QMS is Aggressively Preparing To Help Providers Meet the Challenges of 2010:

QMS is fully aware of the major changes to take place in dialysis during 2010. These changes are perhaps the most dramatic since the inclusion of ESRD in the Medicare program in 1973. Independent dialysis providers are justifiably anxious about what the new rules and requirements portend for their business and business models. QMS feels strongly that the provider community can survive the upcoming challenges and in fact thrive as long as they have the tools to do so. What will be essential is that the owners and clinicians who work for these providers have complete, integrated, and targeted information. With this information providers will assure optimization of clinical practices, assure that claims are complete and comply with the new regulations, and have the information tools to address quality issues with innovative CQI programs.

The new reimbursement regulations will inject a level of complexity into the business aspects of a dialysis unit never experienced before. What might have been possible in the past with available office systems and paper records will become increasingly ineffective. QMS has historically provided comprehensive systems to address clinical and business needs as regulations have become more demanding (e.g., the advent of the EE and ED modifiers for the payment for erythropoiesis-stimulating agents, ESAs). During the rest of 2010, and particularly the last two quarters of the year, when final rules and MAC interpretation of them are available, QMS anticipates that a major development and enhancement effort will be needed in order for its systems to effectively meet the needs of this new domain.

To address these challenges we are:

• Significantly increasing our resources in terms of qualified personnel. By doing so, we will be able to rapidly address the new information needsSignificantly Increasing our Resources that will roll out over the next 10 months. We are currently recruiting key staff specialties so that we will be ready with fully qualified individuals at the point when rapid development is possible and necessary.
• Actively tracking national developments and consulting with QMS clients to proactively re-design parts of our systems, even before definitive regulations are in place.
• Evaluating and enhancing clinical information that is captured in QCS, QMS’s EMR that is totally integrated with the QMS claim generation functionality, to assure that risk factors and qualifying co-morbidities are easily captured and are an integral part of the claim. It should be noted that data libraries are needed because in the proposed rules there are lists of ICD-9 codes that qualify as co-morbidities as well as those that do not. Not inconsequentially, there will also be a change from ICD-9 to ICD-10 part way through the bundling transition period.
• Evaluating and enhancing the analytical tools in QCS to help clients optimize treatment to manage supply costs as well as address areas of patient morbidity. Such tools are necessary to balance the three elements of the new approach to ESRD care: providing better care, reporting complete medical information for accurate reimbursement, and controlling the expense of providing optimal care.

There are additional regulations being imposed in 2010. Namely, the Centers for Medicare & Medicaid Services (CMS) issued two new regulations on January 29, 2010. These will require providers to report dialysis adequacy, infection, and vascular access results and values on all ESRD claims with dates of service on or after July 1, 2010.

QMS is currently in the process of designing the corresponding enhancements for both its products in order to be compliant when these regulations go into effect.

QCS: Adapting to a Changing Industry to Meet the Needs of Our Clients

As we enter a new decade in the dialysis industry we are met with increased challenges of both adapting to the newest regulations placed on the providers but also providing the tools to optimize clinical care. Optimization of clinical care will be needed because of incentives and penalties based on quality of care that are part of the rollout of bundled payment methodology.

As this new paradigm is put in place, QCS has and is adapting to this new environment to capture all key treatment data, reduce it to useful information, and produce targeted analytical tools so clinicians can more easily and efficiently address key quality issues.

Even ten years ago automation in the facility may have been a luxury. However, as we move into 2010, an EMR in the dialysis unit coupled with targetedQMS is Continuing to Enhance QCS business software is a necessity. In 2011, when bundling takes effect this truth will become more apparent. In anticipation of these new demands, QMS is continuing to enhance QCS to fully document records with electronic signatures for full compliance while reducing the burden of printed information. Staff workload is also eased using our full machine interface capabilities as QCS provides clinicians with all the tools to move them towards full automation allowing dialysis providers maximum flexibility of their data and efficiency in their facility.

The new environment requires both comprehensive clinical information and a tight connection between clinical and billing information for accurate records, optimal and quality care, and full reimbursement for services delivered. We continue to strive for a user interface that increasingly eases navigation, usability, and seamlessness to help dialysis staff be even more efficient. We also realize that flexibility in the QCS application is important as we recognize that no two companies are alike in their needs or work flow.

Key Features of QMS Focus that Will Help Meet 2010 Changes

The dialysis industry faces fundamental challenges in reporting, claim generation, reimbursement, and documentation in less than a year due to bundling. To minimize anxiety providers need to be assured that the most comprehensive tools are available to address the new rules as they become clear. This is a key capability of a dialysis billing application: to be confident that the application will continue to evolve with the ever-changing regulations issued by CMS as well as state Medicaids.

Our 34-year history and experience of QMS clients provides such confidence in QMS Focus. Some examples: QMS Focus provides its users with the abilityOur 34-Year History to correctly and automatically report, with minimal effort, NDC values, wastage by means of the JW modifier, and EPO usage and corresponding lab results with the EE/ED and GS modifiers. The impact of inadvertently omitting or improperly representing these data can have a significant impact on one's reimbursement levels as well as generate extra work to trouble shoot issues and to reprocess claims with corrected information.

