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Thursday, February 6, 2025

Hiring a marketing consultant for your medical practice

Marketing your healthcare practice can sometimes feel like uncharted territory, especially if it’s not your area of expertise. You might be thinking, "I need a marketing or public relations firm," but also wonder if you can manage this aspect of your practice yourself. While managing public relations might be something you’re comfortable with, outsourcing the legwork to a professional marketing consultant can free up valuable time to focus on what matters most: your patients.

In this article, we’ll explore why hiring a marketing consultant for your practice can be beneficial and provide practical steps for finding and vetting the right candidate or agency.

Steps for hiring a marketing consultant for your health care practice

1. Define your needs and goals
Before you begin your search, take time to clearly identify your practice's marketing needs and objectives. Consider which areas require assistance—digital marketing, social media management, branding, patient acquisition, or content creation. The clearer your goals, the easier it will be to find a consultant with the right expertise.

2. Use online platforms
Several online platforms can help connect you with marketing professionals. Websites like Upwork, Freelancer, and Fiverr allow you to search for consultants with specific healthcare industry experience. You can review profiles, ratings, and past projects to assess potential candidates.

3. Check industry associations
Look for consultants who are members of reputable healthcare marketing associations. These professionals typically have specialized knowledge of the healthcare industry and stay informed on the latest trends and regulations in healthcare marketing.

4. Research marketing agencies
Many agencies specialize in healthcare marketing. These agencies often have teams of professionals with diverse skills in areas such as digital marketing, content creation, and patient outreach. Research agencies with a proven track record in healthcare, as they will understand the nuances and compliance issues specific to your field.

5. Review portfolios and testimonials
Once you’ve identified potential candidates or agencies, review their portfolios and client testimonials. Look for evidence of success in similar healthcare practices. Testimonials can give insight into the agency's ability to meet client expectations and deliver measurable results.

6. Schedule interviews
Narrow down your list and schedule interviews with potential consultants or agencies. This gives you a chance to discuss your specific needs, learn about their experience, and understand their approach to healthcare marketing. Pay attention to how well they listen to your needs and tailor their responses to your goals.

7. Ask for referrals
Referrals from colleagues or other healthcare professionals who have worked with marketing consultants can be invaluable. A recommendation from a trusted source can help you identify reliable, effective marketing professionals who are experienced in the healthcare space.

8. Check references
Don’t hesitate to ask for references from previous clients. Reach out to these references to learn about their experiences working with the consultant or agency. Ask questions such as:

How responsive are they to calls and emails?
Did they meet deadlines and deliver on promises?
What kind of results did they achieve?
Speaking directly with former clients provides valuable insights into the agency’s effectiveness, professionalism, and work ethic.

Key considerations when hiring a marketing consultant

1. Experience in health care marketing
Marketing for healthcare practices comes with unique challenges. Ensure the consultant or agency you choose has a deep understanding of the healthcare industry, including compliance regulations (like HIPAA), patient privacy, and the sensitivities involved in marketing healthcare services.

2. Budget considerations
Before hiring, be clear about your budget for marketing services. Discuss fees upfront and ensure the consultant or agency’s rates align with what you’re prepared to invest. While quality marketing is an investment, it should remain within your practice’s financial capacity.

3. Contracts and terms
Thoroughly review any contracts before signing. Pay attention to the scope of work, timelines, deliverables, and termination clauses. Ensure there’s flexibility to terminate the agreement with minimal penalties, ideally within 30 days, should the partnership not meet your expectations.

4. Compliance and ethical marketing practices
Given the sensitive nature of healthcare marketing, ensure that the consultant or agency follows strict ethical guidelines and understands the relevant compliance standards. This includes ensuring that all marketing practices protect patient privacy and avoid making false claims or guarantees.

5. Expertise in digital marketing
In today's digital world, having a strong online presence is essential. Look for a consultant or agency that excels in digital marketing strategies such as search engine optimization (SEO), social media marketing, online advertising, and content creation. These are crucial tools for patient engagement and practice growth.

