When EHR chat isn’t enough: What practices need from clinical communication tools

Hospital-affiliated clinicians and group practices are investing heavily in electronic health record (EHR) systems to improve documentation, streamline workflows and enhance patient care. In many respects, these systems have lived up to their promise. But when it comes to urgent, real-time communication within and across care teams, practice leaders are discovering a costly shortcoming: the built-in messaging tools often aren’t enough.

Secure chat functions embedded within EHRs may appear to be a convenient replacement for outdated pagers or phone calls. Yet in everyday clinical practice, these tools fall short of the structure, urgency and accountability required in high-pressure environments.

Why built-in chat tools undermine communication

EHR-native chat systems are attractive because they’re already integrated into the clinical workflow. But they often fail in three key areas:No backup plan: 

• When a message goes unanswered, there’s no built-in mechanism to escalate it to another provider. This creates risky gaps in coverage that can delay time-sensitive decisions and lead the sender to assume a response is coming.
• Everything feels equal: Without the ability to differentiate between urgent and routine messages, clinicians may overlook critical updates or become desensitized to all notifications. This lack of prioritization puts patient safety at risk.
• Was it received?: EHR-native chat tools typically lack delivery or read receipts. As a result, clinicians are left wondering if a message was seen, understood, or acted on. This uncertainty creates redundant follow-ups and increases the administrative burden.

These shortcomings can delay care, increase liability and burden staff with unnecessary follow-ups.

Even worse, many EHR-native systems don’t offer insight into clinician availability. A message may go to someone who’s off shift, in surgery, or away from their workstation—leaving the sender guessing and accountability unclear.

A reality check for practice teams

Clinical communication in health care is fundamentally different from workplace messaging in other industries. It’s dynamic, time-sensitive and often critical to patient outcomes. Practices need more than basic messaging. They need intelligent, action-oriented communication workflows.

To address this, communication tools must do more than transmit messages. They must support fast, accurate and context-aware interactions across roles and shifts. Limitations practice teams face when using EHR-native chat systems include:Scattered tools, missed messages: 

• Care teams in independent and affiliated practices often toggle between EHR chat, text messages, WhatsApp, phone calls and even personal apps. This fragmented approach creates delays, duplicated efforts and missed updates. Without a centralized solution, messages can slip through the cracks.
• Too many messages, not enough boundaries: The message volume in health care is growing rapidly. Providers increasingly find themselves checking secure messages after-hours or on days off, which contributes to emotional exhaustion and burnout. EHR-native tools typically lack the intelligence to prioritize or suppress non-urgent communication.
• Every ping feels the same: Generic alerting systems often flood clinicians with every type of message, whether it’s urgent or not, through the same channel. Over time, this creates alert fatigue, and it becomes harder to spot what truly matters.
• Handoffs that leave gaps: Critical details are often lost during patient handoffs between staff, locations or shifts. While EHRs track records, they can’t guarantee message delivery, acknowledgment or follow-through.

What practice leaders should look for in a communication platform

If your practice relies exclusively on EHR chat, now is the time to reconsider. The right communication platform doesn’t replace your EHR. It enhances it with role-specific workflows that reduce errors and save time.

Key features to prioritize include:

• No message left behind: Implement automated escalation workflows that reroute unanswered messages to backup contacts to ensure clinical alerts don’t sit idle when the initial recipient is unavailable or unresponsive.
• Right person, right time: Use role- and shift-based routing to ensure every message reaches the appropriate on-call provider to remove the guesswork from manual directories or outdated call trees.
• One hub to rule them all: Consolidate all communication channels—text, voice, alerts - into a single secure platform to eliminate the need to switch between multiple apps, systems or devices.
• Boundaries that stick: Enable clinician-level controls for delivery timing and message triage to prevent after-hours interruptions from non-urgent alerts and support work-life boundary protection.
• Smart signals only: Deploy tiered alerts and AI-based filters to distinguish between high-priority and routine messages to reduce alert fatigue and keep clinicians focused on patient care.
• Compliance without the chaos: Activate full audit trails that log message delivery, read status and responses to documentation easier and help practices meet regulatory and legal requirements.
• Plug & play power: Choose systems that integrate with your EHR, on-call schedules, and calendars. This enables real-time syncing and minimizes setup and maintenance.

Better communication, better practice

Clear, reliable communication isn’t just a quality-of-care issue—it’s a practice viability issue. When messages fall through the cracks or clinician burnout rises, everyone pays the price.

