Case Study

Adapt And Thrive With An Integrated Approach

Doctor Taking Pain Notes

By Chris Walls, president and CEO, Pulse Inc.

Running a physician practice has never been easy, something that isn’t going to change any time soon. Today’s environment requires even more than clinical and business expertise — it demands adaptability. It involves building a long-term strategy to handle change.

Facing so many uncertainties, now is an ideal time for practices to assess whether they have the integrated clinical and financial processes necessary to evolve alongside unfolding rules and regulations. After all, one of the few guarantees in healthcare is the push to deliver better care more efficiently will continue.

With that thought in mind, practices should conduct audits of both internal processes and supporting IT to see if they can meet the shifting standards of value-based programs such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Yet as crucial as such audits might be, practices have another challenge to contend with: not enough human capital. How can a business manager — already tasked with multiple mission-critical duties — keep up-to-date with continually changing policies, legislation, and technologies?

In reality, it’s difficult for practices to find time and resources to devote to improving the business office in a way that likewise supports providers and patients. It’s easy to fall into the “good is good enough” trap.

Midwest Orthopaedic Center: How Integration Raised The Bar

For many practices, integrated outsourced technology presents an opportunity to raise standards for both clinical and revenue cycle processes without further taxing already-strapped internal staff. Benchmarks established within well-structured service-level agreements (SLAs), for example, can help practices ensure accountability toward clinical and financial goals.

Midwest Orthopaedic Center (MOC), one of the largest and most diverse orthopaedic groups in Peoria, IL, illustrates some of the benefits practices can achieve through an integrated outsourced approach to revenue cycle and clinical workflows.

A few years ago, MOC wanted more visibility into its revenue cycle as well as the ability to transform clinical processes to embrace value-based initiatives. Leadership soon realized the practice would have to improve its clinical documentation workflows and gain transparency for stronger, faster cash flow.

Consequently, although the organization already had an EHR, practice management (PM) solution, and outsourced billing service, it began to evaluate whether its existing technologies integrated well enough to sustain the practice’s changing needs. Ultimately, MOC opted to replace its systems with an integrated solution suite. After a simultaneous roll-out of the new EHR, PM, and revenue cycle management (RCM) systems, the effect was swift and positive.

The integration resulted in an improved patient experience front office to back. For instance, front-office staff can quickly schedule patients, check insurance eligibility, and get accurate co-pay information — all of which offers clarity to staff and patients alike. Co-pay collections at the time of service have increased 10 percent as a result.

Furthermore, implementing clinical workflows that encourage better clinical data capture at the point of care (including smoking status, height and weight, and reconciliation of medication histories) have enabled MOC providers not only to see more patients each day, but also to qualify for value-based reimbursement dollars. As an added benefit, improved clinical documentation helped reduce the practice’s malpractice insurance premiums by 5 percent.

Greater data capture and data flow have paid off for the practice on the back end as well. Improved documentation, more accurate coding, and deeper visibility into claims status have all contributed to a nearly 12 percent increase in net charges and an almost 20 percent increase in the gross collection rate. Days in accounts receivable (AR) have dropped by about 42 percent — currently averaging about 42 days instead of 72 days.

For MOC, the combination of tighter integration and greater transparency has added up to a healthier bottom line.

Seamless Evolution

Although MOC chose a comprehensive solution suite from the same vendor, that’s certainly not necessary to possess an integrated system. What’s imperative now is for systems to function together to create seamless workflows. Providers must be able to perform clinical and business tasks without going in and out of multiple systems.

With tightly integrated systems, providers can save hours each day — especially if they work in high-volume practices. Less time wasted on administrative chores means more time to spend with patients. That will become increasingly important as value-based care models not only reward improved outcomes and cost savings, but also a positive patient experience.

To adapt and grow, a practice must chart its own strategic course. Does it want to serve a small suburban community? Act as a referral source for a larger healthcare system? Take on risk within an accountable care organization (ACO)? All are viable options.

No matter the direction, one thing is clear: an integrated systems approach can help practices achieve both the clinical and financial goals needed to thrive in these fast-changing times.