6. Content creation capabilities
Content is a cornerstone of effective healthcare marketing. Make sure the consultant or agency is skilled in creating informative, engaging, and compliant content for your website, blog, and social media platforms. Quality content builds trust and helps educate potential patients.

7. Understanding your target audience
A good healthcare marketing agency will have a keen understanding of your target audience, whether it’s prospective patients, referring physicians, or other healthcare professionals. They should be able to create marketing strategies that speak directly to the needs and concerns of these groups.

8. A strategic approach
Choose an agency that takes a comprehensive, strategic approach to marketing. A successful marketing plan should be tailored to your practice's goals, with clear, measurable objectives and a roadmap for achieving them.

9. Measurable results
Finally, inquire about how the consultant or agency tracks and measures the success of marketing campaigns. Marketing efforts should be data-driven, with regular reports on metrics like patient acquisition rates, website traffic, and social media engagement.

Conclusion

Marketing plays a critical role in the growth and success of any healthcare practice. By following the steps outlined above, you can identify and hire a marketing consultant or agency that is a good fit for your practice’s unique needs. The right consultant will help you navigate the complexities of healthcare marketing, improve your visibility, and ultimately, contribute to your practice’s bottom line.

Investing in professional marketing support is an investment in the future success of your practice. Be sure to take the time to choose the right partner—one that understands the healthcare landscape and can deliver measurable, effective results.

_____________________________

Neil Baum, MD, a Professor of Clinical Urology at Tulane University in New Orleans, LA. Dr. Baum is the author of several books, including the best-selling book, Marketing Your Medical Practice-Ethically, Effectively, and Economically, which has sold over 225,000 copies and has been translated into Spanish.

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Wednesday, February 5, 2025

Supporting maternal health with remote patient monitoring

Remote patient monitoring (RPM) has secured its place within our healthcare system thanks to rapid increases in adoption over the past several years. RPM is most often associated with helping manage chronic diseases. With its value, versatility, and cost-effectiveness, we are now seeing RPM moving into a wider variety of specialty healthcare arenas, including maternal health.

Within maternal health, RPM is enabling practitioners to better support patients with gestational hypertension and gestational diabetes.

RPM for gestational hypertension and gestational diabetes

For patients with gestational hypertension, research shows that controlling climbing blood pressure helps keep the mother and baby safe and healthy, but effectively monitoring blood pressure during pregnancy and post-delivery can prove challenging. Contributing factors can include increased frequent office visits or unreliable self-reported blood pressure numbers.

As for patients with gestational diabetes, if it's not controlled, high blood sugar can lead to high-risk pregnancies. Mitigating the effects of gestational diabetes usually requires a combination of close monitoring of blood glucose levels, nutritional tracking, exercise, and, if warranted, medications and/or insulin injections.

Pregnant women who live in rural areas or who have health-related social needs can find that receiving additional in-person care is more difficult and expensive.

RPM provides substantial benefits to pregnant women with gestational hypertension and gestational diabetes. For pregnant women with gestational hypertension, they can be supported by blood pressure monitoring technology. For pregnant women with gestational diabetes, they would receive a blood glucose meter (i.e., glucometer) for blood sugar monitoring.

Using these RPM devices enables the real-time transmission of vital signs that allows the patient's healthcare team to identify and react to concerning trends quicker, resulting in fewer emergency situations and adverse outcomes while helping reduce the number of in-person appointments. When RPM device readings indicate a concerning trend, practitioners can engage with these patients to discuss their situation and recommend next steps. If a face-to-face interaction is warranted, a virtual visit may further eliminate the need for in-person care.

RPM's ability to help patients navigate and overcome barriers to care and accessing services can improve adherence to recommended treatment regimens, which contributes to better neonatal outcomes and increases in patient satisfaction and engagement.

Operational and financial value of RPM for maternal health practitioners

In addition to supporting improvement in clinical outcomes, RPM delivers substantial operational and financial value for maternal health practitioners. RPM enables practitioners and their staff to further streamline engagement with patients and expand access and care capacity with reduced administrative overhead.

