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Sunday, May 12, 2019

Digital transformation in healthcare: Time to focus on the patient

Digital transformation was supposed to revolutionize the healthcare industry by improving patient care and operations and reducing costs. To date, while digital transformation has led to positive changes, it has not radically changed services, processes, or business models.

The focus thus far has been primarily a conversion of analog processes to electronic form: the increased use of mobile devices and the adoption of EHRs, cloud-based services, and applications. The result has been improvement in patient engagement, increased efficiencies and reduced costs in back-office functions, and greater ease in dealing with third-party providers. These steps have been promising, but nothing transformational. This is about to change.

We are now at the early stages of a second phase of digital transformation that focuses on using technology to revolutionize the way patients are diagnosed, treated, and monitored and to deliver more timely, precise, and efficient care. The following are four examples of truly transformational technology:

Analytics

Big data analytics — the computational analysis of data to uncover trends, patterns, and associations — can be used to reduce costs, track, and prevent epidemics and detect medical fraud and identity theft. Big data software can lower the rate of medication errors by alerting doctors and pharmacists to inconsistencies between a patient’s health and drug prescriptions. Analytics can also help a practice manage staffing more efficiently and streamline workflow.

Artificial intelligence

In a broad sense, artificial intelligence (AI) makes it possible for machines to perform human-like tasks and learn and adapt from experience. The more data an AI application receives, the more accurate it becomes. The ability to gather, process, and act on information without human input eliminates routine tasks, improves efficiency, and minimizes risks.

AI provides precise and accurate data that leads to better diagnoses, treatment plans, and patient outcomes across all practice specialties. In oncology, AI powered software can analyze thousands of pathology images of various cancers to deliver highly accurate diagnoses and predict the most effective anti-cancer drug combinations. Surgeons can use AI for real-time guidance to increase precision in removing tumors. Radiologists using AI can spot details that escape the human eye. Similarly, lab tests can be quickly analyzed for patterns of existing or missing data to predict easy to miss conditions.

On the administrative side, AI makes EHRs easier to navigate and automates routine processes associated with them. The use of chatbots to help patients with care plans and answer routine questions is increasing as well.

Internet of Medical Things

The Internet of Medical Things (IoMT) refers to medical devices, equipment, and software applications capable of collecting and exchanging data via the web. WiFi enabled devices link directly with cloud platforms for data storage and also communicate with similarly enabled devices.

These devices, including wearables, implanted devices, infusion pumps, and more, can monitor, inform, and provide objective actual data to identify issues, and allow for earlier intervention before they become critical. The large amounts of real-time data they collect and generate about patients creates a more efficient healthcare system with more accessible, personalized, and proactive healthcare services for all, andalso provides data to help train AI.

Diagnosis, treatment, and monitoring can be done remotely, reducing the need for routine office visits and checkups. Patients can spend more time at home, rather than in a hospital or doctor’s office, and doctors can spend more time with patients requiring critical care.

Robotics

While robots have long been a part of healthcare performing tasks, such as assisting a human surgeon or performing surgeries autonomously, their use in medicine has recently been expanding. Here are some examples:

As life expectancy has increased, robot companions are being used to interact with aging patients to help them remain independent and alleviate loneliness.
Robotic nurses designed to perform repetitive tasks, such as taking vitals, monitoring a patient’s condition, restocking supplies,and drawing blood, free up human nurses to perform tasks requiring empathy and human decision skills.
Several projects are working to develop microrobots that can travel through bodily fluids to precisely deliver medication or repair damaged cells.

Other emerging technologies similarly provide vital tools for patient care. Virtual reality and augmented reality tools are helping Alzheimer’s and dementia patients retrieve memories; genomes are being sequenced faster, leading to better diagnoses and more accurate treatments; and 3D bioprinting is allowing doctors to look into the body more accurately than with any X-ray or scan.

The potential of these digital technologies being harnessed is leading to the best available treatment at reduced costs.

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Friday, May 10, 2019

How to renegotiate payer contracts

Often, physicians think their signed payer contracts are set in stone for the duration of the agreement.

For example, I was working with a physician group that thought they couldn’t renegotiate their contact with a large payer. They were losing money on those patients but thought they were stuck. Wrong. We were able to successfully renegotiate a stronger contract.

