The U.S. House has voted to postpone a planned cut in payments to physicians who treat Medicare patients by approving a reduction in payouts to private insurers. The legislation would forestall a 10.6% cut in Medicare payments to doctors and hospitals for 18 months. Democrats warned that such a decrease would lead to many physicians opting out of treating Medicare patients.
A study by the School of Population Health, University of Queensland, published in The Lancet Infectious Diseases journal shows that 25% of healthcare-acquired infections could have been prevented with proper hospital staff-to-patient ratios. The Australian researchers also found that an increase in MRSA infections specifically is causing a reduction in the number of available hospital beds, despite decreasing staff levels.
In the healthcare industry, physicians run tests and analyze results to help diagnose a patient. An A/R analysis can work the same way by offering ways to identify and ultimately repair the billing processes in your practice.
Practices often see the following A/R problems:
Failure to adequately use technology. Whether it’s an EMR or a practice management system, staff members often fail to get the most out of their computerized technology.
For example, practices might not load managed care reimbursement rates or fee schedules by CPT code into the system. Many also fail to load payer-specific edits.
As a solution, practices should research vendors that provide an electronic interface to access the practice’s payers and download updates. This gives practices the convenience to send out a request to the payer providing the most current insurance information before the patient arrives at the office, helping to avoid a denied claim and saving time.
Failure to bill the correct insurance company. For example, a patient has two insurance companies: a primary and a secondary. The staff member makes the mistake of billing the private company first and then sends a bill to Medicare, which means both bills are in the mail at the same time. Now the office will have to resubmit the claim after receiving a denial statement in the mail.
Failure to track and collect patient payments. Often, the billing department does not give patients a specific time to submit their payment to the office. They do not send out notices in the mail that explain the practice’s collections policy. This may cause confusion regarding what services a patient’s insurance provider will cover and may prevent patients from paying altogether.
These common pitfalls can result in lost time, increased A/R days, and reduced cash flow, says Frank Cohen, a senior analyst at MIT Solutions, Inc., in Clearwater, FL. But establishing an A/R analysis at your practice as a standard task not only can reduce billing mistakes, it can also help staff members recognize and avoid these problems altogether.
This story was adapted from one that first appeared in the June edition of The Doctor's Office, a publication by HealthLeaders Media.
Australian researchers report that the control of MRSA in hospitals can depend on overcrowding and understaffing. The team at the School of Population Health, University of Queensland also found that while the number of available beds in hospitals has decreased, the number of outpatients seeking care continues to rise. This problem is further complicated by a decreasing healthcare workforce.
Every time I open a newspaper or visit a major Web site lately, I see another article about the emergence of online portals that allow patients to rate their physicians. And the recent barrage of media coverage seems to have left many doctors skeptical of the unregulated sites and worried about their potential consequences.
Although perhaps overhyped in the media, many of their concerns are real. A few patients have already used negative online ratings as a form of "vigilante justice" when a malpractice lawsuit or complaint to the medical board didn't do the trick. And the anonymous format of many sites raises questions about whether patients will be honest (and whether it will only be patients leaving feedback).
Facing this reality, physicians have three options.
They can ignore the emerging trend and hope it doesn't affect their practices. This is feasible for now, but new companies are getting into the physician-rating business every day (Angie's List and Zagat, for example), and the influence of the sites is growing. Twenty-two percent of respondents to a recent poll by the California HealthCare Foundation reported looking at physician rating sites in 2007, up from 14% in 2004.
Eventually, physicians will have to accept online ratings as a normal part of practicing medicine.
The second option is resistance. Some practices are considering requiring patients to sign a contract in which they promise not to post any comments online without their physician's approval. The concept was developed by Medical Justice, a group dedicated to preventing frivolous malpractice lawsuits.
Not only is the legality of this approach questionable, but it can't be good for patient satisfaction. I agree that frivolous lawsuits are a major problem for physicians, but as a healthcare consumer, I wouldn't return to a physician who presented a gag order before the visit.
The third option—and best, in my opinion—is to use online ratings to improve your practice, to take the potential bag of lemons presented by physician rating Web sites and make lemonade.
For example, Jeanine Brailey, a practice administrator with Queen City ENT Associates in Cincinnati, was able to use online patient ratings to negotiate a 3% discount in each physician's malpractice fees.
The office had initially evaluated a number of paper surveys to measure patient satisfaction, but it decided instead to direct patients to Cincinnati.md—a physician rating Web site operated by YourCity.md—and monitor the feedback. When the group's malpractice carrier offered a discount if the group could show that, among other things, it was soliciting patient feedback and complaints, Brailey was able to point to the online rating system to negotiate a better rate.
Mark Deutsch, MD, an otolaryngologist with the group, says actively monitoring patient comments on the site has also led to improvements around the office, as well as a few new patients who first read about his service online.
Rating Web sites are still a long way from becoming an integral part of the healthcare process—only about 2% of patients have actually changed physicians based on information from an online rating, according to the California poll.
But most practices want and need patient feedback, and online rating sites provide that. Although there are certain risks involved, savvy practices will see them not as a threat, but as a new tool for managing the practice and improving patient care.
Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at ebakhtiari@healthleadersmedia.com.Note: You can sign up to receive HealthLeaders Media PhysicianLeaders, a free weekly e-newsletter that features the top physician business headlines of the week from leading news sources.
While in route to a recent retreat to speak about disruptive healthcare innovations, I picked up a copy of Harvard Business Review on Managing Health Care, which contained several articles about disruptive innovation and the changing healthcare landscape.
