Communication skills have deteriorated over the past few years, and marketing "boo-boos" have the potential to impact an organization's image and credibility. In this online entry from Marketing Profs, Elaine Fogel asks readers to share their thoughts on the subject.
To some, the renaming of Weston (WV) Hospital to the Trans-Allegheny Lunatic Asylum acknowledges history by readopting one of the many names previously held by the long-vacant, 19th century mental institution. But others say the new owners of the hospital have gone too far, and are disparaging the suffering of former patients.
The Agency for Healthcare Research and Quality has announced the release of an online video with tips for patients when communicating with their doctor. The goal is to reduce medical errors and improve patient outcomes, and the video is part of a massive federal effort to improve the quality of healthcare in the United States.
Focus group hypnosis is increasingly becoming a "secret weapon" for Fortune 500 companies and ad agencies. A typical session takes two hours, with the first 25 minutes dedicated to introducing the subjects to the process and getting them relaxed. Once they are in an "alpha" state of relaxation, the hypnotist asks each individual about topics like the first time they experienced a product.
Research published in the Journal of Consumer Research found that test subjects who were shown a logo for 30 milliseconds were much more likely to be creative or candid in the cases of Apple and the Disney Channel, respectively. The research suggests that brands can subliminally inspire or create certain kinds of feelings in consumers--which is valuable information for marketers.
The healthcare revenue cycle could be compared in some ways to the automobile.
Technology has dramatically improved the speed and convenience at which both can operate. It used to be that all you needed to repair most car problems was a screwdriver and a pair of pliers. Modern vehicles, by contrast, are driven by so many on-board computers that you can hardly inflate a tire without first paying a mechanic to plug it in and check the diagnostics.
Perhaps the most closely aligned similarity between cars and the healthcare revenue cycle is the tumultuous industries in which they reside. Automotive manufacturers in recent years have been pinched between increasing labor and fuel costs and stiffening competition from foreign entities. Similarly, the U.S. healthcare system is front page news with increasing government spending, decreasing insurance payer reimbursement and the rising number of uninsured in the headlines.
But when you boil macro problems down to the perspective of one hospital, it all becomes the same fundamental challenge--figuring out how to get paid in the midst of everything going on around us.
In the past, healthcare providers had much simpler methods for collecting for their services. There were fewer payers and fewer rules by which they paid, and most collections were adequately handled by back-end staff. Today, a more complex revenue cycle yields an increase in the number and complexity of denials, and providers need the ability to collect at every corner of the hospital.
Industry analysts and other experts' research suggest that as much as 25% of all claims are rejected or denied on first submission. Most--90%--of those are preventable, and even after a rejection more than half are still recoverable.
Getting paid is no longer solely a function of the billing office and other back-end departments. In fact, back-end efficiency depends directly on front-end process efficiency, and successful providers are realizing that in order to capture as much revenue as possible as early as possible, they must consider a revenue cycle that begins at the first point of contact with every patient.
Fortunately technology has been developed to aid providers in this effort.
How? By first obtaining accurate patient insurance information and demographic data. Of course this is easier said than done in the fast-paced, high-pressured front-end environment. Most employees filling entry-level front-end positions are less educated and lower paid. Their daily responsibilities include managing patient access according to charity programs and Medicaid, Medicare and commercial payer rules and restrictions. Their performance is evaluated on registration time because it directly affects patient satisfaction. The expectations are high, and so is the turnover rate.
Still, the classic mandate from any CEO, CFO, or business office manager is, "I want each patient registration to be accurate and fast." And the classic response from registrars, although seldom stated out loud, "Pick one and call me back!"
Due to resource and time constraints, registration and admissions personnel cannot realistically meet the demands of today's revenue cycle using manual processes. Automation is required in order to close revenue cycle gaps.
Automated technology gives staff the ability to verify patient data at any and all points during scheduling, pre-registration, registration and admission. By confirming patient insurance eligibility, benefit types and levels, current address and co-pay and deductible amounts up front, providers are greatly increasing the likelihood that they will collect for each service performed.
But automation alone is not enough. To effectively and consistently close revenue cycle gaps, the ideal technology must have the ability to link patient inquiries. For example, if a patient presents in admissions as self-pay, then technology can automatically run his or her information against Medicaid to check for coverage, based on state of residence. If no coverage is found, then an address verification and credit score could be processed to determine the financial risks associated with treatment, particularly in non-emergent scenarios.
Automated technology can also aid front-end staff in a number of other critical functions, including:
Pre-certifications for routine hospital stays or outpatient procedures. Pre-certification is usually done before admission for non-emergency care or shortly after admission for urgent or emergent care. It is increasingly required by some health plans for reimbursement.