If you feel stuck in a lousy deal with your payers, you can renegotiate. Here are six steps to renegotiate your contracts and improve your revenue.

Do your homework

Start by locating your contracts and, if they don’t already have one, give them a designated home in your office. If you cannot locate the agreements, request copies from payers.

Gather all your contracts, review the terms, and know the effective dates of your contracts. Study your payer mix and learn who is your largest payer. Create a database where you can track the terms of every contract and when each is up for renewal. Keep copies or detailed notes of all interactions with your payers, including the last time you renegotiated the contract.

Payers are hoping you have so many payer contracts and too little time to review all the agreements, especially at small practices that don’t have a dedicated team to review them. They are counting on you to not be diligent. That gives them the opportunity to skimp here and there. Don’t let your payers cheat or hoodwink you.

Warning: This will be a time-consuming process.

Know your fee schedule

Anticipate that each payer will establish speed bumps to slow down your claims process. Some payers might require different procedures to submit claims, such as the use of a web portal, special emails, and the like. They will use vague language to give them wiggle room—and the opportunity to deny claims. Beat them at their own game.

Create another database for your most common codes separated by each provider. Note how each code should be submitted. Make sure you capture all of them. Building this central repository will require time upfront, but it should ultimately speed up the daily claims process, reduce the number of days bills are in accounts receivable/accounts payable, lower the volume of denied claims, and make it easier should you to resubmit.

Let the games begin

Once you have assembled all of your data, you can compare each payer to one another. Now you have the information you need to begin the process of renegotiating your contract with a specific payer.

Initiate the process according to the terms of your agreement but do so with a formal notice. Pick a payer that you think you’ll be able to get the desired changes from. It might be based upon the fee schedule, the time to the end of the contract, or the volume of business you do with them. I would recommend starting with payers that offer the lowest rates and those with the least amount of time left on the contract.

Research who you should send the notice to and ask for confirmation of receipt. I would recommend sending your notice to as many people at the payer’s organization as possible.

Remember: These payers aren’t your friends and being friendly won’t yield the desired results. You must approach this process without fear.

Hold the line

Now that formal negotiations have begun, hold the line. Remember, negotiations start with a “no.” Payers will push back and even refuse to open up talks. Press on, and don’t give up.

Stay focused on your mission and purpose. The key to any successful negotiation is knowing what you want. Be specific with your desires. Don’t let their fear tactics intimidate you, and always be comfortable exercising your right to veto.

Begin with the end in mind.

Know what you want—and the outcome you seek—even before you start the renegotiation process the. You’re renegotiating these contracts so that you have capital to continue to provide excellent care to their beneficiaries. If the payer isn’t moving the needle enough, don’t be afraid of walking away. Remember, the payer sold a contract to the patient or their employer, and they must fulfill the terms of that contract. Their contract with you helps them meet their contractual obligations to the other party.

Know what you want and why you want it. Plan your negotiation steps carefully and accept that you might need to change things as the talks progress. However, you should understand what you want from a specific negotiation event, meeting, or email. It might be another meeting with someone else, an acknowledgment of your proposal, or acceptance of your offer, but you must be explicit on this issue.

Seek help when needed

If you ever feel you’re in over your head, ask for help from someone who isn’t as emotionally invested as you are, such as a negotiation coach. Having someone with experience and a fresh set of eyes on your talks can provide insight and propel your success. More importantly, bringing on someone who is not as emotionally involved to help you through the negotiation will help you stay calm and obtain the best results for you and, ultimately, your patients.

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Thursday, May 9, 2019

The leading causes of denials and how to prevent them

Each new denial is essentially a revenue leak. Even when claims are recovered, the costs associated with that recovery must be subtracted from patient revenue. Recent data put that recovery cost at roughly $118 per denial. Factor in the lost revenue from your unrecovered claims and it’s clear why denials are a painful financial drain on practices.

What makes denials so frustrating is that many are avoidable. The leading causes are well known, and it’s possible to prevent these leaks before they occur. The key is having processes in place to identify and correct errors and omissions before a problematic claim is ever submitted.

