5 Signs that Your EHR Implementation is Failing

With an estimated 30% implementation failure rate, the EHR rollout gone wrong is not uncommon and most providers have heard their fair share of implementation horror stories, but there is hope. For agencies looking to avoid or escape the slippery slope of implementation failure, there are five signs to watch for.

1. Always Playing Catch-Up

Lack of internal preparation has been the downfall of many a provider, leaving agencies in a constant race to catch-up. To address this common misstep, providers should clearly document and determine ALL workflows, and define ALL staff roles responsible for data entry and system management. Equally beneficial is an internal or external committee to handle, track and be responsible for data migration. An effective EHR provider will offer guidance during this process.

2. Lack of Staff Buy-In

To achieve staff buy-in, providers should identify internal champions to help promote the implementation and importance of the new EHR. Providers should also create a leadership committee comprised of members from all stakeholder groups to oversee the implementation. Lastly, offering a reliable platform (meetings, group calls, etc.) for stakeholders to share system experiences is the best way to prevent current concerns from becoming future issues.

3. Severe Training Obstacles

Agencies can improve training efficiency by tracking the progress of all trainees to ensure that staff do not fall behind and stay behind. To boost trainee attendance, providers should consider incentivizing participation and make sure that staff is well educated on the importance of the new EHR and its effect on their day-to-day. However, to have the greatest impact on training success, providers should select an EHR with comprehensive, organized and engaging training capabilities.

4. Lack of System Functionality

Disappointing system functionality is a common issue for providers who do not select an EHR that was specifically designed for behavioral health and human services providers. These issues are also caused by EHRs that do not offer critical interfaces making the use of multiple systems necessary, which results in double work and time wasted. To prevent EHR regret due to inefficient functionality, providers should select an EHR that offers a detailed product roadmap with a clear vision of future functionality and interface integration. This will ensure that your EHR grows with you instead of becoming outdated.

5. Bloated Timelines

Never ending implementations have long plagued providers, with many spending years in an implementation, far beyond originally promised timelines. In order to avoid the endless implementation, providers should select an EHR with a reputation for comprehensive, flexible and fast implementations.

As the industry leader, Qualifacts is:

• The gold standard in EHR implementations for behavioral health and human services
• The implementation leader with the industry’s fastest implementations averaging only 6 months
• Synonymous with best-in-class training offering comprehensive and engaging sessions, access to some of the industry’s top trainers and training plans tailored to your agency
• The EHR of choice for providers seeking a solution with product roadmap transparency and a reputation for responsiveness to meet behavioral health and human services provider needs

Making Your Agency Compliance Strong for 2015 and Beyond

There is a seemingly constant stream of grabbing headlines revealing yet another behavioral health or human services agency being penalized under payer take-backs or even accused of fraud, but for many providers these horror stories have not been enough to drive them towards compliance action.

In this post, we’ll take a closer look at compliance for behavioral health and human services providers, and reveal the best practices to guarantee that your agency is compliance strong for 2015 and beyond.

The Rise of the Take-Back

Providers not yet prioritizing compliance should tread carefully, especially considering the prevalence of payment reform causing payers to ramp up their compliance efforts in the form of persistent audits. This combined with the advent of incentive programs, means that payers are looking to minimize costs by enforcing take-backs whenever possible.

These take-backs or the mandatory repayment of overpaid funds continue to hit the healthcare industry hard, but for behavioral health and human services providers, take-backs can mean the difference between agency stability and a funding crisis.

The impact of take-backs is further amplified by existing funding issues which contributing to the extreme likelihood that overpaid funds have already been spent. This leads many providers to resort to desperate measures including layoffs in order to secure funds for repayment.

7 Steps to Guarantee Compliance Excellence

Providers can move closer to effective compliance measures and audit safeguards by following these key steps:

1. Adopting a Leading EHR

   EHRs are one of the most effective compliance tools in a provider’s toolkit. The most effective EHRs make clinical documentation a part of the clinician’s workflow and require the completion of proper documentation for every service provided before a claim can be submitted. This level of checks and balances, makes documentation a natural part of the clinician’s day and integral to the billing process.

2. Assigning a Point Person

   For behavioral health and human services agencies of any size, compliance starts with a point person, the Compliance Officer. This person manages and oversees all agency compliance efforts.

   Avoid: the Compliance Officer/Jack-of-All-Trades. Unfortunately, many agencies that already have Compliance Officers encourage them to priorities other responsibilities unrelated to compliance. These responsibilities usually take precedent over compliance and all compliance efforts are pushed further and further back. Avoid this common pitfall at all costs.

