Christopher FETTERS

District Sales Manager

Point-of-carePoint-of-carePoint of Care Billing:Point of Care Billing:

Yes You Can!Yes You Can!

Point of Care Billing:Point of Care Billing:

Yes You Can!Yes You Can!

© 2005. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.© 2005. All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

GoalGoal

• Goal in Point of Care?• Goal in the Laboratory?• Goal in the Hospital?

Golden Rule: Do unto others as you would

have them do unto your mother.

Golden Rule: Do unto others as you would

have them do unto your mother.

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

To Err is Human - Building a Safer Health SystemTo Err is Human - Building a Safer Health SystemA Report From The National Academies of Science, Institute of MedicineA Report From The National Academies of Science, Institute of Medicine

• 44,000 – 98,000 patients killed each year by medical mistakes

• Key Recommendations Center for patient safety National mandatory reporting Peer review protections Focus greater attention on patient safety FDA should increase attention to safe use of

drugs

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Nurse trainingNurse training

• Right Patient• Right Drug • Right Dose • Right Route• Right Time

770,000 untoward drug errors

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

It is necessary to create a culture of change that embraces patient safety through shared accountability within a blameless culture.

Rosina Jones, LHRM, CHRM

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Causes of Medical MistakesCauses of Medical Mistakes

• 60-80% is human error Active errors

Latent errors

• 15-20% is mechanical failure

NewsweekNewsweek

Who is the most important Who is the most important person inperson inMedia and Entertainment? Media and Entertainment?

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Three approaches to qualityThree approaches to quality

• Remedial Alleviate the symptoms of the existing

problem

• Corrective Eliminate the cause of existing problems

or undesirable situation to prevent recurrence

• Preventative Eliminate the cause of potential problems

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Changing the processChanging the process

• “er” – Season finale• Romano’s accident

Not this oneIDIOT

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Three phases of laboratory testingThree phases of laboratory testing

• Pre-analytical

• Analytical

• Post-analytical

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

hile point-of-care testing (POCT)

has significantly improved the

timely

delivery of diagnostic information for

clinical

decision making, the wide range of

settings

and operators involved in POCT add a

layer

of complexity to an institution’s effort

to

ensure consistently high-quality

results.”

Gerald J. Kost, MD, PhD. “Using operator lockout to improve the performance of point-of-care blood glucose monitoring.” 2000.

WW

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Is 99.9% Good Enough?Is 99.9% Good Enough?• 1 hour of unsafe drinking water every month; • There will be no telephone, electricity or television for 15 minutes each day.

• 315 entries in Webster's Dictionary will be misspelled • 114,500 mismatched pairs of shoes will be shipped/year • 811,000 faulty rolls of 35MM film will be purchased this year.• 880,000 credit cards in circulation will turn out to have incorrect cardholder information

on their magnetic strips • 2,488,200 books will be shipped in the next 12 months with the wrong cover.• 5,517,200 cases of soft drinks produced in the next year will be flatter than a bad tire.

• 1,314 phone calls will be misplaced by telecommunications services every minute.• 18,322 pieces of mail will be mishandled/hour • 22,000 checks will be deducted from the wrong bank accounts in the next 60 minutes.• 2,000,000 documents will be lost by the IRS this year

• Your heart fails to beat 32,000 times each year. • Twelve babies will be given to the wrong parents each day.• 2,500 newborn babies will be dropped in the next month.• 107 incorrect medical procedures will be performed by the end of the day today.• 500 incorrect surgical operations each week; • 200,000 drug prescriptions will be filled incorrectly in the next 12 months.