Defining denials

Unlike a rejection, which occurs when a submission lacks pertinent data or proper coding, denials are received, reviewed, and found to be inadequate by the payer or health plan. This may be due to insurance plan coverage stipulations, limits, or an untimely filing. Denials cannot be resubmitted, but they can be appealed. It’s the appeal that can prove costly.

Most common reasons for denials

The number one cause for a denial is that a patient isn’t eligible for care under the terms of the insurance plan. In the research cited above, nearly one in five respondents said “registration/eligibility” was the leading reason for denials. The simple step of doing eligibility checks before a patient is seen by medical staff can prevent this.

Other common reasons for denials are:

Insufficient information. A simple omission, such as date of birth, can lead to a costly denial.
Duplicate billing. This happens when a similar or equivalent claim is sent because of a clerical error or overlap in office duties.
Improper or outdated CPT or ICD-10 codes. The codes, which determine what is paid, change quarterly, and your practice — or your RCM vendor — is responsible for capturing and operationalizing all updates.

Untimely filing. You only have so many days to file the claim.
Service is not covered. A patient’s coverage may have been terminated or their maximum benefit has been met (often in the case of physical therapy).

Out of network. Some plans require doctors and practitioners to be “in-network” for coverage.
Problems with modifiers. Errors can result from submitting invalid modifier combinations. Many invalid modifier combinations can be avoided with better training for coding personnel or by using a qualified medical billing service.

Prior authorization required. Some payers want authorization or a referral from another physician before services can be performed.

Mitigating risk with technology

The complexity of medical billing puts tremendous pressure on practices as many processes are unlikely to catch common errors such as duplicate billing or incorrect CPT codes. This is where technology can be transformative. It can, for example, automate the updating of CPT codes practice-wide to significantly reduce the risk of using an outdated CPT code.

Technology can also assist with prior authorization, guiding staff through the important steps of assessing patient eligibility. While there is no substitute for adequate staff training and education, having a stepwise process to guide staff who process claims ensures the right information is collected and verified before a claim ever leaves the practice.

Putting technology into practice

A few years ago, a five-person practice in Attleboro, Massachusetts, seeing between six and 15 patients daily, would routinely write off denied claims. It cost them thousands monthly. By adding new technology to predetermine eligibility, the practice addressed its main issue and the number one reason for denied claims: ineligibility.

In the new process guided by technology, front desk staff can verify patient eligibility with the insurance company prior to an appointment. When a patient presents her insurance card during check-in, any issues with eligibility can be addressed in real time. Having this take place beforehand ensures a better experience for the patient and a smoother check-in and billing process for the practice.

Technology and automation don’t replace the human touch patients expect. In fact, revenue cycle management technology, which offers much more than predetermined eligibility review, is enabling practices large and small to focus less on managing loss and more on efficiently and profitably building a vibrant office that provides a better patient experience.

Takeaways

Many practices feel powerless as claim after claim is denied. A closer look, however, reveals that many denials are avoidable. Fix those leaks and you’ll see immediate return to your bottom line. What’s more, you’ll streamline operations and save time that can be put back into delighting patients. Here’s how you can get started:

Audit your practice to see if you’re at risk for any of the most common reasons for denial.
Train and retrain staff to recognize and be vigilant around the key error points that lead to denials.
Consider revenue cycle management technology, which, when properly integrated with your EHR and/or practice management system, can automate critical aspects of the billing process.

Start benchmarking your progress; see how much profit you recoup by stopping leakage that is caused by denials. Focus on “denial rate,” which the American Academy of Family Physicians says should be between 5 to 10 percent on average. Less than 5 percent is more desirable.

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The Executive Suite: Culture and leadership: Two sides of the same coin...

The Executive Suite: Culture and leadership: Two sides of the same coin...: One of my physician practice clients asked me to help them improve their patient satisfaction problem. After a series of interviews with sta...

Wednesday, May 8, 2019

Culture and leadership: Two sides of the same coin

One of my physician practice clients asked me to help them improve their patient satisfaction problem. After a series of interviews with staff and physicians, I gave them my diagnosis and treatment plan — if they did not fix their employee satisfaction problem, they would not fix their patient satisfaction problem. And the primary culprit for the former problem: a dysfunctional workplace culture.

