Readers Write 1/9/13

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The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Why Medical Practices Must Manage A/R Better … Now
By Tom Furr

“I didn’t go to med school to be an accountant.” How many times have we heard those words being muttered from a physician’s mouth?

Until now, that’s been an acceptable sentiment for any doctor. Today such thinking is financially dangerous if not downright disastrous. Even doctors in practice for as little as 10 years kept their focus on the insurance company, the source of 85 to 95 percent of their income. That almost predictable cash flow made reviewing accounts receivable reports — universally known as A/R — barely necessary.

Today, looking at A/R is an absolute requirement because of four letters that are having a huge impact on medical practices of all sizes and types – HDHP, which stands for High Deductible Health Plans.

These insurance plans have sent a loud and clear message to doctors across the United States: the game has changed. Simply stated, those practices that adjust quickly and wisely will be better able to survive. Those that don’t will be at risk of needing to sell out to hospitals or suffer serious issues with cash flow that could threaten the survival of their practices.

According to the annual report of America’s Health Plans, the number of U.S. residents using HDHPs rose nearly 20 percent in the past year. In 2013, 70 percent of larger employers will offer HDHPs, noted a Tower and the National Business Group of Health study. While the growth rate of this type of plan varies from region to region, no practice can think it won’t affect them soon.

The new reality is deductibles as a percent of contracted rates are about 50 percent. The days of the $25 co-pay are gone. Now practices are tasked with securing half the service bill’s balance from the patient. Unfortunately, physicians today don’t know the amount due until weeks after service, making it a priority to get the patient bill out as soon as the claim is adjudicated by the insurance company. That’s especially the case at the start of a calendar or plan year.

No one is suggesting doctors turn in their white coats and stethoscopes for green eye shades and a handful of sharpened pencils. However, they must become more attuned to the state of their practices’ financial condition. If a system is not embedded in their practice management software to manage patient bills and balances as well as produce insightful A/R reports, the doctor and his/her office manager should identify one and put it into place. Even if a new practice management system has just been deployed, that doesn’t mean you don’t need to ask the questions immediately of how to capture patient balances and post them automatically.

In the HDHP environment, everyone in the practice has a role to play, from front desk personnel to physicians. Each member of a practice should be educated on the new reality of HDHPs and how patients understand this new reality. However, it is also the responsibility of the practice to provide patients a simpler way to meet their financial obligations to the practice and continue to keep their healthcare relationships sound. If patients understand and have easy ways to remit payments, the physician keeps a sharp focus on the practice of medicine, secure in the fact that the A/R is being managed.

However, make no mistake, there is a limit on how much delegation a doctor or his/her office manager can allow. The tough calls need to be made by those individuals leading the practice. Decisions of the sort that most medical professionals could never have conceived of during their internships, like “firing” a patient.

Think about it:  with HDHPs, the shift from patient to deadbeat can occur in a matter of weeks if close attention is not paid to A/R.

Tom Furr  is CEO of PatientPay of Durham, NC.

NLP and Physician Workflow: An End to Physician Resistance?
By Chris Tackaberry, MB, ChB

“I hate all the EMRs out there, including the one our practice just bought. Notes that come from an EMR have so much extra stuffing in them that it takes me forever to figure out what you guys really had to say about the patient I referred to you. I have to wade through lines and lines of empty verbiage to finally find a meaningful sentence or two that tells me what I need to know.”

While the promise of the EHR/EMR remains as great as ever for healthcare providers, so too does the issue of physician resistance, as evidenced by this doctor’s comment, part of a conversation highlighted in a MedPageToday online article. Since EHRs came on the scene decades ago, physicians have remained slow to adopt the technology, even with the promise of improved workflow automation, enhanced care quality, rapid data exchange, and increased efficiencies. While the issue of physician resistance is certainly not new, it becomes an ever-more important concern as many hospitals continue to struggle to achieve Meaningful Use requirements.

There may be several reasons why physicians remain slow to come on board, but the most obvious is simply that doctors want to spend their time caring for patients, not struggling to use technology that introduces foreign, cumbersome tasks into their workflow. The truth is, even with today’s best systems, EHR data remains, on the whole, insufficiently descriptive or lacking in clinical context. Complete patient details often reside within historical notes embedded deep inside the EHR, and manually reviewing them for each and every patient, if a physician can access them, is incredibly time consuming and cumbersome.

Even with the technological advancements EHRs have seen over the years, physicians still have to spend tremendous amounts of time describing patient problems, medications, allergies, etc., in cumbersome forms or templates. As my colleague Tielman Van Vleck, PhD, Clinithink’s director of language processing, recently stated: “There is an intrinsic inefficiency in this process because so much of this information must be documented in the clinical notes repeatedly. As a result, there has been significant physician pushback against EHRs, despite their potential to improve both the quality and efficiency of physician-delivered care.”

NLP effectively embedded into an EHR has shown remarkable promise when it comes to minimizing the negative impact EHRs have on physician workflow. Rather than burdening physicians, NLP delivers more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

This is an important concern for providers dealing with Meaningful Use requirements, particularly Stage 2 and ICD-10, where capturing patient problem lists with unfamiliar coding terminology is another big deterrent to physicians. The good news is that NLP within an EHR can automatically tag all the problems referenced in a patient note, which in addition to facilitating analytics and clinical decision support not previously possible, can also support the capture of medications and allergies, saving physicians time associated with filling and maintaining these lists.

Physician resistance to EHRs won’t end tomorrow. But with the advent of Natural Language Processing and the manner in which this technology compliments physician workflow and will ultimately improve care quality, the light at the end of the tunnel may be considerably closer. Dr. Van Vleck recently noted, “NLP isn’t just a bigger hammer to build better widgets. If we do this right, we can improve medicine, helping people lead healthier, longer lives; we can simplify healthcare delivery and involve patients more; we can even help researchers make medical discoveries or respond to new diseases. There are a million ways that NLP can be leveraged in healthcare.”

It would seem tough to find a physician who could resist that scenario.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Vendor Resolutions for 2013
By Vince Ciotti

I tried to go to the gym today, but couldn’t get in. Too many people making New Year’s resolutions to exercise! So I went back to the office early and wrote this piece on New Year’s resolutions for our top 13 vendors, listed in order of their annual revenue.

1. McKesson. So big (over $3B in annual revenue) that they made two: (a) find jobs for the 200+ well-paid Horizon veterans they laid off last year, all with 15+ years experience in healthcare, programming, etc., and (b) hire 200+ new employees for the expanded Paragon line, following the Epic model of young, inexperienced, and cheap.
2. Cerner. Kick Paul Black’s butt.
3. Siemens. Use the excellent marketing materials and RFP responses for Soarian financials to start the design and programming soon.
4. Allscripts. Make Neal Patterson sorry he ever let Paul get away.
5. Epic. Find a NYC bank with a high interest rate on CDs.
6. GE. Sell something to somebody, somewhere, sometime, somehow …
7. Meditech. Start the design work on Release 7.
8. NextGen. Integrate the brochures, proposals, and PowerPoints for Opus, Sphere, and IntraNexus.
9. CPSI. Sell a large hospital (over 25 beds).
10. QuadraMed. Take a Quantim leap backwards.
11. NTT/Keane. Optimize their disparate product lines.
12. HMS. Get ready for Primus time.
13. Healthland. Rearrange their various products in Concentriq circles.

Vince Ciotti is a principal with H.I.S. Professionals LLC.