• A typical day would be 24 hours long (give or take 86.4 seconds)Jeff Dewar

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

•Safety is part of quality

•Process changes ensure long-term benefit

•Labs have opportunity because of attention to quality issues

•Examine pre-analytical processes first

•Use technology to improve processes, address quality & examine data

QualityQuality

• Our healthcare delivery system is NOT safe for the patient

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

82% of Patient Data Still Manually 82% of Patient Data Still Manually RecordedRecorded

18%

82%

Downloaded Manually Entered

Source: 1999 EAC US Hospital POC Survey

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Point of Care ErrorsPoint of Care Errors

• Sensa v. Non-sensa• Documentation of ACT Results• MD Pocket Developer (distilled water)• Documentation of urines• Timing urine dipsticks• Bad Patient/Operator ID’s• Timeliness of data (docking)

wireless

• CHANGE THE PROCESS

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Your mission…Your mission…• Risk Analysis

Brainstorm

What tests? Pre-analytical, analytical, post-analytical

What steps? List what could go wrong? (Risk Analyis) Prioritize (Severity) Change the process / re-educate Audit

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

operators

Three things you MUST DO!Three things you MUST DO!

1. Barcode your patients & operators

3. Bill for point of care testing

2. Install Connectivity

(not just data management)

Christopher Fetters:

Video of barcoding a patient. Video of instrument download, data management station, computer room, Bills printing off, money falling, patient accounting department

Graphics with poof on previous, then diminishing graphic of current one

Find a bite mark for these…

Christopher Fetters:

Video of barcoding a patient. Video of instrument download, data management station, computer room, Bills printing off, money falling, patient accounting department

Graphics with poof on previous, then diminishing graphic of current one

Find a bite mark for these…

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Fetters POC Device ClassesFetters POC Device Classes

• 0 – Manual testing

• i – Marginally Connectable Instruments

• ii – Batch Download Connectable Instruments

• iii – Continuous Connected Instruments (Wired)

• iv – Continuous Connected Instruments (Wireless)

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

POC Device

•Date/Time•Device S/N

•QC Lot#•QC Lockout

•User ID•Patient ID•Strip Lot#

•Result

•Comment Code

Network

Network

Clinical Data Station

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

Network

Network

Clinical Data StationPOC Device

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

POC Device

Network

Network

Clinical Data Station

Downloading

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

Network

Network

Clinical Data StationPOC Device

QC in range

Valid Patient ID

Valid User ID

Comment Code

Flagged Results

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

Network

Network

Clinical Data StationPOC Device

Flagged Results

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

Network

Network

Clinical Data StationPOC Device

QC in range

Valid Patient ID

Valid User ID

Comment Code

Flagged Results

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Standard Data Management Standard Data Management SchemaSchema

Network

Network

Clinical Data StationPOC Device

Flagged Results

LIS System HIS System

HIS Terminal

Cum Report

Patient Billing

…

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

BenefitsBenefits• Time savings (up to 1/3 of POCC)• Ability to bill• Results on EMR• QC tracking / regulatory viability• Improved user compliance

“What I do matters to somebody” QC/Operator Lockout

• Early problem detection (liability)

CONCLUSION: 1. Ability to bill improves ability to staff to an adequate level and use discretionary time to improve patient care.2. IMPROVED CONTROL = IMPROVED QUALITY = IMPROVED SAFETY = IMPROVED PT CARE

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

ChallengesChallenges• Doesn’t inherently save *nursing*

time• Timeline• Apparent Price (Sticker-shock)• Manual testing• Interfaces • Multiple devices / multiple DM

systemsCONCLUSION: Lack of profit, cost of implementation and the challenge of multiple analytes have been a barrier to ubiquitous implementation of connectivity.

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

ObjectivesObjectives

• You should bill for point of care testing!

• Point of care billing is profitable!

• Billing for point of care

improves patient care!

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Why bill?Why bill?

• Gives credit among admin to program (You get what you pay for)

• Count workload• Ought to be paid for services• Recoup costs• Continue to upgrade technology• Add FTE’s to improve control• Good for patient care

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

We should bill for point of care testing.We should bill for point of care testing.

Q.Q. HOW?HOW?

Q. WHY?Q. WHY?

A.The same way we do for all other laboratory testing.

