diabetes practice options, april 2011

OPTIONSDIABETES PRACTICE

™

Improving Patient Care Through Increased Practice Efficiency

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APRIL 2011

EDITORIAL

3 | DIABETES STRATEGYHemoglobin A1c Test Can HelpPhysicians Identify Patients With Pre-Diabetes

6 | BILLINGHow to Improve Your Practice’sForecasting and Collections Performance

8 | PRACTICE MAKEOVEREarly EMR Adopter: Fewer Chart PullsIncrease Physician QOL, Boost Bottom Line

11 | BUSINESS MANAGEMENTWhat to Take Into Account When ConsideringHospital Employment Versus Private Practice

13 | HEALTH CARE TRENDSNIHCR Report: ACO ImprovementsEffective, Hard to Justify Financially

14 | PRACTICE MANAGEMENT NEWSMajor Primary Care Organizations ReleaseJoint PCMH Accreditation Guidelines

The state of Massachusetts is moving forward with a debate about ways to curb ris-ing health care costs. Following the passage of health reform legislation in 2006,Massachusetts has the nation’s highest insured rate, more than 98%. With mandat-

ed health insurance and a state-subsidized plan for people who cannot afford all or part oftheir premiums, the Massachusetts legislation has served as the model for the federalAffordable Care Act.

Massachusetts has fewer primary care physicians than are needed, which created aserious problem as new people became insured. This situation has improved somewhat,but people living in more rural areas of the state still have long waiting periods forappointments.

With an aging population, increased demand due to mandated health coverage, andContinued on page 2

CONTRIBUTORS

Michael Strachan, MD

Marjorie Collings

Massachusetts Leads theWayWith Health Reform—Again!By Michael Bihari, MD, contributing editor

Page 3

IN THIS ISSUE

Neil Baum, MDUrologistNew Orleans

Daniel BeckhamPresidentThe Beckham Co.Physician and Hospital ConsultantsWhitefish Bay,Wis.

Harold B. Kaiser, MDAllergy & Asthma Specialists, PAMinneapolis

Nathan KaufmanPresidentThe Kaufman GroupDivision of SuperiorConsultant Co. Inc.Physician and Hospital ConsultantsSan Diego

Peter R. Kongstvedt, MDP.R. Kongstvedt, LLCMcLean, Va.

JohnW. McDanielPresident and CEOPeak Performance Physicians, LLCNew Orleans

Lee Newcomer, MD, MHASenior Vice President, OncologyUnitedHealthcareMinneapolis

JamesM. Schibanoff, MDEditor in chiefMilliman Care GuidelinesMilliman USASan Diego

Jacque Sokolov, MDChairmanSokolov, Sokolov, BurgessScottsdale, Ariz.

This newsletter is publishedbyPremierHealthcare Resource, Inc.,Morristown,N.J.

©Copyright strictly reserved.This newslettermaynotbe reproduced inwhole or inpartwithout thewrittenpermissionof PremierHealthcare Resource, Inc.The advice andopinions in this publication arenot necessarily thoseof the editor, advisory board, publishingstaff, or the viewsof PremierHealthcare Resource, Inc., but instead are exclusively theopinions of the authors. Readers are urged toseek individual counsel andadvice for their uniqueexperiences.

EditorRevDiCerto845/[email protected]

ArtDirectorMeridith Feldman

PublisherPremierHealthcare Resource, Inc.150Washington St.Morristown, NJ 07960973/682-9003; Fax: 973/[email protected]

EDITORIAL

EDITIORIAL BOARD

easy access to some of the most expensivespecialty health care in the country, healthcare costs in Massachusetts continue to rise.One of the most popular health plans beingoffered in the state is a Blue Cross BlueShield plan that limits an employee’s choiceby charging hefty fees for receiving carefrom one of 15 higher-costs institutions.

The payment reform legislation intro-duced last month does not mandate the

creation of ACOs. However, the legislationencourages the formation and implementa-tion of ACOs by shifting state employees,Medicaid recipients, and residents withstate-subsidized health insurance into anACO or other alternative payment system.

If passed, the state indicates that the infra-structure and payment strategy will be inplace by 2014. The legislation also autho-rizes the state to seek antitrust waivers fromthe federal government, allowing ACOproviders tomore easily share risk andmakereferrals.

The debate about the Affordable Care Actin Congress is likely to capture headlines.With all the bluster, it is unlikely that theU.S.Senate will follow the lead of the House, andeven less likely that President Obama wouldsign any legislation that would repeal healthreform. Meanwhile, the debate inMassachusetts will be vigorous, with patientadvocates, health insurers, and providerslobbying to assure a bill that passes musterwith all groups. The state again has theopportunity to inform the national debate.�

STAFF

Continued from page 1

2 Practice Options/April 2011

More information is available atwww.DiabetesOptions.net

Michael Bihari, MD

New research published in theJanuary 2011 issue of theAmerican Journal of Preventive

Medicine has demonstrated the useful-ness of the hemoglobin A1c blood testfor identifying adults with pre-diabetes.According to the American DiabetesAssociation (ADA), approximately 79million Americans have pre-diabetes, acondition in which blood glucose levelsare higher than normal but not yet highenough to warrant a diagnosis of dia-betes. People with pre-diabetes are athigh risk for developing diabetes andcardiovascular disease. However, esti-mates suggest that only about 7% ofpeople with pre-diabetes are aware oftheir risk status.

“Chronic diseases related to over-weight and obesity, physical inactivityandpoor eating habits are drivingmuchof the decline in population health andthe associated increases in health careexpenditures,” says Ronald Ackermann,MD, MPH, lead author of the study.Ackermann is a primary care physicianwho serves as associate director of theIndiana University School of MedicineDiabetes Translational Research Centerand director of the Community HealthEngagement Program of the IndianaClinical and Translational Sciences

Institute. “The growing number of peo-ple with type 2 diabetes is one of themost significant detrimental outcomesof the obesity health crisis.”

Costs and PreventionSince pre-diabetes nearly always pre-cedes type 2 diabetes, and since indi-viduals with pre-diabetes can preventthe onset of diabetes through lifestyleimprovements ormedication use, iden-tifying pre-diabetes is critical for pre-serving health in this high-risk popula-tion. “Identifying pre-diabetes andoffering effective prevention strategiescould help millions of individuals toavoid diabetes and avert the very highfuture costs of treating it,” saysAckermann.

A diagnosis of pre-diabetes can alertpeople and their health care providersthat they are getting closer to develop-ing diabetes, which might motivatethem to take immediate action, contin-ues Ackermann. “In addition, becausea diagnosis of pre-diabetes indicateswho is at the highest risk for developingdiabetes, cardiovascular disease, andassociated complications, defining pre-diabetes can help health insurancecompanies, government programs, andcommunity-based organizations

decide where to direct resources forprevention activities,” he says.

