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How can we reduce health care costs?

Interesting facts about our healthcare system is The United States has one of the highest cost for healthcare insurances in the world without scoring on the top charts for healthcare systems. In our country, there are thousands of people not receiving health care due to unable to afford insurance. There are four different factors that can help reduce US health care cost such as reducing administrative cost, introducing preventive methods to the patients, removing unnecessary procedures and stabilizing drug prices. The primary factor that cuts health care budget up to a third is the administrative branch. Bonuses to executives, advertising and unnecessary spending in the administrative department are examples on where a third of the budget goes into without helping the citizens. Secondly, most pf the time physicians are specialized in treating the problem with western medicine rather than helping the patient find more affordable solutions to its issues. One factor that can help lower health care cost is planning on informing the patients with prevention and health promotion. Giving the doctors certifications for basic prevention care such as nutrition, exercises and alternative remedies can lower the amount of patients visiting the hospital giving back a lower cost margin to health care institutes. This being said, helping patients use alternative routes, less procedures and test should be prescribed to patients. Doctors should also emphasis in only prescribing necessary diagnostics to patients since the average amount spent on defensive medicine can go up to $50 billion dollars a year.  And lastly, the cost for prescription drugs in the United States are higher than any other country in the world. And why is that?? The United States lets drug companies charge the amount they want on their product causing patients who depend in a life long medication to stop consuming it due to not being able to afford it. Then results on Medicare taking the weight on providing the medicine provoking a higher cost on only drug prescriptions.  In summary, United States has a big problem in not controlling the health care system budget by making small changes in their system to save millions of dollars and also helping it’s citizens achieve a healthier and medication free lifestyle.

https://medlineplus.gov/ency/patientinstructions/000870.htm

https://www.corporatewellnessmagazine.com/article/establishing-a-culture-of-health

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A “Top-ten list” of: a) Ways to improve revenue cycle. b) Increasing patient engagement in the healthcare system

A “top-ten list of:

a.     Ways to improve revenue cycle

1.     Scheduling: First things first, when an established patient schedules an appointment, the first thing is verifying insurance card is still the same on file before hanging up with the patient. This results in decreasing the number of frustrated patients when they arrive at the facility by knowing they’re not eligible for a visit.

2.     Appointment visit: Once the patient has arrived at the office, staff must acquire the insurance card to scan and update the patient’s insurance information as well as the patient’s demographics. This benefits the revenue cycle when submitting a claim and having the latest patient’s address and phone number. If not, claims submitted with wrong address or information are claims that will return to the office receiving no payment for treatment.

3.     Receiving payment: By the time the patients gets out of their consultation with the doctor, the invoice should be already made with the proper codes. Verifying insurance and receiving the correct amount of payment is a priority to the revenue cycle. Having these measures controlled promotes the patient to come back and refer others to the facility.

4.     Make it easy for payment: Increasing the methods of payment for the patient such as credit card acceptance and opening the idea of having payment plans. Also, before services are rendered, notify the patient of possible procedures that have to be charged and inform her of the price so when the patient arrives at the facility they have an idea of how much they have to pay.

5.     It’s all a business: From greeting the patient to walking them through their care process and cordially asking for payment are key points to make the patient feel like they’re not only there to take their money away, but to offer them a good healthcare experience.

6.     Ensuring procedure codes: Verifying with the doctor the procedure codes that were performed on the patient are correct before submitting the claim can improve revenue cycle for avoiding unpaid claims and running behind on payments and revenue.

7.     Submitting claims: The main reasons why providers don’t receive payment can be the smallest detail on a wrong claim. Patient ineligibility, wrong patient information, duplicate claims, wrong codes are small mistakes that result in a claim denial.

8.     Payers information: Another way to improve the revenue cycle is verifying quarterly if any changes have been made that limits them to receive payment. Ensuring all payers are under control permits the facility to ensure payment from the payer’s end.

9.     Managing: In larger healthcare facilities, it's recommended to hire a care coordinator to ensure all claims, reimbursements and policy changes are in order to proceed and avoid any unpaid claims.

