UCAOA-2008 in New Orleans

The annual UCAOA Urgent Care Convention in New Orleans promises to be the biggest and best-ever gathering of urgent care professionals.

In the speaking sessions, I will share my thoughts on managed care contracting in the Comprehensive Clinic Startup track, and I will give an update on urgent care coding (same talk will be available at two different times) during the main convention.

Please sign up at the PV Booth and join us at the Fourth Annual Practice Velocity Event on Thursday, May 1 at 7:30 PM. This year we are having a Blowout Mardi Gras Party. There will be music, food, drink and a drawing for over a thousand dollars in cash. You won't want to miss it.

This year will be your chance to view our new tablet PC EMR--VelociDoc™. Please drop by the Practice Velocity booth and see the EMR and give us your feedback.

See you in New Orleans.

Practice Velocity: The Un-Software Company

MDNG Net Guide (September, 2007) recently ran a story entitled, “Shhhhh! (10 Secrets the EHR Companies Don't Want You to Know).” The article highlighted the seamy underbelly of the EMR business. The “secret” practices referred to in the article are useful for physician to note. Since so many of these practices might be hard to spot--and you might even wonder if Practice Velocity engages in any of these shady practices--we thought that it might be useful to compare these “secret” practices to the open practices of Practice Velocity.

Secret #1: EHR awards have been bought! Yes, many EMR companies have actually paid off companies to give them awards. Practice Velocity has never entered any of these rigged contests, because the only award that Practice Velocity has ever sought is the award the really counts, the accolades of its own customers.

Secret #2: That “non-biased” expert recommending an EHR to you may have been paid off too! Again, many EMR consultants are actually receiving sales commissions as for referrals to purchase their EMR. Practice Velocity has never participated in this deceptive practice. We believe that anyone acting as a salesperson for a product should be identified as a salesperson to the prospective buyer.

Secret #3: Even that EHR-using physician you’ve been referred to may have been paid off! People often ask us how our customers can be such raving fans of Practice Velocity products. No, we have never paid anyone to provide testimonials to the value of our products. Even the many customers that take the microphone and extol the value of Practice Velocity at the annual PV dinner (held during the UCAOA Annual Convention) have never been paid to take the microphone and tell about how PV has worked for them.

Secret #4: The respected physician leader of your local society may also be receiving compensation! Yes, leaders in national urgent care associations have and do use Practice Velocity, but Practice Velocity has never paid them to state this publicly. In fact, in order to protect their credibility as leaders in the urgent care industry, we have encouraged many of them to downplay the fact that they use PV products in their urgent care centers.

Secret #5: Determining how much a specific EHR costs is going to be difficult, and you are going to be nickel-and-dimed every step of the way! Since the very beginning, we have determined that we were tired of the way software companies had treated us as customers. One company even required us to pay up front just to get a quote on how much a modification to their system would actually cost. Instead, Practice Velocity has always made its prices simple and transparent. In addition, since putting our first customer online five years ago, our prices for our charting and coding solutions have never gone up one penny.

Secret #6: Your patient data will be a bargaining chip to prevent you from leaving an EHR company! What a scam! Practice Velocity would never want anyone to say that we had not treated them fairly on exit. That is why we clearly state, up front, in our contracts that the urgent care customer will always have a right to leave with a complete set of patient records.

Secret #7: The return on investment (ROI) argument is another way of saying “this solution is overpriced!” But what if you offered your product on a thirty-day trial basis with no money down, and the urgent care center doesn’t a pay a penny if it doesn’t see real the solution create more value than it costs? Yes, that is what PV promises, “Try us for thirty-days, if you are not absolutely convinced that Practice Velocity Templates (PiVoTs) is paying for itself, then you stop using PiVoTs and pay us nothing.” With the exception of two centers that used the system for under a week, every center that has tried the system for thirty days has decided to pay for and continue using the system.

Secret #8: EHRs don’t improve quality of care and often make you less efficient. And since you won’t figure this out until you are actually using the product, EHR vendors won’t let you try-before-you-buy, and there is no return policy! This is almost always true. But here Practice Velocity is completely different. Remember you can “try-before-you-buy” PiVoTs for 30-days. Even after the thirty days, since PiVoTs work on subscription you only pay for the visits actually charted on the system. You can stop any time with no penalty. Thirty-day trial, only pay for what you use, and stop whenever you want--now, that’s even better than a return policy.

Secret #9: A CCHIT-certified product, by definition, is often more expensive and less usable than non-certified products. That’s an absolute fact. If you make your product for a bunch of academics that don’t practice medicine but do research and evaluate bells and whistles in an EMR, you will make a product with bells and whistles that can pass a bells-and-whistles test. But if you want a product that will work in the cauldron of everyday urgent care, it probably makes more sense to try a product that was developed by urgent care professionals in urgent care centers and is already proven to work in over 180 urgent care centers. That description only fits one product—PiVoTs by Practice Velocity.

Secret #10: There are alternate ways to determine if an EHR, and the company selling you the product, will work for you. And there is no better way than the thirty-day trial that Practice Velocity offers. Try PiVoTs in your urgent care centers for up to thirty days. If you are not convinced that PiVoTs are the absolute best product that you have ever seen or could even imagine for your urgent care, simply stop using PiVoTs and you pay us nothing. As one early implementer (who still uses PiVoTs to chart over 100 patient visits each day in his urgent care center) put it, “Well, David. I guess that’s a no-brainer.”

Yes, and not only is it a "no-brainer," it is one more characteristic that separates PV from the rest of the field--NO SECRETS. Try it and see. For your free web demo of the Practice Velocity suite of urgent care solutions, call today -- (815) 544-7480.

Practice Velocity Upcoming Conferences

The Practice Velocity team will have booths at the following shows. I will, also, be attending the shows, so drop by and let me know what you think of them.

• October 22-24, 2007: National Association of Occupational Health Professionals National Convention: I will be speaking on Monday, Oct 22 about the challenges and benefits of mixed-use (occ health and urgent care) clinics.


• October 26-27, 2007: Urgent Care Association of America Fall Conference, Chicago: I will be speaking in the coding track and the urgent care startup track.


• November 28-29, 2007: Retail Health Summit: I will be speaking and moderating a discussion on the history and future of the urgent care industry

Please drop by and introduce yourselves if you attend any of these conferences.

Urgent Care Works for the Stern Family

This weekend found me out of town with my two boys on our annual trip to an indoor soccer tournament in Milwaukee. After a 11:30 PM game on Friday night we retired to our hotel. The next morning at breakfast, our twelve-year-old soccer player developed a deep cough, could not eat breakfast; and he proceeded to cough, throw up, shiver, and turn pale and lethargic.
After cleaning him up, we drove back home; and on the way home dropped off at our local Physicians Immediate Care where they were experiencing an early afternoon rush. While Eric was getting a chest x-ray, I evaluated an ankle sprain and completed a DOT physical for a forty-two year old trucker, whose urinalysis demonstrated a new diagnosis of diabetes. The clinic was quickly caught up with patient flow.

Eric's chest x-ray is pictured above. The haziness on the lower half of the left lung (right side of image) demonstrated a clear left lower lobe infiltrate--pneumonia. One gram of Rocephin im (didn't hurt "too much"), and we were on our way home with a cracked-lipped, pale, lethargic boy, whose breath reeked of ketosis. For the rest of the day, I followed the advice that I have given to hundreds of parents--fluids, fluids, and more fluids. By the evening Eric was mostly rehydrated, and the next morning felt fine and went to church.
What this family episode drove home was the importance of local urgent care access. What if there was no readily accessible urgent care center in our community? If there was no easy access to urgent care for sick kids, would many parents shun the emergency room and wait till Monday to see their pediatricians; or would many parents spend hours in the emergency department and suffer along with their sick child? Either way, an urgent care is a much better option.
The good news is that our community has ready access to urgent care for sick children. Treating Eric's pneumonia within hours of onset, led to an extremely rapid recovery. His answer the next morning to, "How do you feel," was quite refreshing.
"You know Dad," he said, "when your really sick, it seems like it will never end. But when you get better, it doesn't seem like you were sick for very long."
To those of you who operate local urgent care centers, may I speak personally as a Dad? "Thanks. You really do make a difference in the lives of your friends and neighbors."

Humana Supports Urgent Care Centers

Humana is one managed care organization (MCO) that seems to "get it" when it comes to urgent care. On their website, Humana has a page devoted to guiding their members toward urgent care centers when appropriate.
Humana lists the advantages of urgent care as:

• Urgent care centers usually have extended and weekend hours.
• No appointment is needed.
• Generally wait times are short.
• Urgent care physicians can deal with a wide range of conditions.
• Members can be responsible for "most of the charges," if they use an ED "innapropriately."
• "Best of all... you'll probably just pay a set copayment."