Investing in a purpose-built communication platform helps practices deliver care that’s not just faster but safer and more sustainable. It empowers teams to collaborate effectively, respond confidently and stay focused on what matters most: their patients.

As clinical and operational demands grow more complex, practices need more than just a reliable EHR. Thriving in today’s health care environment requires communication tools that match the pace and precision of modern care.

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Mergers and practice culture

There are many reasons why physician practices merge or acquire other practices: increased market share, gaining new capabilities, diversifying a product offering, and more.

It’s also no secret that mergers and acquisitions sometimes don’t go as planned. The most common reason mergers and acquisitions fail: culture.

In my experience, the largest contributor to merger and acquisition failure has to do not with the business but with the people. More specifically, how we handle (or fail to address) the cultural differences between organizations, which are exacerbated by a lack of effective communication. Leadership did account for the culture or anticipate a potential culture clash.

To ensure your merger or acquisition has the greatest chance of success, it’s critical to make your employees’ experience painless (or at least less painful). Consider what’s at risk during such a transition, how you communicate with employees, and how to support them. It’s especially important to focus on people and culture during an acquisition or merger. Be sure to communicate with employees, collect feedback to take targeted action for retention, and provide ongoing support.

Anticipate potential roadblocks

There are a few things at risk during a merger or acquisition: losing talented employees, disrupting the culture of your practice, and missing opportunities to communicate with newly-acquired employees.

To avoid having employees jump ship, speak with them, ideally before the deal closes. This will give you a better understanding of which parts of the business are at highest risk of turnover. The goal here is to reassure employees of job security and to thus reduce the risk of a mass exodus.

It’s inevitable that your physician practice culture will change after a merger or acquisition. There are three common ways to thoughtfully develop and shape a culture post-merger:

1. Choose one business’ culture to be carried on,
2. Create a new culture that combines the best from both physician practices, or
3. Create a completely new culture.

Each path has its pros and cons. Whichever you choose, it’s important to communicate your decision, and your rationale, with employees. During times of transition, communication often becomes increasingly siloed to top-level decision makers, leaving the majority of employees in the dark. This disconnect causes rumors to spread and breeds distrust of leadership. Devise a communication plan before the deal is finalized and exercise it throughout the process.

Prepare employees

Concerns about job security are top of mind for employees. They want to know if their role will still be relevant, if their past successes going to be recognized, and how they will be accepted as members of the new team. Address their concerns and keep them updated on the process and timeline as much as possible.

Also communicate how and when benefits will transition, what their election options are, time off polices, how you conduct performance reviews, and when and how you review compensation. Addressing employees’ basic needs is crucial to establishing a foundation of trust and building confidence in leadership.

Offering career path training pre- or post-merger is a great way to prepare and support employees. This way, even if there are layoffs or they opt to leave, they have an understanding of what their next step should be and where their strengths lie.

Once the acquisition is complete, it’s a good idea to conduct onboarding for acquired employees, same as you would for a new hire. This is a great way to make them feel integrated and welcomed as well as establish expectations. Is there an actual orientation process? Do they need to participate in any training or watch any videos? Is there written material for them to read on their own? Is there welcome swag?

 Treat them like members of the team, because they are.

Remember, you don’t need to wait until things feel settled to collect feedback post-merger or acquisition. Soliciting employee feedback during times of transition will give you the data you need to take action, and ensure employees’ voices are heard both now and in the future.

By adhering to these pointers, you raise the likelihood of immediate and long-term success for your merger or acquisition. You will also likely significantly reduce the inevitable anxiety that comes with such a significant effort. That’s a win/win for all involved!

 

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8 lessons we can learn from ants

“Go to the ant, you sluggard;
consider its ways and be wise!
It has no commander,
no overseer or ruler,
yet it stores its provisions in summer
and gathers its food at harvest."
- Proverbs 6:6-8

I have looked to business, industry, and Amazon for suggestions on having a more efficient practice and becoming a better doctor. I have also looked at nature to provide examples of efficiency, productivity, and persistence. This blog will describe eight lessons that we might learn from the ants.

1. Have a purpose

Some ants are workers and aim to find food for the colony. This is their only purpose, and they input all their time and energy into this. In our medical practices, we have one overriding goal: to take care of patients. Everything else, including patient satisfaction, online reputation, and collections, is secondary to the goal of providing care for those who come to see us for help. I don't mean to imply that satisfied patients and a doctor's reputation are unimportant. Still, they are secondary to our overriding purpose of caring for our patients.