The most effective strategies for pre-venting diabetes in high-risk individu-als involve intensive lifestyle interven-tions that incorporate dietary and phys-ical activity programs. “When offeredto adults with pre-diabetes, lifestyleinterventions offer benefits not only bypreventing type 2 diabetes but also byreducing cardiovascular risk factors,”Ackermann notes, adding that evenmodest levels of weight loss can have ameaningful impact on whether or notsomeone develops diabetes. “Losing aslittle as 10 or 15 pounds through dietand exercise can cut diabetes risk inhalf,” he notes. The Diabetes PreventionProgram study found that 30 minutes aday of moderate physical activity and a5% to10% reduction in body weightavoided 58% of new cases of diabetesdeveloping over a three-year period.

However, to be effective, these pro-grams have to incorporate ongoing, per-sonalized meetings with a diet expert ora coachwho canhelp participantsmain-tain healthy lifestyle behaviors over thelong term. “Clearly, this type of inter-vention is prohibitively expensive andsomewhat impractical for reaching all ofthe more than 70 million Americanswho are at high risk of developing dia-betes,” Ackerman observes. “Testingpeople we suspect are at risk of develop-ing diabetes can ensure that greaternumbers of patients with pre-diabetesbecome aware of their status and thatmore intensive intervention efforts aretargeted first toward the highest riskindividuals. Less intensive but broader-reaching public health and policy effortsare also needed to improve lifestyles formillions of Americans before the devel-opment of pre-diabetes.”

Testing AlternativesIf identifying people at high risk fortype 2 diabetes and cardiovascular dis-ease can help physicians appropriatelyand cost-effectively implement inter-ventions to prevent the onset of disease,the question becomes how to determinewhich individuals should be classified

Continued on page 4

Practice Options/April 2011 3

DIABETES STRATEGY

Hemoglobin A1c Test Can Help PhysiciansIdentify PatientsWith Pre-Diabetes

DIABETES STRATEGY

as high risk. “Physicians have typicallyused one of two tests—a fasting plasmaglucose test or a two-hour oral bloodglucose tolerance test—to identify dia-betes risk,” says Ackermann. In 2003,the ADA proposed two criteria thatcould be used to diagnose pre-diabetes:fasting plasma glucose concentrationsof 100-125mg/dL and two-hour plasmaglucose concentrations of 140-199mg/dL. These blood glucose concentra-tions are associated with a greater riskof developing type 2 diabetes and car-diovascular disease in the future.

Unfortunately, both the fasting plas-ma glucose test and the two-hour glu-cose test have limitations in the primarycare setting. Both tests require anovernight fast, meaning that the patientwould have to return for a subsequentvisit. In addition, documentation of apatient’s glucose level maynot indicate whether thepatient was fasting at thetimeof the test,meaning thatthe results may not be inter-preted correctly.

Concerned that obstaclesto testing were preventingpatients with pre-diabetesfrom being diagnosed andtreated, Ackermann and his colleaguesexplored whether the A1c test, com-monly used in primary care settings tomonitor people with diagnosed dia-betes, is a suitable alternative to diag-nose pre-diabetes. In June 2009, theADA, the European Association for theStudy of Diabetes, and theInternational Diabetes Federation allrecommended that the A1c test be

adopted for the diagnosis of diabetes.However, these organizations did notpropose an exact cut-off point at whichpatients should be considered at highrisk of developing diabetes.Recognizing this limitation, the ADAin January 2010 recommended that arange of 5.7% to 6.4% indicates theexistence of pre-diabetes.

“Over the last 15 years, since theDiabetes Control and ComplicationsTrial demonstrated that intense glucosecontrol improved health outcomes,physicians have become more depen-dent upon the A1c test as a reliablemethod of tracking average blood sugarin patients with diabetes,” observesAckermann. “The A1c test is not affect-ed by what a person has recently eatenand can be done without an overnightfast; it also reflects the average glucose

level over an eight- to 12-week period,rather than at a singlemoment. If a fast-ing glucose test result or a two-hourglucose test result indicates the possibil-ity that a patient is pre-diabetic, the nextstep most physicians take is to order anA1c test. They use that test to decidewhether to recommend lifestylechanges or prescribemedication. In thislight, there is a strong argument for

simply administering theA1c blood testinitially.” In fact, recent research find-ings have supported the use of the A1ctest to diagnose pre-diabetes by demon-strating an association between elevatednon-diabetic glucose levels (5.0% to6.5%) and a higher risk of future car-diovascular events.

Identifying Pre-Diabetes“Frequently, a patient will come to hisor her physician for a number of clini-cal circumstances such as high bloodpressure, abnormal blood cholesterol,or weight gain that are also risk factorsfor pre-diabetes,” says Ackermann.“Then, the physician will recommendlifestyle changes, which can really ben-efit almost anyone. Unfortunately, itoften ends there, and brief advice aloneby a physician typically isn’t enough to

result in meaningful andsustained weight losses bymost people. An A1c testcan provide more defini-tive clinical informationthat can guide a physi-cian’s recommendationsand motivate a patient totake action. It could alsobe used to provide the

documentation needed for healthinsurers, employers, or other groups topay for the costs of an intensive lifestyleintervention program.”

The analysis by Ackermann and hiscolleagues used cross-sectional datafrom 4,751 subjects participating in the2005-2006 U.S. National Health andNutrition Examination Survey(NHANES)who reportednoprior diag-



A1C test:• Normal: <5.7%• Pre-diabetes: 5.7%-6.4%• Diabetes: >6.5%Fasting blood glucose test:• Normal: <100 mg/dL

• Pre-diabetes: 100-125 mg/dL• Diabetes: >126 mg/dLTwo-hour oral glucose tolerance test:• Normal: <140 mg/dL• Pre-diabetes: 140-199 mg/dL• Diabetes: >200 mg/dL

Source: How to Tell if You Have Pre-Diabetes. American Diabetes Association.www.diabetes.org/diabetes-basics/prevention/pre-diabetes/how-to-tell-if-you-have.html.

—DJN

AMERICAN DIABETES ASSOCIATION CUT-OFFS FORDIABETES, PRE-DIABETES, AND NORMAL BLOOD GLUCOSE

“Hopefully, policies will begin soon toexplicitly include A1c testing as a cov-

ered preventive service.”—Ronald Ackermann, MD, MPH, Indiana University

School of Medicine Diabetes Translational Research Center


• Age over 45• Overweight or obesity• Physical inactivity• Family history of diabetes (parent or sib-ling)

• History of cardiovascular disease, poly-cystic ovary syndrome, or any conditionassociated with insulin resistance

• High blood pressure (140/90 or above)or high blood pressure treatment

• HDL cholesterol level below 35 mg/dL ortriglyceride level above 250 mg/dL

• Previous positive results on a fastingglucose or two-hour glucose test

• Ethnic minority status (AfricanAmerican, Alaska Native, American

Indian, Asian American, Hispanic/Latino,Pacific Islander)

• Gestational diabetes or giving birth to ababy weighing more than nine pounds

Sources: American Diabetes Association;American Heart Association; www.pre-diabetes.com.