In addition, QMS Focus also provides A/R functions and tools to help minimize a user's workload and provide flexibility in managing it. Correct expected payment amounts, including case-mix price adjustments are displayed in A/R so that the client can be sure that payment received is complete and accurate. Another example of helping reduce staff work load is Rapid Coverage Update, which allows users to correct insurance information and have the application manage the tasks of canceling and generating new claims, reposting payments or moving them into unallocated payments as appropriate. Users can choose to allow QMS Focus to automatically allocate credits based on data included in electronic remittances or control manually the allocation of credits and adjustments not only at the service line level, but also by treatment item. And when treatment data is not represented in the same manner between two payors, such as between Medicare and Medi-Cal, California State Medicaid, QMS Focus provides the ability to set up a translation in codes to correctly generate claims without manual intervention on the user's part each month.

As anyone in dialysis billing knows, complexity abounds and margins can be slim. Having the right software solution with a solid track record can provide that additional peace of mind, not only for today's challenges, but also for the future.

Review of 2009 Users’ Meeting

The 2009 QMS Users’ Meeting was held in Las Vegas, Nevada from October 18th to October 20, 2009. Our meeting was an enthusiastic success; we had one of the largest turnouts ever with participants representing approximately 50% of all U.S. clinics. Both days featured discussions of diverse and interesting topics pertaining to our industry. Day one focused on “Hot Topics” and QMS Focus Enhancements. Day two emphasized specific and targeted reports in QCS which help clinical staff address and manage clinical challenges including: Vascular Access, Fluid Management, Treatment Adequacy, and Anemia Management. QMS also devoted a separate session to introduce and explain a large number of new QCS enhancements.

Maureen Michael, RN, CEO of Central Florida Kidney Center, kicked off the meeting with her presentation of “Hot Topics”, a summary of pertinent issues facing dialysis facilities today. Maureen discussed the new bundling changes to Medicare reimbursement, which will include how clinics will now be held accountable for patient performance through incentives and penalties in areas such as low fistula rates and high central venous catheter rates.

Day two of the Users’ Meeting concentrated on treatment and clinical challenges in dialysis and incorporated a reports workshop using QCS reports as concrete examples of how to address specific problem areas. It began with a discussion regarding Vascular Access by Dr. Marcia Keen, RN, PhD, CNN, Research Nurse at Ralph K. Davies Medical Center, San Francisco, as well as Amgen and project manager for The DOPPS study. Dr. Keen’s session touched on the fact that the U.S. is behind most other countries in regards to the goals for the number of fistulas used as a primary access for dialysis patients, especially for patients starting dialysis. The effect of this has contributed to lower quality outcomes for U.S. patients including a higher mortality rate overall compared to the rest of the world as well as higher hospitalization rates. There are several aspects to this problem for the U.S. One is that because of the lack of insurance coverage for a large number of pre-ESRD patients many of them are not worked up prior to going on dialysis and consequently a fistula is not placed early. Another issue is that in comparison to other countries, U.S. vascular surgeons do not have extensive training or experience in fistula creation as is the case in other countries; this factor appears to be associated with high problem rates. Specific QCS reports were discussed in a workshop format to help attendees understand the data available in QCS to evaluate this issue in their clinics.

Following Dr. Keen’s discussion, Diana Hlebovy, RN, BSN, CHN, CNN, Clinical Director of HemaMetrics, and a recognized expert on fluid management, discussed the rationale for emphasizing fluid management in the Conditions for Coverage. She pointed out that volume control is often overlooked and mismanagement is a main cause for cardiac related morbidityMismanagement is a Main Cause for Cardiac Related Morbidity and mortality rates. Lack of aggressive fluid management will result in fluid overload post treatment, hypotension and ischemic events during treatment or both. In the absence of managing volume, treatments delivered to dialysis patients cannot be considered as adequate. Other topics covered were the long-term complications related to fluid volume excess and how it is largely and incorrectly viewed as an inevitable complication of dialysis treatments in our current environment. She also addressed the conditions and interpretive guidelines related to fluid management.

Throughout the presentation Ms. Hlebovy reviewed, in workshop format, how QCS reports could aid in fluid management of patients, with various ways to run reports and analyze data for a facility or individual patient. Specifically, she focused on how facilities can use the Treatment Compliance report and Patient Treatment History report for fluid management and also touched on the benefits of the prescribed medication report and acuity report among others. Ms. Hlebovy answered a number of questions from the attendees and served as a popular resource during the breaks. Ms. Hlebovy’s presentation also offered 1 hour of CEU’s to those attending her session.

The Session “Treatment Adequacy & Patient Evaluation”, presented by John Sargent, PhD, covered the effort imposed by conditions for coverage regarding “adequate” solute removal, during treatment as well as patient evaluations and dialytic adequacy (Kt/V: reasons for under-achieving dialytic adequacy). This presentation was also accompanied by a description of QCS reports that can be used in addressing these issues of adequacy and patient evaluation.

Dr. Sargent and Dr. Keen covered anemia management. Dr. Sargent addressed the impact of iron as a major factor in anemia management which is essential for effective use of ESAs. As iron loss is a common problem for ESRD patients, increased attention to clinical techniques can possibly minimize it. Reducing loss as well as managing iron levels of dialysis patients can result in more effective use of ESAs for management of anemia among the facility’s patient population. There are several QCS reports that can effectively be used to evaluate anemia management – a clinical area that will need to be intensively pursued as bundling will place a premium on this aspect of treatment in contrast to simply the use of medications like ESAs.

Thank you

QMS hopes that the above information is useful as you address the future. We would like to remind you not to hesitate to contact us if you have any questions or concerns about the dialysis industry. We can be reached at 1-800-752-4600 or you can e-mail us at qms@qms-us.com.