2. Teamwork

Ants are team workers, working together to achieve something beyond what one ant can do. They work together in highly coordinated colonies, relying on each other's strengths to achieve common goals. Similarly, doctors collaborate with colleagues and other healthcare professionals to deliver comprehensive, integrated care.

Likewise, doctors must align themselves with others who can help propel them to a higher level. A doctor can't answer the phone, make appointments, write prior authorization letters, and focus on patients alone. It takes a team to provide outstanding care for patients.

Staff motivation is paramount to achieving this goal. A two-minute morning huddle can ensure that your staff is on the same page each morning. This meeting with the doctor and the entire staff ensures that everyone is on the same page and working together to create a positive experience for every patient.

The morning huddle is a pause or time out at the beginning of the day to review the game plan for the whole day. An effective huddle requires the doctor to arrive before the first patient is seen and review the daily schedule with the staff. Each appointment is reviewed for potential "gotchas" or sources of delay. For example, if a patient returns to discuss a biopsy report, check that the pathology report is on the chart and has been reviewed by the doctor before entering the room. Nothing is more discouraging to a patient than waiting for the report from the pathologist or the hospital. Patients who have had a biopsy are anxious about the findings, and a delay of even a few minutes can add to their anxiety. Just as patients have been preparing psychologically for several days for the visit, it is reasonable to expect the practice to take the same care in preparing to review a report or blood test before the doctor has a discussion with the patient.

Another example is anticipating the special needs of a patient with limited mobility. Having a wheelchair ready before the patient arrives sends a powerful and caring message. You can also ensure that a room that accommodates a wheelchair is available.

If a patient is going to have an office procedure, the morning huddle is a time to check the instruments and medications and ensure a comfortable room temperature for the procedure.

The doctor doesn't want to be in the room doing the procedure and must send someone out to obtain more medications or supplies.

Let the staff be aware of any last-minute developments that could affect the daily schedule: for example, the need for a doctor to leave at lunchtime for a meeting, a lecture, or a short case in the operating room. If the staff knows about the time that the doctor leaves, they will have patients in the room and ready to be seen in a timely fashion so that the doctor can be on time for a commitment.

The morning huddle motivates the doctor to start on time and stay on time. If the doctor is consistently late, then the day starts out behind schedule before the first patient is seen. This leads to stress on the staff, and they cannot perform at the highest level when there is stress in the office setting. For the morning huddle to be effective, the doctor must be part of the process and must be on time. We know that some urgencies and emergencies sometimes make it difficult or impossible for the doctor to be on time. But this should be the exception and not the rule. We can do far better to be on time for our patients. The morning huddle takes only a few minutes. It is the best two minutes you spend with your staff daily.

The take-home message on the morning huddle: we can learn about teamwork from the ants to consistently create a productive and enjoyable practice.

3. Rest after work

Ants work with the natural seasons. In the summer, they gather food, and in winter, they hibernate to conserve energy because of the lack of food. It's about knowing when you need to stop.

Doctors can't continuously work 70-80 hours a week. We must take time out to recharge our batteries. I find it better to take frequent, short, 2-to 3-day vacations rather than longer, 2- to 3-week holidays. After a long vacation, I often find myself exhausted when I return, and I don't receive the recharging benefits of shorter holidays.

4. Resilient

Ant colonies recover quickly from setbacks and continue functioning effectively. Doctors can cultivate resilience to navigate medicine's emotional and professional challenges, preventing burnout and promoting a healthy work-life balance.

There will be minor crises, such as a power outage that incapacitates your EMR. Then there are major crises, such as a natural disaster, like Hurricane Katrina, which put the city of New Orleans underwater and required mandatory evacuation. Citizens, patients, and doctors could not return for several months. Minor and major crises will occur in most medical practices and require a resilient physician to restore the practice back to normal.

5. Adaptable

Ants can adapt to various environments and obstacles, finding creative solutions to overcome challenges. Physicians should also demonstrate adaptability in the face of healthcare system changes, evolving patient needs, and technological advancements.

For example, COVID-19 allowed physicians to treat patients using telemedicine. We discovered we could provide excellent care even if we weren't in the same exam room and could not touch the patient. (It also made telemedicine more acceptable to physicians when we were reimbursed at the rate as an in-office encounter) Since telemedicine has become acceptable to patients, practice must adapt to this option even when the pandemic has passed.