Validating procedures against medical necessity for accurate diagnosis codes. Validating medical necessity is the responsibility of the provider and should occur before services are rendered. If a Medicare procedure fails validation and the patient was not notified in writing in advance of providing the service, then the hospital cannot collect for that service. Medical necessity validation can be automated through technology to help hospitals avoid millions of dollars in potential losses.
The actions above should be triggered by technology, not done manually. Doing so:
expedites the registration and admissions process, which improves patient satisfaction
improves data accuracy by eliminating human error
reduces claim rejections and denials, draws faster payment and minimizes re-billing in the back end
improves registration staff efficiency
dramatically boosts collections
Just as we've become accustomed to the bells and whistles of modern automobiles, healthcare providers should expect technology to make for a faster and more efficient revenue cycle.
Providers that implement the right technology will find that when their managers make the recurring mandate, "I want all registrations completed accurately and quickly," the staff response changes to "Not a problem--we have the tools to get the job done!"
Automation is the only sustainable approach that will effectively bridge revenue cycle gaps between the front and back ends.
Max Carter is vice president of sales for Passport Health Communications, Nashville. He can be reached at max.carter@passporthealth.com.
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Let it be said that I am no big fan of legislating healthcare privacy. After all, many people among us willingly blab about the very health conditions that privacy advocates insist are sacrosanct. And the laws that attempt to regulate access to privacy can quickly become confusing and burdensome--just look at the massive industry attempt to comply with HIPAA and its disclosure requirements for personally identifiable health information. But I understand that the burdens of legalese and human nature are not ample reason to throw privacy to the wind. Other than my doctor, it's really nobody's business what my diagnosis is, or was, or could be.
That's why I did a real double take when I saw two recent news stories. First, the state of Texas became the first in the nation to pass a law that compels insurance companies to pass along sensitive health information to employers. Second, the state of New Hampshire killed a proposed law that would have required additional privacy restrictions on electronic medical records.
The new Texas law entitles employers to receive lists of employees whose healthcare bills exceeded $15,000 annually. According to the article, "employers must pledge they won't use the protected information for anything except plan administration." And a state spokesman says he "trusts employers to do the right thing." By that he means, he trusts employers not to fire people simply because they are ringing up too big a healthcare tab and therefore driving up the company's premium. As one of the readers of the article wrote on the Houston and Texas News' online commentary board, if you believe that, I have a bridge to sell you in New York.
The article also states that the Texas law does not violate the overarching HIPAA law, which sent hospitals and medical groups into a compliance tizzy not that many years ago. I am not questioning the validity of that assertion. However, I imagine many people, like me, would be surprised by the news. I have been assuming, falsely I guess, that the HIPAA law would have thrown up more roadblocks to an employer's rights to view personal health information. To me, the spirit of the law was that your personal health information belonged to you, and viewing rights belonged to a defined circle of caregivers with a legitimate need to see it.
I know that staff in hospitals and medical groups who take a peek at someone's health record without a legitimate need are subject to punishment and even termination. Healthcare providers take this responsibility seriously. That's one of the big attractions of EMR technology. While the EMR may be hacked, in fact it is far easier to monitor for inappropriate access compared to the paper chart. The electronic audit trail can reach far and wide. And in many electronic record systems, access is role-based--if not heavily debated. The defeated New Hampshire law would have obliged hospitals to create such audit trails--in addition to banning fund-raisers and marketers from gaining access to patient records. Now they're off the hook.
Both states cite economics as the motivators behind their actions. In Texas, letting employers know about their employees' diagnoses, dates of services, amounts paid, prognoses, treatment plans, and future costs enables them "to get a clear snapshot of health expenses." And in New Hampshire, strengthening EMR privacy requirements would have cost too much money.
Curiously, New Hampshire legislators were worried about the cost of producing gigantic audit trails. Whereas in Texas, they want to do precisely that. Only these patient records would be circulating around corporate headquarters, not the hospital's compliance department.
Editor's note: Don't forget to submit your entries for the 2008 HealthLeaders Media Top Leadership Teams Conference and Awards. Deadline for entries is March 27.
Luling, LA-based St. Charles Parish Hospital will apply for a long-term $8.3 million loan, plus an additional $6 million that doesn't have to be repaid until 2015. The loan request is partly due to changes in the way uncompenstated is reimbursed. Additional funds will be used to launch the operation of the hospital's new wing, which includes more psychiatric beds, a medical-surgical unit and other facilities that are designed to generate more revenue.
Brazil will send 671 health workers to Rio de Janeiro to help overwhelmed emergency rooms that are reporting 80 new cases of dengue fever every hour. Officials have also opened a crisis center for representatives from the state and federal governments and the armed forces to coordinate prevention efforts.
Because chemotherapy costs are rising so dramatically, the American Society of Clinical Oncology is developing guidelines on how to have a straight talk with patients about the affordability of treatment choices. The idea is to treat cost essentially as another side effect to weigh in choosing a therapy.
