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Building New Systems for Stroke Care

ACPH logoHow Should Hospitals Respond to Updated AHA Guidelines on Endovascular Therapy For Stroke?

New findings about stroke therapy prompted the American Heart Association to update its clinical guidelines late last year. The AHA/ASA called for hospitals to develop regional networks to ensure that qualifying stroke patients have rapid access to endovascular therapy following severe stroke. Some larger hospitals already have such systems in place but putting the necessary infrastructure in place will be a challenge for many smaller community hospitals.

I reported on the development for ACP Hospitalist magazine. Following is an excerpt from that article, in which I interviewed leading stroke care experts about how hospitals should respond to the new guidelines. They provide some important insight into the logistical and cost implications of delivering this type of care.

You can read the full article on the ACP Hospitalst website, but here are some of key points:

  • The updated guidelines are based on 5 studies—MR CLEAN, ESCAPE, EXTEND-IA, SWIFT PRIME, and REVASCAT. While earlier trials had failed to report any significant benefit of ET over standard care with intravenous tPA, these studies achieved betteStroke image MRIr results by using advanced imaging to select patients and retrievable stents to remove clots.
  • The studies emphasize the importance of using advanced imaging techniques, including CT angiography (CTA) and magnetic resonance angiography (MRA), in the initial assessment of stroke patients. The tests provide a more detailed view of blood vessels than non-contrast CT, allowing physicians to assess whether a patient has enough salvageable brain tissue to benefit from reperfusion.
  • Timing is tricky: According to David Likosky, MD, director of the stroke and neurohospitalist programs at EvergreenHealth Medical Center in Kirkland, Wash.: “You have to be careful not to divert patients too far away, considering that the bulk of patients are not candidates for endovascular therapy and would benefit more from faster access to IV tPA. At the same time, picking the right patients for ET and transporting them as quickly as possible has huge potential benefit.”
  • Strategies being developed at stroke centers include: Telemedicine units that link ambulances with ED physicians via television monitors (see this recent study in JAMA Neurology); mobile stroke units  with advanced imaging and a specialist on board (see my previous article that discusses this model); Telestroke networks where specialists at major stroke centers assist ED physicians at a network of smaller hospitals in evaluating stroke patients via telemedicine connections.
  • Continue to prioritize tPA: “All patients with ischemic stroke should get tPA while you are making plans about whether they also need embolectomy,” says S. Andrew Josephson, MD, medical director of inpatient neurology and head of the neurohospitalist program at the University of California San Francisco. “The best way to maximize resources and minimize transfers is for all hospitals to also perform rapid vessel imaging to identify patients who might be eligible for endovascular therapy.”
  • The new emphasis on endovascular care is likely to increase demand for hospitalists at both smaller and larger centers.

How to Select a Medical Practice Management System

Prior to implementing a practice management system that automated its billing operations, the staff at Tri-County Eye Physicians and Surgeons in Southampton, Pa., often waited weeks before learning that a claim had been denied due to mismatched diagnosis and procedure codes. Since going electronic, the practice has not only eliminated that wait but prevented errors from occurring in the first place.

Although costly, practice management systems are becoming essential for efficiency, experts say. Physicians can cut costs and boost revenue by automating everyday tasks like claim submissions and insurance authorizations. Read more about how to select the best system and take advantage of new features in this article I wrote for Physicians Practice.

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Revenue Cycle Management: Preventing Claim Denials

Preventing denials requires careful documentation but physicians don’t always make the connection between poor documentation and declining revenue. As a result, some offices get stuck in a downward spiral that’s difficult to reverse without a coordinated effort between the front and back office.

Revenue cycle management experts I spoke with had some great tips for reversing that negative trend. Here are 5 worth noting:

Communicate. Physicians, nurse practitioners, and physician assistants should receive frequent, direct feedback about the quality of their documentation. Whether your billing staff is medical revenue cycleon-site or you work with a third-party, you need to know how often and why your claims are denied. Consider having regular staff meetings or online discussions focused on billing and coding.

Test for coding competency. Perform a baseline assessment of providers’ coding skills and repeat it twice a year to make sure everyone is up to speed.

Invest in training. Both newly hired and established providers should undergo regular training and refresher courses on coding and documentation. Remember: poor documentation + inaccurate coding = denied claim (and lost revenue).

Show them the money. Complying with coding audits and attending educational seminars should be tied to financial compensation and/or bonuses.

Use technology. “Scrubber” tools embedded in your practice management system search for coding errors and generate reports on recurrent problems–consult them regularly to avoid repeating common errors.

 

Please see the longer version of this column that I wrote for Physicians Practice.

 

 

 

 

 

 

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