Healthcare organizations are in a precarious financial position. With operating margins still hovering near zero, revenues are at heightened risk because of a surge in third-party audits following the expiration of the public health emergency as well as increased scrutiny by federal and commercial payers alike to identify – and recover – billions in improper payments and penalties.
This sharp uptick in audit activity has many healthcare organizations – even those that have already adopted revenue cycle management (RCM) technologies to streamline workflows – struggling to comply with both the volume of incoming documentation requests (ADRs) and the timeframes within which they must reply.
The appearance of artificial intelligence (AI), specifically conversational AI, is promising to change that, making it possible to convert the highly unstructured data populating the audit process into information that can be both analyzed and automated.
The Audit Environment
Ferreting out fraud and abuse remains high on the federal government’s priority list. In fiscal year 2022, the U.S. Department of Justice (DOJ) collected more than $1.7 billion in improper payments, while the Office of the Inspector General (OIG) reported identifying more than $200 million in expected audit recoveries and over $277 million in questioned costs in its 2023 Semi-Annual Report to Congress.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is expected to claw back $4.7 billion from Medicare Advantage plans over the next decade thanks to recent adjustments to its risk adjustment data validation (RADV) program. Add to all that the influx of demand letters in the wake of the expiration of the federal PHE – along with many of the waivers that kept external audits in check – as well as claim changes and heightened regulatory and billing practice scrutiny by federal contractors and commercial payers.
All this comes at a time when hospital margins remain “well below historical norms,” per Kaufman Hall, and revenue cycle leaders are facing severe labor shortages, with more than 41% reporting that up between 51% and 75% of RCM and billing department roles are currently vacant.
FutureRx (FRx) announced today that its FRx cloud-based healthcare platform for health plans and pharmacy benefits managers (PBMs) will be implemented by Imperial Health Plan of California, Inc. to enhance medication adherence among its Medicare Advantage population. The health plan will leverage the platform’s Part D Stars module to automate business processes, enhance medication adherence, and improve Part D Star ratings.
“At Imperial Health Plan, our vision is to deliver clinically effective and sustainable value-based care that achieves exceptional outcomes, a significant aspect of which is ensuring medication adherence by our members,” said Dr. Paveljit Bindra, CEO, Imperial Health. “By automating and streamlining much of this high-touch, resource-intensive process, FRx Part D Stars will help our pharmacy team prioritize its outreach to focus on members who are most at-risk for adverse health events, supporting improved health outcomes and enhanced performance on CMS Star Adherence measures.”
The FRx Part D Stars modulesimplifies the complex process of tracking and improving CMS Part D Star ratings with actionable insights and data-driven recommendations that drive performance. It identifies those members who are not getting their prescribed medications, which can negatively impact the member’s health and a health plan’s Part D Stars rating, while reducing administrative burdens and enhancing member and provider satisfaction and retention. The FRx architecture allows for rapid implementation and corresponding market-leading speed-to-value.
“FRx platform is ideal for a rapidly growing health plan like Imperial Health Plan that prioritizes quality care and outcomes,” said Anil Kottoor, CEO, FutureRx. “We are excited for our FRx Part D Stars module to play a key role in helping Imperial achieve Imperial Health’s care quality and Star rating goals through the transformative power of cutting-edge technology, advanced analytics, and expert support.”
In the vast landscape of healthcare, underserved hospitals often face unique challenges in attracting and retaining qualified medical professionals. With limited resources and remote locations, these facilities must devise innovative strategies to overcome the odds and secure the essential workforce needed to deliver quality care. In this blog, we will explore five inspiring ways underserved hospitals have successfully recruited medical professionals, showcasing their resilience and ingenuity in the face of adversity.
Embracing Technology to Bridge the Gap
In an era where technology permeates every aspect of our lives, underserved hospitals are turning to digital solutions to bridge the gap between them and prospective medical professionals. Virtual recruitment fairs, video interviews, and online job portals have emerged as powerful tools for connecting talent with remote healthcare providers. Through these innovative methods, underserved hospitals can cast a wider net and attract candidates from various geographic locations.
Additionally, telemedicine has proven to be a game-changer for underserved hospitals. By adopting telehealth practices, these institutions can collaborate with specialists from urban centers, offer remote consultations, and enhance patient care without compromising on quality. The seamless integration of technology into their operations has not only improved patient outcomes but also positioned these hospitals as attractive employers for tech-savvy medical professionals seeking a blend of tradition and innovation.
Cultivating Strong Community Partnerships
Underserved hospitals have realized that their success lies in their ability to be a pillar of strength for the local community. To recruit medical professionals, they are actively forging strategic partnerships with community organizations, educational institutions, and local authorities. By creating a support network, these hospitals can demonstrate their commitment to the well-being of the community and showcase unique opportunities for personal and professional growth within their facilities.
Just one generation ago, wearable tech sounded like science fiction. Things have changed profoundly since then. Walk down any street and you’ll pass people wearing all kinds of personal technology. One in five Americans now owns a smartwatch or fitness tracker, or the two combined in a medical alert smartwatch. And Bluetooth-enabled hearing aids were once expensive, experimental and hard to find, but this has now mushroomed into a more than two-billion dollar market.
Wearables and hearables are just the tip of the personal technology iceberg. Tech developers large and small are working on the next wave of wearable technology. Some of the hottest areas of development include smart sensors and mobile personal emergency response systems (mPERS). These are gaining traction for both personal and business-related use. Two of the most promising areas for growth are among seniors and companies that have vulnerable employees.
Wearable Tech for Healthier, Safer Seniors
Seniors were some of the earliest adopters of mPERS technology. The well known pendant from Life Alert came out in the late Eighties and continues to serve the market. The earlier iterations of this tech had just one function, connecting the wearer with a monitoring service at the press of a button. However, modern options have gotten much more sophisticated. Features now include emergency alerts, GPS tracking, fall detection, voice-activation and biometrics such as heart rate.
Many seniors are choosing to age in place or with family caregivers. They don’t have the safeguards of round-the-clock monitoring in an assisted living facility. Meanwhile, overstretched caregivers can’t watch their loved one 24 hours a day. The right mPERS device acts as a valuable safety net. It can give the older adult the confidence to stay independent while taking pressure off of caregivers.
Despite these advantages, tech developers need to solve some barriers to use. Cost is a major issue. Insurance companies and Medicaid often don’t cover device purchase or monitoring subscriptions. To persuade insurance companies, developers will need publish solid data on efficacy.
Another major barrier is privacy concerns. Seniors are disproportionately targeted by scammers seeking their personal information. Some hesitate to pick up more sophisticated mPERS devices, worrying that this may be another avenue for hackers to access their information. And technology that monitors their health may be constrained by privacy laws like HIPAA. Tech developers are still working on solving these challenges as they expand into this space.
All businesses need to ensure that their customers are satisfied with their experience. But it’s especially important for healthcare businesses. After all, those customers are typically patients who have a strong emotional investment in the outcome of their trip to the healthcare facility. As such, healthcare operations that want to build a loyal customer base have to ensure their customers have a smooth experience from beginning to end.
In this post, we’re going to run through some handy strategies that healthcare businesses can adopt to ensure that their customers/patients have a good experience — and also no reason to look at your competitors.
Improve Digital Tools
There’s been a host of healthcare-related digital tools released in the last few years, especially during and after the coronavirus pandemic. You can ensure your customers have a great experience by utilizing digital tools to provide a seamless visit. This could take the form of telemedicine appointments, whereby your customers can receive updates, straightforward consultations, and prescriptions online, without having to leave their homes. It’s also recommended to invest in an online patient portal where your customers can view their medical history, request appointments, and other information that increases patient engagement.
Understand What They Value
You’ll be in a better position to offer the best experience possible if you know what your patients value. As with all businesses, having an understanding of the customers — in this case, patients — is key to delivering an exceptional experience that gets to the heart of what they want. There are multiple ways to understand your patients better, including conducting a conjoint analysis, soliciting feedback, or just more broadly analyzing the demographics of the area that you serve and understanding what issues and factors tend to affect those people. Ultimately, the more you know your patients, the more you can offer them.
It’s also recommended to conduct patient satisfaction surveys. They can be vital in ensuring that your healthcare facility is meeting the expectations of your patients. They should reveal what you’re doing well, what they’d like to see, and any common complaints which you can then address.
It can be hard to see any silver lining to the COVID-19 pandemic. But as impacted organizations re-focused on their basics in order to survive – if not thrive – through the hard times, many did see examples of improved business processes, greater efficiencies and new opportunities.
That was certainly the case for our organization,Goshen Health, an award-winning hospital and network of clinics in Northern Indiana. As with most hospitals and healthcare organizations, our staff and our recruiting efforts took a hard hit during the pandemic. It forced us to rethink how we recruit and train key frontline workers, such as medical assistants. Faced with an existing industry staffing shortage, a number of our workers leaving the field because of the pandemic, and fewer potential hires entering the field, the key was to offer training and practical experience to potential candidates, and to promote from within.
Finding candidates with an exceptional bedside manner
Goshen Health has approximately 2,000 Colleagues between the hospital and 30 healthcare clinics. As with many healthcare facilities, one of our toughest hiring challenges is finding enough skilled medical assistants (MAs).
The role of the MA is critically important. They are often the first person a patient sees, and they have a significant amount of direct contact with patients throughout their journey with us. As a result, the bedside manner of a MA is as important as their healthcare expertise. Every day they interact with patients who might be sick, unsure, or are worried about their health or the health of a loved one. Add to that, the work that MAs do in taking vitals and charting for the healthcare provider, and it is quickly evident how vital they are.
Coursework to become an MA can vary, but typically requires between six months to two years of classroom training. Candidates must complete 120 clinical hours of instruction and pass a rigorous certification program to qualify.