6. Determination

Ants are known for their tireless work ethic and determination. Doctors can apply this dedication to their patient care efforts, continuously seeking better treatment options. Doctors must be committed to stay up-to-date on the latest medical advances. It is also beneficial for the practice to update the skills of staff and provide them with continuing education, the use of technology, and knowledge of recent changes in coding to achieve optimal reimbursements.

7. Caring for others

When a few ants in a colony are infected by a fungal disease, they lick the fungus off one another, thus preventing the spread of the disease throughout the colony.

Just as ants care about the colony's health, we must care for the health of our patients and staff. Whenever a staff member has a medical problem, it is helpful for someone in the practice to call another doctor and ask if they can quickly see your staff person. If the staff person is sick and unable to come to work, it is a nice gesture to call the patient at home and check on their condition.

8. Efficiency

Ants optimize their resources and follow efficient processes to accomplish tasks. Doctors can learn from this by streamlining workflows, reducing waste, and implementing cost-effective care strategies.

In November 2022, ChatGPT became available worldwide. ChatGPT acquired 1 million users within just 5 days of its launch. By comparison, it took Instagram approximately 2.5 months to reach 1 million downloads. And Netflix had to wait around 3.5 years to reach 1 million users. Doctors who were early adaptors of ChatGPT learned this technology could take on administrative tasks better and faster than previous inefficient methods.

For example, physicians spend an average of 14 hours a week generating letters requesting prior authorization (PA) for tests, procedures, and medications. I have demonstrated that ChatGPT can generate a PA letter in seconds, resulting in more efficient use of physician time and faster patient care.

Bottom Line: By considering the lessons offered by these industrious insects, doctors can enhance their patient care strategies and adapt to the ever-changing healthcare landscape.

 

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Leveraging denial tracking to root out systemic issues

Denials are rising for physician practices, with 73% of respondents to Experian’s 2024 State of Claims survey reporting that claims are being denied more frequently, up 10% over 2022. It’s bad news for practices that are already struggling to get paid, with nearly 50% of respondents reporting denial rates of 10% and higher.

Revenue leakage may be the most apparent outcome of denied claims, but it is far from the only serious impact. Reworking denied claims consumes time and resources that few practices can spare. Also, frequent denials can lead to a crisis of confidence in payer relationships and technological support. According to Experian, providers’ confidence in payer reimbursements is sinking, due to patient concerns and stringent payer policies. Furthermore, only 54% of respondents were confident in their ability to manage revenue cycle demands with technology in 2024, compared to 77% in 2022.

Curbing denials and their downstream impact requires a dual approach: leveraging insights from denial analytics and relying on the specialized expertise of clinicians trained in revenue cycle management who are uniquely positioned to identify and respond to denial patterns.

Blame to share

Climbing denial rates can be blamed on a variety of issues, with payer maneuvering being a primary culprit—and prior authorization policies playing an outsized role. According to an American Medical Association (AMA) survey, 94% of respondents believed prior authorizations negatively impact patient outcomes, while 89% reported that they interfere with continuity of care, and 61% indicated that patients, once stable on a specific treatment, were at times destabilized.

Yet not only have payers expanding the number of services requiring prior authorization, but they have also demonstrated a tendency to frequently change the rules of engagement. For example, increasingly rigorous documentation requirements often lead to incomplete or inconsistent documentation, resulting in a higher number of rejected claims and heightened administrative burdens.

Payers also utilize increasingly advanced technologies to automate medical necessity reviews, enabling faster and more efficient pre-procedure denial of coverage. This same technology is used post-service to rapidly identify claims for denial, requiring practices to dedicate greater resources to both front- and backend rework for appeals and disputes at an average cost of $25 per claim, according to the AMA.

Payers cannot carry all the blame, however. Physician practices also hold some accountability for reasons ranging from outdated technology and workflow inefficiencies to disconnected revenue cycle management processes. In fact, half of all denials can be attributed to front-end revenue cycle issues, such as inconsistent internal processes that delay reimbursement and increase the time required to rework claims. Fragmented workflows and siloed patient access teams also come into play by creating barriers to efficient scheduling, eligibility and benefits checks, and prior authorization.

A lack of advanced technology and reporting capabilities is particularly problematic for physician practices, especially smaller practices with limited resources. Despite growth in the adoption of enhanced analytics and automation tools by payer organizations, physician practices remain entrenched in a world of spreadsheets and manual processes, where it is impossible to establish efficient and time-sensitive financial clearance and other patient access workflows.

