Hielix Health IT Blog

Know Your Terminology: M.D. vs. D.O.

Understanding the terminology you will encounter working in the healthcare industry is critical; and the first set of acronyms you face will be on the front door of any medical practice you visit, “Medical Offices of John Smith, M.D. and Jane Doe, D.O.”

What is the difference between a Doctor of Medicine (M.D.) and a Doctor of Osteopathic Medicine (D.O.)? In the past 20 years the lines between the two schools of medicine have become increasing blurred and up until about 15 years ago not all major healthcare organizations credentialed D.O.s into their system. For young people entering medical school the trend indicated those who were not accepted into a MD program turned to and were accepted into the D.O. program. Statistics supported this fact with the difference in GPA and MCAT scores that were recorded between the two entities. In 2010 the average MCAT and GPA for students entering US-based M.D. programs were 31.1 and 3.67 respectively and 26.49 and 3.47 for the D.O. curriculum [Source]. However, the scores do not tell the whole story. It is widely known that osteopathic programs are more likely to accept non-traditional students - who are older, coming into medicine as a second career, and are non-science majors. The D.O. medical schools believe the older applicants are more emotionally sound and culturally competent, thus making them a better candidate to becoming a physician [Source].

M.D.s study allopathic medicine – the practice of conventional medicine that uses pharmacologically active agents or physician interventions (surgery) to treat or suppress symptoms or pathophysiologic processes of disease or conditions [Source].

D.O.s study osteopathic theories which encompass all the benefits of conventional medicine including prescription drugs, surgery, and the use of technology to diagnose disease and evaluate injury; combined with the added benefit of hands-on diagnosis and treatment through a system of therapy known as osteopathic manipulative medicine. D.O. students take approximately 200 additional hours of med school to study manipulation therapy [Source]. D.O.s view the patient as a “total person” and treat the whole body rather than treat a specific illness or symptom.

There are several educational similarities and requirements between the two licenses.

• Both D.O.s and M.D.s typically have a four-year undergraduate degree prior to medical training.
• Both D.O.s and M.D.s have spent four-years in medical education. Both take the MCAT and are subject to a rigorous application process.
• D.O.s, like M.D.s, choose to practice in a specialty area of medicine and complete a residency program ranging from 3-7 years. Some D.O.s complete the same residency programs as their M.D. counterparts.
• M.D. students take the USMLE exam and D.O. students take the COMLEX exam. Both must pass a state licensing examination to practice medicine.

Understanding the difference between an M.D. and D.O. practitioner is not as significant as appreciating the time and dedication it took these individuals to achieve the status of “Doctor.” Both M.D.s and D.O.s are recognized and licensed in all 50 states. There are 20 schools of Osteopathic medicine in the U.S., 126 accredited U.S. M.D.-granting medical schools, and 16 accredited Canadian M.D. granting schools.

For further reading visit American Association of Colleges of Osteopathic Medicine (AACOM) and the American Association of Medical Colleges (AAMC).

Look for future installments of our primer in medical terminology for VARs! Once we complete the series we will offer a quick reference guide in PDF for for those we are interested, be sure to sign up to receive updates in the right hand column!

Know Your Terminology: Health IT 101

Understanding the basic terminology is a critical piece of the puzzle towards establishing creditability with a physician and/or practice manager. The medical community is experiencing industry wide changes at a rapid pace and the vendors who have done the research and understand those changes will gain a competitive advantage over their less informed competitors.

Pursuing the development of a robust healthcare vertical can provide fulfillment and opportunity on many levels, but being successful requires knowledge of certain related terms. To perform successfully, healthcare vendors/professionals should have an understanding of key medical-related terminology dealing with the physician, their office and overall operations of the practice. Understanding the various front line terminologies can help with your credibility in the eyes of the practice and ultimately, the sale.

First we'll offer a brief overview for the uninitiated and the delve into some specific terminology. Most vendors typically are working within physician practices to assess their IT hardware infrastructure and are involved in the selection and purchase of an Electronic Health Record (EHR). Incentive money is available from The Centers for Medicare and Medicaid (CMS) as a result of the Health Information Technology for Economic and Clinical Health Act (HITECH) and Meaningful Use (MU).

The Medicare and Medicaid EHR Incentive Programs provide a financial incentive for the "meaningful use" of certified EHR technology to achieve health and efficiency goals. By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives-such as reduction in errors, availability of records and data, reminders and alerts, clinical decision support, and e-prescribing/refill automation. For eligible professionals, there are a total of 25 meaningful use objectives. To qualify for an incentive payment, 20 of these 25 objectives must be met.