3. Building Your Compliance Dream Team

   Establish a committee of stakeholders from across the agency to ensure that the unique compliance concerns of each department are represented. Compliance teams create greater accountability, build staff buy-in and result in stronger compliance initiatives.

4. Getting the Rest of Your Agency On-Board

   Start with the message that prioritizing compliance is mandatory and essential to each person’s role. Incorporate this message into regular staff trainings on compliance and highlight how compliance will benefit the work they do on a daily basis. Educate the entire agency on the necessity of compliance, especially all members of the management, clinical and billing teams.

   Avoid: Take-backs and repayment will be too abstract for the larger agency and should not be the primary message of your compliance training nor should it be the primary goal of your compliance efforts. Providers often forget that the most profound impact of compliance is not avoiding penalties, but positively impacting quality of care, efficiency and overall cost management.

5. Creating a Compliance Roadmap

   With help from the compliance committee, the Compliance Officer should create a compliance plan featuring the following components:

   > Identification of compliance committee members and Compliance Officer
   > Clearly defined compliance objectives and standards
   > Internal staff training programs
   > Enforcement standards for disciplinary action in response to instances of noncompliance
   > Standard guidelines to respond to noncompliance and prevent repeat offenses

6. Monitoring for Signs of Noncompliance

   Continuously monitor for signs of noncompliance. High denial rates and incorrect billings are usually a dead give-away. Pay close attention to clinical documentation, which is consistently one of the highest contributors to noncompliance.

7. Conducting Audits

   Perform regular internal audits to prevent noncompliance surprises and address issues in a timely manner after they arise.

The Compliance Power of an Effective EHR

Qualifacts’ certified Complete EHR, CareLogic Enterprise, enforces the necessary checks and balances to simplify the compliance process and safeguard against failed audits.

With CareLogic, providers can rest easy knowing that…

• Proper and completed documentation is required for each specific service provided.
• Completion of certain document fields is required and signature validation is enforced to reduce “documentation errors.”
• Documentation forms can easily be adapted to changing regulations to ensure that providers are not using outdated forms.
• Only “clean claims” are sent out.
• The billing staff can mark services as “non-billable” if provided in error. Changing a service to “non-billable” no longer triggers a claim, but allows the documentation to remain in the client’s chart.
• Providers receive reliable alerts to notify them of unkept appointments and the need for document completion or signature verification.
• For convenience, documentation generates directly from the clinician’s schedule. This means that they do not have to recreate the information in multiple places which saves precious time and energy.

Qualifacts Named Fastest Growing Behavioral Health EHR

Qualifacts Systems, Inc., the leading cloud-based electronic health record (EHR) provider for the behavioral health and human services industries, is proud to announce that it has been named to the Inc. 5000 as the fastest growing behavioral health EHR in America. This announcement marks Qualifacts’ third consecutive year ranking in the Inc. 5000 and highlights the company’s commitment to continued growth.

“Our growth is a direct result of listening to our customers, understanding their needs, and hiring smart, passionate people who know how to execute. I’m extremely proud of what we’ve accomplished, but even more excited about our future.” says David Klements, President and CEO of Qualifacts.

Qualifacts provides integrated clinical, financial and administrative software solutions to the behavioral health market through its single platform EHR, CareLogic Enterprise. The company has significantly increased its profitability from year to year and more than doubled its revenue from 2011 to 2013. In the past five years, the company has grown its workforce by 650% and customer base by 1,000%. With plans for future growth strengthened by a recent majority investment from private equity firm, Great Hill Partners, the company is on track to increase its workforce by an additional 40% by the end of 2015.

Qualifacts will continue to invest in sales and product development to further reinforce its position as a market leader and continue to support the complex healthcare reform needs of behavioral health organizations.

“Qualifacts’ single platform approach is the best solution for behavioral healthcare providers that either don’t want or can’t afford major software upgrades every few years and rightly prefer to dedicate their resources to serving more clients and improving care quality,” states Klements. He also adds that “at a time of rapid change in the healthcare market, Qualifacts is focused on ensuring that our customers can access and leverage the information and technology they need to not only compete, but thrive.”

What Do You Get When You Cross Technology and Community?

You may have heard that Qualifacts recently secured a private equity investment from Boston-based Great Hill Partners, which presents a valuable opportunity for Qualifacts to create additional value for behavioral health and human services providers and strengthen product quality, but also continue to support local community.