—DJN

RISK FACTORS FOR PRE-DIABETES

nosis of diabetes. The researchersentered the characteristics of these indi-viduals into previously developed pre-dictivemodels that estimate the 7.5-yearprobability of developing type 2 diabetes(the Stern Model) and the 10-year prob-ability of experiencing a cardiovascularevent (the Framingham Risk Engine).The researchers then tested the associa-tions between each individual’s predict-ed risks for diabetes and cardiovasculardisease and A1c, fasting glucose, andtwo-hour glucose test results.

The researchers found that the riskof both diabetes and cardiovasculardisease steadily increased as the A1clevel rose. Overall, approximately 30%of NHANES participants met the 2003ADA criteria for pre-diabetes (basedon fasting and two-hour glucosealone); of this group, the probability ofdeveloping diabetes in 7.5 years was33.5%, and the probably of experienc-ing a cardiovascular event in 10 yearswas 10.7%.

“The analysis helped us identify spe-cific cut-off points that accuratelyreflect the population of patients whowe already accept as having pre-dia-betes,” explains Ackermann. A1c testresults in the range of 5.5% to 6.5%identified a population subgroup witha probability of future onset of diseasecomparable to that of adults identifiedby the 2003 ADA criteria. A1c levelsranging from 5.7% to 6.5% identifiedpatients with an exceptionally highprobability of developing disease com-pared with those of adults who partici-pated in the U.S. Diabetes Program

Study and who had elevations of bothfasting and two-hour glucose valuescombined.

Practical Implications“Many patients with pre-diabetes haveno idea that they have an elevated riskfor developing diabetes and cardiovas-cular disease, partly due to the chal-lenges associated with performing fast-ing and two-hour glucose tests,” notesAckermann. “Using the A1c test toclassify patients with pre-diabeteswould increase the number of patientswho are aware of their risk status,thereby improving the implementationand effectiveness of preventive inter-ventions.”

According to the ADA, clinical indi-cators that suggest a risk of pre-dia-betes include overweight and obesity,age over 45, high blood pressure, heartdisease, low HDL cholesterol and hightriglycerides, a family history of dia-betes, a history of gestational diabetesor giving birth to a babyweighingmorethan nine pounds, or belonging to anethnic or minority group at high riskfor diabetes.

Ackermann and his colleaguesbelieve their analysis validates the useof the A1c test to identify pre-diabeticpatients in clinical practice. “The A1ctest is practical and easy to interpret,”he says. “However, no single test identi-fies all people who are at high risk fortype 2 diabetes. If the A1c test result isnormal but the physician still has ahigh suspicion that the patient is at risk,the physician should order either the

fasting or the two-hour test to obtainadditional clinical data.”

Some health insurance companiespay for structured diabetes preventionprograms, but only if pre-diabetes isclinically demonstrated by a blood testresult. “Since the use of an A1c test toidentify pre-diabetes is a relativelyrecent recommendation, it is uncertainwhether all health plans today willreimburse for the A1c test to diagnosepre-diabetes,” Ackermann says. “In ourpractice, we have found that mosthealth plans do not have a publishedpolicy about reimbursement for thisuse of the test, so there is no guaranteeof reimbursement; however, when wehave phoned administrators at many ofthese plans, we have been told it is ‘like-ly’ the claim will be paid. Hopefully,policies will begin soon to explicitlyinclude A1c testing as a covered pre-ventive service.”

Since the mid 2000s, the Centers forMedicare and Medicaid Services(CMS) has been paying for fasting andtwo-hour blood glucose screening testsin patients with particular characteris-tics, as long as these characteristics aredocumented by the doctor using a spe-cific set of billing codes. “CMS has stat-ed that this policy is subject to changebased on emerging science, and,because its prior policy in this area wasconsistent with recommendations ofthe ADA, it may at some point providecoverage for A1c testing as well,” spec-ulates Ackermann.�—Reported and written by Deborah J.Neveleff, in North Potomac, Md.


BILLING

How to Improve Your Practice’sForecasting and Collections PerformanceBy John Garrett

T he ability to forecast cash flowand collections performance isvital to any medical practice. Yet

many practices don’t realize they havevaluable data at their disposal toimprove these processes and increaserevenue. The key to success for manypractices is to understand how to targetand mine their own data anduse them to their best advan-tage. Effective new collectionsand performance models arehelping to lift the industry outof its “the way we’ve alwaysdone it” mindset.

At the highest level, forecast-ing and performance improve-ments require data about three essen-tial elements of your practice’s billinglandscape: your historic net collectionratios (NCRs), the lag time betweenbilling and payment, and the percent-

age of collections that are insuranceversus private pay. But these “buckets”of information are just the beginning toeffective collections forecasting andperformance. Within each of theseessential areas, you should also go frommacro-view to a more detailed pictureby extracting information about:• Facility mix (e.g., hospitals vs. imag-ing centers)

• Payer mix• Place of servicemix (inpatient, outpa-tient, emergency room [ER])

• Demographic zip code analysisOnce you have these data extracted

to determine your practice’s uniqueprofile, you can apply the informationto help you better understand physi-cian shift valuations, project cash flows,and budget estimates based on growthand collection trends. It’s a matter ofnarrowing your focus so collectionsforecasting is no longer guesswork, butbased on accurate views of historic per-formance. The information can also goa long way to help you build moreeffective marketing strategies.

Payment Differentialby Zip CodeExamining your NCRs, your lag timesand your insurance versus private payratios by zip code can reveal much

about your practice and affect yourstrategies to enhance collections per-formance. You may find particularinsurance carriers, which have histori-

cally performed better for you thanothers, are more prevalent in one zipcode than another. Or you may find acarrier behaves differently in a certainzip code because the employers in thatarea have better contracts with it. Ormaybe a certain zip code houses amajor retirement community whoseresidents are more likely to need yourservices and more likely to be Medicarepatients.

The results of your zip code dataanalysis might look like this:• ER self-pay patient in zip codeXXXX1: NCR = 6.5%

• ER self-pay patient in zip codeXXXX2: NCR = 10.4%

• ER self-pay patient in zip codeXXXX3: NCR = 26.1%

• BCBS inpatient, patient portion in zipcode XXXX1: NCR = 23.7%

• BCBS inpatient, patient portion in zipcode XXXX2: NCR = 31.2%

• BCBS inpatient, patient portion in zipcode XXXX3: NCR = 45.9%A zip code footprint analysis can

make all the difference in how youforecast and how you build strategies toimprove collections performance inevery area of your practice, includingyour marketing efforts. For example,where should you put your next bill-board for the optimum effect? Where

should you build a newimaging center? Whatlocal businesses shouldyoumarket your servicesto? How can you drawmore patients from thezip codes that historical-ly have performed betterfor you?

