Gone are the days when people had to rush to the doctor for regular checkups or medications. Now, with technological advancements, they don’t need to go to the hospital for every small or big health issue. All these are possible because of smartphones. Smartphones have now become a perfect mHealth tool for customized medicine, sending targeted information as well as notification and collecting individual data. Do you know what the best part is? The data that are being used in order to boost population health programs, is getting huge success.
The reason behind the success of this population health messaging using smartphones is simple. An estimated 96 percent of people around the world are using smartphones. This makes it easier for mHealth messaging programs to reach almost all the people in a defined population. Compared to phone calls, people, these days, are making more use of texting and emails to communicate. This has let the healthcare providers create customized and interactive messages that are rich in content and that drives engagement. There are many population health programs that are based on mHealth such as maternal health, smoking, infant health, physical activity, weight loss as well as depression or anxiety. There are also other programs that give people a reminder to visit a doctor for checkups of their children. Some others include programs that are aimed at chronic populations with asthma, diabetes or HIV.
According to a recent study, 91 percent of people admitted that their knowledge of IEHP services was improved with text messages. Compared to a control group, their engagement rate was 2.5 times better. Also, among them, 10 percent participated in a series of health challenges, while one-third completed the challenges. It can be said that there are mainly two reasons why this text messaging became so popular:
About 98 percent of people read it
Text messaging is used by almost 80 percent of the U.S.’ Medicaid population
According to experts, if healthcare providers are going to use mHealth messaging, then they may follow the below-mentioned tips in order to create an effective engagement platform –
Tell patients what they need to do to get the desired results
What if the patients do not understand what their doctors want them to do and why? This is why it is important that you teach the patients very well as to why and what they need to do so that they can properly follow the care instructions. You can provide them with supplemental information or clarify instructions that were given to them at the time of face-to-face office visit. This way, they will get to know what exactly they need to do with the new medical device. Ask them questions regarding the instructions that have been given and clear their doubts if they have any.
The reason why many hospitals or medical practices fail to integrate the EHR system effectively is that they have not gone for in-depth healthcare workflow analysis before implementing the EHR tool. Healthcare workflow analysis helps hospitals and medical centers to find out areas where health IT solutions can help in increasing the efficiency of performance.
It is important to design an EHR which smoothly fits into the workflow pattern of the medical establishment. The same EHR model does not work for every medical center. This is where healthcare workflow analysis techniques come in useful in designing the best EHR system for the medical facility.
Here are some steps that need to be followed during the healthcare workflow analysis in order to implement the EHR system perfectly:
Mapping of processes
This is the first thing that needs to be done while carrying out healthcare workflow analysis. The core processes that usually take place with regard to individual patients and which need to be analyzed in detail are as follows:
Scheduling: When a person first approaches a medical center, an appointment is fixed. The medical center receives multiple appointment requests every day and all these appointments need to be properly recorded in schedule calendars. Fact sheets are prepared to record the number of patients that the medical center receives during a particular time period. The scheduling process also includes alerts. Both the patient and the doctor should receive alerts about the upcoming appointment in order to be ready for it.
Patient visit: When the patient comes to the appointment, the doctor conducts a medical evaluation. The general checkup is followed by a psych evaluation. After the evaluation process is over, the doctor carries out the diagnosis process. Every step needs to be recorded so that progress notes can be made and the doctor can charge the patient accordingly.
Patient admission: After the diagnosis process is over; the patient gets admitted into the medical facility on the recommendation of the doctor. The enrollment process requires the signing of various forms so that the medical facility gets all the details about the patient.
Treatment process: Once the patient is admitted into the facility, the doctor makes a treatment plan. Either individual therapy or group therapy is provided along with medication management so that the patient can recover as soon as possible.
Discharge from the hospital: When the treatment process comes to an end, the patient is discharged on the date suggested by the doctor. A discharge plan is made and lots of reports are generated in order to record the treatment process of the patient in detail.
Then you are seriously in need of healthcare IT solutions.
With advancements in technology, the healthcare sector is becoming digitized. The focus is on personalized and patient-centric technology, which can help in accelerating the process of treatment.
Healthcare IT solutions are meant for delivering the best service to the patients as well as to enhance operational efficiency. The American Recovery and Reinvestment Act of 2009 was passed to provide $19 billion for the purpose of promoting the use of EHR technology in hospitals and medical practices. This proves the growing importance of healthcare IT solutions.