From a financial perspective, RPM can deliver a worthwhile return on investment. Many commercial payers cover RPM, and RPM is covered by more than two-thirds of all state Medicaid programs. We are seeing efforts to convince the remaining Medicaid programs to cover RPM entirely or at least maternal monitoring as a standalone service given the growing women's health crisis. International data show the maternal mortality rate in the United States exceeds the rate in other high-income countries and continues to worsen. Rural counties experience higher rates of maternal morbidity and mortality.

What maternal health practitioners can expect to be paid for RPM services will vary by commercial payer or state for Medicaid patients. To get a general idea of what the reimbursement may look like, we can look at what Medicare pays on average for RPM in 2025.

Medicare reimburses about $20 for initial patient enrollment into an RPM program, with the payment covering device setup and delivering patient education on using the device and receiving RPM services. Medicare provides a base monthly payment of about $43 for monitoring data transmitted from the RPM device and any ongoing device management.

Medicare then provides a monthly payment of about $48 for at least 20 minutes of communication with the patient about their transmitted data and any changes to the care management plan. Medicare provides an additional monthly payment of about $38 if communication exceeds 40 minutes but is fewer than 60 minutes. If communication requires 60 or more minutes, Medicare provides a final monthly payment of $38.

A practice will typically furnish about 20 minutes of RPM care management each month to a single patient, bringing the total monthly reimbursement to around $91 per patient. However, a single RPM patient can earn a practice up to around $167 in monthly Medicare reimbursement.

Let's say a practice enrolled 60 patients with gestational hypertension and 40 patients with gestational diabetes, and these 100 total patients all received 10 months of RPM services. Assuming these patients required the minimum amount of monthly RPM support (20 minutes), the practice would generate around $93,000 — (100 x $20) + (100 x $91 x 10).

Undeniable benefits of maternal health RPM

RPM is a great service for maternal health practitioners to offer pregnant patients with gestational hypertension and gestational diabetes. It can improve disease management and outcomes, reduce patient expenses and time allocated to monitoring their disease, provide practices with a new revenue stream and ability to support more patients, enhance staff productivity, and strengthen overall the delivery of care — all without requiring a substantial financial investment. Given these benefits, it's not surprising that RPM is quickly cementing itself as an essential service for pregnant women.

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Tuesday, February 4, 2025

4 ways autonomous coding prevents claim denials at the source

Healthcare providers face an unprecedented challenge with claim denials. Nearly $20B is lost fighting denied claims annually, while two-thirds of organizations report increasing reimbursement times. These trends are concerning: 55% of revenue cycle leaders experience rising claim errors, and 77% face more frequent payer policy changes than in the previous year. Across the board, each metric has worsened since 2022, pointing to systemic issues in how claims are processed and submitted.

While most organizations look for temporary fixes, forward-thinking industry leaders are finding promising results with autonomous coding as an initiative for denial prevention. By addressing potential denials before claims are submitted, AI coding offers a path to sustainable improvement in denial outcomes. To understand how autonomous coding can help prevent denials, let's first examine the headwinds facing coding today and the coding-related factors that contribute to claim denials.

Examining today's coding challenges

Behind today's high denial rates lies a fundamental tension – coding requirements grow increasingly complex as coding resources lessen. Consider the typical workflow in a practice's revenue cycle. Understaffed coding teams juggle mounting backlogs of encounters while trying to maintain accuracy. Billing staff spend hours on administrative tasks that could be automated. Physicians get pulled away from patient care to address documentation gaps discovered days or weeks after the encounter. These inefficient processes lead to denials that cost an average of $43.84 to rework, while the accompanying reimbursement delays strain operational budgets.

The staffing crisis in medical coding makes these challenges even more acute. With 30% of organizations reporting coding staff shortages, and experienced coders retiring faster than new ones joining the field, the pressure continues to build. Higher workloads lead to more errors, creating more denials that require staff time – a cycle that traditional solutions can't break.

Overall, as coding-related drivers of claims denials, missing or inaccurate data accounts for 46% of denials, followed by authorization issues at 36%, and incomplete patient information at 30%. Manual approaches to these processes struggle to maintain accuracy and velocity at sufficient scale with today's resourcing.

