8 Ways Practices Are Investing in the Patient Experience

Providing a great patient experience is slowly shifting from a differentiator to a survival tactic. In a world where reimbursements are tied to patient experience and where online ratings can impact patient volume, practices can’t afford not to focus on experience.b But are practices investing in patient experience?

Healthcare IT Today recently sat down with Andrew Hadje, Assistant Director, Association Content at the Medical Group Management Association (MGMA) to find out. During our conversation Hadje shared tangible, actionable ways practices and medical groups are improving patient experience. Throughout the year, MGMA has been gathering feedback and information from its members on this important topic.

Here are 8 ways practices are working to keep and delight patients:

1. Let patients book online

Being able to book an appointment online can be the difference between a patient using your clinic and a patient using someone else’s. We all have busy lives. We want to be able to book an appointment when it is convenient for us, which may not necessarily be during your office hours.

What’s more, we don’t want to sit on hold for something as simple as booking an appointment. We can book airline tickets, cruises, dinner reservations and even plumbing services online, yet only a fraction of medical practices offer this convenience to patients. Soon, if a patient can’t book online, they will find a different practice.

“Offering the ability to book an appointment online is just the first step,” said Hadje. “Patients want to check-in and fill out paperwork while at home. Smart practices recognize how much time this saves for patients as well as their staff and are moving to adopt solutions that allow for this type of pre-appointment interaction.”

[Editors note: Companies like Phreesia and Kareo offer solutions to automate patient intake. DocASAP and Solutionreach offer platforms for online appointment booking.]

“Access to care and when, where, and in the modality the patient wants is one of the most important things for patients in 2020,” explained Hadje.

2. Giving patients access to their records

Patients want and deserve access to their medical records. The argument that patients will not understand or will misinterpret the information in their records is no longer an acceptable excuse for preventing access. In fact, the government is about to set rules that may penalize healthcare organizations and software companies that block access to medical information (see “info blocking”).

If practices don’t already have a patient portal where patients can see their records, it’s time to get one.

And that’s just the first step according to Hadje: “It’s no longer enough to put in a portal and let patients see their records. Once patients have access, they want the ability to communicate about their records. They want to be able to ask their doctors questions via the portal and receive answers there.”

Forward-thinking practices are adopting portals and/or patient communication platforms that allow for two-way conversations between patients and providers.

3. Text reminders

Let’s be honest. We’ve all taken that little appointment card from our doctor’s office and promptly stuffed it in our pockets (or purse), never to be seen again. When patients miss or are late for their appointments, it causes waiting room chaos.

Reminding patients of their appointments via text message is one of the easiest ways to eliminate this issue. This will not only provide patients with a positive experience, it will reduce stress and workload on practice staff as well.

[Editors note: Solutionreach, Stericycle Communication Solutions and WELL offer patient communication platforms that include text, email and automated voice messaging.]

4. Answering the phone

In addition to new online methods of communicating, patients still want to be able to call practices.

“Investing in call-handling is something that practices shouldn’t overlook,” warned Hadje. “We were pleased to learn that MGMA members still prioritize phone calls and are looking to new technologies and processes to improve how they handle calls.”

Chatbots – intelligent, natural language virtual assistants – have gotten sophisticated and affordable enough to handle many routine inquiries. A live agent is no longer needed to answer simple questions like “When is my appointment?” or “Where is your office located?”. Chatbots can even handle tasks like rescheduling appointments, requests for an EOB and updates to a patient’s contact information.

It may sound silly, but even if patients never call into a practice, knowing that they can talk to someone if they need to, goes a long way to providing a good experience.

5. Being available whenever, wherever with telehealth

Telehealth capabilities (providing virtual visits that often includes video) helps smaller practices compete with larger organizations that have multiple clinic locations. Telehealth is also extremely convenient for patients.

According to a study conducted by FAIR Health, the number of claim lines related to any type of telehealth service increased 624% between 2014 and 2018. This sustained growth over multiple years is evidence that telehealth is not a fad, but a permanent new fixture of the healthcare landscape. Insurance companies have even started to expand reimbursements for telehealth.