Healthcare IT includes the latest technologies like analytics, cloud computing, electronic health record systems, as well as data management systems. A growing number of institutions are successfully implementing healthcare IT solutions to improve their efficiency. It has been observed that manual entering of data and health records of patients are taking up too much time of the administrative staff as well as the medical personnel. This time can be utilized to provide better services to the patients.
Here are some of the benefits of using healthcare IT:
EHR technology –– Electronic health records are part of the digital revolution that has taken over the healthcare sector. EHRs make the whole process of keeping patient records very streamlined and efficient. Data can be accessed both by the doctors as well as the patients because it is available on an electronic platform. The personal health records portal helps in management of patient information. Medical personnel can take better care of the patients when they have all the information on one platform. Time and effort spent on manually entering the data are saved so that doctors can provide better treatment to the patients and can serve the people who are in need of doctor care.
Better coordination of patient care — Healthcare IT solutions help in better coordination between physicians, specialists, nursing staff, lab technicians and other medical personnel. Vital information regarding the patient’s health is available to all of them. When the same data can be accessed by everyone, the problems of duplicate tests, contradictory medication prescription and miscommunication can be avoided. This saves time and minimizes the chances of errors leading to improvement in the overall quality of care that is provided to the patients.
Patient empowerment– When the patient has access to all his personal health records, he can play a more active role in managing his overall well being and determine the outcome of the treatment that he receives. All the lab results, medical history records as well as drug information are available on an online platform for the patient. The EHR system allows the patient to schedule appointments, communicate with the doctor as well as to refill prescriptions. Such healthcare IT solutions increase patient satisfaction.
Cost savings — Healthcare IT not only saves time, but expenses too. Easier documentation reduces the administrative cost and increases the number of patients that a medical facility can treat. This leads to an overall increase in revenue generation.
Have you ever faced the dilemma when you visited a hospital or a pharmacy and have been told that the impending treatment or even the prescription will need a prior authorization?
Prior authorization has been a topic of debate in the healthcare industry for quite some time and it is important to understand the process in detail to be able to take the informed decision when required.
What is Prior Authorization in the healthcare sector?
Healthcare industry, in general, is quite complex in nature with a large number of standard rules and procedures to be followed. The concept of prior authorization or pre-authorization as it is commonly called is generally used during the payment from the insurance partner.
Prior authorization in the medical industry is an intermediary step mandated by the insurance partner that requires an approval from the insurance company in order to take a decision on whether they will/will not reimburse the cost of a certain treatment/prescription/medicine. To put in simple words, healthcare prior authorization is a health plan cost-control process that requires obtaining approval before performing a service to qualify for payment.
Important points regarding prior authorization
The concept doesn’t affect the cash transactions for prescriptions/ treatment
Prior authorization is only required by the insurance partner on those prescriptions when the medical billing is done through insurance.
Anyone who is uninsured or is willing to do the cash transactions, there is no need for getting any kind of prior authorization.
In normal circumstances, the prior authorization is required for pharmaceuticals, medical services, and durable medical equipment
Prior authorization predicament
Like any other process, there are pros and cons of the prior authorization process as well. While the process brings a certain accountability and cost containment for the players; fighting over prior authorizations costs several hours in lost productivity and an incredible amount lost in revenues as well, thus putting everyone in a difficult position.
The American Medical Association (AMA) along with the other stakeholders from the healthcare industry believes that prior authorization is actually a burdensome process that hinders the productivity and also timely access to treatment. The process puts a barrier for the patients in immediate need of the medical care by delaying the start of the necessary treatment/medical assistance required by the patient that can significantly impact the health outcomes.
The Current Reality
A recent survey conducted by the American Medical Association (AMA) reveals certain shocking findings:
Approximately 75 percent of the physicians who were the part of the survey described prior authorization burdens as high or extremely high.
Approximately 60 percent of physicians who participated in the survey reported that their practices wait for minimum of one business day to maximum three business days for prior authorization decisions on an average.
Approximately a third of physicians who were part of the survey raised concerns over man power inefficiency with staff who works exclusively on prior authorization requests.
Approximately 90 percent of physicians who participated in the survey reported that the prior authorization process often or always delays access to medical care to the patients
What are the disadvantages of the Prior Authorization process?
The process is time consuming, inefficient and lacks the transparency, which is crucial for the patients.
Disrupts the workflow of the medical facilities and the process of providing the quality care to the patients in need.
The processing of the prior authorization wastes a great deal of physicians’ or medical practitioners’ time that would be better spent with the patients and for the treatment.
