Transcript:

Adam: I’m Adam Siladi with the eClinicalWorks podcast, and if you’re watching this, you’re probably the type of person who likes to keep up-to-date with all sorts of relevant information, but did you know that eClinicalWorks offers CME/CE credits for attending live webinars at my.eclinicalworks.com? It’s true! And you can earn credits for physicians, billers and office staff, on over 30 topics on our site. Just looks for the CME/CE icon on my.eclinicalworks.com and sign up. eClinicalWorks has been around for nearly two decades at this point, and from its early beginnings it has grown and evolved ever since. It’s also nice to know that our users take that journey with us, and to speak with me about that today is Josie VanScholten, from River Road Medical Group in Eugene, Oregon. Josie, thanks so much for being here today.

Josie: Thank you, my pleasure.

Adam: So, before we get started, why don’t you tell us a little bit about River Road and who you guys are?

Josie: Yes. River Road has actually been here since 1961, we’re one of the oldest family practices here in Eugene. We’ve been using eClinicalWorks for about 10 years, and, like I said, we’re a family practice so we see babies on up, and currently we have five providers and 19 staff, and I’m the administrator.

Adam: So, we led off speaking about how your experience grows the longer you use the product – you said you’ve been using the product for quite a few years, from 2007, I think, is when you went live. So what do you think is the difference between a user and a superuser?

Josie: For me, I would define those terms as a user is someone who simply uses the computer to get a job done – I know one piece of it, this is my job, this is my task and I don’t need to know any more or any less, which is fine. I would say a superuser is someone who is looking at it more globally, that they want to know the ins and out, they want to be looking at how can I use this tool to make what I do more efficient, learn any tips or tricks to make it quicker and easier – and I guess by that definition I would have to say I’m a superuser because that what I’ve been doing a lot in the last 10 years.

Adam: Well, I was going to say that’s why we’re here talking to you, that’s probably a good indication. So, let’s talk about, as a superuser, what are you doing really well, right now, and what are you working on?

Josie: I think River Road Family Medical Group has gotten very good at using eClinicalWorks dashboards and products to achieve quality bonus funds. Our Medicaid program here in our county, CCO, has had a bonus pool for the last five years, and we also participate in the Medicare PQRS, as well as some commercial Medicare advantage plans, which started offering quality bonus pools, as well for meeting measures and closing care gaps. So things like the HEDIS dashboard, the PQRS dashboard – all those are very valuable to us. One piece is drilling down to the patient and figuring out who those patients are and contacting them and other pieces, how to figure out how the computer works and making sure that you document appropriately, in a structured manner, that you get credit for the work that you’re doing. Some things I think we’re working on, I would say, unfortunately with commercial plans, I feel like reimbursement is still kind of lagging – I feel like we’re small and nimble and have made a lot of changes, but I feel like insurance companies are still kind of negotiating based off who can provide them with the biggest panel, rather than on quality, but I’m hoping that will continue to evolve, as well. Another thing that would be helpful to see over time is, unfortunately there’s a lot of different standards that one program may use one screening tool, another may use another, and so that’s a challenge we’re working on, as well.

Adam: So there’s almost no standard to the standards, everyone has their own, and you mentioned the HEDIS dashboard and I know we support over 250 different quality measures and a lot of them are the shades of the same thing at the same time, and it can be confusing and difficult and I think you mentioned when we were speaking before that you were meeting the type one kind of measure, but not meeting another type of measure because of that shade of difference.

Josie: Right, that was the BMI and we weren’t meeting it, and I thought how could that be possible? Because I know we take a height and weight on every single patient that comes in, and yet, PQRS had a BMI range set one way, and our Medicaid had set a different way, so it was helpful to have my eClinicalWorks project manager that I could call and say, ‘What’s going on with this?’ She was able to look in our system, find that difference and reset it for us.

Adam: Right and of course the HEDIS dashboards and the other dashboards that you mentioned helped you to identify that problem in the first place, and, like you said in the beginning, because otherwise you’d be waiting on that data to come from the payer, all the way at the end of the game and it’d be too late. So, let’s talk about your scores. Where do you rank, in terms of your peers, in terms of those quality scores, now that you have all that information?

