Who Is Press Ganey and why are they measuring patient satisfaction?
In 1979, Irwin Press, PhD focused his interest on the modern patient experience, the study of which would lead him to become known as a patient satisfaction expert. In 1984, Dr. Press introduced the importance of survey methodology when establishing a patient satisfaction program and by early 1985, he had developed a survey that would measure patient satisfaction as a means to improve performance. To address the need for statistical analysis and survey methodology, he collaborated with Rod Ganey, PhD and together, the two formed Press Ganey Associates in 1985.
According to their website, today Press Ganey “partners with more than 10,000 health care organizations worldwide to create and sustain high performing organizations, and, ultimately, improve the overall health care experience. Press Ganey works with clients from across the continuum of care hospitals, medical practices, home care agencies and other providers including 50% of all U.S. hospitals.”
The Press Ganey Pulse Report is an annual report which collates research and analysis of public and proprietary data and the perspectives of patients, employees and physicians to uncover trends in healthcare. The 2011 report reveals:
“The top priority item for medical practices is sensitivity to patient needs, indicating a need for medical practices to personalize their interactions with every patient.”
The remaining top-priority items for medical practices all reference patient satisfaction with the care provider, and include:
- Physicians and medical practices need to serve the whole patient.
- Physicians and medical practices need to understand a patients culture, the relationship with a patients family or caregivers, and the unique communication needs of individual patients.
- Physicians and medical practices need to validate patient concerns and confirm comprehension, which are critical to ensuring compliance with treatment protocols, and also increases the likelihood for better outcomes and greater patient satisfaction.
The report also has some pretty fascinating information on the Overall Satisfaction in Top 25 Medical Practice Specialties (!) and Medical Practice Satisfaction by Waiting Times. Press Ganey outpatient questions are answered by over 3 million people annually over the course of 12 months. You can download the 2011 Press Ganey Pulse Report here.
Press Ganey also has other free resources available on their site:
For Medical Practices and Outpatient Facilities – case studies, recorded webinars, ROI resources and White Papers here
For Hospitals – case studies, Pulse Reports, Emergency Department resources, recorded webinars, ROI resources and White Papers here
For Home Care -case studies, recorded webinars, ROI resources and White Papers here
Government Initiatives for Public Reporting – includingthe Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS) survey, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, the Home Health Consumer Assessment of Healthcare Providers and Systems (HHCAHPS) survey, and Meaningful Use and Value-based Purchasing here
This is a guest post from Joe Hage, CEO of medical device marketing consultancy Medical Marcom.
HIMMS fellow Michael Paquin advises how to set up an appropriate EMR selection meeting in this short video.
Mary Pat: Where does the name of your company, Lutrum, come from?
Ed Garay: When I was developing a name for this company, I didn’t want to be like every other healthcare IT services company with health, md, medical, etc. as part of their name. I wanted it to represent something deeper about what we do and who we are as an IT organization. Although we are IT specialists, I realized that one of the things that I am always working with my team on is to listen and understand our clients needs. Which lead me to creating the name, Lutrum. Lutrum is a slight variant of the Latin word Lutra. Lutra means otter in English. And the otter symbolizes empathy.
Mary Pat: What led up to you starting your own business?
Ed Garay: In late 2000, I worked as an IT Director for an organization that continued to downsize. I came to a career crossroad. With starting to support under 100 systems, and the network running in tip-top shape, there was really no need for me to be there full-time in the long run. So, do I look for another job that cant possibly be as fulfilling as where I was, or do I take a leap of faith and start up my own business and share my knowledge with the masses? Through the feedback of mentors and other resources that knew me personally and professionally, I was highly motivated to take the leap of faith and have never looked back. My business career has evolved over the years and has naturally lead me to Lutrum.
Mary Pat: What are Managed IT Services?
Some of worst horror stories in healthcare operations right now have to do with the failure of Electronic Health Record, (or EHR) installations. The high rate of EHR failures is being compounded by the pressure to attest in 2011 and start recouping some money against the EHR purchase and implementation.
