Web application for clinicians - SidekickCV
- 1. STREAMLINING PRE-AUTHORIZATION WITH by Apps for Docs Clinical Decision Support www.appsdocs.com TM IMPROVE PRODUCTIVITY BOOST PATIENT SATISFACTION INCREASE REVENUE -1-
- 2. INEFFICIENCIES IN THE CLAIMS MANAGEMENT PROCESS THE PROBLEM BACKGROUND: The healthcare landscape continues to change at a rapid pace as an estimated 30 million newly insured people enter the system, alongside ever-rising costs and a declining number of providers. How will physician practices effectively treat more and more patients with fewer and fewer clinicians? To properly manage this state of uncertainty, reform legislation has encouraged providers to adopt new technologies that improve quality and efficiency while reducing costs. An area of opportunity for technology solutions can be found within the claims management process, which is costing physician practices unsustainable amounts of time and money. PRE-AUTHORIZATION CRIPPLES PRODUCTIVITY UNCERTAINTY To receive pre-authorization, the provider must contact the insurance payer and verify the procedure is medically necessary before the procedure is performed. Only then can the claim potentially be reimbursed. This is a burdensome, costly effort managed by clinicians and clerical staff in the physician practice setting. Pre-authorization has been suggested to consume 20 hours of physician, nurse, and clerk time each week. While clinicians wait to receive authorization from the insurance payer, patients wait up to 45 days from the time the procedure is ordered to the time they receive treatment. This can result in patient anxiety and overall dissatisfaction with care received. Additionally, the longer it takes to provide treatment, the more underutilized resources and facilities become. WAITING FOR RESPONSE PEER-TO-PEER CALLS DENIALS 13.1 1 6.3 "What Does It Cost Physician Practices To Interact With Health Insurance Plans," Lawrence P. Casalino et al, Health Affairs 28.4 (2009): w533-w543 at w537. Hours devoted to prior authorization each week Clerk Physician Nurse The claims management process involves submitting claims and collecting appropriate payment for services rendered. The American Medical Association reported that “Cost estimates of inefficient health care claims processing, payment and reconciliation are between $21 and $210 billion. In the physician practice, the claims management revenue cycle consumes an unsustainable 10-14 percent of practice revenue”. CLAIMS MANAGEMENT PROCESS REGISTRATION DOCUMENTATION PRE-AUTHORIZATION BILLING COLLECTIONS WASTE $210BB 14% INEFFICIENCY DISSATISFIED 20hrs/ week 45day wait of revenue -2-
- 3. EVIDENCE BASED DECISION SUPPORT AND DOCUMENTATION sidekickCV SOLUTION Streamlining the pre-authorization process with the intent to improve clinician productivity, cash flow/revenue, and patient satisfaction is achievable by using clinical decision support tools at the point of care in the office setting. The American College of Cardiology Appropriate Use Criteria evidence based guidelines have been adopted as the benchmark for medical necessity documentation for high cost imaging procedures by many payers. SidekickCV delivers these criteria in an accessible form that provides decision support guidance for appropriate procedure selection, and medical necessity documentation for each patient-specific order. This point of care solution has been shown to produce the following results: • Increased revenue The inclusion of evidence-based medical necessity documentation in the procedure order has significantly reduced the number of denied claims, resulting in improved cash flow and overall revenue generation. An analysis on page 5 details a 2200% ROI and a $1.1 million of new revenue for an average 300 bed hospital, by using clinical decision support tools at the point of care in the physician office setting. HIPPACOMPLIANT • Improved clinician productivity The number of “peer to peer” calls between the clinician and the payer is drastically reduced, freeing up 2-3 hours per week of clinician time. • Better patient care The time period from the procedure being ordered to the patient being authorized for the procedure is significantly reduced from an average of 45 days down to 2 weeks or less. As a result, patients experience more satisfaction with the treatment process and less anxiety while waiting for the procedure. -3- IMPROVE FINANCIAL AND CLINICAL OUTCOMES