10.  Technology: A good healthcare facility should never have any technical difficulties when it comes to scheduling online appointments, payment issues or submitting claims. A lack of technology in a facility will quickly show to the patients when running behind.

b.     How to improve patient engagement in their own healthcare

1.     Inform: Having posters or pamphlets in the doctor’s office doesn’t mean the facility is informing the patient of healthcare knowledge. Also, Healthcare professionals tend to use words that patients aren’t aware of. In this case, keeping the information simple at the time of delivery would make the patient understand better.

2.     Be concrete: Sometimes to not make the conversation between doctor and patient harsh, doctors tend to go around the problem by generalizing the issue without going straight to the point in order for the patient to fully understand the issue and execute the doctor’s advice.

3.     Share: The information that is given at healthcare facilities is not only for patients of the facility. Once the patient is knowledgeable, doctors should emphasize on sharing the information and having easy sources for the patients to use and share.

4.     Easy or tough: Providers and patients create a bigger gap when an issue includes harder and detailed steps to achieve a goal. In this case, providers must have the right tools to educate the patient on how to overcome those barriers.

5.     Be accountable: When suggesting an achievable plan to the patient, keep them accountable for such. Having easy tracking sheets for patients to record their progress is a way to empower the patient to peruse their health goals.

6.     Be Engaged: Giving the patient engagement on

7.     Adopt: Adapting and understanding the patient's culture and educating them that if they manage their care better through different sources they will have better information regarding their health.

8.     Universal: Being universal in the healthcare facility promotes any race, religion or beliefs feel welcome rather being judged.

9.     Feedback: Let the patients know they are welcome to leave comments and feedback on what needs to be reinforced or updated in the office for better engagement with the patient.

10.  Keep positive!: When goals are not achieved, patients are more likely unable to show the results to its provider due to being scared of the consequences, In this case, providers must keep the engagement and enthusiasm to let the patient know it’s okay if no progress was made.

https://www.gebauer.com/blog/improve-patient-engagement

https://www.rn.com/clinical-insights/patient-engagement-is-everyones-responsibility/

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10 Qualities of an Effective Leader

1. Positive.  Everything starts with a thought. Leaders choose their mindset. You must be positive, optimistic, and hopeful if you ever expect to effectively lead others.

2. Self-aware.  Being conscious of your character is important when leading others because you are leading them to be a better person and that will be difficult, if not impossible if you have low self-awareness. Emotional maturity helps you properly process constructive criticism. Leaders know who they are and lead others to be the who they want to be.  

3. Organized.  Leaders understand that organization is a key component of success. They know if they expect to achieve, sustain, and improve, it calls for order and structure.

4. Communicator. Leaders are communicators!  Good communication even builds relationships, the glue that makes many things stick together. Leaders will apply various ways of communicating when things need to get done.

5. Honest and Open. If your people don’t trust you, they’ll find someone else to follow. Subordinates who value their leader will make sacrifices and work harder because they trust in good leadership and appreciate transparency.

6. Flexible. Being flexibility is critical because very few things are predictable. Leaders who are flexible and able to adapt to changes have an advantage amongst their peers and are valued. Develop your ability to press forward through change!

7. Visionary.  Leaders are visionaries! Leaders can communicate their visions and beliefs to the affect that others are persuaded to be a part of that same vision.

8. Thinker.  Strategic thinking and planning will be vital for long-term success. Many dream, but few have made their dreams come true by putting their thoughts through proper planning, with intent to execute.

9. Decision Maker. Leaders know how to develop teams. They do not choose people they like or that think like they do but they base their decision on the needs of the team as whole. There is strength in diversity.

10. Delegator.  You can’t do it all by yourself. Many people on on-board for a common goal can get a lot done and sometimes even more than intended. “Sharing the workload and holding people accountable allows leaders to reach higher levels of success.”

 References

https://chiefexecutive.net/top-10-skills-needed-for-effective-leadership/

https://www.citycollege.edu/blog-healthcare/5-qualities-successful-health-care-administrator/

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10 Ways to Improve Your Revenue Cycle

1)   Educate and work with the staff. Educating and continually training staff is essential in submitting claims properly, providing good customer service, and decreasing errors. All of which can improve an organization’s revenue cycle. 

2)   Form an efficient organizational structure. Structure and standardized processes will ensure best practices are consistent within an organization. Striving to achieve leaner processes can also reduce waste, increase patient satisfaction and prove to provide a positive effective on an organization’s revenue cycle.

3)   Set goals and monitor performance. As the saying goes, “What gets measured get done”. Setting goals and monitoring progress of achieving those goals increases probabilities of success. Incentivizing goal achievements can also help an organization achieve their goals and improve its revenue cycle. 

4)   Automate prior authorizations and eligibility. Submitting authorizations prior to delivered care is on the rise. But automated submissions which is more cost-efficient than the manual way has not become general practice yet. The 2016 CAQH Index shows electronic authorizations cost significantly less than manual authorizations. Providers and revenue cycle managers agree that automated prior authorizations can save time and money, yet another way to improve an organization’s revenue cycle. 

5)   Collect patient financial responsibility upfront. “Late and underpaid patient financial responsibility slows healthcare revenue cycles.” Considering patients responsibility to pay their medical expenses has increased, post care recovering payments, contacting, and collecting from patients can add to the already assumed burden of an organization. “Revenue cycle managers can optimize patient collections by implementing point of service collections and credit-card-on-file options. If organizations communicate costs to patients prior to service and utilize modern payment collection strategies, such as credit-card-on-file they can experience a reduced accounts receivable and an improved revenue cycle.

6)   Make sure claims are clean and systems are set up optimally. To reduce rejected claims an organization must ensure they are using current and correct codes, properly submitting claims, and monitoring their billing system. These efforts will reduce accounts receivable and improve the revenue cycle.

7)   Reduce denials and underpayments. Medical Necessity requirements for reimbursement seem to be ever changing. It is important that organizations have real-time information to comply and maximize recovery for services. If not, not only do they risk being underpaid but also risk spending more “money on the back-end trying to collect revenue (or contest denials) with a low probability of return if the front-end process was not handled correctly”. 

8)   Reduce out-of-network revenue leakage. It is important when developing a network, that you have a practice that offers many services. If an organization does not, it creates an opportunity for its patient to go out-of-network for needed services. Organizations that coordinate care and carefully integrate their network reduce their patients being sent out-of-network for care and improve their revenue cycle.

9)   Optimize revenue from physician referrals and orders. Facilities that can find a way to make themselves accessible, cheaper, and convenient to independent physicians to send their patients to them can capture revenue from the referred patient thereby increasing their revenue cycle by not having to “hire the physician or buy their practices”.

10) Establish processes and use tools that improve revenue cycle efficiency. Standardized processes reduce error potential. Less errors, mean more accurate data allows for better organizational forecasts. Less errors also reduces double work that increases operating costs and presents the opportunity for an organization to be proactive and not reactive. When accurate information is present, provided, and communicated, its ripple effect will be overall improvement.

  References

https://www.healthcarefinancenews.com/blog/four-ways-improve-hospital-revenue

https://www.beckershospitalreview.com/hospital-management-administration/5-best-practices-for-improving-revenue-cycle.html

https://revcycleintelligence.com/news/4-key-ways-to-improve-healthcare-revenue-cycle-management

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A Workplace Practice worth Your Time

In Modern Healthcare Reporting webinar presenters discussed their unique and current best practices and time saving techniques. David Caiani shared how Exeter Hospital improved their reporting processes through automating financial reports and automated email distribution. Some of their software tools had limitations or were not a good fit for the company so they switched over to an excel-based automation solution. Their efforts affected both internal and external reporting. Exeter’s decision to use of this software “increased employee workload capacity by 25%” through automating reports which decreased time spent and mistakes from hand-keying.

Jodi Grzybowski shared how ProMedica modernized their reporting with Excel Add-In. Before, their previous software reporting tool was troublesome, and reports had to be adjusted to reflect desired information. Using Excel Add-in now “decreased re-keying errors by 100%”, took less time to generate reports, and is user friendly. Excel Add-in allows, Ms. Grzybowski and her company to run more reports, research transactions, review variances, along with many more options.