The investment will help Qualifacts strengthen its importance in behavioral health technology and, along with a collection of local technology leaders, kick-start a rising technology community in the heart of Music City, Nashville, Tennessee. “The investment helps Qualifacts grow, but at the same time, having those resources in Nashville promotes tech community growth,” says Bryan Huddleston, President and CEO of the Nashville Technology Council (NTC), an organization dedicated to fostering and advancing the technology community in Middle Tennessee.

“I want there to be a change.”

Helping to lead this community progress and economic development is Qualifacts’ CEO, David Klements. Huddleston weighs in on Klements’ role in the Nashville community, saying that “Klements, from both a career and community-give-back perspective, has been very intentional about saying, ‘I want there to be a change.’”

Qualifacts is looking to deliver this change by recognizing the importance of community and helping behavioral health and human services providers deliver a higher quality of care to communities everywhere.

NTC interview and post by Cassidy McHose and Michael Norco

Qualifacts Strengthens Market Leadership with Majority Investment from Great Hill Partners

Qualifacts Systems, Inc. today announced that it has secured a majority investment from Great Hill Partners, a Boston-based private equity firm with more than $3 billion under management. The recapitalization, which was led by Great Hill Partners and existing Qualifacts management, will allow the company to accelerate product development and continue growth. The investment will also help the company identify strategic partnership and acquisition opportunities.

“Qualifacts has emerged as a recognized leader in behavioral health software, but there’s more we want to do to ensure that our customers are successful for the long-term,” said David Klements, President & CEO of Qualifacts. “To help us maximize our full potential, Qualifacts management wanted a financial partner with the right experience and resources. Great Hill was a perfect fit and we’ve already hit the ground running.”

In the past five years, Qualifacts has grown its customer base by 1,000% and workforce by 650%, repeatedly earning the company a place among the Inc. 5000 as one of the fastest growing private companies in America. The company’s single platform EHR, CareLogic Enterprise, supports more than 50,000 behavioral health professionals in 30 states and has supported the delivery of more than 20 million services to one million consumers within the past year.

“We are delighted to partner with David and the entire Qualifacts team,” said Mark Taber, a Managing Partner with Great Hill Partners. “Qualifacts offers a unique and powerful platform for behavioral health organizations to drive operational efficiencies, improve access to patient information, and quickly adapt to changing billing and compliance regulations.”

The investment will accelerate existing product initiatives which support the healthcare reform needs of behavioral healthcare providers. These include demonstrating clinical outcomes, coordinating care with other healthcare systems, delivering integrated primary care services alongside behavioral healthcare and efficiently handling new payment models.

Rafael Cofiño, a Principal with Great Hill Partners, added, “We believe Qualifacts has tremendous growth potential as behavioral health providers seek ways to manage increasing patient volume along with highly dynamic state and federal funding requirements.” Great Hill Partner’s prior healthcare technology investments include bswift, Passport Health Communications and SterilMed.

About Great Hill Partners

Great Hill Partners is a Boston-based private equity firm that manages more than $3 billion in capital to finance the expansion, recapitalization or acquisition of growth companies in a wide range of sectors within the business and consumer services, healthcare, media, communications and software industries. Great Hill targets investments of $25 million to $150 million.

For more information, please see www.greathillpartners.com.

Healthcare R.E.F.O.R.M. = Major Changes to Behavioral Health

A few weeks ago, our healthcare expert Mary Givens, presented a webinar entitled, “The Affordable Care Act Means Major Changes to Behavioral Health.” If you missed it don’t worry, you can see the presentation in its entirety here.

Mary simplified Healthcare Reform with a simple acronym:

     Revise and Refine

     Evidence Based

     Follow Through and Follow Up

     Outcomes and Data

     Real, Quantifiable Results

     Manage Risk

Simple enough, but what exactly does it all mean? And more importantly, how can you apply this to your organization? Use the below tips to get started:

Revise and Refine – Any time that you want to introduce a new process at your organization, you should follow the Plan-Do-Check-Act Model.

Plan – A model that encourages high quality care. You can do this by finding current processes that can be made more efficient. How is your organization spending their time and how can it be better optimized?

Do – Take action on the plan! By educating and training our team, sharing goals, and addressing concerns. Keep in mind, with any major changes to your business there will be objections and people will resist the change.

Check – By running reports frequently and retraining as necessary. Expect to have to retrain staff on specific aspects of an EHR as problems arise.

