Many chiropractic practices operate out of a single facility, with one doctor and one employee. But Virginia-based Tuck Chiropractic Clinic isn’t your average chiropractic practice. Tuck has 17 different doctors and 12 facilities within roughly an hour’s radius of one another. While the average chiropractor sees fewer than 500 patients per month, Tuck Chiropractic averages over 10,000!
In addition to its busy daily routine, Tuck Chiropractic is facing the burden of new regulations under the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act stipulates that in order to receive incentive payments and avoid modest yet escalating penalties to Medicare/Medicaid reimbursement, healthcare providers must implement and prove “meaningful use” of electronic health records (EHR) by 2015. Meaningful use primarily refers to providers’ adoption of EHR software to improve quality, safety and efficiency of patient care.
As a result, many clinics that have traditionally relied upon paper notes and written records to track and communicate about patients’ health histories are transcribing everything to a digital format. For busy practices like Tuck Chiropractic, this proposition can seem daunting. Tuck needed to make the digital transition as smooth as possible, and to exchange patient information and communicate claims issues between clinic locations more easily.
Tuck Chiropractic’s primary physician, Dr. Ray Tuck, describes how his clinic previously relied upon a paper system for record-keeping. They also used two separate software programs for billing and scheduling. The old software was built on a decade-old computer platform, was expensive and offered very poor customer support. In fact, it proved so inadequate at meeting their needs that they went back to a paper system for that, too.
That is, until the HITECH Act came along. In early 2011, Tuck’s staff began their search for a new system that could meet their unique needs–which now included EHR and scheduling capabilities as well as billing. Top of the list was a software system that could do all this while accommodating the volume and scope of their business.
“The reality is that we’re different,” Dr. Tuck says. “We’re not 12 independent offices–we’re one clinic system with 12 different locations. We needed a software that could accommodate one database with multiple sites.”
Dr. Tuck and his staff spent over a year investigating different software options. Only two EHR systems provided the cross-clinic functionality Tuck Chiropractic needed–and only one came with stellar references on ease of use and customer service. In June 2012, the entire ECLIPSE Practice Management suite–EHR, billing and scheduling–was installed on Tuck’s computers as an on-premise solution (meaning it runs locally instead of being accessed online).
Since then, an inter-company team has been managing a phased rollout of the software at their clinics–one or two locations at a time. They assigned one person on the team to the EHR side, one person to billing and one to scheduling. Each team member underwent online training through a certified ECLIPSE representative and used that, along with ECLIPSE’s help desk, to become experts in the program.
These team members then went through the process of training every staff member at every location on the software. Dr. Tuck notes that his company is still in a transition period, not only in terms of training, but also in terms of digitizing paper records. The scale of this digital effort has caused the transition to take longer than the average for most clinics.
Fifteen months in, using ECLIPSE has already streamlined communication between Tuck Chiropractic Clinic’s 12 offices and permitted them to handle insurance claims more effectively than they ever could before. Dr. Tuck reports that his staff now spends less time struggling with claims issues, searching through paper records and playing phone tag with the other clinics–and more time helping patients.
“It’s allowed them to do what they’re there to do: provide great care in an effective manner that is patient-service focused,” he says.
Here’s an example of how Tuck Chiropractic’s staff utilizes ECLIPSE for a typical patient visit:
When a patient walks in, the front desk staff member checks the patient in through the scheduling feature. The staff member will open any relevant notes or templates for that patient’s visit and “pend” them to the doctor, so the doctor doesn’t have to search for them (pending is discussed in more detail below). The patient sees the doctor and receives his or her chiropractic care, and then, all the doctor has to do is open up the pended note and complete it appropriately–or, if it’s a re-exam, update all tests and information ECLIPSE has carried over from the prior exam. The patient is then scheduled for his or her follow-up visit on the way out.
ECLIPSE’s split-screen scheduler with waiting room
There is one feature in particular that Dr. Tuck finds useful: the “pending” feature. ECLIPSE lets staff pend anything–from notes to documentation–to a particular physician, to ensure that he or she sees the information. It could be a document containing medications that needs to be read and finalized, or a note from a staff member to a doctor in another location that is necessary to understanding the patient’s history. Every doctor is listed by username within the system, and when they log in, they automatically see a list of all items pending to them.
Pending encounters (S.O.A.P.) in ECLIPSE
Another useful feature the Clinic is learning to use is the “fast-forward” function. This allows staff to access a patient dashboard and get a quick snapshot of billing information, from when a given payment was made to what the current balance is. This eliminates patient wait time and simplifies billing issues on both sides.
