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Problematic Medical Bills Drive Consumers To Cut Back On Care

Posted on November 7, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

As we all know, patients and families are taking over responsibility for a steadily greater percentage of their healthcare costs over time. Not surprisingly, this can affect their medical decisions in negative ways. In fact, a new study has documented that their medical bills are confusing or unexpected, a patient may get overwhelmed and simply skip some forms of care entirely.

The study, which was conducted by Hanover Research and sponsored by HealthSparq, surveyed more than 1,000 Americans on their experiences with unexpected medical bills. The results should be unsettling to anyone in outpatient services, especially those in primary care.

Researchers found that more than half (53%) of respondents had received a surprise medical bill over the past 12 months. This included bills that were higher than expected (60%), for services they thought were covered by insurance but weren’t (62%) and from multiple providers when they expected to get just one (42%).

When faced with these frustrating billing situations, patients may drop out of their care routine to some extent. Many skip routine checkups (40%), routine health screenings (39%) or care for injuries (39%).

A substantial number of respondents (40%) conceded that they could’ve avoided such shocks by doing more to better understand their benefits and healthcare processes, in addition to blaming their insurers (45%) or their health providers (42%). Regardless, it appears that a large number didn’t know who was responsible for the problem, which doesn’t bode well for their future health behavior.

Look, everyone knows that offering an accurate estimate of patient financial liabilities could be a nightmare in some situations, particularly if insurance companies don’t play nicely with the billing department. It’s also true that in some cases, patients simply won’t be able to pay the bill regardless of how you present it, a problem you certainly can’t surmise on your own as a medical practice.

That being said, you can take a look at the bills your practice management system produces and get a sense whether they’re decipherable to those who don’t work within the organization. Even if the PM system does a good job of supporting your end of the process, that doesn’t mean it’s turning out bills that patients can use and understand.

Yes, arguably the most important thing a practice management system does is to support your claims process effectively, but seeing to it that patients aren’t overwhelmed by their bills is clearly a big deal too. Particularly under value-based care, you can’t afford to have them holding off on the services that will keep them well.

DrChrono App Store Illustrates Important Point

Posted on July 16, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

In a recent post, my colleague John Lynn argued that EHRs won’t survive if they stick to a centralized model.  He contends — I think correctly — that ambulatory practices will need to plug best-of-class apps into their EHR system rather than accepting whatever their vendor has available. If they don’t create a flexible infrastructure, they’ll be forced to switch systems when they hit the wall with their current EHR, he writes.

Demonstrating that John, as usual, has read the writing on the wall correctly, I present you with the following. I think it illustrates John’s point exactly. I’m pointing to EHR vendor DrChrono, which just announced that billing and collections company Collectly would be available for use.

Like its peers, Collectly built on the DrChrono API, and will be available in the DrChrono App Directory on a subscription basis. (The billing company also offers custom pricing for large organizations.)

Other apps featured in the app directory include Calibrater Health, which offers text-based patient surveys; Staple Health, a machine learning platform that providers can use to manage at-risk patients and Genius Video, which sends personalized video via text message to educate patients. Payment services vendor Square is also a featured partner.

Collectly, for its part, digitizes paper bills and sends billing statements and collection notices to patients via text or email. The patient messages include a link to the patient portal which offers a billing FAQ, benefits and insurance info and a live chat feature where experts offer info on patient insurance features and payment policy. The live chat staffers can also help patients create an approved payment schedule on behalf of a practice.

While some of the DrChrono apps offer help with well-understood back-office issues – such as Health eFilings, which help practices submit accurate MIPS data –  those functions may be duplicated or at least partially available elsewhere. However, apps like Collectly offer options that EHRs and practice management platforms seldom do. The number of best of breed apps that an EHR won’t be able to replicate natively is going to continue to increase.

Integrating consumer-facing apps like this acknowledges that neither medical practice technology nor its staff is terribly well-equipped to bring in the cash from patients. It may take outside apps like Collectly, which functions like an RCM tool but talks like a patient, to bring in more patient payments in for DrChrono’s customers. In other words, it took a decentralized model to get this done. John called it.

Cloud-Based EHRs With Analytics Options Popular With Larger Physician Groups

Posted on April 20, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Ever wonder what large medical practices want from the EHRs these days? According to one study, the answer is “cloud-based systems with all the bells and whistles.”

Black Book Research just completed a six-month client satisfaction poll questioning members of large practices about their EHR preferences. The survey collected data from roughly 19,000 EHR users.

According to the survey, 30% of practices with more than 11 clinicians expect to replace their current EHR by 2021, primarily because they want a more customizable system. It’s not clear whether they are sure yet which vendors offer the best customization options, though it’s likely we’ll hear more about this soon enough.

Among groups planning an EHR replacement, what appealed to them most (with 93% ranking it as their preferred option) was cloud-based mobile solutions offering an array of analytical options. They’re looking for on-demand data and actionable insights into financial performance, compliance tracking and tools to manage contractual quality goals. Other popular features included telehealth/virtual support (87%) and speech recognition solutions for hands-free data entry (82%).

Among those practices that weren’t prepared for an EHR replacement, it seems that some are waiting to see how internal changes within Practice Fusion and eClinicalWorks play out. That’s not surprising given that both vendors boasted an over 93% customer loyalty level for Q1 2018.

The picture for practices with less than six or fewer physicians is considerably different, which shouldn’t surprise anybody given their lack of capital and staff time.  In many cases, these smaller practices haven’t optimized the EHRs they have in place, with many failing to use secure messaging, decision support and electronic data sharing or leverage tools that increase patient engagement.

Large practices and smaller ones do have a few things in common. Ninety-three percent of all sized medical and surgical practices using an installed, functional EHR system are using three basic EHR tools either frequently or always, specifically data repositories, order entry and results review.

On the other hand, few small to midsize groups use advanced features such as electronic messaging, clinical decision support, data sharing, patient engagement tools or interoperability support. Again, this is a world apart from the higher-end IT options the larger practices crave.

For the time being, the smaller practices may be able to hold their own. That being said, other surveys by Black Book suggest that the less-digitalized practices won’t be able to stay that way for long, at least if they want to keep the practice thriving.

A related 2018 Black Book survey of healthcare consumers concluded that 91% of patients under 50 prefer to work with digitally-based practices, especially practices that offer conductivity with other providers and modern portals giving them easy access to the health data via both phones and other devices.

Ophthalmologists Worry That EHRs Decrease Productivity, Boost Costs

Posted on January 16, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

A new study has concluded that while EHR use among ophthalmologists has shot up over the last decade, most of these doctors see the systems as lowering their productivity and increasing their office costs, according to a survey published in JAMA Ophthalmology.

To conduct the study, the researchers emailed surveys to 2,000 ophthalmologists between 2015 and 2016. The 2,000 respondents, whose responses were anonymous, were chosen out of more than 18,000 active US members of the American Academy of Ophthalmology.

The researchers involved found that the EHR adoption rate for ophthalmologists, which is about 72.1%, was similar to rates among other specialties. Nonetheless, it’s a big jump from 2011, when only 47% of the 492 respondents reported using EHRs in their practice.

Most respondents were devoted solely to ophthalmology and had an average of 22 years of practice. They had an average of 5.3 years of EHR use, but nearly the entire group had previously used paper records. Eighty-eight percent of those currently using EHRs had been present for the transition from paper records to digital ones, researchers found.

Not surprisingly, given typical EHR acquisition and maintenance costs, the mean number of ophthalmologists in a given practice was higher among those with an EHR in place than practices without one. Researchers found that when practices were part of an integrated health system, a government health system, the higher the odds of their having adopted an EHR.

While the adoption rate has increased, ophthalmologists actually seem less happy with EHRs than they had been before. For example, many reported that they felt EHRs were undermining both their productivity and financial situation.

For example, more than half of respondents in 2016 reported that their patients seen per day had fallen since adopting EHRs. That’s an unfortunate change in perceptions since in 2006, more than 60% of ophthalmologists saw an increase in productivity after their EHR system was implemented.

Meanwhile, respondents were ambivalent about the impact of EHR use on revenue, with 35% reporting that revenue had remained the same after adoption, 41% a decrease and almost 9% an increase.

Despite concerns that EHRs were undercutting practice productivity, researchers reported that three previous studies of academic ophthalmology practices found no change in patient volume after EHR adoption.

There also seems to be a disconnect between what ophthalmologists think their patients want technically and what they want.  While 76% reported that their patients felt mostly positive or neutral toward EHR use, 36% of ophthalmologists would return to paper records if they had the chance.

That being said, ophthalmology practices do seem to see the benefits in keeping their EHR systems in place. For example, despite the fact that 68% saw paper documentation as faster, 53% of respondents felt their EHRs were generating net positive value.

