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3 Types of Medical Billing Companies

Posted on August 31, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently talking with the CEO of an EHR vendor. As we talked about their EHR software and what they were working on in the future, the CEO made a really important comment. He said, “The EHR can be great, but if you don’t take care of the medical billing the right way then none of that matter.”

This was such an important point and one that I’d seen first hand. An OB/GYN friend of mine had an EHR that they loved. As the doctor, she loved it for her clinical work. The problem was that it wasn’t tied to a great practice management system. So, she was having issues with her billing. The problem was so bad that she ended up leaving the EHR she loved clinically to find something that would solve her billing problems. Don’t ever underestimate the importance of medical billing.

I recently came across an article on the Kareo blog which highlighted 3 levels of medical billing and RCM (revenue cycle management) services billing companies can offer a practice:

Light

Level of service offered by many billing software vendors.

Full-Service

Level of service offered by some software vendors and most traditional billing services.

Boutique

Level of service typically offered by smaller “mom and pop” billing companies who have expertise in a limited number of specialties and/or provide more oversight.

As you evaluate medical billing companies for your practice, this is a nice framework for evaluating the various medical billing companies that are out there. Each one provides a different set of expertises to help your practice. Understanding that difference is key to choosing one that will work best for you.

What’s been your experience with medical billing companies? Do these 3 types make sense to you or would you look at them from a different angle?

Nationwide Healthcare Interoperability Isn’t Happening

Posted on August 8, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve got interoperability on the mind today. I think it’s probably because of all the tweets that are coming out on the #InteropForum hashtag from the ONC Interoperability Forum in DC. I would have liked to attend, but I’m grateful that so many people are sharing what’s happening. That said, I must admit that I’m tired of a lot of the tweets that aren’t grounded in reality and that call for things that are never going to happen or tweets that propose goals that aren’t meaningful (yes, I had to use that word).

The first reality that’s become clear to me is that nationwide interoperability of healthcare data isn’t going to happen.

It’s just not going to happen and in most cases it shouldn’t happen when you consider the costs and benefits. Sure, we are all traveling a lot more, but there are 45 or so states in the US where no healthcare organization has need for my health information. If they do, then there are ways they can get it, but they are rare. Even if I have a crazy medical incident in an unusual state, those care providers know how to take care of me even without all my health records. Doctors are always treating patients with limited information. If I’m a chronic patient where certain information would be important for me if I’m treated out of state by a doctor that doesn’t know me, there are hundreds of options for me to carry that information on my phone.

My point here is that there aren’t any massive economic incentives for there to nationwide sharing of health data. Don’t be confused though. I’m not saying that sharing health data is not beneficial. What I’m saying is that we don’t need to build a national framework of health data sharing. When people suggest we should make that a reality, they’re essentially dooming interoperability. Talk about biting off more than you can chew. It’s become quite clear to me that Nationwide Interoperability of health data isn’t going to happen.

I love this excerpt from Brian Mack’s blog post on the Great Lakes Health Connect (an HIE) blog:

The Trusted Exchange Framework and Common Agreement (TEFCA) released by the Office of the National Coordinator last January, was (it was thought) intended to bring clarity and define a path forward for national interoperability, but has instead just added more uncertainty and the promise of additional layers of bureaucracy.

Discussions around national healthcare interoperability just bring more uncertainty and more layers of bureaucracy. It’s a failed approach.

With that said, it’s also very clear that smaller scale interoperability is not only possible but a valuable thing for most in healthcare. This was highlighted by interoperability expert, Greg Meyer, when he tweeted:

It’s really great that Greg is trying to figure out how we can generalize these point to point interoperability solutions. That’s a smart approach. However, buried in this tweet in a way that most will miss is the fact that there are a lot of unique scenarios and solutions where healthcare interoperability has been successful. Healthcare interoperability is possible and many organizations are doing it. Just not on a national scale.

To continue Greg’s analogy, we need more of these interoperability “snowflakes” and we need those creating the snowflakes to share their successes. A blizzard of snowflakes is a powerful thing even though the individual snowflakes are small. As it stands today, a national approach to interoperability is more like spending millions and billions of dollars on a snow making machine and then never turning it on. I’d rather have a million snowflakes than a billion dollar machine that doesn’t produce any snow. </ end snowflake analogy>

Another example of healthcare interoperability in action was shared at the Healthcare IT Expo this year. Don Lee offered a great summary of UPMC’s success with interoperability and the parts of interoperability they have solved. There’s always still more work to do, but if every hospital was able to accomplish what UPMC has accomplished in regards to healthcare interoperability, then we could have a very different discussion around healthcare data sharing.