To help organizations adopt EHRs smoothly and successfully, billing and management specialist Kris Jones, owner of Healthcare Management Services, is providing her clients with an innovative EHR program that she calls “Crawl. Walk. Run. Fly.” Kris told me “I found my clients so resistant to EHR, so paralyzed by the horror stories of money spent and productivity lost that I couldn’t help them move forward like we both knew they should.”
So Kris created the program that she thinks of as “Baby Steps” to make the process much more manageable and less intimidating. She brings the practice team on board a step at a time, removing the fear of the unknown and the greatest fear of all – change! Because Kris supplies the practice management software as well as the EMR, it is feasible for for her to let the practice take as much time as it needs to move through each stage.
Step 1. Crawl
The practice uses the EHR as a repository for medical record images. Staff makes first contact with the software.
Step 2. Walk
The practice adds e-prescribing and the staff enters data into the EHR for the problem list, the medication list and vitals. The software begins a functional role in patient interactions.
Step 3. Run
The physicians start with partial, then move to a full progress note. Physicians make first contact with the software.
Step 4. Fly
The practice achieves Meaningful Use with full implementation of the EHR.
What Kris has developed for her clients is the antithesis of the experience most practices have with the purchase of an EHR. It gives her clients the continual support and incremental change they need to preserve their workflow while slowly integrating the new software. This “slow and steady” approach has allowed her clients to be able to get their feet wet in the Electronic Health Record before being assured that the water’s fine and taking a full dip.
Click here to see the special free offer Kris and her team have put together for Manage My Practice readers.
Kris Jones-Bartley founded Healthcare Management Systems in 1985. Over the last 25 years, Kris built HCMS in to a multi-faceted practice management company with clients nationwide. Kris has personally managed every phase of a medical practice, from start-up to retirement, and including the recovery of practices on the brink of insolvency. Critical thinking, candor and eye-for-detail, make Kris a valuable partner in the business of medicine. HCMS is focused on specialty Revenue Cycle Management deployed in conjunction with E.H.R. capability.
HealthCareManagementSystems Experience. Expertise. Integrity. Determination. Results. Value.
Today, PhysiciansPractice sponsored a webinar with CMS’s Robert Anthony on the topic of “Meaningful Use Stage 1.” Robert Anthony is a Health Insurance Specialist in the Office of E-Health Standards and Services (OESS) at the Centers for Medicare & Medicaid Services (CMS), where he focuses on the EHR Incentive Programs. Robert had a very pleasant voice to listen to, and he gets my vote for the best CMS Employee Speaker that I’ve heard!
I was not familiar with the OESS before, so I looked it up and found out what they do: Provide the overall leadership for and coordinate the implementation of Title IV of the HITECHAct. (Title IV = Medicare and Medicaid Health Information Technology)
Robert briefly reviewed what has happened to date with the EHR Incentive Program and the terms of the Medicare and Medicaid programs. The three main differences in the two programs are:
- The types of providers that are eligible for each program – information here.
- The volume of each type of patient needed to participate: no volume needed to participate in the Medicare program and 30% Medicaid patients for all eligible practitioners except pediatricians who only need 20% Medicaid patients.
- The tasks in year one in which the certified EHR is adopted. For Medicaid the practice only needs to attest that they have adopted, implemented or upgraded an EHR. In year one for Medicare the practice needs to attest to meaningful use for 90 days, which means data is collected and input into the attestation system.
The majority of the webinar was devoted to FAQs (my favorite part of any CMS-related education session!)
FAQs
Q: Can entities participate in the Medicare EHR Demonstration Project, and the Medicare or Medicaid EHR Incentive programs too?
A: Yes. The demonstration projects are about to be sunsetted (completed.)
Q: What information must be provided to patients to meet the requirement for a clinical summary at the end of each visit?