Place of Service MixYour place of service mix is also animportant area to examine for improv-ing your forecasting and collections

It’s a matter of narrowing your focus socollections forecasting is no longer

guesswork, but based on accurate viewsof historic performance.

John Garrett is vice president ofstrategic sales for OrionHealthCorp, Inc. (www.orionhealthcorp.com), a medical billing,collections and practice manage-ment services company located inRoswell, Ga.


processes. For example, if you find ahigh percentage of your businessoccurs in the ER, you can use your datato work with hospitals in educating ERphysicians on what types of tests areappropriate to order and for what rea-sons. Insurance denials by CPT codeand referring physician are a usefulanalysis in communicating possibleproblem areas. Analysis of denials cango a long way to decrease your denialrates and ensure your payment rates forER services are as high as they are forthe inpatient and outpatient areas ofyour practice.

Also helpful are data showing thepercentages of allowable billing that arethe responsibility of insurance or theresponsibility of the patient, and howthose percentages break out by place ofservice. The results might look some-thing like this:• BCBS inpatient: insurance portion =86.3%

• BCBS inpatient: patient portion =13.7%

• Medicare ER: insurance portion =93.6%

• Medicare ER: patient portion = 6.4%

• Outpatient self-pay patients: patientportion = 100%

In addition, being able to view theextent of secondary insurance coveragefor patients by place of service is animportant factor in determining howquickly you will be reimbursed for theservices you provide. Date of servicedata are vital, also, because insuranceand patient responsibilities for pay-ment do shift over time. In the earlymonths of the year, for example, whenpatients bear a higher portion of pay-ment responsibility as insurancedeductibles are being filled, collectionsare likely to be lower. This informationcan help a practice prepare for leanermonths and alter its internal operationsin response to these trends.

Changing ProfilesThrough the ongoing use of these typesof tools, medical billing professionalscan learn much about the industry,payers and specific markets. Forinstance, data collected by OrionHealthCorp show that payer and

patient lag times and NCRs evolve overtime with new technology and outsideeconomic influences. These move-ments need to be taken into account byupdating baseline assumptions contin-uously with rolling-trend data. It ispossible to see the impact of Medicarepayment holds being in place fromtime to time and to identify the dollarsthat were delayed to client practices.Regardless of the type of practice, thesedata mining approaches are immenselyvaluable.

Through the ongoing use of datamining approaches, your practice cangain a better understanding of specificpayers and specific markets, and howthose payers and markets continuouslychange. As insurance and patientresponsibility ratios shift, your ownforecasting models will need to evolve,as well.

The industry will continue tochange, but one thing will remain con-stant: data will always be of the utmostimportance. By leveraging the latestdata mining and analysis capabilities,your practice can stay ahead of thecurve.�

When conducting data mining to improve forecasting andcollections performance, it is helpful to break down his-torical net collection ratios (NCRs) into the following

“buckets”:• Inpatient insurance portion by payer• Inpatient patient portion• Inpatient self-pay patients• Hospital outpatient insurance portion by payer• Hospital outpatient patient portion• Hospital outpatient self-pay patients• ER insurance portion by payer• ER patient portion• ER self-pay patients• Free-standing imaging centers insurance portion by payer• Free-standing imaging centers patient portion with collectionsat time of service

• Free-standing imaging centers patient portion without collec-tions at time of service

• Free-standing imaging centers self-pay patients with collectionsat time of service

• Free-standing imaging centers self-pay patients without collec-tions at time of serviceData mining tools are available today to give practices the met-

rics they need in each of these areas. The data enable cutting-edge performance analyses that pinpoint where collections canbe improved, and how. Such analyses make it possible to predictfuture cash flows based on actual charge posting metrics—infor-mation that helps determine a practice’s charge volume, its man-aged care contract rate, and its fee schedule. It is also possible todetermine what transitional cash flows will look like.The margin between projected and actual collections has been

narrowed to less than 5% for many practices using these meth-ods. For practices whose old forecasting methods were based onthe previous month’s performance, this is similar to the differencebetween striking two flint rocks together and using a flamethrow-er to get the most accurate projections possible. —JG

BEGIN DATA MINING BY DEFINING NCR ‘BUCKETS’

Although the practices and thehospitals that have installedelectronic medical record

(EMRs) systems have been generallylarge groups and institutions, the tip-ping point for a small group in Virginiacame in 1995. The practice had 18physicians, a number of specialties, andtoo many paper files that were too fre-quently not where theyshould be.

The GE Centricity EMRin use at PremierHealthCare Associates ofRichmond, Va., has maderecord-keeping easier andimproved billing, patientcare, and physicians’ qualityof life, while also increasing the prac-tice’s income, according to MichaelStrachan, MD, and practice adminis-trator Marjorie Collings. The currentpractice, which has been together since2000, includes five physicians, threerheumatologists, one hematolo-gist/oncologist, and one internist. Itsoutpatient infusion center treatsrheumatology and oncology patients.The entire staff, including physicians,now numbers about 24.

Fewer Chart PullsThere were a number of reasons whythe practice adopted an EMR so early.“When we had 15 to 16 doctors whoshared patients, we never knew wherethe charts were, and staff memberswould spend hours looking for them,”says Strachan. Hunting down chartswasted staff time, at a considerable costto the practice’s bottom line. Anotherserious concern was the need for pre-cise dates for prescriptions and refills ofnarcotics. “If the nurses couldn’t findthe date of the last refill, it could createa tremendous documentation problembecause the laws are stringent and the

penalty is significant,” Strachan says.“In the early 1990s, before we started

using an EMR,we looked at chart pulls,and we figured 60% were for prescrip-tion refills,” Collings says. The exces-sive number of chart pulls for prescrip-tion refills bolstered the argument foradopting a more efficient records sys-tem.

For Premier HealthCare Associates,EMR adoption led to more accuratepatient billing, improved revenues, andbetter physician quality of life (QOL).These gains, however, were realizedafter a period of adjustment.

Less time in the office doing paper-work translates into improved QOL forPremier physicians and staff. “Most ofmy physicians leave at 5:00 pm,” saysCollings. “They’re not staying later tosign charts.” Physicians see morepatients without having to keep theoffice open until 6:00 pm or later and

pay staff overtime, Collings says. Theshorter hours help the practice’s bot-tom line.

“On Sundays, prior to 1995, I used toreturn to the office for three or fourhours and pull reams of lab work andoffice notes to sign and review,” saysStrachan. “Now, in two hours at homeon Sunday morning, I can review every

record from the pastweek, sign them, send let-ters to the patients ontheir labs, and be done—all before my family isready for the day. That is ahuge lifestyle change. Youcan’t do that unless youhave an EMR system.”

