By Chris Walls, CEO, Pulse Systems, Inc.
Physician practices are under constant pressure to improve value, but that can be difficult when there are so many moving parts: new quality reporting programs like MACRA, changing reimbursement models, and increased regulatory pressures, to name a few. Practice resources are stretched—and smaller practices may struggle to keep up.
So what’s a physician practice to do? For many, technology could be the answer to common pain points. Following are five common challenges physician practices face—and the technology-based solutions that could make a difference.
1. High-deductible plans continue to challenge cash-strapped consumers. Eighty-three percent of physician practices with five or fewer physicians reported that delayed payment from patients with high deductibles is their biggest revenue cycle challenge. Many of the survey respondents—including nearly 1,600 physician practices—are turning to retail-like technologies and processes to recover monies owed.
For example, now may be the time to consider implementing advanced modeling tools to predict patient’s propensity to pay. Some solutions predict payment at the point of service within a few minutes. The data received gives staff an opportunity to establish payment plans where needed. In instances where patients qualify for outside financial assistance, some revenue cycle management (RCM) technologies also give staff the tools they need to help patients apply for assistance at the point of care.
2. Commercial payers are scrutinizing more claims than ever. A recent report revealed big differences between five major national payers when it comes to average time to payment and denial rates. Such differences make it more challenging for physician practices to collect monies owed. When claims or patient billing statements are not accurate, patients’ frustration increases—and so does days in accounts receivable (A/R), the average number of days it takes for an organization to be paid the amount due.
One smart investment for physician practices: claims-scrubbing software that corrects data entry errors and seeks to verify medical necessity prior to claims submission. The most successful physician practices also follow up with payers within five days of claim submission to make sure the claim was received.
3. Medical records are attractive targets for identity theft. With a 50 percent increase in cybersecurity attacks reported in 2017, physician practices often lack the resources to sufficiently protect their data from attack. This may include funds to afford large, complex data storage systems, the bandwidth to support effective backup and recovery, and dedicated IT staff to regularly install security updates. As a result, many physician practices that experience a ransomware attack pay the fine simply because they can’t afford disruptions in care.
Cloud-based services are improving the security outlook for physician practices by offering the potential to better protect and manage patient data. Moving data to the cloud enables physician practices to securely protect patients’ medical and personal data in an economically attractive way. It also positions practices to leverage the big data capabilities of hospitals, health systems and vendors in improving quality of care and population health.
Make sure the cloud solution chosen supports collaborative care with other providers across the continuum, including systems used by hospitals and health systems. Also, having a cloud-based solution that grows with a practice is an important consideration.
4. Electronic health record (EHR) documentation is a burden for physicians. EHR systems are great right up until they take more time to document a patient visit than the visit took itself. Quality program reporting requirements add to this burden. According to an MGMA survey, physician practices in four specialties spend 785 hours per physician and more than $15.4 billion on quality measure reporting programs. Most of this time consists of “entering information into the medical record only for the purposes of reporting for quality measures from external entities,” according to MGMA research.
Use of “smart” technologies that interface with the EHR—like smart forms that provide clinical decision support—helps to ease the EHR documentation burden. For example, investing in automated tools that prompt physicians and staff for documentation that supports medical necessity increases efficiency and speeds prior authorization approvals. With the time savings, physicians are able to spend more one-on-one time with patients.
5. Scheduling is more difficult than necessary. Outdated practice management (PM) systems make administrative tasks more difficult for physician practice staff than they should be. This impacts a practice’s ability to schedule patients, send out accurate billing statements, and manage their revenue cycle. Today, new PM systems use intuitive workflows and user-friendly screen navigation not only to reduce time spent on administrative tasks, but also to ensure and maintain regulatory compliance.
Innovations For Improved Value
The demands on physician practices continue to increase in an era of value, but adding enhanced functionality to existing technologies could help practices solve some of their greatest pain points. Take the time to pinpoint areas where technology-based solutions could make a deep impact on efficiency, engagement, reporting and revenue.
About The Author
Chris Walls is president and CEO, Pulse Systems, Inc.