The Road Ahead
Considering the inefficiency of the process of prior authorization and the various hurdles the patients seeking medical care faces, the American Medical Association (AMA) along with a group of experts from other medical and healthcare organizations came together in an effort to reform the inefficient prior authorization requirements imposed on the patients during the medical tests, devices, drugs, prescription and etc.
Purpose of the AMA and other medical organization coalition
The main purpose of the coalition represented by the hospitals, patients, medical group, pharmacists and physicians, is to make the process of pre-authorization simpler, faster and smoother.
The joint forum believes that the requirement of the pre-approval by insurers in the form of pre-authorization before patients can get the prescribed drugs or treatments can not only delay or interrupt medical services, but also poses the risk of medical complications due to delays in the process.
In the present age, finding a professional and reliable medical billing professional is very hard. Every physician knows the importance of an expert medical biller for the management of cash flow. It would not be wrong to call online medical billing and coding the bloodline of the medical facility.
In this age of technology, hiring a medical biller is not appropriate when you can use the software to get the work done quickly. You have to make sure that you select the best medical billing practice management system that will work for you for decades. All you have to do is enter your practice and the method you use for testing and it would be easy for you to manage everything.
Recently it has been found that most of the physicians have just started their practice and they do not find it important to get the healthcare consulting services. What they do is simply divide the tasks among their employees. As a result, they might save some money but most of the time it is hard to manage data.
Medical billing is not an easy task because there are many particulars that you have to take care of. A mistake in a single figure will disturb the entire calculations and you will have to suffer. Apart from that, you will waste your time and money.
So it is better that you get the online medical billing and coding tools. Here are some of the things that you must consider before selecting the management system.
1. Timely filing
When you are dealing with the insurance companies, you will get only a few days to file the claims. In case you have missed the deadline, you will not be able to appeal a denial.
When the insurance companies miss the services, it gets even worse because the claims are often sent on time. It means you will have to deal with a denial. Such kinds of issues occur when the services are sent in a batch. The insurance company sent you five services and it skipped the second one accidentally and now the company will not pay for it.
With the help of online medical billing and coding system, you can have the detailed records of the time and date when services were sent. They will help you to prove the mistakes and so your denial will be appealed. It would be easy for you to get the payments on time. Most of the workflow analysis in healthcare use the clearinghouse system for the accuracy of the results. It makes the results more effective. The best feature of the billing system is that they provide guaranteed results and you will not have to deal with the errors in the billing or filing.
2. Follow up on denied claims with online medical billing and coding
The insurance companies use different methods for denying the claims and they will easily give you a solid reason for it.
The issues comes when your employees to do not pay attention towards the follow ups
All they do is submit the appeal and get another denial and show you they have done the job
With the help of the online system, you can even appeal four times and it will let them know that they have to pay the claim.
With the help of online medical billing and coding, 90 percent of your claims will be paid.
3. Improve your communication with providers
When you have to log and compile the medical bill you have to make sure that the billing system and provider company are in-step. The healthcare revenue cycle management system has given a specific code to every patient. With the help of billing tools, you will be capable of expediting this category. However, you have to ensure that you maintain and check the system regularly.
With the help of electronic billing system you will get the following benefits:
Information sharing policy
Top-notch security for data and system
Recovery procedure
Data backup
You will never have to deal with virus or data hacks. It will help you to keep your contracts up-to-date with your insurance and provider company. It will manage everything from the requirements of HIPAA to billing compliance.
Regardless of whatever business you operate, the end goal is always customer satisfaction and healthcare is no different. Since healthcare is particularly valuable, it makes sense that the financial reward given to a valuable service should be high and based on a value model.
However, value-based models in healthcare do not have the same outcomes as they do in other businesses.
Value-based payments
Value-based payments have their advantages and disadvantages. For instance, on the one hand, value-based systems effectively liberate physicians from the constraints of fee for service so that they can concentrate on the overall health of their patients. Alternatively, some people say that value-based payment systems impose unneeded extra pressure on providers without necessarily getting the job done.
What is value-based payment in medicine?
Value-based systems reward physicians and healthcare providers with incentive payments for the quality of care given to patients with Medicare. These payment systems are part of a strategy to improve how healthcare is delivered and paid for. The purpose of any value-based system is to:
Improve how patients are given care in hospitals
Improve the overall health of the population
Lower the overall cost of healthcare
Effectively, value-based systems move toward paying doctors and healthcare providers based on the quality of care rather than the quantity of care given. Instead of charging patients based on the number of visits and tests that they order (fee for service payments), today, more hospitals are charging based on the value of the care that they give.
