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10 physician documentation, billing considerations for ICD-10 implementation

Posted on Tue, Sep 23, 2014
10 physician documentation, billing considerations for ICD-10 implementation

This article was originally published on BeckersHospitalReview.com and is republished with permission.

By DIGHTON PACKARD, CMO, EmCare

While CMS announced the new effective go-live date for ICD-10 is Oct. 1, 2015, it's important providers not put off the training and other preparations require to prepare their organizations for the ICD-10.

In April, the HHS announced that it was delaying CMS' implementation of ICD-10. Oct. 1, 2014 was no longer the "go live" date. 

The delay came as a surprise to many in the healthcare community. Providers and payers had already invested millions of dollars in software updates and staff training to be ready for Oct. 1. Now what? Continue reading at Becker's Hospital Review.>> 

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EmCare’s Genesis Cup Honors Innovation, Creativity in Healthcare

Posted on Tue, Sep 09, 2014

This article was originally published in the June 2014 issue of EmCare's EmPressions Magazine.

by: JENNIFER WHITUS

EmCare Marketing Communications Manager

A dramatic redesign has allowed the busiest emergency department in Florida to drastically patient-flow.jpg decrease wait times while improving other key metrics. This dynamic turnaround not only improved operations for the Lakeland Regional Medical Center’s emergency department (E.D.), but also earned the redesign team the prestigious 2014 Genesis Cup award.

The Genesis Cup is an award for healthcare innovation presented each year by EmCare, a leading national physician practice management company. This year’s Genesis Cup honoree, a team that works in the Lakeland E.D. in Lakeland, Fla., presented its award-winning redesign during EmCare’s Annual Leadership Conference at The Wynn in Las Vegas.

“The Lakeland E.D. [emergency department] is the busiest single-site E.D. in Florida,” said Dr. Jim Melton, III, medical director for the Lakeland E.D. “It had roughly 170,000 ED visits in 2012 and is on track to have more than 180,000 E.D. visits this fiscal year. Despite the increase in volume, the E.D. has managed to decrease wait time, length of stay rate and rate of patients leaving without being treated. These improvements are the result of an E.D. redesign that began in 2011, driven by the hospital’s executive leadership.”

Melton’s Genesis Cup-winning redesign team includes:

  • Maureen Leckie, R.N., MSN, the associate vice president of clinical operations at LRMC
  • April Novotny, R.N., MSN, the CEN director of emergency services
  • Pam Carter, R.N., BSN, the assistant director of emergency services
  • Joanne Fuell, R.N., BSN, the assistant director of emergency services

Before this redesign, LRMC’s E.D. had a long-standing practice of segregating adult patients by levels of clinical acuity into either a critical care area or an immediate care area.

The redesigned E.D. care model grouped rooms into nine pods: one for triage, six that serve adults, one that serves children and one for minor non-urgent conditions. A registered nurse (R.N.) acts as a “bed traffic controller” for the triage pod, assigning triaged patients to one of the pods on a rotational basis so no single pod becomes overwhelmed by multiple patient arrivals.

Because the E.D. relies on multiple hospital departments to deliver care, an E.D. redesign required changes outside of the E.D. as well. LRMC created a team with representatives from the E.D., radiology, lab, pharmacy, respiratory department, transportation and patient placement. The team met weekly to review data and ensure the E.D. was regularly maintaining or improving its patient flow.

Data analysis was another driving component of the redesign. The redesign team received daily and weekly summaries of detailed data from the hospital’s strategic analysis team. One unique tool Lakeland had in its redesign was a simulation model developed by an industrial engineer. The model uses existing data to predict outcomes, such as wait times, under various situations, including staffing levels and patient volumes.

The redesign clearly led to improvements for Lakeland Regional Medical Center’s E.D.:
  • E.D. volume increased 16.5 percent from January 2011 to January 2013
  • On average, patients are now assessed by a physician in 20 minutes or fewer
  • The time from when a patient arrives in the E.D. to when he/she is seen by a healthcare practitioner is 38 percent faster than the national average
  • The number of E.D. patients who left without treatment decreased from four percent to 0.3 percent
  • The average length of stay is about two hours
  • Most patients are treated and discharged in fewer than three hours – a 50 percent decrease resulting from the redesign
  • Patients are admitted 30 percent faster than the national average
  • Patients get to a bed after admission 56 percent faster than the national average

EmCare also recognized two runners-up in this year’s Genesis Cup program. Dr. Harry Jung, III, an anesthesiologist who practices at Seton Regional Medical Center Harker Heights and a regional medical director for EmCare, earned runner-up honors through reports of the effectiveness of ultrasound-guided regional nerve blocks. These nerve blocks have been shown to reduce pain, shorten hospital stays and speed recovery post-operatively better than more common pain medications and narcotics.

The second runner-up for the Genesis Cup is E.D. team from Sinai Hospital of Baltimore. The Sinai team was recognized for their Ambulance Immediate Offload Project, and was made up of:
  • Diane Bongiovanni, M.A., BSN, R.N., CHEP, NEA-BC, director of emergency department and critical care
  • Amy Riesner, MSN, BSN, R.N., CHEP, NREMT-P, the E.D. clinical leader and EMS liaison
  • Lakecia Lewis, BNS, R.N., CEN, emergency department RN2
  • Alma Ta-Asan, BSN, RN, emergency department RN2
  • Chandresh Shelat, M.D., E.D. physician and EMS coordinator
  • William Jaquis, M.D., chief of emergency medicine
  • Will Williams, captain of EMS quality assurance and improvement officer with city emergency medical services
  • Christian Griffin, NREMT-P, fire director of county emergency medical services

This new offload program has been very successful: since the faster offload times translated directly to faster EMS response times, in September of 2013 the Sinai E.D. was ranked number one by the City Fire Department.

“All three of these groups personify EmCare’s mission of making healthcare work better,” said Dr. Dighton Packard, EmCare’s chief medical officer. “When you are able to reduce wait times, improve patient flow, better manage pain – it ultimately leads to improved outcomes for the patient.”

EmCare designed The Genesis Cup program to recognize and celebrate the creativity and innovation of everyday physicians as part of the company’s never-ending pursuit to improve the delivery of patient care. In addition to recognizing the inventor/ innovator, The Genesis Cup recognizes those involved in the initiative, including the emergency department, radiology department, hospitalist team, anesthesia team and the regional office in supporting such endeavors.

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