Improving Operational Workflow and Facilitating Accreditation

Medical and diagnostic labs are feeling the pressure to become accredited as more insurers/payers adopt reimbursement directives. In 2007, UnitedHealth Group announced that all freestanding imaging facilities and physician offices performing advanced medical imaging procedures had to apply for accreditation by March 1, 2008. In a press release from January 2008, UnitedHealth Group extended this requirement to the third quarter of 2008, but this change makes the requirement no less real and pending.

On the UnitedHealthcare imaging accreditation overview Web page, the company states that, “Beginning in the third quarter of 2008, all freestanding facilities and physician offices performing outpatient imaging studies that bill on a 1500 Health Insurance Claim Form (HICF) or its electronic equivalent will be required to complete and submit an application for accreditation as a condition for reimbursement.”

The imaging modalities they reference include CT, CTA, MRI, MRA, PET, nuclear medicine/cardiology and echocardiography. UnitedHealthcare recognizes the American College of Radiology (ACR) and the Intersocietal Accreditation Commission (IAC) standards and has even enlisted their expertise in facilitating accreditation. Regardless, even with support, the company recommends that facilities apply for accreditation as soon as possible, to meet third quarter deadlines.

Other payers are announcing similar requirements across other modalities as well. The bottom line is payers want patients to utilize labs that have met a standard level of operating and safety procedures. In the long run, this is beneficial for patients and payers.

For patients, accredited laboratories are a sign that these facilities have been audited by an accrediting institution, such as the IAC and have formal documentation in place that details operating and safety procedures. Examples of documentation required may include proof of HIPAA and patient confidentiality processes, quality assurance protocols, laboratory-specific procedure protocols, patient identification, imaging, processing and display protocols and others clinical and operating procedure reports.

In addition, there is evidence that accreditation may provide higher quality service for patients and support more cost-effective operations. In a statement to the US House of Representatives, House Ways and Means Subcommittee on Health, in 2007, the American College of Radiology stated that, “private insurers requiring accreditation for facilities providing advanced diagnostic imaging have witnessed an increase in quality of care and patient safety, as well as a reduction in repeat tests that have led to cost savings for their programs.” There is no question that it is important that consumers receive services from facilities whose physicians, technologists and equipment are in compliance with established accreditation performance standards.

For laboratories, especially small- to medium-sized organizations, the process to receive and maintain accreditation is not particularly challenging from a medical intelligence standpoint. What is challenging, is the process to gather and organize the information required for accreditation paperwork submission. Aside from operational process documents and case studies, accreditation often requires documentation of employees, reports on numbers of scans completed, diagnostic notes and reports from clinicians and physicians, correlation comparisons and other statistical patient reports.

When these documents are maintained in paper form, or in multiple electronic repositories, the process of gathering and organizing them for accreditation can be a time-consuming, near impossible task.

Smaller organizations have simply made the determination that becoming accredited overwhelms their available manpower and technology resources. Unfortunately, these organizations won’t meet the requirements for Medicare, Medicaid and private payers that require accreditation for reimbursement and will be limited in the insurance they can accept.

This practice decreases the available resources for patients with certain insurance, but also helps direct patients toward accredited labs that have taken the time to document their operational and safety procedures, and may, as a result, have higher customer care standards, patient satisfaction and efficient cost-saving operational models.

It’s unfortunate when a lab decides not to become accredited, simply because the paperwork was seen as too time-consuming or complex. But, as accreditation is designed to do, it also helps patients differentiate between providers – some are accredited and some are not.

The good news for laboratories that are interested in accreditation but have been hesitant to start the application process, is that there are solutions on the market today that decrease the need to individually correlate documents needed for accreditation.

For example, workflow management software can house easily-retrievable data, including some documents needed for accreditation. One solution is Kardia Health Systems’ EIMS (Echocardiography Information Management System), a comprehensive echo lab workflow solution, developed by specialists from Mayo Clinic. EIMS offers all the functions of a workflow management solution, but has also been designed to facilitate ICAEL accreditation though ICAEL-ready reporting – an important designation for any lab completing echo studies.

For echo labs, EIMS supports data acquisition, diagnosis and interpretation, clinical reporting, patient scheduling and coded billing within one application. Documentation related to patient information and studies, notes on diagnosis, reports and approvals are all stored within EIMS, and are easily accessible via built-in, structured reports, designed to facilitate ICAEL accreditation.

Some of the documents required for accreditation may include lab management reports on procedures, such as how many studies were produced in a certain timeframe, or studies completed by individual sonographers, or reports of studies covering various modalities. This type of data, and other data needed for accreditation, such as lists of employees and equipment, is available from within the EIMS workflow management solution.

Unlike other lab management solutions EIMS is a web-based solution. EIMS facilitates ready access to patient records and enables physicians to review echo measurements and generate reports via a browser, from any location.

Being Web-based is especially useful for cardiologists working for multiple practices or from remote locations. The web-based EIMS application provides one central location for patient data with permission-based access from a secure common data server set.

Having a web-based workflow management solution also means that the accreditation manager can access documents stored in the system from any location. This is particularly helpful when managing accreditation for multiple locations. But it can also allow the accreditation manager to pull documents over the weekend, or off-hours from home, rather than go into the office.

For complex accreditation requirements, Kardia also offers accreditation consultation. We realize that you can’t simply click and print every report you need for accreditation – the data required is complex. So we have consultants on board that can walk you through the requirements and how you can leverage EIMS for accreditation.

Having a web-based, central location for data not only improves overall workflow but can greatly reduce the time it takes to correlate documents needed for accreditation and for accreditation renewal.

About Wayne Schellhammer
Mr. Wayne Schellhammer is responsible for managing the operational sales function within Kardia Health Systems and has extensive background in the healthcare industry. His track record of successful planning and growth management stems from his time as president and CEO at ACS, where he was instrumental in growing company revenue and increasing the provider network. Schellhammer began his professional career setting up cardiology practices across the country and continues to apply his knowledge of large health plan administration and healthcare consulting to the industry.

Creating a virtual practice
The idea of having one central location from which to manage medical practice operations is not new. Most organizations have some level of centralized server with document storage. But, medical laboratories are unique because they often have disparate systems for different functions within the practice – PCs for patient scheduling, branded hardware for echo measurements and reports, hard copies of reports to share with other practitioners. This type information impacts the operational nature of the practice, and requires a system that is much more than document storage.

Transitioning the access and management of operational functionalities to a web-based system like EIMS can not only centralize documents for one location, but can act as a “virtual practice” for labs with multiple locations. It centralizes operational processes and allows physicians to manage multiple practices seamlessly from any location. Processes and documents can be accessed from any computer with a web browser, so physicians that work in multiple locations have all of the required information at their fingertips – practice management information, patient records and clinical data.