Patient data - clinical and financial - vital to healthy practice
Whether it's within their own practices or the healthcare continuum within their community, physicians need to set up well-defined pathways of information for patient care, system vendors say.
Within the practice there needs to be a seamless flow of patient information, including insurance coverage, personal health data and financial status, from intake to the backend for accurate claims processing and billing. Within the community, physician practices must have the infrastructure and tools for aligning with hospitals and other healthcare providers.
Introspectively, the priority for physician practices is to have the capability of identifying all the revenues that are due for services performed and to discern who is responsible for payment. More often that responsibility is falling to the patient, said Kevin Weinstein, vice president of marketing for Louisville, Ky.-based Zirmed.
"In today's market, 15 percent to 30 percent of revenues come directly from patients, which is double what it was 10 years ago," he said. "Back in the day it was easy to ignore patient payments because they only represented a fraction of revenues. It is much different now."
Physicians' revenue collection is about efficiency and effectiveness, Weinstein said. On the payer side, practices have gotten to be much more efficient at claims filing and on average have about 90 percent of their claims paid on a timely basis, he said.
"It is all about efficiency - how to get that 90 percent with lower expenditures and fewer people," he said.
The effectiveness quotient refers to patient collections, which Weinstein says physicians only receive about 60 percent to 70 percent of what they are owed. Therefore, he said there is plenty of room for improvement on this front.
"Physicians are only collecting 60 to 70 cents on the dollar, so that gap must be narrowed," he said. "The name of the game is to become more sophisticated on these payments, like getting them online."
Skeptics may scoff at this approach, but Weinstein's research bears this out. When providers issue electronic statements and the patient pays online, it's a three-day process and the patient pays 95 percent of the outstanding balance, he said. When the statement is issued on paper and sent through the mail, it is a 16-day process and only 77 percent of the balance is paid on average, Weinstein said.
Only a small number of practices are utilizing the online option simply because there aren't many vendors that offer the service, Weinstein said.
"It is less a demand issue than a supply issue," he said.
ACO alignment key
Whether it's through an accountable care organization, medical home or other type of network configuration, it is a strategic advantage for practices to partner with local hospitals for patient care, said Frank Marshall, president and COO of Irving, Texas-based MedSynergies.
"By aligning with a health system, the physician practice gets financial stability and incentives," he said. "They're not on the hook for the profitability of the practice, have access to more robust infrastructure and have access to more professional management than they could afford on their own."
MedSynergies works with health systems to align with post-acute care sites, such as physician practices, outpatient surgery centers, rehab clinics and long-term care facilities. It is a multi-faceted approach that comprises practice management, technological infrastructure and governance.
"Geographically a health system needs to demonstrably show improved outcomes while bending the cost curve," Marshall said. "Our role is to assess each organization and either supplement, change or enhance it."
Marshall says there are three levers behind constructing a successful physician alignment - productivity and volume, overhead and revenue cycle management. The next phase, he said, is to look at how physicians employed by the hospital are aligned.
"That is 15 percent of the physician population on average," he said. "Then you must have programs and tactics to interact with the other 85 percent and look at patients across that continuum. We have tactics and technology to help the health system in that regard. They want the right patient at the right provider at right time. To understand all those variables takes pulling together all the clinical and administrative data."
The crux of alignment, Marshall says, is to have the administrative architecture in place before jumping into the clinical piece.
"If the administrative framework is not place, you'll never get to the next step of the quality outcomes pyramid," he said.
Losing autonomy is one common objection physicians have about aligning with a hospital, but Marshall said the opposite is true.
"The thinking is that they give up autonomy, but if set up correctly, they actually gain autonomy through a clearer viewpoint of their practices," he said.
Liberating the ED
Physician practices can also play a definitive role in helping to reduce the overutilization of hospital emergency departments and lower overall healthcare costs, says Mikael Öhman, COO of Dallas-based T-System.
"It is more important than ever that the emergency department be optimized," he said. "Patients need to seek treatment at the right site of care. For the ED, that means chest pains, yes; sniffles, no. There needs to be a better balance."
With nearly 60 percent of hospital intake at the ED level, emergency care is a primary driver of healthcare costs. ACO partnerships with physician practices can help assuage the heavy ED demand and physicians can cite this in negotiations, Oehman said.
"Physicians must take an active role in shaping the ACO and can do so by bringing facts into the discussion," he said. "They must demonstrate how they can improve quality while driving value and efficiency."