Monday, March 18, 2024

Healthcare staffing and reimbursement challenges: How automation and AI can help

Ambulatory surgery centers (ASCs), which proliferated post-pandemic, are a booming business. With the increasing trend towards ASC-based treatments, forecasts predict a 22% rise in ASCs and an 18% increase in outpatient surgical and cardiovascular procedures over the next decade.

The increasing population of individuals aged 65 and older is creating a higher demand for ASC and general healthcare services. Currently, this age group accounts for 34% of the demand for physicians, a figure expected to rise to 42% within the next decade. The implications of America’s aging population on healthcare spending are significant. In 2022, healthcare spending was estimated at $4.5 trillion , but it is projected to soar to nearly $7 trillion by 2030.

Growing demand for ASCs presents both opportunities and challenges, especially in terms of revenue cycle management (RCM) and workforce.

Given these challenges, the questions arise: How can RCM departments cope? How can ASCs and other healthcare providers alleviate their reimbursement and staffing pressures, lower operational expenses, boost efficiency, and support future growth to increase profitability?

The solution lies in addressing staffing and reimbursement issues through automation and AI.


Complexity and claims denials pose a significant challenge


Before exploring why automation and AI are the future, let’s size up the challenges.

Healthcare administration is becoming increasingly inefficient. About $60 billion was spent on healthcare administration in 2023 – $18 billion more than in 2021. The cost of claim submissions also rose by 83%. This isn't the fault of healthcare providers; it's due to the increasing complexity of systems.

Reimbursement has been a persistent issue for RCM departments since the inception of the provider payer system, and it continues to be a growing problem. Claims denial rates are rising by 10% annually. If your denial rate is 10% or higher, you are in the danger zone.

The added work and write-offs associated with denials significantly impact your margins and can hinder your ability to manage claim and patient appointment volumes. Each denied claim adds $118 to your overhead – that’s $8.6 billion a year for the healthcare system at large.

This is in addition to the costs of servicing and processing your existing claims!


Staffing shortages continue to add cost and introduce errors


Healthcare organizations are facing a workforce gap, which is growing exponentially.

Employee turnover in RCM is as high as 40%, significantly greater than the overall employee turnover rate of around 3.8%. Frequent departures from RCM roles mean that existing employees have to take on more work, or healthcare providers must consistently invest resources to recruit, hire, and train new staff.

The constant cycle of recruitment, staffing, and training incurs significant costs. Replacing an employee can cost up to twice their annual salary. New and overloaded employees are more likely to make errors. Furthermore, 80% of healthcare professionals believe that labor shortages can negatively impact patient experience.

The double blow of staffing and reimbursement challenges is hitting healthcare providers hard

Healthcare providers often attempt to tackle either reimbursement difficulties or staff shortages separately. However, these two challenges are closely interconnected.

An increased RCM backlog results in an overwhelming workload for your team. This puts pressure on your staff, leading to decreased job satisfaction and increased turnover.

Insufficient staffing exacerbates reimbursement challenges. Overworked staff members are more likely to make errors and struggle to keep up with the volume of work.

Increased reimbursement difficulties, such as a rise in denied claims due to more errors, require even more staff.

Historically, the solution was to hire more people to handle the increased workload. However, given the current labor shortage, this is no longer a viable solution. It only perpetuates a downward spiral.


Automation and AI are the solution


Automation and AI offer speed, infinite scalability, and efficiency, which can enhance both customer and employee experiences, making your business more efficient and profitable.

Our experiences with customers have shown that AI and automation can perform the same tasks while reducing operating overhead by 80-95%. They can make each employee ten times more effective, retain top talent, enhance patient experiences and outcomes, and eliminate the need for hiring for administrative jobs.

From a reimbursement standpoint, AI can improve Days Sales Outstanding (DSO) and cash cycles by over 50%, reduce claim denials by up to 75%, and provide unlimited transparency and reporting (as AI can self-report). This can further improve providers' RCM processes.


Path to scalability, profitability, and better outcomes


To determine if your organization is a good candidate for automation, evaluate your employee headcount and business revenue. If you have at least 20 people working on RCM, automation could yield significant return on investment. If your business generates $100 million in net patient services, this also suggests that automation could be highly beneficial.

Begin by identifying tasks that could be easily automated. Eligibility verification is often a prime candidate for improvement due to the substantial amount of human labor it requires. Automation can also significantly enhance claims processing efficiency.

Find a partner with the resources to continually invest in research and development. This will allow you to collaboratively improve and grow. Opt for a provider that offers end-to-end automation, uses predictive models to provide insights, gives you an edge in running your revenue cycle more effectively, and is committed to customization and adaptation.

Adopt a comprehensive approach to automation to tackle both staffing and reimbursement challenges. This will enable your organization to leverage automation and artificial intelligence to address staffing issues and resolve reimbursement problems once and for all.


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Friday, March 15, 2024

‘Moneyball’ and investing in primary care

Over the past several years, a series of studies have showed the declining health of Americans, the exorbitant costs the U.S. pays for health care and how these and other factors are leading to a dramatic decrease in life expectancy. These studies are always startling due to the confusion associated with how the people living in the wealthiest nation find themselves in such a position and, more concerning, why we aren’t more aggressive in reversing these trends. For me, the answer is simple: we continue to turn to the same solutions that continue to misidentify and misvalue the true drivers of health. Oddly, this brings me to Michael Lewis.

I recently listened to an episode of the Freakonomics Radio Podcast featuring author Michael Lewis. The episode, revisits his bestselling book, “Moneyball.” In the book, Mr. Lewis writes, “If gross miscalculations of a person’s value could occur on a baseball field before a live audience of 30,000 and a television audience of millions more, what did that say about the measurement of performance in other lines of work? If professional baseball players could be over or undervalued valued, who couldn’t?”

Well, Mr. Lewis, let me tell you about primary care physicians.

The scoreboard


Just as was the case in baseball, our health care system is prioritizing and investing in the wrong things. As a result, we aren’t winning games. In fact, we are losing games at an alarming rate. One recent analysis shows per capita spending on health care increased even while new data from the Centers for Disease Control and Prevention show that life expectancy continues to decrease in the United States. Not to mention the proliferation of chronic disease and our alarming maternal mortality rates.

These two studies aren’t outliers. Each year, the Commonwealth Fund publishes a report that shows the same two distinct results: the U.S. underperforms in most categories associated with quality and patient outcomes; and we spend far more money on health care than any other country – in some cases, twice as much.

Our health care marketplace and those who design benefits continue to grossly misvalue primary care and, some would argue, overvalue other disciplines of medicine. In the United States, on the best of days, we spend about 5% of our health care resources on primary care. Despite research demonstrating that communities who invest in primary care have better health outcomes we continue to operate a benefit structure that disincentivizes the utilization of primary care. This approach has consequences, and those consequences are poorer health outcomes and excessive per-capita spending on health care.

In “Moneyball,” Mr. Lewis explains that the main reason many baseball players were misvalued or overvalued was “vividness bias,” “the tendency to overweight the vivid and prestigious attributes of a decision and underweight less impressive issues.” Vividness bias is widely present in health care as well, we just don’t talk about it.

At risk of upsetting many people, I get it. The work done by primary care physicians isn’t always “exciting.” In fact, primary care is to health care what the sixth pitch at bat is to baseball – slow, methodical, not flashy yet fundamentally consequential to long-term, sustained success. In our case, long-term, sustained success is better health. As individuals and as a society, we glamorize actions we perceive to be heroic. We celebrate those actions that produce immediate results and have a visible risk/reward calculation. These are the home run hitters in medicine, and we need them. They do amazing things that produce immediate results and benefit patients.

However, what we don’t celebrate is the 40-minute visit during which a primary care physician methodically works with a patient to discuss their four chronic conditions, makes certain they are up to date on cancer screenings and vaccinations, takes the necessary steps to ensure the patient has housing and food security, and counsels them on how to deal with a challenging life situation that is making their health conditions worsen. This is primary care – slow, methodical, and foundational to the health of the individual and our communities.

Comprehensive and continuous primary care has been proven to facilitate better health, but we continue to focus our spending on the homerun hitters of medicine. This may seem appropriate to some, but there is a cost being paid. That cost is the health of our fellow citizens and our communities.

Mr. Lewis noted in the interview that over the past two decades there have been endless efforts to “Moneyball” every industry in our economy. However, he also noted that there are people and industries that “are finding better data, analyzing it in different ways and coming to pretty radical different conclusions about how this should be done.”

This describes primary care perfectly. We have found better data, we have analyzed it differently, and we have come to radically different conclusions about how health care should be provided and financed. An ongoing, continuous relationship with primary care increases life expectancy and reduces health care costs. Primary care is associated with reductions in health disparities and a more equitable health care system.