- 4. EXECUTE QUICKLY AND EFFECTIVELY SidekickCV is a web application that provides access to up to date Appropriate Use Criteria guidelines and medical necessity documentation at the point of order. It is accessible from any internet capable device. A hospital subscription provides referring physician access to the Clinical Decision Support tool without complex IT infrastructure redesign. EMR/CPOE system integration with SidekickCV via API interface or simple copy/paste of evaluations provides a quick and smooth workflow for the clinician. The average time to utilize SidekickCV and generate a patient evaluation report is under a minute. Working in a busy Cardiovascular Electrophysiology Office makes SidekickCV imperative to improving our workflow and productivity". - Dawn Aycock, ARNP Streamlining the pre-authorization process for imaging procedures has the potential to show immediate improvements in productivity, patient satisfaction, and revenue without extensive and costly redesign of clinical workflows and processes. TM sidekickCV IN WORKFLOW Diagnostic Test Selection Diagnostic Test Ordered in EHR/ CPOE Test performed in hospital or office Results Communication Better Patient Care Patient Appropriateness Criteria Provider Education Evaluation report with evidence • Signs • Symptoms • Special Risk Groups • Abnormal prior test Clinician workflow in the office setting QA Reports -4-
- 5. A B C D E F G H I Procedure Type CPT Code / DRG CMS Reimbursement per procedure (4) Avg # of Procedures / year Baseline % of procedures in Rarely Appropriate category ( 1,2,3 ) Baseline #of Proceduresw/ denied claimsdue to Rarely Appropriate classification Post SideKickCV # ofProceduresin Rarely Appropriate category (5%) Adjusted #of Procedureswith denied claims Revenue at risk due to denied claims / year Diagnostic Cardiac Cath 93452 2,727.00$ 800 20% 160 40 120 327,240.00$ Percutaneous Coronary Intervention (PCI) G0290 7,279.00$ 100 12% 12 5 7 50,953.00$ Cardiac CT 75574 452.00$ 200 10% 20 10 10 4,520.00$ Echo / TEE 93312 236.00$ 3000 10% 300 150 150 35,400.00$ Cardiac Radioclide Imaging 78472 233.00$ 200 10% 20 10 10 2,330.00$ Peripheral Vascular US 93925 153.00$ 2000 10% 200 100 100 15,300.00$ Implantable Cardioverter- Defibrillator (ICD) 222 - 226 DRG 39,856.00$ 100 22% 22 5 17 677,552.00$ Total 6400 734 320 414 1,113,295.00$ Average procedure rate (Revenue / Total # of Procedures) used in ROI 173.95$ Monthly subscription # months Yearly subscription cost 2,498$ 12 29,976$SidekickCV monthly subscription Rarely Appropriate procedures - Revenue at risk due to denied claims SidekickCV evidence based decision support analytics CMS Part B Cardiovascular Procedure Volumes for 300 Bed Hospital Listing of the cardiovascular imaging proce- dures that are covered by the ACC Appropri- ate Use Criteria Reduce Denied Claims A The following table summarizes the FINANCIAL IMPACT that a reduction in the number of Rarely Appropriate procedures can have for an average 300 bed hospital. The result of retrospective analysis of cardiovascular procedure utiliza- tion in the US shows a certain percentage of imaging procedures have fallen into the “Rarely Appropriate“ catego- ry as per the AUC guidelines. Since January of this year payers have begun denying claims for Rarely Appropriate procedures. E Procedure volumes were determined from an analysis of a cross-section of Florida based mid-size hospitals D The authors of the referenced articles agreed that a certain percentage of patients will not fit into the AUC because their particular clinical scenario are not detailed in the AUC or there are other extenuat- ing aspects of their scenario that the clinician thinks warrant the procedure anyway. The percentage of patients that fall into this category is 5%. This column includes the volume of studies in this group. G Article References: 1) Chan et al, Appropriateness of Coronary Intervention, JAMA. 2011;306(1):53-61. 2) Ward et al Prospective Evaluation of the Clinical Application of the American College of Cardiology Foundation/American Society of Echocardiography Appropriateness Criteria for Transthoracic Echocardiography, J A C C : C A R D I O V A S C U L A R I M A G I N G VO L . 1 N O . 5 , 2 0 0 8 3) Sana M. Al-Khatib et al, Non–Evidence-Based ICD Implantations in the United States, JAMA January 5, 2011, Vol 305, No. 1 4) Procedural Reimbursement Guide Select Percutaneous Coronary and Peripheral Interventions, Boston Scientific 2011 Total revenue at risk equals $1.1MM I -5-
- 6. CONTACT: Aaron Duthie COO Apps for Docs Cell: (352)792-3740 Office: (877) 876-6717 Email: aduthie@appsdocs.com by Apps for Docs Clinical Decision Support www.appsdocs.com TM IMPROVE PRODUCTIVITY BOOST PATIENT SATISFACTION INCREASE REVENUE -6-