I recently sat down with office manager Brandy Fernandes to discuss strategies to improve quality management implementation in an independent practice. Brandy has successfully managed Dr. Fred Taweel’s office, Internal Medicine Associates of Reston (IMAR), for ten years. As one of the highest performing practices at Privia, IMAR has experienced an increase in cleanly coded claims, lowered claim rejection rates, and a significant increase in quality measurement satisfaction percentages since joining Privia Medical Group. In this blog, Brandy offers us first-hand wisdom on how she manages an independent practice efficiently. Read on for her tips on superior quality management that you can easily implement in your own practice.
The healthcare industry as a whole is moving toward value-based care and risk-based contracts, which puts a focus on satisfying and maintaining quality measurements. Can you give an example of the obstacles that you have found most challenging as an office manager under this “new” value-based, risk-based system?
Internal Medicine Associates of Reston is a seven provider practice in Reston, Virginia and all seven of our providers are excited to be a part of this change in healthcare. We’ve implemented expectations within the practice to maximize patient care and manage our patients’ disease processes, and so far we’ve seen positive outcomes in patient care. Our goal has always been proactive, not reactive, management of our patients’ health, even before value/risk-based contracts were introduced. In my experience, the first obstacle is always patient compliance. As their PCP, we order screening tests at their annual exams per quality management guidelines but we cannot ensure that patients will actually go for their mammograms, dilated eye exams or colonoscopies. The second most frequent challenge we’ve encountered in the past was our ability to successfully track measurements, capture data and run status reports from that information. Our current technology allows for tracking and reporting of these metrics, though, so this process is no longer a major obstacle.
Speaking of technology, can you tell me more about the many EMRs you have worked with, and your experiences with each one?
IMAR initially started with Allscripts EMR and ADS practice management system, and then transitioned to GE Centricity EMR and IDX practice management systems. Both of these systems had the front office staff working out of the practice management system and the clinical staff working out of the EMR. Tracking quality measurements, and at the time, meaningful use measures, was a painstaking, time-consuming process. IMAR was the first Privia Medical Group practice to go live with athena. Privia’s customization of our tablespace within athena has allowed us to view all required measurements and view our percentages of measurement satisfaction with approximately four clicks of the mouse, which is highly efficient at a management level. At the administrative level, Privia Medical Group-customized athena shows providers and nurses exactly which measures have not been addressed specific to each patient, within each chart. Because of Privia-led customization, this has definitely been our best experience yet with an EMR. As a practice management system, it fluently integrates with the EMR and proactively and automatically verifies patients’ insurance eligibility. All of these successes are a result of our partnership with Privia and their customization of athena to ensure we are effectively managing patient care.
Quality of documentation and coding can significantly affect a practice’s revenue cycle success. What are some in-office practices that IMAR utilizes to ensure all provider work is captured, including quality measurements?
IMAR implemented an internal policy for closing encounters same day. By doing this, the encounter is completed real-time, which we feel ensures the most accurate depiction of the visit and captures the provider’s work. Because of this, our claims are essentially dropped at check-out and our encounter close rate averages around 97%. If the billers find any problems, they can immediately connect with the provider to confirm or update coding. IMAR providers also have access to Privia’s coding team, which evaluates and improves their documentation in regular audits, as well as Privia’s free coding training. Because of the training and audit feedback that Privia offers, our providers are better able to identify ways to capture work already being performed. One of our partner physicians is also is trialing a scribe program, which is still in the early stages, but already showing signs of increased documentation of work already being performed.
How can Risk Adjustment Coding and Hierarchical Conditioning Categories (HCC) help a practice financially?
Well, risk adjustment actually helps the patient first and foremost. HCC coding is really about appropriate patient care and driving resources for the patient based on the diagnoses that the provider has coded. It ensures that insurance companies recognize that higher risk patients need more and will reimburse the providers appropriately for this added level of care as well as provide services like diabetic management. Without HCC coding, the insurance company would see all patients as equal in regards to cost and management of conditions. With HCC coding, the insurance understands that the “at risk” patient needs more proactive management to prevent worsening of their pre-existing condition which allows for a higher cost target and access to more resources.
Office management entails equipping physicians with data in the right format at the right time and in the right place. How do you equip Dr. Taweel with the tools he needs to treat his patient panel efficiently?
I’m fortunate to work with providers who genuinely have the patient’s best interest at heart, which is also in congruence with Privia Medical Group’s ideals. It really comes down to teamwork, which is essential to effectively treat our patient panel. Our front office staff goes above and beyond to ensure all administrative functions are taken care of before the patient’s appointment and the nurses spend extra time with the patient before their appointment reviewing and updating the chart, so that when the provider walks in the room, they can focus on the most important part of healthcare — the patient.
Thanks, Brandy. Do you have any final advice for office managers?
Sure! Be open-minded to changes in healthcare. Adjust your workflow. Continuously look for new ways to think proactively for your patients. And – if you’re in PMG – embrace Privia! Be sure to utilize all that they offer to better your provider and staff knowledge to ensure successful, meaningful patient care.