The only solution I see to healthcare interoperability is for healthcare organizations to make it a priority. As I said back in 2013, Interoperability Needs Action, Not Talk. The more small interoperability connections we make, the more we’ll understand our data, how to connect, and build relationships between organizations. All of that will be key to even starting to thinking about nationwide healthcare interoperability. Until then, let’s table the nationwide healthcare interoperability discussions.

Your Front Desk Is You

Posted on January 30, 2018 I Written By

Is your front desk welcoming, or repelling your patients, your customers?  Yes, patients are your customers, they are the ones that create your income by coming to your practice.  And whom do your customers first encounter” Your front desk staff. Are they a reflection of what you want your practice to be, representing you, or are they something you really don’t want to think about, low paid, marginal help that you have to have? High turnover, “you can’t get good help”, not worth paying more than minimum wage, staff?

That glass window that you installed for HIPAA privacy in the patient’s view is a device that allows them to hide from their view, to avoid eye contact, avoid dealing with them, the patient. Behind the glass window, are the people that greet your patients, expected to make them feel “welcome”, instruct them on the necessary registration materials to be signed, and most importantly, set the tone, and culture of the office for your patients?  This is critical to your practice’s success.

Such people should be a positive contact point for your practice, yet a study published in the Journal of Medical Practice management reported that 96% of patient complaints about a practice have to do with customer service. It’s not the clinical care, the physicians care, but how they are treated in the experience of visiting your practice.  And the first point of contact in the office is your front desk staff.

Is Your Practice Perfect or Does It Need Improvement?

Now you need to look at your scheduling process as well to see if that is a point of friction, online or by phone, but the human aspect once in the office is your front desk staff.

How is the reception configured, and how are the staff trained?

If that glass window is a barrier that hides the staff, that allows them to ignore the patients, then your message is that they, your customers are secondary to everything else.  If the patient has to ring a bell or tap on the window, or even read a hand-written sign that says sign in and take a seat, this is for the benefit of your staff, not your patients.  Now if you have an alert on the door when it opens and that signals staff to open the window and welcome the patient, inviting them to start the registration process, you have a very different tone to kick off the patient visit.

And that welcoming staff person has to be hired for personality, a welcoming personality, and then trained to do the job, the tasks that need to be performed at the time of registration.  Even if it requires more than minimum wage to fill the slot, the right person sets the cultural tone for the office and set you as the physician up for a better encounter with the patient. The glass window when opened, should not be to simply thrust a clipboard into the hands of the patient saying “fill these out”.  The exchange between your staff and the patient would be welcoming and appreciative.  In other words, make the exchange about the patient.

Take a look at your waiting room as well, is it inviting, clean, up-to-date, and comfortable? If not, take some time to make sure your waiting room reflects the kind of quality care you provide your patients.

About Alex Tate
Alex Tate is a Healthcare IT Researcher and writer at CureMD who focus various engaging and informative topics related to the health IT industry. He loves to research and write about topics such as Affordable Care Act, Electronic Medical Records, revenue cycle management, privacy, and security of patient health data.

Ensuring Patient Comprehension

Posted on October 31, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Erin Gilmer recently posted a very interesting “Literacy Comprehension” form from an Endoscopy Center. Check out the form below:

You have to applaud this effort by a practice to make sure that the patients understand the information being presented to them as part of the procedure. The cynic might argue that the clinic is just trying to cover their backside. However, Erin asks the more important question, “Is this an effective way to prove comprehension?”

I do like how this can open the patient up to the option to have a discussion about something they don’t understand. It sends a good message to the patients in that regard which could make the patient feel more appreciated and help the patient feel comfortable asking a question about something they would have just previously kept to themselves.

However, for those that aren’t literate, I don’t think this form will do much. I expect that many patients that aren’t literate likely get into a zone where they just sign whatever the medical practice gives them regardless of what it is and regardless of whether they can read it or not.

I think the idea is a good one but could be executed better. Could this be done verbally and have a bigger impact? What other ideas have you seen implemented? Do you like this approach or are their better ways to accomplish it?