What do we mean by “culture” and why is it so important to address? Culture is often hard to describe — but we do know how it makes us feel. On the surface, culture is represented by behaviors, by the way people interact, by how patients are treated, and even by the look and feel of the workplace. What are even more critical to culture are all the things that lie below the surface: attitudes, beliefs, assumptions, and values. Research has found a direct link between work culture, employee engagement, and company success factors (such as productivity, financial metrics, and customer/patient satisfaction).

In his research into organizational culture, Daniel Denison, PhD, found four critical factors that impact workplace performance:

Clarity of mission and goals: People understand and are committed to the organization’s strategic imperatives.
Empowerment: People feel that they are part of a high-performing team and are given the training and resources to do their job.
Agility: The organization is responsive to customer needs and concerns, it adapts to changes in the industry, and changes are managed effectively.
Consistency: Processes and procedures that bring value to the organization are leveraged, people agree on core values, and there is good coordination and integration among various departments.

If organizations are not intentional about the culture they want to encourage, then the culture will take on a life of its own. Leaders drive culture, so as leaders of your practice, it is important to identify what type of workplace culture you want to promote. Here are some strategies to enhance employee engagement and teamwork, while driving a patient-centric culture.

Focus on providing positive feedback: Make the feedback genuine, specific, and timely. The more specific the words of appreciation, the more rewarding it feels to people. And everyone can play a role — colleague to colleague; manager to direct reports; physician to staff. Because our brains are hard-wired towards a negativity bias, we tend to notice the negative more, feel it more strongly, and remember it more than positive events. To help mitigate this bias, we need about 8 positives to 1 negative. By “catching each other being and doing good,” everyone plays a role in creating a culture of appreciation, support, and positivity.

Promote a culture of learning: Mistakes should be used as opportunities to learn versus opportunities to blame or shame. Ask “what and why did this happen?” versus “who did it or who’s to blame?” The more that mistakes are talked about (in a safe and supportive culture), the less medical errors get made. But it requires “psychological safety” where people feel safe to talk about mistakes and errors without fear of retribution. In contrast, except for repetitive errors and/or intentional errors, reporting them should be embraced as opportunities to learn and improve.

Develop workplace core values: These values, or guiding principles, need to resonate for people. Involve staff in identifying and defining the values they want to encourage and reinforce so that their work environment feels safe, supportive, collaborative, and patient-focused. When people help to author their core values, they are more likely to own them. Establish practices that will reinforce the values and recognize people for exemplifying one or more of them. Examples of values might include: act with integrity; support your colleagues; bring a positive attitude to work; and treat patients as our “guests.”

Encourage a sense of teamwork: We are wired to quickly form in-groups and out-groups (what is often referred to in the workplace as “cliques” or “silos”), which causes greater affiliation for people we feel connected to and more animosity for those outside our “tribe.” The best way to encourage a sense of team is to help everyone identify with a common purpose (such as providing excellent and compassionate care to patients). It also requires people to work together as a team; rather than thinking about “my” patient versus “your” patient, all patients should be considered to be everyone’s priority. Success is now defined as taking care of all patients that come to the practice, not just taking care of the patients to whom a provider is assigned.

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Tuesday, May 7, 2019

SEM Means Business

When you need a product or service, do you head online to search for information or deals? Most people do, including your potential customers. In fact, four out of five consumers rely on search engines to find local info and prefer localized ads, according to a 2014 Google study. And they act fast—50 percent of mobile phone users and 34 percent of people searching on tablets or computers make a purchase within 24 hours of conducting a local search.

What does this mean for your business? Not putting time, effort and part of your marketing budget aside for online advertising means countless lost opportunities. And search engine marketing (SEM), which uses tools to precisely deliver paid ads within specific search results, should be high on your list of tactics.

SEM can be complicated, but drilled down it's about effectively targeting the right customer. And ad copy is vital—your words are what drives high click through rates (CTR) and low cost per click (CPC).

Effective ad copy should include:

Clear messaging with no ambiguity or surprises.
Correct contact information.
Relevant keywords.
Active language and strong call to action.

A controlled SEM approach can provide speedy results and helpful tracking benefits, but needs fine-tuning and finessing to be successful and cost-effective. Don't jump in without a clear strategy.

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