When a company desire to excel it must review and improve some of its processes. Sharing best practices and time saving techniques, saves time, money, and resources. Saving time is significant for facilities, it allows manpower to be reallocated to different areas of need. Sometimes you may have to upgrade or replace software for your facility to function better. This webinar shared how two entities found a solution to auto-generate needed reports, communicate those reports to the right people, save time and reduce errors. If an organization wants to improve they have to be willing take the time and to do what it takes.

 References

Grzybowski, J., Caiani, D., & Gibson, K. (2018, June 13). Modern Healthcare Reporting: Best Practices and Time Saving Techniques [Webinar]. Retrieved from http://hfma.mycrowdwisdom.com/diweb/catalog/launch/media/eid/2273213/pid/2208240

Photo: https://collisio.digital/saving-time-ux-process/

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The Workforce an Internal Solution

In Conquer the Top Five Workforce Management Challenges webinar presented by GE Healthcare the top three financial concerns that were found to keep healthcare executives up at night were managing labor costs, uncertainty around reimbursements, and staying competitive in the market. Since the workforce accounts for more than 50% of hospitals operating costs, it is vital to successfully manage and optimize it. A facility’s ability to be flexible with its staff based on volumes and patients needs was found to be the greatest workforce management challenge. Staffing is usually inconsistent in comparison to an organization’s constant budget. It is important that shift schedules are constructed in advance, accurately, and communicated in a timely manner.

GE examined ways to reduce overtime costs as well as identified some costs that are associated with staff working overtime, such as increased patient falls and medication errors. An additional challenge for workforce management was leveraging staff. GE’s case studies showed when consolidating facilities that creating and sustaining an internal resource pool was a key factor for long-term success. An internal pool of nursing staff prevented premium labor costs like sporadic overtime and agency use. Turnover also presents itself a challenge in workforce management.  Data shared showed nurses who work more than 13+ hours instead of 8-9 hours have a 2% general increase of being more likely to burn out, be dissatisfied with their job, and leave their job within the next year.

 Therefore, appropriate staffing based on the needs of the facility is important. Standardizing processes is also a good practice in reducing operating costs and training staff. As mentioned, when your staff is happy, the patient will be happy. Facilities must put honest effort towards cultivating a work environment of accountability, consistency, and transparency. All facilities are subject to workforce management challenges. GE’s outcomes-driven approach where they design, implement and optimize is a great starting point.

  References

Roman, R., Gerhart, G., & Christy, William (2017, November 7). Conquer the Top Five Workforce Management Challenges [Webinar]. Retrieved from http://hfma.mycrowdwisdom.com/diweb/catalog/launch/media/sid/48567846

Photo: https://www.healthcarefacilitiestoday.com/posts/Healthcare-facilities-require-flexibility-and-mobility-to-be-successful--9706

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Is Listening to the Patient worth It?

In, Patient experience is a big opportunity for hospitals to drive revenue, Black Books says Jeff Lagasse writes that a survey from Black Book found that 92 percent respondents “said that improving customer experience should a be a top strategic priority”. It is important that organizations provide good service to their customers. After all, their business is what pays the bills. This percentage was a 21 percent increase from a survey conducted the year prior. Surveyors mentioned how certain technologies improve the experience such as online scheduling, online payment, and organizations providing price transparency. We live in an age where people like easy access, convenience, and transparency. Despite the demand, “only 9 percent of total providers reported the ability to offer these consumer demands successfully in a Black Book survey of hospitals and physicians.”

 It is important that the healthcare facilities understand the power of the patient. Organizations unable to deliver such advanced technologies, may be in jeopardy of losing their current and even future consumers. It is apparent that having advanced technologies, which improves today’s patient experience, can positively affect an organization’s financial experience. The law of supply and demands still applies. Organizations will either make appropriate accommodations to meet the demands of their customers or not; either way its decision will reflect in its financial performance. Mr. Lagasse presented a significant claim that organizations can impact their revenue by taking advantage of ensuring their patients have a satisfying experience. This claim was clearly communicated, effective, and accompanied by supporting data.

  References

https://www.healthcarefinancenews.com/news/patient-experience-big-opportunity-hospitals-drive-revenue-black-book-says 

Photo: https://vwhs.org/