Better Performing Practices More Efficient with IT Spending According to MGMA

Posted on October 23, 2017 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

The Medical Group Management Association (MGMA) recently released its 2017 MGMA DataDive Better Performers data, a report that provided a glimpse into the health of US medical practices across four key performance categories:

  1. Operations
  2. Profitability
  3. Productivity
  4. Value

Of the 2,941 physician practices that provided their performance data for the report, only 32 were found to be “better-performing” than their peers in three of the four categories. No practice was considered better-performing on all four categories.

For a deeper dive into the report, check out this post from Anne Zieger.

The report’s most surprising results were in the Operations – Information Technology category:

  • Physician-owned practices spent more than 2x on IT Per FTE Physician than their hospital-owned practices
  • Better performing physician-owned practices spent LESS on IT than their peers
  • Better performing hospital-owned practices spent MORE on IT than their peers

At first glance these results run counter to what many would expect. How could independent physician practices be spending more than 2x hospital-owned practices on IT – especially when you consider that a hospital has many more IT systems and applications.

To help make sense of the results, we sat down with David N Gans, MSHA, FACMPE – Senior Fellow, Industry Affairs at MGMA.

Why are hospital-owned practices spending less overall on HealthIT?

Gans: The raw numbers that we received from the practices was a bit deceiving. What we found was that not all IT costs borne by the hospital are filtering down to the practices owned by that hospital. Server costs, IT department salaries, support costs and network infrastructure costs, for example, did not appear as line item costs for the practices. Only equipment and the EHR licenses used by the practice’s staff were considered IT costs. Independently owned practices, however, bear all the costs associated with IT including licensing, servers, support and ongoing maintenance. Thus, it only appears that hospital owned practices are spending less than their counterparts. It is a quirk of the way costs are allocated in a hospital setting.

Why are better performing physician-owned practices spending less on HealthIT than their peers?

Gans: The scoring system we used for this report rewards efficiency. The more efficient you are in any category, the higher you will score. Using that lens, practices that were more judicious with their IT spending achieved higher efficiency scores. What you are seeing in the report results is an associative effect – the more effective you are with IT, the more efficient your practice is considered.

Gans was quick to point out that the survey did not measure the impact of or the outcomes achieved from the implementation of HealthIT. There was also not linkage between overall IT spend and practice profitability.

Why is it important that practices strive to be efficient. Isn’t that an antiquated notion?

Gans: It’s actually more important than ever for practices to focus on being efficient. If you go back to 2001 and look at three key economic indices it becomes painfully obvious why efficiency is the key to practice survival. Just look at this chart we have compiled:

The red line is the % increase in practice operating costs per FTE Physician relative to what it was in 2001. By 2020, costs will be 116.7% of what they were in 2001. The blue line is the consumer price index. The green line is the rise in Medicare reimbursements. There is no way a physician practice can stay in the black without taking a serious look at their operational efficiency. If you do nothing, costs will eat up your practice.

Gans is hopeful that new technologies and changes to the reimbursement mechanisms will help reduce the performance gap for practices. According to Gans, Artificial Intelligence, like IBM’s Watson, could make practices exponentially more efficient. It can crunch numbers much faster than a human ever could, which would allow physicians to offer more personalized care or care via less expensive channels (ie: telehealth).

“One thing is clear,” says Todd Evenson, Chief Operating Officer at MGMA. “As we change from volume to value, the financial metrics we track in this report will have to change. We will need to de-emphasize the production-style metrics we have used in the past to more value based ones. We will also need to find a way to measure the quality of care provided by practices. This will make this report even more important and relevant in the years to come.”

WorkFlow Wednesday: Patient Satisfaction and West’s Patient Experience Survey

Posted on July 5, 2017 I Written By

Healthcare as a Human Right. Physician Suicide Loss Survivor. Janae writes about Artificial Intelligence, Virtual Reality, Data Analytics, Engagement and Investing in Healthcare. twitter: @coherencemed

Providers can improve patient experiences and revenue. So much of what improves satisfaction is outside the clinical setting.  West’s Insights and Impact Study titled “Prioritizing the Patient Experience” examines the gaps in patient value perception in the current healthcare marketplace.