Improved DocumentationAdoption of the EMR changed patientbilling for the better. Billing questions,such as those about prescription andrefill dates, can now be answeredquickly. The practice frequently has tosend out records to obtain authoriza-tions for drugs and infusions, Collingssays. “Depending upon the sophistica-tion of the carrier, we cut and paste thepertinent data from the EMR and sendit electronically,” she says. With theEMR, data about patient services are


PRACTICE MAKEOVER

Early EMRAdopter: Fewer Chart PullsIncrease Physician QOL, Boost Bottom Line

It is no longer necessary to submita requisition to a medical records

department and then wait, possiblyfor days, for a fax with lab results.

Marjorie Collings Michael Strachan, MD


complete and current, and “we makesure that billing is appropriate for eachservice rendered,” Collings says. “TheEMR makes that easier to do.” Thepractice is now billing more than in itspre-EMR days.

Using the EMR has increased theprofitability of the practice because, bybeing more efficient,each physician can seemore patients in a day.Strachan, who has beenpracticing about 30 years,estimates that his practicesees about 15% morepatients per day com-pared with his rheuma-tology peers in the areawho are not using EMRs.

The time needed to write up notesand lab results can be considerable,says Strachan, complicated by paperrecords that don’t give much informa-tion because they consist of “checkedboxes or a few scrawled, illegible notes.”With the EMR, “we dictate a note intothe chart or use templates for basic labsand basic office visits,” he says.Consequently, the information is thor-ough, specific, and concise, andaddresses the patient’s condition onthat visit. The EMR increases physi-cians’ efficiency, while saving up tothree hours a night that had been spententering patient data.

With the EMR, physicians haveinstant access to patient data. “We havea Web-based server, so I can access up-to-date patient information at any place

and any time, including weekends,”says Strachan. “Also, we can read labresults within 24 hours and generate apatient letter right away. If the patienthas seen one of my associates, I canread his or her notes. It’s also valuable ifan ER [emergency room] doctor callsand wants to run a test.” If that test has

been done recently, Strachan canquickly provide the results, saving time,effort, and money for the patient, theER doctor, and the hospital.

Adjustment Takes TimeUsing the computerized hospital sys-tem, physicians can review radiologyfilms and labs that are done in-hospital,as well as pathology reports and any-thing that’s been generated on an out-patient basis, including ER-orderedtests. Test results are accessible,although “it’s not a seamless process,because we have to log into another[hospital] computer,” Strachan says.However, it is no longer necessary tosubmit a requisition to a medicalrecords department and thenwait, pos-sibly for days, for a fax with lab results.

Though Premier HealthCareAssociates took three years to completethe transition to the EMR and had acommitment from the physicians,there was resistance. Money was oneconcern, and physician time wasanother. “Take it slow,” says Strachan.“You can’t stress enough that the work-

flow for providers andthe clinical staff willchange dramatically. It’sa hurdle for every prac-tice. Surprisingly, theolder physicians did bet-ter than the youngerones in 1995, althoughI’m not sure why.”

Even though EMRusage is not universal,

no one today is surprised if a practiceuses one. Prospective physician hireestypically are now computer literate.“We had to teach keyboarding and howto use a mouse” in 1995, Collings com-ments.

In the early stages of EMR adoption,physicians may resist the need to enterdata, add diagnoses, and update med-ication lists. This work is sometimestoo technical for clerical staff, andphysicians may complain about theextra time needed to fill in their recordsduring the transition from paper chartsto the EMR. Premier staff spent “hoursfor about a year, adding data to chartsevery evening,” Strachan recalls. “Wedidn’t bring in any old medical records,and we did parallel charts for a while.”

Most EMR systems now recommend

SOPHISTICATED INFRASTRUCTURE ENABLES DIGITAL STORAGE OF DOCUMENTS

Premier HealthCare Associates of Richmond, Va., whichadopted a GE Centricity electronic medical record (EMR)system in 1995, has a sophisticated electronic infrastructure

to support its advanced systems.The practice currently has a serv-er farm, as well as software that runs another server for docu-ment management, another for lab information system, and yetanother for the infusion center software. Each of these systemsintegrates with the EMR.

Since the practice started the process of EMR adoption, alldocumentation generated by physicians within the practice hasbeen in an electronic format. Outside sources continued to pro-vide paper records for about 10 years. During that period thepractice started scanning all documents, including the chart fold-ers with outside documents, into the EMR. Currently, all outsidedocuments are received as digital images and imported into theEMR system. —MS

Continued on page 10

“[Adopting an EMR is] like having chil-dren: That first year is a lot of work and,until they start talking and walking andsmiling, you don’t enjoy them much.”

—Marjorie Collings, Premier HealthCare Associates, Richmond, Va.

“a pre-chart population to bring insome of the records as scannedimages,” Collings notes. “We started atground zero and it was very laborintensive.”

“That first year of transition is bru-tal,” Strachan concurs. “Butonce it’s done, you have aworking system. Otherwise,it is incomplete and never asefficient as it should be.”

“People hate it at first,but, after six to 12 months,they begin to realize theEMR’s value,” says Collings.“It’s like having children:That first year is a lot ofwork and, until they start talking andwalking and smiling, you don’t enjoythem much.”

Even though potential new hiresunderstand the EMR’s advantages,some longstanding staff may not enjoythe change. “You’re likely to lose somecurrent staff members when you go toan EMR because they can’t adjust,” saysCollings. “It’s unfortunate if you losegood people, but it happens.”Interestingly, as the practice has grownand shrunk and grown, “we haven’tnecessarily cut employees,” she says.“Our number of FTEs [full-time equiv-alents] hasn’t changed much over theyears.”

Additional BenefitsThe practice recruited a new physicianin July 2009. Interestingly, all the prac-tices at which the candidate inter-viewed had EMRs. Within two weeks,

the new physician was fully acclimatedto Premier HealthCare Associates’EMR system. Most new physiciansentering practice have been trained onEMRs and are accustomed to usingelectronic systems.

The practice’s early adoption of anEMR sent a message to staff members,Strachan feels. “We have tended toretain our staff, and I think part of thereason is our progressive practice,” hesays. “I think potential new hires lookat a practice in terms of where it is,where it was, and where it is going. Ifthe practice doesn’t have or isn’t consid-ering an EMR, it looks stag-nant. I think new recruits wantto be on the forefront of tech-nology. You’ve got to stay cur-rent, and a little ahead, becausethat’s going to be the new normtwo to three years from now.”