Humana, also, regards hospital-based urgent care centers as overusing resources. They state:

Don't let the urgent care sign fool you!
All centers are not created equal, and the difference can affect your wallet. To reduce your costs, choose a free-standing urgent care center, one that isn't located in a hospital. These facilities are well equipped to provide medical care for minor illnesses or injuries. The only difference is the location. Your copayment and other costs could be a lot higher if you choose an urgent care center in a hospital.

We have not previously seen payors steering patients away from hospital-based urgent care centers. This directive seems to be an attempt by Humana to avoid paying the facility fees or ED codes that are sometimes charged in urgent care centers that are based on the hospital campus or centers that are fast track segments of the emergency department. If many payors put this type of pressure on patients to avoid hospital-based urgent care centers, financial pressures on hospitals to move urgent care centers off campus may not be far behind.

Few Practices Using Computer-Assisted Coding

Over 39% of medical offices and institutions are finding a very difficult or extremely difficult time finding coders—so says a survey conducted in May by the American Health Information Management Association and the American Hospital Association with support from the American Medical Association.

Despite this shortage, only 12% of health organizations are taking advantage of computer-assisted coding. Why the do practices disregard computer-assisted coding? There are several obstacles to implemenation of computer-aided coding--all of which have more than adequate solutions in Practice Velocity Templates, PiVoTs:

• Lack of awareness: Many physicians are unaware that Practice Velocity offers a solution that computerizes the coding of all E/M, ICD, and CLIA-waved test codes.
• Expensive systems: Most systems require massive up front outlays to implement the system. Not so for PiVoTs. With no up-front costs, simply try the PiVoTs for 30 days in one of your urgent care centers. If Practice Velocity does not speed up your patient flow and increase your practice revenues, simply stop using the system and pay us nothing. Every urgent care center that has installed PiVoTs in their clinics has immediately realized more revenue than the monthly subscription payment to Practice Velocity. Thus, Practice Velocity systems actually pay for themselves..
• Cumbersome systems: Practice Velocity has become the largest provider of urgent care software solutions for one main reason—the PiVoT is the easiest computerized charting and coding solution. Physician users need no computer skills and never have to deal with navigating computer screens. If you can write with a pen on paper, you can probably use the system with only an hour and a half of training.
• Protective coders: Many coders fear computer-assisted coding, because they have the mistaken impression that the computer will replace the coder. While this is true for the mundane work of coding each and every chart, coders will always be needed to code complex cases and to provide quality assurance. There already is a shortage of coders and high-quality coders will always be needed.

Is one of the reasons above holding back your urgent care from taking advantage of computer-assisted coding? Practice Velocity is your answer for your urgent care center or occupational medicine clinic. Why not sign up for the 30-day trial and watch Practice Velocity speed your charting, improve your coding compliance and improve your bottom line? Call today, and watch implement computerized coding and realize peace-of-mind profitability in your urgent care center.

ICD-9 Coding in the Urgent Care Center

Question: Recently, we received the following question about ICD-9 (diagnosis) coding.

A nursing supervisor through our parent hospital is questioning the ability of an MA to legally write in ICD-9 codes matching physician diagnoses. It is my understanding that MAs get this training in school and as long as the physician is assigning the diagnosis and E&M code, the MA (certified MAs) can write in an ICD-9 code which directly matches. It has been this way in all offices I have worked in. If you have any like or something in writing supporting this, please let me know.

Answer: The physician is ultimately responsible for all codes billed out for all professional services billed under the physician's provider number. There are many ways, however, for the facility to do this.

1. Have staff assign the codes, and require the physician to initial the final codes.
2. Force physician to assign all codes.
3. Have staff assign the codes (after physician writes down the diagnosis), but have physician do audits of randomly selected charts on a regular basis to make sure that, for compliance reasons, the physician agrees with the codes being chosen.
4. Use checkboxes on a form so the physician can assign the majority of codes. If this is combined with a commercially available "cheat sheet" of most common codes, over 90% of the ICD-9 codes can be readily assigned by the physician, without slowing down the process.
5. There are probably other compliant methods for ICD coding in the urgent care center.