This lack of analytics also makes it impossible to track authorizations, verify eligibility and benefits, and identify at-risk accounts for immediate attention—data that is crucial to preventing revenue leakage associated with denials, such as missed filing deadlines and incorrect claim submissions.

Rooting out systemic issues

Indeed, the ability to track and analyze denial data is one of the strongest business cases a practice can make for investing in advanced technologies, including workflow automation tools for enhanced revenue cycle management. They are essential to identifying and correcting the systemic issues contributing to rising denial rates (which should ideally remain below 3% of revenue as a benchmark for accurate billing) and associated revenue leakage.

By scanning historical claims, advanced denial analytics can detect recurring denial trends, such as specific CPT codes, payer types, or documentation gaps, and categorize them to help practices identify areas with the most frequent and costly denial-related issues. When artificial intelligence is thrown into the mix, high-risk claims can be flagged for review before submission, allowing errors to be corrected and denials avoided.

Denial analytics can also be leveraged to optimize front-end processes by revealing breakdowns in key areas such as patient registration, insurance verification, and preauthorization workflows—areas Experian indicates are responsible for up to 76% of denials, particularly those driven by missing, incomplete, or inaccurate data. This same data can be used to inform staff and clinician training by identifying departments or individuals that would benefit from targeted education or redesigned workflows.

Advanced analytics can also enable practices to identify which payers deny claims most frequently and the reasons behind these denials. This allows for improved contract negotiations and tailored submission strategies.

Insights from denial analytics can also be applied to billing and documentation processes to prevent repeat errors. Practices can also compare internal denial rates to industry standards or peer groups to gauge performance and set improvement goals.

Filling clinical resource gaps

One of the most significant challenges physician practices face in optimizing denial management to eliminate systemic issues is the limited availability of clinical resources capable of guiding the transition to a proactive denial prevention model. Successfully disputing denials and improving first-pass rates requires a medical background and skill set. It also requires the ability to coordinate effectively between clinical and business office teams.

The problem is that few practicing physicians have the bandwidth to add these tasks to their daily to-do list without impacting patient volume and care quality. Further, recruiting additional clinical resources in today’s labor market is a challenging and costly endeavor, regardless of how well-funded a practice may be. For many groups, outsourcing some or all clinical administrative services—including clinical documentation, utilization management, clinical prior authorization, clinical denials and appeals, and physician advisory services—to the right partner can put advanced denials management within reach.

Outsourcing clinical administrative services provides practices with access to credentialed physicians who have specific training and experience in both revenue cycle management and patient care. They are uniquely qualified to act as a bridge between clinical and business offices and also to identify and correct patterns in denials, particularly in terms of medical necessity. Importantly, their unique backgrounds and experience also allow them to optimize the use of denial data in a way that others cannot, driving lasting improvements.

This was the experience of a health care organization in the Midwest that was struggling with limited clinical labor resources and increased clinical denials, at a time when operational costs and wage growth were escalating. The group was also experiencing a growing need for Spanish-language support.

The group brought in an outsourcing partner to provide cost-effective, bilingual near-shore support and address claims denied for clinical reasons. The partner assembled a team of highly skilled clinicians, including licensed physicians, with expertise in utilization review, documentation improvement, and clinical denial management.

To ensure seamless integration, a collaborative training program was developed with the health care organization, aligning the vendor’s team with the client organization’s unique processes and diverse IT systems. The two organizations worked together to implement a robust process to analyze denials, evaluate recovery potential, and validate appeal cases using clinical indicators and CMS guidelines, successfully recouping lost revenue.

As the team expanded, the partner introduced a structured learning and development system that prioritized workflows based on complexity. This approach created a talent pipeline where team members gained on-the-job experience, progressing from low-complexity cases to high-complexity tasks, including physician advisory support and clinical documentation integrity.

Through its near-shore outsourcing partnership, the organization successfully recovered 55% of previously denied claims, totaling over $12 million in reclaimed revenue. This approach ultimately delivered a return on investment nearly 40 times the annual outsourcing cost.

The key to successfully outsourcing aspects of clinical administrative services for denial prevention is partnering with the right outsourcing vendor. Look for one with a deep bench of clinically trained experts with the skills and experience needed to augment the capabilities of internal RCM teams seamlessly. Prospective partners should also be able to scale services to meet changing needs rapidly.

