April, 2013:

Physician Champions and All Due Respect

Several years ago while training a group of doctors on the hospital’s new EHR, I had the fortune (or misfortune?) of training two equally unexcited senior physicians.  Both were seated in the first row, one to my right (I’ll call “Dr. Right”), and the other to my left (“Dr. Left”).  Not even in class for 20 minutes,  Dr. Left was becoming visually agitated, squirming in his seat and frowning, then starting to click his tongue and grunt, and finally speaking out with ‘wordsIcan’trememberbutweren’tnice’.  Everyone in the room was quite uncomfortable, especially me!   Having had enough, Dr. Right looked at him and blurted out, “SUCK IT UP”.  Dead silence – except from me, of course, I was the trainer.

 Not the perfect example of respect, but, deferring to Dr. Right, Dr. Left was obliging for the rest of the class.  Whether embarking on an implementation or heading up a new project, choosing physician champions that are well- respected by their colleagues will certainly help ensure a successful undertaking.  Respect is hard earned with physicians – it’s no small feat to become a physician and that in itself deserves a certain respect.  The physician champions don’t need to be liked (although that doesn’t hurt) but they need to be listened to and followed. They have to have proven their worth through exemplary work, recognition, and achievements. These highly regarded doctors also exhibit integrity, willingly carry responsibility and respect themselves as well as others.

While respect is the only value discussed here, there are, of course, many other fine virtues worthwhile to the physician champion.  However, the respected physician champion will help quench the fires of discontent, control the curmudgeons, and re-direct any physician specialists who think their particular specialty is the only one essential for proper human functioning.



Self Pay Management-Taking the Next Steps Toward Revenue Cycle Optimization

 As practices face shrinking reimbursements and increasing costs, there has been a lot of discussion about the need for efficiency in the revenue cycle. Frequently offered ideas include automating key business processes, tightening physician documentation and enhancing payer relationships. Although these are all valuable suggestions, there are a few lesser known strategies for revenue cycle optimization that practices should consider.   

 Get Control over Self Pay

While practices are focused on growing payer reimbursement by seeing more patients, many overlook the patient portion of the healthcare bill, waiting until the insurance company sends its payment before reaching out to the patient about his or her responsibility. This approach increases the workload of internal collections staff—the area of your practice that receives all unresolved accounts. These individuals are typically overwhelmed working a variety of issues and getting a self-pay account addressed quickly may not happen. Additionally, patients aren’t as motivated to pay their bill if the service has already been rendered. If the bill is sent to an external collections agency, the cost to collect goes up further, as practices can pay between 12-30 percent on any collected dollars.

 Requesting self-pay payments at the point of care lessens the costs associated with obtaining them. Using an automated tool that estimates the patient portion of a healthcare bill can help practices move patient payment upfront. Historically practices were hesitant to use software that estimates patient allowables due to inherent inaccuracies.  More recently however, these programs have become easier to set up and the accuracy has increased significantly.  Such software programs look at allowables and reimbursement amounts based on a practice’s contracts and generate a realistic estimate of what the patient will owe. With the insurance information in hand, information can be entered into the program in advance of this visit, making the patient responsibility readily available when the patient arrives.

 Circle Back and Update the Claims Scrubber

A common recommendation for boosting performance is to use a claims scrubber to identify missing data or inappropriate codes and missing modifiers before a claim is sent to the payer. This allows a practice to fix common issues prior to claim submission, sometimes resulting in cash back within 14-28 days.

 While many practices have implemented claim scrubber and correct claim edits one-by-one.  They do not, however, look for trends in both claim scrubber edits and denials which, if corrected at the root cause, would save the work associated with working claim scrubber edits and denials.  An additional benefit is increased cash flow and payments being received sooner.  This is more cost effective than waiting until the claim gets denied to address the issue. It can cost a practice as much as 3-5 times more to resolve a denied claim as it does to get the claim clean up front. Being proactive is especially important for large volume practices where eliminating multiple denials by shifting corrections earlier can translate into significant savings.

 Get Creative

The ideas outlined here go beyond the typical revenue cycle improvement strategies and they can help practices take that next step toward optimization. It’s important to think outside the box when considering ways to streamline revenue cycle operations. By keeping your work flow as nimble and cost effective as possible, you can widen narrowing margins and lay the groundwork for future growth.


Optimizing Appointment Scheduling Using Epic Cadence

The design and implementation of appointment scheduling within the Epic system has great advantages when you utilize advanced functionality provided for building a provider and/or resource schedule to maximize its potential while providing end user, provider and ultimately patient satisfaction.

Provider preferences play a key role when building schedules and determining the best use of visit types  (i.e., new patient, established patient, etc) allowing providers to maintain a sense of control over their schedules. Many providers have different time lengths in which they need to see patients. These providers can be in the same clinic or department but individually need varying time lengths.

Epic functionality allows for the sharing of visit types across departments with the capability of setting modifiers (time lengths)at the Provider level within the visit type taking the burden off the scheduler in determining length of time for any given office visit. These modifiers can additionally be set at Patient Level based on characteristics of sex or age. (i.e., physical for an adult may take 45 min but for the elderly patient may take 60 min) These modifiers adjust the length of the visit to meet the needs of the provider and/or the patient.

Security set up plays a key role in managing how end users can schedule within your facility and will prevent overbooking any given time slot.

Additional Epic functionality allow for Session Limits when a Provider wants to only see a certain number of patient types (i.e. New Patients, Physicals, etc) in the morning or afternoon instead of using blocks. These Session limits, once met, will not allow additional patients of these visit types to be scheduled.

Same day functionality build allows for time on a providers schedule that is locked out for scheduling and does not open up until same day or one day prior. The advantage of this set up is availability for those patients who truly need to be seen on the same day.

Using a Confirm Appointments Report reduces the percentage of No Show patients. Epic systems also have the capability of a pie graph on a patients appointment desk that tracks the percentage of No Shows on individual patients allowing a provider to track and determine at what time on his schedule a chronic No Show patient should be scheduled to avoid wasted time.

 A thorough design, build and validation within any facility can ensure a functioning scheduling system, maximizing its fullest potential for streamlined patient care.

 Open Access and Wave Scheduling are not optimal options in facilities that have individual provider preferences and multi-specialty needs.