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."