A: If system is certified, it will automatically provide the appropriate information for the clinical summary, which includes the patient’s problem list, medication list, medication allergy list, and diagnostic test results.
Robert suggested looking at the answer online at the CMS FAQ which I posted below:
In our final rule, we defined “clinical summary” as: an after-visit summary that provides a patient with relevant and actionable information and instructions containing, but not limited to, the patient name, provider’s office contact information, date and location of visit, an updated medication list, updated vitals, reason(s) for visit, procedures and other instructions based on clinical discussions that took place during the office visit, any updates to a problem list, immunizations or medications administered during visit, summary of topics covered/considered during visit, time and location of next appointment/testing if scheduled, or a recommended appointment time if not scheduled, list of other appointments and tests that the patient needs to schedule with contact information, recommended patient decision aids, laboratory and other diagnostic test orders, test/laboratory results (if received before 24 hours after visit), and symptoms.
The EP must include all of the above that can be populated into the clinical summary by certified EHR technology. If the EP’s certified EHR technology cannot populate all of the above fields, then at a minimum the EP must provide in a clinical summary the data elements for which all EHR technology is certified for the purposes of this program (according to 170.304(h)):
- Problem List
- Diagnostic Test Results
- Medication List
- Medication Allergy List
Q: How and when are incentive payments made?
A: After the online attestation is made (attestation thresholds must be attained), provider information is verified, then in 6 to 8 weeks a payment is generated. Payments are made in whatever way the entity typically gets CMS payments.
Q: What if patients do not routinely receive prescriptions during an office visit? How can the threshold be met? (Referring to computerized provider order entry (CPOE) for medication orders.)
A: For attestation, practices need to do this for 30% or more of all unique patients with at least one medication in their medication list. Note that patients with no medications in their medication list are excluded, so CMS believes this core initiative is realistic.
Q: For the Medicaid program, do you count the patient visit or the number of services (e.g. patient visit plus two tests equals three patient ticks) during the visit?
A: This question needs follow-up and if you send an email to editor@physicianspractice.com, they will be sent to CMS for the answer. Here is additional information from the CMS FAQ:
When calculating Medicaid patient volume or needy patient volume for the Medicaid EHR Incentive Program, are eligible professionals (EPs) required to use visits, or unique patients?
There are multiple definitions of encounter in terms of how it applies to the various requirements for patient volume.Generally stated, a patient encounter is any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums for the service.The requirements differ for EPs and hospitals.In general, the same concept applies to needy individuals.Please contact your State Medicaid agency for more information on which types of encounters qualify as Medicaid/needy individual patient volume.
Q: We are a new practice and plan on getting an EMR in the next 3 months. Can you walk me through the time lines?
A: If you haven’t chosen an EMR yet, your first year in either program will probably be 2012. In the first year of Medicare participation, you will need to use the EMR meaningfully for 90 days during calendar year 2012, and you have up to 60 days after the close of the calendar year to attest to your use. In the first year of Medicaid participation, you will need to adopt (acquire, install), implement (commence utilization of EHR such as train, data entry), or upgrade (expand) a certified EHR and attest to your activity at any time during the calendar year.
Q: What validation or oversight will CMS provide for the attestation process?
A: Before any payment is made, checks of provider eligibility and information will be done. Keep in mind that attestation is a legal process. Random audits will be put in place in the near future.
Q: Should a practice register if we don’t know which program we are going to use?
A: You can register at any time, and you can change from one program to the other prior to attesting, so you can register for one program and change before you begin the attestation.
Q: If your first year of attestation is in 2012, can you get the full 44K over the course of the program?
A: Yes.
Q: Can you verify if Physician Assistants are eligible for one of the programs?
A: Physician Assistants (PAs) are only eligible under the Medicaid program and must be the lead provider for a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) to qualify.
Q: Does a radiology practice have to provide a clinical summary for patients?