Before using ECLIPSE, Tuck’s staff relied on phone, fax and email to communicate. Patients commonly visit multiple clinic locations, and every time they did, their files had to be either faxed or physically transported from one office to the next. And staff members were frequently calling and emailing back and forth to exchange patient information and to access charts and notes. This was not only a hassle for employees, it took up valuable time that they could have been spending serving patients.
But now, with ECLIPSE, clinic staff no longer have to fax or carry records from one location to another–and they don’t even have to write an email or pick up the phone to get the information they need. All patient health records and documentation are stored in one centralized database–so no matter which clinic a patient decides to visit, their notes, records and lab work are only a mouse click away for doctors and office staff. Their next visit can even be scheduled at any of Tuck’s locations.
“It’s easier [now] to function as a group practice, because we all have access to everyone’s information,” Tuck says. “It was absolutely necessary to have that access and to be able to communicate amongst the practices.”
Staff communication is also streamlined when it comes to billing issues. In the past, if they needed more information from a patient in order to bill appropriately, they would have to fax or call that patient to request the information. And if the patient had changed locations, they’d have to contact the other clinic, too. But now, when a staff member opens a patient file, ECLIPSE’s automated alert system displays a pop-up notification telling that person what information needs to be gathered or which form needs to be signed. This allows billing issues to be resolved on the spot, instead of staff having to chase the patient down after the fact.
Multiple print, email and other options–including billing–in one convenient location
In addition to simplifying communication, perhaps the biggest challenge that ECLIPSE has helped Tuck Chiropractic Clinic overcome is handling health insurance claims issues.
“Before [ECLIPSE], we could never effectively centralize claims issues,” Tuck says. “When we had a problem with a claim, we had to ship it to the individual clinic, and that clinic would have to deal with it.” This bogged local staff members down with paperwork and forced them to spend hours on the phone haggling with the insurance companies–instead of helping patients.
Now that all patient records are stored in ECLIPSE’s database, dealing with claims issues has been centralized: one two-person team in Tuck Chiropractic Clinic’s corporate office has access to all patient notes, records and documentation, so they can resolve problems locally instead of farming them out to the 12 individual clinics. In other words: corporate staff deals with the insurance companies, and clinic staff focuses on improving patient care.
The additional requirements HITECH has brought demand significantly more documentation, Dr. Tuck says: he estimates that this additional paperwork now takes up 25 percent of a doctor’s time. It’s more important than ever that staff not waste time on things like looking for records or dealing with insurance companies.
Patient visit encounter (visit / S.O.A.P.) in ECLIPSE
Another important function Tuck Chiropractic was looking for when choosing its EHR software was the ability to create customized templates. Going from a paper to a paperless system was a big change, and staff wasn’t used to the format: they wanted certain forms pre-filled to save time and simplify daily processes. They also wanted to ensure they were meeting industry standards and maintaining HIPAA compliance, without adding extra legwork.
That’s where ECLIPSE comes in: the software’s robust customization features, Dr. Tuck says, were a primary reason they selected it. They created a library of the templates doctors use day-to-day, and the Clinic’s in-house compliance doctor was able to create templates customized to meet the new Medicare requirements, reducing the potential for non-compliance issues.
The Clinic also customizes when it comes to ECLIPSE’s extensive library of patient education resources. These resources, which may include physical therapy exercises or information about a particular condition, can easily be printed out by a doctor or nurse and given to a patient at the time of their visit (which, conveniently, is automatically noted in the patient’s records).
ECLIPSE, says Dr. Tuck, comes with so many built-in resource materials that it’s almost hard to make sense of them all–but it also comes with the ability to create a customized library of the resources that are needed most often. That way, the doctor can simply choose from a specific list, instead of wasting time scrolling through thousands of unrelated materials.
Yet another time-saving customization option is the ability for staff to create custom templates for letters. There are a number of letters that the Clinic regularly sends to attorneys or other doctors in the area, and with ECLIPSE, staff can simply enter the relevant names and information, save it to the patient’s file and print it out. Everything can be handled from the same place, instead of having to toggle back and forth between word processing, scanning and EHR programs.
“We couldn’t have done that with any other system,” says Dr. Tuck. “The ability to customize is a big thing for us. A lot of people just want a turnkey system, but that isn’t the way we do business. Software should enhance what we do–we shouldn’t have to change what we do to match the software.”
One final thing that comes as a relief to Dr. Tuck and his staff is ECLIPSE’s great customer service. After their experience with the previous billing software, Dr. Tuck says, the fact that they can call ECLIPSE’s customer service line and always reach someone who is willing to help has made all the difference.
While Tuck Chiropractic Clinic’s staff is still in the process of learning the software, staff members are already reaping the benefits of ECLIPSE: streamlined communication, centralized claims issues, pre-filled templates and more.
“It’s allowed our staff to focus on what they’re there to do: help more people,” Dr. Tuck says.