More and more practices are looking into telehealth not only to improve patient experience, but also to reduce costs/increase revenue. It was encouraging to hear that telehealth was a discussed technology by MGMA members.

6. Remote monitoring

New wearable and remote patient monitoring devices enter the market every day. Just in the last few years, technologies have advanced to the point where cardiologists can monitor heart patients at home, saving trips into the office for a simple check-in.

Not only does this reduce the workload and burden on already-busy practices, it also helps patients feel safer and better cared for knowing they’ve got a vigilant eye on their health through these wearable and home based devices.

Even better, there are now CPD codes for the most common devices, which means insurance companies may cover the costs.

(Editor’s Note: A great place to check out the latest in healthcare tech is the annual Healthcare Information and Management Systems Society (HIMSS) Conference]

7. Embracing AI

Artificial intelligence (AI) has been a hot topic in healthcare in recent years. Hadje was particularly excited about the promise it holds for quality and speed of care: “AI can gather, process, and share information exponentially faster than we as humans can. And while AI will never 100% replace humans in diagnosis and treatment, AI tools can certainly assist in guiding providers to the right answers more quickly.”

AI has already been successfully deployed in radiology – helping radiologists prioritize image reads based on potential abnormal scans, a significant improvement over the traditional first-in, first-out method.

Practices can adopt AI in several ways. Decision support tools, powered by AI, can assist with diagnosis. Chatbots built with smart AI algorithms can learn patient call/response patterns to provide improved customer service. AI has even helped practices improve their claims processing by detecting errors and flagging claims that were missed.

8. Planning for interoperability

Although “interoperability” is one of the most over hyped buzzwords in healthcare, it should still be a priority for practise and groups. Why? Because sooner or later medical information will need to be shared…and if you don’t have the systems capable of doing it, you may face stiff penalties or be shunned by the broader healthcare ecosystem.

“It’s encouraging to hear practices talk about the need for their systems to be interoperable,” said Hadje. “It shows that many are thinking about the future when health information flows freely, securely and easily between healthcare organizations.”

Imagine how patients will feel when they know the information from their Emergency visit to the hospital will be transferred to their family physician or when their current medication information is available to the first responder that is helping them.

Avoid pitfalls

With new technologies come new processes, conveniences, patient satisfiers, and automations. But new technologies also bring new challenges. Hadje had the following best practices to share for practices looking to use technology to improve their patient experience:

• Prioritize cybersecurity. If you’re building technologies internally for your practice, be sure patient confidentiality is top of mind with your tech team. And always ask potential tech vendors what safeguards they have in place for patient data.
• Be prepared for failure. Make sure you have a backup and disaster recovery plan in place. And be sure to ask any potential technology vendors how/where their solutions are hosted and what their backup systems and disaster recovery plans are.
• Be realistic. Technology is always evolving. Sometimes it works perfectly. Sometimes it needs constant tinkering. Set realistic goals and expectations when deploying new systems. Give yourself plenty of time for testing, training and adapting.

With the right tools and mindset, any practice can make changes that result in huge wins for patients and themselves.

To read more from MGMA on cost, quality, and convenience, check out their Medical Practice Leader’s Guide to 2020

Telehealth Eases Work Life Balance

Telehealth eases work-life balance for solo practitioner, adds revenue stream

800 of Dr. Scott Jensen’s patients have thus far opted for virtual visits in rural Arizona. The telehealth tech has an easy ROI, he says, and boosts patient satisfaction.

With value-based care on the rise, the adoption of digital tools is rapidly progressing, yielding better diagnoses and outcomes.

THE PROBLEM

Today, most physicians know some form of digital transformation is essential to their future. Yet adopting technologies like telehealth continues to become more daunting, especially for small practices. HIMSS Media research found that digital adoption, including telehealth, is a top priority for healthcare professionals, but thus far, fewer than 10% have executed a full digital strategy.