A: No practice type is excluded from clinical summary mandate. CMS has not heard of any practice type having a problem with this so far. Remember, to achieve meaningful use, you must provide clinical summaries to patients for more than 50 percent of office visits within three business days. Exclusion: Any EP who has no office visits during the period of EHR reporting.
Q: Is the problem list supposed to be related to the chief compliant of the office visit?
A: Not necessarily. Practices are required to maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) codes. To comply, at least 80 percent of all unique patients seen by eligible providers must have at least one entry (or an indication of none) recorded as structured data.
Q: What if questions were not able to be answered during the webinar?
A: Please e-mail Physicians Practice and well get your answers from CMS. This could take several days, so please be patient. We will post your answers and all post-webinar questions at http://www.physicianspractice.com and notify you via e-mail as well.
Resources
A great list of additional resources were provided by Robert Anthony and Physicians Practice:
Resources from CMS
- EHR Incentive Programs website
- ONC website
- FAQs
- Listserv
- Meaningful Use Specification Sheets
- EHR Information Center
- Registration & Attestation User Guides
- EHR Hotline: 888-734-6433 / -6563 (TTY)
Resources from PhysiciansPractice.com
- Topic Resource Centers
- Tools
- You can also listen to an archived video of today’s webinar here.
Other Posts I have written on this topic:
Step by Step Directions for Getting the EHR Incentive Money: My Notes From Last Weeks CMS Call
CMS Holds National Provider Calls for the Medicare EHR Incentive Program and EHR Attestation Q & A
Digging Into the Details of Certified EMR & Tips For Buying an EMR
How Do You Get That Stimulus Money for Using an Electronic Medical Record? (You Register!)
How My Practice Knew We Were Ready for EMR
10 Ways to Get More Out of Your PM, EMR or Any Medical Software
First the facts on what has taken place so far in the 2011 EHR Incentive Programs.
- As of June 30th, the total of Medicare EHR Incentive Program payments is over $94 million.
- As of June 30th, over $166 million has been paid in Medicaid EHR incentives since the program began in January. In May and June, four states launched Medicaid EHRIncentive Programs – Indiana, Ohio, Pennsylvania, and Washington, bringing the total states with Medicaid EHR Incentive Programs to 21. More states will launch in July.
- There are 68,001 active registrations of eligible professionals and eligible hospitals for the Medicare and Medicaid EHR Incentive Programs.
If your group hasn’t received a check and hasn’t registered for the Medicare or Medicaid Incentive Program, then this blog post is for you! For anyone who is really just beginning their EHR journey, today’s presentation clarified previous information given by CMS, as well as giving listeners new information about the programs.
Note: I get great pleasure in finding resources for my readers, and today I have a showstopper! Carol Flagg is co-owner of HITECH Answers and is visiting Manage My Practice to announce a free resource for eligible providers and hospitals.
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For the past two years HITECH Answers has been a vendor neutral resource for education on details of the HITECH Act. In that time, weve amassed a significant library of recorded webinars for viewing, along with a body of exclusive white papers and research.
But the time for analyzing the HITECH Act has ended. Similar to the purpose served by the 62 Regional Extension Centers (RECs) , our goal is to support as much as we can the process of adoption of a certified EHR system that meets meaningful use criteria. Given the sheer number of health care providers needing significant help and guidance through this process, we have transitioned our existing web-based subscription model to function as a Virtual Extension Center.
This Virtual Extension Center, or VEC, supports health care providers and hospitals looking for education and analysis throughout the HITECH life cycle in a 100% virtual environment. In a nutshell, our VEC widens the education circle and opportunity for all Eligible Professionals and Eligible Hospitals. Weve also made membership to our VEC completely free for EPs and EHs for the entire life cycle of the HITECH Act.
So what, exactly, is the VEC? And how does it function?
