original provider’s office for having an electronic medical record! Big hugs, big thanks, and praise the Lord that I did not have to decipher reams and reams of handwritten notes. They performed a proper medication reconciliation so I could easily find the date that the medication in question was started and when the medication had been switched to something else. I could easily see all the cool new ICD 10 codes.

But what really confused me was how the insurance company did not leverage the information that was right at their disposal.  They have access to medication utilization and refill data. They also have access to unscheduled office visits, urgent care and ER visits, and inpatient admission data.

.  lungs-diagram-120926As a provider, I know that a mark of well-controlled for asthma is no nighttime symptoms, decrease or no utilization of rescue inhalers, only come in for follow-up visits every three months, no exercise intolerance, they can keep up with other children, no significant exacerbations requiring systemic steroids, and no inpatient admissions and definitely no intubation’s. I also am well aware of the standards of care surrounding this disease and if a patient is well controlled based on the previously mentioned criteria, it is not in the best interest of the patient  to change a patient’s regimen solely based on changes in insurance formularies.

For the insurance company,  if you were to evaluate the aggredated data as far as medication refills, unscheduled office visits, unscheduled ER in urgent care visits, you will find out that there are a subset of patients that are actually under excellent control you may want to offer them an exception to random formulary changes based on that data.  Also can you imagine the goodwill  you can bestow to the provider and family members  because you proactively present the providers a list of their patients that are not going to require prior authorization and utilization reviews because you’ve given them the information up front and they will not have to be interrupted for and utilization review? And also the goodwill bestowed on the families who will have peace of mind that the insurance company is not going to randomly stop coverage of a medication that keeps their son or daughter healthy? Why can’t the companies agressively and proactively reach out to the patients and the providers and basically say we’ve noticed that this patient has been on his medication and has exhibited really good control and here is an incentive honorable mention in the insurance plan newsletter, reduction in premiums or coupons for medications, or higher payment to providers or performance bonuses? I believe these small gestures cost less than payments for catastrophic illness and repeated ER visits. Also, if I were the insurance company I would try to find out and replicate whatever this provider is doing to keep his patients compliant, his practice in the management of these patients and distributing this information to other providers in your network. What if the insurance companies had a Goodwill metric that there are exceptions that take in health of a patient on a non-approved regimen and long term cost savings if they were to continue on that treatment? Although goodwill is an intangible asset, it still is a undeniable and underated contributor to the bottom line of healthcare institution. Goodwill-As-One-Of-The-Assets2