Climbing the Ladder of Success: Service Delivery Changes Post Affordable Care Act

‘Success is not the position where you stand, but the direction in which you look’ ~Author Unknown~

West Central Missouri Community Action Agency

 Are you …  Using Electronic Health Records?  Billing Medicaid and commercial insurances?  A part of a health information exchange?  E-prescribing and incorporating lab results? Where are you on the ladder??

 Collaborations: Old and New  Insurance: Medicaid and Commercial  Implementing Electronic Health Records Where is West Central on the ladder and how did we get there?

Collaborative Efforts West Central Units  Housing  Head Start  Community Services  Energy Assistance  Energy Conservation  In-Home Services  Employment and Training Outside Collaborations  Women, Infant and Children (WIC)  County Health Departments  Women’s Shelters  Pregnancy Centers  Foundations  United Way  Show Me Healthy Women  Etc.

Referring of clients and building a viable reputation Assisting with Medicaid Application Process Funding applications Benefits of Collaborative Efforts

 …You are required to keep confidential all information made available to you in the performance of your duties. You are responsible for assuring confidentiality of such information and releasing information only to authorized agencies or individuals as provided for by law and/or policy. … Sharing of Information The Major Challenge of Collaborative Efforts

This is not an all-inclusive list but just a sample of the laws and their consequences for unauthorized disclosure of confidential information.  Health Insurance Portability and Accountability Act of 1996 (HIPPA)  Internal Revenue Code – Section 7213 (A)  IRS – Section 7431  IRS – Section 6103  IRS – Section 2651 (DEFRA)  The 1997 Taxpayer Browsing Protection Act  Income Maintenance - #42  Wage Data Utilization by the States - #45  Unemployment Insurance – 20 CFR  Food Stamps – 7 CFR ©  Department of Health and Senior Services  Missouri State Children’s Services Law – , and RSMo.

 Fines ranging from $100 up to $250,000  Class “A” to Class “C” Misdemeanor violations  And jail time The above laws included…

 Public Insurance – Missouri Health Net West Central has been a Medicaid provider for years. We are currently enrolled with all Missouri HMO’s. Currently 17% of our clients are on Medicaid and generating approximately $5,000 per year. (73% of our clients are uninsured at this time) Our CPT (Current Procedural Terminology) and diagnosis coding has been updated to enhance reimbursement. Public Insurance

 Commercial Insurance – Blue Cross/Blue Shield, Cigna, etc. West Central has been billing Commercial Insurance for 2 years. We currently are enrolled with 3 major providers and are in the enrollment process with others. Currently 10% of our clients have commercial insurance and the reimbursement rates are approximately $7,000 per year. Our CPT and diagnosis coding has been updated to enhance reimbursement. Commercial Insurance

 Complete and accurate information  Better access to information  Patient empowerment Electronic Health Records

EHR Myths ???

EHR Myths No More Paper  Consent forms  Back up for internet outage  Many clinicians and providers still want paper in hand. Broken Processes are Fixed  Broken processes may in fact become more apparent where reports provide solid data  However, EHR may help identify broken processes so that you can work on correction

EHR Myths Paper Charge Slips are the quickest and easiest to enter  Paper charge slips could be easily lost  Must be manually entered by billing staff  Paper charge slips are often incomplete Greater Efficiency with EHR  May be true, EHR provides increased efficiencies  One information system doesn’t usually meet all needs regardless how extensive the client base.

Challenges and Experiences Of West Central Mo Community Action Agency

Millions & Billions To Fund EHR??  The total amount of grant money the government is allocating towards health information technology is $19 billion…  A total of $12 million in grant money is now available to help rural health-care providers establish…  Vice President Joe Biden announced the availability of grants worth nearly $1.2 billion to help hospitals and health care providers implement and use…  The U.S. Department of Health and Human Services has released final rules on how health care providers can qualify for up to $27 billion in incentive….  The maximum incentive for providers who participate in Medicare and begin in 2013 is $39,000-which decreases to $24,000 in 2014…

 Select an EHR that will meet your needs  Need a plan for meeting the on going expense  Initial Cost  Monthly Fees  Proper equipment  Secure Internet Selection, Cost and Equipment

 Is your server large enough and secure enough to hold client medical records?  Do you have sufficient IT staff to maintain your system?  Is it feasible to pay for storage on “The Cloud”? Data Storage

 Is your staff technology savvy?  Plan for training  Know what training is available from the EHR vendor  Adjust your schedules while staff adjust to the changes Training & Staff Utilization of Technology

 Longer Intake sessions  Appointment Scheduling  Technology/staff mishaps  Scanning process of previous files Clinical Processes

 Assess practice readiness  Establish a budget  Choose the right vendor  Manage change  Redesign workflow Tips for Achieving Success with EHR

WEST CENTRAL MISSOURI COMMUNITY ACTION AGENCY Lea Ann Gatzemeyer Women’s Health Director Cheryl Gutshall Women’s Health Program Manager Contact Information