Home Forums Discussions General Discussion Orders section - should I even send them????

I pose this question only because for the last one year, only two providers in our office have been using AC. No staff had access to the AC computers as they were laptops we used when seeing patients. We were the only ones inputing things into AC.

Now we finally got half of our newer computers and hope to get the other half installed & running within the month (sooner than that hopefully). Our front office has adjusted well but that's a whole other post.

With my nursing staff, I have been for the last year printing my orders to our lab computer. Two copies were made, one to go with the specimen and the other for documentation (medicaid audits have asked to see requisitions before). We will soon have computers with AC in the back for the MA's & exam rooms and lab. I've read your posts over the last year and a half regarding ORDERS, reconciliation lacking etc.

My question is this: Will having years worth of orders that weren't reconciled going to slow the system down? I'm thinking that I can continue to print requitions to the lab. If the auditors want to look back at orders, instead of having a printed copy of the requisition we could pull up the orders section.

This way I could SAVE WITHOUT SENDING and keep the orders box fairly clean. But on the other hand if this is a database driven software, wouldn't it be to my advantage to SEND the orders? This way it would be recorded and codified? Or does SAVE WITHOUT SENDING codify the orders? Sorry but I don't know much about SQL or database stuff. Imagine at some future point upgrades will be done to the orders section and this information that was previously inputed could be useful?

We still have to reconcile our labs and I'm resigned to keeping our old handy archaic spiral binder that has the date of service, pt name & labs collected. Labs are highlighted as the results come in. Maybe someday there will be an easy solution to this.

Sorry for the long post

Marty, I don't understand why Medicare/Medicaid would like to see lab requisitions. I'm assuming this is because you are drawing labs onsite, and are you also running the labs onsite too?

There are other posts and also advice from Angel Support recommending the lab orders be reconciled, because they can slow down the system when in high numbers. So reconciling them would make sense.

When you send the order to your lab user, they can save the order and it's stored in their chart. Thus providing record of the lab order. But if you are drawing labs and processing the labs onsite, keeping the hard copy paper lab order would make sense, especially if you are getting audited frequently.

Marty, a concluding question: why is only half the office computers joined to AC? From my perspective, having only half the computers interfacing with AC seems like it would create a rather difficult working environment for the other staff.

Marty,
When I started using AC, I was using "Save without sending". Unfortunately, I soon discovered that this saves them to the order list for reconciling. The only way to not have them added is to use ONLY the print function.

Adam,

In an ideal world, the whole office would have computers that were able to run AC. We are a community clinic and really didn't have the money to purchase newer PC's. The existing PC's were about 11 years old and AC didn't run on them very well if at all.

I was given to opportunity to chose the EMR since I'm the one that's there most of the time. I did get the office to purchase a couple new PC's so I could play around with AC and figure out work flow etc. The idea was once we got the funds to purchase new PC's, I'd have some what of an idea of how things would work and then could train the staff.

We recently got a grant to help turn our clinic into an FQHC. So with this grant we were able to purchase enough computers for the office (exam rooms, labs, nurses station, provider offices, front desk etc). Half of the computers have been installed, the other half will be shortly.

I know a copy of the labs ordered are saved to the chart. We do have a lab onsite which is why I need copies of the requisitions. I can always save them to PDF if need be, was just trying to save mouse clicks.

Believe me, it was frustrating not having the funds to get enough workstations so we could all use AC.

wow Marty, that sounds like a tough situation to be in. Thank God you were able to find a means to the funding to keep your clinic going. Primary Care is tough enough without having to worry about eeking by on meager reimbursements from Medicare/Medicaid. I hope things go smoothly in the transition to FQHC!

Good luck with the installation of your computers!

I would not in any way wish to offend any fellow AC users.
And Congrats on the FQHC status.
My commnent: Around my neck of the woods, FQHC designation is considered (by us private practice docs) as a license to print money (reimbursements range, reportedly, 5 to 8 times what I get for a 9921x) for MediCaid pts.
Good luck.

Interesting. My perception is that the FQHC docs around here are the ones who practice in the most difficult areas, with the toughest patient mix, and often with minimal logistic and financial support.

Hence my wish not to offend.
As safety-net providers they do have a tough patient population.
As least in california the cost-based reimbursement to FQHC's does result in substantially higher reimbursement (to the clinic, not necessarily to the MD) than the rest of us get when seeing Medi-Cal (california medicaid) patients.

Hold on, we aren't FQHC (yet). Crossing our fingers to find out here within the next month or two. Because we are a community clinic and want to become an FQHC, we got a grant to help prepare our clinic. That entailed being able to budget & purchase equipment, consultation fees, wiring the office etc.

With the caveat that I am sure Marty's will be different; maybe they will all be different. But, I have never agreed with a post more than Nephros'. Maybe I despise most FQHCs wrongly because of our FQHC whose only goal is to become the most powerful medical clinic in the world. We have tons of their patients transfer to us, and I find it crazy that they saw a provider the day before and the FQHC was reimbursed over $110.00 and I see them, diagnose them and get $42.00. They steal patients by seeing them in school clinics and any other way they can. They have already bought at least six practices, OT/PT clinics and other affiliated services. They make TONS of money and when they run short, there is always that $650,000 tax-free stipend. Of course, they have no liability insurance and no taxes, etc. And, the doctors get paid handsomely.

Good luck in getting FQHC status, seriously.

Maybe there. Not here. I once talked to the Department of Justice about misdoings here, and they said, "They are government; you're not." Nuff said.

No offense taken. I honestly don't know much about the FQHC business side of things. I imagine I'll learn more if we do get our FQHC. For now, I'm concentrating on getting the rest of these computers in and training the staff. Once we have all the newer pc's installed, then we can stop all this #&$# paper.

I can definitely understand your feelings regarding FQHC. I would hope the powers that be aren't going to want to take over the world.

The reimbursement disparity of FQHC in Maine is huge. As Bert said, they have massive federal grants, and get paid more than double our reimbursements. It makes it seem unfair but they are dealing with a patient demographic that I frankly do not want to deal with.

My fiance just signed a contract to join an FQHC after completing her residency this year. I can verify for a fact their docs are paid quite handsomely. Considering the fact they deal with many of the worst types of social situations, the salary is fair to possibly underpaid.

Marty,
I am starting a new thread that addresses some aspects of your question.