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Compliance Thresholds and Reimbursement cuts. How can Radiologists Survive 2013 ?

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Can Radiologists cope with the changes Ahead ?

It is a particularly challenging time to be a radiologist. In fact a majority of radiologists would rather forgo financial incentives instead of participating in meaningful use programs. We all know that MU 1 left a lot to be desired. There were rumbles and murmurs about imaging being sidelined.

The stage 2 meaningful use guidelines is believed to be more achievable and radiology specific. But are radiologists ready to embrace the changes ahead ?

“I have no idea”

Most radiology practices especially solo physician practices have no idea about MU guidelines. A survey conducted by RSNA and KLAS sheds more light into this subject. It is reported that about 40% of radiologists complained about lack of clarity. Or, a steep decrease in efficiency after adopting MU guidelines, were the major reasons why they were reluctant to join the MU bandwagon.

More to it than meets the Eye !

Complicated guidelines that are difficult to report against, no penalties at least for the time being are just the apparent reasons. The pressures and financial stress associated with running a radiology practice are the stuff nightmares are made of.

Medicare Physician Fee Schedule; Can have a Chilling effect…

The reimbursements cuts for the year 2013 will lead to a drop of almost 19% in the collections of radiology practices. A 25% cut for interpretation of images has led to voices of dissent and ruffled feathers. Against this backdrop it is only natural that radiologists are not up to speed with the proposed guidelines.

A lot to cope with !

Compliance and quality thresholds, lowered payments and radiology billing issues ensure that the physicians cup of woes brims over ! There are always a million things to do. And that could well be the reason why adopting the latest guidelines, has found its way to the bottom of the priority list.

Take the First step now !

It is likely that radiologists are going to avoid MU as far as possible. But with challenges come opportunities. Though the pains faced by radiologists are not new, the pressing need to address them is increasing by the day. It is important that radiologists step back and take stock of the situation.

Innovative Solutions ?

Healthcare providers have heard this term all too often. But the remedy that radiologists need is certainly nothing unique or path breaking. It is a fact that good old outsourcing can save radiology practices from sinking into an abyss. Letting third party associates to handle billing and clinical documentation needs can reduce costs.

It can also give radiology practitioners the much needed space to concentrate and adapt to changing guidelines. And with financial incentives being available only till 2016 it is time for physicians to take a call, fast.

Why EHR is the Dinosaur in the Room for Pediatricians?

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Pediatricians, it is reported are the most reluctant to take the ehr leap. A recent study conducted by the Seattle Children’s Hospital and APA, throws light into a subject that is often underreported.

According to the researchers pediatricians are a good one to two years behind physicians from other specialties, when it came to ehr adoption and use.

“I cannot Afford it”

Low pay checks, heavy Medicaid cuts, and ehrs that don’t cater to the specific needs of pediatric practices are backing pediatricians into a corner. The financial pressures that pediatric practices face can make pediatricians an endangered species in the near future.

Pediatricians have always been underpaid. There is a huge reimbursement difference when it comes to paying for treatment rendered to children and adults. And to add another log to the fire, pediatricians gain very little ancillary revenue. 56% of physicians surveyed, cited lack of money, the major reason for putting off ehr adoption.

The Pediatrician EHR wish list !

What are the features that can make pediatricians invest those big dollars into an ehr? Most of them feel that the majority of ehrs available in the market offer just straight out of the can templates and nothing much.

The needs of a pediatrician are more specific and distinct than other specialties. Most pediatricians would love to have features such as growth charts, immunization administration templates and an information sheet for vaccine information.

But how many ehrs really do provide the features that can make work easy for pediatricians, is a huge looming question.

A way to bring in the Sunshine Again !

The healthcare industry is changing for the better. And it is important that pediatricians are a part of the change. To join the race pediatricians will have to re-engineer their revenue cycle and make a collective demand for more pediatric specific ehrs.

To, identify where they lose money and explore avenues and opportunities to increase reimbursement, is now more important than ever.

What does Obama’s Second Term as President mean to your Practice ?

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The election frenzy is over. Everybody is sipping coffee and exchanging “I told you so” looks across the water cooler. But not everyone is as relaxed. Healthcare practitioners in particular will have to ensure their ehrs are interoperable and meet compliance standards.

Not just Digitizing Paper Records.

Adopting an Electronic Health Record is not just about computerizing existing workflow patterns. The core purpose of an ehr is to get rid of fragmented, incorrect and incomplete medical information and facilitate seamless exchange of healthcare data.

Failure to select an ehr that is highly interoperable means not just facing compliance issues, but losing millions of dollars.

                             

  Case in Point…

An Illinois hospital was in the news recently for losing millions of dollars due to interoperability issues. According to IOM the hospital lost a staggering 700,000 dollars every year. It includes the money spent on hiring five pharmacists to manually verify prescriptions. So, doctors who couldn’t access the ehr didn’t end up prescribing the wrong drugs and dosages.

The Road Blocks !

In a perfect world doctors would be able view and share data seamlessly. Patients needn’t be worried about their employers getting info about their medical problems. And nobody needs to lose sleep over data security. But the healthcare landscape is far from perfect.

Heavily proprietary, ehr systems, which fiercely, prevent competitors to gain access. Medical terminology, and abbreviations, that differ across specialties. And confusion about where to start, are the major hindrances towards achieving seamless interoperability.

Knowing What Matters !

But before deciding on where to look it is important that physicians have a clear idea of what to look for. There are four key components that experts believe, play a vital role in determining whether you meet interoperability standards.

  • How applications interact and communicate with users.
  • The way different systems communicate with one another.
  • The manner in which healthcare information is used and managed.
  • And the ability to work across different devices and platforms, like smartphones and tablets.

Getting it Right Without Learning the Hard way…

Physicians and practice managers need to keep a cool head. Being pressurized by promises, brochures and tight deadlines is not the way to go. The ehr is an expensive investment, which when done right can save a practice millions of revenue.

How Interoperable is your EHR ? A Quick Checklist

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Why must the Focus be on Interoperability ?

Most physicians are waylaid by features they’re hardly going to use. Smart, intuitive options are great. But if you are the only one who can access and work with them, you are way behind when it comes to interoperability.

It is essential that you can share data effortlessly. A closed door policy isn’t going to work and it is important that doctors speak up to their vendors about this.

Not just about Incentives…

It is not just about incentives and a pat in the back. Being interoperable means you save thousands of dollars. Cut down on additional staff. Reduce the time spent communicating with other physicians and technicians. And above all it means you are on the right path, as far as the future of your practice is concerned.

As with all important decisions, it is essential to be thoroughly informed before taking the plunge. And yes have a thorough check-list to ensure that the ehr ticks all the right boxes.

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Here is What Physicians can do to make 2013 the best year for their Practice !

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 Time for Self Reflection…

As the year draws to an end, it is important that physicians spring clean their revenue cycle. 2013 is going to be a hectic year with major regulatory updates, compliance issues and, yes, unfair deadlines !

So, now, is the best time to take stock of their revenue management cycle process and performance, and formulate better strategies.

Run a Quick Audit ! 

Audits needn’t be extensive or time consuming. Focusing on any one major area to audit can save on time and streamline the auditing process. To start with review the codes that have a high error rate.

According to a CERT report there is a 24% error rate for 99205, 20.8% for 99204 and an 18.6% error rate for 99215.

Run a check on these codes and see if your practice is getting it right.

Cloned claims, non specific diagnosis codes, and errors while assigning evaluation and management codes, are the other few problem areas.

Bundled Payments ; Work out the Math

Work out a clear strategy for bundling and unbundling claims. Most practices lose money due to submitting separate claims instead of one single bundled claim. Determine which claims can be bundled and which ones need not. Work out a reimbursement formula that works for all concerned.

Test the waters…

ICD-10 isn’t going away, no matter how hard you pray. Have an ICD 10 implementation plan in place. If you work with a third party biller, ask them to start checking and working with the new set of codes.

Cut Costs not Corners !

Where does all the money go ? Don’t ask yourself this question again this coming year. Contain costs. Draw up a detailed income and expenditure spreadsheet and enter all the information that matters. Analyze and see where you can scale down on costs. It could be over-staffing or inefficient coordination with ancillary service providers.

Pick out the main reasons and start working on a better future for your practice, now !

Why Physicians are in Verge of a Meltdown ?

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You didn’t really need statistics to know this. For the last few years, physicians have been complaining about having to juggle a million tasks. But the toll it takes on the mental health of physicians is clearly illustrated in a study conducted recently.

According to a finding published in the Archives of internal medicine, an alarming 45.8%, of physicians surveyed suffered from, at least one symptom of a burnout.

Bitter Pills…

Facing a rejected claim again, trying to stay in compliance, chasing deadlines, there are dozens of bitter pills physicians have to swallow everyday. The high level of stress associated with practicing medicine, is not just unhealthy but can lead to doctors becoming endangered species in the near future.

Can I Meet the Doctor ?

This is the first question that most patients ask. And there are chances that they’d be meeting a nurse practitioner or physician assistant, instead. Due to severe shortage of physicians, NPs and PAs are backfilling, to provide patient care.

Not all Grey and Bleak !

Training and hiring staff to shoulder a bit of the responsibilities physicians handle can be a huge relief for doctors. Healthcare providers should work in an environment that facilitates teamwork and shared responsibility, to stop stress from chipping away at their efficiency and morale.

Taking Time off to Catch up on Basketball…

Having a cup of green tea, going for strolls and taking a holiday now and then are important. But to make major decisions such as hiring third party associates or physician assistants, it is important that physicians take time off to reflect. And build a strategy that can help them step over stumbling blocks instead of pretending they don’t exist.

Negotiation Tips to help Physicians land Better Deals

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Stung by the Recent Reimbursement Cuts ?

It is a tough economic climate. Physicians feel they’ve been backed into a corner by tough regulations and, yes, dreaded reimbursement cuts. The business side of medicine has always been scorned upon. But, now focusing on it matters more than ever.

 Negotiate tough…

Doctors have traditionally shied away from negotiation rates with payers. Drowning under paperwork and making long phone calls, are enough to scare the most persistent of physicians. But to get paid and to survive, it is important that practices negotiate tough. The effort you put in today is going to determine the tomorrow of your practice.

Getting the Facts on Paper !

Most medical practitioners make the mistake of sending out proposal letters that do not include key facts. Including a brief introduction to your practice, patient population and expectation is important.Sit with your team and come up with an exhaustive spreadsheet that illustrates your growth curve. Nobody loves facts and figures more than insurers.

What Color does your Insurer like ?

Luckily that is just one of the few things you don’t have to know. But for successful payer negotiation, knowing your insurer is important. What are the cpt codes that are more likely to be reconsidered? What are the documents your insurer might require? Every, information, is key to shorten the turnaround and back and forth phone calls.

It isn’t Mission Accomplished !

You’ve struck the deal. Time, to, celebrate and hope for better collections. But it is also important you have the details of your negotiation summarized. It will help you to inform your billing team about the changes. To, inform your patients about the revised rates. And yes it comes in handy when working on your next set of contracts.

As with all else it is a constant work in progress !

Focus on Patients to Run a more Profitable Practice

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Are your Patients Happy?

What do CQMs, recent Medicare updates and the health center down the road have in common ? An increased focus on the quality of patient care and better patient communication ! There’s been a lot of dust raised in recent times about physicians who rush through appointments.

             Being Sidelined and Neglected…

Patients repeatedly complained in local tabloids and social networking sites about long waits and unfriendly staff. Physicians groaned about the constant need to stay on top of evolving guidelines and frequent updates. It is never easy for anyone during a period of transition.

Towards a Patient Centered Practice…

A Medicare program announced recently is going to push physicians to make that follow-up call ! Doctors will be paid for following up on their services after a patient discharges. Phone calls and other forms of communication and management activities will be reimbursed by Medicare.

A Carrot and Stick Approach…

A value based payment modifier is also in the offing. It could either penalize or reward healthcare professionals based on the quality of their patient care. These updates and changes again emphasize on practices becoming more patient centered. The pressure on physicians to report more meaningful and patient centric services is escalating.

Attainable of Course !

Is it possible for medical providers to reach the benchmarks set for them ?

The upside is that ehr and emr are set to pave the way for better clinical documentation. There are more softwares and tools to track down and store information.

But the flipside is that practices need to hire additional workforce to handle data management tasks to help physicians concentrate on patient care. Working with a third party biller or data management firm can help practices contain costs. And give physicians the time and space they need to focus on what matters, patient care.

Efficient Error Reporting Systems lead to Healthier Practices

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 Be the one to take a call !

To error is human, but, to report it took super human efforts, until recently. A recent study by the Perelman school of medicine at the University of Pennsylvania, confirms that reporting errors leads to a safer medical practice.

As frontline healthcare workers, physicians fear, losing credibility or possible intimidation. And, are dubbed as, “reluctant partners” when it comes to reporting medical errors. This finding is hoped to open the doors for more open communication within a medical practice.

I’d Rather tell My Friend !

Error reporting systems in most healthcare facilities frustrate and limit physicians. Most hospitals do not have a structured reporting system, for physicians to report errors. Though all healthcare facilities have a reporting system in place, they are hardly what doctors hope for.

Not just a Fancy Asset…

The reason why most reporting systems fail is that they’re, like that vase of pansies in the reception, just a fancy asset in most practices. They don’t guarantee privacy and reporting anonymously is not an option at all. This lack of privacy can in effect harm patients and the security of patient data.

Speaking up !

As the awareness about the need for efficient reporting systems increases, it is high time that hospitals set up a system that their staff are, comfortable with. Building baseline data on errors can lead to higher efficiency and healthier patients.

Every physician setting up a new practice should, apart from concentrating on low cost insurance credentialing services , recruiting and payrolls, also set up an efficient reporting system !

Are Private Practices being given the Rough End of the Stick?

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Everybody who’s a name to reckon with in the healthcare industry is at the MGMA12 conference. One of the most pertinent topics discussed was the cookie cutter situation private practices are in. The healthcare landscape is changing and as we all know change can be expensive! It is going to take a lot of effort for small independent practices to stay afloat.

                       

 A Tough Call to Take !

According to recent studies physicians gravitate towards working for multispecialty hospitals, than take the risk of, branching out on their own. The possibilities, advantages, losses and responsibilities can be huge. But the future certainly isn’t bleak for the small practice owner.

The ACO HandShake .

There is a lot of controversy, diverse opinion and heated arguments about small practices collaborating with ACO’s. Some industry experts feel that is could sound the death knell for independent practices and can only benefit large scale “for profit insurers”. But the most widely agreed upon view is that ACO’s hold lots of promise and benefits in the long run.

The Trade-Offs .

It is important for independent medical practitioners to understand the medico-legal implications. Whether it is delivery mistakes or data leaks, the risks can almost outweigh the rewards, at least in the short term. Physicians will have to be completely clued into the minutest of details, before collaborating with an, accountable care organization.

As there is an increasing pressure on small practices to consolidate and build partnerships with the bigger players, it is more important than ever that physicians are aware of the financial aspects of a practice.

Leveraging Resources and Containing Costs…

Making the most of what is available is essential for independent practices to remain independent. Outsourcing tasks that can be outsourced such as medical billing can help in scaling down on costs. And free up in-house staff to attend to more pressing demands such as better patient communication.