First and foremost, this newly created VEC houses all of the existing recorded training material and research accumulated over the past two years. This information is readily accessible upon members logging on to HITECH Answers. Heres what has been added to round out VEC membership:
- Meaningful Use for EPs and EHs Live webinar events hosted twice a month that focus specifically on the details for achieving Stage 1 meaningful use for EPs and EHs.
- Upcoming live web casts on tax implications for incentives for EPs and EHs, workflow, ICD-10 migration, HIPAA security assessment, the pros and cons of SaaS, EHR contract negotiation and more.
- Live web cast for our VEC members who are vendors and HIT consultants that address pressing topics and needs in conducting business in this industry.
- Attendance to live webcast interviews and presentations from leading national experts.
- Access to exclusive white papers and research found only in our VEC.
- Direct access to independent experts to help answers your specific questions.
An obvious large part of the VEC will be our live events. We debut our event offerings with these two important topics Meaningful Use for Specialists andEHR Contract Negotiations.
Meaningful Use for Specialists Qualifying for CMS EHR Incentives
January 18, 2011, 7 pm EST
Event summary: A first glance at the Stage 1 Core and Menu Set objectives makes sense for primary care, but what about specialists? How can Psychiatrists, Oncologists, Radiologists, Urologists, and other specialists meet the requirements and objectives outlined in CMS EHR Incentive Program? EPs that are specialists can still achieve the CMS incentives based on the flexibility that is incorporated into two primary areas: Menu Exclusions and Quality Measures.
EHR Contract Negotiations: Q & A with William OToole, OToole Law Group
January 25, 2011, 7 pm EST
Event summary: The HITECH Act of the American Recovery and Reinvestment Act of 2009 is driving new technology acquisitions unlike anything seen in the healthcare information technology (HIT) sector since Y2K. Specific terms and warranties in Electronic Health Record (EHR) agreements are absolutely essential for the protection of provider customers. Competent and experienced legal advice is extremely important. Get your questions answered in this special Q & A session.
You can visit our Events Page to learn more about these sessions.
And you can learn more about qualifying for a free membership at Become A Member or you can contact me at: carol@hitechanswers.com.
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Disclosure from Mary Pat: HITECH Answers sells my book on their site, and I am a Consulting Expert to HITECH Answers.
Steps to digging under the meaning of EMR certification:
Image via Wikipedia
Image via Wikipedia
- Click to see the most recent alphabetical list (by product name not company) of all products certified here.
- Find the company or companies you are using or are considering using.
- Check that the exact name of the product is what you have or might purchase.
- Check to find out if a module or part of the product is certified or if the complete product is certified.
- Check to make sure the version of the product is the version you have or will have.
If you have questions about each company’s exact criteria met, you are in luck! On the ONC site here, you can click on each company’s detail (“View Criteria”) on the far right column labeled “Certification Status” to see what they have and don’t have. Compare this to how you are anticipating using your EMR to meet meaningful use. The more check marks a company has, the better-equipped they are (and more flexible) to meet your practice needs and to qualify for the stimulus money.
The ONC site with the Certified Health IT Product List (CHPL) is Version 1.0. Version 2.0 is now being developed and will provide the Clinical Quality Measures each product was tested on, and the capability to query and sort the data for viewing. The next version will also provide the reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.
You can tell ONC what you think would be helpful in the new version by emailing your ideas to ONC.certification@hhs.gov, with “CHPL” in the subject line.
If you’d like a list of just outpatient/medical practice EMR products or just inpatient / hospital products, I’ve split the big list into two smaller printable lists here:
Tips On Buying An EMR
Remember that meeting meaningful use does not tell the whole story – if you are shopping for an EMR be prepared to go beyond a product’s certification status to consider:
- Flexibility – does it make the practice conform to it or can it conform to the practice? How?
- Templates and best practices – are you starting from scratch in developing protocols, templates and cheat sheets for your practice, or does it have a storehouse of examples to choose from or tweak?