“Everybody figures out themost effective way to getunique information into therecord,” Strachan adds. “I typein a lot myself, and I’ve tem-plated certain things. I’vetalked to practices that dictate

everything; others use Dragon [speechrecognition software] and find it soefficient that they are doing word pro-cessing through their computer. All thesame, if you used only standardizedtext and templates, everything looks

the same and I think homo-geneity of the reports is onecriticism of EMRs.”

Premier HealthCareAssociates has begun toreceive requests for patientdata from health plans.Eventually, the practice willbe able to mine data forwhatever quality measuresorganizations, associations,

and colleges may want to put in place.The challenge in this area will be to bal-ance patients’ privacy against the valueof information to assess current med-ical practices and to provide guidancefor better treatment.�—Reported by Joseph Burns. Written byMary Service, in Bloomfield, N.J.

PRACTICE MAKEOVER


Despite the long-touted advantages of electronic medicalrecords (EMRs), medical practices have been slow to adoptthe systems. In a survey of 2,758 physicians (62%

response rate) published in 2008 in The New England Journal ofMedicine, 4% reported having a completely operational EMR sys-tem, and 13% had a basic system. However, about 40% had pur-chased, or intended to buy within the next two years, an EMR

system (DesRoches CM, et al. N Engl J Med. 2008;359:50-60).The adoption of EMR systems was encouraged in 2009 throughthe U.S. economic recovery act, in which an estimated $27 billionwas allocated as an incentive to physicians and hospitals toadopt electronic health systems (Lohr S. The New York Times.2011;Feb. 27, Sunday Business, p 3). However, Congressionalaction in 2011 may cut or eliminate these payments. —MS

EMR ADOPTION INCREASING, THOUGH INCENTIVES MAY SOON VANISH


“When we had 15 to 16 doctors whoshared patients, we never knew wherethe charts were, and staff members

would spend hours looking for them.”—Michael Strachan, MD, Premier HealthCare Associates,

Richmond, Va.


Physicians with independent prac-tices have seen their lifestyleschange dramatically over the last

several months. Between recentlyenacted health care legislation, pressureto lower reimbursement rates, andstronger enforcement of Medicare andMedicaid claims, many solo and grouppractice physicians are consideringalternatives to private practice.

One potential opportunity for physi-cians in today’s health care environ-ment is to work as an employee for ahospital. When contemplating thisoption, a physician must first considerthe advantages of running his or herbusiness versus the risks and rewards ofbecoming an employee.

Changing Health Care SystemHospitals first began acquiring physi-cian practices in the early 1990s, large-ly focusing on primary care. As profitsbegan to be squeezed by managed carecompanies, hospitals began vigorouslysearching for new ways to compete. Itseemed like a reasonable notion thatconsolidating a large number of gate-keeper physicians would provide thehospital with increased bargaining

leverage. Primary care physiciansfound these arrangements intriguingbecause of the long-term contractsbeing offered for their services and theoften inflated premiums being paid fortheir businesses.

Unfortunately, most of these agree-ments did not adequately consider howintegration would occur once a practicewas purchased. In addition, there waslittle thought given to benefitsmeasure-ments or business model metrics.Ultimately, some physicians’ sense ofaccountability was lost as many hospi-tals found that they could not managephysicians. Contractually guaranteedincomes often removed the incentivesphysicians had as owners of their ownpractices to be productive and efficient.As a result, most of these arrangementslostmoney andwere not successful, andthe majority of hospitals terminated orsold the practices they had acquired bythe end of the 1990s.

Today, hospitals have turned theirattention to increasing market shareand filling any gaps in service lines forwhich they currently do not providetreatment. For this reason, specialtypractices have become a focus formany

hospitals, and hospitals have becomeespecially interested in adding physi-cians within high-margin disciplines.

Hospital EmploymentPhysicians in private practice are typi-cally freed from reporting to an imme-diate supervisor, can structure theirpractices to minimize or best containprofessional liability, and enjoy an earn-ings potential that may be limited onlyby the number of patients they chooseto see. However, doctors have foundthat owning their own practice fre-quently limits their ability to enjoy theactual practice of medicine. Byzantinereimbursement requirements, adminis-trative work, keeping up with informa-tion technology (IT) developments, anda high overall burden of red tape haveincreased so much in recent years thatmany doctors are consumed with tasksentirely unrelated to treating patients.

Becoming an employee of a hospitalmay often result in more stable workhours, a reduction in time spent man-aging malpractice and regulatory com-pliance issues, and relief from theincreasing costs of medical equipment.An employment arrangement can also

BUSINESS MANAGEMENT

What to Take Into AccountWhen ConsideringHospital Employment Versus Private PracticeBy Randall J. Zarin, David H. DuMay, and Susan B. Murphy

Randal J. Zarin is a Principal for UHY Advisors TX, LLC; David H. DuMay is a manager for UHY Advisors FLVS, Inc.;and Susan B. Murphy is an Of Counsel for Porter & Hedges, LLP. All three organizations are located in Houston, Tex.

Continued on page 12

ease concerns about practice expenses,salary arrangements, and decreasingreimbursement levels.

There is extreme competition amonghospitals in today’s market. The abilityto provide a full spectrum of patientserviceswithin a single health care facil-ity is a major marketing tool providingdifferentiation between various hospi-tals. One strategy utilized by hospitalsto achieve this goal is to hire physicianspracticing in a variety of specialties.

Having a large contingent of physi-cian employees also provides an in-house referral base and may preventgroups of doctors from opening uppractices such as ambulatory surgerycenters, which might compete with thehospital. In addition, having doctors onstaff theoretically aligns the interests ofboth parties. This common purposeshould prove beneficial if health carereform institutes the concept of a bun-dled payment paid to both physiciansand hospitals, whether it is accom-plished through an accountable careorganization (ACO), the pilot programfor which is currently slated to begin in2012, or otherwise.

Assessing a Potential SaleGiving up practice ownership foremployment is not an easy decision.

There are a number of questions andcomments that physicians should con-sider when attempting to determine ifan employment relationship may beappropriate for them.Are you ready to give up the autonomy

of an independent practice?Physicians considering hospital

employment should confirm that theirbusiness and clinical philosophies alignwith those of the hospital. They shouldtake into consideration the hospital’s(or hospitals’ if evaluating more thanone potential buyer) location andpatient base, financial health, marketshare, relationships with physicians,payer mix, and compliance history inthis analysis.Is the practice in good condition to be

sold from both a financial and legalstandpoint?

Physicians considering selling theirpractices to a hospital should be pre-pared to go through a due diligenceprocess. It is crucial to address any jointventures or relationships that need to beunwound before the sale can be made.What will your arrangement with the

hospital look like? Will integration be asan individual employed directly by thehospital, or are you better alignedthrough a “captive PC” (professional cor-poration) model?