West recently conducted a survey of patients providers to get more insights into what patients and providers value.  With value based payment models and consumer focused health providers are increasingly motivated to provide high quality service. Today’s patient is more aware of choice in provider options and will shop around for a provider that matches their needs.

Patients and Value Based Care Provide More Awareness of Choice in the Healthcare Marketplace

Patient experience using current technology and workflows is the space West has been working in for 25 years, including patient reminders for large hospital systems. As a company that specializes in patient experience, they used an outside firm to get insight about how well provider and patient perceptions were aligned. It was impressive to see an engagement company practicing what they preach and being proactive about feedback and improvement.

The most interesting takeaway from all of the statistics and research and report is that we know what the drivers of a good experience are. If you ask patients and providers what their motivation are answers are not usually aligned. This gap in what providers and patients value in terms of healthcare experience can cost providers revenue and patients. Patients value a high level of communication and transparency about cost of care more than providers believe.

Looking at the study, 78% of patients with a Chronic condition are likely to say that their provider cares about them as a person. Personally I’ve experienced this with my son that has a Chronic condition. We researched providers to ensure that we had similar values about communication and follow-up. Social Media groups like mom groups on Facebook have a lot of feedback about provider value. I know his provider gives great care and cares about him.

Patients with a Chronic Condition are Likely to Receive Personalized Care.

My Takeaways From the West Report

  • Current Systems do not always create a seamless workflow. Smooth workflow and patient communications improve patient experience.
  • Patients really want to know about what to expect in appointments. Sending a notification about costs including copays and obligations improves patient satisfaction.
  • Wait times are a huge cause of concern for patients. Electronic messaging or text information about waits can improve patient satisfaction even in cases where delays cannot be avoided.
  • Making payment as easy for patient as possible improves patient healthcare experience. A reminder about a bill with information about how to pay will improve practice revenue and patient experience.
  • Simple workflow improvement and automation improves clinical outcomes and patient retention in an increasingly consumer aware healthcare world.
  • Providers can focus on using the technology to better measure that for further strategy for improvement.

Well developed workflow can ensure that physicians have fewer patient surprises. Rather than waiting for an HCAP you can proactively collect data and brief surveys on specific topics before you are doing emergency triage. Contact recently discharged patients via an automated phone message or email. Have the questions tie back to HCAP survey questions so they can see what they will get.

What can systems do? Select Key measures for patient satisfaction.

What can physicians do? Tell patients that what to expect.

West is following their own advice and getting feedback about the value of communications and technology The survey is a connector for patients and for technology companies in the HealthIT space. Great ideas about Workflow improvement and best practice for business from West.

The report can be accessed online here and these key takeaways and is a great read for providers.

Retail Clinics Are Not the Enemy, Inconvenience Is!

Posted on June 16, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Check out this incredible insight that Gabriel Perna shared on Twitter:

What a great insight and something that most of the entrenched healthcare people don’t understand. Retail clinics are not the enemy, inconvenience is.

In many ways, it reminds me of the approach that taxi cabs took to Uber and Lyft. Taxis described them as evil as opposed to understanding why consumers wanted to use Uber and Lyft instead of a taxi cab. If the taxi cab industry would have understood the conveniences that Uber and Lyft provided customers, they could have replicated it and made Uber and Lyft disappear (or at least they could have battled them more effective than they’ve done to date).

Gabriel Perna further describes the issues of retail clinics and AMA’s approach to retail clinics in his article and this excerpt:

There are many reasons for this phenomenon [growth of retail clinics], but more than anything though, retail clinics are convenient and many physician offices are not. Because of this, the AMA shouldn’t be trying to treat the retail clinics as some kind of foreign invader, but rather use their rise to prominence as a way to guide physician practices forward. For instance, getting in to see a doctor shouldn’t be a three-week endeavor, especially when the patient is sick and needs attention immediately. However, that’s what has happened. Personally, I’ve been told “the doctor doesn’t have anything open for at least a month” more times than I can count.

It’s simple supply and demand. If you or your child needs to see someone immediately because of an illness and your doctor’s office can’t take in you for a week, and there happens to be a retail clinic down the street, guess where you’re going? Any hesitations you may have over your care being fragmented, the limited ability of your retail clinic physician, or anything else will go out the window pretty quickly.

I agree completely with the idea that convenience is key. However, what Gabriel doesn’t point out is that the fact that doctors have a 3 week waiting list for patients is why they don’t care about offering convenience to their patients. They have enough patients and so they don’t see why they should change.