Vendors with these capabilities can deliver prompt and precise processing of clinical documentation, authorizations, and other burdensome tasks, ensuring that each patient engagement receives consistent care and attention regardless of patient volume.

Proactive prevention

By shifting from reactive denial management to proactive denial prevention, physician practices can enhance cash flow, reduce administrative burden, and improve patient satisfaction. Denial data can provide a wealth of insights that, when leveraged for operational improvement, will ultimately reduce billing errors, reimbursement delays, and administrative burdens, while improving overall efficiency.

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Complexifiers and simplifiers

There are two kinds of people: those who make things complex and those who simplify. In contemporary health care, patients are looking for simple solutions to complex problems. Also, medical practices are searching for simple solutions to solve the current complexity of managing a medical practice. This blog will focus on the complexifiers and the simplifiers in a medical practice and how to move from the complex to the simple solutions for many of our management issues.

Complexifiers are averse to reduction. Their instincts are to keep things complicated and to reject simple ideas. Often, they think that keeping things complicated maintains their job security. The complexifiers are stuck in the status quo and reject new ideas and new solutions for solving problems. The complexifiers take pride in consuming more bandwidth, more time, and patience than needed, and expect rewards for it.

Simplifiers thrive on conciseness and brevity. Simplifiers never let their ego get in the way of a better idea, improvement in efficiency, or suggestions to enhance productivity. When a simplifier is given a complicated task, they look for the simplest way to achieve what needs to be done. They find ways to communicate complex ideas in simple terms without losing the idea's essence or significance.

In modern health care, various factors contribute to the complexity or simplicity of managing a medical practice.

Examples of complexifiers and simplifiers in health care:

An issue that confounds doctors, office managers, staff, and even patients is the regulatory environment imposed by the government and insurance companies. Health care policies, regulations, and compliance requirements make it difficult to deliver health care services.

The health care industry is subject to numerous complex regulatory requirements, with rules and guidelines from various governing bodies to deliver high-quality, safe, and effective care. Yet it is these requirements that slow the delivery of health care. An example is the necessity for prior authorization (PA) for permission to see a patient, to prescribe medications, order an imaging study, or to proceed with an appropriate medical procedure. As a result, physicians must create prior authorization letters at the end of their day or generate these authorization letters in the evening, which is referred to as pajama time. The time requirement to create a PA is often several hours a week of uncompensated time.

Regulations such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States protect patient privacy and the security of personal health information. Health care providers must comply with these regulations to ensure sensitive data is appropriately handled and is encrypted to ensure that sensitive patient information remains private and secure.

Regulatory bodies set standards for the quality and safety of health care services, facilities, and medical devices. For example, the Joint Commission in the United States oversees health care organizations based on their compliance with established standards.

Regulatory agencies, such as the U.S. Food and Drug Administration (FDA), oversee the development, approval, and monitoring of pharmaceuticals and medical devices to ensure their safety and efficacy. The cost of studies to approve a new drug is more than $1B. This cost should decrease with the usage of AI.

Regulations govern how health care providers are reimbursed for the services they deliver. In the United States, the Centers for Medicare & Medicaid Services (CMS) play a significant role in determining reimbursement policies for these government-funded programs. Proper coding is necessary to receive the appropriate reimbursement for services provided. Many practices will down-code their services to avoid potential audits and penalties if their documentation does not meet the requirements for the billed codes.

These regulations pertain to the licensing, credentialing, and ongoing education requirements for health care professionals to ensure they possess the necessary qualifications and skills to deliver care. The credentialing process for a new physician can take four to six months, and as a result, the new physician cannot bill for their services.

With the growing adoption of telehealth and digital health technologies, regulatory frameworks are evolving to address privacy, security, and quality concerns specific to these platforms.

The take-home message is that the complex regulatory environment in health care creates both challenges and opportunities for providers. While compliance can be resource-intensive, time-consuming, and expensive, it is essential for promoting high-quality care and protecting the well-being of patients. It is a veritable nightmare for practices to stay informed about relevant regulations. This is an opportunity for simplifiers to find methods that protect the patient but not bury the practice in a mountain of complex regulatory requirements.

Let’s welcome the simplifiers

The holy grail of interoperability remains elusive. Other countries such as England, France, and Germany have solved the interoperability enigma. Why can't the U.S. health care system do the same? Seamless data exchange between health care systems and providers would streamline care coordination and improve decision-making. It is a difficult pill to swallow knowing that other developed countries achieve interoperability. Still, the U.S. health care system can't accomplish this.