The hero of Moneyball is Billy Beane, the former general manager of the Oakland Athletics who challenged the legacy model in baseball to pursue a different approach. The good news for primary care is there are a lot of Billy Beanes out there pursuing a better, more patient-centered approach to health care. Many of these leaders and their organizations have come together through Primary Care for America, a collaboration where innovators, disrupters and primary care pioneers are in pursuit of implementing our “radically different conclusions about health care.” We believe we can do better, that we should do better.


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Thursday, March 14, 2024

My new secret weapon for learning from my customers

Sometimes, I come across something I wish I’d had for years. I have a new favorite secret weapon, and it’s an app. Never thought those two phrases would go together. It combines the best of patient/employee surveys and focus groups, and I am using it to help with employee retention, market differentiation, and planning.

This app is called SEEQ, and it is the creation of the team at ShareMoreStories. As a beta user, I am using it to test my theories about care differentiators and to capture insights into what we are doing swell and what we can do even better.

I will use one of my patient projects to show how it works. I started with a question: What Differentiates Us? We have four cornerstones – 1) a staff who is happiest making others happy; 2) private rooms; 3) heated infusion recliners; and 4) a cost about half of hospital infusions. I wanted to know what is most important to our patients.

The old way of getting this information would be to ask them to rank those four options and maybe give them a fifth ‘other’ option. I would get the prioritization, but none of the emotion or insight tied to the ranking. That’s where SEEQ comes in. Patients share their stories, in their own words. It brings depth, it brings ‘aha’ moments. The SEEQ app uses AI to bring further insight into these stories along several emotional continuums. It is amazing.

Here are some of the things I learned in this little project:
  1. Patients value consistency in their care and find it increasingly rare. Our consistency is a core differentiator.
  2. Patients really appreciate that we get prior authorizations. Other infusion sites do not, putting the patient in the middle all too often. We take on the hassle for them, and they notice.
  3. Patients confirmed what I suspected: our staff is the biggest differentiator. Private rooms and heated chairs are certainly unique in our marketplace, but what elevates us is our team.
  4. Handwritten thank you notes remain in style. Since no one writes them anymore, they carry extra specialness with patients.
  5. Cost is a differentiator. Referring providers are telling patients that Infusion Solutions is not only better, it’s also less expensive. That’s music to my ears.

Everyone worries about employee retention, yet too few employers use patient feedback effectively as a retention strategy. I use patient stories to reinforce our mission – One Happy Patient At A Time – and have had some amazing conversations with my team talking about the difference we are making in patients’ lives. They like to know they are making a difference. Guess what? We have much less turnover than most healthcare providers.

Back to SEEQ: I play a flat monthly rate and am able to create as many projects as I want. How can I learn from referral coordinators what we can do to make their jobs easier? What do my teammates enjoy most/enjoy least about working at Infusion Solutions? I think SEEQ would be very effective in garnering insights from employees by role in a larger organization. Would extending our hours differentiate us? If I have a hypothesis, I can test it quickly and get exceptional insights.

All of us have conducted patient or employee surveys that provide one-dimensional quantitative feedback. Very few of us have conducted focus groups that provide one-dimensional qualitative feedback. SEEQ is the first product I have seen that combines both quantitative and qualitative feedback.

I mentioned earlier that SEEQ is an app. The app is where folks answer a few questions (like old-school survey tools) and then share their stories. It is easy and intuitive, even for an old guy like me. You can learn more here; I think they can do a better job of explaining it than I have.

I have been surprised that so many patients enjoy writing about their experiences. I have been very pleased with how the SEEQ AI distills and discerns common feelings, insights, and differentiators. I feel l know what matters most to our patients, our referring base, and my employees. Those insights are critical to shaping our future, one happy patient at a time.

In the last stages of my career, I look back at when I was most effective or least effective, when my practices were most successful or least successful. The common denominator for the best times was that the patient came first. Margin followed Mission. The worst of times were when we had it backwards. SEEQ keeps my focus on the mission. If I focus on patients and employees, everything falls into place.

________________________________________

Lucien W. Roberts, III, MHA, FACMPE is a semi-retired practice administrator and long-time writer for Physicians Practice and Medical Economics. In his semi-retired kind of life, he is fortunate to be part of an infusion center with a simple measure of success: one happy patient at a time.


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