Charity Boulton is a “technology-lover.” As the Practice Administrator for the North Fulton Internal Medicine Group for over 13 years, Boulton relies on all that today’s modern electronics have to offer. Whether it is e-mail or certain computer programs, Boulton relies on these tools to make her office run smoothly and as the incoming president of the Atlanta Medical Group Management Association (AMGMA). M.D. News spoke with Boulton about her role as a Practice Administrator and the incoming president of the Medical Group.
What are some of the challenges you face as a practice manager?
As the practice manager of a 5-provider internal medicine practice, I face the same challenges as many of my colleagues both in small and large practices alike. While some are specific to primary care many span all specialties and range from physician compensation and contracting to human resources and emerging legislation. You know the saying “Jack of all trades, master of…” Well, I wouldn’t say master of none. I would say master of some and for everything else there’s a resource. That’s where being involved in my local, state and national associations comes into play. Having the ability to network with managers in my locale and/or in my specialty gives me the resources to effectively wear the many hats that are required of a practice manager.
How does being a part of Atlanta MGMA help you address these challenges?
Atlanta MGMA brings numerous opportunities to its members. Whether you call yourself an office manager, a practice manager, a practice administrator, or a CEO Atlanta MGMA has something to offer. At the 5 educational sessions held each year, the association offers cutting edge topics presented by well-informed, professional speakers, many of whom are national MGMA speakers. In addition to the dissemination of useful information, I am able to network with my colleagues which many times means being able to pool our resources to affect a needed change either in my specific practice or across the industry.
What is your practice doing about Pay for Performance (P4P) and Physician Quality Reporting Initiative (PQRI)?
We have participated in several pay for performance programs, some more successfully than others. I have found that the P4P programs that are interactive and that do not benchmark solely from claims data to be the most beneficial for reaching the practice’s and the insurance company’s mutual goals. There are many reasons why claims data is not the best way to benchmark actual procedures performed. Chiefly, it is difficult for any plan to properly capture everything due to claims errors or when a patient utilizes a facility outside of the plan. It further complicates things to reward or penalize based on a previous year’s data that has known flaws.
An interactive P4P program allows you to look at the patient panel ahead of time to see if you meet the guidelines and have the data for the exceptions. After all, isn’t the goal to ensure the proper testing and treatment is provided for the patients? Blue Cross Blue Shield rolled out their first interactive program this spring. The exchange of real time information between BCBS and our office, which can only be credited to improved technological resources, made for a very successful program. While having an EMR (electronic medical record) system made tracking the data and auditing the results much easier, participation is still a very time consuming process.
As far as CMS’ version, PQRI, we are not quite ready to jump on board in its inaugural year. As the Legislative Liaison for the national Primary Care Assembly, I try to stay abreast of emerging legislation. Currently, there is pending legislation regarding the funding of the program for 2008 that may make participation voluntary without financial incentive. The pending bill, HR 3162, rededicates the 2008 PQRI budget to thwart the looming 9.9% physician fee schedule reduction (a.k.a. Sustainable Growth Rate reduction) in 2008 and the 5% 2009 SGR reduction in 2009. While I think PQRI could be beneficial once all of the kinks are worked out; I think the reallocation of funds would be better spent in direct reimbursement to physicians for their work instead of a convoluted program that could cost physicians as much to facilitate, as they would ever gain in increased reimbursements.
How is your practice coping with the new generation of technology driven patients?
As patients are getting used to the security of online banking and other online transactions they are warming up to and asking for online access to their doctors. Prior to implementing an EMR this past fall, we didn’t have a lot of innovations to offer to our “techie” patients. In fact, other than one-way email communication from our patients to a group email box we didn’t have much in place at all. However, our EMR system offers a patient portal in which patients can view their appointments, review approved lab tests, pay their bills online, and communicate with their provider. While we have purchased and installed the necessary enhancements and begun the set-up process for this feature, we haven’t fully implemented it. It is my goal to roll this functionality out to our patients this fall.
What is your practice doing about the new legislation requiring Medicaid prescriptions to be written on tamper resistant prescriptions?
This has been a hot topic recently on the national MGMA email forums as well as the Georgia MGMA email forum. Many questions have been raised regarding the definition of “tamper-resistant.” We looked for guidance from the Washington MGMA Office, which forwarded CMS’s clarification on the provision. They stated that tamper-resistant prescription pads must meet one of the following characteristics for Oct.1, 2007:
- Contain one or more industry-recognized features designed to prevent unauthorized copying of a completed or blank prescription form;
- Use one or more industry-recognized features designed to prevent the erasure or modification of information written on the prescription by the prescriber; or
- Include one or more industry-recognized features designed to prevent the use of counterfeit prescription forms.
By Oct. 1, 2008, prescription pads must meet all of the above characteristics to be considered tamper-resistant. Under the guidance, CMS has given flexibility to state Medicaid directors to determine exactly how each state will meet the new requirement. Note that states that currently have laws and regulations governing tamper-resistant prescription pads will be considered in compliance with the CMS guidance (MGMA Washington Connexion, August 2007).
Our office faxes and sends the majority of our prescriptions electronically. For the prescriptions that have to be written out we fall back to our standard prescription pad, which already incorporates an industry recognized standard. Much like your checks would, the word void appears when the prescription is copied. I think many offices are already in compliance just by using what they have always used.
To learn more about the AMGMA, visit www. atlantamgma.com.