“The problem I faced was one of work-life balance,” said Dr. Scott Jensen, a solo practitioner. “My practice, Jensen Family Medicine, is based in Queen Creek, Arizona, which is a three-hour, 166-mile commute from my home in Lakeside, Arizona. I am committed to my practice, which I opened 12 years ago with my wife Debra. However, I am also dedicated to my family and our home in Lakeside, which is an ideal place for my wife and I to raise our seven children, five of whom are currently home-schooled.”

“Practicing telehealth is a great way to build and maintain strong patient relationships, increase provider satisfaction with their career and add a new revenue stream.”

Dr. Scott Jensen, Jensen Family Medicine

Seeking a way to achieve a better work life-balance, Jensen decided to explore practicing telemedicine. After some comparative research, he decided on telehealth vendor Medici’s HIPAA-compliant app because of its attractive interface, ease of use, and ability to quickly and easily exchange text messages with patients – a feature patients love, he remarked.

PROPOSAL

With the goal of spending more time with his family in Lakeside, he adopted the telemedicine app in the summer of 2019. He selected the app because it would enable him to connect with patients via text message, calls, live video conferencing or photo uploads using nothing more than his smartphone and the app.

“Two other attractive features that drew me to the app are its translation function, which has the potential to help me better connect with Spanish-speaking patients, and its collaboration function, which enables me to invite specialists and other clinicians to join me in consulting with patients,” Jensen explained. “Prior to adoption, I also hoped the app would help me increase patient satisfaction through the convenience and cost savings of telemedicine.”

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services and Tellus.

MEETING THE CHALLENGE

Jensen said the app is very easy to use. He receives a visit request alert, opens the app, taps the phone screen, and begins his patient visit. He observed that patients love that he conducts virtual visits because they are now able to obtain care whenever and wherever they want. They typically consult with him from their homes or workplaces.

Medici is integrated with several electronic health record systems, including DrChrono, CareCloud, athenahealth, Kareo, and Allscripts. The partnerships enable Medici to seamlessly import new users into the HIPAA-compliant messaging app and virtually connect them to their providers at any time, from anywhere.

RESULTS

“The greatest benefit of adopting telemedicine has been increased patient satisfaction,” Jensen reported. “I can’t stress enough how, from the patient perspective, nothing beats the convenience of obtaining care from your home or office. No need to worry about transportation or taking time off of work.”

Virtual visits also are a great deal for patients, he contended.

“That is because most insurance companies recognize that increasing telemedicine utilization is a key to reducing overall health system costs, so they encourage its use by making it much more affordable than office visits,” he explained. “So far, about 800 of my patients have opened Medici accounts to do virtual visits.”

Telemedicine also has helped Jensen find a more healthy work-life balance by enabling him to designate Mondays as “virtual care only” days, which allows him to extend his weekend at home with his family while also seeing patients.

“I meet with patients all day from the convenience of my home office,” he said. “In general, routine and straightforward cases work best for telemedicine – ear infections, rashes and colds are some of the most common.”

Jensen also saves a lot in travel time and fuel. Telehealth calculators have shown him that a teleworker in Arizona with an average round trip commute of 50 minutes saves close to $15,000 a year in oil and gas and wear and tear on the vehicle. His commute time is triple that.

“In terms of finances, I am very easily able to offset the $150 monthly cost of the app,” he noted. “I bill patients $27 for a five-minute consult so I easily cover the entire cost with about 30 minutes worth of consults. On a Monday when I am practicing at home, I typically see five patients per day. On a typical day in the office, I see about 26 patients in-person and four virtually.”

ADVICE FOR OTHERS

“Practicing telehealth is a great way to build and maintain strong patient relationships, increase provider satisfaction with their career and add a new revenue stream,” Jensen advised. “Unlike many solutions that purport to increase physician productivity and

$999,000 HIPAA Settlement

Unauthorized Disclosure of Patients’ Protected Health Information During “Boston Med” Filming Results in Multiple HIPAA Settlements Totaling $999,000

Today, the Department of Health and Human Services, Office for Civil Rights (OCR) announced that it has reached separate settlements with Boston Medical Center (BMC), Brigham and Women’s Hospital (BWH), and Massachusetts General Hospital (MGH) for compromising the privacy of patients’ protected health information (PHI) by inviting film crews on-premises to film “Boston Med,” an ABC television network documentary series, without first obtaining authorization from patients. Collectively, the three entities paid OCR $999,000 to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.