• There are 15 required core objectives.
• The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

(Source: CMS.gov)

Eligible professionals (EPs) are eligible for up to $44,000 per provider if participating with Medicare or up to $67,000 if participating with Medicaid. Eligible professionals under the Medicare EHR Incentive Program include:

• Doctor of medicine or osteopathy
• Doctor of dental surgery or dental medicine
• Doctor of podiatry
• Doctor of optometry
• Chiropractor

Eligible professionals under the Medicaid EHR Incentive Program include:

• Physicians (primarily doctors of medicine and doctors of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• Physician assistant who furnishes services in a Federally Qualified Health Center or Rural Health Clinic that is led by a physician assistant.

For additional requirements please reference: CMS.gov

To be classified as an EP the provider must posses a National Provider Identifier (NPI) which is a unique 10-digit ID number issued to healthcare providers in the United States by CMS.

Physicians who choose to participate with MU must select an EHR that has been certified by the Office of the National Coordinator (ONC). ONC is a division of the Office of the Secretary (OS) who has been tasked with implementing and coordinating the exchange of electronic health information nationwide.

For the past 15 years physician practices have been submitting medical claims through their practice management system (PM) or claims are outsourced to a billing and collections agency. Typically the practice is paying 5-7% of collections to that outside agency. Claims are generated from information gathered from the super bill which is created using documentation from the patients' healthcare visit by the clinician. The information from the super bill is then entered into the PM, which generates a claim. Claims are submitted to a third party entity or clearinghouse. Claims are then "scrubbed" which means they are verified for eligibility, demographics, physician NPI number, and diagnosis codes (International Classification of Disease or ICD-9) are matched with the Current Procedural Terminology (CPT) codes.

The current ICD-9 code set is changing effective January 1, 2013 and clinicians will be expected to generate claims using the ICD-10 code set. Because the ICD-10 code set is more specific and detailed oriented, the adoption of a certified EHR prior to tackling a coding change can make this a much smoother process for the practice. Evaluation and management codes (E&M) are a subset of CPT codes that specifically address the level of care given to the patient. For example, an established patient who had 15 minutes of "face" time with the doctor for the follow up care of an infection could bill an E&M code of 99213. This code indicates to the health insurance carrier that the presenting problem was low to moderate in nature. Documentation off the patient visit is critical in the event of an audit. Most clinicians follow a structured set of documentation guidelines called SOAP notes. "The SOAP note (an acronym for subjective, objective, assessment, and plan) is a method of documentation employed by health care providers to write out notes in a patient's chart, along with other common formats, such as the admission note. Documenting patient encounters in the medical record is an integral part of practice workflow starting with patient appointment scheduling, to writing out notes, to medical billing" (Source: Wikipedia).

The Place of Service Code (POS) is a key indicator on a claim that designates whether or not an EP qualifies for the incentive money and also determines the level of reimbursement. The POS is noted on the claim, this informs the health insurance carrier where the services were rendered. For example, 11 - indicates physician's office, 21 - in-patient facility (patient is admitted into the hospital and is staying longer than 23 hours), 22 - outpatient facility, 24 - urgent care facility. If over 80% of the physicians care is administered to patients with a POS 21, the physician does not qualify to participate with MU.

A benefit to having an EHR is Computerized Physician Order Entry (CPOE), an application that enables providers to enter medical orders such as treatment plans, prescriptions, labs and referrals into a computer system. E-prescribing (eRX) is another application that works with the EHR to help reduce medical errors. eRX allows physicians to electronically send an accurate, error free, legible medication order to the patient's pharmacy of choice. Utilizing the eRX feature will help satisfy one of the MU requirements.

Look for future installments of our primer in medical terminology for VARs! Once we complete the series we will offer a quick reference guide in PDF for for those we are interested, be sure to sign up to receive updates in the right hand column!

Hielix Apps Announced!

We have a new site heading your way in the near future! HielixApps.com will be launched with some major enhancements to the EHR Roadmap as well as a brand new app! Here are the details in some quick bullets, read on below if you want even more details.