If the practice is a group practice or isin a state that prohibits the corporatepractice of medicine, the captive PCmay be the only option. Under thisapproach, shareholders in the PC willbe limited to those partners who areactive at and loyal to the hospital. Acontract for medical director or otheradministrative ormanagement servicesis entered into between the hospitaland physician shareholder(s). A sharetransfer agreement that restricts thephysicians to whom PC stock may besold is also executed. The idea is thatthe combination of contracts affordsthe hospital essentially the same opera-tional and financial control over the PCphysicians as it would over physicians itemployed directly.

Legal counsel and financial consul-tants play an imperative role in hospi-tal/physician transactions. They canhelp physicians to understand thepotential arrangement and structureresulting from such a transaction, makesure that the agreement follows regula-tory guidance, and deal with any issuesthat may prevent the parties from goingforward at the very beginning of thepurchase process. Consultants andexternal counsel are necessary so thatappropriate contingencies can be builtinto a sale strategy.�


There was a time when hospital groups would pay inflatedprices to purchase physician practices, attributing much ofthe financial consideration to payments for goodwill.

Unfortunately, physicians no longer can expect to receive thistype of arrangement. The federal Stark law and anti-kickbackstatute require the price paid for a physician practice to be com-mercially reasonable and consistent with fair market value (as thegovernment defines that term). If the hospital is part of a systemthat is a 501(c)(3), obtainment of an independent external valu-ation confirming the value of the practice is highly recommend-ed. It is also important to include any contemplated physiciancompensation in the analysis to insure that compensation com-plies with the applicable Stark exemption and anti-kickback safeharbor guidelines.

Thanks to the government’s highly publicized and successfulcrackdown on health care fraud, providers that fail to complywith these laws can find themselves defendants in qui tamwhistleblower lawsuits, sometimes brought by the employedphysicians themselves.The amount paid for a practice is now typically based on any

uncollected accounts receivable and the value comprised byinventory, furniture, and fixtures. Ongoing salary for physiciansand staff is often determined by netting practice expenses fromthe revenues earned by the physicians. Both the Stark law and theanti-kickback statute allow for some type of bonus to be paid,but such bonuses must be calculated in accordance with thelaws’ fairly strict parameters.

—RJZ, DHD, SBM

CHANGING LEGISLATION HAS AFFECTED PRACTICES’ SALE VALUES

BUSINESS MANAGEMENT



In the wake of the March 2010 adop-tion of the Patient Protection andAffordable Care Act (PPACA), con-

siderable attention has been paid toemerging new models of care delivery.Prominent among these models is theaccountable care organization (ACO).PPACA provides incentives for the for-mation of ACOs in coming years.

Despite the attention the model hasreceived, there remains little agreementas to how ACOs are to be formed. It hastherefore fallen to individual largemed-ical organizations to attempt to imple-ment broad changes to bring them-selves in linewithACO requirements inthe absence of solid guidelines forimplementation. As these organizationshave implemented various aspects ofthe ACO, reports havebecome available detail-ing their experiences.

Gathering DataA report released by theNational Institute forHealth Care Reform(NIHCR) in January details the experi-ences of seven prominent health careorganizations that have implementedaspects of the ACO model. No two ofthe organizations introduced identicalmeasures or followed identical path-ways, the report, “Lessons From theField: Making Accountable CareOrganizations Real,” states. Authoredby Timothy K. Lake, Kate A. Stewart,and Paul B. Ginsburg, the documentnotes that though the organizations’efforts at improving and coordinatingcare and facilitating communicationamong providers were largely success-ful, “developing these ACO-likeimprovements required substantialinvestment, both in time and money.”

The NIHCR researchers interviewedpeople who worked with seven health

care organizations. The organizationsincluded the Billings Clinic of Billings,Mont., the Carilion Clinic of Roanoke,Va., Physician Health Partners ofDenver, Co., ProHealth Physicians ofConn., Sharp Health Care of SanDiego, Calif., UniNet of Omaha, Neb.,andWestshore FamilyMedicine/MercyHealth Partners of Muskegon, Mich.

Three of the organizations were inte-grated delivery systems, one was aphysician-hospital organization, twowere medical groups, and one was amanagement services organizationaffiliated with four independent prac-tice associations.

“All of the organizations studiedwereengaged in multiple efforts to improvecare coordination and quality of care—

activities likely to be pursued byACOs,” the report says. “The activitiesgenerally fell into two categories: 1)interventions to improve care delivery;and 2) investments in infrastructure orother organizational changes toencourage or facilitate care deliveryimprovements.” The report lists thevarious ACO-type changes implement-ed by each of the health organizations.

Addressing ShortcomingsWhile none of the organizationsreported unsatisfactory results withregard to their ACO improvements, thefindings of the report indicate thatgroups seeking ACO status in thefuture may have difficulty funding thenecessary improvements. “Many fund-

ed these activities through existingreserves,” the report says, “while others,particularly those engaged in qualitymeasurement or HIT [health informa-tion technology]-investment-relatedactivities, applied for and receivedgrant funding.

“None of the organizations indicatedattaining a positive return on invest-ments related to improvement activi-ties,” the report says. “Although somenoted ACO incentives or enhancedpayments for patient-centered medicalhomes in the future might improve thebusiness case for these activities, manyacknowledged that the economic mar-ket rewards may not materialize for along time, if ever.”

The report cites changes in workflowthat affected productivi-ty as a potential draw-back to implementingthe ACO model.However, it goes on tosuggest ways by whichthe difficulties with themodel can beaddressed. These

include the encouragement of physi-cian buy-in and ownership of neededchanges, physician leadership, and thepartnering of nonclinical leadershipwithin organizationswith the physicianleadership to encourage staff buy-inand reduce resistance from clinical andnonclinical staff to change. The reportalso stresses “the importance of otherclinical staff, including nurses andmedical assistants, in developing newprograms or interventions,” and theneed for “transparency, open lines ofcommunication and focus on team-work.” The full report can be read atwww.nihcr.org/Accountable-Care-Organizations.pdf.�—Editor Rev DiCerto

HEALTH CARE TRENDS

NIHCR Report: ACO ImprovementsEffective, Hard to Justify Financially

“None of the organizations indicated attain-ing a positive return on investments relatedto improvement activities,” the report says.


Four organizations representingmore than 350,000 primary carephysicians on March 8 released

joint “Guidelines for Patient-CenteredMedical Home Recognition andAccreditation Programs.” The guide-lines, created by the AmericanAcademy of Family Physicians (AAFP),the American Academy of Pediatrics(AAP), the American College ofPhysicians (ACP), and the AmericanOsteopathic Association (AOA), buildon the Joint Principles of the Patient-Centered Medical Home (PCMH),which they adopted in 2007. The newguidelines aim to ensure some stan-dardization among various organiza-tions’ PCMH accreditation programswhile encouraging a focus on the keyelements of the PCMH.