Lastly, act by using data you have collected over a specific period of time to gauge success. Identify the problem areas and make changes accordingly. Most importantly – don’t forget to celebrate the successes!

Evidence Based
Next, make sure you’re making evidence-based decisions, both clinically and operationally. A 2014 Certified EHR can help you make these decisions by providing CDSR’s, assessment tools and screening tools, helping you maximize capacity while maintaining quality. You should also use evidence to demonstrate your quality of customer service.  A way to do this is to measure customer engagement such as the use of a customer portal.

Follow Through and Follow Up
Once you’ve made an evidence-based decision, provide specific actions carried out in a specific amount of time. A provider should carry out the action and then assign other actions to care team members. ALL actions must be completed, or there must be documentation provided to support why they were not completed. With the use of an EHR, you can easily track all actions to make sure they are being completed, which ultimately improves the quality of care for your customers.

Outcomes and Data
Reform means objective (no comma needed) data based evidence, to demonstrate quality and efficiency (cost saving) service delivery. Some examples of outcomes that demonstrate quality and efficiency are:

Patient Engagement –You should be helping them self-manage their health, wellness, and recovery. Some ways to do this are: by using customer portals, involving their care team (family and friends), using concurrent documentation, and more significantly – involve the customer in all decisions.

Prevention – In addition, your data should help you be proactive. You can reduce the need for emergent, high cost services by encouraging customers to use natural support networks and community support. You should use CDSR to identify early indicators of an illness.

Clinical – Lastly, assess regularly to demonstrate change in assessment score over time (greater level of functioning)

Real, Quantifiable Results
You should be able to demonstrate quantifiable results both operationally and clinically.

When it comes to operations, know your costs first: averages billed for key services vs. net revenue vs. cost. Second, focus on no show rates per type of service, backfill rates, and a centralized schedule. One point of improvement for most organizations is the daily backfilling of cancelled appointments.

From a clinical standpoint, you should be focusing on episodic care needs and measuring a level of care by considering symptoms and functions. To start: focus on a small number of goals centered on moving to a higher level of functioning and lower service utilization. Finally, you should be tracking the ‘ordered’ service mix. Are the services scheduled and are they actually happening?

Manage Risks
Now that payers pay on quality and not just on volume, the risk is now shared, and in some cases there is a greater risk for the provider. You’re now wondering if you’re going to get paid for a service and how much. Some ways to manage these shared risks are to measure and manage based on what your own data is telling you, maximize your capacity and maximize the valued outcomes.

On a pay for performance model, you should know how much you are being paid for each service and how much it costs. It is important to know your mix of risk tiers so you can manage them and stay solvent. You need to identify episodes and levels of care in order to access data per episode to move customers through levels of care as assessment, screening, symptoms and diagnosis warrant.

As far as patient engagement and capacity, make sure you are actively working patients who are not attending appointments or adhering to their treatment, and make changes. You can do this through customer portals or reminder calls. You should be aiming to be at capacity while still delivering a high quality of care at all times. Also, don’t forget that if any symptoms are outside of your specialty area, they must be addressed.

We hope these tips helped simplify Healthcare Reform for you. When it comes to major changes, don’t wait until 2016. Use this time to make changes, tweak your processes and collect data on how well you are doing as an organization. If you don’t define how well you are doing or what high quality services you provide –a payer is going to define it for you.

For more information regarding Healthcare Reform, check out MUforBH.com.

 

Qualifacts Staff Lobby on Capitol Hill for Mental Health Funding

Cat Turpin (L) and Jenn Brinn (R) lobby on Capitol Hill for mental health funding

Last week, over 4,000 mental health and substance use providers, executives, consumers, family members and other stakeholders descended on Washington D.C. for the annual National Council Conference.

More than 1,200 of those conference attendees were also part of Hill Day ’14, the nation’s biggest behavioral health advocacy event. Two Qualifacts team members, Cat Turpin (Key Account Manager) and Jenn Brinn (Digital Marketing Specialist) attended conference sessions on public policy trends and changes, then traveled to Capitol Hill to talk to their legislators about expanding funding for the Mental Health First Aid Act, urging them to support the Behavioral Health IT Act, and asking them for 2015 appropriations for mental health and substance use programs and research.

What made Hill Day especially significant for Qualifacts is that we shared this experience, stood side-by-side, and raised our voices in unison with four of our customers from Tennessee Mental Health Consumer Association: Anthony Fox (CEO), Carolina George (VP of Clinical Services), Stacey Murphy (VP of Administrative Services), and Jennifer Jones (VP of Public Policy).