As I read the book, two questions popped into my mind:
If disruptive innovations are so hot, why aren't they working to lower overall health costs?
And if prices are so high, why are hospitals in such hot water?
Health costs ballooned by 4.4 times the rate of general inflation from 2002 to 2007. In "Will Disruptive Innovations Cure Health Care?"—an article featured in the compilation—Clayton Christensen, who popularized the term "disruptive innovations" in The Innovator's Dilemma (Harper Business, 2000), explains why healthcare costs may remain so high:
"Nurse practitioners, general practitioners, and even patients can do things in less-expensive, decentralized settings that could once be performed only by expensive specialists in centralized, inconvenient locations. But established institutions—teaching hospitals, medical schools, insurance companies, and managed care facilities—are fighting these innovations tooth and nail. Instead of embracing change, they're turning the thumb-screws on their old processes—laying off workers, delaying payments, merging, and adding layers of overhead workers. Not only is this at the root of consumer dissatisfaction with the present system, it sows the seed of its own destruction."
Christensen's comments may be true, but the medical establishment is unlikely to change. Its leaders are heavily invested in specialized facilities, and specialists (two-thirds of all doctors) are accustomed to having things their way and of dictating who can do what to whom.
Resistance to Change
The healthcare establishment is strong. It has lobbying power. And it can always claim only it has the stature and legitimacy to deliver quality care and set standards. For these reasons, disruptive solutions have been slow to come and to bring down health costs. These innovations have been marginally effective.
Sure, there have been signs of progress. Since 2000, Congress has made high deductible plans with HSAs widely available, consumer-driven care has chugged ahead, hospitals have started to decentralize, doctors have invested in specialty hospitals and other physician-owned facilities, large employers have set up worksite clinics, big retailers—Walmart, CVS, and Walgreens—have gotten serious about retail clinics, medical tourism has been born, and some have became delirious about health 2.0 as the do-all and be-all to re-organizing our dysfunctional system.
And the hospital establishment has shown signs of failure and panic. The fear of failure is out there. Michael Sandnes, director of healthcare services for the Executive Sounding Board in Baltimore, writes in a recent column, "Is The Tidal Wave About to Wipe Out the Health Care Sector?":
"Many hospitals and healthcare facilities have come face-to-face with the reality that factors largely out of their control, like insurance reimbursement and government funding, will ultimately determine whether they survive—perhaps in a different form with a new owner or in a downsized facility—or shut down."
Hospital challenges include
Competition from freestanding, investor and physician-owned diagnostic and treatment facilities.
Cost and complexity of technology and IT infrastructure.
Constant need to improve quality and patient safety.
Labor supply shortages
47 million uninsured Americans.
Questions about not-for-profit status
Pressures on Medicare and Medicaid reimbursements.
There are signs hospitals are awakening to the reality the status quo will no longer work. Hospitals are rapidly decentralizing to form their own outlying facilities, or creating partnerships and alliances with physicians groups. A good example of hospital decentralization is partnering with Walmart to own, oversee, and staff retail clinics in the 400 retail clinics Wal-Mart plans to open in the next two years.
The role of physician leadership
As these disruptive changes are underway for hospitals, pundits tend to disregard innovations on the physician side of the equation, perhaps because of physicians' fragmented, disorganized, independent nature. In the managerial and venture capital world, physicians tend to be viewed as organizational mavericks and therefore may receive little respect.
This is a mistake. Physicians know that without physicians, hospitals would be nothing but empty shells of buildings with mediocre food. They also know physicians flooding into hospitals for employment may ultimately rise to top leadership positions, as they have at Johns Hopkins, Mayo, the Cleveland Clinic, Duke, Emory, and Health Partners in Boston.
Finally, physicians know the future lies in detached facilities—emergency rooms, diagnostic centers, surgicenters, big MACCs (multispecialty ambulatory care centers), imaging centers, surgicenters, specialty hospitals, specialized chronic care facilities—established and controlled by physicians, and in their own revamped, rewired, and retooled practices, delivering care outside established institutions.
These shifts are underway, but they sometimes lack overall physician leadership. Needed now are new business models, new ideas, and new innovations. Ideas for these may emerge of such knowledge exchange sites as Sermo.com, which now has 65.000 doctors submitting ideas and suggestions, or the Physicians Foundation for Health System Excellence, whose constituency consists of state medical society leaders representing 300,000 practicing doctors. New consulting firms, focusing on physician innovation, are springing up to provide new directions.
The physician culture as a whole must coalesce around central disruptive ideas that make healthcare more convenient, cheaper, better, and more adoptable by generalists and the public at large. Rather than turnaround firms, practicing physicians need organizations and leaders with market insights, strategic and development skills, and ability to help physician execute through innovation in rapidly changing markets.
I conclude with this cautionary note from Clayton Christensen, Richard Bohmer, and John Kenagy in the Harvard Business Review on Managing Health Care:
"If history is any guide, the established high-end providers of products and services are likely to be articulate and assertive about preserving existing systems in order to ensure patient-well being. Very often, however, their eloquence reflects concerns about their own well-being. Customers have almost always emerged from disruptive transitions better off- as long as the disruptions are not forced into an old mode, but instead enable better service to be delivered in a less-costly, more convenient contract."
Maybe in the end, those at the bottom of the healthcare food chain—patients and primary care doctors, will set the pace for change. But we're not there yet.
Richard L. Reece, MD, is a pathologist, writer, editor, speaker blogger and consultant in Old Saybrook, CT. His blog may be accessed at www.medinnovationblog.blogspot.com. He may be reached at rreece1500@aol.com.