- Built for the physician, or the billing office, or the nurses, but doesn’t really meet the needs of all three? Make sure the functionality is not too skewed to one user group, but if it is, it should be somewhat skewed to the provider.
- Interface and integration with your practice management system. Does the information flow both ways? Do you ever have to re-enter information because one side doesn’t speak to the other?
- Interface with other inside and outside systems: Labs, imaging, hospital systems, ambulatory surgical center systems?
- Built-in Resources: annual upgrade of HCPCS and ICD codes, drug compendium (Epocrates), comparative effectiveness prompting?
- Mobile applications - EMR on your providers’ phones?
- Data entry systems - laptops, notebooks, tablets, iPads, smartphones, voice recognition?
- Hosting – in your office? at the hospital? at the vendor’s data center? in the cloud of your choice?
- What’s the plan for ICD-10? Will they provide practice support and education for the change or will they just change the number of characters in the diagnosis code field?
- Price, including annual maintenance and additional costs for training, implementation, on-site support during go-live, and additional licenses for providers or staff.
CHIME is the professional organization for chief information officers and other senior healthcare IT leaders.
CHIME has produced a CIO-oriented publication providing details on how organizations should focus their efforts to implement EHR systems that will qualify for stimulus funding payments through the HITECH Act. The 80-page guidebook is available free to the public and can be downloaded here.
Also, the American Hospital Association (AHA) and CHIME have worked collaboratively to create a guidebook for CEOs on the HITECH Act and meaningful use implementation. The handbook entitled, “Health Care Leader Action Guide on Implementation of Electronic Health Records”, provides a readable, actionable, step-by-step guide designed to assist CEOs and other C-suite executives in the EHR implementation process. The 22-page guide is available free to the public and can be downloaded here.
Image via Wikipedia
Note: read my latest post on getting the EHR Incentives here.
Medicare Definition of Eligible Provider (EP)
For Medicare, physicians and some hospitals are eligible providers. “Physicians” includes doctors of medicine (MD) or osteopathy (DO), dentists or dental surgeons (DDS or DMD), podiatric medicine (DPM), and optometry (OD) and chiropractors (DC).
For providers, their annual payment will be equal to 75 percent of Medicare allowable charges for covered services in a year, not to exceed the incentives in the table below. Payments will be made as additions to claims payments.
Hospitals include quick-care hospitals (subsection-d) and critical access hospitals and only includes hospitals in the 50 States or the District of Columbia.
Medicaid Definition of Eligible Provider (EP)
Medicaid takes the Medicare definition of eligible providers (physicians) and adds nurse practitioners, certified nurse midwives and physician assistants, however, physician assistants are only eligible when they are employed at a federally qualified health center (FQHC) or rural health clinic (RHC) that is led by a Physician Assistant. Eligible hospitals include quick care hospitals and children’s hospitals.
At minimum, 30 percent of an EPs patient encounters must be attributable to Medicaid over any continuous 90-day period within the most recent calendar year. For pediatricians, however, this threshold is lowered to 20 percent.
The first year of payment the Medicaid provider must demonstrate that he is engaged in efforts to adopt, implement, or upgrade certified EHR technology. For years of payment after year 1, the Medicaid provider must demonstrate meaningful use of certified EHR technology.
Change 1:
The definition of “hospital-based physician” was recently clarified to include physicians working in hospital outpatient clinics (employed physicians) as opposed to the inpatient units, surgery suites or emergency departments. This still excludes pathologists, anesthesiologists, ER physicians, hospitalists and others who see most of their patients in the ER as outpatients or as hospital inpatients.
Possible Change 2:
The Health Information Technology Extension for Behavioral Health Services Act of 2010 (HR 5040) is a bill in the US Congress originating in the House of Representatives that would amend the Public Health Service Act and the Social Security Act to extend health information technology assistance eligibility to behavioral health, mental health, and substance abuse professionals and facilities, and for other purposes. You can track the bill here.
For more information on stimulus money for meaningful use of an EMR, read my post here.