Breaking the denial cycle with AI

This is where autonomous coding provides relief. The way claims are coded plays a critical role in whether they're paid or denied. While basic automation tools can help human coders, they don't address the fundamental challenges in the coding process that lead to denials.

Let's examine four key ways coding impacts claim denials and how autonomous coding helps prevent these patterns.

Checking documentation and finding errors: Many denied claims are due to missing or incomplete documentation. In manual coding workflows, documentation gaps often aren't discovered until weeks after the encounter. By then, getting accurate information from providers becomes difficult or impossible. These delayed discoveries are one of the leading causes of preventable coding-related denials. In contrast, because AI coding analyzes documentation immediately after each visit, it prompts providers to correct deficiencies when the information is still fresh and readily available.
Coding accuracy and consistency: Inaccurate coding leads to denied claims when the codes assigned don't properly reflect the care provided or don't comply with payer-specific rules. In manual workflows, accuracy inevitably fluctuates with coder fatigue, varying expertise levels, and high workloads. As coding volumes increase and guidelines grow more complex, these inconsistencies multiply. Autonomous coding eliminates these variables by applying coding rules uniformly regardless of volume or complexity, maintaining consistent accuracy that helps to prevent denials.
Guideline changes: Keeping up with changing payer requirements is crucial for clean claims. When policies change, manual coding teams typically need months to learn and implement new guidelines proficiently, leading to increased denials during the transition period. The 2023 E/M guidelines change proved this point as practices saw spikes in denials while coders got up to speed. AI coding systems, however, update instantly to reflect new guidelines, maintaining compliance from day one and preventing these transitional denial surges.
Resource allocation: The availability of coding resources directly impacts denial rates. In manual coding environments, organizations face a difficult choice: either invest heavily in expanding coding teams or distribute coding duties across clinical staff to help bear the load. Both approaches drain resources while failing to address the root cause of denials. Autonomous coding offers a different path by handling the vast majority of encounter volumes automatically, allowing both coding teams and clinicians to focus on work that makes better use of their expertise.

Building a sustainable future

With denial rates climbing and organizations losing billions in denied claims each year, healthcare leaders need to consider new approaches to prevention. Autonomous coding offers powerful capabilities that can help reduce denials – bringing precision to documentation, reliability to coding, and speed to the entire process. The benefits extend beyond denial reduction: practices gain more efficient revenue cycles while their teams gain the bandwidth to focus on higher-value activities.

For organizations focused on reducing denials and building sustainable financial operations, autonomous coding represents a significant opportunity to make progress toward these goals.

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Monday, February 3, 2025

Health care’s 2025 revenue cycle imperative: Reduce administrative waste

“How can I stay financially viable?” It’s the question that will continue to keep C-suite leaders up at night during 2025.

It’s understandable as the financial pressures associated with current macro-economic trends are not likely to change in the near future. New year, same story—the cost to collect will continue to increase while reimbursements decline.

Given that so much of the high costs associated with running a healthcare business remains outside of the organization’s control, financial leaders will have to consider how they can impact the one area that is in their control in 2025: reducing administrative waste, especially as it relates to revenue cycle and collecting monies owed for the services they render.

The reality is that current stats related to U.S. administrative waste in healthcare are abysmal, equating to about 30% of total spending waste. In response, healthcare organizations are prioritizing adoption of AI and automation to improve the outlook. This is a step in the right direction, but many, unfortunately, are leaving money on the table because they lack visibility into human generated data.

In contrast to the limitations of common data—the basic data housed in EHRs, practice management and clearinghouse systems such as denials and claims status—human-generated data allows revenue cycle leaders to understand why medical claims are not paid on the first pass, drill down into all the activity involved in getting a claim paid, as well as measure the productivity and effectiveness of staff.

Knowledge of exactly where the breakdown occurred in the revenue cycle that required human intervention for claims adjudication allows healthcare organizations to quickly diagnose how to fix the problem. Organizations that achieve this kind of visibility into daily work effort will be armed with the information needed support three proven strategies for improving bottom-line impact in 2025.

