Strategies for Private Provider Participation in Registries Edna O. DeVries, MD Marshfield Clinic, Wisconsin Copyright 2002

Current Registry Trends In some states, such as Wisconsin, most immunizations are given in the private sector Private providers perceive different needs than public providers Registries are experiencing difficulties in recruiting and sustaining private providers Copyright 2002

Reality for Private Providers Today Expected to do more for less reimbursement Increasing patient loads One-on-one patient contact time is less Vaccine schedules are becoming more complex (need for decision support) Many providers are switching to electronic medical record systems Copyright 2002

What Private Providers Need in Registries Improvement in the workflow Time saving features Flexibility for individual facilities’ needs Financial incentives Copyright 2002

RECIN – A Registry Designed to Meet the Needs Confidential, real-time, internet based registry in Central Wisconsin that has been used live since 1995 Largely privately funded and developed Key - collaboration with competing private providers and public health System must add value to doctors’ offices and not hamper efficiency or it won’t be used Copyright 2002

RECIN Development Considered private providers needs and workflow issues Programmed to include flexibility for both the private and the public sector Copyright 2002

Live Data Entry = Time Savings Quick and easy steps for patient identification Providers can store their own chart numbers One screen data entry Users can set custom defaults for the day Fewer mouse clicks = time savings Automate all documentation for the chart and the patient Copyright 2002

Live Data Entry = Improved Patient Care Eliminate over- and under-immunization Provide cross facility documentation for immunizations and alerts Educate through the use of standard schedules Decision support – “Tool Tips” Based on previous history & age of patient Connecting with children that need more than vaccines Copyright 2002

Pre-RECIN Workflow Obtain medical record for vaccine history Assess history; provider decides what immunizations to administer Refer to documentation (i.e. pink book) for fine print rules for special cases All vaccines, including lot numbers, provider, etc are handwritten in chart Parent copy is hand written Vaccines administered Time needed: approx 5-10 additional minutes per patient to analyze schedule and document Copyright 2002

Post-RECIN Workflow Select patient in RECIN RECIN determines immunization status based on: patient history Age CDC schedule (including all the fine print rules, and additional information from other providers) With defaults set, vaccines are entered in 3-4 mouse clicks Copyright 2002

Post-RECIN Workflow (cont) All documentation, including chart copies, cumulative parent copy, and consent are printed Vaccines are administered and parent is given their full record to take home Time needed: approx 1 additional minute for schedule analysis and documentation Copyright 2002

RECIN – Financial Incentives Time = money Decrease documentation time from 5-10 minutes per patient to less than 1. Equip providers with necessary system reports Vaccine recall VFC reporting Billing interface Copyright 2002

System Reporting Vaccines For Children (VFC) - antigen reimbursement Determined Marshfield Clinic underreported 12,435 VFC eligible doses in FY2000 Significant $’s in lost vaccine reimbursement Vaccine Recall Chart pulls are costly and time-consuming; RECIN can provide the list of patients in minutes versus days/weeks of chart reviews Copyright 2002

Billing Interface-Marshfield Clinic Prior to interface: Lost billing 1/5 childhood immunizations Lost billing 1/2 adult Td and Pneumococcal Why were we missing them? Incomplete charge sheets Charge sheets separated from charts Marshfield Clinic recovered significant $’s in lost billing Copyright 2002

Financial Incentives Lost billing recovery case study (Non-Marshfield Clinic provider) 40% lost billing over 9-month period $6,077 in lost vaccine revenue (this does not include administration fees) Cost to use RECIN during same period was $841; resulting in a net gain of $5,236 Consolidated billing report returns REAL value to providers Copyright 2002

Financial Incentives Increased number of office visits as a result of intervention By using RECIN’s reminder recall system, providers are raising immunization rates One region raised their immunization rate for 0-2 year olds from 67% to 93% UTD in 13 months for the 4:3:1:3:3 series More patients seen by private providers as a result of intervention Copyright 2002

In Summary Private providers are being asked to do more with less Registries should equip providers with an efficient tool to: Improve patient quality of care Track immunizations community wide Reduce administrative time in the process Improves financial outcomes Copyright 2002

How Can Registries Increase Private Provider Participation Include end-users on your development team Listen to their needs, and modify the system accordingly Provide benefits to them when they use the registry Improve workflow Time savings Financial Copyright 2002

If you build it, they will come Copyright 2002

Contact Information Edna O. DeVries, MD Marshfield Clinic 1000 North Oak Avenue Marshfield WI 54449 715.387.5781 devries.edna@marshfieldclinic.org Copyright 2002