Prior to the pandemic, a significant pipeline for these workers – including administrative, clerical and support staff – was filled through partnerships with local community colleges. We also worked with local schools to generate interest among high school students. The hope was that they could matriculate to the community colleges, take one or two years of courses and be candidates for jobs with Goshen Health upon graduation. COVID stalled this pathway for 18 months, forcing us to look into supplementing our traditional hiring practices with new models and new sources.
Adopting a new train-and-hire recruiting model
Goshen Health has since adopted a new model of recruiting both internal and external candidates and paying for their training, in exchange for a two-year work commitment at our facilities. We combine an online training program from an outside vendor with hands-on clinical experience through Goshen’s physician offices.
The applied experience comes through an externship in clinical settings. Candidates participate in 120 hours of training with a senior certified MA or LPN Colleague, and then rotate to several medical practices.
The importance of this rotational strategy cannot be overstated. Trainees gain first-hand experience in Goshen facilities, not in a classroom or an outside healthcare facility. By the time students finish their 120-hour externship, they should have worked in several different Goshen clinics. Upon hire, they would have thorough knowledge of Goshen’s systems, its culture, and its people. They would hopefully hit the ground running on day one.
We learned several other lessons that have impacted our recruiting practices. They include:
By Will O’Connor, M.D., chief medical information officer, TigerConnect
When the World Health Organization (WHO) announced that COVID-19 was no longer a global pandemic, everyone breathed a maskless sigh of relief and tried to put the devastation of a three-year-long crisis behind them. But now, the healthcare industry faces another pandemic – a nurse staffing crisis years in the making.
A recent report by the National Council of State Boards of Nursing found that nearly 100,000 registered nurses had left the profession since the onset of the pandemic in 2020, when exposure was high and support was low. What’s more startling is that another 600,000 nurses intend to leave by 2027 due to stress, cognitive burnout, and retirement. This labor shortage adds to the factors pushing nurses to leave as their workloads inevitably increase while available resources remain scarce. But what’s at the root of this mass exodus?
Navigating The Great Attrition
As of March 2023, 45% of inpatient nurses reported they are likely to leave their role in the next six months because they feel undervalued by their organization and have an unmanageable workload, contributing to burnout, stress, and cognitive burden. As nurses navigate the complexities of providing care to multiple patients, they face the challenge of using ineffective communication methods such as phone and email and balancing various interruptions and disruptions, all of which obstruct patient care. In fact, miscommunication is the root of over 70% of sentinel events, resulting in $1.7 billion in malpractice suits over five years.
In a recent joint survey conducted by Becker’s Healthcare and TigerConnect of more than one-hundred clinical leaders across various healthcare ecosystems, respondents provided valuable insights into the perceived risks to patients and care providers stemming from communication and workflow processes that put care on the line. These risks include:
68% of respondents cited an increase in staff frustration with slow response times or lack of response
64% of respondents noted that numerous alerts and system notifications lead to cognitive overload, also known as alarm fatigue
Over half, or 56%, stated that suboptimal communications create the risks of delays in patient care
Enhancing Clinical Collaboration
Given these insights, it is evident that to develop a successful staffing strategy, healthcare leaders need to understand how nurses spend their time, their desired allocation of time, and how communication methods affect job satisfaction. By identifying the detrimental effects of inadequate workflows and broken communication methods, healthcare organizations can seek ways to alleviate the burdens on nurses and allow them to thrive and deliver exceptional patient care.
It is challenging to ignore mobile smartphones’ influence on our day-to-day lives. Sometimes it’s the first thing you see in the morning and the last at night. The global usage of social media has surged to 4.48 billion users from 2.07 billion in 2015, with each user engaging with an average of 6.6 platforms. While the annual growth rate has declined from 12.5% to 9.2% between 2019 and 2020, the pervasive impact of social media remains substantial.
Regardless of the uncertainty, adopting a mobile-first approach is necessary, as it is a crucial part of the customer experience. It serves as a means for health or other sectors to effectively interact with potential customers. The mobile-first approach in the healthcare sector can help to design and optimize healthcare services, information, and technologies primarily for mobile devices such as smartphones and tablets. This strategy recognizes the increasing reliance on mobile devices and aims to provide consumers with convenient access to healthcare resources, often on the go.
Importance of a Mobile-First Approach in Healthcare Ecommerce
Using a mobile-first approach has several benefits and addresses specific considerations in the healthcare industry. However, here are some mobile-first approaches critical to healthcare e-commerce:
Mobile UX Optimization for Healthcare Websites
The importance of UX design in the healthcare sector cannot be overemphasized. In recent years, the healthcare industry has experienced a notable transition to digital platforms. Patients now turn to websites for medical insights, appointment scheduling, telehealth services, and interaction with healthcare experts. A well-optimized healthcare website can achieve this primary objective.
By Kyle Bachman, senior recruiter, Goshen Health.