Other Qualifacts customers were also on the Hill, fighting for the same initiatives and funding from their state legislators, including Allen Brown (CEO of Unison Behavioral Health in Georgia) and Stephen Christian-Michaels (COO of Family Services of Western Pennsylvania).

Our mission at Qualifacts is to “Sustain and extend our customers’ ability to serve.” However, this doesn’t always necessarily mean just through the software we develop and support. We are honored to speak on behalf of our customers, all the way up to the federal level, to help push forward important legislation that will allow you to continue providing excellent care and services to the people of our society who need it most.

Qualifacts staff members meet with Linda Rosenberg, President & CEO of the National Council for Behavioral Health, before heading to Capitol Hill

(L-R) Representing the state of Tennessee: Stacey Murphy, VP of Clinical Services at TMHCA; Anthony Fox, CEO of TMHCA; Cat Turpin, Key Account Manager at Qualifacts; Jenn Brinn, Digital Marketing Specialist at Qualifacts; Ellyn Wilbur, Executive Director of TAMHO

Historic Mental Health Legislation Passes in the Senate

The U.S. Senate today passed legislation that included $900 million to fund the bipartisan Excellence in Mental Health Act.  The legislation, which passed the U.S. House of Representatives last week as part of the Medicare SGR Repeal bill, establishes a two year demonstration program in eight states to offer a broad range of mental health and substance use treatment services, including 24-hour crisis psychiatric services, while setting new standards for provider organizations.

» Read more from the National Council

That One Thing Every Behavioral Health Provider is Worried About This Year

If you weren’t one of the 400 attendees at our “ICD-10” webinar this week, you missed out on a wonderful learning opportunity from Lisette Wright, independent consultant with Behavioral Health Solutions, P.A.

Lisette Wright, M.A.

If your behavioral health/human services organization is a HIPAA entity (yes, it is), you need actionable information to help you prepare for the transition from ICD-9 to ICD-10. The transition to ICD-10 is mandatory effective October 1, 2014. Will you be ready?

Lisette was able to explain why the change is such a big adjustment for those who diagnose:

• ICD-10 requires far more specificity and details in the documentation to support the diagnosis.
• There are no exact crosswalks between code sets
• Transitioning to the ICD-10 code set will require clinical judgement, thought, and a little more time.
• Some payers may still require DSM codes for prior authorizations

Lisette also included this very helpful diagram and explanation of the ICD-10 “F code” format:

• Chapter F = Chapter 5 in ICD-10
• Category = condition or drug of choice
• Last 4 digits represent the clinical state: etiology, severity, manifestation and placeholders

Note: Some T codes, Y codes, and R codes are applicable to SU diagnosing (T50.905= Adverse effect of unspecified drugs, medicaments and biological substances).

Also very helpful were Lisette’s tips for preparing for the Clinical Documentation Implications:

• Prepare staff that changes are coming and how they need to document
• Medical Necessity and Documentation Improvements
• Higher level of specificity and new policies, procedures and expectations
• Will require training of staff in new workflows and processes; use of diagnostic language and criteria in record

Listette also provides consulting services to providers to help them transition to ICD-10. If you would like to contact Lisette, you can reach her though her website and via email.

2014 Budget Passed by House Includes BIG BUMP for Mental Health

The National Council for Behavioral Health just announced that the U.S. House of Representatives passed a bill –  also expected to pass in the Senate – that provides large increases over the 2013 allocations for mental health funding including $15 million for Mental Health First Aid training. The budget agreement H.R.3547 largely spares healthcare programs from any major reductions.

Important for our CareLogic users is that SAMHSA will receive a $144 million increase over fiscal year 2013 levels, for a total budget of $3.6 billion. Some of the highlights of the SAMSHA grant increases that we think our users will find particularly exciting are:

• $50 million for the Primary-Behavioral Health Care Integration (PBHCI) program, which supports the co-location of services in behavioral health and primary care settings
• $15 million for a new grant program to provide Mental Health First Aid training to police officers, first responders, judges, social workers and the staff of college and university counseling centers, among others
• $484 million for the Mental Health Block Grant, 5 percent of which will be used to support evidence-based programs that address the needs of individuals with early serious mental illness, including psychotic disorders
• $46 million for the National Child Traumatic Stress Initiative

This is a step in the right direction toward parity.

Click HERE to read the full article.