What’s going on with e-CMNs

Electronic document exchange (EDE), including the electronic certificate of medical necessity, or e-CMN, has been inching through the HME pipeline for several years. And despite most HME providers’ cautious attitudes about e-CMNs, developments such as the government’s authorization of electronic signatures and recent adoption of the technology by several prominent players have pushed this e-document into full view.

“The biggest opportunity to cut costs, improve profitability and increase efficiencies is in document management, period,” says Dennis Nasto, vice president of sales, marketing and customer support for Austin, Texas-based SecureCare Technologies (formerly eClickMD), one of the industry’s largest EDE application providers and the developer of SecureCare and SecureMD. “The technology of EDE allows for a reduction in errors and lost documents and for greater efficiencies overall.”

In recent months, Schenectady, N.Y.-based Trac Medical Solutions, which offers an e-CMN system called CareCert, has partnered with the American Association for Homecare to offer the product to its members. Apria Healthcare and The MED Group have also signed on with the company to provide e-CMN processing capabilities. The technology is definitely “cost-effective,” says Jeff Frankel, TracMed’s president and CEO. “A provider’s activities-based cost of processing a CMN manually is $25 to $35 per CMN,” he says. “Our cost is no more than $4 [per CMN], a significant savings. Second, you eliminate human error from this process, which has a direct impact on cost initiatives.”

Nonetheless, using e-CMNs currently is not a feasible business tactic for most HME providers. But it’s not their fault. Physicians are the necessary—and the most reluctant—part of the equation in making EDE and e-CMN technology a standard procedure.

“The biggest challenge in implementing EDE with physicians is physicians,” Nasto says. “Every provider understands the value proposition for their business. The question is, how do they get their physicians to want to do this?”

Both TracMed and SecureCare are tackling the issue through various tactics in an attempt to help providers realize the advantages of using EDE. TracMed is working on numbers, thus its marketing alliance with AAHomecare and a pursuit of provider organizations. Providers “have to be willing to embrace our support early on in this process and to identify the 20 percent of the physicians they do business with–which represent 80 percent of their business—and let us help them sell the physicians early on,” says Frankel.

“The way to look at this is straightforward: If the top 10 largest providers are advocating this to physicians, and a significant number of small to midsize providers are doing the same, physicians will have to acquiesce to this technology.”

TracMed, a subsidiary of AuthentiDate Holding Corp., is counting on CareCert’s security features to convince physicians of its value. The company has technology alliances with the U. S. Postal Service and ChoicePoint. The USPS provides electronic postmarking capabilities, which, in turn, provides security for electronic documents. ChoicePoint authenticates physician credentials. “It’s like sending a message to CMS that you are a compliant HME provider and that you have taken the steps to eliminate fraud and abuse from this part of your process,” Frankel says.

SecureCare is focusing on networking and incentives. The company’s board chairman, Dr. Richard Corlin, is the most recent past-president of the American Medical Association, and its advisory board includes members of the AMA as well as the American College of Physicians-Internal Medicine. According to Nasto, internal medicine is the No. 1 group that refers into home health, followed by family practice. “The advisory board knows all of the major players in all of the major physician groups in the United States,” he says.

“The only way to be successful [with e-CMNs] is to sell the physicians first, not the [HME] providers,” Nasto believes. “The second strategy is to provide incentive; when doctors sign online using our system, they can make money.” This is due to the fact that many physicians who refer to HME also refer to home health. Home health, in turn, pays for certain codes, such as oversight certification and re-certification.

According to Nasto, many physicians don’t bill for these home health codes, and SecureCare offers to do it for them if they will sign e-CMNs online. “The physicians don’t have to do more work. We track it and allow them to bill for it, which allows them to make money for work they were already doing. It could add 20 to 30 percent to physicians’ personal income.”

The task at hand for HME providers is making their own connection with home health organizations in order to offer physicians the incentive.

Comments from Robyn Parrott, HME department manager for Enloe Medical Center, a provider in Chico, Calif., are typical. “Regarding e-CMNs, I think I am going to wait for the nationals to deal with all the heat. In the community I come from, there will be a reluctance to [adopt CMNs]. I think two years from now everybody will be doing it, and it’s my intention to do it. But I think before I can go to e-CMNs, I need to go paperless.”

“DME is such a low priority on physicians’ screens that it becomes a big challenge for [HME] providers to implement EDE,” SecureCare’s Nasto says. “Do not sign up with us or Trac Medical unless you’re going to pull in your relationships with home health. That’s the harsh reality of it.”