Steven D. Atwood, M.D., FACP

1
Leveraging Practice Management Systems for a
More Efficient Practice

• Steven D. Atwood, M.D., FACP
• satwood_at_pol.net
• www.adultmedicine.com/presentations/practice-manag
  ement-systems

2
Key Points for Today

1. What you need to know, not nice to know
2. What might separate the winners from the losers
3. Specific examples of how your PMS can actually
   help you do your job or help
4. save time
5. improve efficiency
6. increase patient satisfaction
7. improve your bottom line

3
Key Sections for the Physician

1. Scheduling / registration
2. Billing / accounting
3. Serving the patient
4. Which program
5. Where to get suggestions and specs

4
Lets Get To It
Scheduling

• Everyone Must Be Able to Schedule
• nurse when telling coag results
• doc when telling patient to drop in
• see schedule at every station and from home
• 30 Second Rule book appointment in seconds
• patient name, doc, reason, when, done
• trim names selection to those that are relevant

5

See Schedule
Easy to Add or Change
6

Know key data beforethe time is reserved
7

How much time, which room
Robust detail
Bundled procedures
8
Are You Behind?When Can You Get
Back to the Hospital?
Helps to track when patients

• Arrive
• Roomed
• Exit
• No Show

Show the data by using symbol, color, highlights
9
Seen and left
You are seeing now
X No Show
e.g. 9am and you are behind
Arrived
9
Practice Management Systems
10
One Write, No Duplication

• Cut Paste
• Drag Drop
• Notes Everywhere e.g. individual claims,
  individual codes such as with
  prolonged detention

11
Cut and Paste or Drag and Drop to any
spot that week or in future months
11
Practice Management Systems
12
Notes, Notes, Notes Everywhere

12
Practice Management Systems
13
Archive the Inactive Data

• No scrolling through 30 people with similar
  names
• Index patients by doctor or site then use
  the list associated with this site etc.

14
Archive or leave out the data you dont need
gtgtleave out patients not seen in 10 years
gtgtjust your sites patients--not entire system
14
Practice Management Systems
15
Billing

• Past we used numerous fee schedules
  generally a Medicare max allowed fee schedule
  and a fee schedule for the rest of your
  practice

• Now generally all accounts assigned but
  everyone has a different payment schedule e.g.
  1.6 x Medicare rate, no coverage for carve outs
  another is 0.8 x Medicare rates

16
Billing

• Paid vs. Expected - your computer should show
  you the expected payment as you enter
  payments

17
Billing

• Paid vs. expected--see as you enter

18
Billing

• charge vs. paid for each insurance company

19
QUERIES

• PMS is basically linked databases
• the setup is proprietary
• you are locked in
• when you buy it you might be married for life
  because you might not be able to get your data
  out if you switch to another program

20
QUERIES

• Future Is Modular
• No All-in-One Program Separate Program or
  Module for Each Part e.g. EMR, Billing,
  Schedule, Ordering
• Now STANDARDS Provide the Connectivity
  Between Programs
• Not Locked In, so Programs Compete on
  Performance
• Best of Breed may be easier to determine
• Export every field will help all this

21
QUERIESPMS Design Linked Databases
22
QUERIES
23
Off the Shelf Software vs.
All-in-One Package

• Software doing majority of operations for
  a large corporation may have dozens of pull
  down menus and take 3 days of training
  before you can use
• e.g. IDX or similar software for large
  health systems

24
Off The Shelf Software vs.
All-In-One Package

• Separate Programs or Discrete Modules
  helps 1.) Training 2.) Security
  3.) Upgrades
  4.) Can Reduce Down Time
• Quicken 79 -- all bills and bank activity
• QuickPay 50 or QuickBooks 179 -- payroll
• HotFax --can fax any file as if you were
  printing it

25
SECURITY

• User ID, Password
• Station ID
• Section Permission e.g. Hospitalize
  Senator, only treating staff have
  access to this patients tests e.g.
  charge and collection for the day not
  accessible by file room staff

Too many programsgive full access to
everythingafter you log on
26
Print to File

• Best thing since sliced bread
• can use a claim clearinghouse NO
  INTERFACE NEEDED
• e.g. Print a HCFA type claim then you can
  Print to File so you can save the printout and
  all its formatting Your clearinghouse can use
  this file and the print layout to transfer this
  information to their database NO INTERFACE
  NEEDED-- NO MORE TYPING

27
Print to File
28
Print to File
Every letter and number is exactly where it
would be on a claim Thus a computer can
import the data
29
Print to File
30
Print To File

