By Ken Congdon
Medical practices and technology collide every year at the MGMA (Medical Group Management Association) annual conference. This year’s event, held October 26-29 in Las Vegas, was no exception. A plethora of information technology products — from EHRs to telehealth to data analytics solutions — was showcased in the MGMA exhibit hall and many were also the subject of educational sessions. However, one central theme seemed to encapsulate how medical practices view all of these technology options. In short, physician practices want IT to make them more efficient so they can place their focus back where it belongs — on their patients and improving outcomes.
The healthcare industry as a whole has been consumed with change over the past several years. Health providers have been struggling to fulfill EHR Meaningful Use (MU) requirements, address healthcare reform, cope with reimbursement changes, and prepare for the imminent transition to ICD-10. All of these initiatives can take focus and resources away from patient care. Medical practices have arguably been impacted more than other providers in this regard. For example, group practices tend to have smaller staffs and budgets than hospitals and other healthcare facilities. Therefore, addressing government directives and compliance mandates takes added effort on the part of the caregivers themselves — effort that often comes at the expense of patient care. Physician practices are getting sick and tired of this trade off. They want to get back to practicing medicine full time, and they are looking to IT to help them get there.
Medical Practices Should Be Caregivers, Not Collection Agents
Collecting payment has always been one of those arduous tasks medical practices have been charged with that divert time and energy away from patient care. Only the largest practices have accounting personnel. Most often this responsibility falls to an office manager, or in the smallest practices, the doctors or nurses themselves. This process has only gotten more complex as healthcare reform prompts higher insurance deductibles and an increase in patient self-pay. Leveraging IT to alleviate the burden of payment collection was a major focus at MGMA.
“The healthcare industry needs to quickly get to the point of price transparency and remove the doctor from being a financial institution,” says Jeff Chester, Senior VP and Chief Revenue Officer for Availity, a healthcare revenue cycle solution provider.
According to Chester, medical practices spend an inordinate amount of time chasing down money from patients. This not only reduces provider productivity, but can also negatively impact the patient/provider relationship. “You don’t want patients to become uncomfortable seeing their doctor because they owe him or her money,” he says.
Several IT solutions and services on display at MGMA were geared towards creating healthcare price transparency and eliminating payment latency. These tools include care/cost estimation software that aggregates and analyzes past claims data for similar procedures from various payers to accurately predict what the patient’s responsibility for a specific treatment will be. This information also allows providers to facilitate upfront payment from patients or establish a payment plan.
For example, Navicure unveiled its new Greenlight patient automation system to the MGMA crowd this year. In addition to estimating payment responsibility, the solution also swipes, stores, and encrypts patient credit card information to automatically apply to the patient responsibility portion of a medical bill. Obviously, these credit card deductions are for amounts and on a timetable agreed upon by the patient. However, the result is less administrative time and costs dedicated to mailing invoices and tracking down payment.
Effectively addressing claims denials is the other end of the payment collection equation. As such, denial management solutions and services were prevalent at MGMA. These tools are designed to leverage data analytics to give health providers an understanding of why their claims are being denied (or even better) why they might potentially be denied. Many of these solutions also offer templates for claims resubmission letters to streamline the process. All in all, these technologies aim to provide practices with the information they need to minimize claim denials and maximize and expedite payer reimbursement.
Getting Out From Under MU & ICD-10
ICD-10 and EHR MU have also competed for medical practice mindshare over the past few years. And, according to many, the federal government hasn’t made these transformative initiatives easy for group practices.
“I feel the federal government has failed medical practices, hospitals, and health IT vendors for taking so long to release the final rules and requirements for Stage 2 MU and for delaying ICD-10 again,” says Mona Engle, CEO/Practice Administrator for Doctors May-Grant Associates, a 15 physician OBGYN practice in Lancaster, PA.
According to Engle, these delays stall progress for different reasons. When it comes to MU, the slow release of the final requirements has caused vendors to accelerate product design and forced providers to rush into implementation and attestation. This hurried execution can easily lead to suboptimal results.
From an ICD-10 perspective, the extra year delay will actually require many providers to reinvest in the ICD-10 training and technologies they put in place for the original deadline. Moreover, the delay simply prevents the industry from realizing the benefits of ICD-10 (e.g. more precise coding and clinical documentation) for another year.
While most medical practices agree with Engle on the MU front, many medical practices were actually relieved that they were given another year to prepare for the transition to ICD-10. Many physicians’ offices simply weren’t ready for this massive undertaking in 2014, but are starting to get their ducks in a row for the new October 1, 2015 deadline.
That being said, these practices don’t want to lose their lives to ICD-10 preparation, nor do they want this initiative to divert too much focus away from patient care. As a result, many medical practices were eager to evaluate ICD-10 solutions at MGMA. Many of these tools help automate some of the coding changes, making the transition easier on clinicians and coders. For example, computer-assisted-coding (CAC) software exists that can suggest new ICD-10 codes based on the ICD-9 codes currently submitted by providers or by the diagnosis language contained in the clinical documentation.
Medical practices still have a ton of projects and initiatives on their plates, but it appears that this segment of the healthcare community is finally starting to envision ways IT can help solve their problems rather than just being another ball for them to juggle.