Fee for service payments
Traditionally, healthcare providers are refunded by third-party payers like insurance firms or by the government through Medicare or Medicaid. The amount of money that is paid is set at a going rate that is typically established by the agencies themselves. Since the budgeting of the costs and expenses are based on third party consumers, the system is marred by administrative hiccups, which has led to runaway care costs at the expense of the quality of care given and the patient.
The differences
The difference between fee for service and value-based payments lies in reimbursements and the quality of care provided.
Thanks to technological innovation, more and more healthcare facilities are now adopting the use of electronic health records (EHRs). Patients now have more opportunities to consult with their physicians about their medical records. Increased access to EHRs also means that providers will now be able to easily share patient information with other providers. The goal of increasing access to medical records is to improve the continuity of care, as well as enhance patient safety.
As more patients are able to access their records, they can impact the accuracy of the information contained within by asking questions about their medical information, by identifying inaccuracies in the information and also by giving additional information that may be useful in improving the correctness of the data. Incorporating feedback from the patients themselves implies that patients indeed do play a crucial role in improving the quality of information in their medical records.
The rewards of keeping up with your medical records are quite obvious.
First, it is the best way to ensure that your physician understands what you communicate to them. It is also a good way for the doctors to ensure that they understand what you communicate. Even though the benefits are clear, many people are often reluctant to request for their medical records. Worse still, countless individuals out there do not know that they can. Every individual is entitled to complete access to their chart from any medical facility that has ever dispensed care.
Not only are you obligated to share more information with your doctors, the information that you give makes a difference in how you respond to the treatment prescribed. Accurate information improves your chances of complying to the therapies prescribed successfully, which will consequently allow you to recover and heal in the shortest time possible.
What is contained in your medical records?
There is a difference between your official medical records and the scribbled notes that are typically handed to you after a consultation. Most scribbled notes simply contain a generic outline of your symptoms and a short prescription often written in a code that many individuals cannot understand. These, are not your medical records.
Your official medical records contain all the juicy details of your medical journey; your lab results, physician’s notes, the past and present allergic reactions and reactions to medicines, blood pressure stats and basically anything that concretely makes up your entire health profile.
Healthcare providers or physicians in the US have lately been facing an increasing number of challenges on multiple fronts; from unresolved insurance issues to juggling the administrative and medical aspects of their work. Some of these issues are more pressing than the others, and directly impact the health care provider’s productivity, cutting down on the quality time that needs to be given to their patients. Thus, physicians find it hard to cope with the recent changes introduced on the national level in the medical health sector.
Some of the major challenges that have put healthcare providers in hot water have been discussed below:
Seeking Reimbursement for Provided Services
Getting paid for services from insurance companies has emerged as one of the major challenges in the recent past. The problem is all the more vexing when it comes to filing claims to seek their due payment. Claims often get denied on the pretext of not being supported with enough documentation, rendering the claims weak to be accepted. This issue has forced some providers to opt out of accepting health insurance altogether, moving to the simple ‘pay as you get treated’ method.
Moreover, the passing of Affordable Care Act or Obamacare on a national level implies a shift to value based compensation to the health care providers, instead of the straight method of payment. The problem escalates for physicians working with patients on Medicaid right now.
Losing Time in Administrative Concerns
Many of the health care providers, because of privacy breach concerns, control the patients’ record keeping and sensitive information in their own hands; handling which requires a huge amount of time. This involvement and handling of all the administrative work becomes challenging as it impacts their ability to tend to the actual work that they’re qualified for; being a doctor and treating the patients. Moreover, a major chunk of what’s left after sorting out the administrative concerns is spent in preparing prior authorizations which are instrumental to having important procedures; getting hold of crucial drugs and medicines while improving the overall value of the treatment of the patients.
Getting Deductibles
The patients that have registered themselves under the Obamacare/ACA are entitled to an extra time frame of three months to pay the cost of their treatments, as part of the act. Healthcare providers find it increasingly challenging to keep up with these patients and recover premiums from them. One of the major problems that many complain about is the ultimate inability of ACA covered patients to pay the premiums, which the doctors then have to forego completely. This is a major blow to their earnings. On one hand, they cannot deny patients the extra time; while on the other hand, the inability of patients to pay premiums is completely out of their control.
Other than the major ones briefly discussed here; operational expenses, tough decision making between independent practice and being employed by another, keeping consistency between staff members and rising costs, and the reins of control being handed over to the patients gradually are some of the other challenges that healthcare providers perpetually face.