Organizing care around patients' needs and preferences can enhance engagement, satisfaction, and outcomes while simplifying care delivery. For example, a frequent patient complaint is difficulty gaining access to the practice. This often necessitates patients going to urgent care centers for acute problems. This issue can be simplified using AI technology to effectively schedule patients 24/7 so that patients do not need to wait weeks or months to see a physician.

We need to simplify the measurement of outcomes and find methods to measure the quality of care. We need to transition from a system that focuses on volume of care to one that emphasizes quality of care. We need to encourage more efficient, effective, and coordinated care, with patients' interests taking priority over physicians' interests.

Since the pandemic of 2020-22, we have learned that we can offer patients good medical care in many instances without the necessity of having to touch the patient and see them in the office. Still, we can provide care using remote care delivery via telehealth platforms. As a result, we can make health care more convenient for patients by simplifying access to care.

Harken AI to simplify the delivery of medical care. AI-driven solutions and automated processes can help reduce administrative burden, analyze data, and optimize workflows, ultimately simplifying various aspects of health care delivery. The time has arrived to implement AI solutions. By leveraging AI as a strategic approach, rather than just reducing administrative burdens, we can deliver high-quality care more efficiently and provide decision support for treatment pathways based on robust data.

Bottom Line: Identifying and addressing complex problems and embracing simplifiers is crucial for optimizing health care systems and improving patient care.

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Meeting patients where they are: Rethinking payment flexibility in health care

Anyone receiving care from a health care provider is more than just a patient—they are an empowered health care consumer. As seen across numerous industries, today’s consumers expect seamless, end-to-end experiences, and health care is no exception. These expectations include flexible, convenient payment options that mirror the ease of use found in other sectors. In fact, multiple McKinsey Consumer Health Insights surveys reveal that health care consumers—regardless of age or background—are eager to integrate the same digital tools and services they already rely on in retail, banking, and travel into their health care experience.

At a time when consumers increasingly are paying for health care out of their own pockets, provider organizations can ill-afford to create confusion and friction in the billing process that will alienate customers and reduce collections. Not only must health care organizations be more transparent about costs of service, but they must also offer payment options that reflect generational preferences – or risk being outpaced by health care providers who offer greater flexibility and a more seamless patient journey.

Diverse patient needs

Health care consumers are a diverse group, spanning multiple generations and socioeconomic backgrounds. These differences are reflected in how (and how much) they use technology for transactions. Pew Research Center reported last November that 97% of Americans ages 30 to 49 own a smartphone; for people over age 65, that number drops to 79%.

Similarly, in a federal consumer survey published last fall, 85% of respondents in their 20s and 30s reported using online financial services such as PayPal, Venmo, or Cash App to transfer funds or pay bills. That percentage fell to 70% for Americans in their 60s, 64% for respondents in their 70s, and roughly half for people over 80.

In addition to providing patients with payment options that meet their needs and preferences, health care organizations must take into consideration other factors that impact their ability to collect payment. There are some patients who lack even basic financial tools like bank accounts, thus sharply limiting their payment options.

Another consideration is propensity to pay, which involves more than just an individual’s credit score. Health care organizations can leverage predictive analytics to more accurately assess what a patient can realistically afford. For example, while one patient may be able to pay a $1,500 bill in full without issue, another may require the option to spread that amount across five monthly payments of $300—because that better aligns with their financial capacity. Tailoring payment options to individual affordability not only supports better patient outcomes but also improves collections and patient satisfaction.

If a provider offers a payment plan, the patient likely will be more willing and able to reimburse that provider over a period of weeks or months. Encouraging convenient and timely payments helps maintain revenue without diminishing the patient experience.

Embedding payment options along the patient journey

Some providers isolate the payment process within a standalone workflow, typically after services have been rendered. However, by integrating payment opportunities at natural touchpoints such as requesting a co-pay at check-in or reminding of a balance due during after-visit summaries, providers can facilitate frictionless payment capture to improve collection rates and patient convenience.

The unpredictable nature of health care costs can impact how patients want to pay. Some might prefer debit cards for known expenses such as copays, but lean toward credit cards for larger or unexpected charges such as deductibles or additional procedures. However, simply accepting card payments is no longer enough to meet patient expectations. Many consumers are using digital wallets as their primary payment method and no longer carry cards with them. And cash hasn’t gone away – some patients continue to rely on it.