You can imagine the taxi cab industry was in a similar position. They had plenty of people using their taxi service. They didn’t see how this new entrant could cause them trouble because they were unsafe and whatever other reasons they rationalized why the new entrant wouldn’t be accepted by the masses. Are we seeing the same thing with retail clinics vs traditional healthcare? I think so. Will it eventually catch up to them? I think so.

What’s even more interesting in healthcare is that retail clinics are just one thing that’s attacking the status quo. Telemedicine is as well. Home health apps and sensors are. AI is. etc etc etc. All of these have the potential to really disrupt the way we consume healthcare.

The question remains: Will traditional healthcare system be disrupted or will they embrace these changes and make them new tools in how they offer care? It took the taxi cab industry years to adapt and build an app that worked like Uber and Lyft. However, it was too late for them. I don’t think it’s too late for healthcare, but it’s getting close.

Finding New Patients for Your Practice

Posted on May 9, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In many practices, one of the biggest challenges they face is finding new patients for their practice. In some ways, technology has helped the situation, but in many ways technology has made this a real challenge for doctors.

Some recent data from Accenture Health provides an interesting look at one element of how patients find a medical practice.

When I saw this number I was shocked that it was so low. In the past, this number has been so much higher since finding a doctor from your health insurance company was the simple, logical way to make sure you were choosing a doctor which would take your insurance. Times are a changing.

When you look at the full report and the graph on how people find doctors, we learn even more:

Coming as no surprise is that highly digital patients leverage social media, internet searches and health websites to find a doctor at a much higher rate than those whom are less digital. However, what’s shocking to me is how much less the highly digital patient trusts the medical professional versus those that are less digital.

Not surprising is that friends and family is one of the most important factors for finding a doctor regardless of digital skills. Of course, it’s worth noting that in many cases, social media is really synonymous with friends and family. Social media is just the next generation of friends and family influence and communication.

What’s important to realize about these charts is that patients are quickly shifting from the less digital to the more digital category. So, 5 years from now we’re going to see a massive shift with how people find doctors. Social media, internet searches, health websites, and online ratings and review sites are going to continue to grow and become more important to practices looking for new patients.

What are you doing to prepare for this future?

Various Medical Practice Model Types

Posted on May 3, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The EHR vendor (and many other services), Kareo, has put out a practice model guide which they call “Practice Models: The ABCs from ACOs to Concierge and Everything in Between.” With this guide they shared this picture that includes various practice models:

When I see an image like this I’m torn on if this is an extremely exciting time for physicians or if it’s a miserable time to be a physician. One thing is clear, times are a changing. The medical practice models of the past are going to be blown up by new models.

Take for example Telemedicine. Can you imagine any healthcare future where telemedicine is not part of that future? I can’t.

I’m still personally torn on concierge practices. I can see why they’re appealing to so many. I love the idea of unlimited primary care and getting insurance out of primary care. However, it’s not clear to me that this idea can scale across the entire healthcare system. Certainly the rich can do it no problem. Can the concierge model work for the middle and lower class? Many fans of concierge tell me it can. I’m still not so sure.

I know a lot of doctors that are part of ACOs. I don’t know very many that are excited by the work ACOs are doing. Most of them just feel like they need to be part of it to understand the future of medicine. They’re not joining ACOs because they think it’s something that shows a lot of promise for their patients.

I’m probably coming off a little more cynical than I am about these shifts. A number of these changes are really exciting to see happening. However, I’m also not blind to the challenges that many of these medical practice models face.

Needless to say, it’s an exciting and challenging time to be in medicine. The structure of how we pay for healthcare is being questioned and new models are being explored. This can be really exciting if you find yourself tracking the right wave. However, if you miss the wave, then you can be stuck out in the middle of the ocean wondering how you missed out.

The Physician – Patient Disconnect

Posted on April 13, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

If you’ve been in healthcare for a while, then you know that there’s often a disconnect between patients and healthcare professionals. However, this divide was illustrated pretty sharply in some research that Conduent (previously known as Xerox) put out about the relationship.

Plus, to add to this disconnect, there was an even bigger divide between patients from different ages. In fact, they’re a very heterogeneous group. However, so many healthcare organizations treat them the same.

For a good illustration of these differences, take a second to look at this infographic: