Connecting the dots key for docs

Aligning with local hospitals often turns out to be a strategic advantage for physician practices.

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