This is the second HIPAA case involving an ABC medical documentary television series, the previous being OCR’s April 16, 2016 settlement with New York-Presbyterian Hospital in association with the filming of “NY Med.”

To resolve potential HIPAA violations, BMC has paid OCR $100,000, BWH has paid OCR $384,000, and MGH has paid OCR $515,000. Each entity will provide workforce training as part of a corrective action plan that will include OCR’s guidance on disclosures to film and media: http://www.hhs.gov/hipaa/for-professionals/faq/2023/film-and-media/index.html.

The respective Resolution Agreements and Corrective Action Plans may be found on the HHS website https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/bostonmed/index.html

COMMON PROBLEMS IN MEDICAL CODING

COMMON PROBLEMS IN MEDICAL CODING

COMMON ISSUES

NOT CODING THE HIGHEST LEVEL

The coder’s job is to code to the highest level of specificity. This means abstracting the most information out of the medical reports from the provider and taking accurate notes. It also means knowing the medical terminology for both procedures and diagnoses. Coding to a general level, or undercoding (which we’ll discuss in a moment) can lead to a rejected or denied claim.

BAD DOCUMENTATION/MISSING DOCUMENTATION

Of course, not coding to the highest level isn’t always the coder’s fault. In certain cases, the provider won’t give the coder enough information about the procedure they’ve performed. Providers may leave important details of the procedure out of the report, or they may provide illegible medical reports. This problem is exacerbated by the next trouble spot on the list.

NOT HAVING ACCESS TO THE PROVIDER

Ideally, every coder would be in constant contact with the provider they’re coding for. Unfortunately, that’s not always the case. Providers aren’t always available to consult on difficult-to-understand claims. Coders have to do the best with what they have in these situations, but you should still try and clarify the report as best as you can.

FAILING TO USE CURRENT/UPDATED CODE SETS

The organizations that maintain the three principal medical coding code sets (the WHO for ICD, the AMA for CPT, and the CMS for HCPCS) update these manuals yearly. It’s up to coders to learn any new or reorganized codes as they come out, and use them correctly. This is partly why professional organizations like the AAPCand AHIMA require every member to complete a certain amount of educational credits every two years. Keeping your skills sharp is imperative.

UNDER AND OVERCODING

We mentioned these in Course 3-7, but they’re worth mentioning again. Undercoding is the purposeful reportage of less expensive medical services than were performed, while overcoding is the reportage of more expensive procedures than were performed. Both of these are fraudulent, and can lead to audits and investigations. These aren’t errors, per se, but we’re obligated to mention them here as something you absolutely must avoid.

UNBUNDLING

Like under- and overcoding, unbundling is not so much of an error as it is a fraudulent practice. Unbundling is closely related to upcoding, in that it involves false reporting designed to earn the provider a higher payout from a payer. Unbundling means separately coding procedures that would normally be included in one umbrella code.

REVENUE CYCLE CHALLENGES

Here are the most common pain points for the Medical Practices revenue cycle and tips for providers about how to avoid financial trouble.

Billing and collections errors
Inattention to a billing process can hurt hospitals to the tune of tens of millions of dollars, and may also shock patients with huge debts that they cannot pay.

As patients become increasingly responsible for out-of-pocket costs, hospitals will need to ensure that they aren’t leaving uncollected revenue on the table – but also that they are not squeezing their patients so hard that they seek care at other facilities the next time they need care.
Not all providers have mastered the art of collecting the maximum amount of revenue at the point of service, yet 85 percent of organizations say that collecting payment from patients after they have left the campus is a very difficult task, a survey found.