The groups developed the 13 guide-lines to describe important elementsconsidered essential for effectivePCMH recognition programs. Theguidelines say programs should attemptto assess all the primary care domainsoutlined by the Institute of Medicine —comprehensiveness, coordination,

continuity, accessibility, and patientengagement and experience. Accordingto the guidelines, all PCMH recogni-tion or accreditation programs should:• Incorporate the Joint Principles of thePCMH;

• Address the complete scope of prima-ry care services;

• Ensure the incorporation of patientand family-centered care emphasizingengagement of patients, their families,and their caregivers;

• Engage multiple stakeholders in thedevelopment and implementation ofthe program;

• Align standards, elements, character-istics, and/ormeasures withmeaning-ful use requirements;

• Identify essential standards, elements,and characteristics;

• Address the core concept of continu-ous improvement that is central to thePCMH model;

• Allow for innovative ideas;• Acknowledge care coordination with-in the medical neighborhood;

• Clearly identify PCMHrecognition oraccreditation requirements for train-ing programs;

• Ensure transparency in programstructure and scoring;

• Apply reasonable documentation/data collection requirements; and

• Conduct evaluations of the program’seffectiveness and implement improve-ments over time.The groups have sent the joint guide-

lines to the National Committee forQuality Assurance (NCQA),Accreditation Association forAmbulatory Health Care (AAAHC),The Joint Commission, and theUtilization Review AccreditationCommission (URAC) to encouragetheir use in the development, imple-mentation, and evolution of theirPCMH programs. “The considerationof these joint guidelines for PCMHrecognition programs will help ensurethat recognized practices truly providepatient-centered care that is effectivelyintegrated and of high quality,” ACPPresident J. Fred Ralston Jr., MD, FACP,stated.

The complete guidelines documentcan be accessed at www.acponline.org/running_practice/pcmh/understanding/guidelines_pcmh.pdf.�

PRACTICE MANAGEMENT NEWS

Major Primary Care Organizations ReleaseJoint PCMHAccreditation Guidelines

Improvements in health care quality continue to progress atabout 2.3% a year. However, disparities based on race and eth-nicity, socioeconomic status, and other factors persist at unac-

ceptably high levels, according to the 2010 National HealthcareQuality Report and National Healthcare Disparities Report, issuedFebruary 28 by the Department of Health & Human Services’(HHS) Agency for Healthcare Research and Quality (AHRQ).The highest rates of improvement were in measures related to

treatment of acute illnesses or injuries. Other modest gains wereseen in rates of screening for preventive services and immuniza-tion. However, measures of lifestyle modifications saw noimprovement.

The reports indicate that few disparities in care quality, andalmost none in access to care, are shrinking. Overall, blacks,American Indians, and Alaska Natives received worse care thanwhites for about 40% of core measures. Asians received worsecare than whites for about 20% of core measures. Hispanicsreceived worse care than whites for about 60% of core measures.Poor people received worse care than high-income people forabout 80% of core measures.About 60% of the 22 measures of access tracked did not show

improvement, and 40% worsened. Only the gap between Asiansand whites in the percentage of adults who reported having aspecific source of ongoing care showed a reduction.The reports are available at www.ahrq.gov/qual/qrdr10.htm.

AHRQ REPORTS POINT OUT DISPARITIES IN CARE QUALITY, ACCESS

T he Health Care and YouCoalition, composed of eightorganizations, including the

AARP, the American Academy ofFamily Physicians (AAFP), theAmerican College of Physicians (ACP),the American Medical Association(AMA), the American Cancer SocietyCancer Action Network (ACS CAN),the American Nurses Association(ANA), the Catholic Health Association(CHA), and the National CommunityPharmacists Association (NCPA), onMarch1 launched anewonline resourceto provide Americans with easy-to-understand information about theAffordable Care Act to enable them tomake informed health care decisions forthemselves and their families.

The Web site will provide tailoredinformation for users, including whatprovisions of the Affordable Care Actare currently in effect and those thatare scheduled to go into effect in thefuture. The content on the site willreflect any updates to the law made atthe federal or state level. It will provideup-to-date facts about the law, includ-

ing a timeline of when new provisionsof the act take effect, and a state-by-state listing of health coverage optionsthat are available to consumers. Theinformation provided will be tailoredto consumers of all ages and circum-stances, including older Americans,small business owners, and health careprofessionals.

Additional information on the Website includes video content and, in thefuture, a planned chat feature that willallow users to ask members of theHealth Care and You Coalition ques-tions about the law. The Health Careand You Coalition will continuouslyupdate the site as changes take effect.The member groups each will engagein sustained efforts to make con-sumers, patients and health care pro-fessionals across the country aware ofthe site. The groups also will continueto educate Americans about the healthcare law through state-level outreach totheir members, presentations atregional and local events, and otherongoing activities. The site can befound at www.healthcareandyou.org.

Physician Organizations Participatein NewWeb Site to Help ConsumersNavigate Health Care Law

To mark National Patient Safety Awareness Week (March 6-12), the AmericanMedical Association (AMA) focused on medication safety by offering a MedicationSafety Checklist and urging patients to give their medicine cabinets a check-up dur-

ing the annual “Know What’s In Your Medicine Cabinet” initiative. The new onlineresource provides patients with helpful tips to keep track of prescription medications, vit-amins, home remedies, and alternative therapies and encourages them to provide thatinformation to their physician, promoting conversation about medications.The Medication Safety Checklist is available on the AMA Web site (www.ama-

assn.org), along with additional patient safety resources on health literacy and medica-tion reconciliation. National Patient Safety Awareness Week is an annual education andawareness campaign for health care safety led by the National Patient Safety Foundation.

AMA INTRODUCES MEDICATIONSAFETY CHECKLIST FOR PATIENTS

The Alexandria, Va.-basedAmerican Medical GroupAssociation (AMGA) in February

released a book on health care inte-gration providing guidance on layingthe groundwork for a successfulaccountable care organization (ACO).Integrated Delivery Systems: A Curefor the Healthcare Delivery Crisis, byDonn Sorensen and Amy Fore from St.John’s Health System in Springfield,Mo., presents tools for developingintegrated delivery systems (IDSs), thefoundation of ACOs.In this concise primer for the busy

health care executive, the authors pro-vide the tools needed to develop anIDS that best serves an organization’sunique patients, physicians, and com-munities. They also share the lessonslearned at St. John’s that have enabledit to become one of the premier healthcare delivery systems in the nation.With practical guidance, the authorsoffer a template for successfully inte-grating hospitals and physician grouppractices, with strategies for sharedleadership, physician compensation,cultural alignment, and coordination ofservices.The volume is available in print or

for download through the AMGA Website (www.amga.org).

AMGA PUBLICATIONPROVIDES GROUNDWORKFOR ACOS


Premier Healthcare Resource150 Washington St.Morristown, NJ 07960

April 2011

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