Josie: For our Medicaid program, in 2014, we were the only family practice clinic in our CCO to meet all 12 measures – we’re pretty proud of that. As far as the Medicare ones, I think usually they’re impressed with the number of care gaps that we’ve closed. I think for regions, 75% of them, I know United Healthcare, I think we met the benchmark to get 60% to get our patients in for Medicare Wellness Visit in the first six months.

Adam: What changes have you seen, as a result of those high quality scores?

Josie: At first, I think there is just unfortunately a part of it that’s just checking boxes to begin with, until you get all the data in there, it’s not really useful until it’s in a structured format and you can start looking at the reports. Now, I feel like we’ve gone through this evolution of figuring out how to put the data in a usable format and meet these measures. Now, I feel like we’re just now getting to the exciting part where we can really look at how we can really improve patient outcomes and meet individual patient needs.

Adam: Would you say that laying that groundwork was really pivotal to getting to where you are now?

Josie: Absolutely, and I would encourage all clinics – it’s okay to take it slow, to take off bits and pieces. I just look for opportunities. Let’s start with flu shots, let’s start with something simple. It doesn’t have to be all or nothing.

Adam: So a lot of emphasis is being placed on the patient and the patient’s role in the care team, and trying to put more responsibility on them and involve them in the decision making. Let’s talk about your experiences with that. Now, while a lot of offices might be a little uncertain about how that might work, your office seems to have jumped right in.

Josie: Again, we had an opportunity to participate in a grant through the Rural Organ Health Initiative on shared decision making and I signed up because I like any opportunity to collaborate with other clinics so that I’m not the only person reinventing the wheel that we’re all kind of working together towards the same common goals, and through that process I can’t say that I knew a lot about shared decision making when I started it but once I was in it I started thinking about our colonoscopy rates because that had been a measure that I felt like we really weren’t meeting, I felt like my nursing staff was pulling their hair out. They would approach a patient and they would get a really negative response that the patient had no intention of doing that, or the alternative, they would say “oh, sure, sure we’re gonna do that.” And we’d create the order and we’d do the referral and the patient would never follow through. So you create all the work for no improvement, no outcome, and I just felt like I couldn’t see how we were ever going to get there and through that process, I kind of realized that we were always approaching a patient with, ‘you need to get your colonoscopy, you need to get your colonoscopy.’ Telling people what to do isn’t always the most effective strategy to get by in, so using our health wise education piece that’s within eClinicalWorks, we were able to find an information sheet, and we start approaching patients by saying, ‘colon cancer kills, it is preventable, let’s talk about screening options and which one is right for you, and here’s some information.’ I think it made a huge difference – in 2014, our compliance rate was 27% and by the end of 2015 it was up to 35. I think it’s pretty powerful that if you let it be the person’s choice, their idea, you get more buy-in.

Adam: True, and you’re starting out with that choice, opposed to being forced into compliance – which, you’re right, it sounds like it can get on people’s bad side sometimes. So, speaking of communication, so that obviously involves a lot of changing the way that you talk to the patient. Do you utilize any of the eClinicalWorks tools to enhance your patient communication?

Josie: Absolutely, we were kind of early adopters. Oregon has their own medical home program and to do that you needed to sign patients up for the patient portal. It’s not easy, it takes work, we had to – we approached patients when they would check in and offer it, we would get high school or college students to volunteer and offer to show patients how to use it while they’re sitting in the waiting room, or answer questions. Now, we have about 65% of our patients signed up and once you have that critical mass, it becomes a really powerful tool for engaging patients and helping educate them. There’s so much in primary care that goes on behind the scenes that I think patients aren’t aware – they get anxious that, ‘They’re not doing anything!’ When, really, we’re waiting on the insurance companies to get that prior authorization or whatnot. So, we started, after we send a referral, we send a message to the patient, ‘your referral has been sent to your insurance company, please allow this many weeks for it to be processed, and I feel like that really cuts down on the phone calls of people coming in and being worried, not knowing how it works. I think it builds trust that they know that we are still working on their behalf.

Adam: So, we’ve covered a lot of stuff there, I just want to recap for the people who are listening or watching, that you, number one, signed up 65% or more of your patients on the patient portal.

Josie: It wasn’t overnight, but it happens.

Adam: It took a process, but you’re there. And that you realized that there was an issue that they started to have some misconceptions with what you were doing, especially in regards to referral process, but that you used the patient portal messaging, or I don’t know if you use eClinicalMessager, to send out phone calls and text reminders, to tell them what was going on in that process to make them more informed and more involved and you’ve found that, that was beneficial.

Josie: Yes, and I think my staff really likes the messenger piece because it’s a lot quicker and easier than making a phone call and trying to track someone down.

Adam: ‘Hi how are you..?’ Right? And then we get to the thing, so it cuts that out and makes it much more efficient, without being less personal.

Josie: Or you don’t have to leave a message, or wait for them to call back, that it’s done an off your list at that point.

Adam: Great, great to hear. You mentioned another really interesting thing there, where you said you brought in some students to help you with the patient education. Now talk to us a little bit more about what you did there.

Josie: Well, being in a college town, we’re blessed with students who are looking for volunteer hours, so we’ve asked some of them to sit in the waiting room and approach patients to see if they needed help or if they had questions or if they could show them how it works. I think, sometimes, people need to see what all I can do and what the benefits are before they’re willing to try it. So, yeah it worked out well.

Adam: I think that’s just a really interesting concept because we’re always looking to keep costs low, and I think this was a great way to do it and it’s kind of thinking physician extenders doesn’t just have a title at the end of it, the PA or RN or whatever it is, it could also maybe be people in the community who can work together to help each other. So, you’re using the patient portal a lot, you’re using messenger a lot, if you weren’t using these tools, what do you think would be different? Is there any kind of a risk involved there?

Josie: Yes, as a HIPAA compliance officer I get to maintain our disclosure log that anytime there’s an inadvertent disclosure we have to keep track of it and make sure the patient is aware of it and our top disclosure is that when we mail out lab results. It seems like once or twice a year, either somebody doesn’t realize that it’s a two page result or they accidentally grab the page that’s behind it or the lab results get mailed to the wrong patient. So whenever I call them, and tell them that this has happened, I always make a pitch for the portal that you could receive these electronically and then you wouldn’t have to worry about this.

Adam: Right and I’ve seen the signs up around your office, too, saying that we can send you text messages, that you can get this on the portal, so I’m sure that helps get the word out and put that in their mind that it’s there and that’s helpful. Now, portal capabilities are evolving all the time and one of the newest capabilities, and I think one of the most anxiety-inducing aspects of it now, is the ability to put your schedule, the physician’s schedule online, so that patients can book it. In our system, that’s healow, but you, again, are starting to use that, as well, and not shying away from it. Tell us about that.

Josie: Okay, well, again, as a small clinic, it can be difficult to differentiate yourself against larger multi-specialty groups – we don’t have the marketing budget that everyone else has, and I was sitting at a lunch group of other moms that we get together monthly for birthdays and socialization and they were all talking about this hairdresser that they loved that did appointments online and because they hated the back and forth, and it was so difficult to find a time to begin with, they like to be able to just pick the one for them. I was really thinking that was a great way for us to differentiate ourselves. We’re really blessed with a lot of long-time patients because we’ve been here for so long, but you always need to keep new patients and new families coming in. So, we had a new PA starting and because she didn’t know any better, I just asked her to sign up and she said okay. So we started with her and then when her whole schedule didn’t fall apart or her whole day didn’t get messed up, Dr. Buchannan, our owner, she agreed to try. She actually found that she has a 75-year-old patient that schedules all her appointments online.

Adam: so it’s not just the young kids, it’s the elderly patients, as well, they’re not afraid of it. That’s good to know, and I think that’s a really creative way to use that – you’ve got the new person coming on, they don’t have a schedule to disrupt, let’s build it with healow. That worked out really well for you.

Josie: Absolutely, and again, it doesn’t have to be all or one. We still have two providers that don’t use it and that’s okay. It can be incremental, your growth and your journey.

Adam: Exactly, as you said, it sounds like change is a matter of taking smaller steps. I think a lot of times we try to encourage people to do a lot at once because we’re very excited about it, but it sounds like it can be more successful if you do manageable bits at a time. So, the healow thing, and the appointment scheduling, how do patients even know that that’s available for them?

Josie: We are trying to, for existing patients who are coming in, for the providers who are participating, let them know ‘hey did you know you can schedule appointments online?’ Most of them are like ‘oh no, wow, that’s great.’ Just go to our website. We also have started experimenting with google ads, and it’s pretty amazing to me that five clicks, somebody’s searching with a symptom, our ad pops up, you click on that, it goes to our website, there’s the healow widget, they click on that, click your provider, pick your appointment time and you’re done.

Adam: And that seems like very vast processes, especially for an audience that’s counting clicks every day, five clicks to a new appointment to your patient, for something that they were looking up as probably a symptom or something like that.

Josie: Right, that’s how we set our ads.

Adam: That’s a great usage of that. And you also mentioned another important piece, that the widget is on your website, so it integrates directly there and book your appointment, accordingly. With all of these projects that you’ve put into place, and we’ve only mentioned some of them, how has eClinicalWorks helped to support those efforts along the way?

Josie: I think they’ve been very helpful, usually you’re assigned a project manager for any new products and that person is just a resource for you to call and ask any questions. In some cases, they’ll call you and check in and see how things are going and make sure you’re following up with stuff, but in general, I found them to be very useful especially in the quality programs, I feel like I wear many hats, as a small clinic administrator, HR, finance, it’s all me, so I don’t know that I would have the time to do all the research on those projects, on those quality programs, and to be able to call one person and ask the questions of ‘wait does this count? Does this not count?’ and it has been invaluable.

Adam: And what about your strategic account manager?

Julie: Yeah, we’re tight. It’s really great, you know, if I’m frustrated with something kind of stalling I don’t understand if something’s working or maybe if I have a question – we went to the conference and we learned about attribution lists because one of the ways we’re struggling to meet our quality programs, are the patients that don’t come in, they’ve picked us as a primary care and we have no idea, they’re not in our system, we don’t know who they are, so they don’t show up on our dashboard. So, he was helping me find who would be the proper person to talk to, to start working with insurance groups to get lists of our patients, as these attribution lists, that we can import them into our system and start using them on our dashboards.

Adam: So, because this is something that other people are probably thinking about, as well, and stressing about. Your plan is to, you’ve found people at the insurance companies, that you’re going to contact proactively, and say who’s attributed to us – maybe all the insurances that you contact with, and get them to send you a list, and then you can maybe use something to reach out to those patients?

Josie: Absolutely, yeah, contact them to come in for their Medicare wellness visit, even just to meet them and make sure that they’re meeting all their quality measures and see how their overall health is and develop a starting point.

Adam: so, let’s ask this question as we try to wrap up because I think there’s been a lot of good stuff here, so far, but, as a superuser, what do you want to tell other people? What’s one or two things that you think that they might benefit from?

Josie: So one of the tools that we’ve found to be very helpful is the Medicare wellness visit in meeting the quality programs because it is such a comprehensive visit in terms of documentation and we have found that providers don’t love those visits because it’s a lot of documentation. So we have actually started using medical assistants and billing is in it too, that have a little more time that frees up providers to see actual chronic care issues, immediate issues. The medical assistant can get it there and get all that information to be ready for the provider and to kind of give us a starting point for where we’re going to start helping them achieve their health goals.

Adam: So get those Medicare wellness visits done, us your PAs, and set up some templates and make it easy on yourselves.

Josie: Yes, the templates definitely make it easier and are good reminders as you’re trying to get through and get all those boxes checked.

Adam: Well, Josie, I think this has been a fantastically informative podcast, thank you so much for all of your time and your insight. For the eClinicalWorks podcast, I’m Adam Siladi, and you can check out our other episodes on YouTube, iTunes or my.eclinicalworks.com. Thanks for watching.