Cautionary advice

Provider organizations must strike a careful balance between offering payment flexibility and protecting their financial health. Common pitfalls to avoid include:

• Applying a one-size-fits-all approach to collections
• Neglecting to communicate clearly and early about payment expectations

A one-size-fits-all approach to collections often fails to reflect the diverse needs of patients. Some are able to pay in full, while others require structured payment plans. Offering flexible, personalized options can improve patient satisfaction and still support revenue goals.

Introducing third-party financing can also be effective, but it’s essential to ensure that the partner aligns with your organization’s values and communication approach. Without insight into how they engage with patients, the experience risks becoming disjointed or inconsistent with your standards of care.

Early, transparent communication is equally critical. Setting clear payment expectations before care is delivered—when possible—helps patients plan and reduces confusion or delayed payments. Being upfront about costs, responsibilities, and options makes the billing process feel less confusing and builds trust.

It's essential to recognize that the payment experience is a core component of the overall patient experience. It also often represents the final step in the patient journey for a particular treatment cycle. A negative billing experience can leave a lasting impression—regardless of the clinical outcome—and may ultimately drive patients to seek care elsewhere.

Conclusion

As technology continues to transform health care, provider organizations are encouraged to embrace digital advances that improve patient care and increase operational efficiency. At the same time, they must remain cognizant that not every patient or demographic group is willing or able to embrace the latest technologies and digital payment options. Tech-forward solutions can't always entirely replace legacy options, which is why providers must work to meet patients where they are.

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What the new primary care patient management code means for your medical practice

Time is back on your side. The Medicare Advanced Primary Care Management (APCM) codes released in January recognize the value of continuous, complex patient care provided by health care providers in primary care settings without the previous minimum time requirements. The Centers for Medicare and Medicaid is crediting primary care physicians and staff for the patient management tasks that many already perform but may not bill Medicare for given the previous need to demonstrate, for example, at least 30 minutes a month for principal care management or a minimum of 20 minutes for non-complex chronic care.

Many primary care offices do not have the bandwidth or staff needed to document and attest to the time it takes to perform these essential services.

Now, however, when they monitor chronic patients for disease exacerbations, medication changes, follow-up care, specialist referrals, and more as standard practice between visits, they can bill Medicare based on the severity and needs of these chronic care patients using the new APCM codes GO556, GO557, and GO558. Bundled payments reflect patient complexity, with codes that differ according to one chronic condition or none versus two or more, for example.

Part of the Medicare APCM requirements state that continuous, proactive care includes remote evaluations of pre-recorded patient information. A primary care practice can meet this standard by partnering with a firm that offers remote care services including remote patient monitoring (RPM) and care coordination by a care team. The physiological data collected by RPM together with care coordination and APCM coding creates the potential to identify emerging health issues sooner and reduces the need for patients to seek emergency or urgent care.

With these new APCM codes, Medicare is acknowledging primary care providers manage complex patients and provide care planning, education, and follow-up. Care management also means checking in to make sure patients have access to their medication and are adhering to their treatment plans. When qualified health care professionals, particularly registered nurses, validate and interpret RPM data while simultaneously providing care management, they can deliver immediate value to both providers and patients. This approach transforms raw data into actionable insights that drive better patient outcomes.

Overall, these APCM codes are exciting because they are dedicated to the primary care world. At the same time, specialists still have access to chronic care management and principal care management billing options. APCM codes give primary care providers a broader space to get reimbursed for their care coordination and management.

Capturing the tasks that comprise APCM also impacts future care initiatives and reimbursement policies. Reporting and tracking these chronic care services will influence resources, coding, incentives, opportunities, and programs. This will allow providers to continue to manage patients in chronic disease states in an optimal way by putting the resources in the right places for the right people.

With these new codes, the Centers for Medicare and Medicaid recognize that primary care providers play a primary role in comprehensive care management in a more practical way. Doctors, nurses, and staff have multiple touchpoints with patients every month, virtually, remotely, and in person during clinical visits. Some of these essential interactions are brief, such as the two minutes it can take to update a prescription online. Before these coding changes, busy practitioners had to stop and note the increments of time required for each task to meet minimum monthly requirements for reimbursement. With APCM codes GO556, GO557, and GO558, however, management of people with chronic conditions is off the clock, meaning primary care physicians can stop being timekeepers and instead focus more time and energy caring for each of their chronic disease patients.

Medical Office Supplies

 Medical and Rx Pads

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