1. Reducing the number of “touches” it takes to get a claim paid

Healthcare organizations aiming to claw back margin in the new year must focus on reducing the number of “human touches” required to get a claim paid. Many financial leaders do not have visibility into the amount of people involved, the total work effort it takes to get reimbursed and where breakdowns may be occurring. Across millions of human touches related to collecting on insurance claims within MedEvolve’s database, we find that upwards of 50% of touches are wasted on a consistent basis—and every touch negatively impacts margin.

What does this mean for provider organizations? Reeling in that waste can mean hundreds of thousands, if not millions, of dollars that can be recouped to improve margin in 2025. Two key foundations for future success are to have the data that tells you the effectiveness of your people in the jobs they are performing and rapid intelligence on where in the revenue cycle the problem occurred which many times is a combination of people and process breakdowns along with the gaps or misuse of technology.

In addition, financial clearance automation can help financial leaders improve a key metric for reducing waste going forward: zero-touch rates, the percentage of claims that get paid without human intervention. Also referred to as pre-registration, improving the financial clearance process ensures all the necessary patient information, insurance and the financial requirements based on the service is collected prior to the visit so claims flow smoothly through the revenue cycle process. This minimizes costly back-end denials which drive labor costs up and reimbursement down, eroding margin in an industry that can’t afford it.

2. Improving labor capacity, effectiveness and overall workflow efficiency

To improve labor costs, many provider organizations are looking to offshore resources. But the reality is that financial leaders must be able to measure every touch staff is taking to process claims (onshore and offshore) to truly understand the impact of administrative waste in revenue cycle and to know whether they are staffed correctly.

All too often, the first answer to resolving lags in reimbursement is to throw more bodies at perceived problems. That’s why the first step should be focused on gaining visibility into where changes are happening in the revenue cycle and what humans are doing to impact that change. It’s entirely possible that simple tweaks to existing processes could double daily productivity and improve first pass resolution rate, providing a notable impact on the bottom line.

On any given day, 80-90% of open claims do not require any work yet legacy workflow solutions are incapable of identifying and carving out those claims. One way to improve staff efficiency and effectiveness is to prioritize the claims that need attention and measure the effectiveness of staff once they take action on a claim. Workflow automation tools guide billing staff towards work that has the most ROI, ensuring the most productive use of time and effort.

3. Leveraging data for process improvement

Oftentimes, healthcare leaders rely on costly consulting projects to uncover opportunities for process improvements. A typical revenue cycle consulting project consists of months of employee evaluations, cost concentration studies, process identification and efficiency studies after which the organization still must implement the recommendations. However, consulting firms are still limited to the common data housed within legacy systems.

With access to the human generated data through a combination of workflow automation and generative AI, healthcare leaders can determine when and wherechanges are occurring in the revenue cycle and understand the true status of claims, the action taken by staff and the team’s ability to positively impact the AR balance.

Once provider organizations have visibility into the innerworkings of staff productivity and effectiveness, they can identify where waste occurs, conduct a root-cause analysis and improve processes. Effective intelligence solutions drill down into every step taken by revenue cycle staff and then apply analytics across the data to show revenue cycle leaders opportunities for improvement. In addition, prescriptive analytics data can be used to recommend the most effective courses of action in real time to improve outcomes.

Reducing administrative waste in 2025 and beyond

Effective Intelligence solutions built on automation and generative AI can help to overcome data shortfalls that exist in today’s healthcare organizations and provide the visibility into the daily work effort needed to reduce administrative waste and improve labor capacity. Workflow automationsolutions that measure every touch in the claim adjudication process provide a superior data set that can be leveraged in the maturing generative AI world where prediction, machine learning and automation is critical for the continuous need for margin improvement.

Forward-thinking organizations understand the need to improve staff productivity and minimize dependence on labor, especially within revenue cycle processes. Consequently, success going forward will also be marked by infrastructures that support automation and smarter workflows.

Helping staff become more effective and identifying in real time where the problems are occurring in the complex revenue cycle is one important step towards financial viability for healthcare organizations in 2025.

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