All told, it seems that ophthalmologists’ concerns about EHR use are working themselves out. However, it also seems as though the doubts we see documented here are deeply rooted and may not go away quickly.

RCM Tips & Tricks: Shortening Length of Claims In Accounts Receivable

Posted on December 21, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

There’s little question that health insurers do little to help your medical practice collect the reimbursement you’re due.  Not only that, ongoing changes in federal laws make improving your collections levels even more difficult.

As a result, physician practices need all the help they can get in shortening the days claims spend in Accounts Receivable, including the seemingly obvious challenge of collecting payment in full from payers, which don’t even honor rates set forth in reimbursement contracts in some cases.

Given these challenges, medical groups need all the help they can get in improving A/R. Here are some tips from medicalbillersandcoders.com:

  • Find claims which might be rejected ahead of time before submitting them to payers. Claims not paid when first submitted are far less likely to ever get paid.
  • Identify such claims using software that can track and respond to rules and regulation changes by payers. This software should also take into account the rate of denials by a given payer for all doctors.
  • Use software (such as practice management tools) to track all payments, and make sure that your practice is paid based on the terms the payer has agreed upon. Insurers pay less than promised for roughly 10% of claims.
  • Create a detailed system to address the aging of receivables, then track those claims by payer, as various payers might have different payment schedules and different procedures for addressing late reimbursement.
  • Make sure you follow up on unpaid claims as quickly as possible, as the sooner your practice follows up with health insurers the more likely you’ll get paid, and the less likely the claim will end up lost or ignored.
  • Using electronic tools, see to it that your A/R workflow is efficient, or your group may endure errors in documentation which slow down reimbursement. Practice management software can be helpful in addressing this problem.

Practices with a large budget may be able to invest in sophisticated, expensive tools which can perform in-depth claims analysis. This can help such practices improve time in A/R for claims.

However, if your practice is smaller and its budget can’t absorb high-end analytical tools, you can still improve your collections by being thorough and having a good workflow in place.

Also, it’s smart to make sure everyone on your staff is aware of your A/R goals. Even if they don’t have direct contact with collections or A/R, they can be the eyes and ears which help the process along.

Should Doctors Offer Concierge IT Security Services?

Posted on December 20, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today, just for fun, I’m gonna start with a thesis and work my way back to see if you agree with its foundations. My conclusion: With the cost of IT security services climbing, the cost of care coordination rising and practice income in many cases remaining relatively level, group practices will have to change their business model substantially.

Specifically, though this may sound insane, I’m suggesting that they may have to begin charging patients for beyond-the-call-of-duty security efforts.

Of course, as we all know, practices are required to offer at least a minimal level of security protection as specified in rules like those in HIPAA. Necessary though it is, it’s a pricey exercise for many groups.

Even so, cold economics may push them to cut data protection further. Given that care coordination will be necessary to meet population health goals, and that quality monitoring and management are indispensable, they may see security as the most dispensable of these spending options.

As the need for care coordination staff, quality management and other necessities of value-based care rise, paying for IT security services will become almost impossible to pay for without borrowing from another source.

That source can come from an internal budgetary resource, such as money allocated for routine general expenses, or other overhead, such as salaries for existing staff members, neither of which is desirable. Of course, there’s also the possibility of obtaining a line of credit, but that’s arguably even worse for the future of the company.

But since no medical organization can go entirely without IT security protection, it will have to find the funds to pay for it somehow. Given that any of the possibilities discussed above will drain the practice and possibly cut its finances to the bone, but something will have to give.

At this point, many practices decide to sell their group to a hospital or health system. That’s certainly a legitimate way of taking on unmanageable levels of overhead and getting access to far more infrastructure options and financial resources.

But if that’s not the direction you want to take, here’s off-ball idea for recapturing some IT security revenue: concierge security services.

While every patient’s data needs to be protected, obviously, you could offer concierge security patients access to extra layers of security attentiveness, such as a private IT staff or to answer any data privacy and security questions they might have about the practice, hospital where they are seen or other entity.

Toss in a special “security report” (in all candor, probably info they could’ve read in any trade magazine), personalized to patient needs, and a free zip drive with secured copies of their data and you’ll have them hooked.

If this worked, and I’m not suggesting that it necessarily would, it could help carry the cost of mundane IT security services. What do you think? Would this model have a chance?