• Completely new, streamlined look for the EHR Roadmap!
• The EHR Roadmap will be integrated with our brand new app - the Healthy Practice Checkup (HPC).
• The brand new app (HPC) supports the IT reseller channel in their efforts to assess the clinical workflows and operational processes of a physician practice and make recommendations to enhance efficiency, reduce costs and drive additional revenue. These recommendations ultimately lead to long-term value and sustainability for the practice and an enhanced perception of the VAR as a trusted advisor.
• Updates to the EHR Roadmap: We've doubled the amount of 2011 certified products from which the selection engine can choose (there are new solutions out everyday!)
• Updates to the EHR Roadmap: We've updated the decision engine to include more considerations and more detailed functionality.

Below we've laid out some common questions and answers to give you some more detailed information:

What will happen to HielixEHR.com?
As part of the launch of HielixApps.com, the web URL HielixEHR.com will be phased out. However, the EHR Roadmap itself will continue to live under HielixApps.com.

I have private label version of the EHR Roadmap, what will happen to it?
Those VARs with private label versions of the roadmap will continue to use the private label version of the Roadmap during and after the launch of HielixApps.com. However, after launch we will migrate all the private label versions of the Roadmap into the look and feel of HielixApps.com based on your agreement with Hielix. This will also allow you to begin to utilize the HPC application as well.

When will the launch of HielixApps.com take place?
There is no official date in place for launch but currently we anticipate the launch of HielixApps.com taking place in mid to late December. Once an official launch date is announced we will be sure to let you know about it.

Please be sure to bookmark HielixApps.com as you won't want to miss the exciting developments in the future!

How to Stay Informed in the Healthcare Industry

Deadlines are looming, incentive requirements are changing and overall the healthcare industry is in a constant state of flux. So how do HIT resellers and healthcare professionals both clinical and administrative stay on top of the changes and demands that are being introduced into the healthcare arena?

In the world of HIT resellers staying current is critical to the success of the organization. The ability to stay ahead of the curve and anticipate the needs of healthcare clients is certainly a challenge but one that can be met with the help of a few different websites. A good place to start to become familiar with the specifics that pertain to your client’s specialty is the site of the ONC or The Office of the National Coordinator for Healthcare Information Technology, the premier site for updates regarding changes in the healthcare industry. The next stop is the Centers for Medicare and Medicaid Services. Search under “Meaningful Use”, “EHR Incentive Programs” or “Physician Incentive Programs” for updates that are specific to physicians. Additional places for top line information would include:

• Healthcare Informatics (@HCInformatics)
• Healthcare IT News (@hitnewstweet)
• EHR Outlook (@ehroutlook)
• the FierceHealthcare Network specifically FierceHealthIT (@FierceHealthIT)

For clinical personnel it is always a wise decision to become a member of your specialty association, register and request weekly or even daily updates be sent to your email. For example: Nurses can access the American Nursing Association (@nursingworld), this website offers government policy updates and addresses the needs of nurses in their professional settings as well as patient care. Another website dedicated to nursing is the American Academy of Nursing Executives (@tweetAONE). Nursing has become so specialized that there are resources available directed to the different specialties. Nurse.org provides multiple lists of websites dedicated to these specialties and are listed by state.

The resources available to physicians are endless and again our recommendation would be to first join the association related to your specialty. One example would be the American Academy of Family Physicians (@aafp). This is site is dedicated to Family Practitioners and offers: updates on clinical practices and research; continuing medical education opportunities and certification; tips on how to run a practice; the opportunity to become a member of advocacy groups; and updates on healthcare reform.

For non-clinical personnel whose primary focus is information systems in the healthcare environment, I recommend becoming a member of HiMSS, Healthcare Information Management Systems Society. From the site: "HIMSS is a cause-based, not-for-profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and management systems for the betterment of healthcare."

Additional resources that could meet the needs of all of the above listed professionals include:

• Health Data Management (@HDMmagazine)
• CHiME (@CIOCHIME)
• HealthcareCIO (@HCIO)
• CMIO (@CMIOmagazine)
• Physicians Practice (@physicianspract)
• Manage My Practice (@mary_pat_whaley)
• FiercePracticeManagement (@practicemgt)
• Modern Physician (@modrnhealthcr)

All these sites offer insight into the healthcare industry, provide crucial information surrounding the industry and government changes as well as additional resources.

As a side note, the Medical Group Management Association (@mgma) is a very involved organization dedicated to non-clinical personnel whose primary focus is practice management. This group is very proactive and provides support to various government advocacy programs through their Government Affairs Department.

Finally, there are a number of focus groups via LinkedIn that will open doors for education and professional affiliations. Trying to stay informed and involved can become a full-time job but when you take the time to do the legwork and get connected you will discover the sites and associations will provide a great benefit your day-to-day responsibilities.