• Select printer then click print to file option
• Go to DOS prompt (in WindowsgtAccessories)
• Enter the command PRINT and file name e.g.
• Then strike enter and your file prints
  thus you can save anything you want to print

31
Print to File printer must be connected by LPT-1
32
Physician in Back Office

• Need a full registration sheet or face sheet
• insurance type may dictate where to go for tests
• insurance type may dictate which hospital to use
• insurance type may only cover certain meds
• may need DOB
• may need SSN
• may need phone numbers for patient
• may need phone numbers for insurance company

33
Physician in Back Office

• then as a batch you can
• printfaxreservereformat

• must be able to tag individual data
• progress notes
• claims to send
• schedule spots to reserve
• rooms or equipment to reserve

Same as hold down Control then left click to
select desired data in Windows
34
FAX

• If you can print it you should also be able
  to fax it

35
Send to fax machine rather than printer
35
Practice Management Systems
36
Orders

• prescriptions goal is to order the
  right med quickly
• formulary
• which med, which dose
• vs. Voice Mail at Pharmacy

FAX a Script--how do you sign
if digital signature not OK
37
Forms

• Scan the form
• Insert the file on a page as a background
• Overlay text boxes where the data goes
• Bookmark each box (controlF9)
• Jump box to box / bookmark to bookmark (F11)

38
Any word processor hopefully your PMS can
prepare and store any form
Start box 1 F11 to jumpto next field
bookmarks
38
Practice Management Systems
39
Physician in Back Office

• Email at every work station

40
Whats Out There
Selecting Your Practice Management System

• How Many Different Programs
• List of Vendors
• Cost
• Features

41
PMS Vendors
There are over 110 programs perhaps ½
have ASP (web based) option
e.g.
Larger Systems
Smaller Offices

1. Medical Manager
2. Millbrook
3. IDX
4. NextGen
5. CompuMedic

1. Lytec
2. Medware
3. Medisoft
4. E-MD
5. FoxMed

42
PMS Vendors
List on Internet at
www.HIPAA.org/ pmsdirectory
about 110 listed
www.HealthCareInformatics.com/
issues/2002/10_02/spotlight.pdf
www.aafp.org/ PreBuilt/fpnet_techguide.pdf
9 rated
43
PMS Purchase or Lease Prices

• Varies by optionswide range
• Buy and own, then elective updates
• Yearly lease and required yearly updates
• Monthly lease per provider or per station

44
PMS Purchase or Lease Prices
Varies widely and changes - many options
- must contact vendor
perhaps

• 200 Medisoft
• 600-2000 MedWare, Lytec
• 7,000 NextGen per provider
• 15,000 IDX, Medical Manager

45
Where to Go for Information

1. www.acponline.org/PMC/practice.htm
2. www.ComputingForClinicians.com by ACP Fellow
3. www.aafp.org/practicemgt.xml user
   comments
4. www.ctsguides.com/medical.asp buy reviews
5. www.HealthComputing.com/KLAS buy reviews
6. www.MGMA.com
   members only
7. www.KnowledgeStorm.com needs free
   registration
8. www.CivicResearchInstitute.com/mi5.html

46
SUMMARYon Leveraging
Your Practice Management System to
Save You Time, Improve Efficiency,
and Improve Your Practice

• 1. Everyone Working with Patients can Schedule
  and Has Access to Registration Data
• Just seconds to reserve an appointment
• Need to know the health plan and contact numbers
• Registration data effects your medications and
  tests
• Old unused data to archives
• MS Office type featurescut/paste, drag/drop,
  tag

47
SUMMARYon Leveraging
Your Practice Management System to
Save You Time, Improve Efficiency,
and Improve Your Practice

• 2. Can really use the ability to easily
• export or query almost every field in the PMS
• List of who is on a medication with a new alert
• List and of patients on a HMO
• 3. Need ability to track expected payments for
  each
• insurance company as the payment comes in
  

48
SUMMARYon Leveraging
Your Practice Management System to
Save You Time, Improve Efficiency,
and Improve Your Practice

• 4. Need ability to easily find, complete, and fax
• paper
• e.g. Referral formwho, what, where, when, why
• 5. Inexpensive programs like Quicken can easily
  manage key functions Maybe everything in one
  program is not a good idea
• 6. Every work station needs office e-mail

49
Questions
50
Leveraging Practice Management Systems for a
More Efficient Practice

• Steven D. Atwood, M.D., FACP
• satwood_at_pol.net
• www.adultmedicine.com/presentations/practice-manag
  ement-systems