“The conversation with the patient has to start early – at or before the point of service – if providers are to reduce the amount of bad debt they’re currently experiencing,” said Availity CEO Russ Thomas.
Hospitals need to develop a better understanding of patient responsibility and devise more streamlined methods of collecting payments from their customers if they are to maintain financial stability in a quickly changing landscape.It’s good practice for a provider to have a competent medical billing process in place. This can help ensure that payments are received without delay. It’s also beneficial for a provider to employ an efficient, well trained medical billing staff that understands the importance of the quality and integrity of the data that they deal with daily.

Health information technology challenges technology to keep track of claims through their entire lifecycle. This is necessary to ensure payments are collected and denied claims are addressed. However, some hospitals struggle to put information technology and billing infrastructure in place in a way that successfully manages claims as well as large outpatient networks. In today’s healthcare environment, effective health information technology is essential.
Unfortunately, not all hospitals and clinics have the capital or infrastructure to invest in new technologies or even required technologies, such as EHRs. Many times, this factor applies to small rural hospitals particularly.

As a result of not being able to implement required technologies, some providers end up consolidating, while others turn to outsourcing. Others end up shutting their doors altogether.
“Generally speaking, in order to strengthen the revenue cycle management, embracing technology within the revenue cycle is key,” said Chad Sandefur, Director and Healthcare Analyst at AArete. “Having the platforms to seamlessly facilitate provider-payer interactions are really integral. In many cases, it’s mostly about bad debt avoidance.”

Other types of new technologies may offer medical benefits but require providers to make a substantial capital investment. It can be challenging for an administrator to determine which technologies to use and how much to send. Providers should turn to information technology consultants to help aid them in decision making. It’s even better if a healthcare facility can have an IT expert onsite at all times to handle any IT-related issues.

Lack of staff training
If healthcare staff members are not trained effectively, they might not bill correctly or capture patient data correctly. Healthcare staff who are responsible for billing need to knowhow to properly capture a patient’s demographic information on the front-end, and how to translate that data to successful insurance claims after that.

“From a revenue cycle perspective, getting the most accurate information upfront starts with patient scheduling and patient registration,” said Gary Marlow, Vice President of Finance at Beverly Hospital and Addison Gilbert Hospital.

“That provides the groundwork by which claims can be billed and collected in the most efficient and effective manner possible,” Marlow stated. “The last thing you want is getting a claim submission kicking back to them then having to work their way through the institution.”
Although training might be costly and time-consuming, it can save a healthcare organization money in the long run. Coding errors can equate to medical error, which causes unnecessary spending. For example, in 2015, twenty-three hospitals in New Jersey paid a $500,000 penalty for medical errors, a previous report noted.

The ICD-10 transition may be more or less complete, but coders will need to stay sharp with the new skills they learned if they are to continue to contribute to the bottom line.
Coding staff should complete a 60-hour long training session in four-hour increments in order to learn how to code effectively. A well-trained staff can reduce billing errors and make the whole process of billing more efficient.

Failure to monitor the entire claims process
The claims process should be monitored closely at every point of its lifecycle. This is another important aspect of a provider’s revenue cycle management processes. If healthcare professionals do not watch claims closely, they won’t be able to figure out when an error was made. Additionally, they won’t necessarily be able to identify a coding issue. As a result, revenue can be lost.It’s a good practice for providers to receive automated alerts as to why a payer is routinely denying claims for a given procedure or code. Otherwise, healthcare professionals may spend hours researching the issue. This takes time away from other important duties.
A streamlined and efficient claims process can improve a revenue cycle and help a healthcare organization run smoothly.

Failure to have a financial policy
Some healthcare facilities fail to have a financial policy documentation in place available for employees. These types of policies are an important part of revenue cycle management. They should be available to employees electronically or in writing. They should also be reviewed by legal counsel.
Financial policies should also provide guidance to patients regarding the collection of copayments and unpaid balances, patient responsibilities regarding insurance requirements and financial arrangements for unpaid balances, charity care or other payment arrangements, according to The American Health Information Management Association.
A financial policy can serve as a helpful tool for healthcare professionals involved in billing. A financial policy could include processes for analyzing the financial capabilities of a patient. It could also include steps for determining a patient’s balance. Additionally, a policy could contain information regarding denied claims and how to address them. It’s best to have a process for tracking and resolving denied the claim