Why do so many small medical practices give up a significant portion of their earnings to outside billers? Depending on its geographic location, volume of billing, and other factors, a practice will pay an average of seven percent of its total revenue to a biller, which could be the difference between profit or loss, maybe even success or failure.
In many cases, the reasons given are that no one in the office has experience with medical billing and the physician doesn’t believe a small staff can handle the added burden of work. But if you dig a little deeper, these assumptions are often wrong.
As a developer of electronic health record (EHR) and practice management (PM) software for small practices, my company hears a lot about billing directly from physicians and staff. We’ve learned exactly who does the billing and how they do it once a practice starts using a PM system for the very first time.
In one case, a medical assistant was able to learn everything he needed to know about billing from the PM product training alone. That’s because the physician specializes in podiatry, so the practice uses a limited set of billing codes. With a relatively light patient workload, this Medical Assistant has more than enough time to handle billing functions during normal office hours.
At another practice, when a gynecologist questioned her staff, she learned that her receptionist was eager to start doing something else, preferably from home so she could care for young children. The receptionist became certified in medical coding at a local community college on her own time, and now uses the PM system remotely and visits the office once a week every few weeks.
In a third practice we know, the pediatrician himself shares the work of billing with two of his part-time staffers, who welcomed the extra hours of pay. One staffer had knowledge of billing from a past job, while another was eager to learn. They all handle billing together as a team, so there’s no burden on any single person.
As president and COO of a leading electronic health record (EHR) and practice management (PM) provider, part of my job is to be in constant communication with providers about health IT. They tell me and my team what works for them and what doesn’t work; what brings joy to their practice and what keeps them up at night. All this insight helps polish my crystal ball, making it clear what we can expect to see in 2016:
EHR system will pivot from regulatory compliance to physician productivity. EHRs are generally blamed for fueling the professional dissatisfaction of physician. A few software vendors are looking at the problem-oriented medical record (POMR), a more intuitive approach that works similarly to the way a doctor thinks. It organizes clinical records and practice workflows around specific patient problems, making it faster and more satisfying for physicians to use.
The problem list not only delivers a “table of contents” to clinically relevant issues, but also gives a provider a longitudinal view of a patient’s healthcare over time. This intuitive method of information organization makes it easier for provider and patient to set the agenda at the start of the exam. During the exam, the POMR supports the nonlinear nature of a patient encounter.
The POMR also helps reduce cognitive overload, which can lead to medical mistakes such as misdiagnosis and other potentially life-threatening errors. Providers can see “bits” of data like lab results associated with a specific problem, thus easing the number of mental connections required to make sound medical decisions.
Chronic care management (CCM) will grow quickly because it makes sense for both patients and providers. Our healthcare system is changing to address the needs of an aging population with chronic illnesses like hypertension, diabetes, heart disease, and more. To promote the effective care coordination and management of patients with multiple chronic illnesses, the Centers for Medicare and Medicaid Services (CMS) introduced CPT code 99490. This code reimburses providers for remote, inter-visit outreach, such as telephone conversations, medication reconciliation, and coordination among caregivers.
The reimbursement for CCM services is an average of $42 per month for Medicare beneficiaries. New levels of technology integration will enable clinicians to complete CCM reporting of remote care from inside their EHR system.
According to the 2014 Exclusive EHR Study conducted by the MPI Group and Medical Economics, 70 percent of clinicians said their EHR investment has not been worth the effort, resources and costs. Widespread dissatisfaction with electronic records systems is casting an unfortunate shadow over the great potential they hold for making today’s medical practices more efficient and for improving healthcare delivery. However, practices can help avoid future disappointment with their EHR decision and save time and resources by understanding how to avoid common implementation pitfalls.
1. Choosing the wrong EHR
The intuitiveness and ease of use of your EHR will affect every area of your practice. If you don’t consider yourself to be technologically savvy, finding an intuitive solution should be at the top of your list. (After all, presumably you’re a clinician, not an IT expert.) Was a clinician was involved with the development of the EHR system? If a clinician wasn’t involved, chances are your idea of “usable” won’t line up with that of the vendor’s.
Another aspect to consider is cost, which can vary across a wide spectrum from free to several thousand dollars a month. Decide on the maximum price that you are willing to pay. This will reduce the list of vendors for consideration. Oh by the way, beware of the word “free.” Your biggest hidden cost is not the dollars spent on software, but the hours of lost productivity from a system that impedes you with banner ads and other annoying distractions.
To be certain that the EHR you choose is the right one for your practice, do everything in your power to expose yourself to the software prior to purchasing. It is worth asking the vendor whether they offer free trials. If not, consider watching video tutorials, attending webinars and shadowing another clinician using the EHR.
2. Underestimating the importance of an implementation plan
To ensure the smoothest transition possible, develop an implementation plan that will introduce you to your new EHR and also help you identify specific questions to ask the vendor. Your EHR vendor will likely have one to give you – just ask.
At a minimum, a useful implementation guide should tell you how to do the following: