In a new survey conducted by Kareo, independent medical practices and billing companies shared the unprecedented challenges created for them and their patients by the coronavirus pandemic. More than 600 medical practices and 140 medical billing companies were interviewed by Kareo in late March.
The research uncovered the immediate actions medical practices and clinics are taking to ensure patient access to care through telemedicine solutions with 75% reporting either a current telemedicine option or the intent to deploy one soon. The survey also highlighted the risks to patients and independent medical practices with 9% of respondents reporting practice closures with many more concerned about potential practice closures as patient office visits plummet due to “stay at home” orders and other concerns. As Kareo was publishing these survey results, the Coronavirus Aid, Relief and Economic Security (CARES) Act was signed into law, potentially providing a lifeline to the most severely impacted medical practices.
By mid-March, independent healthcare professionals were already facing the practice and personal impacts of the coronavirus pandemic, with 28% of practices only offering telemedicine visits and 9% of practices already closed, with many more concerned about the risk of future closure. While 63% of practices were still delivering on-site care, most of these practices were exploring options to move to hybrid or exclusively telemedicine-based care.
Kareo’s ongoing analysis of actual patient encounters across over 50,000 medical providers, found that by late March independent medical practices has experienced an approximately 35% decline in patient volume, raising alarm around both the apparent inability for patients to access care and the operational viability of medical practices if this trend continues.
Kareo’s research also highlighted the impact felt by the more than 5,000 medical billing companies across the country, with these service providers reporting immediate impacts on their businesses due to precipitous decline in medical practice patient volume. These companies play a critical role in the healthcare ecosystem by providing medical billing expertise that is essential for the financial viability of many independent medical practices. Financial risk to these service providers creates another risk for medical practices to manage as practice volumes ultimately return to normal.
To address “stay at home” orders and patient concerns about face-to-face medical encounters, healthcare professionals have rapidly turned to telemedicine solutions. By mid-March, fully 41% of independent medical practices reported offering telemedicine, up from 22% reported in Kareo’s State of the Independent Practice Report in late 2018.
An additional 34% reported current efforts to deploy telemedicine options, which ultimately will result in the vast majority (75%) of medical practices providing remote care solutions. In the third week of March, Kareo saw a 500% week-over-week increase in telemedicine visits while working to accommodate an over 3,000% increase in telemedicine adoption.
The easing of regulatory requirements related to telemedicine security and functionality allowed medical practices to access a broader set of possible telemedicine solutions, ranging from medically-specific options like Kareo Telemedicine that are HIPAA compliant and fully integrated with the broader patient engagement, electronic health record, and billing technology platform all the way to general video call technology such as Apple FaceTime. Easing Medicare, Medicaid and commercial insurance reimbursement requirements for telemedicine also supported the rapid pivot to virtual-care and are essential in supporting the financial viability of medical practices and their supporting medical billers.
“Independent medical practices stand as the cornerstone of the U.S. healthcare system and are responsible for more than two-thirds of annual patient visits,” said Dan Rodrigues, founder and CEO of Kareo. “Yet our research shows that even doctors are not immune to the economic impact of the coronavirus pandemic. Telemedicine and the CARES Act provide critical lifelines to ensure independent practices remain available to their patients through this crisis.”
There are several government programs that practices can take advantage of to ease financial burdens and maintain their current staff levels. Small business loans, tax relief, Medicare payment advances and grants are a few of the options currently available. In combination, these programs can help ensure that independent medical practices and clinics emerge from the COVID-19 pandemic with minimal damage to the long-term viability of their business.
The CARES Act expands eligibility for loans under Section 7(a) of the Small Business Act and authorizes the Small Business Administration to make $349 billion in Section 7(a) loans. The CARES Act also offers an employee retention tax credit (Employee Retention Credit) designed to encourage eligible employers to keep employees on their payroll. The Centers for Medicare & Medicaid Services (CMS) has expanded their current Accelerated and Advance Payment Program to a broader group of Medicare Part A providers and Part B suppliers. Details on the eligibility, and the request process are outlined in the Expansion of the Accelerated and Advance Payment Program fact sheet. The expansion of these programs is also only for the duration of the public health emergency. For more information on resources available to help with the COVID-19 crisis, visit Kareo.com/covid-19.
Response from Avi Price, COO, Uniper Care.
The Trump administration temporarily changed the policy for Centers for Medicare & Medicaid Services (CMS) allowing healthcare providers to have phone-only visits with patients, which is a major breakthrough in the industry and one that was not allowed before.
With the coronavirus being spread throughout the United States, the administration understands the importance of social distancing and the pivotal role that telehealth will play in keeping patients healthy. What is necessary to support the amount of patients today is an economically sustainable, scalable and immediate telecare solution that is available to anyone, regardless of income, age, or location.
The way to keep the general population healthy, is in a fight to flatten the curve and protect most specifically older adults and those at-risk from COVID-19. Telehealth is likely the most effective way to provide care to those who need it and minimize exposure to the virus for the both the patient and the doctor. Right now the hospital systems are overwhelmed with the sudden influx of patients from this virus and telecare’s primary role is to treat patients remotely, reducing the pressure being put on the hospital systems.
Another important factor is the effects that social isolation has placed on older adults and how that will impact their overall physical and mental well-being. We created Uniper to provide a familiar service for older adults, right on their TV screens, mobile phone or desktop to have access to life: their communities, friends, family and physicians so that they can obtain much needed care, from a distance.
Uniper is designed to be economically sustainable, scalable, and accessible to anyone that needs it to help them thrive during these unusual times.
By Josh Horwitz, COO, Enzoic.
Healthcare employees are on the frontlines of the coronavirus pandemic, in many cases working extended hours under extremely taxing circumstances in an effort to treat the growing number of infected patients. In this environment, it’s critical that everyone is cognizant of an unfortunate reality of our times: hackers are always looking for ways to capitalize on a crisis.
As Forbes’ Thomas Brewster put it, the last few weeks have seen “…an avalanche of digital threats piggybacking on the coronavirus pandemic,” and these are only likely to increase as the international community continues to grapple with the virus. With scams ranging the gamut from a coronavirus tracker that installs malware onto visitors’ devices to takeover of teleconferencing software to fraudulent company discounts or services related to the coronavirus, there is no shortage of ways bad actors are seeking to exploit consumers’ fear and confusion.
As such, it’s important that hospitals and healthcare institutions help employees safeguard their data and ensure they are cognizant of the increased security threats associated with the pandemic. Following are a few tips to consider:
- A rise in phishing scams. As mentioned above, many hackers are employing phishing scams to pose as companies offering a legitimate coronavirus-related service in an attempt to trick recipients into sharing credit card information or other personal data. The good news is that there are some common characteristics associated with phishing attacks that people can use to vet these communications. For example, encourage employees to check for grammar, punctuation and formatting errors as these are often phishing red flags. It’s also important to review links before actually clicking on them and look for things that appear odd such as dashes, extra characters, or additional letters and numbers. Another good practice is to check the email address itself to see if it contains multiple numbers or letters. Finally, encourage employees to always reach out to the company in question to determine the authenticity of an offer before clicking on any links if they harbor doubts.
- Increased online shopping: With more shopping taking place online, particularly for healthcare employees working long hours, the importance of strong, unique passwords is more critical than ever. It’s extremely common for people to create simple passwords that they share across multiple accounts. However, if those credentials have been leaked in a previous breach, hackers can easily use them to access these accounts and all the data they contain. Healthcare institutions must stress the significant vulnerability of this poor password practice, and encourage employees to review existing passwords and ensure any new accounts they create are protected by strong, unique credentials. Password manager solutions can be extremely helpful, particularly for people who are setting up numerous new online accounts in response to “Stay Home” orders.
- An uptick in connectivity: With people working from home or participating in remote learning programs, many families are experiencing an increase in internet connectivity. This undoubtedly puts a strain on bandwidth, but it also introduces some security vulnerabilities. For example, what if a child accidentally downloads malware on the home network? And are connected devices like voice assistants or smart TVs protected by unique passwords, or do they still have the default factory settings? It’s important that employees are aware of the threats that can arise with greater connectivity and ensure they take steps to address them. It’s also essential that hospitals insist employees use their VPN whenever accessing work-related systems or data from home to keep this information protected.
In addition to the considerations outlined above, it’s also important that healthcare employees keep an eye on the evolving cybersecurity landscape as it relates to the pandemic. It’s likely that hackers will continue to find new ways to exploit the situation for their own nefarious purposes. As employees work diligently to combat coronavirus, it’s essential that hospitals remind them to keep their personal information safe.
In a world that is constantly being upgraded, streamlined and enhanced by software and technology, is it possible that teaching will no longer be a human profession? What if A.I. progresses to the point that it is unfathomable that humans could even compete? What we are seeing now is the early evolutionary stages of the technology that will soon make these progressive ideas commonplace.
In many ways, this future is already here, as there are numerous applications that already teach us a variety of skills. The platforms and social media applications that we interact with have highly advanced algorithms that are programmed to provide us with the latest news and information. In our pockets at all times, is a highly advanced computer that is capable of executing numerous tasks. Whenever we wish, our smartphones can be used to teach us any task or skill. Let’s have a look at some of the ways technology is currently replacing teachers as we know it.
Phone Applications
One of the most amazing things about our generation of technology is phone applications. These small software programs are often overlooked and taken for granted. To imagine such technology would be so readily available, even just 20 years ago, would be astounding.
Any new skill or hobby you are looking to become proficient in has an app dedicated to it. For chess or learning languages, for instance, there are numerous apps that help you pick up the skill. For card games like poker, there are different training apps that teach you the fundamentals, oftentimes made by industry legends.
When it comes to specialized skills, these apps are often made by or in partnership with industry professionals that help develop the app’s curriculum. This, in turn, creates a course that is available to an unlimited number of people at a given time. Not only that, but apps are interactive, and can be updated constantly with new courses and information. Apps often have embedded AI programming that slowly understands how you learn and the best way to teach you. Overall, this is just incredible technology that is readily available for you to learn, and oftentimes for free.
AI Teachers
Even though we touched on it in the apps section, Artificial Intelligence deserves to be mentioned in its own right. Quite frankly, we have not begun to even scratch the surface of potential when it comes to AI in relation to teaching. What science is envisioning is software and programs that can learn with the student. The programs will be able to work with a student and understand the best ways to teach them after a certain amount of time.
Once this data is continuously reviewed and cycled over and over, the AI will get increasingly efficient at it. While there are numerous concerns we can draw, the benefits could be overwhelmingly positive and revolutionize public schooling. Not only that, but more individuals would presumably be in favor of paying for trade programs if the cost was ultimately cheaper with better results from AI teachers. The possibilities are staggering. It should come as no surprise that this technology is already being trialed in several schools and universities around the globe.
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By Terry Rowinski, president & CEO, Health Payment Systems, Inc.
We’ve seen it time and time again—a patient receives services from an out-of-network provider at an in-network facility and is surprised with a huge medical bill months later. Since out-of-network claims can take much longer to process, the consumer often has forgotten the details of the service received and thinks all bills have been resolved, so the bill itself (not just its size) is unexpected.
According to JAMA Network, in the past two years, one in 5 insured adults had an unexpected medical cost due to seeing an out-of-network provider, and two-thirds of adults worried about affording unexpected medical bills for themselves and their families.
Another study, facilitated by the research institute NORC of UChicago, reported that out of 1,000 Americans surveyed, 57% received a surprise medical bill, most often resulting from physician services (53%), laboratory tests (51%), healthcare facility charges (43%), imaging (35%) and prescription drugs (29%). These surprise medical bills are the result of the lack of transparency throughout the healthcare system and leave consumers in the dark.
This blog details this important issue within the healthcare industry and country, as well as how we at HPS are addressing it.
Where the problem comes from
As an industry, we need to accept the reality that the surprise medical bill issue is further complicated by the fact that the entity an individual receives medical care from doesn’t supply all of the consumer bills. A single hospital or office visit could result in up to 10 separate bills, and patients largely have no visibility into the total cost until they receive these bills.
Why, though, are there so many bills for a single visit? Hospitals have multiple departments, physician groups and other entities, and often, each completes and files their own insurance claims and billing processes outside of the hospital. The issue is actually more complex than this, though—it isn’t just the hospital system that might be sending bills. Bills can be generated from multiple locations or entities, making the healthcare billing process more of an ecosystem.
Another reason that this problem is so huge is that there is not, currently, a widely-available solution to the problem, regardless of the use of transparency tools. Someone must actively take up the cause of communicating with the consumer truthfully and in a timely manner, which doesn’t often happen due to how many processes must take place before a consumer can be informed of final costs for healthcare visits, labs, nursing and more.
To help combat the frustration and stress that individuals and their families experience related to confusing and unaffordable medical bills, Health Payment Systems (HPS) has developed its proprietary SuperEOB® (explanation of benefits statement) solution along with various consumer advocacy services via their all-in-one platform.
HPS is a broad provider network offering the most effective independent provider network delivering significant savings and choices for self-funded and level-funded employees, including billing and collections. Their SuperEOB is an easy-to-read statement that consolidates all of an individual’s or a family’s in-network explanations of benefits (EOBs) and medical bills for an entire month in their digital platform, regardless of how many doctors were seen.
In attempting to find a solution to this problem, we must consider how traditional employer insurance holders get billed, how the payer or insurer level handles claims, and how individuals not utilizing traditional insurance plans can be helped.
How to resolve this issue
One possible solution is to create a billing mechanism that the consumer is familiar with, almost like a credit card bill. In this solution, bills would be consolidated into one statement, and consumers could easily understand how, for what, and to whom they owe money.
The solution needed would offer healthcare providers (who are independent of one another) the option of a singular, aggregated billing experience for healthcare consumers. It would give consumers the ability to see which entities have provided services, how those claims have been processed through insurance, and the total amount owed for all services—all in a single billing statement.
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With clinical documentation integrity (CDI) professionals playing a key role in efforts to “flatten the curve” of the COVID-19 pandemic, the American Health Information Management Association (AHIMA) has developed tools designed to ease administrative burdens during this difficult time.
AHIMA’s two new COVID-19 CDI query templates will help CDI professionals ensure the integrity and quality of a patient’s health record. With data being such an important element in the fight against COVID-19, the new templates provide a clear guideline of what critical data needs to be obtained to accurately document for the virus. The templates are similar to those CDI professionals use to document other diseases.
“I feel immense pride when I see the important work CDI professionals are doing during this pandemic,” said Wylecia Wiggs Harris, PhD, CAE, AHIMA CEO. “We believe these clear, concise, and compliant templates will make it easier for CDI professionals to document this virus, which in turn gives courageous medical providers more time to focus on patient care.”
The new templates are designed to capture high-quality documentation to support the continuum of care in this complicated healthcare environment. Clinical documentation integrity is critical during the pandemic because it can impact research efforts to curb COVID-19 and provides government and healthcare leaders with key information for their decision-making processes.
The two new COVID-19 CDI query templates are available to all healthcare professionals for free at https://ahima.realmagnet.land/covid-19-query-templates-professional.
AHIMA has created more than 130 CDI templates for use in multiple healthcare settings. These templates (not related to COVID-19) are available through the Artifact Health platform.
Registered nurses at 15 HCA Healthcare hospitals in seven states began actions to protest a lack of preparedness by the nation’s largest hospital chain that they say places nurses, other staff, and patients at risk in the face of the coronavirus pandemic, announced National Nurses United (NNU) today.
NNU, which represents 10,000 RNs at 19 HCA hospitals in California, Florida, Kansas, Missouri, Nevada and Texas, is demanding that HCA provide the optimal personal protective equipment (PPE) for nurses and other staff. That means N95 respirators or the more protective powered air purifying respirators (PAPRs), and other head-to-toe coverings.
Separately, RNs at HCA’s Mission Hospital in Asheville, N.C. will deliver a petition to hospital managers with their concerns about hospital COVID-19 preparedness
“Nurses at various HCA hospitals are reporting that they have had to work without proper protective equipment,” said Jean Ross, RN, president of National Nurses United.
“Nurses say they are not informed when they exposed to an infected patient. They are told to unsafely reuse masks and at one hospital they are even being told not to wear masks because it ‘scared the patients.’”
“Protecting our patients is our highest priority, but it becomes much harder when we don’t have the safe protections which puts us in danger of becoming infected,” said Angela Davis, RN, Medical Intensive Care Unit, a dedicated COVID-19 unit, at Research Medical Center Kansas City, Mo. “If we are no longer able to be at the bedside, who will be there to care for our patients?”
“When we are infected no one is safe,” said Kim Smith, RN, Intensive Care Unit, also a dedicated COVID-19 unit, at Doctors Regional Hospital/Corpus Christi Medical Center in Corpus Christi, Texas. “When we are infected, we become a real danger of infecting everyone else around us, patients, hospital staff, and a risk to our own families.”
HCA can well afford to be properly prepared for the pandemic, says NNU. Over the past decade HCA has made more than $23 billion in profits. “For the wealthiest hospital corporation in the United States to show such disregard for the health and safety of its caregivers, is disgraceful and unconscionable,” said Ross.
“We are facing the gravest public health crisis in a century,” said Gary Mousseau, RN, Endoscopy, Fawcett Memorial Hospital, Port Charlotte, Fla. “As nurses at HCA health care facilities across the country, it has been disheartening to see HCA’s poor response to our safety concerns.”
In a national survey of nearly 10,000 RNs in every U.S. state and territory, NNU found that HCA had among the worst records of pandemic preparedness.
- Only 35 percent of nurses at HCA Healthcare hospitals report having access to N95 respirators on their units, compared to 52 percent at other facilities
- 16 percent of nurses have access to PAPRs, compared to 23 percent of all nurses
- Just 7 percent report having enough PPE to protect staff and patients if there is a surge in patients, compared to 19 percent of all nurses
In the actions, nurses will survey their RN colleagues on PPE preparedness as they report to work at shift changes, marking checklist results on a large survey board as to whether their hospital has adequate PPE for RNs, proper isolation for infected patients, notification to staff about COVID-19 cases, and adequate COVID-19 testing for staff.
Some of the concerns RNs are reporting:
HCA West Florida Division – Will issue only one less protective surgical mask per shift. Employees will not be allowed to bring their own N95, a violation also of federal Occupational Health and Safety Administration (OSHA) regulations.
Blake Medical Center, Bradenton, Fla. – Employee sent home for bringing own N95. Another told to enter room of patient under investigation without an N95 mask even though every other employee in the room had an N95 mask.
Central Florida Regional Hospital, Sanford, Fla. – Nurses told that they could not wear masks while working because it “scared the patients.”
Corpus Christi Medical Center, Corpus Christi, Texas – Nurses notified of exposure, but told to continue working until they showed symptoms, even though the virus can still be spread when an infected person is asymptomatic.
Doctors Hospital of Sarasota, Sarasota, Fla. – Nurses exposed because negative pressure room was not working. Some 18 RNs were quarantined.
Fawcett Memorial Hospital, Port Charlotte, Fla. – Delay in reporting exposure to RNs.
Las Palmas Medical Center, El Paso, Texas – Employees in Mother-Baby units exposed to a COVID-19 positive physician. Employees not told of exposure until more than 48 hours after hospital learned about it. Nurses unsafely told to report to work until they learn their test results, potentially infecting patients, other staff.
Research Medical Center, Kansas City, Mo. – Delay in notification of being exposed to a suspected infected patients and staff and expected to continue reporting to work.
The American Hospital Association (AHA) and AVIA are reaching out to all AHA members with a new tool for rapid, critical support to deal with COVID-19. The nationwide roll out of the COVID-19 Digital Response Pulse to all 5,000 members of the AHA provides a free online tool that allows hospitals and health systems to immediately assess critical digital capabilities they will need to meet the challenges of COVID-19 over the weeks and months ahead, and links directly to further information about how members can access and implement the solutions they select.
Members face immediate challenges to stand up a virtual approach for screening, testing, triage, primary care, and specialty care for worried, anxious patients in their communities – all to avoid being at the hospital unless absolutely necessary. These solutions need to leverage scarce clinician resources and build trust and confidence in doing so.
The COVID-19 Pulse shows members where they have gaps in these capabilities and offers specific steps that can be taken now to prevent the spread of the virus, allocate resources, care for the sick, and protect clinicians.
“We don’t have in-house experts and large teams to figure all this out, and we all wear so many hats, so we need partners to help us,” said Liz Dean, executive director of strategy and business development at Riverwood Healthcare in Aitkin, Minnesota. “The COVID-19 Pulse helped us quickly identify virtual health solutions. We gained insights on best practices, resources and reassurance that we were on the right track. Because we used this tool, we were able to implement virtual solutions very quickly and efficiently.”
The AHA formed a strategic alliance in October 2019 with AVIA, the leading digital transformation partner for healthcare organizations across the country. Since then, AHA and AVIA have worked together to create tools that help the industry accelerate digital transformation. The COVID-19 Pulse is an important and timely development for AHA members and their communities and is accessible for any healthcare organization with an AHA member account.
The COVID-19 Pulse contains a framework of 13 critical capabilities identified by AVIA and its Network members, including screening and triage, remote workforce, and addressing social needs for COVID-19, that can effectively be supported by high-value digital solutions. Upon completion, hospitals and health systems receive aggregated data-driven insights into how their organization compares to peers that are also responding to COVID-19. This information will also jumpstart new connections across the AVIA Network, so that hospitals and health systems can share emerging best practices and foster real-time learning.
“In this moment of crisis, there is so much noise when health systems need focus and clarity. The COVID-19 Pulse allows our 5,000 members to identify where they can take rapid action on the front lines to best serve their communities,” said Andy Shin, COO AHA Center for Health Innovation. “In partnership with AVIA, we can allow health systems and hospitals across the country to leverage their existing tools for COVID-19 response and rapidly implement new ones.”
“AVIA was founded on the idea that digital is imperative to catalyze meaningful and quick benefits for healthcare,” said Bruce Brandes, General Manager, Digital & Partner Network at AVIA. “We can move faster if we work together, especially during this crisis. The COVID-19 Pulse powers up knowledge sharing and collaboration needed to simplify and scale care across the country during such a critical time in healthcare.”