A. Because it is laboratory testing.

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Point of Care Testing is Lab Point of Care Testing is Lab TestingTesting

• Clinical Laboratory Improvement Amendments of 1988 (CLIA ’88)

• American Medical Association (AMA)

• Medicare

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

CLIA ‘88CLIA ‘88

• Certifies testing

• Agents of the laboratory

• Human specimens

• Based on complexity, not setting

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

CLIA’s View of In Vitro TestingCLIA’s View of In Vitro Testing

CLIA requires all entities that perform even one test, including waived test on ‘... materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of any disease or impairment of, or the assessment of the health of, human beings’ to meet certain Federal requirements. If an entity performs tests for these purposes, it is considered under CLIA to be a laboratory and must register with the CLIA program.”

www.cms.gov/clia/cliaapp.asp

One Waived Test = Laboratory

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

AMA’s CPT CodesAMA’s CPT Codes

• Defines code for medical procedures

• Laboratory testing in the range:

80000 to 89399CPT Codes for POC

Waived Glucose – 82962Urine dipstick – 81002ACT – 85347Fecal occult blood- 82270•••

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

MedicareMedicare

• Medicare Part A Inpatient Reimbursed by Fiscal Intermediary

• Medicare Part B Outpatient/POL’s Reimbursed by Carrier

Alabama(Regional Office: Atlanta) Part A - Blue Cross and Blue Shield of Alabama;

Mutual of Omaha Insurance Company Part B - Blue Cross and Blue Shield of Alabama

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Inpatient Medicare Billing ProcessInpatient Medicare Billing ProcessPatient discharged

Physician discharge summary and diagnosesMedical Records

Coder ICD-9 codesGrouper DRG codeUpload to Medicare

Payment under Prospective Payment System (PPS)Upload hospital cost report

Christopher Fetters:

Set this up as an animation or video

Christopher Fetters:

Set this up as an animation or video

- 500 codes

- Clinically cohesive groups

Similar consumption of hospital resources

Similar length of stay patterns

- 30,000 codes

- Standardized codes for diagnosis

- Formulated by the World Health Organization (WHO)

- ICD-10CM is coming…

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Use of the cost reportUse of the cost report

• Globally PPS based on averages Set next year’s DRG reimbursement

schedule

• Locally Cost to charge ratio

Christopher Fetters:

Illustrate the averages going down because point of care testing is absent.

Illustrate the cost to charge ratio

Illustrate the lump sum payment at the end of the year.

Illustrate the Part A to Part B Rollover

Christopher Fetters:

Illustrate the averages going down because point of care testing is absent.

Illustrate the cost to charge ratio

Illustrate the lump sum payment at the end of the year.

Illustrate the Part A to Part B Rollover

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Example DRGExample DRG

Primary Diagnosis:ICD-9 36.1 – “Bypass, aortocoronary”

Medicare Average Reimbursement: $37,000

DRG 106: “Coronary Bypass with Cardiac Catheterization”

Secondary Diagnoses: Valvuloplasty, Atherectomy, Catheterization, Angiocardiogram, or Arteriogram

ICD

-9IC

D-9

DR

G

$$

Christopher Fetters:

Set this up as a flow chart. Get video of medical records, picture of discharge notes, doctor writing discharge notes

Christopher Fetters:

Set this up as a flow chart. Get video of medical records, picture of discharge notes, doctor writing discharge notes

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Medicare contractorsMedicare contractorsQUESTION Part A - Coverage Is CPT 82962 a covered service for inpatients?

ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s) cleared by

the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF).

[http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561]

CH

ISO

LM B

CB

STR

AIL

BLA

ZE

R

1212

QUESTIONIs CPT 82962 a covered service for inpatient claims?

ANSWERInpatient claims submitted for Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use, is a covered procedure and reimbursed as a portion of the Prospective Payment System for Hospital and Skilled Nursing care inpatient services.

[http://www.bcbsok.com/chisholm/frequently_asked_questions.html]

QUESTION Part A - Coverage Is CPT 82962 a covered service for inpatients?

ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s)

cleared by the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF).

[http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561]

QUESTION Part A - Coverage Is CPT 82962 a covered service for inpatients?

ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s)

cleared by the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF).

[http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561]

“Waived

Test”

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Covers procedures in CPT Range 80000-89399 Set reimbursement rate (Medicare Part B) Update yearly by Medicare

Medicare Clinical Laboratory Fee Medicare Clinical Laboratory Fee ScheduleSchedule

2005 Clinical Diagnostic Laboratory Fee ScheduleRevised: 11/16/2004 CPT codes and descriptions only are copyright 2000 American Medical Association. All Rights Reserved. Applicable FARS\DFARS Apply

AL GA MS AR NM OK MO2 LA FL CT INNational 2004 Mid 00510 00511 00512 00520 00521 00522 00523 00528 00590 00591 00630

HCPC Modifier Limit Point Floor Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00 Loc 00

80048 $11.70 $15.81 $0.00 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $11.70 $8.8380051 $9.69 $13.10 $0.00 $8.83 $9.69 $9.69 $9.69 $9.67 $9.69 $9.69 $9.54 $9.69 $9.69 $8.8380053 $14.61 $19.74 $0.00 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.61 $14.3980061 $0.00 $0.00 $0.00 $15.70 $18.51 $18.51 $17.57 $16.97 $18.51 $18.51 $16.50 $18.51 $18.51 $18.5180061 QW $0.00 $0.00 $0.00 $15.70 $18.51 $18.51 $17.57 $16.97 $18.51 $18.51 $16.50 $18.51 $18.51 $18.5180069 $12.00 $16.21 $0.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.00 $12.0080072 $0.00 $0.00 $0.00 $35.67 $35.67 $35.67 $35.67 $35.67 $35.67 $35.67 $34.70 $35.67 $35.67 $35.6780074 $0.00 $0.00 $0.00 $63.76 $65.82 $56.88 $65.82 $65.82 $65.82 $65.57 $65.82 $65.82 $65.82 $60.4280076 $11.29 $15.26 $0.00 $11.29 $11.29 $11.29 $11.29 $11.29 $11.29 $11.29 $11.29 $11.29 $11.29 $8.8380090 $0.00 $0.00 $0.00 $79.56 $64.32 $79.56 $79.56 $79.56 $79.56 $79.56 $79.56 $79.56 $79.56 $79.5680100 $20.10 $27.16 $0.00 $20.10 $19.25 $20.10 $20.10 $16.50 $20.10 $19.86 $20.10 $20.10 $14.49 $20.1080101 $19.03 $25.72 $0.00 $17.48 $19.03 $19.03 $19.03 $18.95 $19.03 $19.03 $17.38 $19.03 $19.03 $19.0380101 QW $19.03 $25.72 $0.00 $17.48 $19.03 $19.03 $19.03 $18.95 $19.03 $19.03 $17.38 $19.03 $19.03 $19.0380102 $18.31 $24.74 $0.00 $17.18 $18.31 $18.31 $18.31 $18.31 $18.31 $18.31 $17.14 $18.31 $18.31 $18.3180150 $20.83 $28.15 $0.00 $20.83 $20.83 $20.83 $20.83 $20.83 $20.83 $20.83 $16.08 $20.83 $20.83 $20.8380152 $24.74 $33.43 $0.00 $22.92 $24.74 $23.55 $24.74 $24.74 $24.74 $24.74 $24.74 $24.74 $24.74 $24.7480154 $25.56 $34.54 $0.00 $25.56 $25.56 $25.26 $25.56 $25.56 $25.56 $25.56 $25.56 $25.56 $25.56 $25.5680156 $20.12 $27.19 $0.00 $20.12 $20.12 $20.12 $20.12 $20.12 $20.12 $20.12 $16.08 $20.12 $20.12 $20.1280157 $13.74 $18.57 $0.00 $13.74 $13.74 $13.74 $13.74 $13.74 $13.74 $13.74 $13.74 $13.74 $13.74 $13.7480158 $24.95 $33.72 $0.00 $24.95 $8.24 $24.95 $24.95 $24.95 $24.95 $24.95 $24.95 $24.05 $24.95 $24.0580160 $23.79 $32.15 $0.00 $23.79 $23.79 $20.88 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.79 $23.7980162 $18.35 $24.80 $0.00 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.35 $18.3580164 $18.72 $25.30 $0.00 $18.72 $15.69 $18.72 $18.72 $18.72 $18.72 $18.72 $18.72 $18.72 $18.72 $18.7280166 $21.42 $28.95 $0.00 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $21.42 $17.62 $21.42 $21.42 $21.4280168 $22.58 $30.51 $0.00 $22.58 $22.58 $20.88 $22.58 $22.58 $22.58 $22.58 $22.58 $22.58 $22.58 $22.5880170 $22.65 $30.61 $0.00 $22.65 $22.65 $19.00 $22.65 $22.65 $22.65 $22.65 $16.08 $22.65 $22.65 $22.6580172 $22.52 $30.43 $0.00 $22.52 $20.06 $22.52 $22.52 $22.52 $22.52 $22.52 $22.52 $22.52 $22.52 $20.06

MT AL NY2 NJNational 2006 Mid 00751 00510 00803 00805 Short

HCPC Modifier Limit Point Floor Loc 00 Loc 00 Loc 00 Loc 00 Desc82962 $3.27 $4.42 $0.00 $3.27 $3.27 $3.03 $3.27 Glucose blood test

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Setting charges for analytesSetting charges for analytes

• Using the Clinical Lab Fee Schedule DON’T Glucose (82962) $3.27

• Use lab/hospital Charge Master• Suggest CLSI (NCCLS) GP-11A

“Basic Cost Accounting for Clinical Services”

Calculate using worksheets (Direct cost + Indirect cost) X Hospital multiplier

X

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Medicare Payment PoliciesMedicare Payment Policies

• National National Coverage Decisions 23 lab analytes In effect Nov, 2002 Final Rule:

Federal Register 11/23/2001 Administered by Federal Law

• Local LMRP (Local Medical Review Policy) www.lmrp.net Administered by Carrier

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Medicare National Coverage DecisionMedicare National Coverage Decision

• Specifically addresses glucose testing

• Lists ICD-9 for medical necessity• Lists reasons for denial• Also covers CPT 82947

Christopher Fetters:

Picture of someone putting a grey top on a core lab instrument

Christopher Fetters:

Picture of someone putting a grey top on a core lab instrument

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

AACC Conference Call Poll (2003)AACC Conference Call Poll (2003)

Q: For which POCT procedures does your institution receive reimbursement?

Glucose only (22%) Coagulation (PT/INR) only (30%) Glucose and coagulation only (22%) All POCT charges are billed (26%)

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

lab tests?What is required to bill What is required to bill lab tests?lab tests?

• CLIA Number

• Physician order

• Reasonable and necessary (SSA 1862(a)(1)(A))

• Physician must use to manage pt care (42 CFR 410.32,

411.15)

• Result to physician promptly (implicit)

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Medicare National Coverage DecisionMedicare National Coverage Decision

• Specifically addresses glucose testing• CPT Codes• ICD-9 for medical necessity• Reasons for denial

Absence of signs or symptoms Routine physical (such as employee physical or

community health fair) Failure to provide medical necessity Not ordered by physician Failure to have CLIA certificate Testing performed on device not FDA approved

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

How do I bill?How do I bill?• Manual Billing

Christopher Fetters:

Video of someone filling out a lab card, video of someone docking each type of instrument, video of nurse with stickers on uniform, video of using a pyxis, video of using a data management workstation – Add slide to show increased revenue with data management.

