The DTIMP Scorecard©: What Does Digital Transformation Mean For Independent Medical Practices?
By Christopher Hughey
Today we are introducing you to the concept of Digital Transformation for Independent Medical Practices© (DTIMP©, pronounced DEE-timp) and giving you a guide to how you can rate your current success using Fast Layne Solutions’ DTIMP Scorecard©. This is essentially a patient care efficiency measurement that helps you understand how much effort you are dedicating to clicks versus how much effort you are dedicating to patient care. Because remember: every minute spent on pushing paper (be it actual paper or virtual) is a minute you are not spending on your patients.
Before we talk about DTIMP©, let’s define digital transformation as a general concept for those unfamiliar with it. Wikipedia has an excellent definition: “Digital Transformation is the use of new, fast and frequently changing digital technology to solve problems. It is about transforming processes that were non digital or manual to digital processes. One of the examples of digital transformation is cloud computing.”
Now let’s apply that to independent medical practices. If you work in such a practice, your brain is probably racing ahead with examples. “Oh, our EHR is cloud-based! We’ve done digital transformation! Yay us! I’m going to go tweet about how our practice has done digital transformation!”
Well, no. Sorry. Put down your phone and keep reading, because I have bad news, but followed by good news.
By implementing a cloud-based EHR, you have indeed used technology associated with digital transformation generally and DTIMP© specifically. But to gauge the degree to which you have actually engaged in a real DTIMP©, you have to go through all your major manual processes and evaluate how you have gone from manual to automated using that technology.
Here’s the scorecard (and below you will have the opportunity to download a printable copy):
- Let’s start in the EHR. How much manual typing and coding is involved in the charting process? We can’t assign a score based solely on time spent per patient encounter because that varies too much by specialty (though a good rule of thumb goal for PCPs should be two minutes per encounter). What we can measure across specialties, however, is your level of charting automation. For an effective DTIMP©, you should have reviewed all your coding for at least the past year, determined which codes account for a minimum of 80% of your billing, and automated the charting process associated with those encounters by establishing templates and coding automation based on questions and checklists. Such encounters should lead to a minimal amount of documentation time (pre-populated text should be robust enough to require little editing) and little to no manual coding for the covered encounters. If you have not gone through this process at all, your score is zero. For every ten percentage points of your billing covered by CPT codes that are associated with coding/documentation automation, give yourself four points on the DTIMP Scorecard©.
- How are you handling prescription prior authorizations? With the right DTIMP© technology, almost all drug pre-auths should be automated. And let’s be clear: while logging on to the CMM website or using e-fax or calling over a VOIP line all leverage technology, simply using technology isn’t the same thing as digitally transforming a process if there is zero automation involved. The vast majority of prescription prior auths can be automated with the right solutions in place. For every 10 percentage points of your med prior-auths that you have automated, give yourself one point on the DTIMP Scorecard©.
- Eligibility checks. Everyone in the offices hates them, but they’re necessary for getting paid: the dreaded eligibility verification. Standards vary wildly across practices. Some tell staff to check every patient every appointment (but do little to enforce that policy), some check only upon initial intake and then rely on the old (extremely unreliable) standby of “Mrs. Smith, any changes to coverage since you were here last?” But unless you are fully automating the process and performing it for every patient, every visit, every time, then you are costing the practice valuable money and time that could be spent on patient care. The technology to automate eligibility verification is readily available and costs less than the labor involved in manual checks. For every 10 percentage points of your visits you do fully automated eligibility checks on, give yourself one point on the DTIMP Scorecard©.
- Patient reminders. Let’s not spend too much verbiage here, because the reality is simple and the technology to solve this time-consuming activity has been around for years: if you are doing manual patient reminders of any kind, you’re wasting your staff’s valuable time that could be spent on patient care. Patient reminder automation is easy. For every 10 percentage points of patient reminders you’ve automated, give yourself one point on the DTIMP Scorecard©.
- Now let’s switch to the billing side for a moment. Manually checking, submitting, and managing your insurance claims is a process your insurance companies love. They really want you to stick to that, and would prefer that you not even be reading this article. Why? Because the big insurance companies are not in the claims approval business: they are in the claims rejection business. And the more manually you review and manage your claims, the more excuses they can find to reject them. That’s why many independent practices have initial rejection rates well over 30%, and often far higher. There are four major tools for fighting back: improved coding through automation (see item one above); automated eligibility checks (see item three above); data pulls v data entry; and automated claims-scrubbing. Data-pulling v data-entry means that you almost never enter new patient information manually, but rather pull it from the insurance company’s own database by entering only the insurer ID into your EHR, allowing the EHR to then pull the data from the insurer and populate the system. That means your staff member who enters “John Q. Plublic [sic], 123 Elm Street” risks a rejection, while the staff member who just enters John’s insurance information and pulls “John Quincy Public, 123 Elm St.” does not. So now every claim is properly coded, we’ve confirmed coverage and benefits for every visit, there are no data mismatches, and finally you have applied claim-scrubbing technology to check the claim against a large database of CMS edits to look for common issues. Result? No more than 2% of your claims should be rejected. For every percentage point below 10% you score on combined denials and initial claims rejection rates, give yourself three points on the DTIMP Scorecard©.
Ready to evaluate your practice? Click here to download a PDF of the Fast Layne Solutions DTIMP Scorecard© that you can print and fill in yourself. Or simply click here to schedule a free practice analysis and we will be glad to help guide you through the process and provide recommendations and feedback without any cost or obligation to you.
Christopher Hughey is the founder and CEO of Fast Layne Solutions.