Christopher Fetters:

Video of someone filling out a lab card, video of someone docking each type of instrument, video of nurse with stickers on uniform, video of using a pyxis, video of using a data management workstation – Add slide to show increased revenue with data management.

20-40% Missed charges

• Data management

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

AACC Conference Call Poll (2003)AACC Conference Call Poll (2003)

Q: What are your major stumbling blocks to POC billing?

Too great an investment to set up infrastructure (24%)The lab director or finance department has told us we cannot bill (34%)Consultant told us we cannot bill (8%)We are waiting for connectivity (34%)

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Laboratory TrendsLaboratory Trends

ProfitsProfits CostsCosts

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

US Testing MarketUS Testing Market

The US Laboratory testing market totaled ~$35.4 billion (5.63 bn tests) in 2001(including commercial, hospital, physician office & other labs)

Hospitals/IHN’s = > 4.1 bn tests

Commercial other & labs = ~ 1.53 bn

POCT is almost $4 billion and GROWING!

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Payor mix (typical)Payor mix (typical)• Medicare / Medicaid (45-60%)• Managed care (20-40%)• Fee for Service (15-25%)• Other (remaining)

Medicare

Other

Private Payor

Managed Care

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

As many as 168,000 hospital positions are unfilled in six selected job As many as 168,000 hospital positions are unfilled in six selected job categories. categories. Three out of four vacancies are nursing positionsThree out of four vacancies are nursing positions

Note: Other hospital professions include pharmacists, radiological technologists, laboratory technologists, billing/coders, and housekeeping/maintenance staff.

Healthcare Personnel Healthcare Personnel ShortagesShortages Other Hospital

Professions25%

Registered Nurses75%

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Staff Shortages Continue For U.S. Staff Shortages Continue For U.S. HospitalsHospitals

0 5 10 15

Northeast

A Shortage of Medical Technologists

Mean Vacancy Rate (in percent)

Midwest

South

West

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Billing can improve patient careBilling can improve patient care

• More FTE’s = Better quality

• More leverage with physicians and nurses

• Show ROI on Data Management

• Financial and clinical justification for new point of care analytes

• POC Billing creates more nursing positions

Christopher Fetters:

Picture of a discontented nurse with her arms crossed.

Picture of doctor signing patient chart.

Illustrate data management

Show form with clinical and financial justification request.

Christopher Fetters:

Picture of a discontented nurse with her arms crossed.

Picture of doctor signing patient chart.

Illustrate data management

Show form with clinical and financial justification request.

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Potential

Your mission…Your mission…• POC Committee• Create an impact worksheet

Pt volumes X Charges = Gross Charges Gross Charges X Fee for service % = Net Revenue Potential

• Billing investigation committee (Ad hoc) POC Coordinator (& Staff) Medical Director Lab Manager / Administrative Director Lab Business Operations Mgr LIS Supervisor Patient Accounting Nursing Admin Managed Care Contracts

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

ConclusionConclusion

• You should bill for point of care testing!

• Point of care billing is profitable!

• Billing for point of care

improves patient care!

Christopher Fetters:

Include montage of point of care, data management, money, instruments, downloading, nurse taking care of patients. Build the montage with lots of dissolved shots…

Needs to create a picture of something as it builds. Like a dollar sign or fade into the face of a patient or something…

Christopher Fetters:

Include montage of point of care, data management, money, instruments, downloading, nurse taking care of patients. Build the montage with lots of dissolved shots…

Needs to create a picture of something as it builds. Like a dollar sign or fade into the face of a patient or something…

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Point of Care Optimization

Alabama Point of Care Coordinators (27 Apr 2006)

Questions?Questions?

Christopher FettersChristopher FettersNova Biomedical(781) 647-3700 x293(781) 894-0585 Fax

cfetters@novabiomedical.comwww.nextivity.net

Christopher Fetters:

Include stylized Nextivity Logo, Picture of me…etc.

Christopher Fetters:

Include stylized Nextivity Logo, Picture of me…etc.